Welcome to the Psychiatry and Psychotherapy Podcast. The podcast to help you in your journey

towards becoming a wise, empathic, genuine and connected mental health professional.

I'm your host, Dr. David Puder, a psychiatrist who splits his time practicing psychopharmacology,

individual and group psychotherapy, medical director of a day treatment program,

medical education research, and teaching residents and medical students.

Okay, welcome back to the podcast. I'm here with Dr. Michael Cummings.

He's been with us before, and today we are going to be talking about violence and aggression.

Dr. Cummings, welcome to the podcast. Thank you very much. I'm happy to be back.

As many of your listeners know, I work at a state psychiatric hospital for the criminally insane.

So indeed, treatment of aggression and violence is pretty much our daily bread and butter.

So in this episode, we're going to be hoping to go through some of the definitions of violence and aggression,

what causes it, how to identify it, how to treat it, and so yeah, let's start with maybe definitions of how you would define different types of aggression.

Okay, well first, aggression and violence, although they're all sometimes used synonymously,

aggression can be physical or non-physical directed against either others or oneself,

whereas violence more often denotes use of force with an intent to inflict damage or injury.

In considering violent behavior, a study that came out of New York about a decade ago now looked at the issue of violence and psychiatric patients,

the authors were agnostic regarding diagnosis and just looked at the principal types of aggression and violence that occur in psychiatric patients.

And they've basically found that it broke down into three categories. There was impulsive violence, which was the most common category.

Then there was predatory violence that is instrumental or purposeful violence.

And then lastly, in a chronic population, psychotically driven violence was actually the least common.

That was replicated in the California Department of State hospitals when we looked at 88 of our chronically or persistently violent patients.

The rate of impulsive violence was 54%, predatory violence was 29%, and psychotically driven violence was 17%.

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