Forensic Implications of the Parasomnias.

Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.

Efforts to Reify Other Specified Paraphilic Disorder (Nonconsent) and Their Implications.

The concept of a paraphilic interest in rape was first described in the 1970s but became popular in the early 1990s with the advent of sexually violent predator laws. Today, the concept is described as other specified paraphilic disorder (nonconsent) (OSPD (nonconsent)) and is the second most common diagnosis of individuals committed to state facilities as sexually violent predators. This usage continues despite research indicating that OSPD (nonconsent) lacks scientific validity and has consistently poor interrater reliability. Furthermore, the concept of paraphilic rape has been repeatedly rejected from inclusion in the DSM over a span of decades. Despite obvious flaws in the construct, some experts continue to promote OSPD (nonconsent) and to present unresearched, unvalidated, and idiosyncratic criteria by which to assess individuals. This article reviews the history and development of the concept of a paraphilic interest in rape, describes its scientific flaws, reviews its proponents' efforts to reify it as a clinical entity, and considers the ethics, legal, and evaluative implications of experts' efforts to do so.

Malpractice and Other Civil Liability in Psychedelic Psychiatry.

Psychedelics have the ability to fundamentally alter the consciousness of individuals who take them and thus pose unique legal risks for psychiatrists interested in incorporating them into their practice. Several issues related to malpractice may be relevant, including absence of standards of care, risk of harm, inappropriate treatment, and the doctrine of respondeat superior. In addition to malpractice, psychiatrists should be aware of other potential civil claims, including battery and the intentional or negligent infliction of emotional distress. Before providing psychedelic treatments to patients, psychiatrists should understand and mitigate their risk of malpractice and other civil claims.

Bestiality Law in the United States: Evolving Legislation with Scientific Limitations.

Societies have proscribed bestiality, or sex between humans and nonhuman animals, since the earliest recorded legal codes. In the early American colonies, religious prohibitions against bestiality provided the grounds for punishing those who engaged in such acts. In the 1800's, Henry Bergh imported the animal welfare approach to the United States, which modernized the legislative treatment of animals in the country. Until recently, however, many laws in the U.S. have been outdated and vague and have utilized moralistic terminology. Since the 1960's, a growing body of literature has developed suggesting that individuals who harm animals may also interpersonally offend. This concept, known as the Link, has served as a major motivation for advocates to promote new legislation criminalizing bestiality, to modernize old state statutes, and to expand penalties for individuals convicted of having sex with animals. Unfortunately, data supporting the Link between bestiality and interpersonal violence are limited and of questionable generalizability to the broad public. The Link's weaknesses can assist in guiding further research. This article summarizes the history of bestiality law, the current state of bestiality legislation in the United States, the body of Link-related literature on bestiality and interpersonal violence and other problematic sexual behaviors, and the empirical weaknesses and needs revealed by this legislation.

The QAnon Conspiracy Theory and the Assessment of Its Believers.

Pizzagate and its progeny QAnon are two conspiracy theories with a growing number of believers worldwide. QAnon has entered mainstream conservative politics, with followers identifying themselves with posters and t-shirts at rallies for former President Trump beginning in 2018. With growing numbers of QAnon theorists the world over, psychiatrists will begin to encounter such individuals with increasing frequency. Because some individuals are motivated to engage in criminal behavior on the basis of their beliefs, forensic psychiatrists may also encounter QAnon more commonly in the future. It is therefore important that psychiatrists understand the QAnon conspiracy theory, as well as how it is consistent with and different from other conspiracy theories. Particularly noteworthy is the rapid and global spread of QAnon via social media. Clinically, it is important for psychiatrists to be able to differentiate QAnon beliefs from other types of beliefs, including delusions and other delusion-like beliefs. For forensic psychiatrists, understanding the role that conspiracy theories may play in individuals' legal proceedings is particularly important.

Kahler v. Kansas and the Constitutionality of the Mens Rea Approach to Insanity.

In 1995, the Kansas legislature adopted what is referred to as the "mens rea approach" and abolished the affirmative insanity defense. This approach allows a defendant to be acquitted who lacks the requisite mental state for the crime, without consideration of the defendant's understanding of wrongfulness. In Kahler v. Kansas, the U.S. Supreme Court recently held that this restrictive approach does not violate due process and that a state is not required to adopt an insanity test which considers a defendant's moral capacity at the time of the crime. Four other states currently follow the mens rea approach, or some form of it. In this article, we first discuss a brief history of insanity defense laws in the United States. We then outline relevant legislative history and precedent in Kansas and other states that have adopted the mens rea approach. We next discuss the Supreme Court's reasoning in Kahler The significance of this test is further discussed, including Eighth Amendment considerations. We advocate for continued education of the public, legislators, and the judiciary regarding the use, application, and necessity of an affirmative insanity defense.

