RISK APPRAISAL AND MANAGEMENT OF VIOLENT BEHAVIOR

Objective: To help clinicians enhance the safety of the public, hospit al staff, and patients and improve patient management, this article br iefly reviews recent empirical work on appraisal of the risk of violen ce and the management of violent individuals. Methods: Research on the prediction, management, and treatment of violent persons published in the last decade was reviewed. Results: Risk appraisal research indica tes that violence is predictable in some populations. The factors most highly and consistently related to risk are historical, including age , sex, past antisocial and violent conduct, psychopathy, aggressive ch ildhood behavior, and substance abuse. Major mental disorder and psych iatric disturbance are poor predictors of violence. Actuarial methods are more accurate in predicting risk than unaided clinical judgment, w hich is a poor index. The Violence Risk Appraisal Guide has been shown to be a reliable and accurate actuarial instrument. Well-controlled s tudies have shown the effectiveness of behavior therapy and of behavio ral staff training programs to reduce violence by persons in instituti ons, chronic psychiatric patients, and other populations. Otherwise, l ittle is known about what psychotherapeutic or pharmacological treatme nts reduce violent recidivism by which clients under what circumstance s. Recent work on the neurophysiology of aggression holds exciting pro mise but does not vet provide a scientific basis for prescriptive trea tment. Conclusions: The most exciting and promising avenues for resear ch on the management of violence lie in the joining of two scientific paths to understanding violence-biology and psychology.