Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III)

Psychiatry Res. 2018 Apr:262:384-392. doi: 10.1016/j.psychres.2017.09.012. Epub 2017 Sep 13.


A combined history of violence toward self and others has been reported in clinical and incarcerated populations. Psychiatric disorders have been implicated as risk factors. This study examines the lifetime prevalence of this combined violence in the general population and its associations with DSM-5 psychiatric disorders in comparison with other- and self-directed violence. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were analyzed, including 36,309 U.S. adults ages 18 and older. Violent behavior was defined by suicide attempts; recurrent suicidal behavior; gestures, threats, or self-mutilating behavior (self-directed); and multiple items of violence toward others (other-directed) in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression examined these violence categories in association with sociodemographics and lifetime DSM-5 psychiatric disorders. Results show that approximately 18.1% of adults reported violent behavior, including self-directed only (4.4%), other-directed only (10.9%), and combined self- and other-directed violence (2.8%). DSM-5 psychiatric disorders significantly associated with the violence typology include alcohol, tobacco, cannabis, and other drug use disorders; mood disorders; posttraumatic stress disorder; and schizotypal, antisocial, and borderline personality disorders. Findings extend the clinical literature regarding the co-occurrence of self- and other-directed violent behaviors to the general population.

Keywords: DSM-5 psychiatric disorders; NESARC–III; National Epidemiologic Survey on Alcohol and Related Conditions–III; Suicidal behavior; Violence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol-Related Disorders / epidemiology*
  • Alcohol-Related Disorders / psychology
  • Comorbidity
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / psychology
  • Middle Aged
  • Prevalence
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / psychology
  • Suicide, Attempted / statistics & numerical data*
  • Surveys and Questionnaires
  • United States / epidemiology
  • Violence / psychology
  • Violence / statistics & numerical data*
  • Young Adult