Risky Sexual Behavior, Paraphilic Interest, and Sexual Offending: The Study of a Community Sample of Young Adults in Hong Kong.

Limited information is available on the prevalence and nature of sexual offending in Hong Kong. This cross-sectional study seeks to explore the role of risky sexual behavior (RSB) and paraphilic interests in self-reported sexual offending behavior (i.e., nonpenetrative-only, penetrative-only, and nonpenetrative-plus-penetrative sexual assault) in a community sample of young adults in Hong Kong. Using a large sample (N = 1885) of university students, the lifetime prevalence of self-reported sexual offending was 18% (n = 342; 23% males (n = 166), 15% females (n = 176)). Based on the study subsample of 342 participants who self-reported sexual offending (aged 18-35), the findings indicated that males reported significantly higher levels of general, penetrative-only, nonpenetrative-plus-penetrative sexual assault; and paraphilic interest in voyeurism, frotteurism, biastophilia, scatophilia, and hebephilia than females; while females reported a significantly higher level of transvestic fetishism than males. No significant difference was found in RSB between males and females. Logistic regressions found that the participants who possessed a higher level of RSB, particularly penetrative behaviors, and paraphilic interest in voyeurism and zoophilia were less likely to engage in a nonpenetrative-only sexual offense. Conversely, the participants who possessed higher levels of RSB, especially penetrative behaviors, and paraphilic interest in exhibitionism and zoophilia, were more likely to engage in nonpenetrative-plus-penetrative sexual assault. The implications for practice in areas such as public education and offender rehabilitation are discussed.

Serial sexual murder by juveniles and the role of sexual sadism: An international study.

This is a descriptive study of 21 cases of serial sexual murder by children and adolescents spanning nearly the past century and a half. No earlier cases worldwide were identified. Each of these youth committed two or more sexual homicides prior to age 18. Their psychopathological, psychosocial, crime scene behaviors, and offender-victim relationship characteristics are presented. Additionally, the role of sexual sadism and its measurement using the SADSEX-SH rating scale is addressed. Nearly all of the sample had conduct disorder, a paraphilic disorder, and sadistic fantasies, and two-thirds had sexual sadism disorder. Family dysfunction, serious school problems, and average or above IQ levels were typical. Their modus operandi generally reflected predatory behavior and direct contact methods of killing were most common. Two case reports are provided to illustrate the breadth and complexity of these offenders. Juvenile Serial Sexual Homicide is an extremely rare but persistent phenomenon. Prognostic implications and future research directions are discussed.

Revenge filicide: An international perspective through 62 cases.

Filicide is the purposeful killing of one or more children by a parent, step-parent, or other parental figure. Revenge filicide is a poorly understood, rare form of filicide in which a parent murders their child to cause emotional harm to the child's other parent. This descriptive study presents an international case series consisting of 62 revenge filicide cases from nine countries. Perpetrators were about equally likely to be male or female. Over half of the sample had an active mental disorder of any type, most often a personality disorder. A history of domestic violence was common. The mean victim age was 6 years. They were typically killed by asphyxiation, firearms, or knives, and preschool age children were targeted most frequently. In half of the cases, more than one child was murdered. Post-crime suicidal behavior was commonplace, and one-third of the sample died by suicide. Four revenge filicide subtypes were identified: rejection, custody/visitation dispute, infidelity/jealousy, and argument/conflict. These categories may prove useful in future research and for helping to identify children at high risk of becoming filicide victims. All surviving offenders were criminally convicted, and in only one case was a mental health defense successful in lessening culpability. Notable similarities and differences between the US and international cases are discussed.

Mosaic trisomy 20 and mitigation in capital crimes sentencing: A review and case report.

