A systematic review of the association between attributional bias/interpersonal style, and violence in schizophrenia/psychosis

Despite the widely recognized link between schizophrenia and violence, the illness-specific factors underlying that association remain unclear. A body of work has implicated deficits in social cognition, consistently seen in schizophrenia, that may mediate the risk of violence. Two specific areas of interest are attributional bias and interpersonal style. We conducted a systematic literature search using EMBASE, Scopus, Ovid Medline, PsycINFO and Science Direct databases with search terms relating to attributional bias, interpersonal style and violence/aggression in schizophrenia. Eleven studies were identified, six related specifically to attributional bias and five to interpersonal style. Results suggest an association between hostile and externalizing attribution biases, and violence in schizophrenia. Furthermore, hostile, dominant, and coercive interpersonal styles are also frequently associated with violence in schizophrenia. An interaction between cognitive impairments and underlying personality traits, as well as other co-morbid or illness factors, is proposed to likely underpin associations with violence in schizophrenia. Conclusions are limited by methodological constraints. The field would benefit from consistent definitions of violence, and a more systematic approach to cognitive assessment. Furthermore, studies with more homogeneous samples; and longitudinal designs are warranted in order to gain a better understanding of causation with regard to illness factors specific to schizophrenia.