Consulting to residential programmes for sexually aggressive delinquents

Abstract

Delinquent adolescent boys, especially those looked after in residential settings, often have a long history of coercive antisocial behaviour. Many have a history of aggression and violence, including serious sexual offences such as rape and indecent assault. In light of the Criminal Justice Act 1991 the residential care sector will come under more pressure to accommodate sexually aggressive recidivistic delinquents. However, few staff who work in residential settings with delinquents have received training in the management and treatment of sexually aggressive behaviour. Time spent in residential care settings may therefore do little to reduce the risk of sexual aggression. This paper proposes that the assessment and management of risk is central to the effective rehabilitation of this group of young people. Based on work carried out at Glenthorne Centre a risk assessment strategy is presented consisting of several different strands: an analysis of organisational decision-making; identification of sources and types of information to inform decisions; the development and implementation of a risk assessment protocol; and staff training. A case example is used to illustrate the use of the protocol at Glenthorne.     

An alleged assault by police

A case is presented of self-inflicted injuries alleged to have been sustained during an assault by police. A summary is given of the factors in this case differentiating between self-inflicted injuries and those due to an assault. The desirability of taking photographs of injuries in cases of alleged assault and the importance of keeping an open mind when assessing injuries are emphasised. The need for greater awareness in the medical and legal professions of the advantages of a forensic medical opinion in the assessment of injuries is mentioned.     

The relationship between the quantity of alcohol consumed and the severity of sexual assaults committed by college men

Researchers have suggested that intoxicated perpetrators may act more violently than other perpetrators, although empirical findings have been mixed. Past research has focused on whether or not alcohol was consumed, rather than the quantity consumed, and this may explain these inconsistent findings. The authors hypothesized that the quantity of alcohol consumed would have a curvilinear relationship to the severity of the assault. Data were collected from 113 college men who reported that they had committed a sexual assault since the age of 14. The quantity of alcohol that perpetrators consumed during the assault was linearly related to how much aggression they used and was curvilinearly related to the type of sexual assault committed. The quantity of alcohol that victims consumed during the assault was linearly related to the type of sexual assault committed. Strategies for improving assessment of alcohol consumption in sexual assault research are discussed.     

Prediction of women's utilization of resistance strategies in a sexual assault situation: a prospective study

The present study prospectively explored the predictors of resistance strategies to a sexual assault situation. Participants were assessed at the beginning of an academic quarter on a number of variables, including past history of sexual victimization, perceived risk of sexual victimization, and intentions to use specific types of resistance strategies. Only women who reported being victimized over the interim (N=68) were included in the analyses, which suggested that women's Time 1 intentions to utilize assertive resistance strategies (e.g., physically fight, run away) and offender aggression predicted women's use of assertive resistance strategies in response to the assault that occurred over the follow-up. Women's utilization of nonforceful verbal resistance (e.g., reason, plead, quarrel) was predicted by perpetrator aggression and previous sexual victimization. Women's immobility (e.g., turn cold, freeze) during the assault that took place over the interim was predicted by experiences of childhood sexual victimization and previous sexual victimization.     

Investigation of a typology of alcohol‐related violence defined by ultimate goals

Purpose. Alcohol‐related violence is a serious problem and treatments for high‐risk individuals need to be developed. Classification helps to route people into appropriate treatments. Drawing on animal research, we define alcohol‐related violence in relation to ultimate goals. We propose three types of violence: (1) violence in the pursuit of material goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. The aim is to explore factors that we expect to relate to this tripartite typology, with the aim of providing a preliminary validation. Method. Participants were 149 young male prisoners who had committed an offence of violence that was alcohol related. Semi‐structured interviews elicited information about the offence that enabled classification into one of the three types. Differences between groups were examined at the event level – level of violence during the offence and alcohol consumption before the offence – and at group level – trait aggression, trait anxiety, anger control, and alcohol–aggression outcome expectancies. Results. No differences were found in levels of violence or alcohol consumption. Those whose violence was in the pursuit of material goals were high on trait aggression, trait anger, trait anxiety, and anger suppression. Those who used violence in the pursuit of social dominance showed high trait aggression and trait anger. Those whose violence was a defence in response to threat showed lower trait aggression and trait anger. Conclusion. The findings are discussed in relation to differential group profiles and treatment needs.     

