In recent years, the intersection of violence and mental health has become an increasingly debated topic, often characterized by controversy and misunderstanding (1, 2). Among the psychiatric conditions most frequently associated, often erroneously, with violent behavior, the spectrum of schizophrenia and other psychotic disorders stands out (3–5). This association, however, is not only simplistic and stigmatizing but also dangerous, as it distorts public perception and undermines the dignity and rights of people living with mental illness (6). The scientific evidence indicates that the vast majority of people with schizophrenia or other psychotic spectrum disorders are not violent (7–10). They are much more likely to be victims of violence than perpetrators (11, 12). Media narratives, which often sensationalize rare and extreme cases, contribute to distorting the image of mental illness as inherently dangerous (13, 14); this not only exacerbates stigma but also fuels fear and discrimination, making it more difficult for people to seek help and receive adequate care. Violence is a complex and multifactorial phenomenon influenced by biological, psychological, and social factors (15, 16). The influence of comorbid conditions and states initially diagnosed as bipolar, which have changed over time due to our increased knowledge of modifications in brain and molecular structure, also emerges in diagnoses of the psychotic spectrum (17–24). While some symptoms, such as persecutory delusions or grandiose hallucinations, may be associated with an increased risk of violent behavior in some individuals, these cases are the exception, not the rule. However, these symptoms are sometimes used as a justification for violent actions, which, far from being attributable in a robust and irrefutable way to psychotic symptoms, end up increasing the social stigma towards these pathologies even more (25, 26). Moreover, concomitant factors, such as substance abuse, socioeconomic deprivation, the lack of protective factors, and exposure to trauma play a much more substantial role in the emergence of violent behavior, whether directed against oneself or others, than the mere presence of a psychotic disorder (27–29). It is essential to dispel the myth that mental illness equals violence. To do so requires a critical examination of the scientific data and a cultural shift that promotes empathy, inclusion, and evidence-based communication (30–32). Mental illness should never be used as a scapegoat for criminal actions (33). Hopefully, legal and law systems should avoid generalizations and ensure that psychiatric diagnoses are not misused to justify or explain criminal behavior without a nuanced and personalized assessment (14, 34, 35).
Regarding empathy deficit in male patients with schizophrenia and its relationship with impulsivity and premeditated violence, Gong et al. report in their study that scores related to premeditated aggression are linked to aggressive behavior in patients with schizophrenia, establishing that the trait of premeditated aggression in these patients is a significant predictor of violent aggression. In their findings, patients with violent schizophrenia had more extensive empathy deficits than patients with non-violent schizophrenia, particularly in males. Further analysis also revealed that deficits in empathic ability in male patients with schizophrenia were strongly and positively correlated with premeditation characteristics, while they were not significantly correlated with impulsivity characteristics. These findings could be used in the future to predict the occurrence of premeditated aggression in male patients with schizophrenia through empathy assessments.
In their systematic review of machine learning (ML) for predicting violent behavior in schizophrenia spectrum disorders, Parsaei et al. describe the results of an in-depth evaluation of the literature in this field. They find that ML models have produced convincing results, highlighting the importance of their use in advanced diagnostics. The authors report that given the rapid growth in the application of various artificial intelligence tools in medical contexts, it seems likely that in the coming years ML models could also be used to predict violent behaviors in patients with schizophrenia spectrum disorders. These tools could be used for timely preventive interventions, such as providing social support and rehabilitation, adjusting medications, and considering more personalized therapeutic approaches, significantly reducing the burden of violent behavior on patients, healthcare systems, and society in general.
Additionally, in a randomized controlled trial, Li Z. et al. analyzed the neurofeedback technique for treating male patients with schizophrenia and impulsive behavior. By combining existing scientific evidence with the results of their study, the authors offer new insights and theoretical foundations for the treatment of impulsive behavior in male patients with schizophrenia, demonstrating that six weeks of systematic neurofeedback treatment significantly improves the severity of impulsive behaviors and reduces aggression in these patients.
