Do you know a Killer?

Jeffrey Dahmer. Ted Bundy. John Wayne Gacy. Jack the Ripper. They are all serial killers, but they are not psychotic. Far too often, people misinterpret a sociopath or psychopath and someone who has a psychotic disorder (Schizophrenia). Although the mental health stigma has decreased in certain aspects, there are still some components that are difficult for those outside of the field to understand. This may not be a typical “fun fact,” but profiling and understanding the psyche is always fascinating.

So, let’s begin! A psychopath is usually diagnosed with both Antisocial and Narcissistic Personality Disorders. Those diagnosed with Antisocial, have a reckless disregard for the safety of self or others, is impulsive, deceitful, irritable and aggressive, irresponsible, and is unable to conform to societal norms. In order to be diagnosed with APD, individuals must be at least 18-years of age and diagnosed with Conduct Disorder prior to age 15. Falling under the diagnosis of Conduct Disorder, a child would show three of the following: aggression to people or animals, destruction of property, deceitfulness or theft, and a serious violation of rules. The behavior must also cause a disturbance within their environment.

To be diagnosed with Narcissistic Personality Disorder, an individual would have five or more of the following: a grandiose sense of self, preoccupied with status, believes that he or she should only associate with those of a higher status, requires excessive amounts of admiration, has a sense of entitlement, takes advantage of others, lacks empathy, is envious or believes others are envious of him or her, and is arrogant. The reason most individuals have both disorders are because they need to have the charm and grandiose sense of worth along with the aggression and disregard for others in order to lure victims.

Similar to other diagnoses, individuals might have characteristics of the disorders, but not meet full criterion for the diagnosis. For example, many CEOs have characteristics of Narcissistic Personality Disorder, but that doesn’t mean they are going to be a serial killer. Sex offenders also fall into these categories. In order to help determine someone’s risk, there are two assessments that can be completed, the PCL-R and the VRAG. The PCL-R is the Psychopathy Checklist Revised and the VRAG is the Violence and Risk Appraisal Guide. Don’t worry, I’m not going to get into the full details of the assessments as I know that can be draining.

Now that we have established the background of a serial killer, let’s look at psychosis. Most people are able to recognize the extreme components of psychosis, like paranoia or visual hallucinations. However, as a clinician, not all of those who are paranoid or have visual hallucinations are considered psychotic. I realize that sounds ridiculous, but think about it. Some paranoia is justified. For instance, if someone walks into a restaurant and never sits with their back to the door or if they feel someone is talking about them. Paranoia to that degree does not classify as psychotic because it could be learned behavior or anxiety. Visual hallucinations that are not considered psychosis, would be a child having an imaginary friend or if people believe in seeing ghosts. It is all about context.

Psychosis is determined by someone presenting with the following: delusional thinking, hallucinations, disorganized or nonsensical speech, grossly disorganized or catatonic behavior, or by a flattening affect, empty replies, or unable to participate in goal oriented activities. Delusional thinking can be considered erotomanic (implying someone else is in love with the individual), grandiose (having a great talent, insight, or made a significant discovery), jealous type (spouse or lover is unfaithful), persecutory (the person is being conspired against that must be remedied by legal action), or somatic (bodily function or sensation). Hallucinations are visual or auditory, but can also be command. Command hallucinations indicate the visualizations or voices tell him or her to hurt or kill themselves or others. Even if someone has a command hallucination, they might not have a history of violent behavior or have responded to the command.

Although psychosis looks simple on paper, understanding it can be difficult. Not every individual who displays psychotic behavior demonstrates all of the above criterion. It is essential to examine the extent of the bizarre behavior to make a true determination. In addition, usually a psychotic break will occur in the early 20’s. At times, it can be exacerbated by trauma or a history of schizophrenia in the family. There are also many reasons one might display said behavior outside of the normal age range. For instance, if someone doesn’t sleep for days at a time or it could be induced by a substance. In the geriatric population, psychosis can occur if there is a urinary tract infection that has been left untreated or dementia.

To sum up the difference, having a personality disorder is ingrained within you; whereas, psychosis, can subside with medication and by utilizing coping skills. Similar to all mental health needs, the only person that can change his or her behavior, is the individual themselves. Like any change in behavior, it is essential to determine triggers. Once identified, next steps can be outlined. So, the next time you watch a Netflix documentary on a serial killer or a TV series that has someone with schizophrenia, you can recognize key ingredients and have a little more insight into their psyche.