Citation

Rahman T, Hartz SM, Xiong W, Meloy JR, Janofsky J, Harry B, Resnick PJ. J. Am. Acad. Psychiatry Law 2020; ePub(ePub): ePub.

Affiliation

Dr. Rahman and Dr. Hartz are Associate Professors, Washington University in St. Louis, Missouri. Dr. Xiong is Assistant Professor, University of Maryland, College Park, Maryland. Dr. Meloy is Clinical Professor, University of California, San Diego. Dr. Janofsky is Associate Professor, Johns Hopkins Hospital, Baltimore, Maryland. Dr. Harry is Associate Professor, University of Missouri-Columbia. Dr. Resnick is Professor, Case Western Reserve University, Cleveland, Ohio.

Copyright

(Copyright © 2020, American Academy of Psychiatry and the Law, Publisher American Academy of Psychiatry and the Law)

DOI

10.29158/JAAPL.200001-20

PMID

32409302

Abstract

An extreme overvalued belief is shared by others in a person's cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. Over time, the belief grows more dominant, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. Study participants (n = 109 forensic psychiatrists) were asked to select among three definitions (i.e., obsession, delusion, and extreme overvalued belief) as the motive for the criminal behavior seen in 12 randomized fictional vignettes. Strong interrater agreement (kappa = 0.91 [95% CI 0.83-0.98]) was seen for vignettes representing extreme overvalued belief. Vignettes representing delusion and obsession also had strong reliability (kappa = 0.99 for delusion and 0.98 for obsession). This preliminary report suggests that forensic psychiatrists, given proper definitions, possess a substantial ability to identify delusion, obsession, and extreme overvalued belief. The rich historical foundation of extreme overvalued belief and this small survey study highlight the benefit of inclusion of "extreme overvalued belief" in future glossaries of the Diagnostic and Statistical Manual.

© 2020 American Academy of Psychiatry and the Law.

Language: en