From dangerousness to risk assessment of community violence: taking stock at the turn of the century.

This article focuses on a history of ideas-the history of the last quarter century, in which great advances have occurred in the reshaping of the concept of dangerousness while, at the same time, disappointingly little has happened to improve the abilities of frontline clinical decision-makers to make violence risk assessments. We are now operating in a fundamentally changed environment in the three core areas of research, clinical practice, and law as a result of evolving thinking and new data, shown in the following ways. (1) Risk assessment concepts and associated research models have altered the focus to probabilistic thinking and ideas of graduated interventions as opposed to the Yes-No, In-Out dichotomies formerly associated with the concept of dangerousness. (2) Likewise, it has become clear that dangerousness is a legal and not a medical concept, in which the actual clinical corollary is risk of future violent behavior. (3) The accuracy of psychiatric assessments of future violent behavior is limited, but it may increase for specific subgroups within specified time frames and locations.