Clinical characteristics of hospitalized military patients with narcissistic personality disorder.

Clinical characteristics of 21 psychiatric military inpatients meeting DSM-III and DSM-III-R criteria for narcissistic personality disorder (NPD) were compared to the characteristics of 42 inpatients having other personality disorders (OPD). Chart review indicated that the major differences between NPD and OPD patient groups included a greater likelihood for NPD patients to have been admitted for physically violent conduct and that they were more likely to be undergoing a personally significant rejection, such as divorce or separation, at the time of hospitalization. Additionally, there was a tendency for NPD patients to be sexually abusive towards children, indicating a violation of the incest taboo.

Some aspects of sex offending--causes and cures?

Selected aspects of sexual offending are considered against a background of general observations about sexuality in contemporary society. It is suggested that sexual offending may appear in a variety of guises, that it is more realistic to talk about management than 'cure' and that success in management is highly dependent upon the professional's capacity to form a non-judgemental view and act with this constantly in mind.

Multiple personality: an issue for forensic psychiatry.

The formulation of Multiple Personality (MP) as a distinctive entity by DSM-III while helpful clinically requires, at best, very rigid evaluatory criteria based on independent verification when used as a defense in a Court of Law. The use of the set of eight criteria developed by specialists are helpful guidelines. A case of MP disorder discovered under hypnosis by a psychiatrist and later on vehemently denied by the patient became the object of legal action as part of a malpractice suit. While some well-known experts consulted during treatment believed that she was a MP, the expert witnesses at the trial felt that the patient was not. As a mixed (borderline-histrionic) personality, the patient possibly might have dissociated under stressful life circumstances. The case raises serious issues about the role of auto-suggestion in mimicking MP. It questions the validity of the use of the diagnosis in Court. Legally only carefully evaluated independent data about incongruent past patterns of behavior suggesting alternate personality, can be considered reliable reference for the diagnosis.

Human immunodeficiency virus transmission by child sexual abuse.

During 1987-1989, 14 (14.6%) of the 96 children who tested positive for the human immunodeficiency virus (HIV) and were followed up by the Duke University (Durham, NC) pediatric acquired immunodeficiency syndrome team were confirmed to have been sexually abused. Every sexually abused child was evaluated for each of five modes of HIV transmission, and in nine children the pathway was identified. Four of the study children acquired HIV from child sexual abuse and in six, abuse was a possible source. Transmission by child sexual abuse was the most frequent of the proven modes of acquisition of HIV in this population. The other proven modes of acquisition were vertical transmission (n = 3) and HIV-contaminated blood transfusion (n = 2). Twelve males were identified (n = 8) or suspected (n = 4) of being perpetrators. Three knew themselves to have HIV at the time of an assault and eight were aware that the child had HIV at the time of an assault. There was no indication from any child that "safe sex" precautions had been observed. Children with HIV infection had multiple risk factors for abuse or neglect. The sociological descriptors of the lives of the 14 abused children showed multiple known risk factors for sexual abuse that also overlapped with known risk factors for or sequelae of the acquisition of HIV infection. These included drug abuse and alcoholism in the home, prostitution of a parent, lack of parenting, poverty, and chronic illness of the child. Prevention efforts should recognize that children as well as adults are at risk for sexually transmitted HIV infection.

Patterns of exposure to sexually explicit material among sex offenders, child molesters, and controls.

The Meese Commission Report claimed exposure to sexually explicit material leads to sex offenses and recommended examining developmental patterns and pornography experiences of offenders. This second phase of our study examines developmental patterns and sexually explicit material experiences of sex offenders, a subgroup of child molesters, and controls. Results indicate sex offenders (but not the child molester subgroup) began masturbating at a significantly younger age than controls. Sexually explicit material was used during the first masturbatory experience of 33.3% of sex offenders and 14% of controls. Child molesters were significantly older than controls when exposed to sexually explicit material. Frequency of adult use of sexually explicit material does not differ significantly among groups.

Victims of violence: aspects of the "victim-to-patient" process in women.

This paper is an overview of aspects of the victim-to-patient process which reflects the interrelationship between mental health and mental disorder, particularly of women who suffer the sexual assault, sexual abuse, or wife assault. Knowledge of the psychological processes and symptoms aids diagnosis, modifies treatment and the process of recovery following acts of violence.

[Child victims of sexual abuse in Cameroon]. / Les enfants victimes de sévices sexuels au Cameroun.

Reports of sexual abuse in children are infrequent in the French-speaking nations of black Africa. This study was undertaken to determine the incidence of sexual abuse in children in Yaounde, describe the profile of victims, and identify factors associated with sexual abuse. Seventeen female rape or attempted rape victims were enrolled over an 8-month period. Most (57.05%) were 7 to 15 years of age and lived in underprivileged neighborhoods. Genital bleeding (12 cases), hymenal tears (14 cases) and/or perineal tears were the main lesions found. Most of the rapists were young adults (19-45 years old in 70.5% of cases) who were neighbors, relatives or friends of the family, and single (58.82%). The motivations of the rapists were unclear. This medicosocial reality which is new in Cameroon needs attention.