Introduction
On March 25, 2026, a 13-year-old student in Italy live-streamed himself stabbing his French language teacher multiple times. When police searched the middle schooler’s house, they found precursors to explosives, a manifesto entitled “The Final Solution”, and multiple weapons.1
On April 20, 2026, a 26-year-old man opened fire with a .38 revolver at Mexico’s famous Teotihuacán pyramids, killing 1 and injuring 13. The date of the attack – Adolf Hitler’s birthday and the anniversary of the Columbine shooting – appears to have been deliberate. At the time of the attack, the shooter carried a framed AI-generated picture of himself with the two Columbine shooters, part of an online pattern of fascination with mass murderers.2
On November 7, 2025, a 17-year-old student at a high school in Indonesia detonated 4 IEDs across 2 locations, injuring 96. When the perpetrator was captured, he was found carrying several plastic firearms, inscribed with references to previous mass attacks, including Columbine and the 2019 Christchurch shootings.3
At first glance, all three of these attacks are massively separated by geography, demographics, and culture. However, on closer inspection, these attacks are actually connected by a decentralized online community that glorifies in memetic, metastatic violence: the True Crime Community (TCC).4 This community poses a rapidly growing and self-perpetuating threat to public health across the globe, and remains chronically underreported. It is imperative that emergency medicine physicians, often on the front lines of public health, be aware of the dangers of the TCC.
The True Crime Community
In recent years, nihilistic violent extremism (NVE) has become a rapidly growing global threat.5 Fundamentally, NVE may be understood as violence for the sake of violence, born out of online subcultures such as No Lives Matter, the COM Network, and 764. Decentralized online networks, found on every major social media site as well as gaming platforms such as Roblox, overwhelmingly target youth.6 Of these networks, the 764 Network, which targets children for sexual exploitation, real-world violence, suicide, animal cruelty, and other sadistic acts, is the most infamous, and has recently been designated as a priority by the FBI. Over the past year, hundreds of arrests have been made, but activity with this decentralized network has continued to accelerate. Several nations, including Canada, have gone so far as to designate NVE groups such as 764 as terrorist organizations.7
While 764 is starting to break into the public consciousness, due to increasing news reports and a new focus by authorities on the network, the TCC remains relatively obscure. This is both worrisome and incredibly dangerous, as the TCC is rapidly becoming one of the primary drivers of NVE worldwide.6
The true crime genre is both enormously popular and almost entirely benign. Millions of Americans enjoy consuming true crime content, ranging from podcasts to Netflix documentaries. However, the TCC is where this interest in content becomes dangerous. Members of the TCC participate in an online subculture that evolves from an interest in prior killers and mass murderers to an unhealthy parasocial relationships.4 Eventually, participants in the TCC may glorify past killers and attempt to emulate them.8 Ideology does not matter in this space; instead, TCC participants will focus on aesthetics, imitating the clothing and style of prior attackers, commissioning art of them, and participating in what is effectively an online fanbase.9 AI-generated videos referencing past attacks such as the 2012 Sandy Hook shooting, the 2019 Christchurch shooting, and even figures such as Jeffrey Epstein are also common in this space.10 Unfortunately, the participatory nature of the TCC is alarmingly predisposed to radicalization as participants go deeper and deeper into the rabbit hole. Gore content within the community is popular,9 and online games, such as the “Active Shooter Studios” server on Roblox, can even allow participants to directly re-enact the Columbine and Uvalde shootings.11
The TCC coalesces around a “pantheon of death”4 that ultimately participants wish to become a part of. In one of the most striking examples, a 15-year-old student named Natalie Rupnow committed a mass shooting in 2024 at Abundant Life Christian School in Wisconsin. Rupnow was an extremely active member of the TCC and left behind a digital footprint that was obsessively catalogued by other participants. Her manifesto references mass attacks in Finland, Crimea, and Turkey, and her final uploaded image to X – her hand forming the “OK” symbol over a tiled bathroom floor, taken just moments before the shooting – has made her one of the TCC’s most celebrated figures. Since then, multiple other attacks – including a Colorado school shooting and the Indonesian bombing mentioned earlier – directly referenced Rupnow’s attack, with both of the attackers imitating the “OK” image.4
Rupnow’s attack can be understood as a catalyzing influence on other TCC-related attacks, due to the self-referential and memetic nature of the community. By referencing past attacks like Rupnow and Columbine, TCC participants can make themselves part of the wider TCC mythos through acts of performative violence.10
The danger that the TCC poses to public health cannot be overstated. The community also poses an exceptional risk to pediatric health, given the extremely young age of many of its participants. Victims entering the TCC have been as young as 8 years old.12
Unfortunately, most parents are unaware of these online communities and the danger that they pose. In our ED, we have seen an increasing number of pediatric patients brought in by their parents after they were found consuming this dangerous and alarming content. It is important that ED physicians be aware of the resources available to help manage patients like this.
