They all grew up hating themselves. Gacy for his sexuality, Kearney for his height, Miyazaki because of a birth defect. When they mutilated their victims, it was projection.
Prodigal Son s02e07: Malcolm got the results back from Ainsley’s bloody shirt sample: the blood was porcine, pig’s blood. Ainsley was playing a cruel prank on Malcolm.
“Do you have any idea what you have put me through? I have given up everything for you! I…I don’t even know who I am anymore. — Because of what I have done to protect you.”
“…they are really lining Ainsley up with Martin in the sense that she goes where he goes and she is who he is. That’s been the big question with Malcolm the whole first two seasons, so I think at this point, they’re just moving Ainsley into that same dilemma. Are you like your father or not? So now you’ve learned how Malcolm is and isn’t, and we’re starting to figure out how Ainsley is or isn’t as well.”
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