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From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization

  • S. Hodgins (a1), A. Cree (a1), J. Alderton (a1) and T. Mak (a1)

Conduct disorder (CD) prior to age 15 has been associated with an increased risk of aggressive behaviour and crime among men with schizophrenia. The present study aimed to replicate and extend this finding in a clinical sample of severely mentally ill men and women.


We examined a cohort of in-patients with severe mental illness in one mental health trust. A total of 205 men and women participated, average age 38.5 years. CD was diagnosed using a structured diagnostic tool. Alcohol and illicit drug use, aggressive behaviour and victimization were self-reported. Information on convictions was extracted from official criminal records. Analyses controlled for age and sex.


CD prior to age 15 was associated with an increased risk of assault over the lifespan [odds ratio (OR) 3.98, 95% confidence interval (CI) 1.87–8.44)], aggressive behaviour in the 6 months prior to interview (OR 2.66, 95% CI 1.24–5.68), and convictions for violent crimes (OR 3.19, 95% CI 1.46–6.97) after controlling for alcohol and illicit drug use. The number of CD symptoms present prior to age 15 significantly increased the risk of serious assaults over the lifespan, aggressive behaviour in the past 6 months, and violent crime after controlling for alcohol and illicit drug use.


Men and women with severe mental illness who have a history of CD by mid-adolescence are at increased risk for aggressive behaviour and violent crime. These patients are easily identifiable and may benefit from learning-based treatments aimed at reducing antisocial behaviour. Longitudinal, prospective investigations are needed to understand why CD is more common among people with than without schizophrenia.

Corresponding author
*Address for correspondence: Professor S. Hodgins, Head, Department of Forensic Mental Health Science, Institute of Psychiatry, King's College London, Box P023, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. (Email:
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Armstrong T, Costello EJ (2002). Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology 70, 12241239.
Arseneault L, Moffitt TE, Caspi A, Taylor P, Silver EA (2000). Mental disorders and violence in a total birth cohort. Archives of General Psychiatry 57, 979986.
Arseneault L, Kim-Cohen J, Taylor A, Caspi A, Moffitt TE (2005). Psychometric evaluation of 5- and 7-year-old children's self-reports of conduct problems. Journal of Abnormal Child Psychology 33, 537550.
Asnarow JR (1988). Children at risk for schizophrenia: converging lines of evidence. Schizophrenia Bulletin 14, 613631.
Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, Lewis G, Meltzer H (2004). Psychosis, victimisation and childhood disadvantage. British Journal of Psychiatry 185, 220226.
Belfrage H (1998). New evidence for a relation between mental disorders and crime. British Journal of Criminology 38, 4554.
Berman AH, Bergman H, Palmstierna T, Schlyter F (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research 11, 2231.
Brennan PA, Mednick SA, Hodgins S (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry 57, 494500.
Carlson GA, Weintraub S (1993). Childhood behaviour problems and bipolar disorder – relationship or coincidence? Journal of Affective Disorders 28, 143153.
Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R (2002). Role of genotype in the cycle of violence in maltreated children. Science 61, 851853.
Caspi A, Moffitt TE, Morgan J, Rutter M, Taylor A, Arsenault L, Tully L, Jacobs C, Kim-Cohen J, Polo-Tomas A (2004). Maternal expressed emotion predicts children's anti-social behaviour problems: using monozygotic-twin differences to identify environmental effects on behavioural development. Developmental Psychology 40, 149161.
Department of Health (1999). National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health: London, UK.
Erb M, Hodgins S, Freese R, Müller-Isberner R, Jöckel D (2001). Homicide and schizophrenia: maybe treatment does have a preventive effect. Criminal Behaviour and Mental Health 11, 626.
Eronen M, Tiihonen J, Hakola P (1996). Schizophrenia and homicidal behaviour. Schizophrenia Bulletin 22, 8390.
Farmer EMZ, Compton SN, Burns BJ, Robertson E (2002). Review of the evidence base for treatment of childhood psychopathology: externalising disorders. Journal of Consulting and Clinical Psychology 70, 12671302.
