Schizophrenia Research Blog: Insight and Violence

September 14, 2004

Insight and Violence

Insight and Its Relationship to Violent Behavior in Patients With Schizophrenia

Buckley PF, Hrouda DR, Friedman L, Noffsinger SG, Resnick PJ, Camlin-Shingler K.
Am J Psychiatry 161:1712-1714, September 2004

People with schizophrenia differ on the degree to which they are aware of having an illness and this can impact behavior. A small percentage of those with schizophrenia get violent and it seems that this violence is most likely to happen during periods of active psychosis. Doctors and legal experts go back and forth as to whether patients can be held accountable for such violent acts while they are actively psychotic. Similarly, the role of “insight” into ones illness has also been debated. “Insight” into illness is defined as ‘an awareness of having an illness, an attribution of recognizable symptoms of that illness and an appreciation of the need for treatment’.

This study looked at the extent and pattern of insight deficits in patients with schizophrenia who are violent. Using different questionnaires, the authors asked 115 patients with schizophrenia who were in a jail or court psychiatric clinic to answer questions about their symptoms, illness severity, insight into illness and insight into the legal consequences of their illness ("forensic insight"). They also included a sample of nonviolent patients with schizophrenia in order to have a comparison group. The authors report that they went through reviews by institutional review boards, extensive discussions with jail warden and municipal judges and social workers in order to protect the rights of the patients.

The results confirmed that the overall risk of violent crimes committed by people suffering from schizophrenia is small and that most incidents are of low lethality. In this study, the most common offense by violent patients with schizophrenia was felonious assault, with 1/3 of offenses being committed against a law enforcement officer and ½ against a known person or relative. The majority of violent patients also had active psychotic symptoms and were abusing substances at the time of the violent incident. Also, compared to the nonviolent group, violent patients had poorer functioning and had a more prominent lack of insight which was related to having a lack of forensic insight (ie a lack of awareness of the legal consequences of their actions). This distinction is important because legal debates regarding competency are often based on the extent to which illness-related variables affect the understanding of the crimes committed by individuals with mental illnesses.

This study suggests that for patients with a history of violence it may be helpful to try interventions (eg cognitive behavior therapy) that focuses on helping improve insight into illness and the legal consequences of the illness. Such medication and psychological treatments can also be preventive in helping improve insight and possibly avoiding future acts of violence during psychotic episodes.

This study was funded by the Theodore and Vada Stanley Foundation.

Click here for the PubMed Link to this article

Posted by Farzin at September 14, 2004 11:09 PM | TrackBack


My son is bipolar/schizophrenic 24 year old. He was just released from prison. He had numerous assault charges and did 1 year sentence ran concurrent for all. These assautls began with him at a very young age at home. Police became involved with charges at the age of 15. At 17 he became an adult and suffered the consequences. I hated for him to go to jail but was releaved for the break.

He sat my house on fire 5 times before he was 4. Wrecked my car twice before he was 3, and had a driving record. He hit a highway patrolmans vehicle and was listed as the driver of the car. He also sat my neighbor's home on fire at the age of 4. He is still fascinated with fire, has a very high tolerance to pain, and loves to fight.

He is out of jail now but I fear not for long. When he goes off he cares about nothing and no one. He tells me that he totally blacks out when he gets mad. He has never hit me although I know he has wanted to. Other times when he is not manic we are the best of friends. I am so tired. He cannot hold down a job. He is married but still lives with me and dates his wife. He refuses to take medicine. He complains that it makes him sleepy. He was seeing a phychiatrist with Collin County MHMR and came from a visit one day and said that he was not Bipolar/schizophrenic anymore. I questioned him and he said that him and the Phychiatrist agreed that he would not be that anymore. (Quack) People that have not lived this do not have a clue how devistating it is to the individual with the disorder and everyone they know.

My son cannot stay focused long enough to file for any disability or assistance. Even if he did file he would never follow through the amount of time it would take for him to be declared "disabled" through our Social Security Admin. What are his options besides none. What, Where and When will I ever get any help with him. What will he do when I am dead and gone. I am his only parent. I am all he has. What is going to happen to him then???

Posted by: Single mom/Tired of coping at October 11, 2004 10:43 AM

your son needs you, and he does have God no matter what his problem is God said he can heal all our diseases so let not your heart be trouble pray to the Lord to lead and guide you in this situation and trust Him to solve it, there's nothing to hard for God. ALL THINGS ARE POSSIBLE WITH GOD, create a personal relationship with God daily by praying, reading the bible (psalms,proverbs, and ephesians) and believe your son is healed whether you see it now or not he is subject to change everything is. My husband is healed from schizoprenia and I will not except anything other then that. God wants us to prosper in body, spirit and soul(mind) so ask him for forgiveness, read romans 10:9,10 and receive salvation and you can ask on behalf of your son also and guess what put God first and all the things you desire according to his plan for your life he will give it to you ask in the name of Jesus.I will pray as well for your strength that God can and will give to you to get through this we all go through hard times but the important thing is we are not alone and neither is your son you can tell him to ask God to keep and comfort him and renew his mind this will help him but you keep praying and believing in the Lord and what He can do and I gurantee you will see changein your life. Live right according to what God"s Word says and he will deliver your son from this attack from the devil your son has the victory,Christ gave His life for us all so the devil has no right to occupy your son's mind your son will have a sound mind because God said so don't give up on him or anything in life trust in Lord with all your heart and lean not unto your own understanding but acknowledge God in all your ways and He will direct your path. you may not understand somethings now but all I can say is trust Him, love Him, He knows all that you need and your son needs. And remember that when you are saved by God's grace your household is also saved,so no matter if he leaves and stays out late God will protect him, He loves your son so much and wants him to live normal and happy God will have mercy on him choose God today and live like his Word says(The Holy Bible), also TBN is a very good channel to watch on cable I believe it is inspiring to the spirit. You are his mother love him always support him, guide him most of all pray for God mercy on his soul because heaven will be yours and his receive Christ Jesus and watch how God will manifest his healing to you and his peace that no one on this earth can give you be encouraged don't be weary in well doing GOD IS FAITHFUl. May God Bless You and your son always and He does love you both call upon Him and He will answer.

Posted by: single mom tired of coping don't be at October 11, 2004 07:53 PM

Don't be ridiculous, God doesn't exist! They just made him up so you'll do what they want!

Ps. Schizophrenia has nothing to do with possesion or the devil.

Posted by: Matthew Browning at October 20, 2004 02:30 PM

Matthew-You are the Fool! People with no belief in God are the reason why there are so many problems on earth.Everyone so self absorbed. How did we get here? Your mom, she get here? -her mom etc on for infinity. There is only 1 answer------- Father/Son/Holy Spirit

Posted by: Janel at November 15, 2007 07:54 AM

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