Homicidal ideation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hafsa Ghaffar, M.B.B.S[2]

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Homicide is defined by law as, " when one human being causes the death of another" in other words when one plans , thinks and wants to harm others. In forensic law illegal homicide can range from murder and manslaughter. There is an established difference between illegal and justified homicide .Homicidal ideations can be due to a mental illness such as schizophrenia, but is not always a result of some mental health issue. Homicidal ideation is one of the psychiatric emergencies. Homicide is different from suicide, which means a person want to harm themselves rather than harming self, respectively. A patient who is suicidal might also have homicidal ideations; a risk assessment is used for diagnosing and differentiating the two.


Fire Arm Homicide

Fire arm homicide is a continuing public concern in the United states, It was the 16th leading cause of death among persons of all ages and the third leading cause among youths aged 10–19 years during 2015-2016. A firearm injury was the primary cause of death in 74% of all homicides and in 87% of youth homicides. Earlier there was a declining trend of firearm homicide with a rising trend recently within large metropolitan cities.[1]

Factitious Homicide

Homicidal ideation is often concoct by psychiatric patients in both the emergency room and inpatient settings. These patients claim to have homicidal ideation but do not actually have homicidal thoughts. They may do this for a variety of reasons, e.g. to earn attention, to compel a person or people for or against some action, or to avoid social or legal obligation for eg; temporary relief from complications of substance abuse, illicit reasons, homelessness or primarily to stay in role of patient. Such cases raise both forensic and clinical questions and reinforces the that further investigation is required to develop more sophisticated methods of detection, evaluation, and treatment of factitious disorder with psychological symptoms. [2]


Homicidal ideation is associated with serious psychiatric and behavioral problems and has important implications for offender typologies and homicidality. Numerous conditions present likely with homicidal ideation including antisocial personality disorder (2406%), schizoaffective disorder (1821%), borderline personality disorder (1557%), paranoid personality disorder (1,504%), schizophrenia (1,143%), obsessive-compulsive personality disorder (921%), brief psychotic disorder (771%), unspecified psychosis (737%), avoidant personality disorder (596%), and schizoid personality disorder (571%), delusional disorder (546%), and other psychotic disorder (504%).[3]

Differentiating Homicidal ideation from other Diseases

People who are homicidal have higher chances of developing other psychological conditions, this includes suicidal ideation, psychosis, delirium, or intoxication. Homicidal ideation can be differentiated from suicidal ideation. Suicidal ideation, also known as having suicidal thoughts means planning, thinking about suicide. Suicidal behavior can be specified as a spectrum that ranges from fleeting suicidal thoughts to completed suicide. It is often observed in association with depression and other mood disorders. Suicidal ideation is more common than suicide attempts or suicide death. [4]

In one study, it shows that people with schizophrenia can become violent and commit homicide. Homicidal ideation may become apparent in relation to behavioral conditions such as personality disorder (particularly conduct disorder, narcissistic personality disorder, and antisocial personality disorder). A study in Finland manifests an increased risk of violence from people who have an antisocial personality disorder, which is greater than the risk of violence from people who have schizophrenia.[8] The same study also adduces that many other mental disorders are not associated with an increased risk of violence, of note: depression, anxiety disorders, and intellectual disability.[5][6][7]

Epidemiology and Demographics

Homicide offences increased in the 1960s following a steady decline in the early 1990s in the U.S. and Western Europe however, this research addresses this phenomenon predominantly from the U.S. Less consideration has been taken to trends over time concerning homicides specifically involving intimate partners, particularly outside of the U.S. Although Wolfgang (1957) suggested classification of homicides into subtypes depending on the victim-offender relation as far back as six decades ago, there has been a long custom of treating homicide as a homogenous prototype. In other words, this negligence to classify different homicides may be a partial explanation for the lack of research on trends of intimate partner homicide (IPH). There has, however, been a recent pattern shift in which the advantage of disaggregating into meaningful subtypes is now acknowledged. Furthermore, disaggregation of homicides into subtypes improves the ability to evaluate impact on the victims and gain a refined and nuanced insight into the varying characteristics and possible signs involved.[8]

Risk Factors

A number of risk factors have been associated with homicide but no clear relations have been established. Psychiatric disorders, personality disorders, drug abuse, past history of violence could be a contributor in causing harm to others.

Risk Assessment

It is important to recognise the risk for homicidal ideation, there should be thorough investigation regarding current homicidal desire ;if the person is at risk of harming their partner, their intent, plan and means, especially past violence and protective factors. Clinicians should determine imminent risk; does the client believe that violence is a justified or normal response to situation and develop and document a collaborative intervention plan.

A questionnaire should be filled in a compassionate, supportive, client-centered environment. Questions should be asked regarding means, plans, access to means and protective factors. Analysis about past violent experiences, monitor periodically and document all necessary information.[9] [10]

Natural History, Complications, and Prognosis

No data was found regarding clinical course of homicidal ideation.