Trisomy 20 is a genetic abnormality in which individuals have an extra copy of chromosome 20. Complete trisomy 20 is rare and believed to be incompatible with life. A mosaic form of trisomy 20, in which only some cells or tissues contain the extra chromosome, is a relatively commonly encountered chromosomal abnormality found during prenatal testing, and c. 90% result in a normal phenotype. However, despite the absence of a consistent phenotype, certain findings have been reported across multiple cases of mosaic trisomy 20. These include an array of morphological findings, developmental delays, and learning disabilities. Beyond physical manifestations, a wide range of developmental and learning delays have also been reported. In this work, we provide an overview of the trisomy 20 literature and a case report of a young adult male with mosaic trisomy 20 who committed homicide. His developmental and life history, eventual diagnosis of mosaic trisomy 20, similarities and differences in his condition compared with prior research findings, and potentially new phenotypic findings associated with trisomy 20 that he manifested (childhood visual hallucinations, self-injury, polydactyly) are presented. Additionally, the potential role of this genetic diagnosis in his neuropsychiatric history and its successful application as a mitigating factor at his capital sentencing trial are described. We did not identify other similar cases during our search of major scientific and legal databases. As a backdrop, the use of genetics in criminal trials is on the rise, and courts are increasingly likely to accept behavioral genetics evidence; therefore, it is crucial that the legal system is well acquainted with the opportunities and limitations of these approaches.

An Updated Sexual Homicide Crime Scene Rating Scale for Sexual Sadism (SADSEX-SH).

The Sexual Homicide Crime Scene Rating Scale for Sexual Sadism (SADSEX-SH) is a rating scale which dimensionally measures the degree of offender sexual sadism in suspected sexual homicide cases. Scoring is accomplished using crime scene and related investigative information. Preliminary norms for the SADSEX-SH prototype indicate that it correctly classified offenders with and without sexual sadism. This study further assessed SADSEX-SH sensitivity, specificity, and inter-rater reliability by comparing a larger sample of male sexual homicide offenders with (n = 20) and without (n = 20) sexual sadism. Two items generally undetectable at crime scenes were removed from the originally proposed 10-item scale, resulting in a final 8-item version. SADSEX-SH total scores for the two groups significantly differed (7.7 ± 3.5, range = 2-14 vs. 2.6 ± 2.0, range = 0-7, t = 5.58, p < .001). Inter-rater reliability was excellent (intraclass correlation coefficients [ICCs] = 0.6-1.0). Using a revised cutoff score of 6, sensitivity was 70.0% and specificity was 90%. This revised scale may prove useful for investigators, clinicians, and institutional professionals in helping to identify and address sexual sadism in sexual homicide offenders.

Sexual Homicide by Older Male Offenders.

Recent research has expanded our understanding of sexual homicide offenders (SHOs). However, little exists beyond case reports for older SHOs. We characterized male SHOs ≥ 55 years, comparing them to typical adult male SHOs who are in their 20s. Analysis of 37 years (1976-2012) of US Supplementary Homicide Reports data provided a large SHO sample (N = 3453). Three case reports provide clinical context for the diverse nature and patterns of older SHOs. Only 32 older male SHOs and no older female SHOs were identified. Murders by older SHOs accounted for only 0.5% of US sexual homicides. Unlike typical SHOs that generally target young adult females, over two-thirds of older SHO victims were ≥40 years, and one-third were ≥55 years. Sexual homicides by older SHOs, like sexual homicide in general, decreased over the study period. These crimes, while exceedingly rare, do occur, warranting special consideration.

Challenges and Limitations to Treating ADHD in Incarcerated Populations.

An often underappreciated and hard-to-treat condition in correctional institutions is attention-deficit/hyperactivity disorder (ADHD). Although there are many effective psychopharmacologic treatments for ADHD, such as various formulations of amphetamines, many physicians are hesitant to prescribe controlled stimulants in correctional settings because of concerns about abuse and safety. Although nonstimulant alternatives are available, they are generally seen as less effective than stimulants. However, there are many unique factors regarding corrections populations and their responses to treatment, which makes it difficult to know what the ideal treatment regimen would be for this population. We review the standard treatments for ADHD, for prescribing in correctional institutions, barriers to using medications for off-label treatment of ADHD, and suggest future research that could better guide correctional treatment staff on how to approach patients with ADHD.

