Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning.

Importance: Psychiatry has struggled to clarify the types of mental turmoil that are associated with mass violence. While the problem is complex, it may present an opportunity to improve research, as well as inform public dialogue about what types of mental illness are actually associated with such mass tragedies. Observations: Assuring the diagnostic accuracy of those who commit mass violence is challenging due to the retrospective nature of the analysis and lack of reliable psychiatric data. Psychiatric research has begun to use a dimensional approach that may be well suited to the study of mental illness in perpetrators of mass violence. This approach aggregates psychiatric symptoms into 3 domains of psychopathology: (1) internalizing, (2) externalizing, and (3) psychotic experience. This approach has practical clinical use and research support. A dimensional approach may help clear up misconceptions about the rate of psychosis in mass violence perpetrators, as well as reveal the most common dimensions of mental functioning associated with perpetrators. Conclusions and Relevance: Improved research methods are needed to clarify and prevent mass violence. More precisely identifying the symptoms and mental turmoil of perpetrators may be associated with improved early identification and prevention. Because adolescence is a critical and formative period in which internalizing and externalizing problems arise, early interventions may have the best chance of reducing future mass violence.

The lethality of non-familial child abductions: Characteristics and outcomes of 565 incidents involving youth under the age of 18 years.

Offender motivation for child abduction determines both the nature and final outcome of the abduction. Research has identified victim characteristics, offender characteristics, and sexual motivations as factors influencing child abduction and child abduction homicide. We examine 565 child abductions identified through the Federal Bureau of Investigation (FBI) to determine the characteristics of victim, perpetrator, and crime and their influence on whether the child is murdered. Central to this research was the finding that 88.6% of the abductions involved a sexual motivation for the crime, and sexual motivation was significantly more likely when the victim was female and when the victim was post-pubescent. Of 581 child victims for whom the outcome of the abduction was known, 281 (48.3%) were found alive and 300 (51.7%) were found dead or presumed dead. There was a significant interaction between motive for the crime and the final abduction outcome, with victims abducted for sexual purposes being at higher risk of being murdered.

Denial and minimization among sex offenders.

A review of empirical studies of offenders-particularly sex offenders, and more particularly those who offend against children-demonstrates that denial of offenses and minimization of offending behavior are quite common at every stage of the criminal justice process. This is true during police interviews, during pretrial and presentencing mental health evaluations, among incarcerated offenders, among offenders seeking treatment, among offenders facing parole review, and among offenders already released into the community. This review highlights gaps in the research literature arising from inconsistencies in the definitions and measurement of denial and minimization, from the stage of adjudication or treatment at which measurements are made, and from the use of polygraphy to increase disclosures. Despite these limitations on the generalizability of empirical findings, it appears beyond dispute that many sex offenders maintain their innocence in the face of evidence to the contrary or even criminal conviction, and that many are able to recite additional crimes they have committed when they believe it is in their self-interest to do so.

Gender and violence risk assessment in prisons.

Our study examines the association between Historical, Clinical, Risk Management-20: Version 2; Psychopathy Checklist-Revised; and Violence Risk Assessment Guide scores and violence perpetrated during incarceration by male and female inmates. Using a sample of 288 men and 183 women selected from prisons in 2 states, we used receiver operating characteristics analyses to assess the potential of these 3 measures to predict threatened, physical, or sexual prison violence measured in 2 ways: inmate self-report and formal institutional infractions. We found all 3 instruments to demonstrate moderate to good levels of predictive accuracy for both the male and female inmates, a finding that suggests that actuarial, structured professional judgment and personality measures perform in a broadly comparable manner in assessing institutional violence for both men and women. Our findings did vary on the basis of the way violence was measured: Women self-reported significantly higher levels of prison violence than was suggested by their institutional infractions, and the associative power of the instruments diminished substantially, particularly among the men, when institutional infractions alone were used in the analyses. These findings suggest that the 3 risk measures are likely to be gender neutral in their association with prison violence, albeit with gender-related differences in the frequency of violent behavior and the relevance of particular subscales. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Factitious Disorder in a Patient Claiming to be a Sexually Sadistic Serial Killer.

Factitious disorder involves the conscious simulation of psychological or physiological symptoms of illness, for the purpose of fulfilling the unconscious desire to be taken care of or to assume the "sick role." Typically patients with factitious disorder simulate conditions that are designed to arouse feelings of empathy in care providers with the intention to engage them in caretaking. However, patients might also simulate conditions that arouse revulsion or rejection and still meet full diagnostic criteria for factitious disorder. In this case report, we present a patient who fabricated an elaborate history of being a sexually sadistic serial killer with homicidal ideation with the intention of obtaining personal attention, nurturance, and empathy from his psychotherapist. However, given the nature of his feigned condition, the patient frightened the very person whom he sought to engage in caretaking.

