Insight and Locus of Control as Related to Aggression in
Individuals with Severe Mental Illness (SMI)
Bethany L. Ridling
Faculty Mentor: Dr. William Spaulding
Department of Psychology, University of Nebraska-Lincoln
Introduction
• Individuals with severe mental illness (SMI) are
often stereotyped as aggressive, although research
has consistently shown that the majority of
individuals with SMI are not aggressive. (7% to 35%
depending on the study).
• When aggression does occur, there is evidence that
it is more intense than in normal populations, and it
interferes with treatment and recovery.
• Closer examination of factors that differentiate
between high-aggressors and low-aggressors may
predict which patients are more likely to become
aggressive, thereby preventing aggressive instances.
Methods
Data Analysis and Results
Participants
44 psychiatric inpatients at a state hospital
• 24 males, 20 females
• 40 Caucasian, 3 African American, 1 Asian American
• Average age at admission: 39.63 (Range from 22-66)
• All had diagnoses in the schizophrenia spectrum
• All met the administrative criteria for “severe and persistent mental illness”
Purpose and Hypotheses
The purpose of this study was to examine the
relationship between insight, locus of control, and
aggression in individuals with SMI, while controlling
for neurocognitive ability. This study enhanced the
understanding of aggression in SMI.
Hypotheses:
• Low insight is related to aggressive behavior
• External locus of control is related to higher
aggression
• Low insight is related to external locus of control
• Linear discriminant function was used to determine the
relationship between the Birchwood Insight Scale
scores, the Externality subscale of the FKK scores, and
aggression, while controlling for neurocognitive
function.
Results
History of aggression
• 7 had history of verbal aggression
• 27 had history of physical aggression
• 10 had no history of aggression
Previous Findings
• Many studies have examined the relationship
between insight and locus of control and
aggression.
• Findings on insight are contradictory. Some studies
have found that low insight is associated with
aggression, while others have not.
• Findings on locus of control have generally been
that external locus of control is associated with
aggression.
Data Analysis
Materials
Social History
• History of aggression was extracted from Social History included in each patient’s
medical record. Reliability was established through a preliminary interrater check
requiring 100% agreement.
Birchwood Insight Scale
• Evaluates 3 dimensions of insight
– Perceived need for treatment
– Awareness of illness
– Relabeling symptoms as part of illness
Inventory of Competence and Control Beliefs (FKK)
• Assesses locus of control
• Each individual receives both an internal and an external score
Repeatable Battery for the Assessment of Neurocognitive Status (RBANS)
• Assesses neurocognitive ability
• Contains 5 scoring indices
– Attention
– Immediate Memory
– Delayed Memory
– Language
– Visuospatial/Constructional tasks
Procedure
The Birchwood Insight Scale, FKK, and RBANS are administered by program staff as
part of a routine battery that is given every 6 months.
• Multivariate analysis showed that the function did not
reliably differentiate among the groups
λ=.855, X2(3)=2.123, p=.547, R2 canonical=.15
• A simple correlation between scores on the Birchwood
Insight Scale and scores on the Externality subscale of
the FKK scores showed that scores on the two
assessments were not significantly related (r=.03,
p=.84).
Conclusions
• Insight and locus of control measures are not related to
aggression in this patient sample.
Why?
• Historical aggression data was used in this study,
instead of current data.
• Much of the previously collected data on insight and
locus of control in relation to aggression was collected
with a more heterogeneous population, whereas the
population for this study included individuals with
especially severe and chronic mental illness.
Acknowledgements
Dr. William Spaulding, Faculty Mentor
Melissa Tarasenko, Graduate Student Mentor
Ashley Wynne, Graduate Student
Felice Reddy, Graduate Student
Severe Mental Illness (SMI) Research Group
McNair Scholars Program