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Friends of the Forensic Science Club, this week we present the paper “Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime?” by Hodgins, S. (2022), in which the author carries out a revision about previous literature about the treatments that people with schizophrenia have received to improve their aggressive behavior. 

Schizophrenia is a very complex and difficult to treat mental illness, which causes suffering to those who suffer it in the first person, but also their loved ones.

Some people who develop or present it, engage in aggressive and sometimes criminal behavior.

Most of these individuals suffer a first episode of psychosis that marks a before and after, but before this episode they usually show behaviors with a certain level of aggressiveness.

However, the needed services to treat the first episodes of psychosis have improved the care of these people, by their early interventions in the course of the illness. This would also help with violent behavior, since some people with schizophrenia have a history of violent behavior and even antisocial behavior since childhood, so they will need urgent treatment. 

Even so, the reality is that many care services for the first episode of psychosis do not treat or evaluate aggressive behavior, so patients manifest them inside and outside psychiatric services.

On many occasions, when this aggressive behavior explodes and someone gets hurt, the perpetrator is charged with a violent crime. Some of these people are judged not criminally responsible due to the mental disorder they suffer, and are sent to forensic psychiatric hospitals. Others are found guilty and sentenced to prison in a conventional center.

In other words, the human costs of the inability to identify and treat these patients when they first come to clinical services are enormous.

Existing literature indicates that first episode psychotic care services have the potential to prevent many manifestations of these aggressive behaviors and, therefore, violent crimes by people with schizophrenia.

This would reduce the human suffering of patients and victims, as well as the costs of police, courts, prisons and other social care resources, also helping to reduce the stigma against people with mental illnesses.

There is evidence that confirms that people with schizophrenia are more likely than their peers of the same age and gender to engage in aggressive behavior (which, in turn, can lead to criminal prosecution). They are at higher risk of being convicted of non-violent and violent crimes, and especially of being convicted of homicide. However, mental health services for people with schizophrenia do not assess or treat aggressive behaviors.

A meta-analysis found that 35% of people who contacted care services for their first episode of psychosis had previously suffered at least one aggression.

For example, a study with more than 200 people treated by these services, carried out in the United Kingdom, found that a third of men and 10% of women were convicted or found not guilty for mental illness in at least one violent crime . That is, it appears that most patients with schizophrenia who display aggressive behavior are indeed at increased risk of offending.

In general, among the people that present a first episode of psychosis and suffer from schizophrenia, there are two groups: one of them are people who have a long history of violent behavior problems that have sometimes ended up turning into crimes, and on the other hand, there are the people who recently manifest this type of aggressive behavior.

Another significant piece of information is provided by a study carried out in Canada, which reports that the majority of people declared not criminally responsible due to a mental disorder, between 2000 and 2005, were men with a diagnosis of schizophrenia who had committed a violent crime.

A meta-analysis showed that 29-38% of the patients seen in first-episode psychosis clinics used cannabis regularly. Another meta-analysis found that, among people with severe mental illness, the risk of violent attitudes increased between two and five times with cannabis use. This suggests that these people may also suffer from an addiction disorder.

On the other hand, adults with schizophrenia show higher levels of victimization than their neighbors, even after being aware of their own criminality, and are also more at risk of being victims of homicide.

It has been shown that when treatment is applied to these patients, which in addition to being focused on schizophrenia also focuses on violent behavior, their mental health improves and aggressive episodes are reduced.

Therefore, all the available evidence suggests that identifying and treating this behavior, in addition to psychosis, would reduce the suffering of patients, and the secondary human and economic costs. In addition, it would promote the safety of patients and their loved ones and help them with their independence and autonomy.

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Friends of the Forensic Science Club, this week we present the paper “Personality Disorder Traits, Rorschach Performance, and Neuropsychological Functioning in the Case of a Serial Killer: The Importance of a Multilevel Approach in the Assessment of Personalities Associated with Extreme and Repetitive Violence”, by Schug, R. A. (2021), in which the author carries out a multilevel analysis, using different techniques used by mental health and forensic science professionals, to know the personality of a serial killer. 

Serial killers are at the extreme end of the violence and therefore draw our attention, because they can represent some of the most serious forms of personality disorders.

For this reason, researchers continually point out the need to correctly evaluate the personality characteristics that may be exclusive to serial killers, since it has been seen in previous studies that there are certain characteristics that seem to be repeated in these cases and can act as clues to the investigation.

Some of the studies focused on this idea use the serial killers’ self-reports or tests for detecting the presence of personality disorders as a tool. This has provided us with very useful data, but what other techniques could be used?

We have, for example, the Rorschach test, which has been used to try to elucidate the psychological functioning and personality of those who kill. When used with murderers and sexual offenders, it has indicated alterations in personality and psychological functioning in several areas, such as the cognitive processing, perception, stress and distress…

There are also neurobiological studies of violence, which can explain how an individual is capable of committing multiple murders; nevertheless, they have to be complemented with some kind of tool to study personality.

