Deliberate self-harm and suicide attempt in custody: distinguishing features in male inmates' self-injurious behavior

Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of "serious" vs. "non-serious" and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of "low seriousness" (i.e. low lethality and low suicidal intent) and of "high seriousness". Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.     

The function of self-harm behavior in a forensic population

This article examines the functions of self-injurious behavior (SIB) in forensic populations. The cases of four individual offenders who have engaged in SIB are presented. These cases depict the four main functions of self-harm behaviors including (a) suicidal intent, (b) manipulation of the environment, (c) emotion regulation, and (d) a response to psychotic delusions or hallucinations. Assessment and treatment implications are discussed.     

Predictors of suicidal ideation, suicide attempts, and self-harm without lethal intent in a community corrections sample

Purpose

Little published research data exist about suicidal ideation and self-harm behavior in community corrections and we seek to fill this void.

Aims

To examine the effects of drug dependence, depression, anxiety, psychopathy, fracture, and child trauma on suicidal ideation, suicide attempts, and self-harm without lethal intent in community corrections.

Methods

The Semi-Structured Assessment for the Genetics of Alcoholism Revised (SSAGA II) and the screening version of the Hare Psychopathy Checklist (PCL:SV) were administered. Separate binary logistic regression analyses were used to predict lifetime suicidal ideation, suicide attempt, and self-harm behavior.

Results

Prevalences of suicidal ideation, suicide attempt, and self-harm without lethal intent were 41%, 19%, and 14%. Suicidal ideation was predicted by drug dependence, elevated PCL:SV Factor 2 score, and Caucasian race. Suicidal ideation and attempt were both predicted by fractures, depression, and child trauma. Self-harm was predicted by fractures, panic, PCL:SV score, and child trauma.

Conclusions

Child trauma and multiple fractures are potent predictors for suicidal ideation, suicide attempts, and self-harm without lethal intent in this community corrections sample. Depression predicted suicidal ideation and attempts, while panic predicted self-harm without lethal intent. Psychopathy was also an important predictor of suicidal ideation and self-harm behaviors without lethal intent.     

Self-injurious behaviors, PTSD arousal, and general health complaints within a treatment-seeking sample of sexually abused women

Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.     

Prospective associations among borderline personality disorder symptoms, interpersonal problems, and aggressive behaviors

This study examined the prospective relationships among borderline personality disorder (BPD) symptoms, interpersonal problems, and types of aggressive behaviors (i.e., experiencing psychological and physical victimization and perpetrating psychological and physical aggression) in a psychiatric sample (N = 139) over the course of 2 years. We controlled for other PD symptoms and demographic variables. BPD symptoms at baseline were associated with interpersonal sensitivity, interpersonal ambivalence, interpersonal aggression, need for social approval, and lack of sociability 6 months later. In turn, interpersonal sensitivity predicted not experiencing physical aggression, interpersonal aggression predicted experiencing physical aggression and perpetrating both psychological and physical aggression, need for social approval predicted experiencing both psychological and physical aggression, and lack of sociability predicted perpetrating physical aggression 2 years later. Results demonstrated that interpersonal problems mediated the relationship between BPD and later violent behaviors. Our findings suggest the importance of distinguishing between these groups of aggressive behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.     

Patterns of violence and self-harm in women prisoners: characteristics,co-incidence and clinical significance

Self-harm and violence in women’s prisons in England are common and occurring with increasing frequency. We aimed to describe the characteristics and patterns of violent and/or self-harming behaviours in women in prison by conducting a retrospective analysis of routine data about self-harm incidents and adjudications. Incidence rates of self-harm and violence were calculated and associated factors explored using logistic regression. We found that only 6.7% of 5486 women prisoners self-harmed and 7.9% had been violent. Eighty per cent of all self-harm incidents related to 70 women. Almost 4 in 10 women prisoners who self-harmed were also violent. Multiple incarcerations and court movements are associated with incidents of self-harm and violence. Women with high-frequency self-harm (≥6) began self-harming early in their custodial period. We conclude that women prisoners who are very behaviourally disturbed can and should be identified early. They warrant clinical formulation and multi-agency responses to risk. Those with high-frequency self-harm should be cared for by external health services.     

