Are “Psycho Killers” Psychotic?

Are psycho killers psychotic? Hint: probably not – image from American Psycho

They may not be politically correct, but terms like “psycho killers” and “psychotic killers” get tossed around rather freely. Sometimes people will assume that to do horrific things people must have a mental illness. But is that accurate?

It’s not, but that kind of misconception may originate from a few different mistaken assumptions.


One issue is public confusion about the word psychosis and what exactly that means. Psychosis is a cluster of psychiatric symptoms including delusions, hallucinations, and/or highly disorganized thinking. Psychosis impairs the ability to distinguish between what is real and what is not. It can occur in the context of a number of different psychiatric illnesses, including schizophrenia, bipolar, and major depressive disorder. It may also be drug-induced. Regardless of the cause, the definition of psychotic symptoms remains the same.

Another mistaken assumption is that people would not be able to commit heinous acts if they were in touch with reality, so therefore they must be psychotic and unable to comprehend reality. However, human beings have been doing very bad things to each other for a very, very long time, including tyrants and the otherwise regular people who perpetrate war atrocities for them. Even if mental illness did make people perpetrate violent acts (which is rare), it seems wildly unlikely that psychosis spread like wildfire through, say, the SS guards in Nazi concentration camps. Even if they were psychotic, the vast majority of people who experience psychosis are not violent.


So, if killing in cold blood while fully aware of one’s actions is something that can happen, what on earth is going wrong in the minds of people who perpetrate some of the most atrocious crimes, like serial killers?

One possible answer is psychopathy. It’s not a disorder in the DSM-5; the closest equivalent would be antisocial personality disorder. Psychopathy can be particularly problematic when it occurs as part of the dark tetrad of traits, along with narcissism, Machiavellianism, and sadism. While the word psychopathic sounds similar to psychotic, they mean very different things.

Psychopaths lack empathy and tend to be extremely skillful at manipulating the people and situations around them to serve their own needs. They have a strong need for control and a lack of remorse for the negative effects of their actions. While the words themselves sound similar, being psychotic and psychopathic are two extremely different things. Psychopaths are very much in contact with reality and are in control of their actions.

The causes of psychopathy are complex and poorly understood, but this isn’t something that develops spontaneously later in life. Psychopathic individuals begin to demonstrate problems in childhood. Childhood bullying and abuse by family members are common in this population. They tend to demonstrate elements of what’s known as the Macdonald triad for predicting future violence risk: arson, cruelty to animals, and bed-wetting beyond age 12.

Characteristics of serial killers

Serial killers often have intense fantasy lives. We all fantasize to some extent, but we’re able to maintain a clear distinction between our inner world and the world around us. As children, serial killers tend not to have learned to establish these boundaries, so violent fantasies spill over into real-world behaviour.

Many of the prominent serial killers people are aware of, like Ted Bundy and John Wayne Gacy, were very deliberate and methodical, which required them to know exactly what they were doing. They are considered “organized” serial killers. They are very much in control, and none of this is consistent with a psychotic thought process.

“Disorganized” serial killers, on the other hand, tend to be more impulsive and erratic, and they don’t usually try to hide the bodies. Mental illness may be part of the picture with this subtype.

Cult leaders

Cult leaders responsible for mass suicides or other violence (e.g. Jim Jones, David Koresh, and Charles Manson) are another type of perpetrator that may fall under the idea that the behaviour makes no sense, therefore the individual must be psychotic. However, consider the level of finely tuned manipulation that would be required to exert total control over a group of followers.

Someone who was psychotic would never be on the ball enough to wage that kind of psychological campaign even if they wanted to. While the kinds of individuals that would engage in this type of manipulation are deeply disturbed, that does not make them psychotic.

For all the books and tv shows that try to get inside the heads of these criminals, the reality is we’re never going to get a clear picture. There is no clear “why”. What is clear, though, is we should not be assuming that serious mental illness is responsible for people doing the unimaginable.

Source: Wikipedia: Serial killers

Book cover: A Brief History of Stigma by Ashley L. Peterson

My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.

You can find it on Amazon and Google Play.

There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.

36 thoughts on “Are “Psycho Killers” Psychotic?”

  1. Extremely frightening. I watch so many of those true crime shows, and the ones on Netflix, and I’m always astonished of the things that happen to the deviant as a child. It’s scary that no one picks up on this behaior earlier on in years.

  2. Yes. I think it scares people that we don’t understand why people could commit brutal crimes with no obvious financial, religious or political motive. We feel there should be some cut-off in the brain that would stop people doing that, and it must somehow get by-passed for a serial killer. The superhero genre doesn’t help. I like Batman, but I get annoyed that all the villains are supposed to be murderously “insane” yet capable of plotting complex crimes and escapes.

      1. And let’s be realistic, Batman was pretty messed up. Saw his parents killed as a kid, is a lonely bachelor millionaire and has a crazy bat fetish. Not a lot of real estate between his mind and that of his foes.

  3. This is really good content, to the point and very clear. Research is being done on brains of serial killers and psychopaths so there is a possibility of understanding more. A relevant distinction can also be made between the psychopath and the perverted. I took a class on that in uni and while writing my paper on it, I discovered places on the internet that I’m still processing as so to speak. People always are shocked that I know these things but we all need to learn no?

    1. Yes we do. It’s astonishing (not necessarily in a good way) what the mind is capable of. And hopefully the better these kinds of things are understood the more that can be done early on to change the trajectory.

