In many severely disturbed patients who act out violently, early traumatic experiences reveal the defensive illusion that their inner and relational worlds are somehow “normal”. This illusion often emerges from the child's need to adapt to abusive or emotionally neglectful caregivers upon whom survival and attachment depend. Such traumatised children may later develop psychotic or severely narcissistic organisations in adolescence and adulthood, within which delusional dynamics can arise.

For therapeutic work to become possible, these patients must gradually relinquish their psychotic solutions and tolerate the emergence of disillusionment, including the mourning of both the life they imagined and the healthier future they struggle to envision. This article presents two clinical cases illustrating different developmental trajectories and psychodynamic configurations underlying murder–suicide.