Researchers, beginning in the 20th century, spawned a proponent of “layered” conceptualizations of personality, each representing different levels of awareness and accessibility.

Leary was one of those who supported this theory, and five levels in the personality dimension: 1) public communication, 2) conscious descriptions, 3) private symbolization, 4) the unexpressed unconscious and 5) values.

Since then, contemporary researchers have been expanding these concepts with empirical studies. For example, McAdams emphasized the importance of studying the organization and integration of personality, highlighting the theory of multiple layers of information.

Taking all this into account, it seems logical that the tools mentioned above can be combined to carry out a multilevel analysis of personality. This is precisely what the author of this article is trying to achieve: to comprehensively assess the personality of a serial killer, using a real case.

The protagonist of the case was a 66-year-old man who was serving time at the time of writing the article. He underwent a series of telephone interviews and face-to-face visits to the prison.

Basic data about his life was first collected, especially his childhood and youth. For example, he described his father as good, although drunk. He did not speak of his mother, besides, neither of them was especially affectionate with him. He also recorded verbal and physical conflicts between them. He did not suffer sexual abuse, but he did suffer physical abuse from his parents. He used alcohol from the age of 12 on an occasional basis, but not other drugs. Apparently, he did not manifest any mental illness. He killed eight women between the ages of 34 and 39, all of whom were asphyxiated. There seemed to be some sexual component to his crimes, but it wasn’t clear.

When given various personality tests, he met all the diagnostic criteria for antisocial personality disorder (for example, a pervasive pattern of disregard and violation of the rights of others appeared).

In addition, he met most of the criteria for narcissistic personality disorder (grandiose, lack of empathy, arrogance…), with some for schizoid disorder (does not enjoy or desire close relationships, chooses solitary activities, has no interest in sexual experiences with others …) and obsessive-compulsive disorder (excessive dedication to work, reluctance to delegate work unless others submit to their exact way of doing things, rigidity, stubbornness…) and great difficulty in controlling anger.

The Rorschach test suggested a defensive attitude towards life, an effort to please others, and poor psychological boundaries. In addition, his responses indicated emotional avoidance, very limited emotional reactivity, and a preference for reflection and reason, which the author translated into a preference for “living in his head” and not “living in reality.”

The multilevel analysis provided, as we can see, many keys to discover the subject’s personality. All this shows that the evaluation methods used, combined, could bring benefits for the diagnosis.

Authors mention, as a guideline for the future, that these methods should be improved, and find out what is the most appropriate way to combine the different tools.

If you want to know more about the criminal mind, criminal profiling, and forensic science, don’t miss our Certificate in Criminal Profiling, a 100% online program certified by Heritage University (USA), with special grants for the Forensic Science Club readers

Friends of the Forensic Sciente Club, this week we present the paper “’Anyone who commits such a cruel crime, must be criminally irresponsible’: context effects in forensic psychological assessment” by Rassin, E. (2021), in which the author carries out a study to know how contextual data affects the judgement of forensic psychologists when they have to make a criminal expert report. 

We know that criminal procedures are different in each country because they all have their own legal system, but in general, something that is crucial for the judge or jury is to determine if the suspect has committed a crime or not.

When there is conflicting evidence, this can be a difficult task. For this reason, the help of expert experts is usually used.

We think that these people will present ideas that are scientifically analyzed and always objective. However, these expert reports have been shown to be prone to error and bias, as they are produced by people, and we all make mistakes.

In fact, there is a lot of literature on how biases affect experts. For example, they may be vulnerable to loyalty bias, that is, the tendency to produce reports that are favorable to the party that has hired them.

But beyond that, forensic confirmation bias may exist. In short, it would be a bias through which beliefs, expectations and situational context would influence the collection, perception and interpretation of evidence.

This last component of forensic confirmation bias is called the context effect. In other words, elements of the context that should be considered irrelevant to make the decision are sometimes overestimated.

An experiment cited in the article was conducted in 2021, which found that for a sample of 133 forensic pathologists, the gender and age of the caregiver of a child who had been found dead determined how suspicious they considered the death. If the caregiver was the child’s mother’s African-American boyfriend, pathologists were five times more likely to label the child’s death a homicide rather than an accident, with the opposite occurring when the suspect was the child’s Caucasian grandmother.

It is true that experts provide high quality reports to make legal decisions, but we must be fair, since in addition to being experts, they are people susceptible to bias like any other.

In fact, context effects and other biases have been documented in the work of experts from all sorts of fields, including DNA analysis, fingerprint analysis, anthropological bone analysis, bite marks, bloodstains, manual writing and voice analysis, among others.

There are reasons to believe that forensic psychologists are also susceptible to bias. Forensic psychological analyzes refer, among other topics, to risk assessment, fitness to stand trial and evaluation of treatment. Furthermore, they try to answer the question of whether the suspect is criminally responsible and therefore suitable for prison, or criminally irresponsible and therefore in need of treatment in a forensic psychiatric clinic.

