Search

The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder.This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively.Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases.This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

The purpose of this paper is threefold: (a) to report an unusually high prevalence of encopresis in a sample of boys in psychiatric residential treatment; (b) to explore the possible relationship of sexual abuse to the development of encopresis in these cases; and (c) to discuss the diagnostic and treatment implications of our findings.

In a follow-up study of incarcerated Connecticut youth, 66 subjects participated in extensive personal interviews. This paper documents discrepancies between early data regarding abuse and retrospective self-reports of abuse given at the time of follow-up. It describes the development of an interview protocol in which inquiries regarding medical history, the general temperament of caretakers and their behaviors when intoxicated, and instruments and methods of punishment used in the home enabled subjects to describe abusive experiences not disclosed in response to direct questions about maltreatment. The paper also discusses the use of explicitly worded probes to flesh out a clear picture of subjects' experiences. The conflicts that underlie denial or minimization of abuse are discussed, along with interviewing strategies for overcoming them.

This paper reviews the psychophysiological literature related to violent behaviors. It explores the interactions of environmental influences, pain, stressors, hormones, and neurotransmitters. It presents ways in which maltreatment in the form of abuse or neglect exacerbates preexisting psychobiological vulnerabilities. It proposes that whatever forces increase impulsivity and irritability, engender hypervigilence and paranoia, diminish judgment and verbal competence, and curtail the recognition of pain in the self and others, will enhance violence, and presents evidence that maltreatment has all of these effects.

Eighteen males condemned to death in Texas for homicides committed prior to the defendants' 18th birthdays received systematic psychiatric, neurologic, neuropsychological, and educational assessments, and all available medical, psychological, educational, social, and family data were reviewed. Six subjects began life with potentially compromised central nervous system (CNS) function (e.g., prematurity, respiratory distress syndrome). All but one experienced serious head traumas in childhood and adolescence. All subjects evaluated neurologically and neuropsychologically had signs of prefrontal cortical dysfunction. Neuropsychological testing was more sensitive to executive dysfunction than neurologic examination. Fifteen (83%) had signs, symptoms, and histories consistent with bipolar spectrum, schizoaffective spectrum, or hypomanic disorders. Two subjects were intellectually limited, and one suffered from parasomnias and dissociation. All but one came from extremely violent and/or abusive families in which mental illness was prevalent in multiple generations. Implications regarding the ethics involved in matters of culpability and mitigation are considered.

Objective This paper describes the adult adaptation of a group of 97 formerly incarcerated male delinquents. Method Follow-up clinical interviews were administered to subjects, approximately 9 years after discharge from uvenile corrections. The records of the correctional school, state police, FBI, state psychiatric hospitals, and state health department also were reviewed. Results All but six had adult criminal records, most for violent crimes. Only 10% were graduated from high school; 30% received minimal job training; most worked sporadically at unskilled jobs. Few married. Although 35 had fathered children, only 5 were living with them. Psychiatric treatment for identified vulnerabilities was negligible. Upon discharge, the most neuropsychiatrically impaired and violent subjects tended to be placed in adult corrections; the most intact were placed in special schools and psychiatric hospitals. Numbers of vulnerabilities continued to contribute most significantly to violent outcome regardless of placement. Placement in families was associated with fewer adult aggressive offenses than was institutional placement, even while controlling for vulnerabilities and early juvenile violence. Conclusions Based on their well-documented early vulnerabilities and needs, this sample of delinquents did not obtain the kinds of supports subsequent to juvenile incarceration that might have enabled them to function independently in society.

Twenty-one female delinquents, neuropsychiatrically evaluated while in a juvenile correctional facility, were followed up to 7 to 12 years later. Compared with a matched sample of male delinquents, they committed fewer and less violent offenses. Unlike the males, early biopsychosocial variables were not predictive of adult criminality; however, most females were seriously impaired neuropsychiatrically. Mortality rates were high. Having come from abusive households, the female delinquents became suicidal, alcoholic, drug addicted, enmeshed in violent relationships, and unable to care for their children.

This article reviews evidence regarding contributions of neuropsychiatric and psychological vulnerabilities to violent delinquency, and the interaction between intrinsic vulnerabilities and experiential factors in the genesis of antisocial juvenile behavior. Consideration is given to biochemical and physiological factors, genetics, medical status, and neurological, psychiatric, and neuropsychological factors. Implications for treatment are discussed.

