Clinical Risk Factors

The clinical setting is one of intensified emotions. Patients who are at risk of perpetrating violence include those who:

• are under the influence of drugs or alcohol
• are in pain
• have a history of violence
• have cognitive impairment
• are in the forensic (criminal justice) system
• are angry about clinical relationships, e.g., in response to perceived authoritarian attitude or excessive force used by the health provider
• have certain psychiatric diagnoses and/or medical diagnoses.

It is important to realize that, although some psychiatric diagnoses are associated with violent behavior, most people who are violent are not mentally ill, and most people who are mentally ill are not violent. Substance abuse is a major contributor to violence in populations both with and without psychiatric diagnoses (Friedman, 2006).