When should I become concerned that a patient with delusions poses a risk to others?

Delusions can present as many different types of beliefs and they can be chronic or acute. Delusions themselves do not prospectively predict violence. However, it is important for the clinician to explore the content and affect related to a patient’s delusion. Studies have found that where violence occurs in an individual with delusions, the pathway to violence is complex. Escalating feelings of threat, affective state, and temporal associations to violence outcomes are all important considerations. Persecutory delusions including fears of being spied upon, followed, plotted against, thought insertion, or being under external control, or beliefs of having special gifts tend to be associated with violent outcomes. Affective states of anger or elation due to delusional beliefs therefore should be explored in a violence risk assessment. Delusions causing an individual to feel threatened and angry warrant intervention, including treating the delusion and addressing the anger.

This answer card supplements the issue brief, Duty to Warn, Duty to Protect, And Duty to Control: The Exceptions to Mental Health Provider-Patient Confidentiality.



Simone Ullrich, Robert Keers, Jeremy W. Coid, Delusions, Anger, and Serious Violence: New Findings From the MacArthur Violence Risk Assessment Study. Schizophrenia Bulletin, Volume 40, Issue 5, September 2014, Pages 1174–1181.

  • Was this Helpful ?
  • YesNo

Join our #MissionForBetter now

Sign up for our newsletter. We’ll let you know about new resources, education, and more.