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Violence in Bipolar Disorder
Only a small percentage of people with a serious mental illness like bipolar disorder are violent or aggressive but, much to my chagrin, it’s a higher number of people than in the general population—in some cases, much higher.
How Common is Violence in Bipolar Disorder?
The numbers are actually staggering. According to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in people without a psychiatric condition aggressive behavior was found in 0.66 percent of persons over the course of their lifetime. In people with bipolar disorder I, the number climbs to a shocking 25.34 percent and in bipolar II the number is 13.58 percent.
(Aggressive behavior is defined as an “overt act intended to harm.”)
The numbers for bipolar disorder represent those with and those without comorbidities (co-occurring disorders). We’ve always known that those with alcohol or drug abuse issues have much higher numbers of violence and other comorbidities like personality disorders also increase the risk of violence, but this doesn’t account for the whole difference.
In those with bipolar disorder without comorbidities, the numbers on violence are:
- 2.52 percent in bipolar I
- 5.12 percent in bipolar II
In another study from Sweden, it was found that 9.5 percent of people with bipolar disorder committed a violent crime at some point after their initial diagnosis as compared to 1.7 percent of the general population. Again, this risk was much higher in those with substance abuse comorbidities but this did not entirely account for the increase.
Violence and Bipolar Mania
It was found that those who have experienced mania are at the highest risk for violence. An analysis of the NESARC study data showed that 13 percent of those who have had a manic episode report police involvement during the most severe manic episode. Legal involvement was most likely in those with:
- Increased self-esteem or grandiosity (delusions of grandeur)
- Increased libido
- Excessive engagement in pleasurable activities with a high risk of painful consequences
- Having more manic symptoms
- Having both social and occupational impairment
Current psychosis and a history of a suicide attempt also increases the risk of violence.
Treating Violence in Bipolar Disorder
Not surprisingly, research has been done on treating violence in bipolar disorder. Pharmacological options include:
- Benzodiazepines (like lorazepam)—often given in-patient, short-term due to concerns over abuse and dependence
- Antipsychotics (often second generation like ziprasidone and olanzapine)—may be used in conjunction with a benzodiazepine
Long-term management of mania is considered paramount for controlling violent behavior.
Cognitive behavioral therapy can also be used to treat the symptoms that increase the risk of violence (including concurrent personality disorders, substance use disorders and issues with treatment adherence). Family-focused therapy may also protect family members from violence as dispute resolution techniques are taught.
Violence in Bipolar Disorder
Personally, I’ve not been violent a day in my life and I hate suggesting that people with bipolar disorder have an increased risk of violence. I think it runs the risk of increasing stigma and discrimination. Nevertheless, it is true. So maybe the best solution is to find understanding within ourselves that there is this increased risk and take actions to ensure it doesn’t manifest. After all, if we can’t stop the violence, then who can?
Violence in Schizophrenia and Bipolar Disorder by Jan Volavka
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