Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited.

To develop a testable psychological framework explaining violence in psychosis – grounded in patient experience – to guide targeted treatment development.

We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis.

Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour.

The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.

法医精神病患者经常有暴力行为。在了解暴力风险因素方面取得了重大进展，但对暴力因果机制的认识有限。

开发一个可测试的心理框架来解释精神病中的暴力行为——以患者的经历为基础——以指导有针对性的治疗开发。

我们利用英格兰三个地区的法医精神病学服务对 20 名精神病患者进行了深入访谈。使用反思性主题分析对访谈进行分析。有生活经验的人对分析做出了贡献。

对访谈的分析确定了与暴力发生有关的几个心理过程。暴力是应对困难的主要反应方式，它既是习惯性的，也是受到攻击和证明攻击正当性的规则所支撑的。暴力是由对其他人的三种敏感性引发的：对身体威胁的敏感性，可以防止暴力；对社会不尊重的敏感度，通过这种不尊重，暴力提高了地位；对不公平的敏感，通过暴力进行报复。暴力是一种调节困难的内心状态的尝试：强烈的情绪通过攻击性得到释放，暴力是一种试图逃避被声音、幻象或偏执所淹没的尝试。在解释个别参与者的违规行为时，这些过程中存在不同的侧重点模式。

根据我们对患者描述的分析得出的暴力七因素模型强调了多种可能导致暴力的可改变的心理过程。该模型可以指导有针对性的治疗方法的研究和开发，以减少精神病患者的暴力行为。