Fast Five Quiz: Homicidal Ideation

Stephen Soreff, MD


August 12, 2022

Assessment of homicidal or suicidal ideation is extremely important in evaluating patients with delusional disorder. The presence of homicidal or suicidal thoughts related to delusions should be actively assessed and the risk of carrying out violent plans should be ascertained. Some types of delusional disorder — erotomanic, jealous, and persecutory — are associated with higher risk for violence than are others. History of previous violent acts as well as history of how aggressive feelings were managed in the past may help to assess the risk. Access to weapons needs to be explored.

In the erotomanic type, the central theme of delusions is that another person, usually of higher social status, is in love with the patient. The object of delusion is usually married, geographically or socially distant, or otherwise unavailable. Erotomania is usually intense. Signs of denial of love by the delusionally desired love object are frequently paradoxically and falsely interpreted as affirmation of love. Patients may attempt to contact the object of the erotomanic delusion by initiating email and other electronic communications, making telephone calls, sending letters and gifts, making unwanted visits, and even stalking. Some cases lead to assaultive behaviors as a result of attempts to pursue the object of delusional love or attempting to "rescue" them from some imagined danger. Men with this type are known to be aggressive.

Learn more about delusional disorder.


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