Chevalier found, in 2015, findings suggesting that forensic psychologists do exhibit the loyalty bias: when they do a risk assessment they tend to benefit either the defense or the prosecution in some way, depending on who has hired them.

However, the extent to which forensic psychologists are susceptible to contextual information is unknown.

The aim of this study was to test whether context effects also occur in forensic psychologists.

To do this, 60 forensic psychology students with an average age of 23 were gathered. They were asked to judge the mental state of a suspect and were divided into two groups. One of these groups received very explicit images of the case, they were told that the victims had been “cut with a knife” and they were shown a photograph of a face intended to provoke mistrust. The other group, given much more subtle images, was told that the victims had been “dismembered” and the suspect’s face shown to them was meant to create a good feeling.

It was hypothesized that they are indeed susceptible to this bias. Participants who were exposed to very explicit evidence were expected to judge the suspect’s mental state more harshly, while the opposite was true for participants who saw more subtle evidence.

Indeed, it happened as expected. The assessment of the suspect’s mental health was significantly affected by the contextual factor.

A limitation of the study was that it was not known how each type of contextual information influenced. Future research should explore this aspect.

If you want to know more about the criminal mind, criminal profiling, and forensic science, don’t miss our Certificate in Criminal Profiling, a 100% online program certified by Heritage University (USA), with special grants for the Forensic Science Club readers

Friends of the Forensic Science Club, this week we present the paper “Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder” by Savard, J.; Hirvikoski, T.; Öberg, K. G.; Dhejne, D.; Rahm, C. and Jokinen, J. (2021) in which authors investigate how impulsivity influences these disorders and their treatments to avoid recidivism.

This week we will talk about a couple of mental disorders that always carry controversy, plus, society tends to ignore these illnesses to pretend they do not exist, these are compulsive sexual behavior disorder and pedophile disorder.

Compulsive sexual behavior disorder refers to a persistent pattern of error in the control of sexual impulses, which are repetitive and intense, resulting in sexual behaviors with negative consequences. This implies that it affects many areas of life.

There is evidence that compulsive sexual behavior disorder (CSBD, from now on) and impulsivity are closely related, and that CSBD exhibits patterns of reward processing and impulse management similar to addictive disorders.

However, it is not known whether impulsivity can be considered an intrinsic part of CSBD or if it is indirectly related, because CSBD is common in patients with other disorders characterized by impulsivity, such as attention deficit hyperactivity disorder (ADHD).

Symptoms of compulsive sexual behavior are common in men seeking primarily treatment for paraphilic disorders and vice versa. This is where the relationship with pedophile disorder would come in, about which there are also no consistent findings to confirm that it is directly related to impulsivity.

Since deviant sexual preferences, sexual preoccupation and impulsivity are risk factors for recidivism when it comes about sexual crimes, authors decided to investigate, with this study, the behavioral and neurocognitive dimensions of impulsivity, in addition to the appearance of neurodevelopmental disorders that tend to be associated with impulsivity in men seeking treatment for CSBD or pedophile disorder.

Authors assume that compulsive sexual behavior disorder is associated with impulsivity, and thus they hypothesize that it is positively related to ADHD and alcohol consumption, which is a typical impulsivity and lack of f self-control behavior.

For this purpose, 32 men with compulsive sexual behavior disorder were evaluated in person and individually, 65 men with pedophile disorder were evaluated by telephone and 57 healthy individuals as a control group, also by telephone.

Their psychiatric comorbidity, compulsive sexual behavior, and impulsivity were assessed using scientifically valid tests approved by psychology.

The results give us interesting ideas, which we will comment on now.

Despite having obtained similar levels of education in the three groups, the pedophile disorder group had lower psychosocial functioning, as well as higher rates of autism spectrum disorders and affective and anxiety disorders currently, compared to the compulsive sexual behavior disorder group and control group.

Furthermore, attention deficit hyperactivity disorder was more common in both clinical groups (pedophile disorder and CSBD) than in the control group (representative sample of the bulk of society).

Attentional impulsivity was higher in both clinical groups, but there were no significant differences between men with pedophile disorder and men with CSBD.

Impulsivity was positively associated with the level of compulsive sexual behavior also after adjustment for ADHD, although a large part of the variation in compulsive sexuality is explained by factors other than the measures used in this study. For example, it has been suggested in previous literature that affective disorders predict compulsive sexuality.

That is, in a nutshell: individuals with CSBD and individuals with pedophile disorder reported greater impulsivity, in addition to having comorbid ADHD more frequently than healthy individuals in the control group.

ADHD did not predict the level of compulsive sexuality, but impulsivity did. However, authors suggest that the detection of neurodevelopmental disorder should be part of the routine evaluation in deviant sexuality disorders, since the treatment of ADHD can improve impulsivity, and therefore help in these related disorders.

If you want to know more about the criminal mind, criminal profiling, and forensic science, don’t miss our Certificate in Criminal Profiling, a 100% online program certified by Heritage University (USA), with special grants for the Forensic Science Club readers.

 

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