Forensic Evaluation of Sexsomnia.

Sexsomnia is a non-rapid eye movement parasomnic behavior characterized by sexual activity during sleep. Recognized in the most recent editions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Sleep Disorders, sexsomnia is likely to arise with increasing frequency in court as a potential explanation for sexual offending. The forensic psychiatrist has a unique role in the evaluation and management of sexsomnia. The psychosexual evaluation may elucidate the presence or absence of paraphilias and paraphilic disorders and identify any overlap between the alleged sexsomnic behavior and paraphilic interest. In addition, forensic psychiatrists may assess for malingered sexsomnia, provide an opinion regarding criminal responsibility, or evaluate the risk for committing future sexual offenses. Forensic psychiatrists should therefore understand basic information regarding the disorder, as well as how to conduct a psychosexual evaluation effectively in cases of alleged sexsomnia. This article describes the various considerations involved in the forensic evaluation of sexsomnia.

Psychedelic Psychiatry: Preparing for Novel Treatments Involving Altered States of Consciousness.

The past decade has seen a renaissance of research interest into the psychotherapeutic potential of psychedelic compounds. In 2019, Oakland and Denver became the first two jurisdictions in the United States to decriminalize the possession of psychedelic-containing organisms. As research and public policy continue to evolve, it becomes increasingly plausible that psychedelics will become viable treatment options for psychiatric conditions. Psychiatrists should be integral to models of psychedelic prescription and patient management. The risk for adverse psychological and medical effects from psychedelic sessions necessitates psychiatric supervision. The literature on psychedelic-assisted psychotherapy may provide wisdom regarding practical aspects of managing patients' treatment sessions.

Bestiality Among Sexually Violent Predators.

Bestiality, or sexual contact between humans and nonhuman animals, is a poorly understood aspect of sexual behavior. There is a dearth of scientific research on the prevalence of bestiality, the motivations for individuals to engage in the behavior, and the risk that such individuals pose for interpersonal sexual and nonsexual violence. This study is a descriptive analysis of bestiality in all individuals found to be sexually violent predators (SVPs) in the state of Virginia between the years 2003 and 2017. Of 1,248 SVPs, 33 (2.6%) had a history of engaging in bestiality. SVPs with a history of bestiality were significantly more likely to be victims of childhood sexual abuse (P < .005), to engage in nonsexual animal abuse (P < .0001), and to have committed child sexual abuse (P < .005). They were most likely to report sexual contact with dogs and demonstrated a breadth of other atypical sexual behavior. The lifetime prevalence of 2.6 percent is low compared with other published findings, suggesting that offenders may have intentionally minimized their history of atypical sexual behavior. The relationship between childhood sexual victimization and bestiality has not previously been reported in the literature and represents an important nidus for future investigation. Further research is necessary to characterize human-animal sexual interactions in SVPs and other populations.

The admissibility of other specified paraphilic disorder (non-consent) in sexually violent predator proceedings.

Following the advent of sexually violent predator (SVP) legislation in the early 1990s, forensic evaluators began to apply diagnostic labels related to a paraphilic interest in rape as a mental condition predisposing individuals convicted of sexual offenses to recidivate. The most recent iteration of the concept, other specified paraphilic disorder (non-consent) (OSPD (non-consent)), is a commonly utilized diagnostic entity in SVP proceedings. Research on paraphilic interest in coercive sex has failed to define a valid methodology or set of criteria to make a diagnosis of OSPD (non-consent) and has repeatedly demonstrated that the diagnostic construct has poor interrater reliability. The state of the science pertaining to OSPD (non-consent) thus raises serious concerns regarding its admissibility in SVP proceedings. Indeed, there are recent cases in which courts have deemed it inadmissible. The forensic expert involved in SVP proceedings should understand admissibility concerns related to OSPD (non-consent) and how to address them in court.

The Psychedelic Renaissance and Its Forensic Implications.

Recent years have seen a renaissance of research into the use of psychedelic compounds to address various psychiatric conditions. The study of these substances went dormant in 1970 when the United States government passed the Controlled Substances Act, which categorized lysergic acid diethylamide, commonly known as LSD or acid, as a Schedule I drug. The rise of psychedelics in research settings raises questions regarding their risks outside of clinical trials. The available data on the impact of psychedelic use on interpersonal violence and other criminal behavior remain scant. Although Timothy Leary's work of the 1960s failed to clearly demonstrate a reduction in criminal recidivism with psychedelic-assisted psychotherapy, recent studies suggest that the use of psychedelics may reduce individuals' risk of interpersonal violence. Forensic psychiatrists should be aware of this research, as well as the role that psychedelics may play in various forensic assessments. This article summarizes basic information that the forensic practitioner should know about psychedelic substances, including their various effects and proposed mechanism of action; describes historical and recent research into psychedelics and criminal behavior; and offers evaluators a practical means by which to assess individuals' psychedelic use in forensic contexts.