Clustering of adolescent dating violence, peer violence, and suicidal behavior

To understand the co-occurrence of multiple types of violence, the authors developed a behavioral typology based on self-reports of suicidal behaviors, physical violence, and psychological abuse. Using a sample of dating adolescents from a high-risk school district, they identified five clusters of behaviors among the 1,653 students who reported being abusive or violent in the past year. Victimization and perpetration with same-sex peers and dating partners clustered together among the students who reported the highest levels of abusive (n = 357) or violent behavior (n = 146). These students also reported high levels of suicidal behavior. There were few significant demographic differences across clusters. The implications of the results for the need to design and evaluate efforts to prevent multiple types of violence are discussed.     

Suicidal behavior among low-income, African American female victims of intimate terrorism and situational couple violence

This study examined risk of suicidal behavior among low-income, African American women (N = 369) in three types of male intimate relationships- intimate terrorism (IT) (i.e., physical violence used within a general pattern of coercive control), situational couple violence (SCV; i.e., episodic physical violence that is not part of a general pattern of coercive control), and nonviolent (NV; i.e., no physical violence). IT victims had more than double the odds of suicidal behavior compared to SCV victims and this association remained significant after controlling for physical violence severity, depression symptoms, and alcohol and drug abuse. Risk of suicidal behavior was not significantly different for SCV victims compared to women in NV relationships. Findings emphasize the need for researchers and practitioners to distinguish between types of male partner violence when examining its context and consequences for female victims.     

Sexual victimization and health-risk behaviors: a prospective analysis of college women

The present study utilizes the National College Health Risk Behavior Survey to examine the relationship between health-risk behaviors and sexual victimization among a sample of college women. A prospective design is utilized to examine the relationship between health-risk behaviors as measured at baseline and sexual victimization during a 3-month follow-up period. After controlling for age and parents' education, a history of adolescent sexual victimization was associated with the following health-risk behaviors as measured at pretest: increased likelihood of cigarette smoking, marijuana use, suicidal ideation, experience of physical violence within a dating relationship, use of diet pills and vomiting or laxatives to lose weight, multiple sexual partners, and early sexual intercourse. Prospectively, women's history of adolescent sexual victimization was the strongest predictor of sexual victimization during the 3-month follow-up. Implications of univariate associations between early sexual intercourse, suicidal ideation, and problematic weight loss behaviors and subsequent experience of sexual victimization are discussed.     

Beyond Rational Choice: the Hot/Cool Perspective of Criminal Decision Making

This paper proposes a general framework of criminal decision making that assumes both ‘cool’ cognition and ‘hot’ affect, i.e. feelings, to influence criminal choice. Drawing from judgment and decision making research and social psychology, the hot/cool perspective extends rational choice and deterrence theories by explaining how affect is likely to influence criminal decisions alongside cognitive considerations, such as the perceived costs and benefits of crime. It is shown how the hot/cool perspective offers a more realistic account of criminal decision making processes than existing decision models and approaches and also allows for the explanation of criminal behaviors that are difficult to explain in terms of rational choice.     

The Associations Among Family-of-Origin Violence and Young Adults' Current Depressed, Hopeless, Suicidal, and Life-Threatening Behavior

The purpose of the current study was to determine if college students' retrospective reports of family-of-origin physical abuse were related to their current reports of depressed symptomology, hopelessness, and suicidal and life-threatening behavior. Consistent with hypotheses, abuse by a parent (physical and psychological) and physical perpetration toward a parent were associated with increased rates of suicidal and life-threatening behavior. Gender of the parent was also shown to be important as symptoms of depression were related to mother but not father victimization and perpetration. Contrary to expectation, witnessing parental spouse abuse was not associated with young adults' current symptoms of depression, hopelessness, and suicidal and life-threatening behavior. These findings were interpreted with regard to the intergenerational transmission of violence theory.     

