OBJECTIVE: To help clinicians enhance the safety of the public, hospital
staff, and patients and improve patient management, this article briefly
reviews recent empirical work on appraisal of the risk of violence and the
management of violent individuals. METHODS: Research on the prediction,
management, and treatment of violent persons published in the last decade
was reviewed. RESULTS: Risk appraisal research indicates that violence is
predictable in some populations. The factors most highly and consistently
related to risk are historical, including age, sex, past antisocial and
violent conduct, psychopathy, aggressive childhood behavior, and substance
abuse. Major mental disorder and psychiatric disturbance are poor
predictors of violence. Actuarial methods are more accurate in predicting
risk than unaided clinical judgment, which is a poor index. The Violence
Risk Appraisal Guide has been shown to be a reliable and accurate actuarial
instrument. Well-controlled studies have shown the effectiveness of
behavior therapy and of behavioral staff training programs to reduce
violence by persons in institutions, chronic psychiatric patients, and
other populations. Otherwise, little is known about what psychotherapeutic
or pharmacological treatments reduce violent recidivism by which clients
under what circumstances. Recent work on the neurophysiology of aggression
holds exciting promise but does not yet provide a scientific basis for
prescriptive treatment. CONCLUSIONS: The most exciting and promising
avenues for research on the management of violence lie in the joining of
two scientific paths to understanding violence--biology and psychology.
Abstract Teaser