Published findings on the relationship between schizophrenia and violence have been mixed, due to differences in study design and quality. In this review, we address the issue with an emphasis on characterizing who is most likely to be violent and when. We conclude that: (1) individuals with schizophrenia are at an increased risk for violence due to specific psychotic symptoms; (2) this risk is increased by brain abnormalities, psychiatric comorbidities, and demographic factors that are not specific to schizophrenia; (3) the majority of violent offenses committed by people with schizophrenia are indistinguishable from offenses committed by others; and (4) despite our knowledge of factors related to increased violence risk and the existence of effective treatments to mitigate this risk, valid risk assessment instruments for this population are lacking, and treatment strategies are rarely employed at any level of psychiatric care. In short, while most people with schizophrenia are not violent and violence committed by people with this condition accounts for only a small percentage of overall violent crime, there is nevertheless a significantly increased risk for violence among subgroups in this population. This has implications for people living with people with schizophrenia, mental health professionals, administrators of psychiatric care facilities, law enforcement personnel, the court system, and policymakers.

Research has consistently demonstrated that people diagnosed with serious mental illness (SMI) are at increased risk for violent ideation and behavior (VIB) and that this is especially the case for SMI patients with comorbid substance use disorders (SUD). Despite this, what is still largely unknown is the relative prevalence of VIB across diagnostic categories, whether the rates of VIB in SMI groups exceed the rates observed in people with SUD only, and which demographic factors increase the likelihood of VIB under different circumstances for people with SMI. To address these questions, we analyzed the intake records of 63,572 patients diagnosed with SMIs (i.e., schizoaffective disorder, schizophrenia, bipolar disorder, and unipolar depression), substance use disorders, and non-SMI psychiatric disorders. Raw prevalence rates for a combined metric of VIB were established and compared for each group, and a series of logistic regression analyses were performed to estimate how various demographic factors influenced the likelihood of VIB endorsement in each study group. Our results revealed that (a) patients with SMI conditions had higher rates of VIB than both patients with non-SMI psychopathology and those with substance use disorders only; (b) patients with SMI and comorbid substance use pathology were responsible for the majority of VIB within each SMI condition; and (c) men with SMI conditions had higher prevalence rates of VIB than females. In addition, we found that for every SMI diagnosis, comorbid substance use disorders and younger age were related to greater risk for VIB, and where race and gender were found to significantly alter the likelihood of VIB endorsement, African American status and female gender were independently related to greater risk. The implications of these findings and directions for future research are discussed.

The most recent legislative attempts to curb violence in schools have been school-based dating violence prevention laws. In the previous decade, there was an increase in legislation designed to prevent bullying in schools; these laws now exist in 50 states. However, most anti-bullying laws provide an expansive definition of bullying that includes any type of peer aggression, harassment, or teen dating violence (TDV). Having several different state and federal laws aimed at curtailing multiple forms of aggression may produce confusion about appropriate intervention and disciplinary responses, requiring school districts to develop parallel sets of policies, educational curricula, intervention approaches, and reporting requirements for overlapping behaviors that can be simultaneously peer aggression, bullying, harassment, and TDV. We conducted a systematic search of applicable laws and systematically coded those we identified for relevant content (i.e., definitions, covered locales, protected groups, and personnel, procedural, preventive, and disclosure elements). Anti-bullying laws were typically more detailed than dating violence laws. TDV laws were more likely to target TDV and control intimate behavior and to provide for education about healthy relationships. Both types of laws often mandated trainings; specified reportable behaviors; discussed sanctions, recommendations, and interventions; and mentioned counseling, specially trained staff persons, or designated specialists. Both anti-bullying and TDV laws also sometimes directed reporting of aggregate incident rates and impacts of prevention efforts. Neither type of law tended to specify school and community resources or prevention approaches. Results inform discussion of the merits of different approaches to school-based violence prevention laws.

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