In the United States, mental health problems have come to the forefront of the public consciousness through large-scale public information campaigns, grassroots mental health movements, and more formal education on the specifics of various conditions. Mental illness is broadly defined here as clinical levels of psychiatric disorders that negatively impact one’s social, academic, and/or occupational functioning. The clear need to develop an official classification system for mental disorders led the American Psychiatric Association (APA) to develop the first manual of mental disorders in 1952, known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). With over 400 mental disorders defined and diagnosed, the DSM is the current guide for clinicians, academics, and practitioners in the United States. Although public acceptance and understanding of mental illness is increasing, there is still considerable social stigmatization, stereotyping, and fear of persons with serious mental health problems. Of particular concern to the public are delusional, psychopathic, or antisocial persons who may become violent.
Deinstitutionalization And Public Fears Of The Mentally Unstable
Although about half of all Americans will have a DSM disorder in their lifetimes, the vast majority of these diagnoses are not associated with aggressive behaviors. Estimates from the National Institute of Mental Health (NIMH) project that less than one out of five Americans receives the help needed for their mental problems. Research in the 1920s through the 1950s showed that mental patients actually had similar arrest rates as that of the general population. With the rise of deinstitutionalization in the 1960s or the release of mental patients from hospitals into community-based treatment, studies began reporting that mentally ill persons were responsible for a disproportionate number of violent crimes. Although many of these studies were later criticized for methodological weaknesses, they helped to fuel public fears about the release of mentally unstable persons into the community.
Numerous studies have reported on public perceptions that mental disorders and violence are invariably related. Individuals with severe mental illness are commonly regarded as dangerous, unpredictable, and at times, predatory. Yet according to a 2001 report by the U.S. Surgeon General, the danger that the majority of individuals with mental illness pose is actually quite small. Although an abundance of research has come forward to support these statements, the same literature does indicate that specific types of mental illness may play a role in the development of violent offending in childhood and adulthood.
Childhood Or Adolescent Mental Disorders Linked With Violence
Although most children are unruly, disruptive, or recalcitrant at times in their growth, such behaviors become problematic when they regularly interfere with their function across a number of domains, including family, school, and peers. Numerous studies have documented a link between early and persistent aggressive behaviors in childhood and adolescence and subsequent later aggression. The number of juvenile offenders entering the criminal justice system with multiple mental health problems has also raised important questions about what role mental health might play in the development of violent behaviors.
There is compelling evidence of a relationship between various childhood disruptive disorders such as oppositional defiant disorder and conduct disorders and later serious offending. In addition, other disorders such as attention-deficit/hyperactivity disorder, depression, and substance abuse disorders have also been associated with aggression in youngsters. Depressed children, especially boys, may be filled with feelings of hostility, irritability, and aggression much more than are similar adults. Depression in children and adolescents has also been linked to violent behaviors such as suicide ideation and attempts, delinquency in adolescence, and homicidal ideation in adulthood. Research has suggested that boys with depression who also use or abuse substances become significantly more aggressive against others than do females, who tended to hurt themselves more. Youths with comorbid, or co-occurring, mental disorders have been shown to have a greater risk of violence later in life. Although there has been increasing attention to these types of juvenile mental health problems, the complexity surrounding childhood disorders and human development makes this a controversial topic. The media attention given to high profile school shootings and senseless acts of cruelty by youths has only reinforced public fears about juvenile predators.
Other Mental Disorders Linked With Violence
Besides these disorders, antisocial personality disorder (APD), schizophrenia, and substance abuse disorders (SUDs) have also been empirically linked to violent behaviors. Arguably the most controversial and feared adult mental health disorder is APD, which is typically preceded by oppositional defiant or conduct disorders earlier in childhood and adolescence. These individuals possess personality traits including a lack of conscience, low frustration thresholds, impulsivity, sadistic tendencies, and reckless abandon for others in their behaviors. There has been considerable controversy over the years concerning the symptomology of antisocial personalities, with current debates focused on the reliability of the diagnostic criteria and possible over diagnosis in criminal populations. Despite these concerns, APD is one of the most commonly linked diagnoses with serious and aggressive criminal behaviors, especially in males.
Schizophrenia includes symptoms such as psychotic delusions, hallucinations, disorganized thinking, purposeful and repetitive behaviors, and social withdrawal. The onset of this disorder typically occurs in late adolescence and into young adulthood for most individuals. Gender appears to influence the typical age of onset, with females developing the disorder later in life than males. In contrast to public perception, a review of the empirical relationship between schizophrenia and violent behaviors indicates a weak association at best. As adult schizophrenics may withdraw from others and be severely limited in functioning, it is more likely that psychotics will hurt themselves before committing violence against others.
Although not absolute, the most impressive body of scientific evidence shows a link between SUDs and violence, especially with respect to alcohol. This relationship has been much more tentative and indirect with marijuana use and violence. Overall, SUDs have been consistently identified as the most commonly associated mental disorder co-occurring with violent behaviors. The use of alcohol or illicit drugs has been shown to dramatically increase the likelihood of interpersonal violence when combined with certain mental disorders.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.
- Loeber, R., Farrington, D. P., Stouthamer-Loeber, M., & Van Kammen, W. B. (1998). Antisocial behavior and mental health problems. Mahwah, NJ: Lawrence Erlbaum.
- Meadows, R. J., & Kuehnel, J. (2005). Evil minds: Understanding and responding to violent predators. Upper Saddle River, NJ: Pearson/Prentice Hall.
- Monahan, J., & Steadman, H. J. (Eds.). (1994). Violence and mental disorder: Developments and risk assessment. Chicago: University of Chicago Press.
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