The Effect of Threat Control-Override on the Relation Between Psychosis-Risk Symptoms and Aggression in Help-Seeking Adolescents

Abstract

Psychosis is a heterogenous, transdiagnostic phenomenon that exists on a spectrum of severity with subclinical symptoms, also known as psychotic like experiences (PLEs), reflecting a potential risk of progressing to full threshold psychosis. Across time, country, and culture there has been a widely held misconception that those with psychosis are dangerous and prone to aggression. Modern empirical evidence indicates a modest association between psychosis and aggression, but studies are subject to consistent methodological flaws and biases, yielding conflicting and complicated interpretations of results. Although the true nature of this modest relation remains unknown, some researchers posit that a subset of psychotic experiences called threat/control-override (TCO) symptoms may largely explain an increased risk of aggression among those with psychotic symptomatology. Despite considerable evidence demonstrating a link between TCO symptoms and aggression among those with diagnosable psychotic illnesses, studies on populations with PLEs, a potential risk factor for formal psychosis, are limited. The current study aimed to fill this gap in the literature by examining the relation between psychosis-risk symptomatology (i.e., PLEs) and aggression in a sample of help-seeking adolescents. To offer a comprehensive assessment of symptomatology, PLEs were independently reported by three informants: (1) youth self-report; (2) parent self-report; and (3) clinician-rated assessment (Structured Interview for Psychosis-Risk Syndromes, SIPS; Miller et al., 2003). Aggression was assessed using a parent-rating scale of adolescent behavior (Behavioral Assessment System for Children, Second Edition, BASC-2; Reynolds & Kamphaus, 2004). Following the TCO theoretical model, the current study estimated the unique effects of a specific subset of PLEs reflective of increased threat perception (i.e., suspiciousness) and control-override on aggression.Results partially supported study hypothesizes, revealing small, independent effects of threat and control-override respectively, as well as a significant joint effect of threat and CO (i.e., TCO), on aggression for parent reported data. While the current study failed to observe the same significant relations for clinician-rated and adolescent-reported psychosis-risk data, current findings highlight the importance of considering multiple perspectives and support the use of symptom-specific measures of psychosis, ideally those following the TCO model, to study aggression and psychotic symptomatology in future research.