Charles Reece is a serial killer who commits a number of brutal mutilation-slayings in order to drink blood as a result of paranoid delusions.

The prosecutor, Anthony Fraser, was previously against capital punishment, but he seeks such a penalty in the face of Reece's brutal crimes after meeting one victim's grieving family.

In the ending of the revised version, Reece is sent to a state mental hospital, and in a chilling coda, he sends a letter to a person whose wife and child he has killed, asking the man to come and visit him.

However, Reece and Chase had a similar history of being institutionalized for mental illness prior to their murders, along with sharing a fascination with drinking blood and cutting open the organs of their victims.

[9][10] In the early 1990s, Friedkin said he changed this detail of Chase's life in the second cut since having him be released from prison fitted better with the traditions of the United States.

While Chase was noted for having an unkempt appearance and exhibiting traits of paranoid schizophrenia in public, the film's makers intended to portray Reece as "quietly insane, not visually crazed.

[5] The film had a negative portrayal of courtroom experts, and this was personally motivated by Friedkin's ongoing custody battle for his son, which he was having with his ex-wife.

[12] The film's score was composed, orchestrated, arranged and conducted by Ennio Morricone and was released on vinyl LP, cassette and compact disc by Virgin Records.

Plans for the film's theatrical release in America were shelved when production studio DEG, the distributor of Rampage, went bankrupt.

[14] During that time, director Friedkin reedited the film, and changed the ending (with Reece no longer committing suicide in jail) before its US release in October 1992.

[20] Janet Maslin of The New York Times praised the acting and commented: "Rampage has a no-frills, realistic look that serves its subject well, and it avoids an exploitative tone.

"[21] Owen Gleiberman of Entertainment Weekly called the film "despicable", saying that the "movie devolves into hateful propaganda" and "its muddled legal arguments come off as cover for a kind of righteous blood lust".

[2] Desson Howard of The Washington Post noted that in the film's five year delay, there had been several high profile serial killer cases, saying: "In this Jeffrey Dahmer era, McArthur's claims of unseen voices and delusions that he needed to replace his contaminated blood with others' are familiar tabloid fare", however, he noted that despite this, the film "still preserves a horrifying edge.

"[23] In a separate 1992 review for The Washington Post, Richard Harrington had a more negative view, criticizing the film for feeling like a made for television feature, and claiming that it had a dated look to it due to its long delay.

[12] In 2021, Patrick Jankiewicz of Fangoria wrote: "Half-serial killer thriller, half-courtroom drama, Rampage is an unnerving study on the nature of evil and what society should do about it.

"[25] Friedkin's original cut featuring the alternate ending and some additional footage was released on LaserDisc in Japan only by Shochiku Home Video in 1990.