Anders Breivik: Extreme beliefs mistaken for psychosis

The case of Anders Breivik, who committed mass murder in Norway in 2011, stirred controversy among forensic mental health experts. His bizarrely composed compendium and references to himself as the “Knights Templar” raised concerns that he had a psychotic mental illness. Beliefs such as Mr. Breivik’s that precede odd, unusual, or extremely violent behavior present a unique challenge to the forensic evaluator, who sometimes struggles to understand those beliefs. Psychotic disorder frequently is invoked to characterize odd, unusual, or extreme beliefs, with a classification that has evolved over time. However, the important concept of overvalued idea, largely ignored in American psychiatry, may better characterize these beliefs in some cases. We discuss the definitions of delusion and overvalued ideas in the context of Anders Breivik’s rigidly held extreme beliefs. We also review the British definition of overvalued idea and discuss McHugh’s construct, to introduce the term “extreme overvalued belief” as an aid in sharpening the forensic evaluator’s conceptualization of these and similar beliefs.