Major Mental Disorders and Violence: A Critical Update

Abstract

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.

Relationships between dimensional factors of psychopathy and schizotypy

“…Although the majority of patients with schizophrenia are not violent, rates of violence are relatively higher for individuals with schizophrenia when compared to most other psychiatric disorders (Krakowski et al, 1986; Hodgins et al, 1996; Joyal et al, 2007), particularly when schizophrenia is comorbid with substance abuse (Swanson et al, 1990; Erkiran et al, 2006). For instance, in one study, 8.36% of individuals with schizophrenia reported violent behavior compared to 3.45% of individuals with an affective disorder and 2.37% of individuals with an anxiety disorder (Swanson et al, 1990).…”

A whole-of-population study of the prevalence and patterns of criminal offending in people with schizophrenia and other mental illness

“…Across the range of studies, inconsistent research findings have been attributed to the use of varied, sometimes flawed methodologies and biased samples such as in-patient and prison samples (Link & Stueve, 1995 ;Walsh et al 2002). The risk of violent offending has been estimated to be three to seven times higher in people with severe mental illness compared to the general population (Joyal et al 2007 ;Fazel et al 2009a). Wallace et al 2004 ;Fazel et al 2009b) provide more consistent results but tend to focus on violent offending alone, or are restricted to selected diagnostic categories, most notably schizophrenia.…”

“…Wallace et al 2004 ;Fazel et al 2009b) provide more consistent results but tend to focus on violent offending alone, or are restricted to selected diagnostic categories, most notably schizophrenia. The review by Joyal et al (2007) concluded that major mental illness was associated with an increased risk of violence, independently of substance abuse. However, debate continues as to whether increased risk of violence is attributable to the presence of co-morbid substance abuse (Steadman et al 1998 ;Van Dorn et al 2012).…”

Community mental health services and responsibility of psychiatrists in Italy: Lessons for the globe

“…It is well-recognized that human behavior, including dangerousness, might be determined by multiple variables at multiple levels (Joyal, Dubreucq, Gendron, & Millaud, 2007).…”