Bestiality: An introduction for legal and mental health professionals.

Bestiality, or human-animal intercourse, has been a concern of the legal and mental health communities for many years. Ancient legal codes delineated punishments for those who engaged in the behavior, denoting a moral and general societal concern surrounding bestiality dating to ancient times. Despite this longstanding interest in and legal efforts to punish humans for having sex with animals, there has been little research on the behavior. Current available research has largely been siloed based on the populations studied, making it difficult to render any firm conclusions about bestiality's prevalence, frequency, and the risk posed by those who have sex with animals. It is important for clinicians to know the legal status of the behavior in their jurisdictions, to understand possible medical and psychiatric complications and comorbidities, and to know how to evaluate and treat individuals who engage in bestiality or have the related diagnosis of zoophilic disorder. This article provides an overview of the terminology and research pertaining to bestiality, summarizes legal and ethical considerations, and describes clinically relevant information for the evaluation and management of individuals engaged in sex with animals.

Animal maltreatment law: Evolving efforts to protect animals and their forensic mental health implications.

Animals have long formed an important part of human communities and served various roles in human activities. Some of the earliest human civilizations developed laws that protected animals for assorted reasons, including their economic value, religious beliefs pertaining to animals, and societal concerns about cleanliness. In the 1800s, Western thinkers began to view animals as having rights of their own and proposed legislation that changed the legal landscape regarding animal maltreatment. In the United States today there are widely varying laws designed to address the various forms of animal maltreatment. Each state's laws are different. Some states have modern statutes designed to identify and punish animal maltreatment, and others are relatively lax in their consideration of what constitutes abuse. The purpose of this article is to review the development of animal maltreatment legislation from ancient civilization to the present day in the United States; to identify current legislative reforms designed to assist in investigating and prosecuting animal abusers; to describe the role that forensic mental health experts may play in evaluating abusers for a variety of related concerns, including violence risk, sexual violence risk, and fitness for guardianship of an animal; and to delineate areas requiring further research to improve the forensic evaluation of animal abusers.

Sexsomnia as a Defense in Repeated Sex Crimes.

Sexsomnia and related sexual behaviors during sleep may be diagnosed in individuals accused of sex crimes. Although sexsomnia is now formally recognized in the DSM-5, the variable presentation of such behaviors and the possibility of malingering in medicolegal situations can cause challenges for forensic evaluators and legal professionals alike. Review of the literature reveals a paucity of cases involving allegations of repeated incidents due to abnormal sexual behaviors or experiences in sleep. It is important for experts involved in such cases to understand how the courts have responded to sexsomnia defenses involving diverse alleged incidents. The authors review the case law and discuss methods of examining evaluees with suspected sexsomnia in cases of alleged sexual assault.

Trouble at teens' fingertips: Youth sexting and the law.

The last decade has seen a rapid increase in the use of smartphones among young children and adolescents. One consequence of this phenomenon is sexting. Although researchers of sexting have yet to arrive at a single, cohesive definition for the behavior, it generally involves the transmission of text, pictures, or videos containing sexual material. Different definitions of the behavior have led to widely varying estimates of its prevalence, although some studies have documented relatively high rates of sexting among teenagers. As adolescence is the time period in people's lives where the psychological tasks of identity consolidation and the development of intimate relationships become primary, it is not surprising that many teens utilize sexting as one way of practicing skills associated with successful completion of these tasks. The criminal prosecution of sexting cases, then, raises many legal and ethical questions. Offenders may be prosecuted under state or federal child pornography laws or state-specific sexting laws. Sexting laws, particularly in instances of consensual sext exchange, call into question who they are meant to protect and from what. In this article we review the research on teen sexting, its prevalence, and its association with mental health problems; summarize legal responses to the behavior in the United States; and identify considerations for prosecutors and legal decision-makers facing sexting cases.

Insane Sex Offenders: Psychiatric and Legal Characteristics of Sexual Offenders Found Not Guilty by Reason of Insanity.

There is little known about sexual offenders hospitalized under forensic commitment statutes such as not guilty by reason of insanity (NGRI). We conducted a chart review to delineate the demographic, clinical, and legal characteristics of NGRI sexual offenders (n = 68) committed to the California Department of State Hospitals-Napa, including 41 found NGRI for a sexual offense and 27 found NGRI for a nonsexual offense. The two groups did not differ significantly in their demographics, psychiatric diagnoses, victim characteristics, or recidivism risk as measured by the Static-99R. Those found NGRI for a sexual offense were older at the time of their first criminal and first violent offense, younger at the time of their committing offense, and had fewer prior total convictions and sexual offense convictions. These findings may indicate that sexual offenders found NGRI for a sexual offense are less antisocial than those found NGRI for a nonsexual offense.