Many people believe that Violence on Mental Disorders goes hand in hand. For example, researchers conducted a national survey in 2006. It found that 60 percent of Americans thought that people with schizophrenia were likely to act violently against someone else. And 32 percent thought that people with major depression were likely to do so.
Studies suggest that this public perception does not reflect the truth. Most people with mental disorders are not violent. Assaults and violent offenses are committed by a group of individuals with mental illnesses. Research results are not consistent with how much mental disorder contributes to this behavior. And how much drug abuse and other factors contribute to it.
The report showed that 31 percent of people who have both a substance use disorder and a psychiatric illness (“dual diagnosis”) committed at least one act of violence a year. 18 percent of people with a psychiatric disorder did this. Other research has confirmed that drug abuse is a major contributor to violent behavior. But researchers further researched and compared the rates of Violence in one area in Pittsburgh to environmental factors and substance use control.
They Found No Significant Difference In The Rates Of Violence On Mental Disorders
We can make a general estimate of the relative danger. But, it is difficult to predict an actual, particular act of Violence on Mental Disorders. It is because such actions tend to occur when the perpetrator is highly emotional. During a clinical session, the same person can be cared about, less emotional, and thoughtful. He may mask any signs of violent intent. And suppose the patient expressly shows the intention to hurt someone else. The relative risk of acting on the plan is still greatly affected by life events and clinical factors. Individuals who behaved violently in the past are more likely than others to be violent again.
Suppose the patient expressly shows the intention to hurt someone else. Then, the risk of acting on the plan is still greatly affected by the following life conditions:
History of Violence. Individuals arrested or acted violently in the past are more likely than others to become violent. Most of the research suggests that this could be the largest single predictor of future Violence. However, this research cannot show whether previous Violence was related to mental disorder. Or to some of the other causes explored below.
Substance use. Patients with dual diagnoses are more violent than patients with mental illness alone. So a comprehensive review requires questions about substance use. It also requires questions about signs of psychiatric disorder.
One theory is that substance use can induce violent behavior in people with or without mental disorders. It is because they are at the same time harmful to judgment. And they change the mental balance of an individual and remove cognitive inhibitions. In individuals with mental problems, drug misuse may exacerbate symptoms. These include paranoia, grandiosity, or aggression. Patients who use drugs or alcohol are often less likely to follow mental disease treatment.
This Can Worsen Psychiatric Symptoms
Another theory, however, is that drug abuse can be associated with other risk factors for Violence. Clinical Antipsychotic Intervention Effectiveness Trials surveyed 1,410 people with schizophrenia. It showed that substance abuse and dependency raised the risk of self-reported violent. However, as researchers adjusted for other causes, such as psychotic symptoms and mental issues during childhood, the effect of substance use was no longer significant.
Personality Disorders. These disorders often result in aggression or Violence. These include borderline personality disorder, antisocial personality disorder, behavioral disorder, and other personality disorders. Suppose a personality disorder arises in association with another mental disorder. The combination can also raise the likelihood of violent behavior. The CATIE study above suggests this.
Nature Of Symptoms. Patients with paranoid illusions, delusions, and airy psychotic thoughts may be more likely to become violent than other patients. Doctors need to understand the patient’s own perception of psychotic feelings. This may reveal where a patient may be compelled to fight back.
Age and Gender. Young people are more likely to act violently than older adults. In comparison, males are more likely to act violently than women.
Social Stress. Those who are poor or homeless are more likely than others to become violent.
Personal Stress, Crisis or Loss Of Life. Unemployment, divorce or breakup in the past year may increase the risk of Violence. People who have been victims of violent crime in the past year are much more likely to be assaulted by someone.
Early Exposure. The risk of Violence increases with:
- Exposure to aggressive family struggles during childhood
- Physical abuse by a relative or to a parent with a criminal record
Preventing Violence On Mental Disorders
Treatment for mental disorders and drug abuse may help to decrease violence rates. For example, in one study, CATIE authors studied the rates of Violence in patients that had already been randomized to receive antipsychotic treatment. Family members have double-checked the patients’ own memories. This study showed that the number of patients with schizophrenia who took antipsychotic drugs as prescribed was less likely to be violent than those who did not.
Participants diagnosed with a mental disorder as a child became an exception to this general pattern. No drugs were better than others in reducing violence rates. But this study excluded clozapine (Clozaril).
Indeed drug treatment alone is impossible to decrease abuse risk in people with mental illness. Ideally, interventions can be long-term and include various psychosocial techniques. These include cognitive-behavioural therapy, conflict management, and drug misuse.
Of course, this kind of ideal treatment can be increasingly difficult to achieve in the real world. For example, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines explained the type of multimodal therapy needed to improve full recovery chances. Most patients with schizophrenia do not get the kind of treatment provided in the PORT guideline. Solutions to these issues would arise not from doctors but from policymakers.
The Bottom Line
Violence on Mental Disorders has serious implications for culture and psychiatric practice. This, directly and indirectly, affects patients’ quality of life, their families, the environment. The spectrum of Violence in psychiatric practice requires risk stratification and management as part of an overall patient’s overall assessment.
Psychiatrists must treat any variable risk factor. Psychotherapy and pharmacotherapy are used in the course of illness.