Screening in the Emergency Department
Screening for internet usage behaviors in the clinical setting has historically been difficult, especially in the fast-paced and often chaotic environment of the ED.13 While there are a number of clinical screening tools available, such as the Emergency Department Media Use Screener (EDMUS) developed in 2019,13 the United Kingdom’s Identifying Vulnerable People (IVP) guidance,14 and the Short-Term Assessment of Risk and Treatability (START),15 data remains unfortunately extremely limited in this field.16 Guidance on assessing violent extremism is further limited by a traditional focus on past criminal and violence history, ideological/religious fanaticism, and social grievances,15, 17 which are less likely to be applicable in recent cases of NVE.
Unfortunately, the recent explosion of NVE is such a new phenomenon that there is not yet any standardized or validated screening tool for it. Subcultures such as the TCC have even less standardized resources available.
Given this, in collaboration with Mr. Dexter Ingram, a counterterrorism expert with over 30 years of experience at the State Department, Defense Department, FBI, DHS, and INTERPOL, we recommend the following questions, meant for the parents of pediatric patients.
These questions should be conducted in conjunction with standardized screening for suicidal/homicidal ideation. Be careful to look for patterns of concerning online activity, increasing withdrawal from the world, fascination with gore/violent content, and other patterns that suggest an escalating trend.
Resources for Parents
There are a number of resources online that can be given to parents and caregivers concerned about online radicalization. We recommend the Polarization and Extremism Research and Innovation Lab (PERIL) of American University, which can be found at https://perilresearch.com/. PERIL also has an online database called the NVE Tracker that can be used to track incidents of NVE and provide a map of ongoing trends in the wider NVE space (https://nve.perilresearch.com/). Parents For Peace (https://www.parents4peace.org/) is another extremely helpful resource. An NGO providing psychoeducation that was founded by parents and survivors of extremism, they provide one-on-one support to an individual of concern and their families. They are a team of interdisciplinary experts from psychologists, to social workers, even former extremists who are now professionally trained as interventionists. We also strongly recommend Dexter Ingram’s handout regarding possible warning signs of online radicalization, which can be found and downloaded for free at https://dexteringram.substack.com/p/welcome-to-for-parents-and-teachers.
Ultimately, we believe that increasing education and public awareness of the threat that online networks like TCC pose is the key to defeating them. Making parents aware of the dangers of unmonitored Internet activity, of the threats targeting their children, and the signs to look out for can be done with a simple pamphlet.
Author Bios
Matthew Turner, MD, is an EM physician at Penn State Milton S. Hershey Hospital in Hershey, Pennsylvania. His scholarship spans emergency medicine, military medicine, and counterterrorism. His work has appeared in Homeland Security Today, the Small Wars Journal, Military Medicine, the Emergency Medicine Journal, and other journals.
Dexter Ingram is the former Director of the U.S. Department of State's Office of Countering Violent Extremism and a Research-to-Practice Fellow at NCITE. He writes on radicalization prevention at Dexter Ingram: Declassified (dexteringram.substack.com).
Mubin Shaikh is a retired Canadian former counter-terrorism operative who was previously a jihadist extremist himself, first rising to prominence for his role in thwarting the Toronto 18 case in 2006. He currently works as an interventionist for Parents for Peace.
References