Factitious Disorder in a Patient Claiming to be a Sexually Sadistic Serial Killer

Factitious disorder involves the conscious simulation of psychological or physiological symptoms of illness, for the purpose of fulfilling the unconscious desire to be taken care of or to assume the “sick role.” Typically patients with factitious disorder simulate conditions that are designed to arouse feelings of empathy in care providers with the intention to engage them in caretaking. However, patients might also simulate conditions that arouse revulsion or rejection and still meet full diagnostic criteria for factitious disorder. In this case report, we present a patient who fabricated an elaborate history of being a sexually sadistic serial killer with homicidal ideation with the intention of obtaining personal attention, nurturance, and empathy from his psychotherapist. However, given the nature of his feigned condition, the patient frightened the very person whom he sought to engage in caretaking.     

开展动物法医学研究的必要性与可行性

动物资源对于人类社会的生存和发展有着不可估量的价值。加强对动物的保护是有序利用动物资源的前提和保证,动物司法鉴定技术手段能够为动物资源的保护提供有效的技术支撑,动物司法鉴定技术手段的确立和完善有赖于动物法医学的开展及研究。从动物法医学技术本身及其研究论述动物保护方面的必要性及可行性,期望在动物资源保护以及提高动物的福利等方面发挥出积极作用。     

Psychopathy in a mixed gender sample of adult stalkers

The authors present data on a mixed gender sample of 78 adult stalking perpetrators, each of whom was assessed with the Psychopathy Checklist:Screening Version (PCL:SV). Results indicate a generally low frequency of psychopathy in this group, although 15% of the sample was composed of psychopaths. Comparisons between this sample and other forensic samples indicate that both the frequency and degree of psychopathy were lower in the stalking group. The findings support previous theory and empirical findings, including the concept that underlying attachment pathology among stalkers and psychopaths is quite different, and psychopathy--in contrast to other areas of violence risk assessment--is usually not relevant when evaluating dangerousness among stalkers.     

Severe Sexual Sadism—An Underdiagnosed Disorder? Evidence from a Sample of Forensic Inpatients

Abstract:  Severe sexual sadism is a disorder of sexual preference that focuses on humiliation and subjugation of the victim, sometimes causing grievous injury or death. Sexual sadists pose a particular risk. However, the diagnosis as such is unreliable and prevalence estimates vary. In a sample of male high-security forensic inpatients who had committed sexual offenses, we found two-thirds of sexual sadists had not been identified as such prior to commitment. Possible reasons for missing the diagnosis are many fold. Present data support the notion that unrecognized sexual sadists more closely resembled non-sadistic sex offenders than accurately diagnosed sadists. In particular, initially unrecognized sexual sadists had less severe previous convictions, less vocational training, and experienced a less supportive upbringing than their correctly identified sadistic counterparts. The latter, in contrast, more often reached media coverage through their offense(s). We conclude that severe sexual sadism is likely an underdiagnosed, yet forensically highly relevant disorder.     

Somnophilia and Sexual Abuse Using Vaginal Administration of Triazolam

Somnophilia is a rare paraphilia, a form of sexual fetishism which is characterized by the desire to have sex with an unconscious human object who is unable to respond. To the author's knowledge, this is the first case study concerning somnophilic sexual abuse associated with vaginal administration of triazolam. The perpetrator video‐recorded his sexual acts with two unconscious female victims with whom he also had normal sexual intercourse and who were unaware of his paraphilic activities. His Internet conversations with other persons whom he thought to be interested in somnophilic sex and his plans to kidnap a child were recorded by the police. It was evident that sex with an unconscious object played a specific fetishistic role for this man. He obviously used a combination of drugs mixed with alcoholic drinks to make his victims fall sleep and videotaped vaginal administration of triazolam used to deepen the victim's unconscious state.     

Preliminary Data on the Role of Emotional Intelligence in Moderating the Link between Psychopathy and Aggression in a Nonforensic Sample

This short report presents preliminary data on the role of emotional intelligence (EI) in moderating the relationship between psychopathy and aggression in a nonforensic sample. A sample of 109 volunteer men was administered the Psychopathic Personality Inventory‐Revised (PPI‐R), the Reactive‐Proactive Aggression Questionnaire, and the Mayer‐Salovey‐Caruso emotional intelligence Test in individual sessions. Correlation and moderation analyzes showed that, at low levels of EI (in terms of strategic ability to understand and manage one's own and others’ emotions), people scoring high on the total PPI‐R and impulsivity dimension seemed to be both reactively and proactively aggressive. By contrast, at high levels of strategic ability, the relationships between psychopathy and aggression were no longer significant. These preliminary results encourage further investigation into the role of EI ability in mitigating aggressive outcomes in psychopathic subjects.     

