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STUDY: Manic Symptoms Linked to Specific Criminal Acts

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psych-services-jan-coverIndividuals with bipolar disorder are “more than twice as likely as the general population to commit violent crimes and nearly five times as likely to be arrested, jailed or convicted of an offense other than drunk driving,” authors of a new study on the association between manic symptoms and criminal acts report.

Thirteen percent of the individuals studied who were diagnosed with bipolar I reported “legal involvement” during their most severe manic episode,” according to “Prevalence of Involvement in the criminal justice system during severe mania and associated symptomatology” (Psychiatric Services, Jan. 2012). “Legal involvement” was defined as being arrested, held at a police station or jailed.

The figure undoubtedly understates the actual number of impacted people who become "justice-involved" when manic because the study excluded individuals in prisons and jails – 100% of whom have "legal involvement" – or hospitals. It also looked only at individuals during their most severe manic episode.

Nonetheless, for those of us living or working with severe mental illness, the findings provide some insight into risk factors for arrest during mania.

Risk of legal involvement increased with symptoms of “increased self-esteem or grandiosity, increased libido, excessive engagement in pleasurable activities with a high risk of painful consequences, having six or more criterion B manic symptoms and having both social and occupational impairment.” Being a male with a first episode of mania at 23 or younger also increased risk.

Risk was lower among people with hypertalkativeness or pressured speech. The authors speculate this may be because manic periods characterized by these symptoms tend to be briefer (no more than two weeks). “(L)egal involvement in this group may have been less frequent at least in part because there was less time for it to occur,” they wrote. The symptom of distractibility during mania halved the likelihood of becoming involved with the criminal justice system.

A dual diagnosis of substance abuse and bipolar further increased the risk of criminal justice involvement during mania: Individuals who were abusing drugs or alcohol during manic episodes were eight times more likely than those with bipolar alone to have been involved with law enforcement and six times more likely than the general public to have committed a violent act.  

The authors – all affiliated with the University of Massachusetts Medical School Department of Psychiatry – concluded that “routine evaluation of patients for these high-risk symptoms, particularly among those with other risk factors for criminal justice problems, seems prudent.” By identifying those most at rest to end up involved with law enforcement and intervening early, they said, “the myriad adverse outcomes that follow criminal justice involvement of persons with serious mental illness” could be prevented.

We agree, of course, with this conclusion. Prevention of the consequences of non-treatment is what assisted outpatient treatment (AOT) is all about.

For tips on responding if your loved one is in psychiatric crisis, including a manic episode, visit our Get Help section. 

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