The role of psychopathy and sexuality in a female serial killer

The case of Aileen Wuornos, executed in Florida for the serial killing of seven men, is studied to determine her degree of psychopathy and the presence or absence of sexuality or sexual sadism as a motivation or gratification for her crimes. The authors, one of whom evaluated the subject shortly before her death, determined that she evidenced a psychopathic personality (PCL-R score 32). She also met DSM-IV-TR criteria for Antisocial Personality Disorder and Borderline Personality Disorder. While her killings ostensibly were carried out during routine acts of prostitution, there was ambiguous evidence that her crimes were sexually motivated or gratifying. Her articulated motivation was robbery and elimination of the witness/victim. After carefully considering all available data, the authors concluded there was no convincing evidence of sexual sadism in either her personal history or her method of committing serial murder, and it remains unclear whether sexual gratification was to some degree a motivating factor in her commission of these offenses. The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history likely contributed to her having serially murdered seven victims.     

Outcome evaluation of a high-intensity inpatient sex offender treatment program

The treatment outcome of a high-intensity inpatient sex offender treatment program was evaluated by comparing the sexual recidivism rates of 472 treated and 282 untreated sex offenders. The program is designed for moderate- to high-risk sex offenders and follows the principles of effective correctional treatment. The current investigation is an extension of an earlier study (Nicholaichuk et al., 2000) with the addition of 176 participants, an extra 4 years follow-up, and the use of Cox regression survival analysis to control for three potentially confounding variables: age of release, sexual offending history, and length of follow-up. Treated offenders sexually recidivated significantly less than the comparison group over nearly 20 years of follow-up, even after controlling for the aforementioned variables. The substantive findings suggest that treatment adhering to the what works principles can reduce long-term sexual recidivism for a moderate- to high-risk group of sex offenders.     

The catathymic crisis: An explanation of the serial killer

Various explanations have been proposed to explain the motivation of serial killers. This article proposes that the theory of the Catathymic Crisis is an explanation that adds light to the “serial” nature of serial murder as well as an explanation of why and how a person can become a serial killer. The theory of Catathymic Crisis was presented in 1937 by Dr. Frederic Wertham as an explanation for some types violent and seemingly motivationless crimes. Dr. Wertham's theory describes a five stage process in which (1) a thinking disorder occurs within the mind of the criminal, (2) a plan is created to commit a violent criminal act, (3) internal emotional tension forces the commission of the criminal act, which leads to (4) a superficial calmness in which the need to commit the violent act is eliminated and normal activity can be conducted and (5) the mind adjusts itself and understands that the thinking process that caused the commission of the criminal act was flawed and the mind makes adjustments in order to prevent further criminal activity. The serial killer never reaches the fifth stage but returns to the second and operates in a cycle between stage two and four. This article advocates that the Catathymic Crisis explains why the serial killer needs to commit murder, why that need develops and why there is an escalating nature of the criminal activity by the serial killer.     

Aggressive hybristophilia in men and the affect of a female serial killer

A case is presented of hybristophilia – attraction and sexual arousal to the criminal acts of another – in men which, to date, is a phenomenon that has not been documented. A sexually motivated female serial killer recruited the help of three male accomplices to aid her in her crimes and avoid police detection. The men became enthralled by the killer, falling ‘under her spell’, and willingly aided her, in varying degrees, in locating and disposing of victims. The behaviour of those men is explored here and the scant literature base on hybristophilia is expanded.     

A psychodynamic-behaviourist investigation of Russian sexual serial killer Andrei Chikatilo

This paper looks briefly at the case study of Russian sexual serial killer Andrei Chikatilo. Whilst serial homicide has received wide ranging attention more broadly in the literature, Chikatilo’s criminality and sexually deviant behaviour have thus far lacked any in-depth psychological explanation, with his crimes attributed tentatively to dysfunction upbringing and innate deviance. However, based on theoretical arguments presented in the present investigation, a more detailed account of what may have contributed to the development of such extreme sexual violence and cognitive distortions is discussed. Consideration of psychodynamic and behaviourist perspectives lead to the conclusion that a complex interaction of biological, psychological and sociological factors may account for the onset and continuation of his homicidal behaviour.     

Piquerism in homicide: A knife wound analysis of a sexually motivated serial killer

As part of a wider research project into paraphilic disorders and homicide, a case is presented of a piquerist who achieved sexual satisfaction through the infliction of stabbing wounds. Against a background of sexual domination with willing and unwilling sexual partners, the offender stabbed four men to death. A study of the resulting autopsy reports, in association with the offender's testimony and crime scene documentation, was undertaken to discern a piquerist crime scene signature. An excessive number of stabbing wounds, the targeting of sexual areas, and a variation in wound size and depth were found to be evidence of piquerism. Although there was opportunity to commit a sexual assault upon victims, the preference was to penetrate them with a knife. It is contended that, even without any evidence of sexual assault at a crime scene, a knife wound analysis can reveal a sexual motivation in some cases of homicide.     