Shifting the focus to network analysis of clinical characteristics in patients with treatment-resistant schizophrenia (TRS), the work of Li W. et al. describes treatment resistance in schizophrenia as multifactorial. At present, no single definition encompasses all aspects, as the pathogenesis is not well understood and the disease remains poorly characterized. From a symptomatic point of view, positive and negative symptoms are key clinical features of TRS; it also appears that differences in core symptoms between TRS and non-treatment-resistant schizophrenia may partly explain this particular resistance. The authors conclude that managing positive and negative symptoms in TRS remains crucial, with particular attention to negative symptoms and related clinical characteristics.
In an in-depth study of cognitive impairment and cortical thickness abnormalities in first-episode schizophrenia patients who had not previously been treated with medication and who exhibited symptoms of agitation, Liang et al. explored the relationships between agitated behavior, cognitive function, and cortical thickness in first-episode schizophrenia not treated with medication (FESN). Based on the results of their study, the authors report that working memory performed worse in FESN and agitation (FESN+A) patients than in controls; furthermore, cortical thickness of the left paracalcarine gyrus was increased in the FESN and non-agitation (FESN-NA) group compared to the healthy control group. The FESN+A group had greater cortical thickness in the right posterior cingulate cortex (rPCC) than the FESN+NA group. The cortical thickness of the rPCC was negatively correlated with working memory scores in the FESN+A group. The authors conclude that abnormal cortical thickness of the rPCC may be related to agitation behavior and cognitive function in patients with FESN+A, suggesting a potential therapeutic target for agitation behavior and cognitive impairment in schizophrenia.
Bravve et al. present a systematic review of suicide risk in patients with aggression in schizophrenia; in their assessment, the authors highlight that suicide is the leading risk factor for mortality among individuals with schizophrenia, with a mortality rate 10 times higher than the general population. In the study conducted on individuals who committed suicide, some showed a high risk of aggression and impulsivity, which allowed these indicators to be considered predictors of suicide risk.
Based on the evaluation of the proposed studies and the currently available literature, it is important not to minimize the complexity of psychotic disorders and the suffering involved with them (36–39). These conditions can profoundly affect a person’s perception of reality, emotional regulation, and social functioning (40, 41). Therefore, early intervention, integrated care, and social rehabilitation, by any means currently provided by scientific literature (37), including and not only modern applications of virtual reality for rehabilitation purposes, are fundamental to promoting recovery and reducing the risk of social marginalization, which in itself can contribute to increasing vulnerability (42–44). In conclusion, addressing the link between violence and mental health in the context of the spectrum of schizophrenia and psychotic disorders requires a balanced and unbiased approach (45, 46). We must strive to protect public safety without compromising the rights and dignity of people with mental illness. The way forward is a nuanced, compassionate understanding; the integration of such an approach with the most modern preventive and rehabilitative techniques and with pharmacological therapies could effectively enable the prevention of the most marked episodes of violence and the achievement of an increasingly optimal outcome.
Statements
Author contributions
MT: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. SD: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.
Acknowledgments
The authors thank all contributing authors who have made this Research Topic a reference for the field.
Conflict of interest
The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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The author(s) declare that no Generative AI was used in the creation of this manuscript.
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References
1
BalfourJ. Representing Schizophrenia in the Media: A Corpus-Based Approach to UK Press Coverage. London: Routledge (2023). 218 p. doi: 10.4324/9781003096054
2
CarverLMorleySTaylorP. Voices of deficit: mental health, criminal victimization, and epistemic injustice. Illness Crisis Loss. (2017) 25:43–62. doi: 10.1177/1054137316675715
3
SperryLSperryJ. Schizophrenia spectrum and other psychotic disorders. In: Psychopathology and Psychotherapy. New York, NY: Routledge (2014).