Sexual homicide in the USA committed by juveniles and adults, 1976-2007: Age of arrest and incidence trends over 32 years.

BACKGROUND: Reliable epidemiological data on sexual homicide are sparse, especially on trends in its incidence over time and age at arrest. AIMS: Our main aims were to study age at arrest and incidence trends for sexual homicide in the USA over about three decades (1976-2007). METHODS: We conducted longitudinal analyses of data from the largest USA homicide database available for the years 1976-2007. RESULTS: The mean age at arrest for a sexual homicide was 26.3 years (range 7-76; modal 21 years). Three quarters of these offenders were young adults aged 18-35. Age at probable first arrest for a sexual homicide rose significantly from a mean of 25 to a mean of 29 years over the study period. The last decade of the three studied accounted for just one quarter of the homicides as charged in the whole period, but the proportion of sexual homicides specifically fell with each decade, so that the first period accounted for 56% of those in the whole period, the second for 33% and the final decade for just 11%. This was reflected in a reduction in the proportion of all homicides that were sexual, from 1.4% in the first decade to 0.8% in the second and 0.4% in the third, declining by a factor of five for adults and seven for juveniles. CONCLUSIONS: Use of official national criminal statistics has limitations in studying the epidemiology of any particular behaviour. Nonetheless, our findings of falling sexual homicide rates and of changes in at least one important demographic of these killers indicate a need for a considered reappraisal of such crimes. Establishment of accurate epidemiology and a study of associated factors may assist in the improvement of investigative and preventive strategies.

Commentary: Bringing Order to Chaos--How Psychiatrists Know the Standard of Care.

In this commentary, we explore the clinical and educational implications of the study by Recupero and Harms on the standard of care (SOC) as it pertains to obtaining psychiatric outpatient clinical records of prior treatment. We discuss differences between the legal and clinical SOCs and make recommendations to incorporate risk management training and education about the medicolegal aspects of SOC in psychiatry residency curricula.

Single-victim and serial sexual homicide offenders: differences in crime, paraphilias and personality traits.

BACKGROUND: Information on psychopathological characteristics of sexual homicide offenders is scarce. AIMS: To investigate criminal, paraphilic and personality trait differences between serial and single-victim sexual homicide offenders. METHODS: All 73 single-victim and 13 serial sexual homicide offenders presenting within a cohort of 671 men sentenced for sexual crimes between 1994 and 2005 and serving their sentence in one high-security Canadian prison and who consented to interview were assessed and compared on their offending patterns, personality pathology and paraphilic behaviours. RESULTS: Serial sexual homicide offenders were more likely than the single offenders to report deviant sexual fantasies, having selected victims with distinctive characteristics, to have targeted strangers, structured premeditation and/or verbal humiliation of their victims during the offences. Personality pathology, defined by at least two Diagnostic and Statistical Manual of Mental Disorders IV criteria for personality disorder, was common in both groups, but the serial offenders were more likely to have narcissistic, schizoid and/or obsessive-compulsive traits; they were also more likely to engage in sexual masochism, partialism, homosexual paedophilia, exhibitionism and/or voyeurism. IMPLICATIONS FOR PRACTICE: Samples of serial sexual homicide offenders will, fortunately, always be small, and it may be that more could be learned to assist in preventing such crimes if data from several studies or centres were pooled. Our findings suggest that an investigation of sexual homicide offenders should include strategies for evaluating premeditation as well as personality and paraphilic characteristics. Crime scene features that should alert investigators should include similar characteristics between victims and particular aspects of body exposure or organisation.

Should AAPL enforce its ethics? Challenges and solutions.