This study reports the high prevalence (42%) of physical abuse in the histories of 166 psychiatrically hospitalized children and adolescents and identifies those characteristics of abused patients that distinguish them from their nonabused counterparts. Although psychiatric symptoms were similar in abused and nonabused patients, injury to the central nervous system was more prevalent in the abused patients. The abused were significantly more violent and their parents were more psychiatrically impaired. Implications of these findings for identification and treatment are discussed.

This paper reports results of a study of medical histories of black and white delinquents and a matched sample of nondelinquents. Medical records were analyzed in terms of numbers and timing of hospital contacts, nature of services used, and reasons for contacts. Black delinquents made somewhat more hospital visits than white delinquents. White delinquents had significantly more hospital contacts and accidents, injuries, illnesses, and psychiatric problems than white nondelinquents. Findings are discussed in terms of the relevance of particular medical events to the development of maladaptive behaviors, the tendency of clinicians to dismiss as culturally expectable certain medical and psychological factors in black children and their families, and the failure of physicians to recognize the existence of severe family disorganization in black children with multiple hospital contacts.

On the basis of previously reported findings that a high percentage of court-referred children suffered from serious psychopathology other than sociopathy, attention is called to some essential, though often overlooked, elements of the diagnostic evaluation of delinquents. Emphasis is on a meticulous history, including careful attention to the significances of family histories of serious psychiatric and/or neurological disorders. The importance of a detailed perinatal and medical history, with emphasis on determining a possible history of significant insult to the central nervous system, is stressed. A systematic mental status evaluation is strongly recommended. Techniques for assessing the existence of significant hallucinatory and delusional experiences in children are suggested. The uses of psychological and neurological evaluations to augment the psychiatric are discussed. The poor social situation from which many delinquents come as well as the obvious intrafamilial psychodynamic factors influencing delinquent behavior are recognized as frequent impediments to the search for less obvious psychotic and/or organic vulnerabilities in the juvenile offender. Case histories of several children who had previously been dismissed as merely sociopathic, illustrate the thesis of the paper.

Matched samples of 31 incarcerated delinquents and 31 nondelinquents were compared neuropsychiatrically. The constellation of abuse/family violence, severe psychiatric symptomatology, cognitive impairment, minor neurological signs, and psychomotor symptoms correctly predicted group membership nearly 84% of the time. The most significant variable was abuse/family violence. This constellation also distinguished the more aggressive from the less aggressive subjects in each group. The existence of a syndrome characteristic of recurrently violent individuals composed of the above variables is suggested.

The authors present the results of clinical evaluations of 15 death row inmates, chosen for examination because of the imminence of their executions and not for evidence of neuropsychopathology. All had histories of severe head injury, five had major neurological impairment, and seven others had other, less serious neurological problems (e.g., blackouts, soft signs). Psychoeducational testing provided further evidence of CNS dysfunction. Six subjects had schizophreniform psychoses antedating incarceration and two others were manic-depressive. The authors conclude that many condemned individuals probably suffer unrecognized severe psychiatric, neurological, and cognitive disorders relevant to considerations of mitigation.

This report explores some associations among juvenile-delinquency, subsequent criminality, and subsequent psychiatric treatment. A sample of 255 males known to the juvenile court 25 years prior to the study is examined in terms of subsequent documented psychiatric treatment and/or criminal activity. Of the 255 former delinquents, 6% were known later to both criminal justice and psychiatric systems, 6% to psychiatric systems only, 28% to the criminal justice system only, and 60% to neither. Delinquents with later psychiatric histories were twice as likely to be known to the criminal justice system than were those without psychiatric histories. Those with adult psychiatric histories were also significantly younger at the time of their first delinquent offense and committed more juvenile offenses than the nonpsychiatric group. Only 2 of the 16 individuals later known to both systems were diagnosed sociopathic. The findings are discussed.

