The hardest part of confronting targeted violence is seeing the storm form before it breaks. We sit down with Dr. Pedro Julnes, MD, a psychiatrist who is an expert in lone actor violence. During this discussion with our hosts, he traces how personal grievance hardens into ideology, why extreme overvalued beliefs aren’t delusions, and what real world cues tell us when risk is rising. Along the way, we compare lone actor violence with psychotic aggression, crimes of passion, and predatory harm, then focus on the behavioral signatures that cut across politics and subcultures.
 
 Dr. Julnes presents the indicators of this type of violent behavior: distal warning signs versus proximal indicators. Distal signs include grievance that becomes central to identity, ideological framing, failure of sexual pair bonding, and a shift toward simplistic, absolute thinking. Proximal signs look like a suicide risk pathway: research, planning, preparation, capability testing, leakage, and rapid functional decline. Terrorist Radicalization Assessment Protocol (TRAP-18) provides a useful structure here, but the clinical mindset is familiar—act on behavior, anchor to specifics, and escalate safety when planning appears.
 
 This conversation is practical, not abstract. We cover alliance-building with patients brought in under duress. We outline concrete steps clinicians can take. We also address the systems gap: many cases live in the gray zone of “no crime, no psychosis.” Hospitals, schools, and courts need coordinated threat assessment processes; the VA’s model shows it can be done.
 
 If you want a grounded guide to spotting fixation, understanding internet-fueled contagion, and acting ethically when ideology meets behavior, this conversation delivers clarity without sensationalism. Subscribe for more thoughtful dives, share with a colleague who handles risk assessments, and leave a review to tell us what more you’d like to know on this topic and others.

Resources named in this episode:   

Book: Extreme Overvalued Beliefs: Clinical and Forensic Psychiatric Dimensions   (By Tahir Rahman, MD, with Jeffrey Abugel​)

 Threat assessment tool: Terrorist Radicalization Assessment Protocol-18 (TRAP-18)​ - TRAP 18 Manual - Global Institute of Forensic Research (J. Reid Meloy, PhD, ABPP)

Further reading: see the source list at end of the episode transcript.

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