American Board of Psychiatry and Neurology (ABPN) Practice Exam 2026 - Free ABPN Practice Questions and Study Guide

Substance abusers are identified as the group most likely to exhibit violent behavior in psychiatric assessments. This association primarily arises from the impact of substances on cognition and impulse control. Psychoactive substances may impair judgment, reduce inhibitions, and exacerbate aggressive tendencies, leading to increased aggression and violent behaviors.

Moreover, the environment often surrounding substance abuse—characterized by stress, conflict, and criminality—can further elevate the risk of violent encounters. The interaction between substance use and co-occurring mental health disorders also contributes to this risk, as these patients may face a myriad of psychosocial stressors that influence their behavior.

In contrast, while individuals with bipolar disorder may experience episodes of mania that can involve impulsive or aggressive actions, the overall prevalence of violence in this group is lower compared to substance abusers. Similarly, although individuals with schizophrenia may sometimes exhibit aggressive behaviors, especially during acute psychotic episodes, they are more commonly victims of violence rather than perpetrators. Borderline personality disorder can also involve emotional dysregulation and impulsivity, but the violent behavior is typically directed toward oneself rather than others.

By considering these dynamics, it becomes evident why substance abusers are more frequently associated with violent behavior in psychiatric settings.