Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.     

The Motivation Behind Serial Sexual Homicide: Is It Sex,Power, and Control,or Anger?*

Controversy exists in the literature and society regarding what motivates serial sexual killers to commit their crimes. Hypotheses range from the seeking of sexual gratification to the achievement of power and control to the expression of anger. The authors provide theoretical, empirical, evolutionary, and physiological support for the argument that serial sexual murderers above all commit their crimes in pursuit of sadistic pleasure. The seeking of power and control over victims is believed to serve the two secondary purposes of heightening sexual arousal and ensuring victim presence for the crime. Anger is not considered a key component of these offenders' motivation due to its inhibitory physiological effect on sexual functioning. On the contrary, criminal investigations into serial sexual killings consistently reveal erotically charged crimes, with sexual motivation expressed either overtly or symbolically. Although anger may be correlated with serial sexual homicide offenders, as it is with criminal offenders in general, it is not causative. The authors further believe serial sexual murderers should be considered sex offenders. A significant proportion of them appear to have paraphilic disorders within the spectrum of sexual sadism. "sexual sadism, homicidal type" is proposed as a diagnostic subtype of sexual sadism applicable to many of these offenders, and a suggested modification of DSM criteria is presented.     

Psychiatric and Forensic Differences Between Men Charged with Sex Offences and Men Charged with Other Offences

Studies on differences between individuals convicted of sexual offences and nonsexual offences are sparse and there is an on-going debate as to whether sexual offenders differ from other offenders. The primary aim of this study was to determine demographic characteristics, prevalence of mental disorders, alcohol and drug use at the time of the crime and the criminal responsibility of individuals charged with sexual offences, compared to nonsexual crimes, with the aim of bringing awareness to the similarities and differences between men charged with sex offences and those charged with other crimes. This is a single-institution retrospective study of subjects charged with sexual offences and sent for institutional psychiatric evaluation to a Forensic Psychiatric Centre in an urban, academic, tertiary-care center. The control group consisted of individuals charged with nonsexual offences referred to the same center. Results showed significant differences between individuals charged with sexual offences and nonsexual offences. Men charged with sex offences more frequently committed their crimes alone and victimized children equally as often as adults. They also less frequently pleaded guilty in court. They were more likely to be abused in childhood and more often had antisocial personality disorder and paraphilias and less often substance-related disorders. The majority were considered criminally responsible. Our results show that sex offenders are different from nonsex offenders in many characteristics of their personal history, offence characteristics and forensic evaluations and these particular differences warrant different approaches to the prevention of future re-offending, compared to nonsex offenders.     

Women and Men who Committed Murder: Male/Female Psychopathic Homicides

The present study was designed to compare gender differences in psychiatric diagnosis with the dimension of psychopathy in women and men who had attempted or committed homicide. The study samples consisted of 39 homicidal females and 48 homicidal males who were confined in one of Italy’s REMS or prison facilities in two southern provinces of Italy (Puglia and Basilicata). Assessment instruments included the SCID-5, the PID-5 IRF, and the PCL-R. Each gender group was stratified according to the level of criminal responsibility for the homicidal offense (full, partial, absent), and after assessments, according to the degree of the psychopathic dimension. There were clear gender differences in homicidal individuals. Female offenders were less likely to have had a record of criminal charges/convictions or imprisonment, and their homicides were more often intrafamilial, victimizing especially of their children, whereas males targeted intimate partners and extrafamilial victims. In the entire group, there was an inverse relationship between the level of psychopathy and the personality disorder on one side, and the psychotic disturbance on the other. Factor 2 (lifestyle/antisocial dimension) of the PCL-R was higher among the homicidal males, whereas females tended to score higher on Factor 1 (the interpersonal/affective dimension). Finally, if the psychopathic dimension is a qualifier for antisocial personality disorder, as indicated in DSM-5, this appears to be less true for females who tend to have other personality disorders.     

