Is bedwetting really “linked to future serial killers”?
- Steve Hodges, M.D.
- 4 hours ago
- 5 min read
By Steve Hodges, M.D.
Over the last half-century, the psychiatry profession has done plenty of harm to children with enuresis (bedwetting and daytime wetting) by linking this condition to emotional problems or abuse.
To this day, enuresis rates an entry in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), described by its publisher, the American Psychiatric Association (APA), as “an authoritative volume that defines and classifies mental disorders.”
Even though enuresis is decidedly NOT a “mental disorder” but rather a symptom of chronic constipation.
Every facet of popular culture — the media, the movies, political punditry — takes this false narrative and runs with it, perpetuating a stigma that crushes kids’ self-esteem and prevents them from receiving effective treatment.
Well, pop culture is back at it!
Thanks to the Netflix release of Monster: The Ed Gein Story, sadistic murderers are a hot topic. And thanks to my “bedwetting” Google alert, I’ve been informed that enuresis is among “three disturbing childhood traits linked to future serial killers.”
Let’s unpack this.
Normally, I wouldn’t bother, but the London-based outlet spreading this nonsense, The Tab, claims to have “a global audience of millions” and describes itself as the “Voice of Young People” specializing in “hot takes.”
This particular hot take will likely reach many young people who have enuresis, a group that already suffers enough. I know — I have a large caseload of teens with enuresis.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
According to the Tab piece, “psychologists say that there are three childhood signs which could signal a future serial killer”: cruelty to animals, obsession with fire-setting, and persistent bedwetting.
Who are the psychologists making this claim?
The Tab reporter cites just one source: the late forensic psychiatrist (not a psychologist!) John Macdonald, who offered up this theory in a 1963 paper titled “The Threat to Kill,” published in the American Journal of Psychiatry.
Mimicking journalism, the Tab article provides a link to Macdonald’s original paper, as if the paper supports his theory. But it doesn’t.
In the paper, Macdonald describes interviews he conducted with 100 patients at a Colorado psychiatric hospital. These 55 men and 45 women had threatened homicidal violence but had not actually killed anyone. Some 48 of the patients were psychotic, and according to Macdonald, “some patients showed sadistic behavior throughout their lives.”
The money quote: “In the very sadistic patients, the triad of childhood cruelty to animals, fire setting, and enuresis was often encountered.”
But wait: Exactly how many patients were “very sadistic”? And in this group, exactly how “often” was the triad encountered?
Macdonald doesn’t say. Thought his paper is loaded with statistics (35 patients had paranoid delusions and 20 reported parental brutality in childhood), Macdonald provides no numbers pertaining to enuresis, animal cruelty or setting fires.
Nonetheless, Macdonald’s salacious theory went viral — or at least the 1960s equivalent. FBI profilers jumped on the bandwagon, conducting a similar study and promoting it in their 1988 book Sexual Homicide: Patterns and Motives.
But if you spend 10 seconds on Google, you’ll find the “Macdonald triad,” as the theory came to be known, has been thoroughly debunked for decades.
Turns out, the FBI profilers’ paper was just as flawed as Macdonald’s. The profilers studied 36 murderers and claimed that “many” showed “one or more elements” of the triad. But they provided no numbers, let alone a statistical analysis, to support their claims.
The triad theory collapsed in a 1984 study, “The predictive value of the triad for sex offenders.” Turns out, the predictive value was . . . nonexistent.
This analysis of 206 incarcerated sex offenders concluded: “There was no compelling evidence to support the prognostic value of the triad of behaviors for predicting adult criminal outcome.”
The study also showed “a much lower frequency of triad behaviors than has been reported in the literature.”
The whole sordid saga of the Macdonald triad is dissected in a 2009 paper, “The Macdonald triad: predictor of violence or urban myth?”
“It turns out that the Macdonald triad was like a game of telephone, a really long game of academic telephone,” according to the paper’s author, Kori Ryan, a behavioral sciences expert at Fitchburg State University in Massachusetts.
Yet none of this has stopped The Tab from spreading the myth to its readership in 2025.
The Tab concedes the triad might not be a “crystal ball for predicting future murders” but calls the theory “chilling” and “a warning to watch for children struggling with underlying trauma, because catching problems early can make all the difference.”
With regard to enuresis specifically, the Tab says: “Bedwetting beyond age five may not seem threatening, but within the triad, it is linked to poor emotional regulation or childhood trauma.”
That’s total bunk. Enuresis has no connection with childhood trauma and everything to do with an enlarged, stool clogged rectum that is aggravating the bladder nerves and causing the bladder to spasm and empty without warning.
X-ray the abdomen of kids with untreated enuresis and you’ll find the same thing, regardless of their psychological well-being: a rectum full of stool.
However, this message, a mantra of mine for decades now, has demonstrated a spectacular inability to break through, let alone become one of those “hot takes” the Tab specializes in.
Even the numerous articles that debunk the Macdonald triad misunderstand enuresis.
For example, a Psychology Today article discredits the Macdonald triad as a predictor of violence but states: “Instead, childhood enuresis, firesetting and animal cruelty more likely represent three, among many, indicators of severe childhood abuse.”
This article was updated in 2025!
I cannot speak to the meaning of fire setting or animal cruelty, but enuresis is not an indicator of child abuse, trauma, or emotional disturbance. I wish the psychology and psychiatry professions would stop perpetuating this myth.
An article on the A&E website at least makes an effort to separate enuresis from the other two prongs: “The piece of the Macdonald triad that makes the least sense is persistent bedwetting, a common childhood behavior.”
The article quotes behavioral specialist Kori Ryan, whose understanding of enuresis is less off base but still inaccurate: "Persistent bedwetting can be really common in boys until they're much older and it can be related to other issues like ADHD. But it doesn't necessarily mean anything in isolation."
Actually, enuresis is equally prevalent in boys and girls, and while the condition is indeed quite common, that doesn’t mean it should be normalized or left untreated.
It’s true that children with ADHD have elevated rates of enuresis, as I discuss in my Zoom course Autism, ADHD, and Accidents. However, that’s because children with ADHD (and autism) have higher rates of chronic constipation.
Psychologically speaking, persistent bedwetting means literally nothing.
Yet the world will not surrender the idea that enuresis signals something nefarious or deeply psychological, whether it’s a proclivity toward homicide, a history of trauma or neglect, or reaction to parental divorce.
“The Macdonald triad is a mainstay in pop culture and still cited by criminologists,” the A&E article says.
Even while debunking the triad theory, A&E suggests there may be a grain of truth to it:
“Evidence shows that any one of the triad behaviors, when isolated, could be associated with future aggression and serial offenses—including serial murder. But it is rare to find all three behaviors together as predictors.”
Again, false! There is no evidence at all suggesting enuresis “could be associated with future aggression and serial offense.”
None.