Diagnostic Study of Choice

It is believed that a psychiatric focus is central in the diagnosis of homicide as it is the behavioural end product of mental processes. However, the allocation of a psychiatric diagnosis must not be confused with that more global examination of personality functioning, which seeks to describe all of the dynamics of a given individual's behaviour patterns. Both the status of general mental functioning and the presence and impact of mental disorders must be taken into account to fully understand what leads a person to be homicidal. Certain criteria should be kept in consideration when diagnosing homicide; diagnostic patterns in a population of murderers, violence pattern, can relevant distinguishing factors be used to divide them into useful clusters based on demographics and common diagnostic patterns.[11]

History and Symptoms

  • Violence is the act of purposefully hurting someone and is a concerning issue amongst the youth. There could be a number of reasons that people act violently which might end up in being homicidal or suicidal.[12]
  • Individuals should be assessed for the following signs to diagnose homicide:
    • A history of violent or aggressive conduct
    • Been a target of bullying
    • Difficulty in disciplining or numerous disagreements with authority
    • Childhood abuse or neglect at the young age
    • Living in a violent home environment
    • Family or parent tolerates violence
    • A history of cruelty to animals
    • Having a parent with mental illness
    • Serious drug or alcohol use
    • Access to firearms
    • Difficulty with anger management
  • Other alarming signs could be:
    • Engaging in fights
    • Increased use of alcohol or drugs
    • Increased risk-taking conduct
    • Acute episode of major mental illness
    • Strategies to commit violence
    • Broadcasting threats or plans for hurting others
    • Obtaining or carrying a weapon

Physical Examination

Non contributory

Laboratory Findings

There is no data available on this topic.

Other Diagnostic Studies

There are no other diagnostic studies associated with this condition but thorough review for underlying mental disorders should be done.


Medical Therapy

We have limited information regarding the management of patients with homicidal thoughts. The management of such people lies within the dominions of the police force and the health care system. People with homicidal thoughts who are at high risk of acting on their ideations should be observed for help. They should be brought promptly to a place where an assessment can be made and any underlying medical or mental disorder should be treated.[13]

Primary Prevention

Studies have revealed that the interval between deciding to act and attempting suicide is as brief as 10 minutes or even less, and that persons tend not to substitute a alternate method when a highly lethal method is unavailable or difficult to access. During an acute suicidal crisis preventing access to firearm by safely storing or temporarily removing them from the home can prevent lethal damage, particularly among youths. Blocking persons convicted of or under a restraining order for domestic violence from possessing a firearm has been associated with decreases in intimate partner-related homicide, including firearm homicide. Vigilant background checks to better identify persons convicted of violent crimes or at risk for harming themselves or others might also be helpful, although these policies need further study.[1]


  1. 1.0 1.1 Kegler, Scott R.; Dahlberg, Linda L.; Mercy, James A. (2018). "Firearm Homicides and Suicides in Major Metropolitan Areas — United States, 2012–2013 and 2015–2016". MMWR. Morbidity and Mortality Weekly Report. 67 (44): 1233–1237. doi:10.15585/mmwr.mm6744a3. ISSN 0149-2195.
  2. Thompson CR, Beckson M (2004). "A case of factitious homicidal ideation". J Am Acad Psychiatry Law. 32 (3): 277–81. PMID 15515916.
  3. Carbone, Jason T.; Holzer, Katherine J.; Vaughn, Michael G.; DeLisi, Matthew (2019). "Homicidal Ideation and Forensic Psychopathology: Evidence From the 2016 Nationwide Emergency Department Sample (NEDS)". Journal of Forensic Sciences. 65 (1): 154–159. doi:10.1111/1556-4029.14156. ISSN 0022-1198.
  4. Eronen, M; Hakola, P; Tiihonen, J (June 1996). "Mental disorders and homicidal behavior in Finland". Archives of General Psychiatry. 53 (6): 497–501. doi:10.1001/archpsyc.1996.01830060039005. PMID 8639032.
  5. Asnis, Gregory; Kaplan, Margaret; Hundorfean, Gabriela; Saeed, Waheed (June 1997). "Violence and homicidal behaviors in psychiatric disorders". The Psychiatric Clinics of North America. 20 (2): 405–425. doi:10.1016/S0193-953X(05)70320-8. PMID 9196922.
  6. Walsh, Elizabeth; Buchanan, Alec; Fahy, Thomas (2002). "Violence and schizophrenia: examining the evidence". British Journal of Psychiatry. 180 (6): 490–495. doi:10.1192/bjp.180.6.490. PMID 12042226.
  7. Eronen, M; Hakola, P; Tiihonen, J (June 1996). "Mental disorders and homicidal behavior in Finland". Archives of General Psychiatry. 53 (6): 497–501. doi:10.1001/archpsyc.1996.01830060039005. PMID 8639032.
  8. Caman, Shilan; Kristiansson, Marianne; Granath, Sven; Sturup, Joakim (2017). "Trends in rates and characteristics of intimate partner homicides between 1990 and 2013". Journal of Criminal Justice. 49: 14–21. doi:10.1016/j.jcrimjus.2017.01.002. ISSN 0047-2352.
  9. Bland RD, Clarke TL, Harden LB (February 1976). "Rapid infusion of sodium bicarbonate and albumin into high-risk premature infants soon after birth: a controlled, prospective trial". Am J Obstet Gynecol. 124 (3): 263–7. doi:10.1016/0002-9378(76)90154-x. PMID 2013.
  10. "Basic Homicide Risk Assessment - Dustin K MacDonald".
  11. Yarvis RM (1990). "Axis I and Axis II diagnostic parameters of homicide". Bull Am Acad Psychiatry Law. 18 (3): 249–69. PMID 2245242.
  12. Warning signs of youth violence. https://www.apa.org. https://www.apa.org/topics/physical-abuse-violence/youth-warning-signs. Published 2021. Accessed July 14, 2021.
  13. Kuehn, John; Burton, John (1969). "Management of the College Student with Homicidal Impulses—The "Whitman Syndrome"". American Journal of Psychiatry. 125 (11): 1594–1599. doi:10.1176/ajp.125.11.1594. PMID 5776871

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