Commentary: delusions and homicide in women--stories, old and new

It is not possible to predict homicide in an actuarial or statistical sense with any appreciable degree of accuracy. In an important and interesting study, Ferranti and colleagues highlight the centrality of religious delusions in women who kill children, consistent with the long-standing recognition that delusions are especially important in the context of violence by the mentally ill. They also note, among other findings, high rates of borderline personality disorder among female homicide offenders found not guilty by reason of insanity (60%) compared with their male counterparts (9%). As a result, the combination of religious delusions, unstable affect, access to children, and features of borderline personality disorder can usefully guide clinical decision-makers toward higher levels of treatment and follow-up, especially in women with aggressive tendencies. Despite the importance of this kind of risk stratification and treatment, however, homicide remains impossible to predict at an individual level.