Personality Disorders and Violence Potential

Violence associated with personality disorders is usually best viewed separately from psychiatric diagnosis, as a syndrome of violence rather than a syndrome of diagnosis. The authors describe eight categories of violence associated with personality disorders that may help clinicians choose treatment or management techniques: purposeful, instrumental violence; purposeful, non-instrumental violence; purposeful, targeted, defensive violence; targeted, impulsive violence; nontargeted, impulsive violence incidental to emotional escape; random but purposeful violence; violence related to perceived or feared loss or abandonment; and violence related to chronic paranoia or related misconceptions. The categories are not completely mutually exclusive, nor do they represent a "decision tree." We also point out three important principles about the relationship between personality disorders and violence: 1) Personality disorders are rarely ego dystonic; 2) Most patients and violent situations that come to clinical attention involve comorbid conditions. 3) Violence and violence risk are often associated with intoxication.