Rape reform in Canada: Public knowledge and opinion

Rape reform legislation in Canada was designed to change: 1) the way sexual assault cases were processed by the criminal justice system and 2) public opinion about crimes of sexual aggression. This article reports findings from a representative survey of the Canadian public and an experimental analysis of the effects of the legislation on public knowledge and attitudes. Results from the nation-wide survey indicated that most people are unaware of the semantic shift (from the old language of rape and indecent assault to the new crimes of sexual assault). However, there is awareness of the substantive legal changes introduced by the rape reform legislation (such as the fact that husbands are no longer immune from criminal changes involving their wives). It is clear that rape reform legislation has affected public knowledge of statutory reforms regarding crimes of sexual aggression. Results from the experimental component of this research show that the new sexual assault label has not achieved one of the important goals, namely of changing public perceptions of the nature of crimes of sexual aggression. Indeed, one negative effect predicted by feminist writers seems to have emerged: sentencing decisions made by the public for the offense of rape were less severe when the incident was described as a sexual assault.     

Anxiety,alcohol use,and aggression: Untangling the causal pathways

Given the enormous social and economic costs of alcohol‐related violence, understanding the causal processes that give rise to the relationship between alcohol and violence is of paramount importance. McMurran provides a valuable contribution to this literature by offering a conceptually coherent, empirically grounded, and plausible model of the relationship between anxiety, alcohol intoxication, and aggression ( McMurran, 2011 , pp. 357–371). In this commentary, I first look more narrowly at the proposed causal relationships that link anxiety problems with aggression via alcohol use, suggesting that although they are largely consistent with McMurran's thesis there may be scope to build yet more complexity into the model. In the second part of the commentary, I consider the nature of both anxiety and aggression within the broader framework of our evolutionary history and argue that considering the adaptive functions of anxiety and aggression may contribute to our understanding of the proposed links with alcohol use. In particular, I highlight the potential value of disaggregating the links between anxiety, alcohol use, and aggression by gender, and type of violence.     

Swollen Lips After a Night of Partying—An Allergic Reaction to Ecstasy?

Ecstasy (MDMA) is a mood‐lifting drug with numerous somatic side effects, for example, dehydration or continuous chewing and biting. We describe the case of a young woman who underwent a forensic medical examination for suspected sexual assault. She claimed to have suffered from a memory lapse, and she had a painful swelling of her lips with a plaque‐like coating on her lips and buccal mucosa. The attending physician suspected that these findings might have been caused by strong sucking pressure on her lips within the context of a sexual assault. A toxicological examination of a blood specimen verified that she had been under the influence of an extremely high dose of ecstasy (1.456 mg/L MDMA and 0.0213 mg/L MDA). Pursuant to the forensic medical assessment, the described findings on her lips, and buccal mucosa were interpreted as an allergic and mechanical reaction (through continuous chewing and biting) to ecstasy.     

A prospective analysis of the relationship between childhood sexual victimization and perpetration of dating violence and sexual assault in adulthood

The majority of studies evaluating the relationship between childhood sexual assault and subsequent sexual assault perpetration by men have been conducted retrospectively and with incarcerated populations. The present study seeks to improve on previous research by prospectively investigating the relationship between childhood sexual assault and subsequent perpetration of dating violence in adulthood in men. Although there is a significant relationship between childhood sexual abuse and history of sexual assault perpetration at baseline, prospective analyses indicate that childhood sexual assault is not predictive of perpetration during the follow-up period. The role of family factors, including parental conflict resolution, is implicated in subsequent sexual aggression. These results are supportive of the idea that the effects of childhood sexual abuse may be mediated by a variety of factors.     

A Rare Case of Sudden Death Due to Hypotension during Cesarean Section in a Woman Suffering from Pheochromocytoma and Neurofibromatosis

Sudden death following acute hypotension due to an undiagnosed pheochromocytoma (PHEO) is a rare event. Moreover, histopathology of the myocardium in such cases is rarely reported. We present a case of a woman who died during delivery. A 37‐year‐old parturient, who was 38 weeks pregnant, suffering from neurofibromatosis underwent a cesarean section following peridural anesthesia. Acute hypotension, acute intra‐operative pulmonary edema and supraventricular paroxysmal tachyarrhythmia occurred during delivery, followed by death. The autopsy revealed the presence of a PHEO, confirmed immunohistochemically with chromogranin‐A (CgA), CD20 antibody (L26), anti‐Keratocan antibody (KER‐1) and neuron‐specific enolase (NSE), and a PHEO‐induced cardiomyopathy. The physiopathology of both stress‐induced cardiomyopathy and PHEO‐induced cardiomyopathy, as well as the role of anesthesia in provoking the death, are discussed. The association of an undiagnosed PHEO with neurofibromatosis as the cause of sudden death in pregnancy is an obstetric urgency that raises forensic pathology issues.     

