Four Keys of Threat Analysis

Predatory vs Affective Violence

Affective violence is something most people are familiar with. A bar fight or shoot-out after a brawl is one example (high adrenaline). Another type of violence, called predatory violence, is calm, planned and involves a low level of autonomic activity. This is the type of violence seen in targeted attacks such as mass shootings, terrorism and assassinations. I have developed four keys of threat analysis to guide mental health providers.

Fixations

Humans develop fixations that we count on for success. Finishing college, remodeling a house, raising an infant or planning a vacation, requires focus. Some might say they become "obsessed" with researching a vacation spot or new kitchen ideas. In another scenario, let's say your uncle believes in conspiracy theories (9/11 was a government plot, JFK was assassinated by the mob, the moon landing was a hoax, etc.) You might joke that he is "delusional."

The use of such terms, obsession and delusion are part of our socially accepted vernacular. However, for threat assessment and management, mental health professionals must embrace the proper definitions of delusion, obsession and extreme overvalued belief when conducting a comprehensive assessment.

Let's say an individual is determined to pose a danger to themselves or others. A comprehensive history is gathered, which includes culturally relevant information (for example, religious rituals or political views might be perfectly normal and misunderstood by outsiders). In threat assessment, we now categorize threats using four keys: 1) psychotic delusions 2) extreme overvalued beliefs 3) obsessions and 4) addictive/ behavioral issues. Each category demands a tailored response for mitigation.

Key 1: Psychotic Delusions

Psychotic delusions are fixed, false and idiosyncratic marking a detachment from reality. These unshakable beliefs, resistant to reason or evidence, often stem from severe mental illnesses like schizophrenia, bipolar disorder with psychosis, depression with psychosis, or drug-induced psychosis. An individual might, for example, believe that they are under constant surveillance or that their neighbor intends to harm them. The distorted reality can drive violent actions, necessitating immediate intervention. It should be remembered that most of these individuals have other cardinal symptoms such as hallucinations, behavioral disorganization, and speech disorganization, etc.

Most people with schizophrenia are victims, not perpetrators of violence and pose a low threat to the mainstream public. However, persecutory delusions ("I have to stop my neighbor who is a space alien from destroying the Earth.") or religious delusions ("Satan is in my children and should be stopped.") are associated with a higher risk of harm to others, usually family or acquaintances. Law enforcement can help secure weapons and mental health professionals can provide further care, such as administering antipsychotic medication and arranging hospitalization.

Key 2: Extreme Overvalued Beliefs

Unlike delusions, extreme overvalued beliefs are shared and reinforced within groups, often rooted in ideology, religion, or cultural narratives. This forensic definition was derived from neuroscientist Carl Wernicke's work on overvalued ideas (1892). Though not delusional, these beliefs are held with such fervor that they can justify harmful actions (terrorist attacks, school shootings, assassinations, riots or mass murders). For instance, anti-government terrorist Timothy McVeigh detonated a homemade fertilizer bomb, killing 168 people in Oklahoma City. Members of Al-Qaeda flew passenger jets into buildings on 9/11, killing nearly 3,000. Members of ISIS recently plotted an attack against Taylor Swift's concerts in Austria.

School shooters and assassins also have extreme overvalued beliefs. Thomas Crooks relished Lee Harvey Oswald's tactics. School shooters intensely study and become mesmerized by prior shooters-- a shared, macabre ideology. Parkland, Florida shooter, Nikolas Cruz posted "I am going to be a professional school shooter" six months before carrying out his attack. It is important to note that suicide can be part of an extreme and cult-like subculture such as martyrdom. Many attackers, including school shooters kill themselves or know they might be killed.

Warning Behaviors

Attacks from extreme overvalued beliefs are part of an ideological framework, meaning they are shared by others of the same ilk. Professional instruments such as the Terrorism Radicalization Assessment Protocol (TRAP-18) developed by Reid Meloy, PhD can be helpful. Perpetrators often belong to depraved online subcultures and receive their inspiration from prior killers.

Terms such as fixation, identification, leakage, pathway, last resort and changes in thinking and emotion are a few examples of what professional threat assessments evaluate. They must determine whether a threat warrants further monitoring, making an arrest, or intervening with mental health strategies. Such intervention strategies may include securing weapons with law enforcement, disrupting plots, obtaining a comprehensive history and making a treatment plan.

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Assassins and Their Fixations

Mental health professionals may be engaged to treat co-occurring issues such as mood disorders, substance use disorders and to provide guidance through psychotherapy. These are analogous treatments to eating disorders (also an overvalued idea) that can help alter pathological identities. Some radicalized individuals have been known to totally change their identities and are productive members of society, while others are determined to have crossed the line and are charged criminally.

Key 3: Threats due to Obsessions

Obsessions are intrusive, unwanted thoughts causing significant anxiety and distress. Unlike delusions or extreme overvalued beliefs, individuals usually recognize their obsessions as irrational but struggle to control them. These thoughts might manifest as a fear of harming others, even without any intent to act on them. Though typically posing a low risk of harm to others, rare cases can lead to harmful behaviors. Treatment involves cognitive-behavioral therapy (CBT) and sometimes medications or deep brain stimulation in refractory cases to manage obsessive thoughts and reduce anxiety. Most of these individuals want their symptoms stopped or slowed down as they can be quite disabling.

Key 4: Threats due to Behavioral Issues/ Substance Use

The goal here is to break harmful cycles and support healthier impulse management. Addictive behaviors and issues like substance use, domestic violence, stalking, paraphilias, and personality disorders (e.g. psychopathy) pose distinct threats. These often result from poor impulse control, intense emotions, and harmful behavioral patterns. Substance use disorders, for instance, can lower inhibitions and escalate violence and suicide risk. Addressing these involves personalized care and may include securing weapons, medication assisted treatment, behavioral therapy, and sometimes legal measures, like incarceration or probation, are the only answer.

Precision Threat Assessment

Understanding four threat analysis categories—psychotic delusions, extreme overvalued beliefs, obsessions, and addictive/behavioral issues is vital for effective threat assessment and intervention. Each forensic category presents unique challenges and requires specific strategies to prevent violence. By recognizing these differences and tailoring our approaches, we can better protect individuals and communities from potential harm. We can also help the legal system and the public a better understanding of what is driving an individual's violent behavior.