Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis

Abstract

Aims and MethodThe aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.ResultsFor each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.Clinical ImplicationsA history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.

Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention

“…Consequently, violence committed by some individuals with severe mental illness promotes stigmatization and rejection of all persons with severe mental illness. Stigmatization may affect diagnostic decision making and treatment (Walsh & Fahy 2002;Clark & Rowe 2006), pose barriers to recovery and integration in the community, and compromise quality of life (Link & Pelham 2006).…”

La lucha contra el estigma y la discriminación en salud mental: Una estrategia compleja basada en la información disponible

“…Algunos estudios muestran además por ejemplo cómo, en el caso de psiquiatras, una historia previa de violencia en un paciente tiende a determinar más fácilmente que le diagnostiquen de esquizofrenia (78). En resumen que parecería que, en este caso, el papel positivo del contacto social -al que luego haremos referencia como factor que se asocia a menor grado de estigmatización y deseo de distancia social hacia las personas con enfermedad mental (12; 20; 66)-no funcionase en el «contacto profesional».…”

Mood disorders and violence: a new focus

“…There is evidence of just such a diagnostic bias. In a vignette-based study of diagnostic decisionmaking, Clark & Rowe (2006) demonstrated that psychiatrists are more likely to diagnose schizo phrenia than bipolar disorder in a patient with a diagnostically non-specific psychosis if that person has a history of violence than if they do not. This diagnostic bias will be liable to lead to underreporting of mood disorders in violent populations, perpetuating this erroneous assumption.…”