Gender Differences and Risk Factors for Violent Behavior in Bipolar Disorder: a Systematic Review

• In Event: Gendered Risk

Abstract

Bipolar Disorder (BD) is commonly associated with aggressive behaviors, particularly during manic episodes, contributing to the stigma of the "violent bipolar patient." However, recent research indicates that aggressive acts can also occur in patients in remission, and the literature on this topic remains inconclusive. This review examines the prevalence of aggression in BD, focusing on gender differences, comorbidities, and the social context in which these behaviors occur. A systematic search of multiple databases (PubMed, EMBASE, Scopus, PsycINFO, Cochrane) identified five studies that met the inclusion criteria. Results show that while aggression is more frequent in BD patients compared to the general population, it is influenced by factors such as substance use, psychotic symptoms, and lack of insight. Aggression during manic episodes is typically impulsive and affective, while depressive states are more linked to premeditated, altruistically motivated violence. Additionally, aggression during euthymia is rare and often associated with co-occurring conditions. Gender differences were observed, with males showing higher aggression, particularly during euthymia, although this was not always statistically significant. The review also highlights the role of substance use in exacerbating aggression, with substance use disorders increasing the likelihood of violent behavior, especially in criminal contexts. Studies on homicide suggest that violence in BD patients differs by mood state, with manic episodes more likely to involve impulsive acts towards strangers, and depressive episodes often associated with intrafamilial violence. Overall, while aggression is more common in BD, it is not a defining feature of the disorder. Early diagnosis, personalized treatment strategies, and addressing substance use are crucial to mitigating aggressive behaviors and reducing the stigma surrounding BD.

Authors

• felicia stefani, Università Vita-Salute San Raffaele, Milano (MI)

• marta ballabio, Università Vita-Salute San Raffaele, Milano (MI)

• sebastiano busseni, Università Vita-Salute San Raffaele, Milano (MI)

• francesco attanasio, Università Vita-Salute San Raffaele, Milano (MI)