[Psychiatric aspects of terrorism]

Terrorism belongs to the extreme forms of violence that have so far received little attention in psychiatric research and are rarely mentioned in textbooks of psychiatry. After terror attacks, however, the question regularly arises whether terrorists suffer from mental disorders.

The aim of this review is to summarize the multidimensional causes of terrorism with special emphasis on psychopathological aspects of the perpetrators. In addition to a brief summary of the historical background and recent developments in terrorism, a literature search was performed using PubMed, SCOPUS, PsychInfo and PsychARTICLES.

From a psychiatric point of view, a differentiation between lone terrorists and group terrorists is essential. Lone terrorists have a much higher prevalence of psychiatric disorders, such as psychotic, paranoid and affective symptoms. The majority of terrorists acting in groups rarely suffer from such mental disorders. For these perpetrators biographic aspects and socialization, group dynamics and ideological personality profiles with narcissistic, histrionic, fanatic and antisocial components are more relevant. The phenomenon of terrorism predominantly being a male domain is discussed.

The manifold manifestations of terrorism are caused by complex patterns of interacting biographic, sociological, ideological and psychopathological components that differ between lone acting and group terrorists. The real causes for acts of terrorism are not various ideologies permitting violence but consist more of a pre-existing violence-oriented mentality of the perpetrators looking for such ideologies to justify their acts. The possibilities of psychiatry in prevention and early recognition are limited. Some recently developed scales for risk assessment of extreme violence are mentioned.