Abnormal Psychology

730 CHAPTER 16

or to others, or establishing an inability to care for oneself. Dangerousness can be

broken down into four components regarding the potential harm (Brooks, 1974;

Perlin, 2000c):

1. severity (how much harm might the person infl ict?),


2. imminence (how soon might the potential harm occur?),


3. frequency (how often is the person likely to be dangerous?), and


4. probability (how likely is the person to be dangerous?)

Evaluating Dangerousness

Clinicians are sometimes asked to evaluate how dangerous a patient may be—

specifi cally, the severity, imminence, and likelihood of potential harm (Meyer &

Weaver, 2006). Such evaluations are either/or in nature—the individual is either

deemed not to be dangerous (or at least not dangerous enough to violate confi denti-

ality) or deemed to be dangerous, in which case, confi dentiality is broken in order to

protect the individual from self-harm or to protect others (Otto, 2000; Quattrocchi &

Schopp, 2005). Prior to each discharge from a hospital or psychiatric unit, Gold-

stein had to be evaluated for dangerousness; he was then discharged because he was

deemed not dangerous, or not dangerous enough.

Researchers set out to determine the risk factors that could best identify which

patients discharged from psychiatric facilities would subsequently act violently. A

summary of the fi ndings appears in Table 16.3. Here are the most notable fi ndings:

• Almost 20% of the patients studied committed at least one violent act within
  5 months of their discharge from the psychiatric hospital.


• Men were only somewhat more likely than women to be violent; when female pa-
  tients were violent, it was generally family members who were victims.


• A history of violent behavior—assessed through hospital records, arrest records,
  and self-reports—was a strong risk factor for later violence. Part of the problem
  in evaluating whether Andrew Goldstein was dangerous was that he received care
  in different facilities, and each facility only had access to information about his
  violent behavior that led to his admittance to that facility, or his violent behavior
  while in that facility.


• Persistent thoughts about harming others and higher scores on an anger scale pre-
  dicted later violence.


• Childhood experiences of serious and frequent abuse, as well as having a father who
  was a criminal or who engaged in substance abuse, predicted future violent behavior.


• Certain diagnoses, such as substance abuse and antisocial personality disorder,
  were relatively good predictors of future violence; schizophrenia predicted a lower
  rate of violence. In general, the presence of delusions or hallucinations was not as-
  sociated with later violence; however, delusions involving suspicions of others and
  hallucinations that “commanded” a violent act did predict later violence (Stead-
  man et al., 1998).

Confining individuals deemed to be dangerous involves taking away their

liberty—their freedom—and is not done lightly. Loitering or yelling at “voices”

should not be considered legally dangerous. Rather, the legal system allows an indi-

vidual to be incarcerated or hospitalized, or to continue to be incarcerated or hospi-

talized, in only two types of situations:

1. when the individual has not yet committed a violent crime but is perceived to be
   at imminent risk to do so, or


2. when the individual has already served a prison term or received mandated
   treatment in a psychiatric hospital and is about to be released but is perceived
   to be at imminent risk of behaving violently.

Patient’s Prior Arrests

• More serious crimes


• Greater frequency of crimes
  Patient Experienced Child Abuse


• Experienced more serious abuse


• Experienced greater frequency of abuse
  Patient’s Father...


• Used drugs


• Was absent during patient’s childhood
  Patient’s Demographics


• Younger


• Male


• Unemployed
  Patient’s Diagnosis


• Antisocial personality disorder
  Other Clinical Information About Patient


• Has substance abuse problems


• Has problems controlling anger


• Has violent fantasies


• Has had loss of consciousness


• Has been brought to the attention of
  mental health professionals involuntarily,
  through the legal system
  Source: Monahan et al., 2001. For more information see
  the Permissions section.

Table 16.3 • Major Risk Factors

For a Patient to Act

Violently