Domestic Homicide: Neuropsychological Profiles of Murderers Who Kill Family Members and Intimate Partners

Domestic homicide is the most extreme form of domestic violence and one of the most common types of homicide. The objective was to examine differences between spontaneous domestic homicide and nondomestic homicide offenders regarding demographics, psychiatric history, crime characteristics, and neuropsychological status, utilizing neuropsychological test data from forensic examinations of 153 murderers. Using standard crime classification criteria, 33% committed spontaneous domestic homicides (SDH) and 61% committed nondomestic homicides (NDH). SDH offenders were more likely to manifest psychotic disorders, but less likely to be diagnosed with antisocial personality disorder or to have prior felony convictions. SDH offenders manifested significantly worse neuropsychological impairments than NDH offenders. The mean number of victims was lower for the SDH than the NDH group and only 14% of SDH offenders used a firearm, whereas 59% of NDH offenders used a firearm. These findings corroborate the notion that spontaneous domestic homicide may represent a discernible criminological phenotype.     

Homicidal Ideation and Forensic Psychopathology: Evidence From the 2016 Nationwide Emergency Department Sample (NEDS)

Homicide is the most serious and costly criminal offense and better forensic and criminological understanding of homicidal ideation as a potential psychobehavioral precursor to homicidal conduct is critical. Using data from the 2016 Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP) distributed by the Agency for Healthcare Research and Quality (AHRQ), we found 64,910 cases of homicidal ideation among a sample of 25.6 + million—a prevalence of 0.25%. Numerous conditions conferred increased substantially the likelihood of homicidal ideation including antisocial personality disorder (2406%), schizoaffective disorder (1821%), borderline personality disorder (1557%), paranoid personality disorder (1,504%), schizophrenia (1,143%), obsessive–compulsive personality disorder (921%), brief psychotic disorder (771%), unspecified psychosis (737%), avoidant personality disorder (596%), and schizoid personality disorder (571%), delusional disorder (546%), and other psychotic disorder (504%). Homicidal ideation is comorbid with serious psychiatric and behavioral problems and has important implications for offender typologies and homicidality.     

A study of the psychosexual characteristics of sex killers: can we identify them before it is too late?

Thirty-three sex killers were compared to 80 sexual aggressives, 23 sadists, and 611 general sex offenders on sexual history and preferences, substance abuse crime, violence, mental illness, personality, neurological and endocrine abnormalities. Compared to other groups, sex killers started their criminal careers earlier, more often had been to reform school, were members of criminal gangs, set fires, and were cruel to animals. They tended so show more sadism, fetishism, and voyeurism. They more often collected pornography, but they did not use it in their offenses. They more often abused drugs and some suffered from drug induced psychoses. Their most common diagnosis was antisocial personality disorder, but only 15.2% met criteria for psychopathy. Sex killers showed most signs of neuropsychological impairment, grades failure, and learning disabilities. Results suggest that greater emphasis be placed on studying adolescent sex offenders and conduct disordered children which may help identify potential sex killers.     

Psychological distress and severity of personality disorder symptomatology in prisoners convicted of violent and sexual offences

Abstract

Background: There have been recent proposals in England and Wales to develop services aimed at reducing the risk to the public posed by offenders with so-called “severe personality disorder”. The emphasis of the proposals is on risk. However, prisoners with personality disorder may have psychiatric treatment needs other than those purely relating to public protection. The aim of the study was to examine the association between severity of self reported personality disorder pathology and psychological distress in serious offenders.

Method: All male prisoners in two prisons, convicted of violent or sexual offences, were sent the Personality Diagnostic Questionnaire 4+(PDQ?4+) and the Symptom Checklist 90-R (SCL-90-R).

Results: High levels of self reported personality pathology were associated with high levels of psychological distress.

Conclusions: Offenders with the most severe self reported personality disorder pathology experience distress that may be clinically significant. Services for offenders with personality disorder will need to address their associated psychiatric symptoms.     

Do sex offenders minimize psychiatric symptoms?