Experiencing and witnessing familial aggression and their relationship to physically aggressive behaviors among Filipino adolescents

The effects of family violence on children's aggressive behaviors have been the focus of much research. However, results have been equivocal in at least the following three areas: (a) the specific effects on aggression of child-directed violence versus child-witnessed violence, (b) the salience of family violence as an explanation of aggression when other theoretically relevant explanations of aggression are controlled (i.e., peers, attachments, or moral beliefs), and (c) the gender-specific effects of family violence. Using a probability sample of adolescents from a medium-sized city in the Philippines, this article assesses the effects of child-directed and child-witnessed violence between parents on aggressive behaviors of adolescents while controlling for theoretically relevant explanations of aggression. Results show that child-witnessed and child-directed violence are positively and significantly related to self-reported aggression, that child-witnessed violence accounts for most of the variance in adolescent aggression, and that neither measures of family violence interacts with gender.     

The predictive validity of the Depression Hopelessness Suicide screening form for self-harm among prisoners

The Depression Hopelessness Suicide Screening Form (DHS) includes 12 ‘critical items’, which have not been validated for the prospective prediction of self-harm. We conducted a retrospective cohort study (N = 4196) to validate the ability of the DHS critical items to prospectively predict inmates with at least one incident of self-harm during the first six months of imprisonment. While the critical items were highly sensitive (89.5%) at predicting incidents of self-harm, 51.3% of the inmates endorsed at least one item. Five items reflecting more recent and specific risk factors reduced the referral rate to 17.7%, while maintaining high sensitivity (84.2%). While the DHS has high sensitivity to predict inmates at risk of self-harm, treating all items as equally critical results in excessive numbers of false positives that likely exceed the capacity of prison resources for professional assessment and intervention. Referral rules based on recency and specificity of risk factors are proposed.     

Potentially Lethal Behaviors Associated With Rapid Eye Movement Sleep Behavior Disorder: Review of the Literature and Forensic Implications

Abstract:  Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of the muscle atonia of REM sleep, with release of complex and violent behaviors that are often attempted dream-enactments. This study reviewed the literature on RBD with regard to potentially lethal behavior. A total of 39–41 clinical cases of RBD associated with potentially lethal behaviors to self and/or others were found, involving a child and adults of all age groups, that manifested as choking/headlock ( n  = 22–24), defenestration/near-defenestration ( n  = 7), and diving from bed ( n  = 10). A total of 80.8% ( n  = 21) were males; 19.2% ( n  = 5) were females; mean age was 65.6 ± (SD) 13.8 years (range: 27–81 years, and a child). (Gender/age data were not listed in the remaining cases.) An etiologic association of RBD with a neurologic disorder (or with pharmacotherapy of psychiatric disorders, n  = 4) was present in 21–23 patients. Thus, RBD carries well-documented, potential forensic consequences during RBD episodes that could possibly have been misinterpreted as suicidal or homicidal behavior.     

Suicide by multiple blunt head traumatisation using a stone

Apart from collisions with road or rail vehicles and falls from height, self inflicted blunt force is a rare suicide method and mainly seen in psychiatric patients. The paper presents a rare case of suicide by active blunt force. A 68-year-old man committed suicide by repeatedly hitting his head with a stone. He sustained a craniocerebral trauma and finally died from hypothermia due to the low outdoor temperature. According to the relatives, the man was not diagnosed with a mental disorder or suicidal tendencies. Uncommon manners of self-harm are challenging for those involved in the investigation, and a differentiation between suicide, accident and homicide can only be made in synopsis of all findings.     

Warning behaviors and leaked intent: Potential new avenues to prevent mass shootings

On March 12, 2018, John Laubscher, owner of AJ’s Archery in Nelson, NY, had a gut feeling and refused to sell a rifle to a Syracuse University student—disrupting a mass shooting ( https://www.syracuse.com/crime/2018/04/how_gun_shop_owner_thwarted_on_the_edge_su_student_from_buying_high-capacity_rif.html . Accessed 10 Nov 2021). Prompted by this, we surveyed the opinions, beliefs, attitudes, and current practices of gun sellers in Onondaga County, NY, in regard to safe gun sales. The primary outcome was to determine which types of “concerning behaviors” are more likely to cause a seller to intervene in some manner. Secondary outcomes included the following: ascertaining the frequency of denials of customer purchases, frequency of reporting to law enforcement, and identifying any gaps that make it difficult for gun sellers to report behaviors to the authorities. Follow-up interviews were conducted with those who were willing to speak with the authors in more depth. A response rate of 12.9% was achieved. Sixty-two percent (62.5%) of respondents had some experience in uniformed services, with specialized training in mental or emotional crises, as well as deception detection. The majority found the training helpful in their gun selling career. Reasons for personal denials were reported as: “interest in illegal fittings,” “information revealed during conversation,” and “lack of basic knowledge of using the firearm looking to purchase.” Two respondents stated that due to a lack of a “reporting protocol,” they would not report any concerns to law enforcement. The study helps inform future research in regard to surveying more sellers across NY state and nationwide.     