Ethics enforcement in psychiatry occurs at the district branch and American Psychiatric Association (APA) levels under the guidance of American Medical Association (AMA) and APA ethics documents. Subspecialty ethics consequently have no formal role in the enforcement process. This reality challenges practitioners to work according to guidelines that may not be sufficiently relevant and challenges ethics reviewers to apply frameworks not intended for the subspecialties. This article offers the theoretical and practical support to amend APA Procedures to permit formal consideration of subspecialty ethics during ethics complaints and to include forensic practitioners on panels reviewing them. This is the first step toward an integration of two conflicting models of ethics enforcement, regulatory and aspirational, that bring together specialty and subspecialty ethics.

Toward a more holistic understanding of filicide: a multidisciplinary analysis of 32 years of U.S. arrest data.

Filicide is the killing of one or more children by a parent, stepparent, or other parental figure. This study presents the first comprehensive analysis of U.S. filicide, drawn from 94,146 filicide arrests tabulated over a 32-year period in the U.S. Federal Bureau of Investigation's Supplementary Homicide Reports (SHR). Filicides comprised 15% of all murders during this period. Modal victim age was less than one year old. One-third of the victims were under a year old; over two-thirds of the victims were age six or less. Fathers were as likely as mothers to kill infants. The mean age of offenders was 32 years with a mode of 22 years, and nearly three-quarters were aged 18-45. Female offenders were notably younger than their male counterparts. Black (or African American) offenders were significantly overrepresented in filicide compared to Whites. Most common killing methods included using hands and feet, strangulation, beating, asphyxiation, drowning, and defenestration. Stepparents were not at higher risk of filicide than genetic parents, but were twice as likely to kill using firearms. Synthesizing these results with studies from other fields, we propose three transdisciplinary, empirically informed filicide categories primarily defined by effects of (1) psychopathology associated with neurotransmitter disturbances, (2) gender and sex hormones, and (3) evolutionary motives. Approaching filicide using this proposed hypothetical framework for future research may help identify at-risk populations and improve prevention and treatment.

Commentary: the insanity defense and youths in juvenile court.

Juveniles, like adults, should be afforded the right to raise an insanity defense. In this commentary on the article by Morse and Bonnie on the abolition of the insanity defense, we explain why so few juveniles across the United States are granted access to the insanity defense and the reasons that they should have that option. We also consider whether the Delling case was the best suited vehicle to argue for extending constitutional protection to the insanity defense nationwide.

Female sexual homicide offenders: an analysis of the offender racial profiles in offending process.

Despite the recent effort by Chan and Frei in studying female sexual homicide offenders (SHOs), much is still unknown about this underresearched offender population. One largely unexplored area is how female SHOs of different races commit their killings. Using FBI Supplemental Homicide Reports (SHR) data (1976-2007), 105 White and 94 Black female SHOs (N=204) were examined for their differential offending patterns. Most female SHOs, regardless of race, killed victims of the opposite gender (i.e., heterosexual offenses). Most frequently targeted by female SHOs of both races (44% of Whites and 57% of Blacks) were known victims (e.g., friends, acquaintances) who were not intimate partners or family members. Firearms were the most common weapons used by female SHOs (60% of Whites and 48% of Blacks). The second most common weapon type used by Black offenders was an edged weapon (32%), whereas for White offenders it was a personal weapon (17%). Black female SHOs normally perpetrated their offense in large cities (69%), while White female SHOs most often committed their crime in suburban areas (40%). This study underscores importance of considering the offender racial group in female sexual murder investigations. Hence, several implications for offender profiling are offered.

Prevalence and Assessment of Malingering in Homicide Defendants Using the Mini-Mental State Examination and the Rey 15-Item Memory Test.

This study surveyed malingering prevalence in pretrial homicide defendants and assessed the usefulness of the Mini-Mental State Examination (MMSE) and the Rey 15-Item Memory Test (FIT) in detecting malingering among them. Malingering prevalence was 17%. MMSE and FIT scores were positively correlated. The MMSE and FIT had modest positive predictive value (67% and 43%), but reasonably good negative predictive value (93% and 89%), for malingering. Overall, the MMSE outperformed the FIT, with no advantage to combined use of the MMSE and FIT over the MMSE. The widely used MMSE, traditionally a bedside test of cognition, may have a role in malingering assessment.