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets,violence risk and aggressive behaviour in a sample of mentally disordered offenders*

This study examined the impact of an intensive inpatient violent offender treatment programme, Life Minus Violence-Enhanced (LMV-E), on intermediary treatment targets, risk for violence, and aggressive behaviour during treatment in a sample of male mentally disordered offenders. Using quasi-experimental design, offenders who completed LMV-E and a comparison group showed reduced problems with impulsivity and anger regulation and improvements in social problem solving. Aggregate risk for future violence lessened in both treatment and comparison groups, although by a significantly greater degree for the comparison group. The aggressive behaviour of both groups reduced. Completion of the LMV-E conferred additional improvements in some facets of social problem solving and anger regulation. Neither group showed improvements in empathic responses, coping skills or problematic interpersonal style. Overall, these results suggest anger regulation, impulsivity and social problem solving are most amenable to change, that reductions in certain facets of these dynamic risk factors transpires with nonspecific psychiatric inpatient treatment, but that the LMV-E, a cognitive behavioural violence specific psychological treatment, confers greater change in some facets of social problem solving and anger regulation.     

The forensic evaluation and treatment of children: ethics and values

This article will review the history of ethics and values in the forensic evaluations and treatment of children. Topics to be discussed include paternalism, advocacy, parental responsibility, and legal doctrine of parens patriae. Various aspects of the treatment of children, including medications, behavior modification, and psychotherapy, are also examined for ethical considerations. Agency consultation in conflicts of ethics that are associated with public laws are also addressed. The ethical implications of the use of children in any research as research subjects is also addressed.     

住院病人请假外出相关法律问题探讨

对住院病人请假外出的相关法律问题，目前各方的观点和做法不一。笔者从医疗机构能否阻止住院病人请假外出、医患之间签订的免责条款的效力、医疗机构在病人外出时应尽的义务及病人外出受到损害医疗机构的责任四个角度人手，试图对住院病人请假外出涉及的相关主要法律问题做出梳理和分析，以期为解决病人请假外出相关法律问题提供思路。     

Psychopathic traits and change on indicators of dynamic risk factors during inpatient forensic psychiatric treatment

The main objective of the present study was to investigate the impact of treatment on forensic psychiatric inpatients, examining changes on 22 indicators of five dynamic risk factors for violence (i.e., egocentrism, hostility, impulsivity, lack of insight, and negative distrustful attitudes), and to relate these potential changes to level of psychopathy assessed with the Hare Psychopathy Checklist - Revised (PCL-R). Also, we studied the relationship between psychopathy and treatment compliance, as indicated by the attendance rate of therapeutic activities. Eighty-seven male patients (due to missing data on at least one measure, sample size varies from 58 to 87; 42 patients have complete datasets) were administered a standardized psychological assessment battery (self-report inventories, performance-based personality test, observer ratings) upon admission (T1) and after on average 20 months of treatment (T2). Upon admission, psychopathy (median split, PCL-R score≥22) was significantly related to a higher score on five of the 22 indicators of dynamic risk. The analyses showed no significant differences between psychopathic and non-psychopathic patients on the indicators of dynamic risk factors during 20 months of inpatient forensic psychiatric treatment. However, psychopaths showed the expected pattern of treatment noncompliance, compared to non-psychopaths. The clinical and research implications of these findings are discussed.     

The relationship between serial sexual murder and autoerotic asphyxiation

This case series documents and examines the association between autoerotic asphyxiation, sadomasochism, and serial sexual murderers. Autoerotic asphyxiation, along with other paraphilias found in this population, is reviewed. Five cases of serial sexual killers who engaged in autoerotic asphyxiation were identified worldwide: four from the United States and one from Russia. Case reports for each are provided. All (100%) were found to have sexual sadism in addition to autoerotic asphyxiation. Furthermore, two (40%) had bondage fetishism, and two (40%) had transvestic fetishism, consistent with these paraphilias co-occurring in those with autoerotic asphyxiation. Overall the group averaged 4.0 lifetime paraphilias. Some possible relationships were observed between the offenders' paraphilic orientation and their modus operandi, e.g., all of these serial killers strangled victims-suggesting an association between their sadistic and asphyxiative paraphilic interests. The overlap of seemingly polar opposite paraphilias in this sample--sexual sadism and autoerotic asphyxiation--is explored from a historical and clinical perspective. Multiple commonalities shared between these five offenders and serial sexual murderers in general are addressed. A primary limitation of this study is its small sample size and empirical basis; the results may not be generalizable beyond the sample. The findings from this study support the supposition that crime scene behaviors often reflect paraphilic disturbances in those who commit serial sexual homicides.     

The incidence of child abuse in serial killers

Fifty serial killers who murdered for the primary goal of attaining sexual gratification, termed lust killers, were studied to determine the prevalence of childhood abuse. Information regarding the childhood abuse sustained by each killer was obtained primarily from biographical books, newspaper articles, and online sites. Abuse was categorized into physical abuse, sexual abuse, psychological abuse, and neglect and was then compared to societal norms from 2001. Abuse of all types excluding neglect was significantly higher in the serial killer population. For serial killers, the prevalence of physical abuse was 36%; sexual abuse was 26%; and psychological abuse was 50%. Neglect was equally prevalent in the serial killer (18%) and societal norm populations.     

