IMO, it depends on the person's mental stability.
If you get a thought of something like "holy stuff what if I [insert something crazy/horrific here]? that would be forgeted up.", that doesn't mean you're instantly a completely crazy, mentally unstable going-to-be-serial-killer.
If your mental health is stable, you're most likely going to be able to tell the difference between reality and fantasy; I feel bad for pixels (As in I feel bad whenever I shoot some random innocent most of the time), but most people won't because they're simple pixels, while in real life that mentally stable person knows that if a person gets shot, it's not just a pre-recorded audio file going "AHHHH", nor are they just virtual feelings.