Virginia Via Research Day Book 2026

Medical Student Research Case Reports

47 SUICIDE AND REVENGE FANTASY CASE REPORT

Priya Batheja (VCOM OMS-3), Michella Donfack (VCOM OMS-3), Nicole Muhlenbruck (VCOM OMS-3), Adedoyin Ojimi (VCOM OMS-3), Mary Jarad (LUCOM OMS-3), Thomas Thomson (LUCOM OMS-3), Dr. Partam Manalai (MD) Corresponding author: pbatheja@vcom.edu

VCOM-Virginia, Blacksburg, Virginia Liberty University College of Osteopathic Medicine, Lynchburg, Virginia Mary Washington Healthcare, Fredericksburg, Virginia Snowden At Fredericksburg, Mary Washington Healthcare There are numerous theories regarding what drives an individual to engage in suicidal or homicidal behavior, ranging from revenge-based fantasies to neurobiological dysregulation. In this report, we evaluate two psychiatric case presentations to illustrate how these theoretical frameworks manifest clinically. The first case describes a woman experiencing severe auditory and visual hallucinations who expressed a desire to kill herself as a means of retaliating against and silencing the persecutory voices in her mind. The second case involves a young man with chronic psychosis who reported escalating homicidal ideation and endorsed suicidal intent as a way to protect others from perceived dangerous impulses. These contrasting cases raise a central question: what motivates suicidal ideation in psychosis—an attempt to eliminate tormenting internal stimuli, or an effort to prevent harm to others?

Multiple theoretical models attempt to explain these motivations. Freud conceptualized suicide as a defense against intolerable homicidal impulses, reflected in the second case. Melanie Klein’s theory of violent fantasy describes how individuals with severe trauma may develop internal retaliatory fantasies, consistent with the first case. Durkheim’s sociological framework further explains how social forces may predispose individuals to self-harm. Beyond psychological and sociological theories, biological research demonstrates decreased levels of 5-HIAA in cerebrospinal fluid of individuals who have died by suicide, suggesting a neurochemical contribution. Together, these cases reflect overlapping themes across psychodynamic, sociological, and biological models, emphasizing that no single theory can fully account for suicidal motivation. Although the precise mechanisms

underlying suicide remain uncertain, it is likely that multiple pathophysiological and psychological processes converge to shape suicidal behavior. Developing a psychodynamic understanding of these motivations not only supports clinical insight but may also help guide individualized management for complex psychiatric patients.

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