Psychotic symptoms and violent behaviors: probing the components of "threat/control-override" symptoms

Evidence for an association between mental illness and violence has grown i n recent years, leading many to ask why such an association exists. One hyp othesis links elevated rates of violence among people with mental illness t o a small set of psychotic symptoms - so called threat/control-override (TC O) symptoms. Several studies have supported this hypothesis, but none has e xamined which of the components, threat or control-override - if either - p redominates in explaining violence. To explore this issue we used data from a two-stage epidemiological study (n = 2741) conducted in Israel. Data on TCO symptoms were collected using two methods - fixed-format self-report qu estions from the first stage and psychiatrists' ratings based on interviews using the Schedule for Affective Disorders and Schizophrenia (SADS) from t he second. Results show that both a measure of threat and a measure of cont rol-override are independently associated with violent behaviors. Results a lso show that neither method - neither fixed-format questions nor psychiatr ist rating - predominates in explaining violence. In sum, these results ind icate that both the threat and the control-override components of the TCO c oncept are useful in predicting violent behaviors and that a better measure ment of the TCO concept is achieved using a multimethod approach.