Farrington DP, Gallagher B, Morley L, StLeger RJ, West D (1988). Are there any successful men from crimogenic backgrounds? Psychiatry 51, 116130.
Fazel S, Danesh J (2002). Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys. Lancet 259, 545550.
Fergusson DM, Horwood LJ, Nagin DS (2000). Offending trajectories in a New Zealand birth cohort. Criminology 38, 525561.
Fergusson DM, Horwood LJ, Ridder EM (2005). Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology and Psychiatry 46, 837849.
First MB, Spitzer RL, Gibbon M, Williams JBW (1996). Structured Clinical Interview for Axes I and II DSM-IV Disorders – Patient Edition. Biometrics Research Department, New York State Psychiatric Institute: New York.
Foley DL, Eaves LJ, Wormley B, Silberg JL, Maes HH, Riley B (2004). Childhood adversity, monoamine oxidase A genotype, and risk for conduct disorder. Archives of General Psychiatry 61, 738744.
Fombonne E, Wostear G, Cooper V, Harrington R, Rutter M (2001). The Maudsley long-term follow-up of child and adolescent depression: psychiatric outcomes in adulthood. British Journal of Psychiatry 179, 210217.
Fulwiler C, Ruthazer R (1999). Premorbid risk factors for violence in adult mental illness. Comprehensive Psychiatry 40, 96100.
Geller B, Cooper TB, Watts HE, Cosby CM, Fox LW (1992). Early findings from a pharmacokinetically designed double-blind and placebo-controlled study of lithium for adolescents comorbid with bipolar and substance dependency disorders. Progress in Neuropsychopharmacology and Biological Psychiatry 16, 281299.
Gosden NP, Kramp P, Gabrielsen G, Andersen TF, Sestoft D (2005). Violence of young criminals predicts schizophrenia: a 9-year register-based followup of 15- to 19-year-old criminals. Schizophrenia Bulletin 31, 759768.
Grounds A, Melzer D, Fryers T, Brugha T (2004). What determines access to medium secure psychiatric provision? Journal of Forensic Psychiatry and Psychology 15, 16.
Heilbrun K, Peters L (2000). Community-based treatment programmes. In Violence, Crime and Mentally Disordered Offenders: Concepts and Methods for Effective Treatment and Prevention (ed. Hodgins S. and Müller-Isberner R.), pp. 193215. John Wiley & Son: Chichester.
Hodgins S (1992). Mental disorder, intellectual deficiency and crime: evidence from a birth cohort. Archives of General Psychiatry 49, 476483.
Hodgins S (2004). Criminal and antisocial behaviours and schizophrenia: a neglected topic. In Search for the Causes of Schizophrenia, vol. V (ed. Gattaz W. F. and Häfner H.), pp. 315341. Steinkopff Verlag: Darmstadt, Germany.
Hodgins S (in press). Criminality among persons with severe mental illness. In Handbook of Forensic Mental Health, chapter 16 (ed. Soothill K., Dolan M. and Rogers P.). Willan Publishing: Cullompton, UK.
Hodgins S, Alderton J, Cree A, Aboud A, Mak T (2007 a). Aggressive behaviour, victimisation, and crime among severely mentally ill patients requiring hospitalisation. British Journal of Psychiatry 191, 343350.
Hodgins S, Cote G, Toupin J (1998). Major mental disorders and crime: an etiological hypotheses. In Psychopathy: Theory, Research and Implications for Society (ed. Cooke D., Forth A. and Hare R. D.), pp. 231256. Kluwer Academic: Dordrecht, The Netherlands.
Hodgins S, Mednick SA, Brennan P, Schulsinger F, Engberg M (1996). Mental disorder and crime: evidence from a Danish birth cohort. Archives of General Psychiatry 53, 489496.
Hodgins S, Müller-Isberner R (2004). Preventing crime by people with schizophrenia: the role of psychiatric services. British Journal of Psychiatry 185, 245250.
Hodgins S, Müller-Isberner R, Allaire J (2006). Attempting to understand the increase in the numbers of forensic beds in Europe. A multi-site study of patients in forensic and general psychiatric services. International Journal of Forensic Mental Health Services 5, 173184.