Correlates and predictors of self-reported suicide attempts among incarcerated youths

The correlates and predictors of suicidal behaviors among 900 young offenders in detention centers in South Australia are investigated. That young offenders are a high-risk population is confirmed, with a quarter of the youths reporting recent suicidal ideation and more than a quarter reporting having made a suicide attempt. Past suicide attempts are significantly predictive of future suicide attempts. Other variables both concurrently and prospectively associated with suicidal behaviors (even after controlling for prior suicide attempt status) are substance use, prolonged dysphoric mood, attention deficit hyperactivity disorder signs, and having a bad temper. These variables not only have predictive value but should also be considered as appropriate targets when intervening to reduce suicide risk. It is suggested that impulsiveness is an underlying common factor.     

Historical Injuries,Temporality and the Law: Articulations of a Violent Past in Two Transitional Scenarios

This paper deals with the connections between historical injury and temporality in two transitional scenarios, and explores how the National Unity and Reconciliation Act of 1995 (South Africa) and the Justice and Peace Law of 2005 (Colombia) ‘articulate’ particular conceptions of ‘violence’ as well as conceive the prospect of an imagined new future. I argue that in trying to grasp the multiple dimensions of violence through different mechanisms, collective languages instituted by State-sponsored laws that seek ‘national reconciliation’ fail (in countries defined by historical, chronic dispossession) to render intelligible—at the very moment of their enunciation into a legal language—the structural dimensions of violence that are at the root of conflict itself. In this regard, the text concentrates on the ways in which difference and inequality—despite the promise of the newness reiterated by Transitional Justice paradigms—are woven together into a longue durée that lies beyond the theoretical contours and the technical mandates defined by and inherent to these laws.     

Male Peer Support,Hunting, and Separation/Divorce Sexual Assault in Rural Ohio

Male peer support is one of the most powerful determinants of woman abuse across the globe. Still, key gaps remain in rural male peer support literature, such as overlooking the importance of hunting as a public male-bonding ritual that serves to reinforce abusive behaviors against women in private settings. The main objective of this article is to present findings from an exploratory, qualitative, back-talk study of twelve women’s experiences of separation/divorce sexual assault in rural Ohio. The results reveal a relationship between rural hunting subculture dynamics and core elements of male peer support (i.e. frequent drinking with male friends, informational support, attachment to abusive peers, and patriarchal masculine identity). Male peer support in hunting subcultures coupled with the availability and access to ‘legitimate’ weapons creates a fertile breeding ground for woman abuse in some rural communities.     

Two simultaneous suicidal gunshots to the head with robbed police guns

The suicidal infliction of two gunshot wounds to the head represents a critical issue for medicolegal investigation. In principle, simultaneous infliction with two firearms or third parties' involvement, i.e. two consecutive gunshots, have to be considered. We report for the first time on a case of suicidal infliction of two simultaneous gunshots to the head (oral, temporal) with Action 4 expanding ammunition. A male had robbed two service guns and committed suicide thereafter under the influence of high-dose alcohol and cocaine. Interestingly, Action 4 ammunition had been used, leading to an uncommon gunshot wound morphology and extensive backspatter. At the scene, these findings caused confusion; moreover, the number of gunshot wounds was unclear, until autopsy revealed two gunshot wounds to the head, which had obviously been inflicted simultaneously. Expanding ammunition like QD-PEP and Action 4, used by several German federal state police forces, can cause an atypical gunshot wound morphology, most probably due to its peculiar deformation behaviour. Investigators should be careful when interpreting gunshot wound morphology at the scene after usage of such expanding ammunition. With regard to reconstruction in cases of two gunshot wounds to the head and two guns at the scene, two simultaneous gunshots should be taken into consideration.