Cognitive-affective drivers of fixation in threat assessment

J. Reid Meloy, Tahir Rahman

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Pathological fixation – preoccupation with a person or a cause that is accompanied by deterioration in social and occupational functioning – has been found to precede most cases of targeted violence. It is clinically observed and theorized to have three different cognitive-affective drivers: delusion, obsession, or extreme overvalued belief. Each driver is explained, and case examples are provided in the context of threat assessment. Extreme overvalued belief as a new concept is discussed in detail, both its historical provenance and its demarcation from delusions and obsessions. Threat management for each separate cognitive-affective driver is briefly summarized, based upon current clinical findings and research. Emphasis is placed upon understanding both the categorical and dimensional nature (intensity) of these cognitive-affective drivers, and suggested guidelines are offered for the assessment of such in a clinical examination by a forensic psychiatrist or psychologist.

Original languageEnglish
Pages (from-to)170-189
Number of pages20
JournalBehavioral Sciences and the Law
Issue number2
StatePublished - Apr 1 2021


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