Psychiatry has struggled to clarify the types of mental turmoil that are associated with mass violence. While the problem is complex, it may present an opportunity to improve research, as well as inform public dialogue about what types of mental illness are actually associated with such mass tragedies.
Assuring the diagnostic accuracy of those who commit mass violence is challenging due to the retrospective nature of the analysis and lack of reliable psychiatric data. Psychiatric research has begun to use a dimensional approach that may be well suited to the study of mental illness in perpetrators of mass violence. This approach aggregates psychiatric symptoms into 3 domains of psychopathology: (1) internalizing, (2) externalizing, and (3) psychotic experience. This approach has practical clinical use and research support. A dimensional approach may help clear up misconceptions about the rate of psychosis in mass violence perpetrators, as well as reveal the most common dimensions of mental functioning associated with perpetrators.
Conclusions and Relevance
Improved research methods are needed to clarify and prevent mass violence. More precisely identifying the symptoms and mental turmoil of perpetrators may be associated with improved early identification and prevention. Because adolescence is a critical and formative period in which internalizing and externalizing problems arise, early interventions may have the best chance of reducing future mass violence.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: October 4, 2022.
Published Online: December 14, 2022. doi:10.1001/jamapsychiatry.2022.4191
Corresponding Author: James Knoll IV, MD, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210 (email@example.com).
Conflict of Interest Disclosures: Dr Dietz reported personal fees from Park Dietz & Associates, Inc (serving as president) and the Threat Assessment Group, Inc (serving as founder and president), as well as past service as the president of the American Academy of Psychiatry and the Law outside the submitted work. Dr Knoll reports being the president of the American Academy of Psychiatry and the Law outside the submitted work. No other disclosures were reported.
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