Mental disorder and violence: is there a relationship beyond substance use?

  • Richard Van Dorn
  • Jan Volavka
  • Norman Johnson
Original Paper



A general consensus exists that severe mental illness (SMI) increases violence risk. However, a recent report claimed that SMI “alone was not statistically related to future violence in bivariate or multivariate analyses.” We reanalyze the data used to make this claim with a focus on causal relationships between SMI and violence, rather than the statistical prediction of violence.


Data are from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a two-wave study (N = 34,653: Wave 1: 2001–2003; Wave 2: 2004–2005). Indicators of mental disorder in the year prior to Wave 1 were used to examine violence between Waves 1 and 2.


Those with SMI, irrespective of substance abuse status, were significantly more likely to be violent than those with no mental or substance use disorders. This finding held in both bivariate and multivariable models. Those with comorbid mental and substance use disorders had the highest risk of violence. Historical and current conditions were also associated with violence, including childhood abuse and neglect, household antisocial behavior, binge drinking and stressful life events.


These results, in contrast to a recently published report, show that the NESARC data are consistent with the consensus view on mental disorder and violence: there is a statistically significant, yet modest relationship between SMI (within 12 months) and violence, and a stronger relationship between SMI with substance use disorder and violence. These results also highlight the importance of premorbid conditions, and other contemporaneous clinical factors, in violent behavior.


Violence Severe mental illness Epidemiology Causality versus statistical prediction 



The authors would like to thank Dr. Randy Borum for his helpful comments on an earlier draft of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Richard Van Dorn
    • 1
  • Jan Volavka
    • 2
  • Norman Johnson
    • 3
  1. 1.University of South FloridaTampaUSA
  2. 2.Department of PsychiatryNew York University School of MedicineNew YorkUSA
  3. 3.U. S. Census BureauWashingtonUSA

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