Psychopathy,Treatment Involvement,and Subsequent Violence Among Civil Psychiatric Patients

Individuals with psychopathy typically are viewed as incurable cases that should be diverted from treatment settings to environments where their behavior can be monitored and controlled. The prevailing clinical conviction that psychopaths are untreatable has crucial implications, given the scarcity of mental health care resources, the number of legal contexts that call for assessment of treatability, and the explosion of research on psychopathy and violence risk over recent years. Based on a sample of 871 civil psychiatric patients (including 195 potentially psychopathic and 72 psychopathic patients), this study explores the relations among psychopathy, receipt of outpatient mental health services in real-world settings, and subsequent violence in the community. The results suggest that psychopathic traits do not moderate the effect of treatment involvement on violence, even after controlling statistically for the treatment assignment process. Psychopathic patients appear as likely as nonpsychopathic patients to benefit from adequate doses of treatment, in terms of violence reduction. We interpret these results in light of prior research with offenders and analyze their implications for future research, policy, and practice.     

Child Sexual Abuse Perpetrated by Women: Case Series and Review of the Literature

The literature on child sexual abuse (CSA) perpetrated by female sexual offenders (FSOs) is exiguous, and many studies have focused on judicial databases. The present retrospective study, instead, analyzed clinical and judicial data of a group of both victims and alleged FSOs, to additionally include women who have not been convicted by the criminal justice system, but who hold strong clinical suspicions of being perpetrators of CSA. The medical records and the Court files of 11 children and their eight suspected FSOs have been collected and critically reviewed in light of the literature to date. This approach allowed for a deeper understanding of the relationship between child and FSO. The authors hypothesize that the victims’ severe psychopathological outcomes were a result of a failure to develop appropriate attachments with their prospective caregivers, which could have been damaged by the pathological relationship with FSOs, who were the victims’ caregivers.     

Assessing Psychopathic Traits and Criminal Behavior in a Young Adult Female Community Sample Using the Self‐Report Psychopathy Scale

This study assessed psychopathic traits in a nonforensic female population (N = 343). Respondents completed the Self‐Report Psychopathy Scale‐4: Short Form (SRP‐SF) and also reported on their Criminal Behavior. The results revealed relatively higher scale elevations for the Interpersonal and Lifestyle SRP‐SF facets, compared to the Affective and Antisocial facets. Also, those with a history of Criminal Behavior had significantly higher SRP‐SF facet scores on all four psychopathy domains, compared to those without such history. Consistent with a number of previous studies, the structural equation modeling results revealed good fit for the four‐factor SRP‐SF model. In addition, a super‐ordinate SRP‐SF factor, which accounted for the majority variance of all four SRP‐SF first‐order factors, also accounted for 50% of the variance in a latent Criminal Behavior factor. Taken together, findings support use of the SRP‐SF to assess psychopathic features in a moderately large sample of Belgium women.     

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6‐year‐old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo–ecto‐mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.     

Matricide and Two Sexual Femicides by a Male Strangler with a Transgender Sadomasochistic Identity

Abstract: While violence against sexual minorities is a well‐known phenomenon, sexual homicides committed by men with cross‐dressing or transsexual identity are not, because they are relatively few. We report a 23‐year follow‐up of the case of a transvestite, possibly transsexual, man who killed his mother by strangulation at the age of 20, and later in two separate cases strangled a female victim towards whom he felt sexual desire. He reported being sexually aroused by being strangled himself. The case raises questions concerning legislation which does not allow life‐long control of criminals.     

Correlates of the Co-Occurrence of Wife Abuse and Child Abuse Among a Representative Sample

The co-occurrence of domestic violence and child abuse is well documented (Appel, A. E., & Holden, G. W. (1998). J. Fam. Psychol. 12: 578–599; Edleson, J. L. (1999). Violence Against Women 5: 134–154). However, little is known about the correlates of co-occurring wife and child abuse. Analyzing data from the 1985 National Family Violence Survey (subsample N = 2733), this study identified risk factors associated with the co-occurrence of wife and child abuse. One-way ANOVA and chi-square analyses were conducted to compare characteristics of parents, children, and households among subgroups of families reporting some form of abuse. Key differences emerged between the three types of homes compared (i.e., those with child abuse alone, wife abuse alone, or wife and child abuse), indicating possibly distinct etiologies and processes. In particular, the co-occurrence of wife and child abuse was marked by less education, worse health, increased reports of depression, and increased husband drug use. Findings may be useful to practitioners and researchers interested in risk factors for different forms of family violence.The total does not equal 100% because certain states report more than one form of maltreatment per child.     

