There is a recent study out concluding that those with borderline pd are just as likely to demonstrate other-directed aggression as they are to demonstrate self-directed aggression, due to their traits of high impulsivity and inappropriate, extreme anger, which then impact and diminish the capacity for empathy:

"Serial Murder:
Ansevics and Doweiko21 studied 11 serial killers through a detailed retrospective analysis. All of these subjects had experienced a significant loss around age 5, the majority had grown up in violent homes, and murder seemed to be a “working through” process and/or an attempt to adjust to internal and external demands. The authors concluded from their investigation that serial killers do not represent a subtype of antisocial personality disorder, but rather a subtype of borderline personality disorder."


"...empirical evidence indicates that individuals with borderline personality disorder may exhibit physical violence toward partners, physical violence toward known but nonintimate individuals, criminal behaviors that embody externalized violence (e.g., property damage), and, on very rare occasion, murderous behavior (either of family members or anonymous others through serial killing). Given this under-researched area, there are probably other types of externalized aggressive behaviors that have not been empirically revealed. However, externalized aggressive behaviors in individuals with borderline personality disorder clearly exist and need to be assessed in both psychiatric and primary care settings in an effort to promote safety of medical personnel and effective patient management."

There is an interesting article at "Mother Jones" that details all the serial murder incidents (and spree murders or mass murders) in the US over the last 30 years (including weapons used, and there is an article at Wikipedia breaks down the motives of serial killers into categories; both of these articles seem to be well-researched.

The theory that sounds the most plausible to me is that it takes a combination of a Cluster B personality disorder PLUS a psychotic disorder to produce either a serial murderer or mass murderer. Just one or the other isn't enough, it takes the rage, paranoia and "grudge collecting" of a Cluster B pd plus the break with reality of psychosis to provide all the factors needed to turn revenge fantasies into hideous reality.

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