Hodgins S, Müller-Isberner R, Tiihonen J, Repo-Tiihonem E, Eronen M, Eaves D, Hart S, Webster C, Levander S, Tuninger E, Ross D, Kronstrand R (2007 b). A comparison of general and forensic patients with schizophrenia living in the community. International Journal of Forensic Mental Health 6, 6375.
Hodgins S, Tiihonen J, Ross D (2005). The consequences of conduct disorder for males who develop schizophrenia: associations with criminality, aggressive behaviour, substance use, and psychiatric services. Schizophrenia Research 78, 323335.
Hollin CR (2004). The Essential Handbook of Offender Assessment and Treatment. Division of Forensic Mental Health, University of Leicester: Leicester.
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry 60, 709717.
Maughan B, Taylor A, Caspi A, Moffitt TE (2004). Parental smoking and early childhood conduct problems: testing genetic and environmental explanations of the association. Archives of General Psychiatry 61, 836843.
Meltzer H, Gatwood R, Goodman R, Ford T (2003). Mental Health of Children and Adolescents in Great Britain. The Stationery Office: London.
Moffit TE, Caspi A, Harrington H, Milne BJ (2002). Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Development of Psychopathology 14, 179207.
Mueser KT, Crocker AG, Frisman LB, Drake RE, Covell NH, Essock SM (2006). Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders. Schizophrenia Bulletin 32, 626636.
Meuser KT, Drake RE, Ackerson TH, Alterman AI, Miles KM, Noordsy DL (1997). Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. Journal of Abnormal Psychology 106, 473477.
Mueser KT, Rosenberg SD, Drake RE, Miles KM, Wolford G, Vidaver R, Carrieri K (1999). Conduct disorder, antisocial personality disorder and substance use disorders in schizophrenia and major affective disorders. Journal of Study in Alcohol 60, 278284.
Naudts K, Hodgins S (2006). Neurobiological correlates of violent behaviour among persons with schizophrenia. Schizophrenia Bulletin 32, 562572.
Nicolas S, Povey D, Walker A, Kershaw C (2004/2005). Crime in England and Wales. Home Office Crime Statistics: London.
Odgers CL, Caspi A, Broadbent JM, Dickson N, Hancox RJ, Harrington H, Poulton R, Sears MR, Thomson WM, Moffitt TE (2007). Prediction of differential adult health burden by conduct problem subtypes in males. Archives of General Psychiatry 64, 476484.
ODPM (2004). The English Indices of Deprivation. Implications for London Boroughs. Office of the Deputy Prime Minister: UK.
Olin SS, Raine A, Cannon TD, Parnas J, Schulsinger F, Mednick SA (1997). Childhood behaviour precursors of schizotypal personality disorder. Schizophrenia Bulletin 23, 93103.
Priebe S, Badesconyi A, Fioritti A, Hansson L, Kilian R, Torres-Gonzales F (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 330, 123126.
Rhee SH, Waldman ID (2002). Genetic and environmental influences on antisocial behaviour: a meta-analysis of twin and adoption studies. Psychological Bulletin 128, 490529.
Rice ME, Harris GT (1995). Psychopathy, schizophrenia, alcohol abuse, and violent recidivism. International Journal of Law and Psychiatry 18, 333342.
Robins LN (1993). Childhood conduct problems, adult psychopathology, and crime In Mental Disorder and Crime (ed. Hodgins S.), pp. 173193. Sage: Newbury Park, Canada.
Robins L (1966). Deviant Children Grown Up. Williams & Williams: Baltimore, MD.
Robins LN, McEvoy L (1990). Conduct problems as predictors of substance abuse. In Straight and Deviant Pathways from Childhood to Adulthood (ed. Robins L. N. and Rutter M.), pp. 182204. Cambridge University Press: Cambridge.
Robins LN, Price RK (1991). Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project. Psychiatry 54, 116132.
Robins LN, Tipp J, Przybeck T (1991). Antisocial personality. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (ed. Robins L. N. and Reiger D. A.), pp. 258290. The Free Press: New York.
Royal College of Psychiatrists and British Psychological Society (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Developed by the National Collaborating Centre for Mental Health; commissioned by the National Institute for Clinical Excellence. London and Leicester: Royal College of Psychiatrists and British Psychological Society.
Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction 88, 791804.
Scott S, Davies J (1999). The cost of antisocial behaviour in younger children. Clinical Child Psychology of Psychiatry 4, 457473.
Scott F, Whyte S, Burnett R, Hawley C, Maden T (2004). A national survey of substance misuse and treatment outcome in psychiatric patients in medium security. Journal of Forensic Psychiatry and Psychology 15, 595625.
Silver E, Mulvey EP, Swanson JW (2002). Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science and Medicine 55, 14571470.
Steadman HJ, Mulvey EP, Monahan J, Robbbins PC, Applebaum PS, Grisso T, Roth LH, Silver E (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55, 393401.
Swanson JW, Holzer CED, Ganju VK, Jono RT (1990). Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry 41, 761770.
Swanson JW, Swartz MS, Elbogen EB, Van Dorn RA (2004 a). Reducing violence risk in persons with schizophrenia: olanzapine versus risperidone. Journal of Clinical Psychiatry 65, 16661673.
Swanson JW, Swartz MS, Elbogen EB (2004 b). Effectiveness of a typical antipsychotic medications in reducing violent behaviour among persons with schizophrenia in community-based treatment. Schizophrenia Bulletin 30, 320.
Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR (2006). A national study of violent behaviour in persons with schizophrenia. Archives of General Psychiatry 63, 490499.
Swanson JW, Van Dorn RA, Swartz MS, Smith A, Elbogen EB, Monahan J (2007). Alternative pathways to violence in persons with schizophrenia: the role of childhood antisocial behavior problems. Law and Human Behavior. Published online: 30 June 2007. doi:10.1007/s10979-007-9095-7.
Swartz MS, Swanson JW (2004). Involuntary outpatient commitment, community treatment orders and assisted outpatient treatment: what's in the data? Canadian Journal of Psychiatry 49, 585591.
Swartz MS, Jeffrey WS, Hiday VA, Borum R, Wagner HR, Burns BJ (1998). Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. American Journal of Psychiatry 155, 226231.
Tengström A, Hodgins S, Grann M, Långström N, Jullgren G (2004). Schizophrenia and criminal offending: the role of psychopathy and substance misuse. Criminal Justice and Behaviour 31, 125.
Tengström A, Hodgins S, Kullgren G (2001). Men with schizophrenia who behave violently: the usefulness of an early versus late starters typology. Schizophrenia Bulletin 27, 205218.
Teplin L, McClelland GM, Abram KM, Weiner DA (2005). Crime victimization in adults with severe mental illness; comparison with the National Crime Victimization Survey. Archives of General Psychiatry 62, 911921.
Tiihonen J, Isohanni M, Räsänen P, Koiranen M, Moring J (1997). Specific major mental disorders and criminality: a 26 year prospective study of the 1966 Northern Finland birth cohort. American Journal of Psychiatry 154, 840845.
Volavka J, Czobor P, Nolan KA, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, Cooper TB, Lieberman JA (2004). Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. Clinical Psychopharmacology 24, 225228.
Volavka J, Laska E, Baker S, Meisner M, Czobor P, Krivelevich I (1997). History of violent behaviour and schizophrenia in different cultures. Analyses based on the WHO study on determinants of outcome of severe mental disorders. British Journal of Psychiatry 171, 914.
Wallace C, Mullen PE, Burgess P (2004). Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of co-morbid substance use disorders. American Journal of Psychiatry 16, 716727.
Walsh E, Moran P, Scott C, McKenzie K, Burns T, Creed F, Tyrer P, Murray RM, Fahy T; UK700 Group (2003). Prevalence of violent victimisation in severe mental illness. British Journal of Psychiatry 183, 233238.
Widom CS, Brzustowicz LM (2006). MAOA and the ‘Cycle of Violence’: childhood abuse and neglect, MAOA genotype, and risk for violent and antisocial behaviour. Biological Psychiatry 60, 684689.
Wolfe N, Blitz CL, Shi J (2007). Rates of sexual victimization in prison for inmates with and without mental disorders. Psychiatric Services 58, 10871094.
Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G (2002). Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. British Medical Journal 325, 11991201.
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