With increasing frequency, forensic psychiatrists are called upon to evaluate sex offenders for the courts and criminal justice system. While many clinicians have observed that denial of paraphilia is common in sex offenders, few studies have examined whether this population has severe psychopathology other than paraphilia. Similarly, little is known about whether sex offenders minimize or deny symptoms of psychopathology when undergoing psychiatric evaluations. To study these questions, the authors administered the Minnesota Multiphasic Personality Inventory (MMPI) to 36 sex offenders, comparing the degree to which they minimized or denied psychopathology, dividing subjects among two dimensions: (a) whether they admitted to, or denied, paraphilia, and (b) whether or not they faced legal charges for sex offense. Results indicated that, first, patients who denied paraphilia were significantly more likely to minimize psychopathology than were those who admitted to paraphilia (P less than 0.05); second, patients who faced no legal charges showed significantly more psychopathology than did those who faced charges (P less than 0.05); and third, the most frequent forms of psychopathology were antisocial attitudes, depressive features, somatization, and thought disorder. These findings suggest that many sex offenders may experience, and deny, widespread and severe psychiatric symptoms in addition to their sexual disorders.     

Sexual offenders in preventive detention: data concerning the inmates and expert witness practice

In the last decade, preventive detention-especially that relating to sexual offenders- has gained relevance for the German legal system. However, data are lacking concerning the inmates and the modus operandi of the psychiatric experts. Court orders and psychiatric statements of 114 offenders with orders of preventive detention were examined, 57 of whom were incarcerated because of sexual offences. Sexual offenders mostly show antisocial personality traits or even disorders, with a history of poly-trophic delinquency. In only four cases, the diagnosis of a sexual disorder was given. The analysis showed a high rate of psychiatric expert testimonies' lacking basic information, with incomplete assessment of sexual history. None of the experts used standardized prognostic instruments, meaning that most of the risk factors included in the Sexual Violence Risk-20 and the Static-99 were not considered. Further work needs to be done to improve the quality of psychiatric statements concerning sexual offenders.     

Psychological profile of sex offenders using weapons in their crimes

Abstract

A sample of 1533 sex offenders was examined for clinical characteristics associated with weapon use in their crimes. A total of 24.9% used weapons, most often knives (50.1%), with 13.6% using multiple weapons. Weapon-users were a very disturbed group, who showed a significantly higher prevalence than non-users of psychoses, suicide attempts, alcoholism, drug addiction and abuse, personality disorders, psychopathy, attention deficit hyperactivity disorder, cognitive impairment and violent criminal histories. The weapon-users recidivated more often than non-users and appeared in court on 8.7 separate occasions compared to 2.9 for non-users in an average follow-up of 21.5 years. The best predictors of weapon use were total violent offence convictions, sadism diagnoses and adult versus child victims. The importance of examining weapon use in assessing sex offenders is discussed.     

Psychosocial characteristics of criminals committing incest and other sex offenses: a survey in a Taiwanese prison

The purpose of this study was to investigate the psychosocial characteristics of criminals who had committed incest or other sexual offenses. The participants, 240 criminals serving sentences for sex offenses in a Taiwanese prison, were divided into two groups: incest offenders (20.4%) and other sex offenders (79.6%). The psychosocial characteristics taken into consideration included age, parental survival, education, marital status, previous crime records, drug and alcohol abuse, diagnosed mental disorders, and victim abuse at the time of the offense. After an analysis of the data, the authors concluded that even though incest offenders showed fewer mental disorders, they needed psychiatric treatment and that this treatment should be focused not only on their mental disorder and related symptoms but especially to correct their abnormal behavior. Also, attention should be given to their psychosocial characteristics.     

Psychiatric and neurological characteristics of murder defendants referred for pretrial evaluation

After literature review, this paper presents the largest study to date (n = 270) of psychiatric and neurological characteristics of accused murderers in the United States. This retrospective record review of pretrial detainees undergoing competency to stand trial and criminal responsibility evaluations examined demographic characteristics, psychiatric diagnosis, substance use patterns, Intelligence Quotient (IQ), and results of electroencephalogram (EEG), neuroimaging (MRI or CT) and neurological examination. Substance use and mood/adjustment disorders were common. Neuroimaging was abnormal in 18% of subjects and was associated with lower Performance IQ. EEG and neurological exam findings were not associated with measured cognitive impairment. While 16% of subjects had a FS IQ < 70, only 6% were diagnosed with mental retardation. Subjects with a psychotic disorder (p = 0.001) or an anxiety disorder (p = 0.005) were more likely to use a knife than other subjects in the study. Violence risk assessment in these patients must not only involve inquiry about firearm availability.     

