Violence and Mental Health

People diagnosed with psychiatric disorders are more likely to be both victims and perpetrators of violent conducts (Sariaslan et al., JAMA Psychiatry 77:359–367, 2020). Several studies (Witt et al., PLoS One 8(2):e55942, 2013) have found the correlation between different risk factors and violent behavior: history of violent victimization, male gender, low socioeconomic status, history of physical or sexual abuse in childhood, parents with criminal behavior and alcohol abuse, lack of insight, diagnosis of antisocial personality disorder and Cluster B, manic episodes, positive symptoms, history of substance abuse, and nonadherence to psychological and pharmacological treatments. People diagnosed with schizophrenia, bipolar disorder, depressive disorder, attention-deficit hyperactivity disorder (ADHD), antisocial personality disorder, substance use disorders and psychopathy are more likely to engage in violent behavior. Violent risk assessment in psychiatric patients takes into account a series of co-occurring factors of different nature (clinical, social, environmental) that are also distinguished into static and dynamic risk factors. The evaluation, prevention, and management of violent recidivism, therefore, involve the early identification of personal risk factors, through several assessment tools: BPRS, SCID-5-CV, SCID-5-PD, MMPI-2, PID 5, DERS, TAS-20, BIS-11, AIS, HARM-FV, HCR-20 V3, PCL-R. The prevention of aggression in the early stages involves interventions and techniques used in the immediacy to reduce the emotional reactions that lead to aggression; in the long term, the risk factors resulting from the assessment tools are considered to reduce or eliminate, when possible, the highlighted risk themselves and also psychopathological relapse. In forensic settings, the presence among staff of shared procedures aimed to prevent violent episodes is necessary. Various therapeutic de-escalation techniques are used, in order to manage aggressive behaviors.