Creating a State‐Academic Partnership to Advance a Forensic Teaching Service: Benefits and Barriers

In Washington State, like many states, there is a shortage of forensically trained mental health clinicians to work with criminal justice‐involved individuals. At the direction of the state legislature, a collaborative project was undertaken by the University of Washington, the state Department of Social and Health Services, and a state psychiatric hospital to develop a proposal for a jointly sponsored forensic teaching service. The authors reviewed the literature, surveyed and interviewed forensic psychiatry and psychology training directors, and conducted site visits of selected training programs that offer multidisciplinary training or have affiliations with state hospitals. The authors conducted focus groups of additional stakeholders, including clinicians and patients in forensic settings, to better understand the needs in Washington. The authors report on several common benefits and barriers to establishing forensic teaching services. Other states and forensic programs may find this article useful in identifying common considerations for forensic mental health teaching services.     

Psychopathy and Female Gender: Phenotypic Expression and Comorbidity; A Study Comparing a Sample of Women Hospitalized in Italy's Maximum Security Facility with Women Who were Criminally Sentenced and Imprisoned,

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL‐R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation.     

Claims of amnesia for criminal offenses: psychopathology, substance abuse, and malingering

The forensic psychiatric examiner often encounters defendants who deny memory for their offense. Past research proposes a variety of factors to account for offense amnesia. To date there have been few systematic studies of offense amnesia in relation to psychiatric diagnosis, either alone or in combination with other known factors such as substance use and malingering. We studied 53 pretrial felony defendants who had been referred for psychiatric examination; 40% claimed amnesia for their offense. Examinees with psychotic disorders in general, and schizophrenia in particular, were relatively less likely to claim amnesia than were examinees with other diagnoses. Substance use at the time of the offense and associated substance use disorder diagnoses were positively associated with offense amnesia. Malingering diagnosed by general clinical criteria was a poor predictor of amnesia claims. These data suggests that two prominent reasons for referral for forensic psychiatric evaluation include the presence of psychotic symptoms and claims of amnesia for the offense.     

Homicide,Psychopathy, and Aging—A Nationwide Register‐based Case‐comparison Study of Homicide Offenders Aged 60 Years or Older*

Abstract: With populations aging there have been some concerns on elderly offending. We compared elderly homicide offenders with a younger comparison group with special emphasis on psychopathy. We analyzed nationwide register‐based material on all homicide offenders aged 60 or older who were in a forensic psychiatric examination in Finland 1995–2004 and their gender‐matched comparison group of younger homicide offenders. The offenders 60 years or older were diagnosed less often than the younger ones with drug dependence and personality disorders and more often with dementia and physical illnesses. The mean Psychopathy Checklist—Revised total scores as well as factor and facet scores were lower in the 60 or older age group. The group 60 years or older had significantly lower scores on eight individual items of social deviance. The interpersonal/affective factor 1 scores did not differ. Understanding the possible underlying phenomena of violent behavior may provide help for developing services for the elderly.     

The Influence of Evidence on Animal Cruelty Prosecution and Case Outcomes: Results of a Survey

Two hundred prosecuting attorneys completed a survey concerning priorities in taking on animal cruelty cases and the factors that help or hinder prosecuting such cases. Respondents commented on the priority given such cases. Questions also addressed specific kinds of evidence that had been used to decide whether to take on a cruelty case and were used in court. Results showed that prosecutors most frequently relied upon “traditional” sources of evidence, including detailed medical and crime scene reports and good quality photographic evidence. Other sources of forensic evidence such as DNA, computer forensics, forensic accounting, blood, and trace evidence were rarely employed. Veterinary forensic evidence, including forensic necropsies and detailed medical reports, was viewed as an important factor by a majority of prosecutors in deciding whether to accept a case for prosecution and in achieving a successful outcome, but a need for additional training for investigators was indicated.     

The Value of Crime Scene and Site Visitation by Forensic Psychologists and Psychiatrists

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after‐the‐fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision‐making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations.     

Loperamide as a Potential Drug of Abuse and Misuse: Fatal Overdoses at the Medical University of South Carolina

Loperamide is an over‐the‐counter, μ‐opioid receptor agonist commonly used as an antidiarrheal agent. Loperamide was thought to have minimal abuse potential due to its low bioavailability and limited central nervous system activity; however, there have been increasing reports of loperamide misuse in supratherapeutic doses to achieve euphoria and/or avoid opioid withdrawal. A literature review suggests a rise in loperamide abuse was inevitable, with substantial increases in reported cases over the last decade. Five fatal cases of toxic medication use where loperamide was listed as a primary or contributory cause of death were identified at the Medical University of South Carolina. The characteristic autopsy demographics and findings are described, and the mechanisms of abuse and toxicity of loperamide are reviewed. Loperamide overdoses are a growing concern from both a forensic and clinical standpoint, and the frequency of reported cases will likely increase as awareness grows within the medical and toxicological communities.