Determining whether there is an association between schizophenia and violence is the ultimate question. We believe that in certain circumstances there has indeed been a link between acute schizophrenic symptoms and violence. Although studies may differ regarding violence toward others, it has been clearly documented that people with schizophrenia are at an increased risk of violence toward themselves. Roughly 10% of people with schizophrenia will die by suicide (5). It is not difficult to fathom that in this group already predisposed to such desperate acts as suicide, given the right circumstances, desperate and violent acts could be inflicted on others.
Multiple studies have concluded there is a relationship between schizophrenia and violence. For example, the Epidemiological Catchment Area (ECA) study revealed that 12% of those with schizophrenia admitted to being violent in the previous year, as opposed to only 2% of the non-mentally ill (6). In addition, the ECA study showed that even though most mentally ill people do not commit assaultive acts, serious mental disorder by itself is quite significantly associated with violence, as shown by odds ratios in the range of 2.4 to 3.6 (7). Also, the Northwick Park study evaluating first episodes of schizophrenia found that, of the 253 first-episode patients, over one-third had behaved violently in the month before they were admitted to the hospital (6). Given the practical knowledge we have as clinicians, and the numerous studies that point to a relationship between schizophrenia and violence, it would be foolish to ignore a sleeping volcano. Even though authors have used different methods and definitions of violence, useful information can be garnered to provide a template to guide clinical decisions.
In conclusion, there is a weak relationship between schizophrenia and violence. The argument appears to be over how strong the association is.
Let us turn to the risk factors for potential violence in the general population and the factors unique to schizophrenia.
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