Behaviour problems in childhood and adolescence in psychotic offenders: An exploratory study

Background: Several studies have shown that adults who develop schizophrenia and commit a criminal offence may already have shown behaviour problems in childhood or adolescence. It is less clear whether such problems follow a particular pattern in such patients. Aims: To examine the utility of the Child Behavior Checklist (CBCL) among offenders, to test whether externalizing behaviour problems, as measured by the CBCL, are more frequent in psychotic offenders than in non-offenders with psychosis, and to investigate relationships between early behavioural problems and adult personality disorder in psychotic offenders. Methods: Three groups of violent offenders detained under the Dutch Entrustment Act (TBS-detainees)(n = 78) and one group of psychotic patients in general psychiatry (n = 16) were rated from case records on the CBCL. Results: There was a significant difference between psychotic offenders with a personality disorder (n = 25) and the non-offender patients with psychosis (n = 16) on the 'delinquent behavior' scale, but no such difference between psychotic offenders with (n = 25) and without (n = 21) personality disorder. A hierarchic cluster analysis revealed significantly higher scores for externalizing behaviour in all TBS-detainees with a personality disorder. Those starting to offend early had higher scores for externalizing behaviour than late starters. Conclusions: Psychotic and non-psychotic offenders with personality disorder resemble one another in their early childhood behaviour problems; psychotic offenders without a personality disorder differ from these two groups but resemble non-offenders with psychosis. In contrast to findings in non-forensic populations, there were no differences on other problem scales of the CBCL. Given the small sample sizes, replication is needed, but the findings lend weight to treatment models which focus on the psychosis in the latter two groups but extend also to personality disorder in the former.

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