The possibility of a causal link between major mental disorders (MMDs) and violence has been the matter of a debate for decades in psychiatry. Just as a consensus seemed to emerge, a standout and unprecedented large-scale community investigation lead to contradictory conclusions. The main goal of this review was to provide clinicians with a critical summarizing of all major relevant studies published during 15 years. It is concluded that major mental disorders per se, especially schizophrenia, even without alcohol or drug abuse, are indeed associated with higher risks for interpersonal violence. However, further stigmatization of persons with MMDs should be considered, as between 85% and 95% of community violence is not related with MMDs and the absolute number of assaults committed by psychiatric outpatients is low. A summary Table 1 includes comments and conclusions related with each reviewed study and circumstances related with this type of assaults are discussed. Interpersonal violence associated with MMDs seems to be due to a heterogeneous minority of patients and current research aims at better characterizing subgroups who assault in similar contexts.

These results explain in part the high diversity of previous violent rate reviews and support the notion that inward repetitive violence might be more closely related with ND and impulsivity than psychopathology.