Several especially well-designed studies have now established specific clinical risk factors for violence (e.g., references 7– 9, 12 –14). This has led some to argue that the same actuarial risk factors operate for both mentally disordered and non-mentally-disordered offenders, suggesting that clinical factors contribute little to the risk for violence (10, 11). On one hand, actuarial models have demonstrated the predictive power of age and history (e.g., references 1, 2) on the other hand, clinical and personal distress variables, most notably symptoms and diagnoses, have traditionally failed to predict violence (10). Two complementary approaches-actuarial and clinical-have until recently produced divergent findings. The means by which mental disorders increase the risk for violence have, however, remained controversial. Some mental disorders increase the risk for violence (1– 6), with higher rates of violence now firmly established most prominently for individuals with diagnoses of substance abuse, followed by cluster B personality disorders, and to a lesser extent, schizophrenia spectrum disorders (7– 9). CONCLUSIONS: This review supports the hypothesis that these four fundamental personality dimensions operate jointly, and in varying degrees, as clinical risk factors for violence among groups with these classes of mental disorders. By contrast, paranoid cognitive personality style and narcissistic injury increase the risk for violence, respectively, in persons with schizophrenia spectrum disorders and in samples of both college students and individuals with personality disorders. Low impulse control and affect regulation increase the risk for violence across disorders, especially for primary and comorbid substance abuse disorders. RESULTS: The risk of violence may be understood in terms of four fundamental personality dimensions: 1) impulse control, 2) affect regulation, 3) narcissism, and 4) paranoid cognitive personality style. METHOD: Empirical studies are reviewed that have often used objective measures of personality and epidemiological samples with low levels of subject selection biases. OBJECTIVE: This review examines the role of personality dimensions in the greater rates of violence that have now been established to accompany certain classes of mental disorders.
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