Common Risk Factors For Violence in People With Schizophrenia and in General Population

Rob Wipond
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People diagnosed with schizophrenia are more likely to commit violent crimes than the general population, and their rate of committing violent crimes has been increasing in recent decades, according to a study in The Lancet Psychiatry. An accompanying commentary clarified, however, that the data showed that the dominant risk factors for committing violence did not actually include diagnoses of schizophrenia, and were similar in both people with schizophrenia and in the general population.

Led by University of Oxford psychiatrist Seena Fazel who has co-authored a number of studies linking violence and mental illnesses, the researchers conducted a population cohort study in Sweden of 24,297 patients with schizophrenia-related disorders between 1972 and 2009, and matched them to general population controls and unaffected sibling controls. They examined a variety of outcomes such as convictions for crimes, mortality and suicide.

They found that 10.7% of men and 2.7% of women diagnosed with schizophrenia were convicted of a violent offense within five years of their diagnosis. However, in line with other studies, the researchers found that the dominant risk factors for violence were concomitant substance use problems or histories of violence.

They also found that “the risk of premature death, suicide, and conviction for a violent offense has increased for men and women with schizophrenia in the last 38 years, compared with both the general population, and their unaffected siblings.” In the discussion section of their article, the researchers noted that they did not examine how increasing psychiatric treatment may have influenced people’s likelihood of committing violence.

In a connected Lancet Psychiatry commentary about the study, two University of North Carolina-Chapel Hill School of Medicine psychiatrists stated that, “Several other reasons for outcomes, which were not measured, could explain the higher rates of violence, suicide, and premature mortality in people with psychotic disorders and are not necessarily representative of the disorders themselves. The question remains as to whether schizophrenia could be serving as a proxy for other unmeasured variables such as depression, unemployment, absence of social support, and financial strain, which could mediate the relation between diagnosis and the adverse outcomes studied.”

The authors of the commentary added, “Finally, and importantly, we should remember that, when reporting about the intricate links between schizophrenia and these adverse outcomes, most people with schizophrenia and related disorders are neither violent nor suicidal. Despite the need to ensure people with schizophrenia are provided help to reduce their risks of suicide, violence, or premature death, researchers reporting findings also bear the burden of ensuring that most people with schizophrenia and related disorders, who are not violent, are not left to contend with stigma and discrimination. Policy makers, researchers, and clinicians need to remember the importance of appropriately weighing up the issue of schizophrenia relative to the myriad of other factors that contribute to increased risk of violence and suicide. A focus on the separation of people with schizophrenia from those without the disorder with respect to risk management can contribute to perpetuating a negative public image for people with mental health problems.”

Fazel, Seena, Achim Wolf, Camilla Palm, and Paul Lichtenstein. “Violent Crime, Suicide, and Premature Mortality in Patients with Schizophrenia and Related Disorders: A 38-Year Total Population Study in Sweden.” The Lancet Psychiatry 1, no. 1 (n.d.): 44–54. Accessed June 14, 2015. doi:10.1016/S2215-0366(14)70223-8. (Abstract and full text)

Elbogen, Eric B, and Sally C Johnson. “Violence, Suicide, and All-Cause Mortality.” The Lancet Psychiatry 1, no. 1 (n.d.): 6–8. Accessed June 14, 2015. doi:10.1016/S2215-0366(14)70246-9. (Summary and full text)

The Lancet Psychiatry: Study shows increasing rates of premature death and violent crime in people with schizophrenia since 1970s (The Lancet press release on EurekAlert!, June 3, 2015)

14 COMMENTS

    • Yes, lots and lots of variables unaccounted for, which of course, make this a completely unscientific study.

      The most common cause of schizophrenia today, according to John Read’s research is doctors misdiagnosing child abuse victims as ‘psychotic’ – 2/3 of all so called schizophrenics have dealt with ACEs or child abuse. This, of course, results in an inappropriately given neuroleptic prescription, because being a victim of a crime is not the same thing as having a brain disease. And the neuroleptics are known to cause both the negative and positive symptoms of schizophrenia via both neuroleptic induced deficit syndrome and the central symptoms of neuroleptic induced anticholinergic intoxication syndrome (aka anticholinergic toxidrome).

      And my guess is the other third of schizophrenia patients are actually people who’d dealt with easily recognized iatrogenesis, and had an unethical doctor who wanted to cover up the malpractice. This is my guess because an ethical pastor was kind enough to confess to me that shipping people off to the psychiatrists, to be tranquilized for such unethical reasons, is the “dirty little secret of the two original educated professions.”

        • Exactly same with me, Fiachra. First one about a year after I began taking them, and them, 20 years later at the time I was withdrawing.

