Mental Disorder and Serious Violence: The Victims. [CME]
J Clin Psychiatry 2003;64:819-824
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Media representation of violence by
people with mental disorder tends toward images of random,
serious violence to strangers. Studies of general psychiatric
patients do not support this representation, but include few
cases of serious or homicidal violence. This study describes the
relationship of mentally disordered offenders to victims of an
attack that was serious enough to result in the offender's
detention in a high-security hospital. Hypotheses tested were
that perpetrators of stranger violence would be more likely than
those targeting people they know to be male, nonwhite, and
younger and have a violence history and less likely to have
Method: A clinical register and record study of
all patients with an index offense of interpersonal violence who
were resident in English high-security hospitals Jan. 1, 1993, to
June 30, 1993, was conducted.
Results: Among 887 men and 88 women, 33% had
attacked strangers. After adjustment for the high proportion of
men in this male-dominated population, men were still more likely
than women to have attacked strangers. There was no independent
association between stranger victimization and perpetrator's age,
ethnic group, or violence history. Stranger victimization was,
however, more likely to have been committed by those with
personality disorder than those with psychosis. The most serious
violence and homicide were more likely to be against intimates
Conclusion: Among patients selected for high
risk to the public, high rates of stranger victimization would be
expected. The rates appeared, however, only slightly higher than
in other reported patient samples and lower than in an untreated
sample. The safety of people close to such patients urgently