A biopsychosocial model of violence when sleepwalking: review and reconceptualisation

Abstract

Summary: Violence towards others during sleepwalking is relatively uncommon, but can result in serious injury or even death. Much of the research in this field has focused on the forensic consequences of violence during sleepwalking without sufficient attention to an understanding of the risk factors for violence during sleepwalking and the development of prevention and interventions based on these risk factors. This paper reviews the characteristics of impulsive violence in general and reconceptualises violence during sleepwalking as an extension of this prior vulnerability. We propose a biopsychosocial model of the risk for violence during sleepwalking that is supported through a review of empirical literature both within sleepwalking and violent behaviour more generally. Biological, psychological and social risk factors are hypothesised to mediate the relationship between sleepwalking and violence. Implications for prevention and treatment of this potentially fatal problem are discussed.

Declaration of interest: None.

Copyright and usage: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Fig. 1. Initiation and modulation of impulsive violence during sleepwalking. Shaded variables showed the pathway for impulsive violence while awake. Unshaded variables are related to sleepwalking violence. Dashed arrows are normal pathways that modulate violence not available during sleepwalking.