Acting on delusions: the role of negative affect in the pathway towards serious violence

Simone Ullrich, Robert Keers, Jenny Shaw, Michael Doyle, Jeremy W. Coid

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Acting violently on delusions is a significant clinical problem. Recent research has identified state anger as key component in the pathway from persecutory/threat delusions to serious violence. To determine the magnitude of the effect of delusional anger and to investigate a dose-response relationship we carried out a prospective follow-up study of forensic in-patients discharged into the community. Men and women (n = 409) were assessed before/after discharge at 6 and 12 months (Positive and Negative Syndrome Scale, MacArthur Community Violence Interview). No association was found with a content un-specific measure of delusions, thought disorder, hallucinations, grandiosity and violence. Suspiciousness/persecution was significantly associated with both violence and anger. Anger was also associated with violence. Mediation analyses suggested that 84% of the association between suspiciousness/persecution and violence was explained by anger. Key target of interventions should primarily be the anger; treatment of delusional beliefs plays a secondary role in the management of risk.

Original languageEnglish
Pages (from-to)691-704
Number of pages14
JournalJournal of Forensic Psychiatry and Psychology
Issue number5
Early online date25 Feb 2018
Publication statusPublished - 3 Sep 2018
Externally publishedYes


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