Manic Symptoms Increase Risk of Victimization in Schizophrenia

Manic episodes are present in many individuals with schizophrenia, bipolar, and other forms of psychosis. Increased irritability, excitement, and agitation can lead to difficulty with communication and can present challenges in social situations. Further, this type of behavior, coupled with reduced emotional control, could place individuals with schizophrenia and other psychotic conditions at risk for victimization. That was the main finding from a recent study conducted by Federico Fortugno of the Neurosciences, Mental Health, and Sensory Functions Department at the School of Medicine and Psychology at Sapienza University in Italy. Because there is an abundance of literature examining the factors that predict violent behavior and perpetration in people with psychosis but little research exploring factors that predict victimization, Fortugno wanted to research what specific symptoms of schizophrenia and other related issues were common among those who reported a history of victimization.

For his study, Fortugno interviewed over 900 adults between the ages of 18 and 65 during the first week following their involuntary hospital admittance. The participants were English and European, and each was evaluated for symptom severity, mania, violent behaviors, and victimization. Fortugno chose to look at both perpetration and victimization to determine if the predicting symptoms overlapped. He found that nearly 40% of the English and nearly one-third of the European participants all reported being a victim of a violent crime in the year prior to hospitalization.

The main finding was the presence of manic symptoms in all of the participants reporting victimization. The more severe the mania, the more likely the participant had a history of victimization. However, manic symptoms also led to increased reporting of perpetrating violent behavior as well.

Another factor that was common among those reporting victimization was unemployment. Although men were more likely to perpetrate violence than women, the men and women without steady employment had equal rates of victimization. Fortugno believes the lack of a structured environment and lower functioning capacity could explain that finding. Overall, these results add to the scant literature examining symptoms that predict victimization in mentally ill individuals. This study clearly shows that high levels of mania put individuals with schizophrenia at greater risk for being hurt. Fortugno added, “Such symptoms should be specifically considered in risk assessments.”


  1. Fortugno, F., Katsakou, C., Bremner, S., Kiejna, A., Kjellin, L., et al. (2013). Symptoms associated with victimization in patients with schizophrenia and related disorders. PLoS ONE 8(3): e58142. doi:10.1371/journal.pone.0058142

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Blue Raven

    April 12th, 2013 at 11:48 PM

    This is sad,really sad.These people are suffering from a disorder and being victimized all at the same time.the victimization could push the disorder towards an even worse state.its easy to say they may be perpetuating violence themselves but what they need is help,they are not doing it voluntarily.

  • Alen

    April 13th, 2013 at 4:02 AM

    How sad is it that someone woud want to hurt another person so badly that they choose the weakest in society to harm? These are for the most part victims who have little chance to stand up for themselves and take care of themselves let alone protect themmselves from someone intent on inflicting pain and harm. It makes me sick to think of just how many people there are like this out in this world. It no longer seems to be good enough to take care of one another- there is this need to be in control and often this is exerted against someone who cannot defend themselves against the violence.

  • gabby

    April 13th, 2013 at 1:03 PM

    It seems that these things all sort of snowball and create one another. What I mean is that you have one thing go wrong and it all seems to go downhill after that.

