# "Excited Delirium" - Real, or 'Police killed this guy?'
**URL:** https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110
**Category:** Great Debates
**Created:** [June 5, 2020, 6:04pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110 "2020-06-05T18:04:50Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@Pantastic](https://boards.straightdope.com/u/Pantastic)
#### Post date: [June 5, 2020, 6:04pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/1 "2020-06-05T18:04:50Z")
Police and their defenders often talk about the danger of people dying from “Excited Delirium”, and blame a great many deaths of people in custody on it. But the American Psychiatric Association, the American Medical Association, and the World Health Organization don’t even recognize it as an actual medical condition. When I look for information on it, there seem to be a lot of police organizations that support it, and not a lot of medical documentation, and almost all of the cases of it seem to involve someone in police custody, rather than someone under similar stress in similar conditions.
Is there any support for this being a real condition, or explanation of why it only seems to affect people in police custody, or is it just the police equivalent of ‘oh, she bumped into a door, that’s how she got a black eye. Again.’
> **[Excited delirium: Rare and deadly syndrome or a condition to excuse deaths by...](https://www.floridatoday.com/in-depth/news/2019/10/24/excited-delirium-custody-deaths-gregory-edwards-melbourne-taser/2374304001/)**
>
> For decades, critics of using "excited delirium" as a cause of death have expressed concern that the term appears frequently on medical reports for deaths in custody or that otherwise involve law enforcement.
---
### Author:  [@mhendo](https://boards.straightdope.com/u/mhendo)
#### Post date: [June 5, 2020, 6:33pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/2 "2020-06-05T18:33:50Z")
A 2011 [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088378/) in the West Journal of Emergency Medicine, hosted on the National Institutes of Health website, notes:
> [@](#):
>
> EXD has gained increasing public attention recently due to the number of post-mortem explanations offered by medical examiners regarding the death of individuals being restrained by police or being taken into custody. This diagnosis has caused concern because EXD is not a currently recognized medical or psychiatric diagnosis according to either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) of the American Psychiatric Association or the International Classification of Diseases (ICD-9) of the World Health Organization. Likewise, the authors of one review article found enough evidence in the literature to suggest that excited delirium, rhabdomyolysis and neuroleptic malignant syndrome might represent the clinical spectrum of a single disease.5 Although more research is needed to elucidate cause and effect, it is important to note that a lack of recognition of the condition in the context of law enforcement activities does not negate the significance of the behavioral and physical signs referred to as EXD. For instance, one important study found that only 18 of 214 individuals identified as having EXD died while being restrained or taken into custody.6 If anything, the possible association with other life-threatening syndromes only gives impetus to the need for critical emergency medical intervention when encountering a person thought to be in a state of excited delirium.
And, after reviewing the pathophysiology, management, and outcomes, the article concludes:
> [@](#):
>
> EXD is a unique medical issue characterized by the acute onset of agitation, aggression, distress, and possibly sudden death. While the contribution of restraint, struggle and the use of electrical conduction devices to the cause of death raises controversy, recent research points toward central nervous system dysfunction of dopamine signaling as a cause of the delirium and fatal autonomic dysfunction. Victims of EXD usually die from cardiopulmonary arrest, although the exact cause of such arrest is likely multifactorial and chronic. Unfortunately, an adequate treatment plan has yet to be established, although rapid sedation, followed closely by external cooling, IV fluids, monitoring, and treatment of potential medical complications is likely critical to decrease morbidity and mortality. Neuroleptics, benzodiazepines and ketamine are among the potent sedating agents that have been proposed to stabilize EXD victims. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and appropriately respond to EXD.
---
### Author:  [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)
#### Post date: [June 5, 2020, 7:17pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/3 "2020-06-05T19:17:19Z")
Stupid question, but has anyone died of this that _wasn’t_ in police custody?
---
### Author:  [@mhendo](https://boards.straightdope.com/u/mhendo)
#### Post date: [June 5, 2020, 7:24pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/4 "2020-06-05T19:24:09Z")
> [@Typo\_Negative](#):
>
> Stupid question, but has anyone died of this that _wasn’t_ in police custody?
