Assessing Violence Risk? Consider THREATS

What separates people who act on thoughts of mass violence from those who do not complete such acts? During IPS: The Mental Health Services Conference, John Rozel, M.D., an associate professor of psychiatry and adjunct professor of law at the University of Pittsburgh, suggested that the following mnemonic known as THREATS can be helpful when assessing risk:

• Take all threats/leaks seriously. Analyses have shown that over 80% of mass shooters in the United States either directly threatened an intended victim or leaked their intentions to a third party prior to a shooting. Such actions are the best predictors of future violence.

• History of violence. Though one might look first for acts of public aggression (such as at school or the workplace), Rozel said not to underestimate domestic violence/interpersonal violence (which can be hidden) as a contributing factor.

• Recent stressors. Stressful events can be an inflection point that may push someone with thoughts of violence forward in the process (for example, someone complaining about work gets laid off).

• Ethanol or substance use. Alcohol and illicit drugs are known to impair impulse control and decision making, both of which can contribute to violence.

• Agitated easily. People who become easily annoyed or frustrated are more likely to accumulate grievances that are typically the starting point on the pathway to violence.

• Takes no responsibility for personal actions. Such behavior often reflects underlying traits like narcissism and lack of empathy.

• Suicidality. Studies have suggested that most mass shooters were suicidal at the time of the attack, and these events are often seen as a “final act.”

Rozel said that psychiatrists should be on the lookout for multiple signs. “Targeted violence results from a complex interaction. No single risk factor will be sufficient to predict future violence, and these risk factors affect each other as well as the final behavior,” he said. ■