Psychopathy, schizophrenia, alcohol abuse, and violent recidivism

Abstract

The relationships between various mental disorders and violent behavior have been the subject of much public and professional debate. The public perceives major mental disorder as a risk factor for violence (Steadman & Cocozza, 1977). The scientific evidence on the relationship, however, is mixed. Despite earlier reports that there was no link between violence and mental disorder (Monahan, 1981), more recently there have been reports of a positive, although modest, association between schizophrenia (and sometimes other psychotic disorders) and violence (Cirincione, Steadman, Robbins, & Monahan, 1992; Lindqvist & Allebeck, 1990; Monahan, 1992; Wessely & Taylor, 1991). Some of the strongest evidence comes from a subsample from the Epidemiological Catchment Area study (Swanson, Holzer, Ganju, & Jono, 1990; Swanson & Holzer, 1991), in which approximately 10,000 community citizens' self- reported violent acts were related to schizophrenia, as rated from the Diagnos- tic Interview Schedule. Among schizophrenic and other psychotic individuals, delusions have been linked to violent behavior (Robertson & Taylor, in press; Taylor, 1985). In another study, current psychotic symptomatology was posi- tively associated with violent behavior among both former mental patients and never-treated community members (Link, Andrews, & Cullen, 1992), but once current symptoms were taken into account, diagnosis made no additional con- tribution to the prediction of violence. In samples of persons at high risk for violence, there is less evidence that schizophrenia or psychotic symptoms increase that risk. In a study of jail detainees, a diagnosis of schizophrenia did not increase risk of future violence, and the evidence regarding delusions and hallucinations was inconclusive