Well, there’s one data point right there in the quote I posted:
> [@](#):
>
> For instance, one important study found that only 18 of 214 individuals identified as having EXD died while being restrained or taken into custody.
---
### Author:  [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)
#### Post date: [June 5, 2020, 9:27pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/5 "2020-06-05T21:27:35Z")
> [@mhendo](#):
>
> Well, there’s one data point right there in the quote I posted:
>
> > [@](#):
> >
> > For instance, one important study found that only 18 of 214 individuals identified as having EXD died while being restrained or taken into custody.
I’m not sure what that quote is saying. Is it saying that 214 people have died of EXD and 18 of them were in police custody at the time they died? Or is it saying that 214 people have been identified as having EXD while in police custody, 18 of whom died?
---
### Author:  [@Happy\_Fun\_Ball](https://boards.straightdope.com/u/Happy_Fun_Ball)
#### Post date: [June 5, 2020, 9:49pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/6 "2020-06-05T21:49:54Z")
I read it as the latter.
---
### Author:  [@Pantastic](https://boards.straightdope.com/u/Pantastic)
#### Post date: [June 6, 2020, 3:22am UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/7 "2020-06-06T03:22:53Z")
Yeah, definitely the latter. Like I said, I haven’t seen any cites of someone dying of this condition outside of police custody even though the precursor elements should apply to people under other circumstances - including police officers themselves and soldiers. And I haven’t seen any reasonable explanation for why that is, other than the obvious.
---
### Author:  [@RickJay](https://boards.straightdope.com/u/RickJay)
#### Post date: [June 6, 2020, 3:28am UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/8 "2020-06-06T03:28:35Z")
I cannot find any examples of “Excited delirium” occurring in a case where a person isn’t being arrested or physically attacked by police officers. It appears to exist nowhere else.
It is total bullshit. There is no such thing.
---
### Author:  [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)
#### Post date: [June 6, 2020, 3:41am UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/9 "2020-06-06T03:41:09Z")
> [@Pantastic](#):
>
> Yeah, definitely the latter. Like I said, I haven’t seen any cites of someone dying of this condition outside of police custody even though the precursor elements should apply to people under other circumstances - including police officers themselves and soldiers. And I haven’t seen any reasonable explanation for why that is, other than the obvious.
> [@RickJay](#):
>
> I cannot find any examples of “Excited delirium” occurring in a case where a person isn’t being arrested or physically attacked by police officers. It appears to exist nowhere else.
>
> It is total bullshit. There is no such thing.
I tend to agree. If this was a real condition, you’d expect to be seeing it in people in other stressful situations like natural disasters or car accidents. A medical condition that only strikes people when they’re in police custody seems unlikely.
---
### Author:  [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)
#### Post date: [June 6, 2020, 3:51am UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/10 "2020-06-06T03:51:54Z")
I don’t think a term like “Excited Delirium” was ever used, but back when people with autism, some forms of mental retardation, and most forms of psychosis were institutionalized, their life expectancy was 38-48 (it varied by state, and you could guess what types of restraint and other forms of subduing inmates were permitted by whether or not life expectancies were on the high or low end.
Schizophrenia and autism could actually be causes of death on death certificates, because people with these conditions had lowered life expectancies, and frequently died having “episodes.” :dubious: The direct cause of death, in states that listed one, would be something like “psychotic fit,” and the underlying cause schizophrenia, or autism, or something like “emotional disturbance.”
People with psychiatric and neurological-behavioral conditions don’t live in institutions anymore, and surprise! have nearly normal life expectancies (normal minus about five years, because autistic people are more likely to die from household accidents, and schizophrenics have a higher rate of suicide than the non-psychotic population, but their life expectancy is way, way higher than 38-48), and don’t have “fits,” or die while being restrained or subdued (“for their own good”).
This is the same phenomenon, in different clothes.
I wouldn’t be surprised to find out that slaves and prisoners are believed to have died/die from fits of some kind related to being caught trying to escape, or to being disciplined.
