Violent Behavior and DSM-IV Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Attila J. Pulay, MD; Deborah A. Dawson, PhD; Deborah S. Hasin, PhD; RisÃ« B. Goldstein, PhD; W. June Ruan, MA; Roger P. Pickering, MS; Boji Huang, MD, PhD; S. Patricia Chou, PhD; Bridget F. Grant, PhD, PhD

J Clin Psychiatry 2008;69(1):12-22

Article Abstract

Objective: To present nationally representative data on the lifetime prevalence and population estimates of violent behavior among individuals with DSM-IV psychiatric disorders.

Method: The data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Prevalences, population estimates, and associations of violent behavior occurring among individuals with pure, comorbid, and specific DSM-IV psychiatric disorders were examined.

Results: After controlling for sociodemographic characteristics and other comorbidity, it was found that the odds of violent behavior were significantly increased (p < .05) among individuals with substance use disorders; pathological gambling; major depressive disorder; bipolar disorders; panic disorder without agoraphobia; specific phobia; and paranoid, schizoid, histrionic, and obsessive-compulsive personality disorders. Percentages of violent behavior among individuals with each comorbid disorder were, with few exceptions, significantly greater (p < .05-p < .001) than the corresponding percentages among those presenting with the pure form of each disorder. Alcohol and drug use disorders were the most significant contributors to the public health burden of violent behavior.

Conclusion: The majority of individuals with psychiatric disorders do not engage in violent behavior, and public perception associated with stereotypic violence among individuals with psychiatric disorders appears unwarranted. Elevated risks and burden of violent behavior were not equally shared across the spectrum of psychiatric disorders, with particular disorders, especially substance use disorders, contributing disproportionately to the burden. Future research should examine the circumstances under which violence among individuals with psychiatric disorders occurs with a view toward improving clinical prediction and developing more effective prevention strategies.