Violence and Delusions: Data From the MacArthur Violence Risk Assessment Study

• Published in: The American journal of psychiatry Vol. 157; no. 4; pp. 566 - 572
• Main Authors: Appelbaum, Paul S., Robbins, Pamela Clark, Monahan, John
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.04.2000; American Psychiatric Association
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Cohort Studies; Delusions; Delusions - diagnosis; Delusions - psychology; Female; Follow-Up Studies; Hospital discharged; Humans; Male; Medical sciences; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - psychology; Miscellaneous; Patient Discharge; Patients; Prospective Studies; Psychiatric disorders; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Violence; Violence - psychology; Human; Hospital discharge; Violence; Acute; Sex; Delusion; Negroid; Hospitalization; Latinamerican; Ethnic group; Symptomatology; Treatment; Follow up study; Sociodemographic factor; Risk factor; Mental disorder; Diagnosis; Caucasoid; Age; Comparative study
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.157.4.566

OBJECTIVE: Previous work has suggested that delusions are associated with a higher risk of violence, particularly delusions in which patients believe that people are seeking to harm them or that outside forces are controlling their minds (denoted as "threat control override" delusions). This study explores the relationship between delusions and violence among patients recently discharged from acute psychiatric hospitalization. METHOD: Data were drawn from the MacArthur Violence Risk Assessment Study, a study of violence in the community that followed 1,136 recently discharged psychiatric patients for 1 year. Interviews at discharge and at five 10-week intervals gathered clinical, historical, situational, and dispositional information, including the presence and nature of delusional thoughts. Violence was ascertained from reports of subjects, collateral informants, and official records. RESULTS: Neither delusions in general nor threat control override delusions in particular were associated with a higher risk of violent behavior. Comparisons with prior studies suggest that reliance on subject self-reports of delusional symptoms may result in mislabeling as delusions other phenomena that can contribute to violence. CONCLUSIONS: Although delusions can precipitate violence in individual cases, these data suggest that they do not increase the overall risk of violence in persons with mental illness in the year after discharge from hospitalization.