![]() A was a Caucasian man in his forties with a history of chronic medical conditions and multiple emergency room (ER) visits for chest pain and alcohol intoxication. Both cases are discussed at length below, and their main findings are later summarized in Table 1. We hope that the cases and the discussion provide the reader with an understanding of how such cases may present at different stages of mental health treatment in a hospital, and when feigned homicidality is suspected, how the providers can perform a reasonable assessment to establish a diagnosis and treatment plan. We then discuss the recommended evaluation of verbal threat, assessment of risk, differentiation from pseudologia fantastica, and approach towards cases with suspected feigning of homicidal ideation. In this article, we present two cases of feigned homicidal ideations to gain access to hospital. ![]() Within a few days, they are eager to return to the situation from which they came without considering rehabilitative measures. Once detoxified, the addicted patient no longer claims suicidal or homicidal thoughts and may even admit to having fabricated such thoughts in order to gain hospitalization. Intended escape from destructive conditions and circumstances is a positive motivation that is adaptive and supportive of mental health. Patients often have alternative motives for entering hospitals, such as the motive to detoxify comfortably from addicting drugs, to seek sedative medications, to obtain lodging that is more comfortable than a homeless shelter, or to avoid jail detainment. However, feigned homicidality seems to be becoming a more frequent strategy for gaining hospitalization for various reasons. Without mentioning feigned homicidality specifically, literature on malingering recognizes hospitalization as a goal in some cases. In recent years, increasing reference is made to the patient who achieves hospitalization for “three hots and a cot”, rather than for psychiatric treatment of symptoms of mental illness. Homelessness of the mentally ill was limited, and addiction to street drugs was not as prevalent. Involuntary hospitalization in a mental facility could extend for months or years. Sixty years ago, it would have been rare for anyone to threaten to kill another person simply to gain hospital access. Without research and scientific literature on feigned homicidality, the clinician is faced with a daunting task when a patient threatens to kill another person. ![]() In many cases, the possibility of feigned homicidality must be considered together with fantasized and planned homicide when assessing risk. Not usually included in such discussions is a third possibility: the verbal statement is made to achieve a self-serving but non-homicidal goal. The professional literature on assessment of a patient’s verbal threat to kill concerns a determination as to whether the homicidal statement is only a fantasy, not likely to be carried out, or a serious intention with a realistic potential for a lethal or injurious outcome. ![]()
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