Acquaintance molestation and youth-serving organizations.

This article is based not only on the research literature but also on the extensive field experience of the authors in consulting with investigators, attorneys, and organizations on the prevention, investigation, prosecution, and civil litigation of molestation of children within or in connection with youth-serving organizations. Acquaintance molesters have often pursued careers or sought out paid or volunteer work with organizations through which they can meet children. To address the problem of such offenders, it is necessary for youth-serving organizations to recognize the diversity of sexual activity, the phenomena of "nice-guy" offenders and compliant child victims, and the grooming/seduction process, each of which is reviewed here. The four most important protection practices for organizations are screening; management, and supervision; response to suspicions, allegations, and complaints; and prevention and awareness programs. The authors recommend general approaches to each of these and describe the reasons many organizations resist implementing available preventive measures.

Commentary: Approaching and stalking public figures--a prerequisite to attack.

The concept of studying approaches to public figures (i.e., physical pursuit or stalking) arose as a proxy measure to aid in the development of tools to prevent assassination, a low base rate event. In this commentary, we review the origins of this concept and the historical record of public figure attacks in the United States that formed the empirical basis of the concept, we describe case examples of approaches toward public figures in the United States that did not result in injurious attacks, and we provide a synopsis of our findings on the ways in which communications predict approach.

Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations.

Evaluations of competence to stand trial (CST) are the most common type of criminal forensic evaluation conducted, and courts tend to defer to clinician opinions regarding a defendant's competence. Thus, it is important to study the ways in which clinicians arrive at opinions regarding adjudicative competence and the data they consider in forming their opinions. We reviewed 8,416 evaluations conducted by forensic evaluators in Virginia over a 12 year period, and examined (a) the clinical, demographic, and criminal characteristics of a defendant as related to opinions regarding competence, predicted restorability, and impairment on "prongs" of the Dusky standard, (b) process and outcome differences in evaluations conducted by psychiatrists versus psychologists and inpatient versus outpatient evaluators, and (c) the consistency of incompetence base rates over a 10 year period. Overall, clinicians opined that 19% of defendants were incompetent and considered 23% of these unlikely to be restored to competence. Not surprisingly, psychotic and organic/intellectual disorders were most strongly associated with findings of incompetence. However, there were some notable differences between evaluations by psychologists versus psychiatrists and between evaluations conducted in inpatient versus outpatient settings.

Opinion formation in evaluating sanity at the time of the offense: an examination of 5175 pre-trial evaluations.

Sanity evaluations are high-stake undertakings that explicitly examine the defendant's culpability for a crime and implicitly explore clinical information that might inform a plea agreement. Despite the gravity of such evaluations, relatively little research has investigated the process by which evaluators form their psycholegal opinions. In the current study, we explore this process by examining 5175 sanity evaluations conducted by a cohort of forensic evaluators in Virginia over a ten-year period. Our analyses focus on (i) the clinical, criminal, and demographic attributes of the defendant correlated with opinions indicative of insanity; (ii) the clinical content of the evaluations and the legal criteria referenced as the basis for the psycholegal opinion; (iii) the process and outcome differences in the sanity evaluations conducted by psychologists versus psychiatrists; and (iv) the consistency in these opinions over a ten year period. Analyses predicting an opinion of insanity indicate a positive relationship with psychotic, organic, and affective diagnoses and previous psychiatric treatment. Analyses also indicate a negative relationship with prior criminal history, drug charges, personality disorder diagnosis, and intoxication at the time of the offense. Modest racial disparities were observed with evaluators offering opinions that the defendant was insane more often for white than for minority defendants despite comparable psychiatric and criminal characteristics.

Acute dissociative responses in law enforcement officers involved in critical shooting incidents: the clinical and forensic implications.

The authors examine the prevalence of acute traumatic dissociative responses in a group of 115 law enforcement officers involved in critical incidents. Law enforcement officers were retrospectively surveyed for the presence of dissociative symptoms at the time of the critical incident, as well as for the presence of acute stress symptoms and posttraumatic stress symptoms. Results show that 90% of the officers reported experiencing a dissociative response during the critical incident. Thirty percent meet the Dissociative Criterion B of acute stress disorder under the DSM-IV. The mean number of dissociative symptoms in this group was two and one-half. In addition, 19% of the law enforcement officers reported varying forms of memory impairment for details of the incident. There were no reports of amnesia for the entire event. The clinical, forensic, and legal implications of these preliminary findings are discussed in this paper.