Summary: Researchers propose a new forensic term to help classify non-psychotic behavior driven by extreme beliefs that can lead to criminal violence.
Source: University of Missouri School of Medicine.
Researchers propose a clearer definition for non-psychotic violent behavior
In the wake of high-profile violent incidents such as mass shootings, the public and media often assume a link to mental illness. After analyzing the 2011 case of Norwegian mass murderer Anders Breivik, researchers at the University of Missouri School of Medicine suggest a new forensic term to describe non-psychotic behavior driven by rigid, dangerous beliefs. Their aim is to improve how forensic psychiatrists and legal systems distinguish between psychotic disorders and other causes of severe violent acts.
Tahir Rahman, M.D., an assistant professor of psychiatry at the MU School of Medicine and the study’s lead author, explains that extreme beliefs can sometimes resemble psychosis to observers and evaluators. “When these tragedies occur, people want to understand why,” he said. “Violence is often assumed to be the consequence of psychotic mental illness, but that is not always accurate. Our work on the Breivik case highlights how strongly held ideological beliefs can be misinterpreted as psychosis, and it proposes a term that more precisely captures this form of non-psychotic motivation.”
On July 22, 2011, Anders Breivik detonated a bomb in Oslo and later carried out a mass shooting on the island of Utøya, killing 77 people. He claimed affiliation with a fictional “Knights Templar” and said his actions were intended to defend Europe against multiculturalism. Two court-appointed psychiatric teams examined Breivik. The first team diagnosed paranoid schizophrenia, while a second team later found no evidence of psychosis and diagnosed narcissistic personality disorder. Breivik was ultimately sentenced to 21 years in prison.
Rahman, who conducts forensic psychiatric evaluations though he was not involved in the Breivik assessment, says the case illustrates an important challenge: some individuals endorse extreme ideological beliefs so intensely that they come to justify violence, yet their behavior does not stem from psychosis. To address this, the researchers introduce the term “extreme overvalued belief.”
According to Rahman, an extreme overvalued belief is a conviction shared by others or embedded in a subculture that the individual amplifies, defends vigorously, and emotionally relishes. The person demonstrates an intense emotional commitment to the belief and may take violent action because of it. While the individual may have other psychiatric conditions, the belief itself and the resulting actions are not attributable to insanity or psychosis.
Forensic evaluations and legal standards for insanity vary, and courts often lack a consistent method to determine when mental illness, rather than non-psychotic ideological conviction, explains a defendant’s actions. Rahman believes adopting the term extreme overvalued belief will help forensic psychiatrists and legal professionals better identify motive and mental state when sanity is in question.
The researchers call for further study into how extreme overvalued beliefs develop and what factors increase vulnerability. “Certain psychological factors may predispose individuals to develop dominant, amplified beliefs,” Rahman said. “Amplification can also happen through internet communities, group dynamics, or following charismatic leaders. These social mechanisms can intensify and normalize dangerous ideas, making individuals more likely to justify and commit violence.”
Prevention efforts could benefit from recognizing this risk. Rahman notes that public health messaging has long warned youth about the risks of substance use, unsafe sex, and smoking; he argues that education and awareness programs should also address the risk of radicalization into extreme overvalued beliefs and the potential for resulting violence. Early identification of at-risk individuals and targeted interventions could reduce the number of violent acts motivated by such beliefs.
Funding and conflicts of interest
Research reported in this publication was supported by the University of Missouri School of Medicine and the MU Department of Psychiatry. The researchers reported no conflicts of interest related to this study.
Source and original research
Jeff Hoelscher – University of Missouri School of Medicine
Original research: “Anders Breivik: Extreme Beliefs Mistaken for Psychosis” by Tahir Rahman, Phillip J. Resnick, and Bruce Harry, published in the Journal of the American Academy of Psychiatry and the Law (online May 23, 2016).
Abstract
The case of Anders Breivik, who committed mass murder in Norway in 2011, presented a controversial challenge for forensic mental health experts. His manifesto and self-references, including calling himself a “Knights Templar,” raised questions about possible psychosis. Beliefs that precede unusual or extremely violent behavior present a unique problem for forensic evaluators. Although psychotic disorder is often invoked to explain such beliefs, the concept of an overvalued idea—which has received limited attention in some psychiatric contexts—may better capture certain cases. The authors review definitions of delusion and overvalued ideas and introduce the term “extreme overvalued belief” to help forensic evaluators better conceptualize rigid, shared ideological beliefs that can lead to violence.