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It is well-established and beyond dispute that some individuals diagnosed with personality disorders are predisposed to offend violently [1]. But what is it about personality disorder (PD) that predisposes such individuals to violence? Personality disorders are not alone in predisposing to violence, which has been found to be linked to a range of other mental disorders, including schizophrenia (odds ratio 7.4) [2], bipolar disorder (odds ratio 5.8) [3], and depression (odds ratio 3.0) [4]. In reviewing the functional link between PD and violence, Duggan and Howard [5] gave the example of a patient who meets criteria for both narcissistic and paranoid PDs, has multiple (DSM-IV) Axis I conditions including substance use and post-traumatic stress disorder (PTSD) and is prone to violence. They ask: “Does one give precedence to a blow to the individual’s selfesteem (narcissism), or to a suspiciousness of the motives of others (paranoid traits), his or her substance abuse or the activation of PTSD symptoms in explaining his or her violent behaviour?” (p.25). In other words, which condition has causal primacy in determining the links between mental disorder and violent behavior?

Emotional Impulsiveness: A Link to Violent Criminality in the Personality Disordered?