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Can murder be a source of PTSD for those who commit it? While it is clear that trauma can affect criminal behavior, little attention has been given to the notion that the act of murder may serve as a source of PTSD for the offender. The authors’ perception is that this topic has been insufficiently examined, and there may be a tendency to think that murderers have psychological characteristics that make them immune to the onset of a traumatic psychopathology.  
Since Harry and Resnick (1986) first raised this issue, contributions to the subject over the last few decades have been limited. Indeed, our meta-analysis identified just 11 studies in the past 40 years. We believe that murder as a source of PTSD is more than a theoretical or scientific curiosity; it may have critical implications for forensic assessment and treatment of the offender, as well as his or her adaptation to the prison context. In fact, careful observation of post-traumatic symptoms in offenders is important in the forensic psychiatry and psychological evaluation process of competency to stand trial (Owen et al., 2020). It should be remembered that PTSD can affect several areas of psychological functioning, including concentration, attentional skills, modes of social interaction, quality of interpersonal relationships, and reality testing. These are important functions in determining the competency to stand trial. Instead, it seems that forensic experts tend to focus on psychotic symptoms, which are the main source of negative outcomes of competency assessments. In this respect, PTSD symptoms have several similarities to psychotic symptoms and PTSD is often co-occurring with psychotic symptoms (Hannah et al., 2020). 
In the prison population, PTSD also appears to be associated with decreased psychological adjustment and increased risk of aggressive behavior and suicide attempts (Facer-Irwin et al., 2019). This reflects the importance of trauma-based assessments and treatments in the prison context with this specific population. Therefore, we believe it is important to extend our knowledge of the prevalence and risk factors associated with homicide-related PTSD, and to support the training and awareness of mental health workers who interact with perpetrators of homicide and serious crimes.
 We thus conducted a meta-analysis, in accordance with the PRISMA statement. Several databases (PubMed, Scopus, Google Scholar, Web of Science) were consulted using keywords related to PTSD and homicide. Combining these keywords and looking at the reference lists from the retrieved studies returned a total of 691 articles. Once the duplicates were removed and the inclusion criteria applied, only 11 articles were included in the meta-analysis. These 11 articles were published between 1989 and 2017 in  peer reviewed journals, in English. The coding process was conducted in a standardized and systematic manner, and the data were extracted by two in-dependent reviewers, both with training in forensic psychologic and in systematic reviews. 
Our meta-analysis highlighted the following:

  • 42% of incarcerated adult homicide offenders meet criteria for a full PTSD diagnosis after committing homicide, while 13% develop partial criteria (PTSD symptomatology) after committing homicide.
  • Homicide offenders have a higher frequency of PTSD than violent offenders who have not committed murder. According to Pollock (1999), this could be related to the fact that the severity of the crime’s damage may affect the development of symptoms. In fact, murder involves the death of a person, which is an irreparable event compared to other violent attacks.
  • Adult offenders appear to be at higher risk of developing PTSD following homicide than juvenile offenders. This may be due to the fact that adults have been exposed to more lifetime trauma, creating greater susceptibility to developing PTSD symptomatology (Briere et al., 2016). However, this interpretation contrasts with the arguments of other authors who assert that accumulated past trauma decreases the risk of developing post-homicide PTSD by causing a habituation response (Ternes et al., 2020). Clearly, further study regarding the role of previous traumatic experiences and PTSD following murder is needed.

Overall, our research shows that a high percentage of homicide perpetrators develop full or partial criteria PTSD. Further contributions are needed and future research will help us implement theoretical models that can explain the onset of PTSD following homicide, highlighting mechanisms and risk factors that can serve as objects of evaluation and intervention for this specific population.

Reference Article

Badenes‐Ribera, L., Molla‐Esparza, C., Longobardi, C., Sánchez‐Meca, J., & Fabris, M. A. (2020). Homicide as a Source of Posttraumatic Stress? A Meta‐Analysis of the Prevalence of Posttraumatic Stress Disorder After Committing Homicide. Journal of Traumatic Stress. In press. https://doi.org/10.1002/jts.22630

Discussion Questions

  1. Do you think mental health professionals in the forensic field are adequately prepared and sensitized to the subject of PTSD-following homicide? Do you think that this aspect is ignored or not carefully recognized in forensic expertise or psychological assessment in the prison context?
  2. What impact can a diagnosis of PTSD - following homicide have on the treatment of the offender and detention in the prison setting?
  3. which psychotherapeutic techniques can be used in the treatment of PTSD-following homicide?
  4. Could the cultural variable be of interest in future research?
  5. What theoretical models or variables could be included in future research to explain PTSD following homicide?

About the Authors

Dr Matteo A. Fabris, PhD candidate at University of Turin. He is a developmental and forensic psychologist specializing in Forensic Based Cognitive Behavioral Therapy. He is main research area are child abuse and neglect; legal and forensic psychology; developmental psychology; deviant behaviors and sexuality in adolescent. Dr Matteo A. Fabris can be contatted at matteoangelo.fabris@unito.it
Prof. Claudio Longobardi, PhD is a professor at the University of Turin with expertise in child abuse and neglect. His main research areas include interpersonal violence, including bullying behavior, domestic violence, and defiant behavior.

References Cited

Badenes‐Ribera, L., Molla‐Esparza, C., Longobardi, C., Sánchez‐Meca, J., & Fabris, M. A. (2020). Homicide as a Source of Posttraumatic Stress?: A Meta‐Analysis of the Prevalence of Posttraumatic Stress Disorder After Committing Homicide. Journal of Traumatic Stress. In press. https://doi.org/10.1002/jts.22630
Briere, J., Agee, E., & Dietrich, A. (2016). Cumulative trauma and current posttraumatic stress disorder status in general population and inmate samples. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 439–446. doi:10.1037/tra0000107
Facer-Irwin, E., Blackwood, N. J., Bird, A., Dickson, H., McGlade, D., Alves-Costa, F., & MacManus, D. (2019). PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours. PLoS one14(9), e0222407. doi:  10.1371/journal.pone.0222407
Hannah, R., Stig, P., Jessica, C., & Sabina, P. (2020). PTSD with secondary psychotic features among trauma-affected refugees: The role of torture and depression. Psychiatry research, 112898. doi: 10.1016/j.psychres.2020.112898
Harry, B., & Resnick, P. J. (1986). Posttraumatic stress disorder in murderers. Journal of Forensic Science, 31, 609–613. doi:10.1520/JFS12293J
Owen, E. A., Perry, A., & Scher, D. P. (2020). Trauma in Competency to Stand Trial Evaluations. In Assessing Trauma in Forensic Contexts (pp. 65-84). Springer, Cham.
Pollock, P. H. (1999). When the killer suffers: Post‐traumatic stress reactions following homicide. Legal and Criminological Psychology, 4, 185–202. doi:10.1348/135532599167842
Ternes, M., Cooper, B. S., & Griesel, D. (2020) The perpetration of violence and the experience of trauma: Exploring predictors of PTSD symptoms in male violent offenders. International Journal of Forensic Mental Health, 19, 68–83. doi:10.1080/14999013.2019.1643428

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