Affective violence is something most people are familiar with. A bar fight or shoot-out after a brawl is one example (high adrenaline). Another type of violence, called predatory violence, is calm, planned and involves a low level of autonomic activity. This is the type of violence seen in targeted attacks such as mass shootings, terrorism and assassinations. I have developed four keys of threat analysis to guide mental health providers.

Humans develop fixations that we count on for success. Finishing college, remodeling a house, raising an infant or planning a vacation, requires focus. Some might say they become "obsessed" with researching a vacation spot or new kitchen ideas. In another scenario, let's say your uncle believes in conspiracy theories (9/11 was a government plot, JFK was assassinated by the mob, the moon landing was a hoax, etc.) You might joke that he is "delusional."

The use of such terms, obsession and delusion are part of our socially accepted vernacular. However, for threat assessment and management, mental health professionals must embrace the proper definitions of delusion, obsession and extreme overvalued belief when conducting a comprehensive assessment.

Let's say an individual is determined to pose a danger to themselves or others. A comprehensive history is gathered, which includes culturally relevant information (for example, religious rituals or political views might be perfectly normal and misunderstood by outsiders). In threat assessment, we now categorize threats using four keys: 1) psychotic delusions 2) extreme overvalued beliefs 3) obsessions and 4) addictive/ behavioral issues. Each category demands a tailored response for mitigation.

Psychotic delusions are fixed, false and idiosyncratic marking a detachment from reality. These unshakable beliefs, resistant to reason or evidence, often stem from severe mental illnesses like schizophrenia, bipolar disorder with psychosis, depression with psychosis, or drug-induced psychosis. An individual might, for example, believe that they are........

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