Brief Treatment and Crisis Intervention Advance Access originally published online on December 14, 2007
Brief Treatment and Crisis Intervention 2008 8(1):73-91; doi:10.1093/brief-treatment/mhm025
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The Prediction of Violence; Detection of Dangerousness
From the Yale University School of Medicine
Contact author: Michael A. Norko, PhD at Connecticut Mental Health Center, Law and Psychiatry Division, 34 Park Street, New Haven, CT 06519. E-mail: michael.norko{at}yale.edu.
Contemporary evidence on the correlates of violence and the accuracy of predictions of violent outcomes is derived from a large body of research dating from approximately 1990. Substance abuse and several demographic variables have clearly been demonstrated to be significant risk factors for violence. The data on the link of various specific symptoms of psychiatric disorders to violence are inconclusive, though suggestive, because of conflicting research findings. Mental disorder does, however, represent a modest risk factor for violence. Actuarial predictions of future violence based on static nonpsychiatric characteristics achieve greater statistical accuracy than purely clinical methods, but the former are insensitive to effects of treatment and do not inform clinical intervention in an established way. Future research directions are encouraging in attempting to identify dynamic actuarial risk factors that will be both accurate and mutable. Substantive critiques of violence prediction and limitations of this body of research present a useful framework for evaluating both assumptions and conclusions about the prediction of violence in a psychiatric population.
KEY WORDS: prediction, dangerousness, violence, inpatient treatment, mental health, mental disorder