Assessing Trauma-Related Dissociation in Forensic Contexts: Addressing Trauma-Related Dissociation as a Forensic Psychologist,Part II

Chronic dissociative reactions and dissociative disorders can occur following traumatic events and are associated with suffering and impaired functioning. Therefore, trauma-related dissociation could be part of the claims made in civil actions or contribute to mitigation or an insanity defense in criminal actions. Dissociative reactions to trauma, including dissociative disorders, are more common than most mental health professionals realize. Unfortunately, few professionals have training in the assessment of dissociation, and forensic experts may be unaware of research indicating that standard interpretations of well-regarded assessment instruments can result in inaccurate determinations of symptom exaggeration in cases with dissociation. This paper is the second paper of a two-part series that aims to expand assessors’ knowledge about trauma-related dissociation (TRD) and enhance their ability to assess and present information about dissociation. In this article, we focus on the forensic assessment of TRD and discuss: dissociative symptoms; complex trauma; trauma-related disorders; an approach to assessment of TRD; trauma-related reactions that can impede the detection of TRD; and differential diagnosis of genuine versus feigned dissociation. In addition, we review research related to the validity and appropriate interpretation of the following measures in use with persons with TRD: Dissociative Experiences Scale, Multiscale Dissociation Inventory, Somatoform Dissociation Questionnaire, Trauma Symptom Inventory-2, Multidimensional Inventory of Dissociation, Structured Clinical Interview for Dissociative Disorders-Revised, Minnesota Multiphasic Personality Inventory-2, Personality Assessment Inventory, Structured Interview of Reported Symptoms, Test of Memory Malingering, and the Gudjonsson Suggestibility Scale.     

Risk factors for stalking violence,persistence, and recurrence

This study used a retrospective design to investigate risk factors associated with violence during a stalking episode, persistence (increased duration of stalking) and recurrence (multiple subsequent separate stalking episodes) in 157 people (91% male, mean age 35 years) with an established history of stalking behaviour. Results showed that diverse risk factors are associated with different types of stalking outcomes. Consistent with previous research, stalking violence was more likely to occur when the victim was an ex-intimate, when explicit threats had been made and where there had been previous property damage (AUC = .74). Personality disorder, older age, criminal versatility, a prior acquaintanceship and erotomanic delusions (AUC = .75) predicted stalking recurrence. Finally, previous acquaintanceship, the presence of delusional beliefs and the absence of a history of physical or sexual violence were associated with stalking persistence. These results clearly show that effective assessment and management of stalking requires consideration of different stalking outcomes and the diversity of associated risk factors.     

Freedom to think – the value of multiple clinical narratives in women’s prisons†

Abstract

The merits of being multi-lingual are widely recognised. This paper considers the application of this metaphor to the conceptualisation of clinical work in a women’s prison. We suggest that sharing ‘languages’ from different theoretical orientations in open fora enables teams to build deep and nuanced understandings of clinical and systemic complexity, of particular value in secure settings. This discussion reflects the service model developed and used within HMP/YOI Holloway, a large women’s prison in London, which has recently been closed. We utilise a case example, with formulations and recommendations from several perspectives, to illustrate the value of maintaining a rich, inclusive discourse. We describe the benefits of such an approach to staff teams, to institutions and to those we serve, and consider the implications for organisation of services to maximise potential for change and recovery.     

Web campaigning from a global perspective

Since the mid-1990s, political parties around the world have been moving into cyberspace. During the early years, it was not evident that many of them had any clearly defi ned ideas about why the internet would prove useful, or how they should present themselves on it. As time has passed, however, a number of key uses for the new technology have emerged as well some common trends in parties' and candidates' website content and appearance. Paramount among those uses has been the increasing use of the World Wide Web (WWW) and email as electioneering tools. This paper aims to chart the development of so-called "cyber-campaigning" by political parties both in terms of what they are doing (supply side) and also how the electorate are responding (demand side). The two key questions that will be addressed are 1) whether the practice is adding anything new to parties' campaign practices, and 2) what difference, if any, it is making for voters. Does cyber-campaigning play a decisive role in terms of changing minds, if not hearts? The analysis covers developments in cyber-campaigning across a number of contexts but has particular emphasis on Europe, the US, and Australia. Beginning with an historical overview, we chart the rise of web campaigning since the mid-1990s in the US and then move to look at the academic research that has attempted to compare and contrast website content and quality and also explain the distribution of party and candidate sites. After identifying some of the key elements within the cyber-campaign tool box, and the factors that appear to promote its practice, we then turn to look at the audience for election websites and discuss the crucial issue of the extent to which having a website actually matters for parties. One obvious measure of success may be whether the site actually produces an increase in the electoral support for the party. However, using such a measure may present problems given that more than half of the electorate in most countries remains without access to the web. Perhaps cyber-campaigns benefi t parties and candidates in more subtle and diffuse ways? Would perhaps having an attractive and user friendly website contribute to a positive image of organisational competence, and more importantly, contemporary relevance?     

Deliberate self-harm patients who discharge themselves from the general hospital without adequate psychosocial assessment

Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.     

Self-extraction of teeth involving gamma-hydroxybutyric acid

A case involving self-extraction of teeth linked to the abuse of gamma-hydroxybutyric acid (GHB) is reported. A 28-year-old woman and her 29-year-old boyfriend were discovered by paramedics following an extensive period of GHB use. The paramedics were alerted by a neighbor who had heard screaming from the house. On presentation to the accident and emergency department, it was noted that the female had 18 fresh extraction sockets visible intra-orally. At the scene, a mirror, a pair of pliers, and a bowl containing human teeth were found. Charges of assault were taken to the courts against the boyfriend who was subsequently acquitted. Odontological evidence centered on whether or not it was possible to self-extract the teeth using the pliers found. This case is the first to describe possible oral self-mutilation under the influence of GHB and odontologists should always consider self-injury as an explanation for intra- and perio-oral injuries of unknown origin.     

Mortality in cerebral palsy (CP): the importance of the cause of CP on the manner of death

Cerebral palsy (CP) is a nonprogressive motor deficit present or sustained in the perinatal period. We reviewed the files of the Office of Chief Medical Examiner of the City of New York for the 1997-2001 interval seeking those with any mention of cerebral palsy. There were 26 such cases, including 18 natural deaths, three accidents, two homicides, two therapeutic complications, and one death classified as undetermined. Proper reporting and careful investigation of these deaths is required for accurate certification of cause and manner of death, as well as for adequate tracking of these deaths for public health purposes.