The case of Jeffrey Dahmer: sexual serial homicide from a neuropsychiatric developmental perspective

Sexual serial homicidal behavior has received considerable attention during the last three decades. Substantial progress has been made in the development of methods aimed at identifying and apprehending individuals who exhibit these behaviors. In spite of these advances, the origins of sexual serial killing behavior remain for the most part unknown. In this article we propose a biopsychosocial psychiatric model for understanding the origins of sexual serial homicidal behavior from both neuropsychiatric and developmental perspectives, using the case of convicted serial killer Jeffrey Dahmer as the focal point. We propose that his homicidal behavior was intrinsically associated with autistic spectrum psychopathology, specifically Asperger's disorder. The relationship of Asperger's disorder to other psychopathology and to his homicidal behavior is explored. We discuss potential implications of the proposed model for the future study of the causes of sexual serial homicidal crime.     

Predicting the residential location of a serial commercial robber

Residential location of a serial offender can potentially be predicted by using models created from home to crime site journeys of solved crimes in the area [N. Levine, Journey-to-crime estimation, retrieved 23 October 2003 from http://www.icpsr.umich.edu/NACJD/crimestat/CrimeStatChapter.9.pdf, last visited 1 February 2005]. Aims of this study were: (1) to examine the accuracy of this technique, (2) to explore relation of modus operandi (m.o.) to the distance the crime was committed from home and (3) to analyse whether the accuracy of prediction is enhanced by taking the m.o. into account. Data consisted of 76 commercial robbery series from the Greater Helsinki area. Accuracy of prediction was tested by using leave-one-out technique: the series which the predicting function was applied to was never part of the function used to predict. The functions allowed limiting the area to be searched to 4.7% (Mdn, IQR = 31.0%) of the study area generally, and to 1.0% (Mdn, IQR = 2.6%) when the suspect's spatial behaviour conformed to the circle hypotheses presented by Canter and Larkin [D. Canter, P. Larkin, The environmental range of serial rapists, J. Environ. Psychol. 13 (1993) 63-69]. Significant correlations between m.o. and the length of the journey-to-crime were found, but this information did not enhance accuracy of prediction. Low percentage of marauder style perpetrators in the data gives support to the possible separation of hypotheses of underlying spatial behaviour in instrumental crimes versus crimes of interpersonal violence or arson. Suggestions for development of investigative tools are presented.     

The admission of Alzheimer's patients to hospital inpatient psychiatric units

Alzheimer's Disease presents extreme challenges not only to the individuals afflicted with it and their families, but also to both our legal and healthcare systems. The nature of the disease is such that current legal standards and requirements simply fail to function in an appropriate manner. So too, the health system currently is not in a position to handle the anticipated influx of Alzheimer's patients over the next several decades. This Article examines some of the challenges presented by this disease, and suggests several possible methods to improve our response to it.     

The utilization of forensic science and criminal profiling for capturing serial killers

Movies and nightly television shows appear to emphasize highly efficient regimens in forensic science and criminal investigative analysis (profiling) that result in capturing serial killers and other perpetrators of homicide. Although some of the shows are apocryphal and unrealistic, they reflect major advancements that have been made in the fields of forensic science and criminal psychology during the past two decades that have helped police capture serial killers. Some of the advancements are outlined in this paper. In a study of 200 serial killers, we examined the variables that led to police focusing their attention on specific suspects. We developed 12 categories that describe how serial killers come to the attention of the police. The results of the present study indicate that most serial killers are captured as a result of citizens and surviving victims contributing information that resulted in police investigations that led to an arrest. The role of forensic science appears to be important in convicting the perpetrator, but not necessarily in identifying the perpetrator.     

The importance of a urine sample in persons intoxicated with flunitrazepam--legal issues in a forensic psychiatric case study of a serial murderer

The sedative-hypnotic benzodiazepine flunitrazepam (FZ) is abused worldwide. The purpose of our study was to investigate violence and anterograde amnesia following intoxication with FZ, and how this was legally evaluated in forensic psychiatric investigations with the objective of drawing some conclusions about the importance of urine sample in a case of a suspected intoxication with FZ. The case was a 23-year-old male university student who, intoxicated with FZ (and possibly with other substances such as diazepam, amphetamines or cannabis), first stabbed an acquaintance and, 2 years later, two friends to death. The police investigation files, including video-typed interviews, the forensic psychiatric files, and also results from the forensic autopsy of the victims, were compared with the information obtained from the case. Only partial recovery from anterograde amnesia was shown during a period of several months. Some important new information is contained in this case report: a forensic analysis of blood sample instead of a urine sample, might lead to confusion during police investigation and forensic psychiatric assessment (FPA) of an FZ abuser, and in consequence wrong legal decisions. FZ, alone or combined with other substances, induces severe violence and is followed by anterograde amnesia. All cases of bizarre, unexpected aggression followed by anterograde amnesia should be assessed for abuse of FZ. A urine sample is needed in case of suspected FZ intoxication. The police need to be more aware of these issues, and they must recognise that they play a crucial role in an assessment procedure. Declaring FZ an illegal drug is strongly recommended.