---
### Author:  [@RickJay](https://boards.straightdope.com/u/RickJay)
#### Post date: [June 6, 2020, 2:18pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/11 "2020-06-06T14:18:51Z")
> [@RivkahChaya](#):
>
> I don’t think a term like “Excited Delirium” was ever used, but back when people with autism, some forms of mental retardation, and most forms of psychosis were institutionalized, their life expectancy was 38-48 (it varied by state, and you could guess what types of restraint and other forms of subduing inmates were permitted by whether or not life expectancies were on the high or low end.
The earliest references to the term “excited delirium” I can find are in the 1980s, though it didn’t start to be used as a standard euphemism for “killed by cops” until 15 years ago or so.
But hell, yeah, of course it happened before. They didn’t just start murdering people in 1987.
---
### Author:  [@pkbites](https://boards.straightdope.com/u/pkbites)
#### Post date: [June 6, 2020, 2:50pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/12 "2020-06-06T14:50:05Z")
> [@Little\_Nemo](#):
>
> I tend to agree. If this was a real condition, you’d expect to be seeing it in people in other stressful situations like natural disasters or car accidents. A medical condition that only strikes people when they’re in police custody seems unlikely.
Because those people typically aren’t overdosing on meth, crack, bath salts, etc…
The reason excited delirium involves police so much is because when there is a maniac running nude down the street yelling and screaming, the cops are who people typically call. But fire fighters and paramedics also get caught in the trick bag when dealing with these people as well.
Excited delirium is real, and it is frightening. I’ve been involved with people experiencing it twice. Both loved but man, it was an ordeal.
---
### Author:  [@mhendo](https://boards.straightdope.com/u/mhendo)
#### Post date: [June 6, 2020, 3:08pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/13 "2020-06-06T15:08:21Z")
[Philippe Gonin et al., “Excited Delirium: A Systematic Review,” _Academic Emergency Medicine_, 25:5 (May, 2018).](https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13330)
The full article is available free at the link. Some possibly relevant sections:
> [@](#):
>
> ExDS [excited delirium syndrome] usually requires the use of physical or mechanical restraint, including the intervention of security officers or law enforcement officers. An associated significant morbidity and a mortality rate of 8% to 10% has been reported.
>
> The term “ExDS” was coined and an initial flurry of reports published in the 1980s, particularly in forensic records, in the context of deaths of individuals in custody or during arrests following extreme agitation. ExDS typically involved men in their 30s after cocaine, methamphetamine, or ecstasy abuse. Similar cases of extreme agitation have also been described in psychiatric conditions since the 19th century, referred to as “Bell’s mania.”
>
> Over the past few years, the association between police coercion methods (conducted electrical weapons [CEW; e.g., TASER™], pepper spray, ventral decubitus physical restraint, etc.) and cases of in‐custody deaths drew the attention of the media and contributed to public opinion about ExDS . However, fatal cases of ExDS also appeared inside the hospital, in the absence of any major trauma, physical restraint, or police intervention. Although ED [emergency department] caregivers regularly face such cases of extreme, unusual agitation in their daily practice, its presence in multiple areas of medical care in the presence of people with varying degrees of medical training contributes to the difficulty in forming a unifying definition of the syndrome.
It seems to me that, if physical or mechanical restraint is basically a requirement for the condition itself, then it’s not unreasonable to argue that ExDS basically only exists as a medical condition is a law enforcement context, or similar situations.
The last paragraph quoted above does say that it occurs in emergency departments, in the absence of police intervention, but it’s not quite clear whether such cases still involve physical or mechanical restraint. If they do, and the restraint itself is a “but for” cause of, or contributor to, the condition, then it seem to me that the use of the term is basically an effort to use medicalized terminology to describe the results of physical restraint.
The study notes that there is not a single definition of ExDS, that some medical organizations recognize it as a “specific clinical entity” (e.h., the American College of Emergency Physicians), while others don’t (American Psychiatric Association; World Health Organization). And even the ACEP’s definition is “syndromic,” with no “unique pathophysiologic cause or specific diagnostic test.” The “Definition of ExDS” section of the review points to the various criteria posited by different studies.