          These legal drugs cause all sorts of distortions in belief and life experience, creating a totally artificial reality. I lived a manageable life on them for a while, until it became clear that they were slowly destroying me. These drugs may create the temporary illusion of “stability” or some such thing, for whatever reason, but truly, in the end, they only create chaos and suffering. There are so many natural ways to restore balance, we need to explore these fully. There is a plethora of natural and safe remedies for all sorts of things out there, I hope everyone is realizing this by now. Thanks to the internet, these are growing in visibility daily.

          Finally coming off of these chemical poisons and fully detoxifying allowed me to thrive, because I could learn my true self and follow my true path, which is the biggest relief of my life. We are self-healers, by nature.

          • “These drugs may create the temporary illusion of “stability”…”
            I agree – sometimes this can be seen on people that take them, initially. But further down the line comes the chronicity (and sad ending).

      • Yes, I too had two suicide attempts while on Zyprexa and Avanza. Also felt quite homicidal, which I found extremely distressing as I have never been a violent person and was appalled by the feelings I was having – shrink put it down to repressed anger finally unmasked.

        Being told, as a middle aged mother, former emergency helpline volunteer, and respected community member with a six figure salary and no history of violence, that I had underlying and pervasive character flaws that meant I was at heart a homicidal maniac was distressing, to say the least.

        …and surprise, surprise, once off the meds (no help from shrinks with that) the urges ceased…five years down the track I am still recovering from trauma and long term side effects of those ghastly meds and psychiatry.

    • My thoughts exactly. If psychiatric drugs are helping so many people become less disabled and more functional, why are violence rates among the “mentally ill” increasing as the use of these drugs becomes more common? Rhetorical question, of course…

      —-Steve

      • The drugs are awful, that’s true but in case of violence and suicide (the latter one is associated with psychiatric “treatment” in a dose-dependent manner) I think it’s important not to overlook the effect of dehumanization and torture. If you label people, treat them like human garbage, subject to daily dose of physical and psychological abuse and torture with no prospect of ever getting out not to mention receiving justice – it’s not very surprising that many of them will react by taking their own lives (who would not want to escape?) or by lashing out on others, sometimes the perpetrators and sometimes just the unfortunate bystanders. It’s a normal and human reaction to abuse.

        When the powerful and people in authority commit crimes against humanity the society shrugs it off as necessary evil. When the powerless respond with anything other than total submission – well, these ba***rds must have deserved it all along. It’s the same whether you think of minorities, people who are occupied or “mentally ill”. Oppression is so predictable.

    • what’s also missing is how people diagnosed as schizophrenic are treated by those around them who are aware of their diagnosis.
      When people are looked upon as subhuman, defective, sick, incapable etc., it tends to bring out the worse sides of them, rather than the better ones.
      when people are force-fed drugs that inhibit their higher modes of expression and make them feel like prisoners in their own bodies, sometimes the only way to react strongly and effectively to others is physically.
      Not that i’m excusing violence in any way, but all those who somehow imagined that categorizing “mental illness” as biological would reduce stigma should pause for thought (not that they will – of course they won’t)

  2. Personally I’d be very wary of any theory that took violent deeds as symptomatic of disease rather than evidence of a crime. Problematic are the differences between the mental health system and the criminal justice system. In the criminal justice system, you have due process. The defendant is presumed innocent until proven guilty in a trial by peers. In the mental health system, the patient is presumed “sick” until processed into confinement. Were the patient presumed ‘healthy’, then you’d be putting the mental health system on trial every time you had a hearing and, of course, somebody would object. We aren’t getting all those potential mass murderers the “help” they need. Mental health treatment as crime prevention, well, so runs the theory. Certainly, given the small percentage of people who engage in such acts, they’ve overshot their mark, and it ends up being very ineffective crime prevention at that. There is more likelihood of any such prevention measures actually proving causative when it comes to both violent crime and so-called “mental illness”. People caring for and loving people rather than merely managing the unwanted, that’s what it ain’t.

  3. Sadly more and more ‘research’ is showing violence and schizophrenia are ‘linked’. Few actually discuss, like here, the psuedoscience involved with the result very filtered versions are presented perpetuating and adding to the myth that violence and schizophrenia are joined at the hip.
    Funny why nobody thinks diabetes and violence are joined at the hip… 🙂

  4. “they did not examine how increasing psychiatric treatment may have influenced people’s likelihood of committing violence”
    A major oversight. I can testify that psychiatric “treatment” aka torture causes suicide and violence (very often well justify as everyone should have a right to self-defense). The people who are most dangerous and aggressive are the ones who run the “hospitals”.