Violence in bipolar disorder

Bipolar disorder is associated with a high prevalence of childhood trauma as well as with the possibility of aggressive and potentially violent behavior. It is important for clinicians to assess a patient's potential for violence as accurately as possible to minimize risk. Taking historical and clinical information into account, such as violence history, substance abuse, childhood trauma, and impulsivity in addition to mood symptoms can help clinicians reach an accurate assessment. Handling emergencies and treating mood episodes pharmacologically are first steps in managing risk; this should be followed up with treating substance abuse and trait impulsivity and with involving significant others and teaching coping skills. Recognizing the impact of early trauma on a patient can help improve the therapeutic alliance and lead to better treatment outcomes.