Not all people who commit acts of violence have psychosis, and not all individuals with psychosis commit acts of violence. So what makes people with psychotic conditions become violent? That was the question at the center of a study led by Katrina Witt of the Department of Psychiatry at the University of Oxford in the United Kingdom. Witt wanted to review existing research to narrow down the broad range of risk factors indicated as predictors of violence in people with psychoses. To do this, Witt analyzed 110 research studies on people with schizophrenia, bipolar, and other forms of psychosis. The final sample included over 45,000 participants who were treated as either inpatient clients or on an outpatient basis. The participants had been assessed for symptom severity, perpetration of violence, victimization, and various factors including history of violence, childhood abuse, and drug or alcohol use.
Witt found that the strongest indicator of violent behavior in the participants, regardless of whether they were inpatient or outpatient clients, was criminal history. This factor predicted violence more accurately than prior drug use or nonadherence to treatment and medication. However, the latter circumstances also had a significant influence on risk of perpetrating violence. Other indicators were impulsivity, hostility, and involuntary treatment. Witt did not find an association between symptom severity and violent behavior, suggesting that negative symptoms by themselves may not put individuals at risk for becoming violent.
When Witt looked at the other side of violence, she found that the cycle of victimization was especially high among those with psychosis. In fact, those who had experienced childhood abuse or other traumas were more likely to experience victimization in adulthood than to commit violent acts against others. Another interesting finding was the fact that suicide attempts, but not ideation, predicted violent behavior. Perhaps impulsivity contributed to this finding, suggesting that individuals with low impulse control are more likely to engage in violence against others and themselves. These risk factors and those mentioned previously persisted in both inpatient and outpatient populations, but were stronger for inpatient participants. In sum, Witt believes this study illuminates several risk factors that could be targeted in treatment approaches for individuals with psychosis. She added, “Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.”
Reference:
Witt, K., van Dorn, R., Fazel, S. (2013). Risk factors for violence in psychosis: Systematic review and meta-regression analysis of 110 studies. PLoS ONE 8(2): e55942. doi:10.1371/journal.pone.0055942
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