Homicidal ideation
Encyclopedia
Homicidal ideation is a common medical term
for thoughts about homicide
. There is a range of homicidal thoughts which spans from vague ideas of revenge to detailed and fully formulated plans without the act itself. Many people who have homicidal ideation do not commit homicide. 50-91% of people surveyed on university grounds in various places in the USA admit to having had a homicidal fantasy
. Homicidal ideation is common, accounting for 10-17% of patient presentations to psychiatric facilities in the USA.
Homicidal ideation is not a disease itself, but may result from other illnesses such as psychosis
and delirium
. Psychosis, which accounts for 89% of admissions with homicidal ideation in one US study, includes substance induced psychosis
(e.g. amphetamine psychosis
) and the psychoses related to schizophreniform disorder
and schizophrenia
. Delirium
is often drug induced or secondary to general medical illness(es) (see ICD-10 Chapter V: Mental and behavioural disorders
F05).
It may arise in association with personality disorder
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.
. 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
al beliefs or command hallucination
s, the feeling of being controlled by an outside force, the belief that other people wish to harm him or her, the perception of rejection
or humiliation
at the hands of others, being under the influence of substances or a past history of antisocial personality disorder
, frontal lobe
dysfunction or head injury
. If a person has access to drugs
, alcohol
, or weapon
s at home, their risk of homicidal ideation or violence is increased.
, psychosis
, delirium
, or intoxication. It is well established that people with schizophrenia
have an increased risk of committing violent acts, including homicide.
Homicidal Ideation may arise in relation to behavioural conditions such as Personality Disorder
(particularly Conduct disorder
and Antisocial personality disorder
). A study in Finland shows 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 illnesses 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
, greed/lust
or even fear
and self defence prompt homicidal thoughts and actions in the majority of cases. In a minority of cases there are homicides and violence related to mental illness. These homicides and fantasies do not seem to have the same underlying triggers as does homicide within the normal population, 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.
or Factitious disorder
.
have been proposed to explain the phenomenon of homicidal ideation or homicide
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
. A brief synopsis of theories specific to homicide follows.
Medical terminology
Medical terminology is a vocabulary for accurately describing the human body and associated components, conditions, processes and process in a science-based manner. Some examples are: R.I.C.E., trapezius, and latissimus dorsi. It is to be used in the medical and nursing fields...
for thoughts about homicide
Homicide
Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...
. There is a range of homicidal thoughts which spans from vague ideas of revenge to detailed and fully formulated plans without the act itself. Many people who have homicidal ideation do not commit homicide. 50-91% of people surveyed on university grounds in various places in the USA admit to having had a homicidal fantasy
Fantasy (psychology)
Fantasy in a psychological sense is broadly used to cover two different senses, conscious and unconscious. In the unconscious sense, it is sometimes spelled "phantasy".-Conscious fantasy:...
. Homicidal ideation is common, accounting for 10-17% of patient presentations to psychiatric facilities in the USA.
Homicidal ideation is not a disease itself, but may result from other illnesses such as psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
and delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
. Psychosis, which accounts for 89% of admissions with homicidal ideation in one US study, includes substance induced psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
(e.g. amphetamine psychosis
Amphetamine psychosis
Stimulant psychosis is a psychotic disorder that appears in some people who use stimulant drugs. Most commonly, stimulant psychosis occurs in drug abusers who take very large doses but, in rare cases, it can also present in patients taking therapeutic doses under medical supervision...
) and the psychoses related to schizophreniform disorder
Schizophreniform disorder
Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of the time within a one-month period, but signs of disruption are not present for the full six months required for the diagnosis of schizophrenia.The symptoms of both...
and schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. Delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
is often drug induced or secondary to general medical illness(es) (see ICD-10 Chapter V: Mental and behavioural disorders
ICD-10 Chapter V: Mental and behavioural disorders
- Organic, including symptomatic, mental disorders :* Dementia in Alzheimer's disease* Vascular dementia** Multi-infarct dementia* Dementia in other diseases classified elsewhere** Dementia in Pick's disease...
F05).
It may arise in association with personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
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.
Violence risk
Homicidal ideation is noted to be an important risk factor when trying to identify a person's risk for violenceViolence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
. 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
Deferred gratification
Deferred gratification and delayed gratification denote a person’s ability to wait in order to obtain something that he or she wants. This intellectual attribute is also called impulse control, will power, self control, and “low” time preference, in economics...
, impairment or loss of reality testing, especially with delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
al beliefs or command hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, the feeling of being controlled by an outside force, the belief that other people wish to harm him or her, the perception of rejection
Social rejection
Social rejection occurs when an individual is deliberately excluded from a social relationship or social interaction. The topic includes both interpersonal rejection and romantic rejection. A person can be rejected on an individual basis or by an entire group of people...
or humiliation
Humiliation
Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It can be brought about through bullying, intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have...
at the hands of others, being under the influence of substances or a past history of antisocial personality disorder
Antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
, frontal lobe
Frontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
dysfunction or head injury
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....
. If a person has access to drugs
Psychoactive drug
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
, alcohol
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
, or weapon
Weapon
A weapon, arm, or armament is a tool or instrument used with the aim of causing damage or harm to living beings or artificial structures or systems...
s at home, their risk of homicidal ideation or violence is increased.
Associated psychopathology
People who have homicidal ideation are at higher risk of other psychopathology than the normal population. This includes suicidal ideationSuicidal ideation
Suicidal ideation is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts...
, psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
, or intoxication. It is well established that people with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
have an increased risk of committing violent acts, including homicide.
Homicidal Ideation may arise in relation to behavioural conditions such as Personality Disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
(particularly Conduct disorder
Conduct disorder
Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated...
and Antisocial personality disorder
Antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
). A study in Finland shows 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 illnesses 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
Jealousy
Jealousy is a second emotion and typically refers to the negative thoughts and feelings of insecurity, fear, and anxiety over an anticipated loss of something that the person values, particularly in reference to a human connection. Jealousy often consists of a combination of presenting emotions...
or revenge
Revenge
Revenge is a harmful action against a person or group in response to a grievance, be it real or perceived. It is also called payback, retribution, retaliation or vengeance; it may be characterized, justly or unjustly, as a form of justice.-Function in society:Some societies believe that the...
, greed/lust
Lust
Lust is an emotional force that is directly associated with the thinking or fantasizing about one's desire, usually in a sexual way.-Etymology:The word lust is phonetically similar to the ancient Roman lustrum, which literally meant "purification"...
or even fear
Fear
Fear is a distressing negative sensation induced by a perceived threat. It is a basic survival mechanism occurring in response to a specific stimulus, such as pain or the threat of danger...
and self defence prompt homicidal thoughts and actions in the majority of cases. In a minority of cases there are homicides and violence related to mental illness. These homicides and fantasies do not seem to have the same underlying triggers as does homicide within the normal population, 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 Factitious 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, eg. 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) - malingeringMalingering
Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation ; avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences;...
or Factitious disorder
Factitious disorder
Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...
.
Theories
A number of theoriesTheory
The English word theory was derived from a technical term in Ancient Greek philosophy. The word theoria, , meant "a looking at, viewing, beholding", and referring to contemplation or speculation, as opposed to action...
have been proposed to explain the phenomenon of homicidal ideation or homicide
Homicide
Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...
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
Criminology is the scientific study of the nature, extent, causes, and control of criminal behavior in both the individual and in society...
. A brief synopsis of theories specific to homicide follows.