Vol. 5, No. 3, 1999 Page 6

Violence: detecting its causes is critical

Doctors dealing with violent patients need to conduct thorough evaluations to rule out both common violence-causing disorders such as schizophrenia and substance abuse, and more rare disorders of the brain, psychiatrist Kenneth Tardiff cautions. Among the disorders that Tardiff notes can lead to bizarre and violent behavior:

Brain tumors. Tardiff cites the example of a teenager who began having temporal lobe seizures and "developed personality changes with aggressive behavior, emotional tension, and withdrawal." Doctors attributed his behavioral problems to his disruptive home life. Eventually, the boy developed depression and paranoid delusions. At age 19, he was hospitalized in a coma, and died shortly afterward. While performing his autopsy, doctors found the cause of his behavior changes: an astrocytoma (tumor) in the right hippocampus.

Brain infections. A good example, Tardiff says, is herpes simplex encephalitis, which "produces rage attacks, together with severe language deficits and memory loss and bizarre eating patterns, such as eating bedding and feces."

Toxins. Tardiff cites the case of a cat owner who applied a tick powder containing carbaryl to his cat twice a day for a month. The man first noticed a change in the cat, which became highly aggressive. When he mentioned this to a friend, Tardiff says, "his friend pointed out that he too had undergone a personality change," his once mild-mannered mood replaced by constant rage. The friend noted that the man had become verbally abusive to other people, and was physically abusing his cat. The man discontinued the use of the tick powder, and within a week, both he and his cat were back to normal.

Tardiff notes that exposure to organophosphate and carbamate insecticides "can produce irritability, paranoia, and violence, and exposure in animals... produces aggressive display and killing behavior."

Thyroid disorders. One case outlined by Tardiff involved a 31-year-old merchant seaman who had had most of his thyroid gland removed years earlier because of hyperthyroidism. He took thyroid medications, but was unable to obtain his medicine for several months. He became depressed and began suspecting that his shipmates were planning to rape him, and one night he stabbed a shipmate to death. When placed back on his thyroid medication, the man recovered fully from his delusions and hallucinations. A jury found him not guilty by reason of insanity.

Other disorders that can cause violence, Tardiff says, include Wilson's disease, Huntington's disease, hyperparathyroidism, vitamin deficiencies, limbic encephalitis, and sleep disorders. He notes that while these diseases generally present with clear-cut medical and neurological symptoms, "occasionally psychiatric symptoms may present alone with the aggression and violence, which points out the importance of complete medical psychiatric evaluations of patients who present with recent histories of violent behavior."


"Unusual diagnoses among violent patients," Kenneth Tardiff, Psychiatric Clinics of North America, Vol. 21, No. 3, September 1998, pp. 567-576. Address: Kenneth Tardiff, Department of Psychiatry, Cornell University Medical College, Box 140, 525 East 68th Street, New York, NY 10021.

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