From Mistrust to Malice: Examining the Influence of Adverse Childhood Experiences on Reactive and Appetitive Aggression in Male Forensic Psychiatric Patients with a History of Drug Abuse Through the Lens of Psychodynamic Personality Structures.

Adverse childhood experiences (ACEs) represent one of the most critical factors contributing to the manifestation of psychiatric disorders later in life. Furthermore, such experiences are often associated with deficits in interpersonal relationships, manifesting as mistrust and violent behaviors, and are indicative of a fragmented personality. This study aimed to analyze the correlative relationships between personality deficits influenced by ACEs and the expression of reactive and appetitive aggression using self-report questionnaires in 53 male forensic psychiatric patients with a drug dependency background detained under §64 of the German Criminal Code between 2019 and 2022. Instruments included the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SF), the Maltreatment and Abuse Chronology of Exposure Scale-German Version (KERF), and the Appetitive and Facilitative Aggression Scale (AFAS). Specifically, the OPD-SF used the following subscales: self-perception, self-regulation, the regulation of object relations, emotional communication inward/outward, internal/external attachment, and total score. The results demonstrate a significant relationship between childhood traumatic experiences, personality structure, attachment capacity, self-perception, and regulation and the expression of both reactive and appetitive aggression. While the association with reactive aggression is intuitively plausible, the findings notably reveal that the propensity to derive pleasure from violence is also associated with personality deficits caused by adverse childhood experiences. These findings have important implications for the treatment of offenders with personality disorders and should be considered in therapeutic interventions.