Presence and impact of adverse childhood experiences and reflective functioning on aggression in adults with antisocial behaviour

This cross-sectional study investigated the relationship between the presence and impact of ACEs with both reactive and proactive aggression, and the possible moderating role of mentalization (operationalized as reflective functioning) in these expected relationships. Sixty-five inpatient and outpatient adults with any kind of antisocial behaviour completed the Dutch version of the Traumatic Experiences Checklist, the Reactive-Proactive Aggression Questionnaire, and the Adult Attachment Interview with the use of the Reflective Functioning Scale. Preliminary analysis showed a remarkably high level of ACEs, and a relatively high reported impact of these experiences. We found a positive relationship between the total presence of ACEs (including childhood maltreatment and adverse household factors), and both reactive and proactive aggression. We also found positive relationships between the experienced impact of these ACEs and both reactive and proactive aggression. Regarding childhood maltreatment in family of origin, we did not find a correlation between the presence of these experiences and respectively reactive and proactive aggression. However, we found a correlation between the impact of childhood maltreatment and reactive aggression. These results suggest that in addition to the cumulative experience of ACEs, the subjective burden of these experiences on individuals must not be underestimated in case of aggression. Additional moderation analysis showed no differences in these relationships in case of less developed versus medium-high developed reflective functioning. The findings substantiate the importance of early prevention and treatment programs with focus on ACEs to possibly reduce aggression.