As mental health experts look at the shooting in Colorado, a Chicago psychologist points to certain patterns that are emerging which may offer insight into the mind of James Holmes.
"The Individual knows right from wrong, but perhaps does not have a conscience," said Rush University Medical Center Psychologist Stevan Hobfoll, who used the shooting at Columbine, less 20 miles away from Aurora, as an example.
The 1999 Columbine High School shooting was orchestrated by seniors Eric Harris and Dylan Klebold. The violent crime left 13 people dead and 21 others injured.
In the case of Harris and Klebold, there was desire to harm others combined, with a lot of anger, which prompted the teens to commit the violent act, said Hobfoll. The two were described as loners, like neighbors have described Holmes, Hobfoll said.
Both Harris and Klebold were involved in online video gaming worlds, which created an alternate reality that fueled their anger.
“The whole gaming world can enter into that fantasy," Hobfoll said. "It’s sort of a perfect world for them, because you can do it as a recluse and have others online supporting you."
There is also the possibility the massacre in the Colorado theater was a result of paranoid schizophrenia, a genetic condition which often is not apparent in childhood or adolescence.
"That DNA tends to emerge and blossom, if you will, usually in the early to mid-twenties," said Hobfoll, adding that Holmes is in his 20's when the condition begins to show.
Hobfoll believes this was what drove Norwegian Anders Breivik to go on a bombing and shooting rampage that killed 77 people almost a year ago to the day.
"There's plots against you. There's a very elaborate plot that you are hearing voices," said Hobfoll. "Sometimes these individuals have a high degree of control of their thinking and other times they don't and feel like they are being manipulated."
The conditions of the offenders in Columbine and Norway are not mutually exclusive, said Hobfoll. He added Holmes could have both conditions combined with the motivation to get attention.
Our media and the Internet makes this person sort of like a baseball card star,” Hofboll said. “Suddenly his name will have ten million hits on the Internet, where as he might have had 30 hits for his abstract dissertation that no one can read or understand.”
High intelligence is often a trait of paranoid schizophrenia because it gives people with the condition the ability to create elaborate fantasies involving conspiracies and other delusions, Hobfoll said.
Hobfoll stressed the vast majority of people with mental illness are never violent. Holmes' case is extremely rare, said Hobfoll.
New medications and therapies allow many people with paranoid schizophrenia to live productive, well-adjusted lives, according to Hobfoll.