In its conclusion, the review notes:
> [@](#):
>
> The LOE [level of evidence] remains very low, as 65% (n = 43) of the articles were retrospective case reports, case series, or case‐control studies. Furthermore, we were able to only partially answer the questions. To our knowledge, this is the first systematic review to evaluate the definition, epidemiology, pathophysiology, and treatment of ExDS.
>
> Because the definition of ExDS remains mostly syndromic and based on clinical criteria, it is prone to subjectivity.
Of particular note, regarding law enforcement, is this section of the Discussion:
> [@](#):
>
> The prevalence of ExDS appears to vary widely with context and by case definition. Beyond health care providers’ issues, this syndrome appears to be particularly relevant for police agencies. ExDS is in question in more than 3% of police interventions that require the use of force and is associated with more than 10% of deaths in police custody. At the same time, severe ExDS requiring out‐of‐hospital restraint is observed in fewer than two cases for 10,000 advanced life support EMS calls. It also seems to be frequent in the forensic setting, where ExDS represents more than 10% of CEW‐related [CEW = conducted electrical weapons, such as Tasers] deaths and more than 15% of cocaine‐related deaths. No data are available about admission rates to EDs or critical care units.
The Conclusion of the study argues that ExDS is “a real clinical entity, that it still kills people, and that it probably has specific mechanisms and risk factors,” but that evidence levels for studying it are low to very low, and that much better definitions and randomized and clinical tests are essential in dealing with it.
Note that the fact that they conclude that it’s a “real clinical entity” doesn’t absolve police of responsibility here. The people writing the review are doctors who need to understand how and why something like this happens, and how best to deal with it. It is possible, I think that it’s completely possible for it to be both a “real clinical entity” for medical purposes, but ALSO something that is exclusively (or almost exclusively) associated with particular types of force or restraint, and that can be prevented by less aggressive police techniques.
---
### Author:  [@puddleglum](https://boards.straightdope.com/u/puddleglum)
#### Post date: [June 6, 2020, 3:11pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/14 "2020-06-06T15:11:28Z")
> [@RickJay](#):
>
> The earliest references to the term “excited delirium” I can find are in the 1980s, though it didn’t start to be used as a standard euphemism for “killed by cops” until 15 years ago or so.
>
> But hell, yeah, of course it happened before. They didn’t just start murdering people in 1987.
The first mention of a similar disorder is from 1849 where it was called Bell’s Mania.It seems to be seen more often than in the past because it is associated with prior mental illness, which in the past would have led to institutionalization, and drug use, specifically cocaine and methamphetamine. Both those drugs gained popularity in the 70s and 80s.
It seems to be a well established condition in emergency medicine. [Here](https://www.emra.org/emresident/article/excited-delirium/)is an article about it on the Emergency medicine resident association webpage.
At 2:15 in this [video](https://www.ems1.com/ems-assaults/videos/dealing-with-excited-delirium-gbQq8nQJlCxwJPB7/)is an encounter with a man purported to be suffering from excited delirium.
Since common symptoms are said to be extreme agitation, removing clothes, and running into traffic, it is no surprise that the police are the first people called on to deal with them.
---
### Author:  [@Pantastic](https://boards.straightdope.com/u/Pantastic)
#### Post date: [June 6, 2020, 3:47pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/15 "2020-06-06T15:47:43Z")
> [@pkbites](#):
>
> Because those people typically aren’t overdosing on meth, crack, bath salts, etc…
If someone is overdosing on meth, crack, bath salts, etc and dies as a result of the effects of those drugs, wouldn’t that be the cause of death and not some mysterious ‘excited delirium’? And how does this explain ‘excited delirium’ for people who aren’t on drugs?
> [@](#):
>
> Excited delirium is real, and it is frightening. I’ve been involved with people experiencing it twice. Both loved but man, it was an ordeal.
The fact that someone overdosing on drugs does odd stuff doesn’t mean that the mysterious ‘excited delirium’ medical condition exists, and doesn’t explain why it only seems to exist for people in police custody, or how it affects people who aren’t on drugs.
