Threatening and Non-Threatening Verbal Aggression as Predictors of Physical Aggression in Violent Psychiatric Patients

Abstract

Abstract Mental health clinicians must frequently assess and manage the risk posed by threatening behaviors. Threat assessment requires knowledge of base rates of threats as a function of several factors including the setting, the nature of the interaction, and individual characteristics of threateners and their victims. The purpose of the present study was to compare threatening and non-threatening instances of verbal aggression as predictors of physical aggression. To examine the strength of the relationship between threatening and non-threatening instances of verbal aggression and assaults, 103 forensic patients in a maximum-security hospital were monitored around the clock for 3 years. Participants included 53 patients previously identified as highly violent (mean frequency of assaults = 5.6) and 50 low violence patients (mean frequency of assaults = 1.0). All instances of aggressive behavior were recorded using the Overt Aggression Scale (OAS) (Yudofsky, Silver, Jackson, Endicott, & Williams, 1986). Frequency of verbal aggression was strongly and positively associated with frequency of physical aggression against others (r = .90), as were severity of verbal aggression and severity of physical aggression against others (r = .92). Threats were stronger predictors of physical aggression than were non-threatening instances of verbal aggression. Psychiatric diagnoses did not contribute to this pattern of associations. These findings confirm that verbal aggression is a significant risk factor for violence in the psychiatric hospital setting, and suggest that the strength of that link is much greater than previously suspected.