Schizophrenia Aggression Toward Loved Ones: 9 Tips To Help

Despite what you may see in movies or on TV, the majority of people with schizophrenia are not violent or aggressive. In reality, people living with schizophrenia are more likely to be harmed by others than to harm someone else.

In rare cases where aggression does happen, it’s usually directed at someone close, like a family member, friend, or caregiver. These moments can be stressful for everyone involved and difficult to navigate without a clear plan.

In this article, we’ll offer nine tips for staying safe, setting healthy boundaries, and better supporting someone with schizophrenia through difficult times.

1. Know That Aggression and Violence in Schizophrenia Is Rare

Violence and aggression are not core features of schizophrenia. Most people living with schizophrenia are not violent. In fact, they are about 14 times more likely to be victims of violence than to cause it.

In a large international analysis, about 1 in 3 with schizophrenia showed some form of aggression. This includes nonviolent behaviors, like yelling or breaking objects — not just physical harm.

Other studies report aggression rates ranging widely — from about 4 percent to over 50 percent — depending on how aggression was defined, the setting, and whether the person was receiving care. Most estimates place the rate of violence between 10 percent to 15 percent, which is lower than for some other mental health disorders, including bipolar disorder and depression.

Aggressive behavior may be more likely to occur when symptoms aren’t treated or when the person with schizophrenia doesn’t take their medication as prescribed. Substance use — such as certain recreational drugs or alcohol — or experiencing high levels of stress can also raise the risk of aggression or violence.

2. Prioritize Your Safety First

If a loved one with schizophrenia becomes aggressive, your safety comes first. It’s OK to step away — even if it feels difficult or unsupportive. Taking care of your own well-being doesn’t mean you’re giving up or that you don’t care.

Know where the nearest exits are and position yourself to have a clear path to the door. If the situation escalates, leave the room momentarily. Find a safe space to wait it out until things calm down. Avoid trying to physically intervene, as this can increase the risk of harm for everyone.

If you live with or care for someone who has had aggressive episodes before, plan ahead. Make sure you have a phone nearby in case you need to call for help. It can also help to share your safety plan with a trusted friend or neighbor who can check in or assist if needed.

3. Use a Calm Voice and Body Language

When someone is showing signs of aggression, the way you speak and move can make a difference — even if they’re experiencing a psychotic episode. Try to stay calm and speak in a soft, steady voice. Use clear, simple language to help reduce tension.

Avoid yelling, arguing, or making sudden movements. Give the person plenty of space. Don’t touch them unless they ask for it or say it’s OK. Avoid direct confrontation, and keep your body relaxed to convey that you’re not a threat.

Even if you feel scared or upset, staying calm can prevent the situation from getting worse.

4. Set Clear Boundaries

Caring for someone with mental illness doesn’t mean you have to accept behavior that puts you at risk. Setting clear, respectful boundaries helps create structure and safety for both of you. You can be firm and kind at the same time.

Try to talk about boundaries when the person with schizophrenia seems more calm, aware, or open to conversation. That’s often the best time to set expectations.

You might say something like, “I care about you and want to help, but I can’t stay if you yell at me,” or “Let’s take a break and talk again when we’re both feeling calmer.”

5. Make a Safety Plan During Calm Moments

When things feel calm and stable, it’s a good time to talk about how to handle harder moments in the future. Creating a safety plan together can help everyone feel more prepared if symptoms like paranoia, agitation, or hallucinations begin to get worse.

Start by writing down early warning signs of a possible psychotic episode, such as hearing voices, becoming unusually fearful, or showing social withdrawal. You might gently ask how regularly your loved one is taking their antipsychotic medications. Skipping doses or stopping medication suddenly can often lead to more intense symptoms.

Next, make a list of what to do if things escalate. That might include who to call for support, when to contact a doctor or therapist, or when to reach out to a help line.

Having a safety plan can reduce stress — not just for the person living with schizophrenia, but for their family and care partners, too.

6. Watch for Triggers and Warning Signs

Aggression in schizophrenia is often connected to certain triggers or changes in symptoms. Learning what to look for may help you respond early and prevent the situation from becoming more serious.

Watch for early warning signs like:

• Hearing voices
• Feeling watched or paranoid
• Speaking very quickly
• Pacing rapidly
• Suddenly pulling away from others

If these symptoms are already present, look for signs that they may be getting worse than usual.

Common triggers might include stress, disruptions in daily routines, or insufficient sleep. Skipping or stopping antipsychotic medications can also be a major warning sign. Using recreational drugs or alcohol may greatly increase the risk of aggressive behavior.

7. Seek Help From a Mental Health Professional

If aggression is getting worse and seems uncontrollable, it may be a sign that your loved one’s schizophrenia treatment plan needs to change. A psychiatrist (mental health specialist) or another healthcare team member can check for changes in symptoms of schizophrenia, go over medications, and adjust the treatment plan if needed.

If someone’s current medication isn’t working well, don’t give up hope. It’s not uncommon for people with schizophrenia to try multiple different medicines or combinations before finding a good fit.

8. Know When and Where To Call for Help

If someone becomes violent and can’t regain control, it’s time to get help. Call a mental health hotline, a trusted healthcare provider, or your local mental health services.

For urgent situations, you may need to call 911. If you do, clearly explain that this is a mental health situation involving schizophrenia. Ask — politely but firmly — if there are officers available who are trained to respond to mental health situations and in de-escalation techniques.

It’s normal to feel nervous about involving the authorities. You may worry about how your loved one will be treated. These concerns are valid. But when someone’s safety is at risk — including your own — calling for help may be the best option.

Here are other supports you can reach out to:

• National Alliance on Mental Illness (NAMI) Hotline — Call 800-950-6264 or text “helpline” to 62640, Monday through Friday between 10 a.m. and 10 p.m. Eastern time.
• SAMHSA National Helpline — Call 800-622-4357 for 24-hour confidential, no-cost information about treatment referral, prevention, and recovery.
• 988 Lifeline — Call or text 988 any time of day or night for no-cost, confidential support. If someone is feeling overwhelmed or considering self-harm, trained professionals are available to listen and help connect them to care.

It’s a good idea to write these numbers down and keep them somewhere handy, like on the refrigerator, so you don’t have to go looking for them during a stressful situation. For more information or help finding local support, visit the SAMHSA website or the NAMI website.

9. Build a Long-Term Support System

Living with schizophrenia can be challenging and isolating, but no one should have to face it alone. Building a strong support system helps both the person living with schizophrenia and those who care for them.

For someone with schizophrenia, long-term support might include a treatment plan with antipsychotic medication, regular appointments with a psychiatrist, and individual or group therapy. Community-based mental health services, family therapy, occupational therapy, and psychosocial programs can also improve daily life and emotional well-being.

Support for caregivers is equally vital. Caring for someone with a mental illness can lead to burnout, stress, and sadness. Feelings of guilt, worry, or grief are common. Talking to a therapist or joining a caregiver support group can help you find resources to support your mental health and, in turn, your loved one’s.

Talk With Others Who Understand

On MySchizophreniaTeam, the site for those with schizophrenia and their loved ones, people come together to gain knowledge about this condition and share their stories with others who understand life with schizophrenia.

What does your safety plan look like? What tips do you have for others? Share your thoughts or start a conversation in the comments below.