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Homicidal ideation is a common medical term for thoughts about
homicide Homicide occurs when a person kills another person. A homicide requires only a volitional act or omission that causes the death of another, and thus a homicide may result from accidental, reckless, or negligent acts even if there is no inten ...
. There is a range of homicidal thoughts which spans from vague ideas of revenge to detailed and fully formulated plans without the act itself. Most people who have homicidal ideation do not commit homicide. 50–91% of people surveyed on university grounds in various places in the United States admit to having had a homicidal
fantasy Fantasy is a genre of speculative fiction involving Magic (supernatural), magical elements, typically set in a fictional universe and sometimes inspired by mythology and folklore. Its roots are in oral traditions, which then became fantasy ...
. Homicidal ideation is common, accounting for 10–17% of patient presentations to psychiatric facilities in the United States. Homicidal ideation is not a disease itself, but may result from other illnesses such as
delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
and
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
. Psychosis, which accounts for 89% of admissions with homicidal ideation in one US study, includes substance-induced
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
(e.g.
amphetamine psychosis Stimulant psychosis is a mental disorder characterized by psychotic symptoms (such as hallucinations, paranoid ideation, delusions, disorganized thinking, grossly disorganized behaviour) which involves and typically occurs following an overdose or ...
) and the psychoses related to schizophreniform disorder and
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
.
Delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
is often drug induced or secondary to general medical illness(es). It may arise in association with
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s or it may occur in people who do not have any detectable illness. In fact, surveys have shown that the majority of people have had homicidal fantasies at some stage in their life. Many theories have been proposed to explain this.


Diagnosis


Violence risk

Homicidal ideation is noted to be an important risk factor when trying to identify a person's risk for
violence Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or Power (social and p ...
. This type of assessment is routine for psychiatric patients or any other patients presenting to hospital with mental health complaints. There are many associated risk factors which include: history of violence and any thoughts of committing harm, poor impulse control and an inability to delay gratification, impairment or loss of reality testing, especially with
delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
al beliefs or command hallucinations, the feeling of being controlled by an outside force, the belief that other people wish to harm them, the perception of rejection or humiliation at the hands of others, being under the influence of substances or a history of
antisocial personality disorder Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard of, or violation of, the rights of others as well as a difficulty sustaining long-term relationships. Lack ...
, frontal lobe dysfunction or head injury.


Associated psychopathology

People who have homicidal ideation are at higher risk of other
psychopathology Psychopathology is the study of abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biological psychopatholo ...
than the normal population. This includes
suicidal ideation Suicidal ideation, or suicidal thoughts, means having thoughts, ideas, or ruminations about the possibility of ending one's own life.World Health Organization, ''ICD-11 for Mortality and Morbidity Statistics'', ver. 09/2020MB26.A Suicidal ideatio ...
,
psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
,
delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
, or intoxication. In one study, it shows that people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
have an increased risk of committing violent acts, including homicide. Homicidal ideation may arise in relation to behavioural conditions such as
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
(particularly
conduct disorder Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckles ...
,
narcissistic personality disorder Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, a diminished ability or unwillingness to empathize with other ...
and
antisocial personality disorder Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard of, or violation of, the rights of others as well as a difficulty sustaining long-term relationships. Lack ...
). A study in Finland showed an increased risk of violence from people who have antisocial personality disorder, which is greater than the risk of violence from people who have schizophrenia. The same study also cites that many other mental disorders are not associated with an increased risk of violence, of note: depression, anxiety disorders and intellectual disability. Homicidal ideation may arise in people who are otherwise quite well, as is demonstrated by the fact that the greater majority of people within the general population have had homicidal fantasies. When triggering factors are sought regarding homicidal fantasies the majority seem to be linked in some way to the disruption of a couple relationship. Either jealousy or
revenge Revenge is committing a harmful action against a person or group in response to a grievance, be it real or perceived. Francis Bacon described revenge as a kind of "wild justice" that "does... offend the law ndputteth the law out of office." Pr ...
, greed/
lust Lust is a psychological force producing intense desire for something, or circumstance while already having a significant amount of the desired object. Lust can take any form such as the lust for sexuality (see libido), money, or power. It can ...
or even
fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...
and
self-defense Self-defense (self-defence primarily in Commonwealth English) is a countermeasure that involves defending the health and well-being of oneself from harm. The use of the right of self-defense as a legal justification for the use of force in ...
prompt homicidal thoughts and actions in the majority of cases. In a minority of cases, homicides and acts of violence may be related to
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
. These homicides and fantasies do not seem to have the same underlying triggers as those by people without a mental disorder, but when these trigger factors are present the risk for violence is greater than usual. People who present with homicidal ideation also have a higher risk of suicide. This shows the need for an assessment of suicide risk in people with thoughts of violence towards others.


