Empirical evidence of a relationship between insight and risk of violence in the mentally ill — A review of the literature

Lack of insight has established itself both as an important element of models of risk of violence and as a clinical item in structured approaches to measuring risk of violence. The main purpose of this paper is to delineate findings from a review of the literature concerning the empirical basis for the existence of a relationship between insight and violence risk. A second aim is to examine whether certain dimensions of insight may have a higher violence-triggering potential, and, if so, to learn more about valid and reliable approaches for measuring these dimensions. Results of this review show that there are very few empirical studies that demonstrate a possible association between insight and violence risk. Five out of a total of nine investigations found a positive relationship between poor insight and violent behavior. Nonetheless, the strength and specific nature of the relationship remain unclear due to considerable methodological and conceptual shortcomings in the reviewed studies. Seven recommendations for future research are presented to address these shortcomings.