A common myth about people living with schizophrenia is that they tend to be aggressive and commit violent acts. That idea often comes from how the mental health disorder is portrayed in the media. In movies and TV shows, people with schizophrenia are sometimes shown yelling at or hurting others. In addition, if a violent crime is committed by a person with schizophrenia, the news stories about it tend to be heavily focused on their diagnosis.

If you or someone you care about is living with schizophrenia, it’s important to understand how aggression may or may not be related to this condition. That way, you can make sure that you or your loved one gets the care they need to stay safe and well. In this article, you’ll learn more about when and why aggression might happen in people with schizophrenia.

How Common Is Aggression in Schizophrenia?

Research suggests that people living with schizophrenia may have a higher risk of becoming aggressive compared with the general population. In one study of almost 4,000 people diagnosed with schizophrenia, about 43 percent had been verbally aggressive. However, the study didn’t address two factors that can make aggression more likely in people with schizophrenia — whether these individuals were on an effective treatment plan or if they were misusing drugs or alcohol.

People living with schizophrenia may have a higher risk of becoming aggressive compared to the general population.

It’s also hard to know just how common aggression is in people who aren’t diagnosed with schizophrenia. Many acts of verbal aggression — or even actions such as damaging property or cars — may go unreported to doctors, researchers, or the police.

It’s important to note that compared to those without the condition, people with schizophrenia are more likely to be harmed by others. They also tend to hurt themselves, rather than others around them.

People with schizophrenia are more likely to hurt themselves, rather than those around them.

Most people living with schizophrenia aren’t violent. Violence isn’t a core part of the condition. It’s wrong to assume that someone will be dangerous or engage in aggressive behavior just because they’ve been diagnosed with schizophrenia.

Possible Causes of Aggression in Schizophrenia

Aggression related to schizophrenia may be linked to a few different factors, including:

• Substance use or misuse — Using alcohol or drugs is the most common factor connected to aggression in schizophrenia.
• Lack of an effective treatment plan — This can include not taking medications for schizophrenia as prescribed.
• Genetic differences — Some people may have genetic traits that affect how their brains use and process certain neurotransmitters (brain chemicals) or handle stress.
• Brain function changes — Schizophrenia can affect how different parts of the brain work, which may influence emotions or behavior in some people.

Using alcohol or drugs is the most common factor connected to aggression in schizophrenia.

Most people with schizophrenia who are getting effective treatment and aren’t using drugs or alcohol aren’t likely to be violent. According to a systematic review, over a 35-year period, fewer than 5 percent of women and fewer than 25 percent of men with schizophrenia spectrum disorders committed a violent act. The researchers found that the risk of violence was much higher when other risk factors were involved, especially substance misuse.

If you’re concerned about aggression in yourself or a loved one living with schizophrenia, talk to a psychiatrist (a medical doctor who specializes in mental health conditions). They can help you understand how to monitor and manage these risk factors.

Most people with schizophrenia who are getting effective treatment and aren’t misusing drugs or alcohol aren’t likely to be violent.

Warning Signs of Possible Aggression

There’s no sure way to know if someone will show verbal or physical aggression. This is the case for most people, whether they have schizophrenia or not. Still, certain signs may suggest that there’s an increased risk of aggressive behavior.

One risk factor is an early history of aggression. Some people who became aggressive later in life were diagnosed as kids with conduct disorder — a condition linked to trouble following rules and to acting out or hurting others. This may mean that they didn’t learn how to manage emotions or recognize other people’s feelings by looking at their faces. Having conduct disorder also raises the risk of being mistreated, including later in life.

Other signs to look out for include:

• Using or misusing alcohol or drugs
• Having hallucinations (seeing visions or hearing voices that aren’t actually there) that involve a voice or entity telling someone to do harm
• Feeling paranoid or fearful without a valid reason
• Talking about hurting people, especially in specific detail
• Focusing on aggression, death, or violent behavior
• Getting access to weapons or ways to hurt others
• Talking about feeling afraid or in danger
• Having a history of violence or aggression
• Experiencing new symptoms of psychosis or developing symptoms of schizophrenia for the first time
• Stopping or skipping treatment

If you notice any of these signs in yourself or someone you care for, contact a mental health professional or another healthcare provider right away.

They can offer treatment and support to help reduce aggressive behavior and keep everyone safe.

Management of Aggression Related to Schizophrenia

There are several ways to help manage aggression in people diagnosed with schizophrenia. The most important step is to get effective treatment — and stick with it. If you or a family member is following a treatment plan but still experiencing aggression, it may be time to change medications. Some medications may help reduce aggressive episodes. Antipsychotic medications and psychosocial options, such as therapy, may help.

Avoiding alcohol and drugs is another key step. If an individual has a substance use disorder, treating that condition can help lower their risk of aggression.

If you’re living with someone who is acting aggressively, you can take action in the moment to help calm the situation. You may have to use these techniques before getting medical help or making treatment changes. You can try:

• Giving the person extra physical space — Step away or leave the room or home to avoid an unsafe confrontation.
• Staying calm and supportive — Speak in a steady, clear, and gentle voice, and don’t confirm or challenge what they say or believe to be real.
• Getting help — Call a local mental health crisis team or 911 if there’s a risk of violence.

If you’re concerned about safety, including the risk of self-harm or violence, or any mental health or substance abuse crisis, call or text 988 to reach the Suicide and Crisis Lifeline. Support is available for free at any time of day, seven days a week.

Talk to a Doctor if You’re Concerned About Aggression

If you or a loved one is showing signs of aggression related to schizophrenia — or you’re worried it might happen — it’s important to talk with a mental health professional. They can do a risk assessment to help determine if someone with schizophrenia is in danger of being aggressive. A healthcare provider who is trained and skilled at understanding this mental health condition can help ease your worries and ensure that the person with schizophrenia gets the treatment and support they need.

They can also help if you or your loved one has been a victim of aggression or violence. You don’t have to handle these situations alone. Your healthcare team can provide the support you need to heal and stay safe in the future.

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