Violence and delusions: Data from the MacArthur Violence Risk Assessment Study

Objective: Previous work has suggested that delusions are associated with a higher risk of violence, particularly delusions in which patients believe that people are seeking to harm them or that outside forces are controlling their minds (denoted as "threat/control override" delusions). This study e xplores the relationship between delusions and violence among patients rece ntly discharged from acute psychiatric hospitalization. Method: Data were d rawn from the MacArthur Violence Risk Assessment Study, a study of violence in the community that followed 1,136 recently discharged psychiatric patie nts for 1 year. Interviews at discharge and at five 10-week intervals gathe red clinical, historical, situational, and dispositional information, inclu ding the presence and nature of delusional thoughts. Violence was ascertain ed from reports of subjects, collateral informants, and official records. R esults: Neither delusions in general nor threat/control override delusions in particular were associated with a higher risk of violent behavior. Compa risons with prior studies suggest that reliance on subject self-reports of delusional symptoms may result in mislabeling as delusions other phenomena that can contribute to violence. Conclusions: Although delusions can precip itate violence in individual cases, these data suggest that they do not inc rease the overall risk of violence in persons with mental illness in the ye ar after discharge from hospitalization.