Locard's Principle of Exchange,Dental Examination and Fragments of Skin

The transfer of materials between victim and perpetrator was first reported by Locard in the nineteenth century. While in recent years DNA testing has been very successful in matching biological material from crime scenes to perpetrators, the following cases demonstrate that other more time‐honored methods remain useful. Two cases of lethal assault are reported where the victims had bitten their assailants resulting in fragments of the perpetrators’ skin being wedged between their teeth which were discovered during post mortem oral examinations. As the fragments were able to be matched to injuries in the perpetrators, identification was established prior to confirmatory DNA testing. In case 1 a criminal conviction for manslaughter resulted, and in case 2 the identity of the assailant was confirmed. Examination of a properly exposed and illuminated oral cavity may provide useful evidence in assault cases. These cases represent an unusual dental variant of Locard's principle.     

Epidemiological characteristics of male sexual assault in a criminological database

Sexual assault among males, compared with females, is understudied, and may also be significantly underreported. Past studies have relied primarily on population-based survey data to estimate the prevalence of sexual assault and associated health outcomes. However, survey-based studies rely primarily on self-reports of victimization and may not accurately estimate the true prevalence of male sexual assault victimization. In order to obtain a detailed assessment of sexual assault among males, criminological databases like the National Incident Based Reporting System (NIBRS) may provide an important and unique source of information. The objective of the current study was to use data from the 2001-2005 NIBRS to construct an epidemiological profile of sexual assault among males. Our results suggest that the incidence of sexual assault was higher among young males (less than 19 years of age), with approximately 90% of all cases being reported among members of this age group. Among males of all ages, forcible fondling and sodomy were the most prevalent forms of sexual assault. Results from additional analyses include age- and race-specific rates of male sexual assault, the prevalence and severity of injury, and time trends detailing incidence by time of the day and location of the incident. Our analyses show that sexual assault is experienced by males of all age groups. However, the rate of sexual assault is higher among younger males. Despite some limitations, results from this study suggest that NIBRS data may provide a important complement to survey data for understanding breadth and consequences of male sexual assault.     

STR Genotyping from a Dry‐Cleaned Skirt in a Sexual Assault Case

In this sexual assault case, the standard preliminary semen examinations could not confirm physically or biochemically whether the accused's semen had stained the victim's skirt because the skirt had been dry‐cleaned for stain removal and had been worn for more than a year after the assault. Fortunately, however, a photograph taken just after the assault was found in the court records that showed white stains on the checkered skirt. The locations of the stains were estimated based on the checkered pattern of the fabric, and microscopic examination using Baecchi's staining revealed the presence of spermatozoa. Further analysis indicated the male DNA profile generated from the sperm cells was consistent with the suspect's DNA using three multiplex STR typing systems for a total of 21 autosomal and 17 Y chromosomal short tandem repeats (STRs). Ultimately, the result of the DNA profile played a very useful role as additional evidence.     

Intimate partner violence among pregnant and parenting Latina adolescents

The purpose of this study was to examine the nature and extent of mutual violence among a sample of pregnant and parenting Latina adolescent females and their partners. The sample consisted of 73 Latina adolescent females between the ages of 14 and 20 who were referred to a community-based organization for case management, education, and psychosocial support for pregnant and parenting adolescents. They completed the Conflict Tactics Scale (CTS-2) as part of a pretest to evaluate this intervention program. A small number (12 out of 73; 16%) reported no use of aggressive conflict tactics. Eighty-four percent (61 out of 73) of the study respondents reported using at least one form of minor psychological aggression and 62% (45 out of 73) reported using at least one form of minor physical assault over the past 6 months. Mutuality of conflict was high, especially in cases of minor assault by partner. There was no difference in severity or chronicity of conflict between those who were pregnant and those who were not. Female respondents reported that they and their partners engaged in comparable levels of sexual coercion. Discussion of the context of psychological, physical, and sexual aggression in adolescent relationships suggests alternative approaches to prevention of intimate partner violence among adolescents.     

