Temperament and Insight in Offender and Non-Offender Patients with Schizophrenia in Türkiye

Offending behavior in individuals with schizophrenia reflects complex interactions extending beyond psychotic symptoms alone. Affective temperament and insight, particularly insight related to treatment compliance, may be relevant to offending-related outcomes and recidivism. This study examined the relationships among affective temperament, insight, and offense-related judicial involvement in individuals with schizophrenia.

This single-center, cross-sectional study included 103 adults diagnosed with schizophrenia, classified as offenders (n = 63) or non-offenders (n = 40). Sociodemographic and clinical data were collected, and participants were assessed using the Positive and Negative Syndrome Scale (PANSS), the Schedule for Assessing the Three Components of Insight (SAI), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). Statistical analyses were conducted employing t-tests or Mann-Whitney U-tests for group comparisons, chi-square or Fisher's exact tests for categorical variables, and Spearman correlations.

Affective temperament profiles did not differ between offenders and non-offenders. Within the offending group, lower insight into treatment compliance was associated with recidivism. Irritable temperament showed weak negative associations with multiple insight dimensions and was related to greater symptom severity. Substance use and frequent hospitalizations were more common among individuals with repeated offending and were also associated with self-harm and suicide attempts.

Temperament traits and global insight did not distinguish offenders from non-offenders with schizophrenia. Instead, reduced treatment-compliance insight emerged as a clinically relevant correlate of recidivism within the offending subgroup. These findings suggest that repeated offending in schizophrenia may be more closely related to dynamic, treatment-related, and behavioral factors than to stable affective temperament traits. Although causal inferences cannot be drawn, the results highlight the potential importance of adherence-focused clinical strategies in efforts to reduce recidivism.