Individuals with Psychosis Symptoms More Likely to be Victimized

A review recently published in Schizophrenia Bulletin finds that persons with a diagnosed psychotic disorder are more likely to experience victimization than the general population. Additionally, risk factors associated with victimization were found to include: delusions, hallucinations, manic symptoms, drug use, alcohol use, perpetration of a crime, unemployment, and homelessness.

 “In reality,” the authors write, “people with severe mental illness are more commonly a victim than a perpetrator of violence.”

While individuals diagnosed with a psychotic disorder are often portrayed as dangerous, most people diagnosed with psychosis never engage in violent behavior. The authors of this study highlight that persons with severe mental illness are more often victims rather than perpetrators of violence. Moreover, victimization has been shown to increase the risk of psychotic experiences.

The Lifestyle Routine Activity Theory (L-RAT) suggests that elevated risk of victimization results when a suitable target is exposed to a motivated offender in the absence of a capable guardian. Additionally, experiencing psychotic symptoms, sociodemographic factors, and other clinical variables, can make individuals more vulnerable to victimization.

Current rates of victimization in persons with a severe mental illness diagnosis range from 2 to more than 100 times that of the general population. Noting this wide range, resulting from methodological differences, the authors of this study aimed to review the prevalence rates for violent, nonviolent, and sexual victimization in individuals with a psychotic disorder diagnosis.

The authors conducted a search of the literature to identify articles that assessed the prevalence rates and/or risk factors of adulthood victimization. Twenty-seven articles were included in the final analysis and review. Victimization was defined as “an event in which an individual is the target of a criminal act by another individual.” Four categories of victimization were identified:

• Violent victimization: crimes that involve physical violence, threats with a weapon, robbery, mugging, assault, and sexual victimization.
• Sexual victimization: sexual offenses such as forced sexual penetration, sexual touch without consent, or sexual harassment.
• Nonviolent victimization: crimes without physical contact including threats, theft of property or money, burglary, identity theft, and fraud.
• Victimization not otherwise specified: when studies did not differentiate between victimization types or gave a total score based on more than one type.

Risk factors were also divided into four categories:

• Clinical risk factors: clinical characteristics that are associated with victimization such as positive symptoms, comorbidity, treatment-related factors, etc.
• Behavioral risk factors: this can include substance use and being a perpetrator of a crime.
• Sociodemographic risk factors: this can include age, gender, ethnicity, education level, living situation, income, and social contacts.
• Negative life experiences: such as previous victimization and childhood abuse.

The results showed that in studies with a maximum time frame of 3 years, 20% of participants reported violent victimization, 19% nonviolent victimization, and 19% victimization not otherwise specified. Two studies reported sexual victimization and gave rates of 15% and 24%. When studies looked across all of adulthood, victimization rates were 66% violent victimization, 39% nonviolent victimization, and 27% sexual victimization.

Results of risk factors in the meta-analysis showed that across the four categories, the following variables were significantly associated with victimization:

Clinical factors: lower satisfaction of basic needs, higher satisfaction of social needs, hostility, unusual thought content, grandiosity, conceptual disorganization, excitement, higher disorganization score, higher emotional withdrawal, higher blunted affect score, higher general symptoms score, higher difficulty in delaying gratification score, personality disorder, higher affective lability score, higher anger score, higher anxiety score, higher depression score, deliberate self-harm, suicidal ideation,  higher posttraumatic stress disorder score, and medication non-adherence

Behavioral factors: been in jail at least 1 night in the past 6 months and nonviolent conviction

Sociodemographic factors: not having a disability pension, living in a disadvantaged neighborhood, impaired social and occupational functioning, not living with family, less than daily contact with family, having an intimate relationship shorter than 10 years, less than 1 social contact a month was associated with less victimization, and females reported less nonviolent victimization and more sexual victimization

Negative life experiences: previous victimization and childhood abuse

This study clarified prevalence rates of victimization in people with a diagnosed psychotic disorder as well as the risk factors associated with victimization. The authors conclude that an increased risk of victimization is present in this group. The risk was especially present for individuals experiencing symptoms and/or behavior that impairs social functioning, and people with a lifestyle that exposes them to potential offenders.

The authors explained this that clinical factors increase target attractiveness and make the offenders see the person as an easy target. Individuals with poorer social functioning are placed at higher risk as they may have less social supports to protect them that demographic variables such as homelessness and unemployment place the person in an environment where they are more likely to encounter an offender.

 

****

de Vries, B., van Busschbach, J. T., van der Stouwe, E. C., Aleman, A., van Dijk, J. J., Lysaker, P. H., … & Pijnenborg, G. H. (2018). Prevalence rate and risk factors of victimization in adult patients with a psychotic disorder: a systematic review and meta-analysis. Schizophrenia Bulletin. (Link)