Understanding Violent Behavior in Early Psychosis Through the Fluid Vulnerability Theory: an Exploratory Qualitative Study

Abstract

Compared to the general population, young adults with early psychosis are at increased risk of violent behavior. Existing research has found contextual similarities between violent behavior and suicidal behavior. Therefore, this study examines the drivers and consequences of violent ideation and behavior among young adults with early psychosis by applying frameworks developed for suicide prevention. This research was conducted at OnTrackNY, a network of early intervention services (EIS) that provides coordinated specialty care services to young adults with non-affective psychosis that began within the past two years. Qualitative interviews were conducted with 6 EIS participants and 12 EIS staff members. The interview guide applied the “suicide narrative” format from the Stanley-Brown Safety Planning Intervention by asking EIS staff and EIS participants detailed questions about a specific episode of violent ideation or behavior. Participant responses were then categorized using Fluid Vulnerability Theory (FVT). This study found that it was feasible to discuss information about a specific violence-related crisis for young adults with early psychosis and their treatment teams by eliciting violence narratives. In doing so, EIS participants and staff identified several risk factors from the FVT domains that previously sparked either violent ideation or behavior. In addition to identifying potential target mechanisms for future interventions, these narratives may lead to more compassionate and therapeutic understandings of violence for young adults with early psychosis. Future research is recommended to explore how best to incorporate violence narratives in the treatment of early psychosis.