Major affective disorders and violence: epidemiology, clinical and forensic considerations

Abstract

Only few empirical contemporary studies consider the relation between major affective disorders and violence.
This literature review envisage the main clinicals forms of mood disorders, unipolar (UP) and bipolar (BP) in their
relation with violent behavior against persons. The French National Authority for Health and several recent
international publications provide a new perspective on this aspect of the illness albeit emphasizing importance
of variables such as substance abuse, history of violence, individual and contextual factors. In a recent metaanalysis, 9,8% of subjects with a bipolar disorder had previous violent behavior, in comparison with only 3% of
control subjects in general population, and the odds ratio for the violence risk was 4,1 (IC 95%: [2,90-5,83]), with
a large heterogeneity however between studies.
Violent acts are relatively frequent in manic episodes of bipolar disorder and are often associated with substance
abuse or dependance. Mania is rarely linked to serious criminality but led to various minor offences, often furthered
by comorbidity with alcohol and substance abuse and sometimes antisocial personality disorder.
Several authors argue for a underestimation of criminal potential of depression and suicidal ideation. In homicidesuicides, a depressive illness seems the more common disease at the time of the offence, ranging from 36 to 75%
of cases in studies. These crimes are rare and essentially filicides and/or spouse homicides