Fixation, driven by delusion, obsession, or an extreme overvalued belief, frequently precedes lone-actor grievance-fuelled violence. Extreme overvalued beliefs are a novel concept in threat assessment and refer to a pathological preoccupation with a shared belief or ideology that grows increasingly intense and emotional over time. They are believed to be ego-syntonic, aligning with one's identity, and frequently fuelled by a personal or moral grievance. However, much remains unknown about the aetiology, risk and escalation to violence. This systematic scoping review explored psychosocial risk factors of fixated offenders driven by extreme, overvalued and delusion-like beliefs who committed acts of lone-actor grievance-fuelled violence. A systematic search of eight medical and social science databases was conducted, as well as a backwards and forward citation search, to identify research papers that covered violent, non-delusional, fixated lone offenders. A total of 3050 papers were uploaded for screening, with 64 papers meeting the inclusion criteria. The psychosocial factors were structured and synthesised using a clinical case formulation, which displayed some patterns across studies of the effects of social media use, online information gathering, isolation, fixation with previous offenders, narcissism, depression, and neurodivergence. However, the findings were scarce and inconsistent. The eligible papers consisted primarily of case studies and case series, and many focused on the same offenders. These limitations are discussed with recommendations for future research, which would benefit from more rigorous empirical evidence and consistency in terminology and conceptualisation of extreme overvalued beliefs. Fixation is a significant risk factor for violent extremism and lone actor violence, and exploring the underlying psychopathology is essential for reliable clinical and forensic evaluations.
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