Violent Behavior and DSM-IV Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Attila J. Pulay, M.D.; Deborah A. Dawson, Ph.D.; Deborah S. Hasin, Ph.D.; Risė B. Goldstein, Ph.D.; W. June Ruan, M.A.; Roger P. Pickering, M.S.; Boji Huang, M.D., Ph.D.; S. Patricia Chou, Ph.D.; and Bridget F. Grant, Ph.D., Ph.D.

Objective: To present nationally representative data on the lifetime prevalence and population estimates of violent behavior among individuals with DSM-IV psychiatric disorders.

Method: The data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Prevalences, population estimates, and associations of violent behavior occurring among individuals with pure, comorbid, and specific DSM-IV psychiatric disorders were examined.

Results: After controlling for sociodemographic characteristics and other comorbidity, it was found that the odds of violent behavior were significantly increased (p < .05) among individuals with substance use disorders; pathological gambling; major depressive disorder; bipolar disorders; panic disorder without agoraphobia; specific phobia; and paranoid, schizoid, histrionic, and obsessive-compulsive personality disorders. Percentages of violent behavior among individuals with each comorbid disorder were, with few exceptions, significantly greater (p < .05-p < .001) than the corresponding percentages among those presenting with the pure form of each disorder. Alcohol and drug use disorders were the most significant contributors to the public health burden of violent behavior.

Conclusion: The majority of individuals with psychiatric disorders do not engage in violent behavior, and public perception associated with stereotypic violence among individuals with psychiatric disorders appears unwarranted. Elevated risks and burden of violent behavior were not equally shared across the spectrum of psychiatric disorders, with particular disorders, especially substance use disorders, contributing disproportionately to the burden. Future research should examine the circumstances under which violence among individuals with psychiatric disorders occurs with a view toward improving clinical prediction and developing more effective prevention strategies.

(J Clin Psychiatry 2008;69:12-22; online ahead of print December 12, 2007)

Received Feb. 21, 2007; accepted May 8, 2007. From the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, Md. (Drs. Pulay, Dawson, Goldstein, Huang, Chou, and Grant, and Ms. Ruan and Mr. Pickering); and Division of Epidemiology, Mailman School of Public Health, and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York (Dr. Hasin).

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), with supplemental funding from the National Institute on Drug Abuse (NIDA), Bethesda, Md. This work was supported, in part, by the Intramural Program of the National Institutes of Health, NIAAA, Bethesda, Md.

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring agencies or the U.S. government.

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Bridget F. Grant, Ph.D., Ph.D., Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Lane, Bethesda, MD 20892-9304 (e-mail: bgrant@willco.niaaa.nih.gov).