Psychosis and Violence: Stories, Fears, and Reality

Abstract

Individuals with psychosis are often feared. In fact, they are themselves likely to be victims of violence; however, the main aim of this review is to provide an overview of the evidence on relations between psychosis and violence to others. The terms psychosis and violence were used in a literature search limited to the Cochrane Library and PubMed, a manual search of 8 journals, and a follow-up of additional references in the articles found. The overview draws on new empirical data and major reviews. Almost all sound epidemiologic data on psychosis and violence dates from 1990. There is consistency on a small but significant relation between schizophrenia and violent acts. Since then there has also been movement toward understanding the nature of associations and progress on strategies for managing individuals who have psychosis and are violent. Public fears about individuals with psychotic illnesses are largely unfounded, although there would be benefit in greater attention to the safety of those in their close social circle. The task for the next 10 years must be the development and application of knowledge to improve specific treatments—that is, interventions that go beyond holding and caring to bring about substantial change.

Moral cognition in schizophrenia

“…The first mimics pathways to violence in the general community and is primarily associated with proactive aggression via psychosocial disturbance, including drug and alcohol abuse, lifestyle factors and comorbid premorbid personality (including psychopathy). The second route is via association with the positive symptoms of schizophrenia, in particular persecutory delusions, which, in otherwise non-violent individuals, has been primarily linked to reactive aggression, including delusion-fuelled reactive aggression (Bo et al, 2011;Taylor, 2008).…”

Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

“…First, a diagnosis of schizophrenia (and other severe, enduring psychotic disorders) has been demonstrated unequivocally to increase a person's risk of violence in comparison to the general population. 4,6,9,22,23,29,30,32,33,[48][49][50][51][52][53][54][55] The risk of violence is also higher when the psychopathology is more severe, e.g., when more severe positive symptoms of psychosis are present. 4,7,9,32,33,48,53,56,57 Some studies suggest that the effect of a diagnosis of schizophrenia on the risk of violence is only really significant when it is amplified by additional factors such as comorbid/premorbid antisocial conduct or antisocial personality traits.…”

Schizophrenia: Causes, crime, and implications for criminology and criminal justice

“…The combined weight of numerous studies leads to the conclusion that the risk for committing a violent crime for persons with schizophrenia is considerably greater than that of the population at large. However, it is important to emphasize that psychosis-driven violence is still a very small part of society's violence problem (Taylor, 2008).…”

“…Nevertheless, the majority people with schizophrenia are nonviolent and are more likely to be victims of violence than perpetrators (Taylor, 2008). Those most at risk for victimization are also those most at risk for committing violence.…”