Extremism, Not Psychosis, Drives the Deadliest Mass Shootings in America

We've created a comfortable fiction about mass shootings in America - that they're senseless, random acts of insanity. The truth is far more disturbing: these killers know exactly what they're doing,

For decades, the media has painted a distorted picture of the motives behind mass shootings in America. While headlines often blame mental illness as the driving factor, the real data tells a starkly different story: extremism—not psychosis—is the deadliest and most common motive behind these tragedies.

Photo by David Levêque on Unsplash

An Alarming Trend the Media Ignores

Over the past 25 years, extremist mass shootings have claimed the lives of at least 315 Americans in 57 attacks, making them the most lethal motive for these acts of terror. Shockingly, in all but two extremist shootings, psychosis played no significant role.

In fact, 68% of all U.S. mass shootings show no major involvement of psychosis, shattering the media’s persistent narrative that mental illness is the primary driver of such violence.

Extremist shootings are markedly more lethal—57% deadlier than attacks carried out by psychotic shooters.

We've created a comfortable fiction about mass shootings in America - that they're senseless, random acts of insanity. The truth is far more disturbing: these killers know exactly what they're doing, and why.

Extremism is by far the deadliest motive behind mass shootings

Let’s look at the past 25 years. When we break down mass shooting events by motive, it becomes clear that extremism is by far the deadliest category—1 in 3 American victims were killed by an extremist perpetrator.

Looking at the different types of hate within the extremism category, racism was the deadliest primary motive, killing 122 Americans, followed by fame-seeking (87), homophobia (54), misogyny (18) and religion (18).

Extremists are almost never psychotic

Contrary to popular belief, extremists responsible for mass shootings are rarely psychotic. In all but two extremist shootings, psychosis played no significant role.

As long as we keep misdiagnosing extremism as mental illness, we'll keep failing to prevent the next attack.

Childhood trauma is NOT the cause

Another pervasive myth is that childhood trauma or abuse drives individuals to commit mass shootings. However, the data reveals that the rates of childhood trauma—while significant—do not stand out compared to the general population. For instance:

• Only 5.7% of perpetrators experienced childhood sexual abuse, which is statistically similar to the 5% rate among the general male population.

• Rates of childhood physical abuse among perpetrators (10.6%) are also lower than the general population estimate of 14.8%.

The focus on childhood trauma as a cause distracts from addressing the ideological and societal factors that radicalize individuals into committing acts of mass violence.

Mental Health and Treatment: A Complicated Picture

• Higher Rates of Mental Illness (Short Term):
  Over the course of a year, perpetrators exhibit significantly higher rates of mental illness diagnoses (33.3%) compared to the annual rate in the general population (21%).

• Lower Lifetime Mental Illness Rates:
  When compared to lifetime prevalence in the general population (30–50%), the mental illness rates among perpetrators fall into a similar or slightly lower range.

• More Likely to Have Been Hospitalized or Medicated:
  Perpetrators are much more likely to have been hospitalized for mental health reasons (22% vs. 10%) and to have used psychiatric medications (28.5% vs. 16.5%).

• Counseling Usage is Higher:
  A higher percentage of perpetrators received counseling prior to their attacks (29.3% vs. 10.1%), reflecting more engagement with mental health services.

• Treatment Rates Similar to General Population:
  Among those diagnosed with mental illness, 61% of perpetrators received treatment compared to 66.7% of the general population. This indicates that treatment access for perpetrators is relatively on par with broader trends.

  
  What This Means

  While mental illness is more prevalent among perpetrators compared to the general population in the short-term, it is not the root cause of mass shootings.
  
  Over 50% of Americans will experience mental illness in their lifetime, and yet 50% of the country isn’t committing mass murder. While mental illness can certainly play a contributing role and shows some correlation, it’s not a cause of mass violence.
  

  The focus should remain on extremism and ideological drivers as the key motives for mass shootings, not mental health conditions that are common across the American population.

The data is clear: addressing extremism—not psychosis—is the key to saving lives and preventing future tragedies. Let’s focus on what matters most: Solutions.

1. Stop politicizing tragedy. Terror attacks, often in the form of ideologically-motivated mass shootings, are a danger to all Americans. When we rush to score political points, we only distract from the urgent work needed to prevent future attacks.

2. Pass bipartisan legislation to fund and implement the National Strategy for Countering Domestic Terrorism. The strategy focuses on sharing counter-terrorism intelligence, strengthening terrorism prevention efforts, and disrupting terror plots.

3. Work with local communities to deliver violence prevention programs with a focus on crisis intervention and social services for at-risk individuals, thus reaching more people than law enforcement alone (public health approach)
   
   Focus on mentorship and peer support programs for young men, especially active duty military and veterans.

4. Teach digital media literacy in schools to build young peoples’ resilience to extremist narratives.

5. Provide crisis intervention resources for families and educate the public about early warning signs of mobilization to violence.

The tools to prevent future tragedies are within our reach.

But fighting extremism demands something radical: the courage to see beyond party lines and heal the very divisions that make extremism possible.

The path forward isn't left or right - it's together.

Works Cited

1. Kaplan A, Kenzi Abou-Sabe, Luce DD. Experts warn of growing threat from online extremism and political polarization in U.S. [Internet]. NBC News. 2025 . Available from: https://www.nbcnews.com/investigations/online-extremism-political-polarization-us-attacks-threat-rcna186017

2. Strategic Intelligence Assessment and Data on Domestic Terrorism - 2023 | Federal Bureau of Investigation [Internet]. Federal Bureau of Investigation. 2023. Available from: https://www.fbi.gov/file-repository/fbi-dhs-domestic-terrorism-strategic-report-2023.pdf/view

3. Five Things About Community-Based Terrorism Prevention Programs [Internet]. National Institute of Justice. 2024. Available from: https://nij.ojp.gov/library/publications/five-things-about-community-based-terrorism-prevention-programs

4. Peterson J, Densley J. U.S. Mass Shooters Database - The Violence Prevention Project [Internet]. The Violence Prevention Project. 2024. Analysis focuses on U.S. mass shootings since 2000. Available from: https://www.theviolenceproject.org/databases/

5. CDC. About Adverse Childhood Experiences [Internet]. Adverse Childhood Experiences (ACEs). 2024. Available from: https://www.cdc.gov/aces/about/index.html

6. Mental Illness [Internet]. National Institute of Mental Health (NIMH). 2022. Available from: https://www.nimh.nih.gov/health/statistics/mental-illness

7. National Security Council. National Strategy for Countering Domestic Terrorism [Internet]. White House; 2021. Available from: https://www.whitehouse.gov/wp-content/uploads/2021/06/National-Strategy-for-Countering-Domestic-Terrorism.pdf