Predicting violence and dangerousness

Dangerousness varies according to the situation, and is impossible to predict with complete accuracy in individual cases. Nevertheless, general guidance can be given. Risk factors for repeated violence include the following:

• past history of violence: by far the most important guide to present and future risk

• personal/family history of criminality/substance misuse/suicidal behaviour

• preoccupation with, or threats of, violence

• psychiatric disorder, especially with paranoid delusions or command hallucinations regarding violence

• cold/callous explosive/antisocial personality traits

• impulsivity/irritability/emotional arousal

• ready availability of a weapon and a victim.

In a potentially violent situation in psychiatric practice, consider the above factors with due regard for intuition and common sense. If the interviewer feels anxiety or fear, it is prudent to adjourn the interview to seek assistance and advice.

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