4
McKennaPJMcKennaPJ. Schizophrenia and Related Syndromes. 2nd ed. London: Routledge (2013). 536 p. doi: 10.4324/9780203718506
5
AndersonCNathanR. The clinical assessment of violence in the context of psychosis: taking a phenomenological stance. BJPsych Adv. (2025) 31:28–35. doi: 10.1192/bja.2024.2
6
BiswasJ. Dignity restored: the power of treatment first. CNS Spectrums. (2025) 30:e11. doi: 10.1017/S109285292400052X
7
SwansonJWSwartzMSVan DornRAElbogenEBWagnerHRRosenheckRAet al. A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry. (2006) 63:490–9. doi: 10.1001/archpsyc.63.5.490
8
WhitingDGulatiGGeddesJRFazelS. Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: A systematic review and meta-analysis. JAMA Psychiatry. (2022) 79:120–32. doi: 10.1001/jamapsychiatry.2021.3721
9
OkideCCEseadiCEzenwajiIOEdeMOIgboROKoledoyeULet al. Effect of a critical thinking intervention on stress management among undergraduates of adult education and extramural studies programs. Medicine. (2020) 99:e21697. doi: 10.1097/MD.0000000000021697
10
HodginsS. Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. Philos Trans R Soc B: Biol Sci. (2008) 363:2505–18. doi: 10.1098/rstb.2008.0034
11
YounSWatsonAEGuadagnoBLMurrihySByrneLKChengNet al. Systematic review and meta-analysis: risk factors of violence during first-episode psychosis. Trauma Violence Abuse. (2025) 15248380241309297. doi: 10.1177/15248380241309297
12
KananiHFairfax-ColumboJDeMatteoD. Considering nuance in the relationship between substance use and risk: A critical analysis of a one-size-fits-all model. In: MillerMKBornsteinBHDeMatteoD, editors. Advances in Psychology and Law, vol. 7 . Springer Nature Switzerland, Cham (2025). p. 117–44. doi: 10.1007/978-3-031-82806-5_5
13
HeenanDBettsJ. Stigma. In: The Short Guide to Mental Health. Bristol: Policy Press (2025). p. 151–78. Available at: https://bristoluniversitypressdigital.com/display/book/9781447370345/ch006.xml.
14
HeenanDBettsJ. The media and mental health. In: The Short Guide to Mental Health. Bristol: Policy Press (2025). p. 179–98. Available at: https://bristoluniversitypressdigital.com/display/book/9781447370345/ch007.xml.
15
CartaMGAgugliaECaraciFDell’OssoLDi SciascioGDragoFet al. Quality of life and urban/rural living: preliminary results of a community survey in Italy. Clin Pract Epidemiol Ment Health. (2012) 8:169–74. doi: 10.2174/1745017901208010169
16
CartaMPretiAAkiskalH. Coping with the new era: noise and light pollution, hperactivity and steroid hormones. Towards an evolutionary view of bipolar disorders. Clin Pract Epidemiol Ment Health. (2018) 14:33–6. doi: 10.2174/1745017901814010033
17
CartaMGOualiUPerraABen Cheikh AhmedABoeLAissaAet al. Living with bipolar disorder in the time of covid-19: biorhythms during the severe lockdown in Cagliari, Italy, and the moderate lockdown in Tunis, Tunisia. Front Psychiatry. (2021) 12:634765. doi: 10.3389/fpsyt.2021.634765
18
CartaMGAngstJ. Screening for bipolar disorders: A public health issue. J Affect Disord. (2016) 205:139–43. doi: 10.1016/j.jad.2016.03.072
19
HardoyMCSerraMCartaMGContuPPisuMGBiggioG. Increased neuroactive steroid concentrations in women with bipolar disorder or major depressive disorder. J Clin Psychopharmacol. (2006) 26:379. doi: 10.1097/01.jcp.0000229483.52955.ec