  • Todd

    April 15th, 2013 at 2:57 AM

    It’s strange that my mom posted this on my page and it nailed the last two years of my life on the head. So I’m posting. I’m unemployed and looking at jailtime for a violent crime… Fighting for custody of my son, but my tendancy to be manic is making it hard for me to have solid ground to stand on for that…. I’ve always kinda wondered if I was bipolar or schizophrenic (extreme emotional fits, violent thoughts). I was 3 years sober and going to aa before a relapse last Christmas. The year before I was assaulted on the job and my girlfriend cheated on me with her ex while she was pregnant with my son. I stayed at the job and with her and shut myself off from the world.. I exploded twice in the last 6 months, both resulting in dv charges… I need help and I have no money and I also know jail isn’t really the kind of help I need. But like therapy without narcotic drugs. I did 6 months of in patient therapy when I first got sober, its the maintenance and after care I need to motivate myself on. Since the relapse I have had some difficulty quitting drinking again. I force myself to go to as many aa meetings as I can get myself to, but for now it feels like it’s just keeping me alive. I need some one on one with a licensed professional.. one that can challenge me and see thru my bullshit.. I have a hard time letting people in all the way and am very afraid of myself and what I might do… I’m also hyper intelligent (as many of us tend to be) so hiding the real me from people I’m involuntarily told to speak with about my mental health is simple considering how much psychology I took in college. I understand my own brain pretty well so I’m looking for a very dedicated antagonist.. I have to say this all now because when I wake up tomorrow I’m probably going to lie to myself and tell myself I’m fine and I don’t need help this drastic. Fighting myself is becoming difficult and I have nearly bankrupt my family and almost caused them to get a divorce.. I really don’t want to hurt anyone anymore. Mostly myself. I’m looking for long term outpatient, I’ve learned absolute volumes about getting sober, but like I had said I’m having problems with motivation, maintenance and follow up, like I need more than aa. Just not sure where to start looking with no money. I tried the state and their care isn’t very challenging.. but may also be getting on state ran ins very soon.. Idk, my mom put this link up, and it feels like a sign that this was the first post… It seriously described my life and how I’ve felt for the last couple years, ESPECIALLY after my relapse in December of last year, continuing til well I guess I have to say still struggling..

  • Todd

    April 15th, 2013 at 3:10 AM

    I forgot to mention the last bit where my ex was using sex and promising visitation, that she bailed on constantly, to keep me in her life. Plus on top of the physical abuse I had endured at work I was verbally degraded constantly and sometimes even in front of customers, but it was a family run co. A family I wasn’t a part of. Letting people use me has been a consistent problem in my life cause I hate arguing, just causes me to bottle stuff up and explode and live a little too close to the edge and lie and be unhappy until I do blow up. My ex was also a victim of abuse in childhood and wasn’t treating herself very well when we met. She is bipolar. So I’m seeing this pattern ya’ll are talking about. And about that snowball, living inside this head, it has about the chance in hell if I don’t do something fast. I know what I’m doing, what its doing, or he as I call him, is doing. One side of me is using alcohol and drugs to kill the other, this is chemical warfare inside me and both sides don’t realize they live on the same planet and we will all die… I just want to get better or just plain start getting help for my son. I miss him so much :(

  • Jameson

    April 15th, 2013 at 3:46 AM

    As just a guess my thoughts would be that when one is in a manic state there is a greater chance for making very poor decisions in regards to behavior and that someone with schizophrenia would only stand a greater chance of this due in large part to the other mental disabilities that are a part of this disease. Interesting to see where science and treatment goes with this, how doctors and patients alike are able to meld the treatment of these two things together to create a safer alternative for this situation.

  • Brady

    April 15th, 2013 at 8:00 AM

    It’s funny-you always think about people with this disorder in terms of the harm they could do to someone while in a manic state. Interesting to see that they themselves can end up being victimized.

  • Callie

    April 15th, 2013 at 8:02 AM

    I am so confused. Since when are the English not European?

  • jenkins

    April 15th, 2013 at 8:06 AM

    so what i dont get is what they mean by victimization like what kind of victims are they talking about do they mean violent crime or just smaller stuff like somebody taking stuff from them? its bad to think that somebody suffering already has to go through more suffering that aint even there own fault i wish them all well.


    April 15th, 2013 at 8:11 AM


  • Syracuse Mandolin

    April 15th, 2013 at 8:13 AM

    Personally, I think that being unemployed is just another example of victimization. How can society expect the mentally ill to be able to find a job? Better yet, how can society expect a business owner to hire someone with severe mental illness? We need to do a better job taking care of the weak among us.

  • Tiara

    April 15th, 2013 at 12:34 PM

    Its like pedophiles…they prey upon the weakest and those that are defenseless…there is always going to be sadists like that who take pleasure in troubling those that cannot give them a good fight…that is how they ‘win’ in their heads…but that ‘winning’ can stop if we all stand together and say we will not tolerate abuse against those that cannot fight back…!

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