Clinical Assessment of Dangerousness: An
Overview of the Literature
LINDA PAGANI AND GEORGES-F. PINARD
“I think you have to define for yourself the word 'danger' and then having decided that in your mind, you go see the patient and look for it with every conceivable means that you have at your command, and if you wind up not knowing something, you ought to say so. This is a complex business”
(John A. Ordway in Rappeport, 1967) (p. 53)
In spring 1965, this was in reply to audience demands for a definition of dangerousness at the first panel discussion ever held on the topic at a meeting of the American Psychiatric Association. Almost a decade after the symposium proceedings were published, Steadman (1973) once again grappled with the concept of dangerousness. He offered that it represents a probability estimation that something “dangerous” will happen in the presence of an individual. In attempts to further clarify the concept, he added that dangerousness is not an inherent characteristic of a person or situation and that it does not represent a quality, but rather an attribution of a quality.
Because of such vague conceptualizations, misguided public perceptions, and the tendency to clinically overestimate violence potential, the prediction of dangerousness among persons with mental disorders has been viewed as an inherently dangerous proposition (Shah, 1975). While the risks are not underestimated, more than ever, the assessment of dangerousness has important consequences in numerous decisionmaking processes: (1) Mental health professionals remain accountable to the public and courts, for their clinical judgments regarding future violence potential of patients (Lidz & Mulvey, 1995); (2) Estimates of dangerousness represent essential components of day-to-day management of many patients (Jones, 1995); and (3) There is a duty to protect potential victims (Monahan, 1993). Hence, concerns of the new millen