Studies pointing out the inaccuracies of predictive diagnosis of violence have been extrapolated by some groups to the inaccurate assumption that no one can ever predict violence in any patient. Early studies emphasized the difficulty in predicting violence. If the patient directly expresses the intention of committing violence, this expression should be taken seriously by the physician and the patient's entire life situation carefully assessed so that appropriate measures (at times including involuntary hospitalizations can be carried out.ĭuring the past 20 years, many studies have been done to judge the accuracy with which potential for violence can be assessed. When patients are very angry, it behooves the physician to inquire whether they have considered violence as a solution to their problem. In general, patients who have been involved in criminal activities and show evidence of an antisocial personality disorder represent a higher risk for violence than the general population.Īt times, patients will directly express their intentions to commit violence. When inquiry indicates the presence of such exposure, the physician should be alert for a wide variety of later psychiatric effects, including anxiety disorders and depression. (1984) found in an examination of the life experiences of 188 male and female psychiatric patients that almost half of the patients had histories of physical abuse, sexual abuse, or both. The exposure of patients to physical or sexual abuse clearly has many long-term psychologic effects. It is well known that parents of battered children were usually physically abused during their own childhood. This includes both patients who have been subjected to severe violence during their childhood and those who have been reared in situations in which violence has been regarded as an acceptable response to difficulties. Most clinicians feel that patients who have experienced extensive violence are more likely to resort to it themselves. This is particularly true if the patient is hearing voices commanding that someone be harmed. If the patient is in poor contact with reality, there is increased danger that misperception of reality might lead to violent activity. Use of phencyclidine (PCP) has also been associated with violence. At times, psychedelic drugs such as LSD may cause terrifying illusions that lead to serious violence. Amphetamines are especially prone to stimulate outbursts of violence. Other drugs can similarly be associated with violent outbursts. In one large study, 65% of all homicides were associated with drinking on the part of the murderer. When patients feel persecuted and unable to obtain redress of fancied injustices, the likelihood of their taking violent measures to correct the situation is heightened. In retrospect, the man had given clear evidence of his homicidal potential, and the murder could have been prevented had stronger action been taken to control him or to help the wife separate from him. Because she was frightened of him, the wife had him arrested on numerous occasions. In one case, a man had repeatedly threatened his wife and had beaten her severely on a number of occasions. In general, patients who have shown frequent loss of control and who have inflicted significant injuries on others must be regarded as having more potential for homicide. Perhaps the most important factor in judging potential for violence is the patient's past performance.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |