Psychiatric Annals

CME 

Rampage Murderers, Part I: Psychotic Versus Non-Psychotic and a Role for Psychiatry in Prevention

C. Ray Lake, MD, PhD

Abstract

Mass murders are horrific tragedies that gain intense media coverage; they do not seem rare any more. In the U.S., there have averaged 20 mass rampages a year since 1976. Of all killers, in general, only a modest percentage (5%–10%) are psychotic; however, among rampage mass murderers, a substantial percentage are likely psychotic since they often kill in numbers under bizarre circumstances, slaughtering innocent victims, including children. Although psychotic rampage murderers often kill at random, their mental health professionals, their families, and their friends are at high risk for violence, even homicide. Psychotic killers differ substantially from non-psychotic killers, but there are complex and overlapping motivations involving terrorism, anger, revenge, intoxication, and a desire for notoriety, all of which can be tinged with varying degrees of psychosis and challenge diagnostic categorizations.

Of the 1,400 incidents of rampage murders found in the literature, 23 were selected for discussion within this article. Four of these 23 cases were motivated by terrorism, four were primarily motivated by anger and/or revenge, and 15 resulted from psychotic, delusional thinking. There is overlap in event characteristics and among motives in several of these cases.

Prevention must be the primary goal. It is unlikely that gun control alone will be effective. Since nearly 50% of psychotic mass murderers had some contact with a mental health professional prior to their rampages, more effective methods of intervention may be possible, focusing on behavioral threat assessment and risk mitigation. An appreciation of how psychotic perpetrators differ from non-psychotic killers and their characteristics may contribute.

Abstract

Mass murders are horrific tragedies that gain intense media coverage; they do not seem rare any more. In the U.S., there have averaged 20 mass rampages a year since 1976. Of all killers, in general, only a modest percentage (5%–10%) are psychotic; however, among rampage mass murderers, a substantial percentage are likely psychotic since they often kill in numbers under bizarre circumstances, slaughtering innocent victims, including children. Although psychotic rampage murderers often kill at random, their mental health professionals, their families, and their friends are at high risk for violence, even homicide. Psychotic killers differ substantially from non-psychotic killers, but there are complex and overlapping motivations involving terrorism, anger, revenge, intoxication, and a desire for notoriety, all of which can be tinged with varying degrees of psychosis and challenge diagnostic categorizations.

Of the 1,400 incidents of rampage murders found in the literature, 23 were selected for discussion within this article. Four of these 23 cases were motivated by terrorism, four were primarily motivated by anger and/or revenge, and 15 resulted from psychotic, delusional thinking. There is overlap in event characteristics and among motives in several of these cases.

Prevention must be the primary goal. It is unlikely that gun control alone will be effective. Since nearly 50% of psychotic mass murderers had some contact with a mental health professional prior to their rampages, more effective methods of intervention may be possible, focusing on behavioral threat assessment and risk mitigation. An appreciation of how psychotic perpetrators differ from non-psychotic killers and their characteristics may contribute.

Between 5% and 10% of all murder victims are killed by psychotic killers.1–4 In support of the 10%, one report stated that each year in the U.S. about 1,600 homicides, among the some 16,000 total, are committed by the seriously mentally ill.4 To put this statistic in perspective, it has been estimated that approximately 3.3% of the U.S. population (309 million), or about 10 million people, suffer from severe mental illness. It is estimated that some 14% of these perpetrate violence within a given year.3,4 Between 40% and 50% of these individuals are untreated and are thus more likely to be subject to and to perpetrate violence, including suicide, homicide, and mass murder. Regarding only mass murderers and excluding wars, terrorism, and gang violence, the majority of the adult perpetrators are psychotic.5,6 It has been said that, “While most of these folks [the severely mentally ill] will remain law-abiding citizens, enough of them will make headlines with an act of violence so that failing to find a way to treat them isn’t just a public health crisis, but a public safety one too.”3 Understanding what motivates rampage killers to act is relevant to prevention.

In an effort to simplify, several motives may stand alone or overlap to explain mass killings in general: 1) war, terrorism, and gang violence; 2) anger, jealousy, and revenge; 3) “copycat” efforts to gain media attention; and 4) psychotic thinking that includes grandiose and paranoid delusions. About half of the psychotic rampage murderers were identified with histories of serious mental health problems before their rampages, with “… either a hospitalization, a prescription for psychiatric drugs, a suicide attempt, or evidence of psychosis.”4 More than 50% of the mass killers had warned or threatened specific violence, but neither significant others (family, friends, teachers), law enforcement officials, nor mental health professionals acted effectively. This is partially explained by our prioritization of individual freedoms over public safety, making the commitment process challenging. Correct diagnosis of psychotic patients with a risk for violence is critical for maximally effective treatment and efforts at prevention. This is addressed in Part II, to follow.7

Psychotic Versus Non-Psychotic Killers

In general, the behaviors of psychotic killers differ from those of non-psychotic killers. For instance, psychotic killers act alone, they can kill in numbers; the victims are innocent, seemingly chosen at random and may include children; they usually kill during daylight; they do not try to escape the murder scene; nearly half commit suicide after the rampage or are shot dead by others (ie, “suicide by cop”) at a rate of 10 times the rate recorded after all homicides;8 and they are not intoxicated, radicalized, or members of a gang. Additionally, they are typically older, Caucasian, and educated but unemployed males; and upon media scrutiny of the past histories of psychotic killers, a deterioration in overall function, often episodically, is usually found, accompanied by other periods of productivity, sometimes exceptional.9–13 Psychotic perpetrators have a bizarre personal, delusional, paranoid, grandiose, psychotic logic and motive for their attacks, and psychotic killers often give warnings of their carefully considered plans (about 63% of the time),2 but the decision to act can seem “spur-of-the-moment” (Table 1). Psychotic killers think they are making the best choice to kill, even though they realize their actions are illegal. This characteristic can exclude an insanity plea; mental health professionals recognize that psychotic (insane) killers can make detailed plans and know they are committing illegal but, in their minds, necessary acts. Many believe they must kill to achieve some delusional, grandiose greater good, such as preventing a global disaster, killing the devil, or sparing loved ones more torture on Earth. Examples are the delusional motives of Carey,14–16 Shoop (likely depression with psychotic features),17 Ciancia,18–20 Alexis,21–26 Zawahiri,27 Quick,28–31 Holmes,11,12 Breivik,32,33 Loughner,34–38 Cho,39 Barbarin,40–42 Duy,41,43 Hinckley,44 Whitman (motive complicated by brain tumor),45 and possibly Lanza.46–48 (Tables 2, 3, and 4) In the case of Hinckley, his grandiose motive was to gain the attention and love of actress Jodi Foster by killing the President of the United States, and for Whitman, it was to spare his wife, mother, and potentially his other victims from suffering any longer on this Earth by shooting them from the University of Texas Tower, Austin, TX. Psychotic killers do not recognize that their reasoning and motivations are based on the paranoid and grandiose delusions that are part of their severe mental illness and not reality. Based on forensic psycholinguistic analysis of the killers’ writings, there is a continuum of the degree of severity of paranoia across mass murderers.6

Psychotic Versus Non-Psychotic Murderers

Table 1.

Psychotic Versus Non-Psychotic Murderers

Summary Of Mass Rampage Murderers: Psychotic PerpetratorsSummary Of Mass Rampage Murderers: Psychotic Perpetrators

Table 2.

Summary Of Mass Rampage Murderers: Psychotic Perpetrators

Summary Of Mass Rampage Murderers: Terrorist Perpetrators

Table 3.

Summary Of Mass Rampage Murderers: Terrorist Perpetrators

Summary Of Mass Rampage Murderers: Revenge and Anger Perpetrators

Table 4.

Summary Of Mass Rampage Murderers: Revenge and Anger Perpetrators

Acts of terrorism such as the murders in Nairobi;49 London;50–53 Boston;54 and Ft. Hood, TX,55 as well as those murders motivated primarily by anger and revenge, such as in Reno, NV,56 Arapaho57,58 and Columbine59 High Schools, and possibly Newtown, CT,46–48 can cloud distinctions between criminal and psychotic behaviors.3 Confusing terrorist and psychotic motivations are assertions that some terrorist leaders suffer with psychotic mental disorders.60 Mental illness and psychosis are likely more contributory when the act is based upon paranoid and grandiose delusions, is planned well ahead, when drugs and alcohol are not involved, and when the event ends with suicide. There is a spectrum of overlap of psychotic delusions with achieving notoriety, a terrorist goal, and/or revenge to explain motivation. For example, the motivations of Lanza in Newtown, CT,24 Ciancia at Las Angeles International Airport,18–20 Loya of Kansas City, KS,61,62 and Duy40,41,43 and Barbarin,40–42 both of Utah, likely include mixtures of psychosis, anger/revenge, and, in some cases, desire for attention.

Psychotic Mental Illness: Increased Risk for Violence and Homicide

Mental health advocacy groups and many mental health professionals have argued that violence perpetrated by mentally ill individuals is no greater than that carried out by the non-mentally ill population. Studies on this subject area have focused on schizophrenia, and early conclusions have varied. In 2006, the National Institute of Mental Health (NIMH) stated, “… people with schizophrenia are not especially prone to violence … most individuals with schizophrenia are not violent … they are withdrawn and prefer to be left alone. … Most persons with schizophrenia do not commit violent crimes.”63 However, as early as 1990, using the Epidemiologic Catchment Area Study, Swanson et al.64 reported that the incidence of violence was five times higher among people with serious mental illnesses such as schizophrenia, major depression, and bipolar disorder and 10 to 16 times higher among persons with alcohol or substance use disorders compared to people without a diagnosis of a mental disorder. Marzuk65 reported results from studies that involved more than 300,000 persons and concluded that the link between violence “… appears strongest for the severe mental illnesses, particularly those involving psychosis. … It is increased by the use of alcohol and other psycho-active substances. … In the last decade, the evidence showing the link between violence, crime, and mental illness has mounted. It cannot be dismissed; it should not be ignored.”36 In 2009, another systematic review and meta-analysis of schizophrenia and violence included 20 individual studies reporting data from 18,423 individuals diagnosed with schizophrenia and other psychoses. Conclusions stated that, “Schizophrenia and other psychoses are associated with violence … particularly homicide,” especially when accompanied by paranoid, persecutory delusions; command auditory hallucinations; and substance abuse.1,2,66 Yet another meta-analysis found that “… psychosis is the most important predictor of violent behavior in an analysis of 204 studies….”76 Otto68 and Scott and Resnick69 reviewed the evaluation and management of psychotic patients’ risk of violence. They concluded that, “Clinicians need to be familiar with aspects of persecutory delusions and command auditory hallucinations that are associated with an increased risk of aggression.”

Additional reviews have focused on mass murders committed by psychotic perpetrators. For example, The New York Times published an article that included 100 cases perpetrated by mentally ill killers.1,2 Criteria for inclusion were: 1) multiple victims, 2) at least one died, 3) all occurred substantially at one time, 4) all occurred in a place where people gather. Exclusion criteria included killings that were a result of domestic strife, robbery, serial killings, war, and political terrorism. Cases were limited to those that occurred within the United States during the previous 50 years (between 1950 and 2000). Twenty episodes occurred at schools, 11 at restaurants or shopping malls, and 32 at the killers’ workplace; 425 victims were killed and 510 were injured. Mother Jones provided a review of 62 cases of mass murder between 1982 and 2012.70 A search from Wikipedia of rampage killers provided 1,259 episodes that have occurred around the world.71 Lake13 reviewed 33 cases. There are redundancies across these reviews. Knoll and Meloy5,6 have substantially contributed to our understanding of mass murderers.

A challenge is to determine who is at high risk for injury and which psychiatric disorder most likely accounts for these rampage murders; more discussion on this topic can be found in Part II, also in this issue.7

Who Is At Risk For Violence From Psychotic Perpetrators?

Although rampage killers often kill at random, putting the general public at some risk, some specific groups are at an especially high risk. The psychotic individuals themselves are at the highest risk for death at their own hands or by law enforcement or others. Psychiatrists, other mental health workers, and the psychotic perpetrators’ families and friends are also at high risk of violence, injury, and murder. “According to the Department of Justice National Crime Victimization Survey for 1993 to 1999, the annual rate for nonfatal violent crime for all occupations was 12.6 per 1,000 workers. For physicians, the rate was 16.2, and for nurses it was 21.9. But for psychiatrists and mental health professionals, the rate was 68.2 [per 1,000 workers], and for mental health custodial workers, 69.”72 For example, in Bethesda, MD, on September 3, 2006 (the day before Labor Day), Dr. Wayne Fenton, a psychiatrist and expert in schizophrenia from the NIMH, agreed to see on an emergency basis his recently new 19-year-old patient, Vitali Davydov. Mr. Davydov beat Dr. Fenton to death with his fists saying that he had killed Fenton in self-defense. He was “afraid that Fenton was about to sexually assault him.” Mr. Davydov was psychotic.72

The Vancouver Sun73 reported the occurrence of “… more than 130 murders and murder-suicides across Canada since 1997 [through 2002], in which mental illness played a prominent role … particularly schizophrenia. Psychiatric patients are assaulting and murdering their loved ones at an alarming rate, with family members the victims in three out of four killings committed by the mentally ill…”73 Of the 108 killings that were unequivocally attributed to psychotic mental illness, more than 95% of the victims were either related to their killers by blood or marriage, or were friends, neighbors, employers, employees, roommates, or fellow residents of an apartment or rooming house. Twenty-seven of the victims were parents or grandparents.73

Suicide, “Suicide by Cop,” and Lethal Over-Reaction by Law Enforcement Against the Mentally Ill

According to the Centers for Disease Control and Prevention, nearly 20,000 of the 30,000 deaths from guns in the U.S. in 2010 were suicides. Suicidal acts with guns were fatal in 85% of cases versus just 2% in overdose cases.74 Further, suicide rates are said to be increasing rapidly among middle-aged Americans, with a rise of 28% during the last decade.75 According to another report, however, public mass shootings declined in the 1990’s but seemed to increase again in 2010.8 Meloy5 reported that the incidence of psychotic mass murders in the U.S. is about 20 per year, and that this figure has remained stable since 1976. More than half of the psychotic mass killers committed suicide or “suicide by cop.” (Tables 2, 3, 4, and 5) Most but not all rampage killers used firearms, of which approximately 75% were obtained legally. Suicide among this group indicates severe mental illness, with the rampage sometimes prompted by a perception — likely delusional — of being mistreated, disrespected, or persecuted.8

Epidemiology of Mass Rampage Killers Motivated by Psychosis, Anger/Revenge, or Terrorism

Table 5.

Epidemiology of Mass Rampage Killers Motivated by Psychosis, Anger/Revenge, or Terrorism

“Suicide by cop” is a relatively new term that can be confused with lethal overreaction by law enforcement in cases of mentally ill victims. One media report noted that, “In April [2013], a man suffering from terminal cancer walked into an Illinois police station and pointed a replica gun at an officer, who shot him. The man, who survived, had a note in his pocket that apologized to officers and said he ‘couldn’t do the deed himself.’… A 10-year study in California of shootings by deputies in Los Angeles County revealed that 13% of officer-involved justifiable homicides could be classified as suicide by cop. … ‘Their [the perpetrators] actions are designed to force us to protect ourselves…so they can commit suicide.’”76 Recently, the Kansas City, MO, police averted a suicide by cop situation by shooting bean bags and a Taser. Police were sent to the man’s home around 11:45 p.m. because of a reported prowler. Dispatchers determined that the same residence had been the subject of a suicide call earlier and notified officers in route to the scene. At the house the man ignored officers’ commands to drop his knife and lie on the ground. Police managed to handcuff him without injuring him and he was taken to a psychiatric hospital for evaluation. The man said, “Why didn’t you use real bullets? That’s what I was hoping for.”76 In sharp contrast, on November 16, 2013, police in Kansas City, KS, shot to death Nick Loya, a psychotic 22-year-old, single, unemployed, Caucasian male who had been smashing car windows up and down his residential street with a baseball bat. A witness said, “The officer told him to put down the bat, so he acted like he was putting down the bat. When the officer stepped to him, he swung the bat just barely missing the officer, and the other officer [fatally] shot [him] at that point.”61,62 His uncle said Loya did not sleep at all the night before his rampage and had only gotten 1 or 2 hours of sleep for the past week. He was observed by his father and uncle to be very agitated, irritable, and angry, and was pacing back and forth around the house all night. He was said to be paranoid; he thought that he was being followed and watched. Loya’s father and uncle both stated that he did not use illegal or prescription drugs and was not intoxicated. They also said Loya’s sister and mother were diagnosed with bipolar disorders.61,62

Similarly, on December 2013 in Iowa, Tyler Comstock — a 19-year-old, single, Caucasian male diagnosed with schizophrenia — got into an argument with his father and angrily drove off in his father’s truck because his father wouldn’t buy him a pack of cigarettes; his father then proceeded to call the police to intervene. After a car chase, during which Comstock reportedly ran a red light, drove erratically, and refused police orders to exit his truck, he was shot to death with seven bullets fired into his truck.77

More recently on January 7, 2014, Keith Vidal, an 18-year-old, single, Caucasian male who was diagnosed with schizophrenia, was shot to death by law enforcement in North Carolina after he had been Tasered and restrained. The officer who killed him was quoted in the media as saying, “We don’t have time for this,” just before shooting the teen dead. This article also noted two other similar incidents. In December 2013, “Police fired 15 to 20 rounds at a schizophrenic man who they mistook for drunk, killing him.” And in November 2013, “A mentally ill man carrying a shovel was gunned down by police after his mother called them [police] for help calming him down.”78

Epidemiology of the Perpetrators

There were 29 perpetrators who participated in the 23 cases discussed. These were divided into three categories according to the apparent primary motives: psychotic perpetrators (15 perpetrators, 15 cases [16 counting Lanza]); terrorists (nine perpetrators, four incidents); and anger and revenge (five perpetrators [counting Lanza] in four incidents) (Tables 2, 3, 4, and 5). Lanza fits into two motive categories: psychotic and anger/revenge. Of the 15 or 16 cases in which psychosis was the primary motive, only one perpetrator was involved in each case; their mean age was 25.1 years, with a range of 20 to 34, excluding one 70-year-old, who was considered an outlier. This is younger than the average age of rampage killers from the literature (33 years). The mean age of all killers is 27 years.79 Twelve psychotic perpetrators (including Lanza) were Caucasian, two were African-American, and two were Asian; 14 were male, two were female (one African-American and one Asian); 15 were single, and one was married. Ten (including Lanza) were unemployed (another was retired), three were employed, and three were students. All (but Holmes at the midnight movie) occurred during the day, and none tried to escape. Including Lanza in the psychotic group (motive overlaps with anger), four psychotic perpetrators committed suicide, four committed “suicide by cop,” two were shot to death by law enforcement but not deemed to be “suicide by cop,” and six were arrested (Tables 2, 3, 4, and 5).

There were four incidents in which anger and revenge seemed to dominate as motives, and psychosis was not as clearly suggested in media reports. Three were carried out by a single perpetrator and one, at Columbine High School, was carried out by two perpetrators — all during the daytime. Their mean age was 24.8 with a range of 17 to 51. All were single, Caucasian males that included three high school students; of the other two, one was employed and one unemployed (Lanza). All five perpetrators committed suicide, implicating the presence of psychotic depression.

Two cases, those of Loya and Lanza, were motivated both by anger and severe mental illness. Loya left no suicide note, and it is unlikely that he committed “suicide by cop.” Lanza, who may have also sought recognition like the Columbine perpetrators received, also committed suicide at the conclusion of his murderous rampage on site at the school where he was an alumnus.

Discussion

Strategies for prevention must be multifaceted. Although most of the attention toward prevention in the U.S. has focused on gun control, especially in preventing the seriously mentally ill from getting guns, it is clear that ample guns will remain in circulation despite the now unlikely passage of any gun control law. Additionally, firearms were not primarily used by all mass killers. Therefore, preventative strategies beyond gun control are necessary. Some responsibility for prevention may fall to mental health professionals because nearly half of the psychotic perpetrators had received mental health care prior to their rampages. Opportunities for intervention, such as involuntary commitment, are limited by our sensitivity to personal freedoms. Some believe the laws regulating commitment are too limiting and put the public at risk based on the numbers of untreated seriously mentally ill individuals who are on the streets and their propensity for violence, both upon themselves and on others. Compliance with medication is poor among potentially psychotic patients when there is only sporadic or no regular follow-up by mental health professionals. Psychotic patients discharged from inpatient settings, even after recovery or partial recovery, remain at substantial risk for perpetrating violence upon themselves and others. Twenty-seven percent of patients released from psychiatric hospitals reported at least one violent act within 4 months of their discharge.3 The Treatment Advocacy Center in Arlington, VA, advocates for mandatory assisted community treatment laws such as outpatient commitment and conditional discharge for potentially violent and psychotic patients.4

Other prevention efforts have addressed the motive of “copycat” killers’ desire for recognition, fame, or infamy. Lanza (Newtown, CT), Pierson (Arapaho High School, CO), and Shoop (New Jersey Mall) may be cited as possible examples, as they evidently knew of the media attention given to the Columbine High School rampage. According to a recent article, “… many families of [mass murder] victims and law enforcement officials have begun urging journalists and public officials to avoid using the gunmen’s names and photos in public. … Their hope is that refusing to name the actors will mute the effects of their actions and prevent other angry, troubled young men from being inspired by the infamy of those who opened fire at Columbine High School, Virginia Tech, or Newtown, CT.”80

Conclusions

Mencimer3 stated, “The cultural context of delusions blurs the line between sanity and insanity in a way that makes it difficult for people to intervene with a mentally ill individual before he blows up a federal building. Yet of all the possible solutions to such mass violence, real mental health reform holds the most promise for saving lives by ensuring that people with brain diseases get the care they need before they seek out the always easily accessible American firearm. It would be nice to see the mental health system, or what’s left of it, come up for real discussion, including serious consideration of vastly expanding mental health services, so that people like Loughner’s parents or his philosophy professor or his algebra teacher could have actually gotten him the help he needed before he killed someone.”

Increased knowledge and vigilance are necessary on the part of teachers, employers, law enforcement officials, and especially mental health professionals as to risk factors and the actions needed to get potentially psychotic murderers into protective custody. Forcing such individuals into mental health custody can be complicated and time-consuming, but the potential benefit of saving lives should override these factors. Part II of this series addresses enhanced prevention by focusing on the necessity of the correct diagnosis in potentially psychotic killers.

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Psychotic Versus Non-Psychotic Murderers

Psychotic Killers Non-Psychotic Killers
Commit 10% or less of all murders. Commit 90% or more of all murders.
Usually act alone; not member of a gang. One or more than one perpetrator working together; gang member.
Rarely try to get away; usually stay at the scene (about 90%). Almost always try to escape and flee the scene.
About 80% kill during the day. Majority kill at night.
Zero of the 102 killers from The New York Times database got away. More than 33% of non-psychotic homicides went unsolved in 1997.
About half commit or attempt suicide at the scene or later; about 10% commit “suicide by cop” (ie, are shot dead at the scene). Suicide rare; perpetrator #1 in the Boston marathon rampage (Tamerlan Tsarnaev) may or may not have committed “suicide by cop.”
Generally not intoxicated nor radicalized. Often intoxicated, radicalized, and/or addicted to violent video games, movies, or music.
Typically older (30s), Caucasian, and educated but unemployed males. More often younger (20s), non-Caucasian, and less educated.
In their past, when scrutinized, a notable deterioration in function from baseline has occurred, often episodically mixed with productive times. Criminal behavior more consistent over lifetime.
Motivations based on “out-of-touch-with-reality” delusional systems that justify murder as the best or only choice. Motivations more logical: robbery, drug trafficking, gang-related activity, or based on money, sex, jealousy, revenge, and other conflicts.
Often not sudden or random but planned with a purpose (delusional). Often spur-of-the-moment in heat of an argument.
Give warnings of plans (usually noted before rampage but not addressed by significant others). Try to hide plans.

Summary Of Mass Rampage Murderers: Psychotic Perpetrators

Name, Age, Demographics Date and Location # Killed, Injured, or Endangered Outcome Motive / Warning Psychotic Symptoms
Nick Loya (also anger), 22, Caucasian, male, single, unemployed Nov. 16, 2013 Residential neighborhood, Kansas City, KS 1 killed (perp only) Few endangered Killed by cops, not suicide by cop Psychotic, anger Warning unknown Paranoid delusions, details unknown
Richard Shoop, 20, Caucasian, male, single, employed Nov. 4, 2013 Westfield Garden State Plaza Mall, Paramus, NJ 1 killed (perp only) Hundreds endangered Committed suicide Suicide, desire for recognition Warning unknown Suicide suggests severe / psychotic depression
Paul A. Ciancia, 23, Caucasian, male, single, mechanic Nov. 1, 2013 LAX, Los Angeles, CA 1 killed 3 injured Hundreds endangered Shot and arrested, in critical condition Psychotic, anger Gave warning Delusional system about Transportation Security Administration unknown
Miriam Carey 34, African-American, female, single, unemployed Oct. 3, 2013 Capitol, Washington, D.C. 1 killed (perp only) Hundreds endangered Killed by cops, not suicide by cop Psychotic Gave warning Thought President Obama was stalking her; thought she was a prophet
Aaron Alexis, 34, African-American, male, single, computer tech Sept. 16, 2013 Navy Yard, Washington, D.C. 12 killed (plus perp) Dozens endangered Killed by cop, suicide by cop Psychotic Gave ample warning Thought Navy was targeting his brain with ELF radio waves from the Navy Yard. Grandiose and paranoid.
John Zawahri 23, Caucasian, male, single, unemployed June 9, 2013 Santa Monica, CA 8 killed (plus perp) Dozens to hundreds endangered Killed by cops, suicide by cop Psychotic Warning unknown Delusional system unknown
Dylan A. Quick, 20, Caucasian, male, single, student April 9, 2013 Lone Star College campus, Cypress, TX near Houston 14 injured Dozens endangered Arrested Psychotic Gave warning Thought he was Hannibal Lecter and had to cut off peoples’ faces to wear as masks.
Adam Lanza (also anger), 20, Caucasian, male, single, unemployed Dec. 14, 2012 Newtown, CT 28 killed plus perp Dozens endangered Committed suicide Anger, likely psychotic, desire for recognition Gave warning in call to radio talk show 1 year earlier Delusional system unknown
James E. Holmes, 24, Caucasian, male, single, unemployed July 20, 2012 Movie theatre, Aurora, CO 12 killed 58 injured Dozens to hundreds endangered Arrested Psychotic Gave some warning Thought he was “The Joker” and had to kill people. Details of delusional system that motivated him to kill, unknown.
Anders B. Breivik, 32, Caucasian, male, single, unemployed July 22, 2011 Oslo, Norway 77 killed 242 injured Hundreds endangered Arrested, sentenced to 21 years Psychotic Gave warning Thought he was future Regent of Norway; Master of Life and Death, and Europe’s most Perfect Knight since WWII; thought he had to save Norway from Islamization
Jared Loughner, 22, Caucasian, single, male, unemployed Jan. 8, 2011 Tucson, AZ; political rally for U.S. Rep Gabrielle Giffords 6 killed 13 injured Dozens to hundreds endangered Arrested, sentenced to seven consecutive life sentences Psychotic Gave warning over several years Details of political and grandiose delusional system motivating his rampage unknown except it involved a conspiracy around politics, currency, the Constitution, and grammar.
Seung-Hui Cho, 23, Asian, male, single, student April 16, 2007 Virginia Tech, Blacksburg, VA 32 killed 25 injured Hundreds endangered Committed suicide Psychotic, desire for recognition (transfixed by Columbine high school massacre) Gave warning Said he vacationed in NC with President Putin of Russia. Thought he was Jesus Christ. Threatened then-President George W. Bush, Vice President Dick Cheney, and Secretary of State Condoleezza Rice.
Sergei Barbarin, 70, Caucasian, male, single, retired April 15, 1999 LDS Family Library, Salt Lake City, UT 2 killed 5 injured Dozens endangered Suicide by cop Psychotic Gave warning Thought his son was CIA spy, but the details of his delusional reasons for his LDS Library rampage are unknown. Paranoid and grandiose.
De-Kieu Duy, 24, Asian, female, single, unemployed January 14, 1999 TV/radio station, Salt Lake City, UT 1 killed 1 injured Dozens endangered Arrested, mentally incompetent Psychotic Gave warning Thought radio station DJ was putting voices in her head. Paranoid and grandiose.
John Hinckley, Jr, 25, Caucasian, male, single, unemployed March 29, 1981 Washington Hilton Hotel, Washington, D.C. 0 killed 4 injured Dozens endangered Arrested, sentenced to St. Elizabeth’s Psychiatric Hospital Psychotic Gave warning Followed President Carter to kill him and shot President Reagan to gain the attention of Jodi Foster. Grandiose.
Charles J. Whitman, 25, Caucasian, male, married, student July 31-August 1, 1966 University of Texas Tower Austin, TX 16 killed (including unborn child) 32 injured Dozens to hundreds endangered Suicide by cop Psychotic Gave warning Thought he was saving his wife and mother from further suffering on Earth by killing them.

Summary Of Mass Rampage Murderers: Terrorist Perpetrators

Name, Age, Demographics Date and Location # Killed, Injured, or Endangered Outcome Motive / Warning
al-Shabaab militants, unknown ages, Middle Eastern/African descent, males, marital and employment status unknown Sept. 21, 2013 Nairobi, Kenya 68 killed 175 or more injured Hundreds endangered Fled scene Terrorism Warning N/A
Michael Adebolajo, 20, African descent, male, marital and employment status unknown Michael Adebowale, 22, African descent, male, marital and employment status unknown May 22, 2013 London, UK 1 killed Did not flee Arrested Terrorism Warning N/A
Dzhokhar Tsarnaev, 19, Caucasian, male, single, employment status unknown. Tamerlan Tsarnaev, 28, Caucasian, male, married, employment status unknown April 15, 2013 Boston Marathon, Boston, MA 3 killed Approx. 260 injured Hundreds endangered Fled scene T. Tsarnaev-later killed. D. Tsarnaev-later arrested. Terrorism Warning N/A
Nidal Malik, 39, Middle Eastern, male, single, active-duty Army major and psychiatrist Nov. 5, 2009 Ft. Hood, TX 13 killed, 30+ injured, Dozens endangered Shot, paralyzed, and arrested Terrorism Gave warning

Summary Of Mass Rampage Murderers: Revenge and Anger Perpetrators

Name, Age, Demographics Date and Location # Killed, Injured, or Endangered Outcome Motive / Warning Psychotic Symptoms
Alan Frazier, 51, Caucasian male, single, former power plant control room operator Dec. 17, 2013 Reno, NV, medical building 2 killed (including perpetrator) 2 injured Dozens endangered Committed suicide Anger, revenge Gave warning with suicide note Suicide compatible with severe/psychotic depression. Delusional system unknown
Karl H. Pierson, 18, Caucasian, male, single, student Dec. 13, 2013 Arapaho High School, Centennial, CO 2 killed (including perpetrator) Dozens endangered Committed suicide Anger, revenge Desire for recognition (acted on anniversary of Newtown, CT) Warning unknown Delusional system unknown
Adam Lanza (likely psychotic), 20, Caucasian, male, single, unemployed Dec. 14, 2012 Newtown, CT 28 killed (plus perpetrator) Dozens endangered Committed suicide Psychotic, anger, desire for recognition Gave warning 1 year earlier in a call to a call-in radio show. Delusional system unknown
Eric Harris, 18, Caucasian, male, single, student Dylan Klebold, 17, Caucasian, male, single, student April 20, 1999 Columbine High School, Columbine CO 15 killed (including perpetrators) 21 injured Hundreds endangered Both committed suicide Anger, revenge Warning unknown Delusional system unknown. Harris had a general hatred of society and a desire to kill. Treated for depression and suicidal ideations.

Epidemiology of Mass Rampage Killers Motivated by Psychosis, Anger/Revenge, or Terrorism

Epidemiology Psychotic Perpetrators (16 incidents, 16 perpetrators w/ Lanza) Terrorist Perpetrators (4 incidents) Revenge- and Anger-Motivated Perpetrators (4 incidents, 5 perpetrators w/Lanza)
Number of perpetrators Single perpetrator per incident 4, 2, 2, 1 1, 1, 1, 2
Age (y) 25.1 (range 20–34; excluding one 70-year-old) 25.2 (ages of the 4 Nairobi perpetrators unknown) (range 19–39) 24.8 (range 17–51)
Sex M – 14 (w/ Lanza); F - 2 M – 9 M – 5 (w/ Lanza)
Race Caucasian – 12 (w/ Lanza) African-American - 2 Asian - 2 Middle Eastern - 0 Caucasian – 0 African-American – 0 Asian – 0 Middle Eastern – 9 Caucasian – 5 (w/ Lanza) African-American – 0 Asian – 0 Middle Eastern – 0
Marital Status S – 15 (w/ Lanza) M −1 S – 2 M – 1 Unknown – 6 S – 5 (w/ Lanza) M – 0
Employment Status Employed – 3 Unemployed – 10 (w/ Lanza) Student – 3 Employed – 1 Unemployed – 8 Employed – 1 Unemployed – 1(Lanza) Student – 3
Time of Day 15 day (w/ Lanza); 1 midnight (Holmes) All daytime 4 daytime (w/ Lanza)
Tried to Escape, Suicide/Suicide by Cop, Killed by Cop (not SbC), Arrested Escape – 0 Suicide – 3 (w/ Lanza) SbC – 4 Killed by Cop (not SbC) – 2 Arrested – 7 Escape – 6 (later 1 killed and 1 arrested) Suicide – 0 SbC – 0 Killed by Cop (not SbC) – 1 Arrested – 4 Escape – 0 Suicide – 5 (w/ Lanza) SbC – 0
Authors

C. Ray Lake, MD, PhD, is Professor Emeritus, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine.

Address correspondence to: C. Ray Lake, MD, PhD, Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS 66160-7341; email: craylake@hotmail.com.

Disclosure: The author has no relevant financial relationships to disclose.

10.3928/00485713-20140502-05

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