Evaluating Anger and Psychosis Can Predict Violence in Psychiatric Cases

Psychiatric clients with a history of violence pose a particular threat to the community. Psychosis and anger are two major factors that contribute to violent behavior. Self-directed violence (SDV) and violence directed toward others (ODV) are patterns of behavior that are of key concern and also increase an individual’s risk for suicide. Understanding which individuals are most likely to commit these types of violence will allow clinicians to develop targeted interventions for psychiatric clients who will be reintroduced to community settings after hospitalization. Marc T. Swogger, Ph.D., of the Department of Psychiatry at the University of Rochester Medical Center in New York, chose to examine which factors influenced both ODV and SDV. He focused on individuals with personality disorders, substance misuse behaviors, and antisocial tendencies because these psychiatric clients are more inclined to exhibit externalizing psychopathology.

Swogger evaluated the participants for anger and psychopathy. Anger has been linked to multiple forms of violence, including child abuse, domestic violence, and even workplace conflict. Additionally, research has shown that mental health clients who report high levels of anger are more likely to engage in ODV. Psychopathy was examined because individuals who struggle with psychopathic violence are less remorseful and more impulsive than healthy individuals who engage in violence. For his study, Swogger interviewed 851 psychiatric clients prior to their release from an inpatient mental health facility. He completed follow-up assessments every 10 weeks for several months and found that the participants with anger were more likely to engage in ODV, SDV, and co-occurring violence (COV) than nonviolent participants. The results also showed that psychopathy predicted ODV and COV. However, the clients with psychopathy only exhibited SDV in combination with ODV. This finding suggests that clients with psychopathy are likely to succumb to anxiety and anger and impulsively engage in reactive violence. Swogger believes these results demonstrate how specific traits of violent behavior can help reduce the risks to the community. He added, “The measurement of anger and facets of psychopathy during discharge planning for psychiatric patients may provide clinicians with information regarding risk for specific types of violence.”

Swogger, M. T., Walsh, Z., Homaifar, B. Y., Caine, E. D., Conner, K. R. (2012). Predicting self- and other-directed violence among discharged psychiatric patients: the roles of anger and psychopathic traits. Psychological Medicine, 42.2, 371-379.

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  • Jason thomas

    Jason thomas

    March 16th, 2012 at 4:24 AM

    I would be kind of afraid if you want to know the truth of exposing myself to the dangers of working with patients who would have the tendency to express such violent behavior. What kinds of measures do you think should be put in place to protect those who are only tryi g to help in each situation?

  • Paula


    March 16th, 2012 at 11:16 AM

    The one thing that I don’t understand is that even if you think that someone is at risk for suicide, that does not always mean that you are going to be able to make them reconsider that option. Yes some will see how their thinking is flawed but there are others, probably more, who, if they are desperate enough to end their own lives and exhibit a lot of violence toward themselves, then they are probably going to be successful with their wishes. I know that that does not mean that we shouldn’t try to deter them, but often that is a battle that we are not destined to win.

  • dale james

    dale james

    March 17th, 2012 at 7:26 AM

    those with these anger problems early, even when they are noticed are usually shunned and pushed to the edge and fringe of society, those that nobody wants or that anyone wants to deal with

  • mike


    March 18th, 2012 at 12:04 AM

    anger predicts violence?this isn’t something new, and isn’t this true to everybody and not just psychiatric clients?the question now would be how do we measure or even identify the presence of such anger that could lead to violence.

  • Karen


    March 18th, 2012 at 5:48 AM

    It’s one thing to exhibit self directed violence. I mean if you are going to hurt something then for as bad as this sounds I would rather you hurt yourself than someone else.
    But I think that we all know that this does not usually hold to pattern. It seems that there is far more violence directed toward others, even when it is close family, than there is toward oneself.
    But in these cases how do you stop it from happening? It is like if they are determined to hurt someone or something then they are going to do it no matter the consequences because they are clearly not thinking things through in a rational manner.

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