20
KalcevGScanoAOrrùGPrimaveraDCossuGNardiAEet al. Is a Genetic Variant associated with Bipolar Disorder Frequent in People without Bipolar Disorder but with Characteristics of Hyperactivity and Novelty Seeking? Clin Pract Epidemiol Ment Health. (2023) 19:e174501792303280. doi: 10.2174/17450179-v19-e230419-2022-53
21
CartaMGKalcevGScanoAPrimaveraDOrrùGGureyeOet al. Is bipolar disorder the consequence of a genetic weakness or not having correctly used a potential adaptive condition? Brain Sci. (2023) 13:16. doi: 10.3390/brainsci13010016
22
ChavesCDursunSMTusconiMHallakJEC. Neuroinflammation and schizophrenia – is there a link? Front Psychiatry. (2024) 15:1356975. doi: 10.3389/fpsyt.2024.1356975
23
TusconiMDursunSM. Editorial: Further findings in the role of inflammation in the etiology and treatment of schizophrenia. Front Psychiatry. (2024) 15:1349568. doi: 10.3389/fpsyt.2024.1349568
24
CorrellCUTusconiMCartaMGDursunSM. What remains to be discovered in schizophrenia therapeutics: contributions by advancing the molecular mechanisms of drugs for psychosis and schizophrenia. Biomolecules. (2024) 14:906. doi: 10.3390/biom14080906
25
HébertSTHélieSRoyerM-NEspositoT. Time-out placements in residential care: Towards a better understanding of restrictive measures in response to the behavioral manifestations of vulnerable youths. Child Prot Pract. (2025) 4:100113. doi: 10.1016/j.chipro.2025.100113
26
GligorićVReinhardtCNieuwenhuijzenEde CastroJOFeddesARvan KleefGAet al. The role of worldviews, radicalization risk factors, and personality in harassment of scientists. Sci Rep. (2025) 15:1261. doi: 10.1038/s41598-025-85208-7
27
Kovess-MasfetyVPilowskyDJGoelitzDKuijpersROttenRMoroMFet al. Suicidal ideation and mental health disorders in young school children across Europe. J Affect Disord. (2015) 177:28–35. doi: 10.1016/j.jad.2015.02.008
28
MuraGRochaNBFHelmichIBuddeHMaChadoSWegnerMet al. Physical activity interventions in schools for improving lifestyle in European countries. Clin Pract Epidemiol Ment Health. (2015) 11(Suppl 1:M5):77–101. doi: 10.2174/1745017901511010077
29
CartaMGCossuGPintusEZacchedduRCalliaOContiGet al. Moderate exercise improves cognitive function in healthy elderly people: results of a randomized controlled trial. Clin Pract Epidemiol Ment Health. (2021) 17:75–80. doi: 10.2174/1745017902117010075
30
TusconiMKätzelDSánchez-GutiérrezT. Editorial: Reviews in psychiatry 2023: schizophrenia. Front Psychiatry. (2024) 15:1444818. doi: 10.3389/fpsyt.2024.1444818
31
TusconiMNibbioGGuptaRCarrE. Editorial: Case reports in schizophrenia and psychotic disorders. Front Psychiatry. (2023) 14:1282780. doi: 10.3389/fpsyt.2023.1282780
32
TusconiMSanchez-GutierrezT. Editorial: reviews in psychiatry 2022: schizophrenia. Front Psychiatry. (2023) 14:1237676. doi: 10.3389/fpsyt.2023.1237676
33
VeronaEFoxB. Pathways to Crime and Antisocial Behavior: A Critical Analysis of Psychological Research and a Call for Broader Ecological Perspectives. Annu Rev Clin Psychol. (2025) 21. doi: 10.1146/annurev-clinpsy-081423-024754
34
BabchishinKMSetoMCLångströmN. Psychiatric and neurological morbidity predicts sexual offending: A nationwide, population-based, case-control study. J Criminal Justice. (2025) 96:102355. doi: 10.1016/j.jcrimjus.2025.102355