Spurious and fictitious homicidal ideation

Sometimes people claiming to have homicidal ideation do not actually have homicidal thoughts but merely claim to have them. They may do this for a variety of reasons, e.g. to gain attention, to coerce a person or people for or against some action, or to avoid social or legal obligation (sometimes by gaining admission to a hospital) — see malingering or factitious disorder.


Theories

A number of
theories A theory is a rational type of abstract thinking about a phenomenon, or the results of such thinking. The process of contemplative and rational thinking is often associated with such processes as observational study or research. Theories may be s ...
have been proposed to explain the phenomenon of homicidal ideation or
homicide Homicide occurs when a person kills another person. A homicide requires only a volitional act or omission that causes the death of another, and thus a homicide may result from accidental, reckless, or negligent acts even if there is no inten ...
itself. Many of these theories seem to overlap. They often are not mutually exclusive. At present no single theory explains all the phenomena noted in homicide, although many theories go some way to explaining several areas. Most of these theories follow the reasoning of theories studied in
criminology Criminology (from Latin , "accusation", and Ancient Greek , ''-logia'', from λόγος ''logos'' meaning: "word, reason") is the study of crime and deviant behaviour. Criminology is an interdisciplinary field in both the behavioural and so ...
. A brief synopsis of theories specific to homicide follows.


Homicide adaptation

This is the most recent of evolutionary theories. It claims to explain most of the phenomena associated with homicide. It states that humans have evolved with adaptations that enable us to think of and/or plan homicide. We come up with the idea as a possible answer to our problem position (threat to ourselves, our mate or our resources) and include a range of thought processes regarding killer and victim (degree of relatedness, relative status, gender, reproductive values, size and strength of families, allies and resources) and the potential costs of making use of such a high penalty strategy as homicide. If homicide is determined to be the best solution strategy, then it might be functional.


By-product hypothesis ("slip up")

According to this hypothesis, homicide is considered to be a mistake or over-reaction. Normal psychological mechanisms for control of property, partner or personal safety may not appear to be sufficient under certain stressful circumstances and abnormal mechanisms develop. Particularly extreme expressions of this may occur leading to homicide where in the normal state the perpetrator would not behave in this manner.


Management

Not much information is available regarding the management of patients with homicidal thoughts. In Western countries, the management of such people lies within the realms of the police force and the health system. It is generally agreed upon that people with homicidal thoughts who are thought to be at high risk of acting them out should be recognized as needing help. They should be brought swiftly to a place where an assessment can be made and any underlying medical or mental disorder should be treated.


References


External links


Deadly Dreams
- Analysis of homicidal ideation in school shooters. (
Scientific American ''Scientific American'', informally abbreviated ''SciAm'' or sometimes ''SA'', is an American popular science magazine. Many famous scientists, including Albert Einstein and Nikola Tesla, have contributed articles to it. In print since 1845, it i ...
, 1 August 2007) {{Medical resources , DiseasesDB = , ICD10 = {{ICD10, X, 85, , x, 85 , ICD9 = {{ICD9, E960 , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , eMedicine_mult = Medical terminology Homicide