Homicides committed by delusional patients in the early 20th and 21st centuries: A study conducted in a French secure unit

Abstract

Homicides committed by delusional patients are the object of a rich scientific literature, which puts the risk of such acts occurring into perspective when analyzing the offenders’ sociodemographic and clinical characteristics. However, few articles detail the themes and mechanisms underlying those patients’ delusions. To help bridge that gap, the authors conducted this retrospective descriptive study, including two samples of delusional homicidal patients, one from near present day and one from nearly a century ago. This study considered similarities observed in the literature (such as patients’ sociodemographic profile, clinical data, and acting‐out dynamics), but also explored the characteristics of delusion. In the 2015–2019 sample, the typical patient profile was: single male (31.5 years old on average), without child, unemployed, and with psychiatric history (56.6%). Most patients suffered from schizophrenic disease (83%) with non‐systematized delusions exhibiting multiple themes in 80% of cases. Four principal types of delusion were observed: persecutive (100%), mystical (43.3%), megalomaniac (30%), and bodily (30%). The mechanisms were interpretative, hallucinatory, and intuitive. There was a societal influence in 23.3% of the cases (most often terrorist acts). The 1910–1914 historical sample revealed several differences: patients were older, more often married and employed. There were more diagnoses of chronic delusional disorder (30%). Persecutory delusion was constant (100%), and the other delusional themes were the “intimate relationship” type (50%)—jealousy, erotomanic—and the bodily type (40%). Additional studies are useful in order to reinforce our findings, and to further investigate the possibilities of prevention.

Guilty or not guilty by reason of insanity? a comparative study of murderers referred for psychiatric examination by court order

“…In the NGRI group, the main motive was paranoid delusions which, in some cases, appeared in combination with hallucinations. As three of the murderers said in their psychiatric examination, “it was either me or him/them.” Paranoid delusions as a main motive is consistent with other studies (Provoost et al, 2022 ). In the guilty group a variety of motives were reported, primarily revenge, jealousy, response to their wife’s intention to leave them, and economic problems.…”

Homicides committed by women with mental disorders: A descriptive study conducted in a French secure unit

“…When considering the persecutory delusions, we identified three different contexts in which the act occurred: an experience of imminent death, an experience of threat and psychic intrusion, or the impression of being controlled by an external force. In all these cases, the homicidal act appeared to be related to a struggle for survival [36].…”

“…Female homicide perpetrators with mental illness also appear to be young (average age [34][35][36][37][38], often unemployed (40%-60%), and more likely to have been married (66%) than their male counterparts [24,[29][30][31]. A history of physical or sexual abuse in childhood is also often found, as well as domestic violence in adulthood [29].…”

Primary and Secondary Prevention in Delusional Disorder

“…80 Poor or pervasive mental health in a community is a mental health concern because this can lead to widespread disability and mortality, as well as become an economic concern. 81 It is, of course, a cause of major personal and family distress. Prevention, therefore, addresses public and individual health and quality of life.…”

“…80 Delusional disorder (DD) is considered a schizophrenia-related disorder, and, by implication, a severe mental illness associated with disability and suicide, sometimes homicide. 81 It is an understudied disorder, which is why we chose to review the literature pertaining to its primary and secondary prevention.…”