35
BoehmeHMKleinBRSpencerMDJonesAMcMains-NurisioMMorganKet al. Social determinants of health, driving time to trauma hospitals, racial composition, and firearm violence in South Carolina. Injury Prev. (2025) 31(2):123–30. doi: 10.1136/ip-2024-045442
36
WilkinsonSHareSHouldersJHumpstonCAlderson-DayB. Thinking about hallucinations: why philosophy matters. Cogn Neuropsychiatry. (2021) 27(2-3):219–35. doi: 10.1080/13546805.2021.2007067
37
Țenea-CojanȘ-TDinescuV-CGheormanVDragneI-GGheormanVForțofoiuM-Cet al. Exploring multidisciplinary approaches to comorbid psychiatric and medical disorders: A scoping review. Life. (2025) 15:251. doi: 10.3390/life15020251
38
ReddyKJ. Neuropsychology of criminal responsibility. In: ReddyKJ, editor. Foundations of Criminal Forensic Neuropsychology : Bridging Mind, Law, and Criminal Justice. Springer Nature Switzerland, Cham (2025). p. 93–127. doi: 10.1007/978-3-031-83771-5_5
39
RidenourJMHammJALeonhardtBLBuckBLysakerJT. Facing fear in the psychotherapy for psychosis. J Contemp Psychother. (2025) 55(1):45–58. doi: 10.1007/s10879-025-09665-x
40
SarwarRAsmatA. Mental health expert’s perspective on risk and protective factors of suicide ideation in Patients with OCD and depression. BMC Psychiatry. (2025) 25:266. doi: 10.1186/s12888-024-06404-9
41
Muños GarcíaJJHodann-CaudevillaRMGarcía CastañoAAguilera GarridoSDurán TischhauserRPico RadaÁChecktaeet al. The psychosocial impact of insight paradox and internalized stigma in chronic psychotic disorders. Behav Sci. (2025) 15:410. doi: 10.3390/bs15040410
42
PirasIPortogheseITusconiMMinafraFLeccaMPirasGet al. Professional and personal experiences of workplace violence among Italian mental health nurses: A qualitative study. AIMSPH. (2024) 11:1137–56. doi: 10.3934/publichealth.2024059
43
ChavesCdos SantosRGDursunSMTusconiMCartaMGBrietzkeEet al. Why N,N-dimethyltryptamine matters: unique features and therapeutic potential beyond classical psychedelics. Front Psychiatry. (2024) 15:1485337. doi: 10.3389/fpsyt.2024.1485337
44
ParkHYKimYCParkSCChoYJSurYJ. Comparison of the demographic and wound characteristics of non-suicidal and suicidal self-wrist cutting injuries. Medicine. (2020) 99:e19298. doi: 10.1097/MD.0000000000019298
45
NasimRNawazSNasimMT. The effects of antipsychotic drugs and non-pharmacological therapies on schizophrenia. Targets. (2025) 3:10. doi: 10.3390/targets3010010
46
Fernández-VillardónAde IbarraASDomínguez-PanchónAGarcía-CarriónR. Progress in mentalizing ability among people with psychosis through dialogic literary gatherings. BMC Psychol. (2025) 13:65. doi: 10.1186/s40359-025-02381-0
Summary
Keywords
biomarkers, neurobiology, neuroimaging, schizophrenia, violence, recovery, psychosis
Citation
Tusconi M and Dursun SM (2025) Editorial: Violence and mental health. focus on schizophrenia spectrum and psychotic disorders. Front. Psychiatry 16:1618000. doi: 10.3389/fpsyt.2025.1618000
Received
25 April 2025
Accepted
28 April 2025
Published
08 May 2025
Volume
16 - 2025
Edited and reviewed by
Ingrid Melle, University of Oslo, Norway
Updates
Copyright
© 2025 Tusconi and Dursun.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Massimo Tusconi, massimotusconi@yahoo.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.