Guidance for Working With a Patient Who Elicits Fear in the Psychiatrist
Abstract
While it is clear that most societal violence is not due to mental illness, there is conflicting evidence regarding whether mental illness itself increases violence risk.1 Nonetheless, variables associated with mental illness, particularly substance abuse, have been shown to be predictors of violence.1 As such, psychiatrists do treat individuals at risk of violence and are at times themselves at risk. The rate of nonfatal violent crime against mental health professionals is more than 5 times that for all occupations.2 While underreporting of assaults seems prevalent, more than one-third of psychiatrists report having been physically assaulted at least once, and psychiatrists in training seem particularly vulnerable.2 This article provides guidance to psychiatrists and other mental health clinicians regarding working with a patient who evokes anxiety and fear in the clinician regarding their own physical safety or the safety of others. This may involve overt aggression or violent behavior, explicit or implicit threats of violence, or stalking behaviors. The encounter with a patient who elicits fear can be immediate, such as an extremely agitated patient in an inpatient unit, or fear can emerge over time, such as when a psychiatrist is treating an individual as an outpatient who they fear could harm them despite the absence of evidence of imminent risk. This guidance provided in this article applies to both types of encounters. While psychiatrists experience anxiety and fear…
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