Arsenic Poisoning Caused by Intentional Contamination of Coffee at a Church Gathering—An Epidemiological Approach to a Forensic Investigation

Abstract: An outbreak of apparent food‐borne illness following a church gathering was promptly reported to the Maine Bureau of Health. Gastrointestinal symptoms among church attendees were initially attributed to consumption of leftover sandwiches that had been served the previous day. However, a rapid epidemiological and laboratory assessment revealed the etiology of illness, including the death of an elderly gentleman, was not food‐borne in origin. A criminal investigation determined that deliberate arsenic contamination of the brewed coffee by one of the church members was the source of the outbreak. Public health officials and criminal investigators must be aware that intentional biologic aggression can initially present as typical unintentional disease outbreaks. Practitioners must also consider the need to properly maintain and preserve potential forensic evidence. This case demonstrates the key role public health practitioners may play in criminal investigations.     

Analysis of Dental Case Reports in the Context of Court Decisions: Causal Nexus and Aspects of Fault

The purpose of expert reports is to support the judge in his decisions, by providing technical information. However, it remains uncertain as to what extent the content of these reports is used, and if they are effectively associated with judicial decisions. The aim of this study was to perform a qualitative analysis of case reports in relation to the judicial decisions rendered in association with these reports, by determining the connection between causal nexus and aspects of fault. The case reports included lawsuits against dentists, issued by the Medical Justice Department of the State Court of Appeals of Rio Grande do Sul, Brazil, between 2010 and 2013. Comparing the percentage of agreement between case report and judicial decision, causal nexus was 79.9% and fault was 86.7%. The high percentages of agreement found in relation to fault and causal nexus highlight the relevance of expert reports in weighing the judge's decision.     

Disseminated fungal infection with renal infarction simulating homicide

Renal infarction is an uncommon finding at autopsy most often related to occlusive thromboembolism or to trauma. A 42-year-old woman is reported who presented with persistent right flank pain after an alleged assault with injury to the area 3 weeks previously. Renal infarction necessitated a right nephrectomy that was followed by multiorgan failure and death. Given the possible link between the assault and the renal pathology, a homicide investigation was initiated. Although renal infarction had been confirmed by hospital pathologists, microscopy with special staining of both kidneys and the heart after autopsy revealed multifocal areas of angioinvasion by fungi having morphologic characteristics of mucormycosis. The only other finding of significance was alcohol-related micronodular cirrhosis of the liver. Renal infarction had therefore been caused by an angioinvasive fungal infection predisposed to by immunocompromise associated with alcoholism and not by trauma-induced arterial dissection. This case demonstrates that careful histological assessment of tissues from medicolegal autopsies may occasionally identify unexpected and rare disorders that have been confused with the sequelae of inflicted injury.     

A risk marker analysis of assaulted wives

In the wife assault literature, a number of risk markers have been identified. Using the data of the female respondents to the National Family Violence Survey (n = 699), a multivariate analysis was performed to examine which risk factors best differentiated between women involved in nonviolent relationships, verbally aggressive relationships, relationships exhibiting minor physical aggression and severely violent relationships. High levels of marital conflict and lower socioeconomic status emerged as the primary predictors of an increased likelihood of wife assault. Research implications are discussed.     

Changes in Intimate Partner Violence During Pregnancy

Women's experiences of partner violence, both before and during pregnancy, are described using a convenience sample of women recruited from prenatal clinics. Included were an index group of women who told their clinicians that they had been physically abused during pregnancy, and a comparison group of women who told their clinicians that they had not been physically abused during pregnancy (even though later more detailed assessment found that some of these comparison women had experienced such violence). The women averaged 27 years of age, with 83% being high school graduates, 26% being married, and 66% having had previous children. The Conflict Tactics Scales 2 assessed rates of partner violence victimization of the women and their male partners, including psychological aggression, physical assault, and sexual coercion. Injuries also were assessed. Results showed that comparison men were physically assaulted at significantly higher rates than were their female partners, both before and during pregnancy (even though these victimization rates were much lower than those seen among the index couples). Index women experienced higher rates of psychological aggression, physical assault, and sexual coercion than did their male partners, and these women were significantly more likely than their male partners to be injured. Pregnancy onset was associated with significant increases in the rates of psychological aggression among both the index and comparison couples. In addition, the index women experienced a significantly increased rate of sexual violence victimization during pregnancy. However, pregnancy was not associated with significant increases in the rates of physical assault or violence-related injuries among the index or comparison couples.