In contemporary psychiatry, few topics elicit such intense and complex debate as the relationship between mental health and extreme forms of violence. Among these, mass shootings stand out as a particularly alarming and high-profile phenomenon, though they represent just one manifestation of severe violent behaviour. This introduction aims to explore the broader context of extreme violence while focusing on mass shootings as a significant example.

Extreme forms of violence, including but not limited to mass shootings, terrorist attacks or acts of self-initiated terrorism (lone-actor terrorism), serial homicide, and severe domestic violence, pose significant challenges to society and mental health professionals alike. While these events occur globally, the frequency and impact of mass shootings, particularly in the United States, have brought this specific form of violence to the forefront of both public consciousness and academic research.

Monocausal explanations for extreme violence, whether focusing on firearm availability, severe mental illness, or other singular factors, have proven insufficient to capture the complexity of these tragic events. Specifically, analyzing the role of mental health in acts of extreme violence, including mass shootings, presents significant methodological and conceptual challenges.

One of the primary obstacles to research in this field is the low base rate problem. Existing studies tend to concentrate on a limited number of high-profile cases, which may not be representative of all perpetrators of extreme violence. Moreover, the very definition of "severe mental illness" proves problematic, given the evolution of diagnostic categories, the variety of mental disorders, and the high prevalence of mental health issues in the general population.

It is important to note that, contrary to popular perception, researchers generally agree that extreme acts of violence (including mass shooting, self-initiated terrorism, serial homicide)are not primarily caused by diagnosable psychopathologies in the perpetrators. However, this does not mean that the role of mental health in these crimes can be disregarded. Studies of individuals who commit extreme acts of violence have revealed that a non-trivial number of them exhibited clinical signs such as depression, delusions, and paranoia at various points in their lives.

The goal of this Research Topic is to gather a comprehensive body of research to clarify the current state of knowledge on the role of mental illness and other factors that cause extreme violence such as mass shooting, self-initiated terrorism, serial homicide.

Articles of interest will address the following questions:
• What are the etiological factors of extreme violence?
• Given the rarity of the phenomenon and the paucity of subjects to examine should we abandon the idea that we can predict extreme acts of violence?
• Is there a link between mental illness and extreme acts of violence?
• Can mental health services be an important sentinel to intercept shooters or lone-actor terrorists before they commit a crime?

Taking stock of what is known about extreme violence to gather the latest research insights.

Specific themes:
• Theories and concepts to explain extreme violence
• The challenge of predicting extreme violence crime
• Mental illness and extreme violence

This topic will consider the following article types: review, original research reports, perspectives, opinion, hypothesis and theory

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Frontiers in Psychiatry

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