---
### Author:  [@Pantastic](https://boards.straightdope.com/u/Pantastic)
#### Post date: [June 6, 2020, 3:56pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/16 "2020-06-06T15:56:36Z")
> [@mhendo](#):
>
> Note that the fact that they conclude that it’s a “real clinical entity” doesn’t absolve police of responsibility here. The people writing the review are doctors who need to understand how and why something like this happens, and how best to deal with it. It is possible, I think that it’s completely possible for it to be both a “real clinical entity” for medical purposes, but ALSO something that is exclusively (or almost exclusively) associated with particular types of force or restraint, and that can be prevented by less aggressive police techniques.
So essentially it’s ‘stuff that happens when police use force or restraint on people’, but certain parties like to list it as a cause of death instead of the police use of force or restraint? I mean, yeah if you restrain someone, shock them, poison them, and pump them full of ketamine then they’re going to have some symptoms in common, but that’s just a symptom of being subjected to ‘policing techniques’, the symptoms aren’t the cause of death.
---
### Author:  [@Magiver](https://boards.straightdope.com/u/Magiver)
#### Post date: [June 6, 2020, 4:40pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/17 "2020-06-06T16:40:51Z")
> [@Little\_Nemo](#):
>
> I tend to agree. If this was a real condition, you’d expect to be seeing it in people in other stressful situations like natural disasters or car accidents. A medical condition that only strikes people when they’re in police custody seems unlikely.
How would you know if they’re found dead unless you could document what they went through prior to their death?
Barring other evidence that lead to their death in police custody I would tend to believe people in a highly agitated state would die from it. If you take something like claustrophobia, being restrained would induce a psychotic response almost instantly. It’s hard to explain this to someone who has never experienced it. It’s a massively horrible state of mind that someone would not want to experience for even a few seconds without some avenue of relief.
So, if we’re to accept the premise that the condition exists then there is a need to alter the triggers causing the condition. If someone is completely out of control then tying them to a chair with their hands cuffed behind them and and a hood covering their face is, IMO, going to greatly increase the agitation and likelihood of death.
If officers are faced with a person who is out of control then maybe we should be looking at sedating the person as a method of restraint and then monitoring their life signs for any changes in condition.
---
### Author:  [@pkbites](https://boards.straightdope.com/u/pkbites)
#### Post date: [June 6, 2020, 4:45pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/18 "2020-06-06T16:45:38Z")
> [@Pantastic](#):
>
> If someone is overdosing on meth, crack, bath salts, etc and dies as a result of the effects of those drugs, wouldn’t that be the cause of death and not some mysterious ‘excited delirium’? .
Not all overdoses result in death. And those that do not all are directly from the drug itself but a secondary issue either caused or made worse by the drug. In the case of excited delirium many times it is a cardiac issue coupled with a form of temporary insanity. Victims of it are completely out of their head. Smashing things, tearing off all their clothing, sweating profusely, screaming incoherently. In layman’s terms their heart literally explodes. In many ED cases these people are going to die no matter what happens.
Go on You Tube and watch some videos of it. Officers do go through training for it and some of the training is available online for you to watch. But it’s a huge shit sandwich and no cop drams of being involved in one. It is usually a lose/lose situation.
---
### Author:  [@RickJay](https://boards.straightdope.com/u/RickJay)
#### Post date: [June 6, 2020, 5:45pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/19 "2020-06-06T17:45:47Z")
> [@pkbites](#):
>
> In layman’s terms their heart literally explodes.
Hearts don’t literally explode.
---
### Author:  [@pkbites](https://boards.straightdope.com/u/pkbites)
#### Post date: [June 6, 2020, 6:09pm UTC](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110/20 "2020-06-06T18:09:13Z")
> [@RickJay](#):
>
> Hearts don’t literally explode.
It’s called myocardial rupture. What part of “layman’s terms” don’t you get.
[Next page](https://boards.straightdope.com/t/excited-delirium-real-or-police-killed-this-guy/855110.md?page=2)