Violence Risk Assessment

Presented by Leonard William Mulbry, Jr., M.D.

South Carolina Forensic Psychiatry

Covering the Topics of:

Study of Violent Behavior

Personality Research

Personality research traces its origins to 1890's Germany.

Social Deviancy Research

Social Deviancy Research traces it origins to 1960's U.S.

Antisocial Personality Disorder

The individual must be age 18 or older.

The individual must have exhibited a Conduct Disorder before age 15.

Antisocial Personality Disorder requires three of the following characteristics:



As studied by Cleckly (1941)

Psychopaths exhibit superficial charm and good intelligence.
Psychopaths exhibit an absence of delusions and irrational thought.
Psychopaths exhibit an absence of nervousness.
Psychopaths exhibit unreliability.
Psychopaths exhibit untruthfulness.
Psychopaths exhibit a lack of remorse of shame.
Psychopaths exhibit inadequately motivated antisocial behavior
Psychopaths exhibit poor judgment and failure to learn from experience.
Psychopaths exhibit pathological egocentricity and incapacity for love.
Psychopaths exhibit a general poverty of major affective reaction.
Psychopaths exhibit a specific loss of insight.
Psychopaths exhibit unresponsiveness in interpersonal relations.
Psychopaths exhibit fantastic and uninviting behavior.
Psychopaths rarely commit suicide.
Psychopaths exhibit an impersonal, trivial and poorly integrated sex life.
Psychopaths exhibit a failure to follow any life plan.

Violence Risk Assessment

Impact of Mental Illness (Swanson 1990)

Diagnosis % reporting violence
No diagnosis 2
Obsessive-Compulsive Disorder 11
Panic Disorder 12
Major Depressive Disorder 12
Bipolar Affective Disorder 11
Schizophrenia 13
Cannabis Abuse & Dependence 19
Alcohol Abuse & Dependence 25
Other Substance Abuse & Dependence  

Violence Risk Assessment

Impact of Mental Illness (Monahan 1997)

There is a weak relationship between mental illness and violence.
Most people with mental illness are not violent.
Victims of mentally ill people are rarely strangers
Substance abuse is a much greater risk factor than is mental illness.
Violent behavior in the mentally ill is only manifested during acute symptoms

Violence Risk Assessment


Clinical Approach

The Threat Assessment Model of violence risk assessment is tailored to the patient.

Actuarial Approach

The Actuarial approach is more systematic.

Structured Professional Judgement Approach

Explores factors from the actuarial assessment. It is done by a systematic assessment of violence risk factors associated with the individual

Violence Risk Appraisal Guide (VRAG)

Historical Clinical Risk (HCR-20 v2)

Clinical (Present)
Future (Risk Management)



This information is designed for general information only. The information presented at this site
should not be construed to be formal legal advice nor the formation of a doctor/client relationship.

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