Aggressive behavior and metacognitive functions: A longitudinal study on patients with mental disorders

Valentina Candini, Marta Ghisi, Giorgio Bianconi, Viola Bulgari, Antonino Carcione, Cesare Cavalera, Giovanni Conte, Marta Cricelli, Maria Teresa Ferla, Clarissa Ferrari, Laura Iozzino, Ambra Macis, Giuseppe Nicolò, Alberto Stefana, Giovanni De Girolamo, and for the VIORMED-2 Group

Research output: Contribution to journalArticlepeer-review


Background: Metacognitive functions play a key role in understanding which psychological variables underlying the personality might lead a person with a severe mental disorder to commit violent acts against others. The aims of this study were to: (a) investigate the differences between patients with poor metacognitive functioning (PM group) and patients with good metacognitive functioning (GM group) in relation to a history of violence; (b) investigate the differences between the two groups in relation to aggressive behavior during a 1-year follow-up; and (c) analyze the predictors of aggressive behavior. Methods: In a prospective cohort study, patients with severe mental disorders with and without a lifetime history of serious violence were assessed with a large set of standardized instruments and were evaluated bi-monthly with MOAS in order to monitor any aggressive behavior. The total sample included 180 patients: 56% outpatients and 44% inpatients, and the majority were male (75%) with a mean age of 44 (± 9.8) years, and half of them had a history of violence. The sample was split into two groups: poor metacognition (PM) group and good metacognition (GM) group, according to MAI evaluation scores. Results: The PM patients reported a history of violence more frequently than GM patients, during the 1-year follow-up, but no differences between groups in aggressive and violent behavior were found. The strongest predictors of aggressive behavior were: borderline and passive-aggressive personality traits and a history of violence, anger, and hostility. The metacognitive functions alone did not predict aggressive behavior, but metacognitive functions interacted with hostility and angry reactions in predicting aggressive behavior. Conclusions: This study led to some important conclusions: (a) some aspects closely related to violence are predictive of aggressive behavior only in patients with poor metacognition, thus good metacognition is a protective factor; (b) poor metacognition is associated with a history of violence, which in turn increases the risk of committing aggressive behavior.

Original languageEnglish
Article number36
Number of pages13
JournalAnnals of General Psychiatry
Issue number1
Publication statusPublished - Jun 3 2020


  • Aggressive behavior
  • Internal mental states
  • Mental disorders
  • Metacognition
  • Risk of violence

ASJC Scopus subject areas

  • Psychiatry and Mental health


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