The influence of brain abnormalities on psychosocial development, criminal history and paraphilias in sexual murderers

The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.     

Diagnostic profiles of civilly committed sexual offenders in Illinois and other reporting jurisdictions: what we know so far

The records of 377 men civilly committed under Illinois' Sexually Violent Persons Act were compared with similar published samples from seven other states. Civilly committed sexual offenders in Illinois were more likely to be diagnosed with any personality disorder and more likely to exceed the cutoff score for psychopathy than similar offenders in other states. The authors then present a national composite of demographic, victim, and diagnostic information on men referred or pursued for civil commitment in eight states to better understand how these individuals differ from sex offender populations in correctional settings. Results suggest that there may be less victim specificity in sexually violent person (SVP) populations, as although nearly 50% of SVPs are diagnosed with pedophilia, 80% had committed at least one sexual offense against a child or adolescent victim. Across all samples, 72.7% of SVPs were diagnosed with a personality disorder, with antisocial personality disorder the most prevalent.     

Sex Offenders of East Asian Heritage Resemble Other Canadian Sex Offenders

Although there is considerable research on Caucasian sexual offenders, there has been much less research on sex offenders of Asian heritage. The current study compared East Asian (e.g., Chinese, Japanese, and Korean) sex offenders in British Columbia (B.C.), Canada, and other B.C. sex offenders on items and total score of Static-99R. This study included all provincially sentenced adult male sexual offenders (n = 4580) supervised in the community by B. C. Corrections (including 122 East Asian sex offenders). Sexual, violent, any crime, and any recidivism (including technical violations) data were collected with an average follow-up 4.3 years. The total scores of Static-99R were similar between East Asian sex offenders and other ethnic groups (M = 2.0 vs. M = 2.4). East Asian offenders scored significantly lower than other ethnic offenders on several items measuring general criminality (e.g., prior non-sexual violence, prior sentencing dates, and any prior sex offenses). In contrast, Asian offenders appeared to be more paraphilic (e.g., any convictions for non-contact sex offenses). Lastly, Static-99R significantly predicts sexual, violent, and criminal among sex offenders of East Asian heritage.     

Juvenile Sex Offenders: Differences between Group and Solo Offenders

We report on findings from a study into differences in personality and background characteristics between juvenile sex offenders who commit their sex offenses on their own and those who do so in a group. Solo offenders were found to score significantly higher on neuroticism, impulsivity and sensation seeking, but scored lower on sociability. In addition, the solo offenders in the sample were more often recidivists for sexual offenses, and were more often themselves a victim of a sexual offense. Solo offenders were significantly older than juveniles who had committed a sexual offense with a group. On the basis of these results we recommend differential treatment for the two types of offenders.     

Adolescent homicides in Finland: offence and offender characteristics

Approximately 9% of the homicides in Finland are committed by adolescents under 20 years of age. The purpose of this study was to investigate the offence and offender characteristics in homicidal adolescents. Forensic psychiatric evaluation statements of adolescent offenders accused of a homicide during 1990-2001 were reviewed retrospectively (n=57). In 38% of the cases, there were multiple offenders. In 58% of the cases, the victim was an acquaintance, in 25% a stranger, in 12% a family member and in 5% of the cases an (ex)intimate partner. Sixty-nine percent of the offenders were intoxicated and 21% under the influence of drugs at the time of the killing. The most frequent motives were an argument (25%) and a robbery (25%). Sixty-four percent of the offenders had developmental problems and 42% had a crime history. Approximately half were diagnosed as having a conduct or a personality disorder, but 32% of the offenders were considered not to suffer from a mental illness or substance abuse. For 63%, the level of intellectual functioning was average or above average. There were signs of more than one form of violence in 54% of the cases and 28% of the cases contained excessive violence. The use of multiple and excessive violence was significantly related to the offender age, multiple offenders, offender-victim relationship and substance abuse, but not related to having developmental problems, crime history or mental illness.