There Are No Coincidences: Proposed Usefulness of the Alternative DSM-5 Model for Personality Disorders in the Conceptualization of QAnon-Related Threats

The QAnon conspiracy theory gained popularity on internet forums and social media sites between 2017 and 2021. The theory posits that there is a cabal of Satan-worshiping elites who engage in child sex trafficking for the purposes of harvesting adrenochrome, and it is believed many Hollywood elites and politicians take part in these rituals. Although the same enthusiasm no longer exists for "Q," the theories borne out of the online trend have become implicitly mainstream and continue to be held by those who are prone to extreme overvalued beliefs and at risk of becoming radicalized. Acts of QAnon-adjacent violence are also more commonplace and of concern for law enforcement, and recent events in the United States, such as the attack on the U.S. Capital, underscore the rise of violent domestic extremism and associated threats to various entities. This work conceptualizes the QAnon narrative as an extreme overvalued belief and highlights personality characteristics of individuals who may be susceptible to adopting these views. We argue that the attitudes and beliefs of people who have become radicalized by conspiracy theories are associated with dynamic markers of personality dysfunction. The threat assessment professional can utilize the alternative DSM-5 model for personality disorders (AMPD) to augment formulation of threat assessments, as the AMPD provides rich and dynamic context for the radicalization process. We demonstrate the utility of this approach using a fictionalized case vignette, and in closing, we offer ways in which to integrate the AMPD into the threat assessment landscape. Public Significance Statement Domestic extremism, centered upon QAnon-adjacent themes, continues to be on the rise in the United States. Given characteristics of individuals who are prone to adopting extremist beliefs, which may include subclinical maladaptive personality traits, the threat assessment professional might consider utilizing the alternative DSM-5 model for personality disorders (AMPD) as part of the larger assessment framework.