  4. Aren’t sociopaths also in the category of person who may be(come) a serial killer? Or is that another under the umbrella of antisocial behavior personality? I personally think media (movies and docudramas and so forth) have glorified serial killing, so people with tendencies that way might be motivated because it ‘looks cool’. I’m horrified with the casual nature that murder and mayhem is dealt with in the media, and how films like “Split” (which is a horrible film) are viewed as really cool how ‘he’ (the villain) gets away with so much. That film made me sick.

    1. Sociopath is a non-clinical term that overlaps antisocial personality disorder and psychopathy. I agree, the glorification of these assorted sick and twisted things is really problematic.

  5. When I have read about why people do mass shootings, I always read they were mentally ill or something along those lines. It seems like people need a reason as to why they would kill or try to soften what they did.

  6. Whenever my wife sees one of these people on TV doing something horrible to a child or shooting up a school or whatever, she always comes from the point of view of how can somebody do that and I always say that it is somebody who is not wired correctly. Even contract killers have some kind of wiring off despite their “doing it for the money.” I’ve always believed that, for instance, with school shootings, that it is possible to plan everything, create a sound strategy for attack, yet still be completely insane. Premeditation should not be the litmus test for sanity. My very first therapist told me for six or seven weeks I wasn’t mentally ill when I knew something was wrong that wasn’t just average depression or anxiety. I remember telling him once, “Just because I’m eloquent doesn’t mean I’m not crazy.” Guess who was right?

    1. The essence of insanity is differentiating right from wrong (and therefore inability to have mens rea), and I think there’s a big difference between being so ill that one is unable to distinguish the two, and knowing that something is wrong in the eyes of the law and not seeing that as an obtacle.

  7. Johnzelle Anderson

    Very well written! A lot of the misuse of these terms relates to ignorance. You a great job showing different angles of the issue

  8. This is very very interesting – and also horrifying what people are able to do to each other 🙁 I often can’t watch the true crime type stuff on TV because it’s just so disturbing – a very educational breakdown you’ve written here!

  9. Well written article Ashley, clear and concise. Unfortunately psychopathy describes one or two of my exes and l’d be surprised if people haven’t met at least one person in their lifetime who fulfils the criteria.

    Psychopaths don’t live by social rules or expectations and it’s well documented that they often tell lies, have inflated view of themselves, they can’t control their impulses and they feel no guilt or regret for actions that hurt other people. However, over here in the UK, psychopaths like Harold Shipman (“Dr. Death” who killed 218 patients), Charles Bronson (known as the most violent prisoner in Britain) are sent to psychiatric hospital prisons as though they have a mental illness.

    Your island for psychopaths sounds “just the ticket.”

  10. Fantastic post. I wish peoples’ go-to characterization of serial killers wasn’t always “crazy” or “mentally unstable” – just another way that people unfairly (and inaccurately) stigmatize mental illness. Love that you are using your blog to call out and clarify this.

  11. I think labeling such criminals as psychotic is a way of dealing with things that are so shocking and unbelievable. Perhaps it is a security blanket, so to speak, to help us deal with the horrific things humanity does to one another.Otherwise we would have to consider that this darkness that enables horrific crimes can be done by almost anyone and that is something that makes us reel. Labels give us a sense of meaning when things seem “unreal”. that’s my take in any case.

    1. I think that’s very likely to be the reason people do this, but when labels give a sense of meaning that is false, that ends up perpetuating stigma against people who actually do experience psychosis.

  12. Psychopaths are born, while sociopaths are made. Most psychopaths never kill: they go on to lead normal lives and usually take on positions of power such as police officers, company CEOs, political officials. The psychopaths who do murder, you can almost always find traumatic childhood events which prompted them to kill later in life. And i say Almost, because with a very few serials you can find no severe trauma – such is the case with Karla Homolka. Interesting study she is.

  13. Psychotic- no. Insane? Again no. The textbook organized serial killers are rational, methodical, hold down jobs, have emotional intellect to blend in, come off as polite and quiet and nice individuals. Some have family’s. Friend. They know what they are doing is wrong. There isn’t necessarily a traumatic and abusive childhood.

    They lack empathy. They want to kill. So they do.

    Now the biological makeup of their brain might give us more answers. It’s actually very intriguing if you research all the different serial killers.

    I happen to believe they are born without a soul, lack empathy. You can’t teach someone empathy. Anti-social personality lacks empathy but doesn’t make them a killer.

    But definitely they aren’t psychotic.

    1. It’s an interesting question of nature vs. nurture. Abuse by mother figures seems to be a common theme, yet it’s hard to believe the foundation wasn’t already there from the very beginning.

      1. That is a good question. I know that there was a landmark study by Michael Aamodt; which studied 50 serial killers. Childhood abuse was more prevalent in lust serial killers.

        In contrast 35% of the serial killers studied had no history of childhood abuse or trauma.

        There was another study, I’m not sure which one off the top of my head, that studied and analyzed variables of childhood abuse and sexual aggression to their victims. So those abused in childhood tended to sexually assault a victim prior to murdering them.

        There was another study that found a correlation with criminal psychopathy and brain abnormalities. Problem in this study is they studied criminal psychopaths but not all psychopaths are criminals nor killers. So I’m not sure the validity of those findings.

        I’m sure as the field keeps growing and progressing they will be able to narrow down more traits or genetics or environment to analyze serial killers to a more in depth capacity.

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