The biopsychosocial characteristics of a sample of 13 juvenile murderers, evaluated after committing homicide, were compared with those of 14 violent, incarcerated delinquents and those of 18 nonviolent incarcerated delinquents. The juvenile murderers did not differ significantly from other very violent but nonhomicidal delinquents. A constellation of neuropsychiatric and family characteristics, however, distinguished the murderers from the nonviolent delinquents. The 13 juvenile murderers evaluated after their homicidal acts were also compared with nine juvenile murderers evaluated before committing homicide. Differences between these groups are described in relation to the timing of their evaluations.

This paper reports the results of a comparison of degrees of violence in adolescents psychiatrically hospitalized in the late 1960s and adolescents hospitalized 10 years later. The authors studied a random sample of 51 adolescents, including 26 boys and 25 girls in the late 1960s, and a random sample of 51 adolescents matched for sex and race 10 years later. Psychiatrically hospitalized girls in the 1970s were significantly more violent than psychiatrically hospitalized girls in the 1960s. The implications of these findings are discussed.

This study compares the neuropsychiatric, intellectual, and educational status of extremely violent and less violent incarcerated boys. The more violent children were more likely to demonstrate psychotic symptomatology (paranoid ideation and rambling, illogical associations) and to have major and minor neurological abnormalities. They were also more likely to have experienced and witnessed extreme physical abuse. The contribution of these factors to violent delinquency is discussed and implications for therapeutic intervention are suggested.

The psychopathology of 29 delinquent and 25 nondelinquent psychiatrically hospitalized adolescent boys was similarly severe. Similar proportions had hallucinations, delusions, learning disabilities, and evidence of neurological impairment, and over half in each group had been diagnosed as being psychotic. Fire-setting, enuresis, and cruelty to animals did not distinguish the two groups. Significantly more of the delinquents had been psychiatrically hospitalized previously, and significantly more of the delinquents had engaged in violently aggressive acts. The household composition of both groups was similar, but more mothers of delinquents than of nondelinquents had been psychiatrically hospitalized. The authors discuss the issue of the treatment of psychiatrically ill violent adolescents. Language: en

The authors compared psychiatric symptoms, violent behaviors, and medical histories of an entire one-year sample of adolescents from the same community who were sent either to the correctional school or the only state hospital adolescent psychiatric unit serving the area. The initial hypothesis that the incarcerated group would be equally disturbed but more violent than the hospitalized group was contradicted. Violence as well as severe psychiatric symptomatology was equally prominent in the two groups. The most powerful variables distinguishing the groups were race, accidents, and injuries (especially head injury), and sex. The medical and social implications of the findings are discussed. Language: en

The authors studies the hospital records of 109 delinquent children and a matched comparison group of 109 nondelinquent children. The number, reasons for, and timing of hospital contacts significantly differentiated the delinquent from the nondelinquent children; perinatal difficulties did not. The authors hypothesize that an interaction of developmental factors and parental inadequacies accounts for the clustering of hospital contacts before age 4 and between ages 14 and 16 in the delinquent sample. They discuss the implications of their findings for prevention. Language: en

A consecutive sample of 16 women with laparoscopy-diagnosed endometriosis were evaluated for mood disorders. Twelve women met DSM-III criteria for a mood disorder: seven for bipolar disorder, mixed, three for bipolar disorder, manic, and two for major depression. Two women had equivocal diagnoses and two showed no evidence of mood disorder. Nine subjects had first-degree relatives with histories of severe mood disorders.

The results of a follow-up study of 95 formerly incarcerated delinquents are reported. Adult F.B.I. and state police records were used. All but six of the subjects had adult criminal records. The average number of adult offenses was 11.58. Juvenile violence alone did not distinguish well between those who would and would not go on to adult violent crime. Seventy-seven percent of the more violent juveniles and 61% of the less violent juveniles committed adult aggressive offenses. The interaction of intrinsic vulnerabilities (cognitive, psychiatric, and neurological) and a history of abuse and/or family violence was a better predictor of adult violent crime.

In clinical practice the authors observed that many of the delinquent children of psychiatrically impaired and/or criminal parents had remarkably adverse health histories. To test their clinical impression they systematically compared the medical histories of 20 delinquent children with criminal parents and 85 delinquent children with less obviously maladapted parents. They found a strong association between paternal criminality and serious medical problems in these delinquent children. On the basis of this finding the authors suggest that the behavioral manifestations resulting from such physical illness or neglect, although they appear genetic in nature, may reflect the physical and psychological consequences of parental neglect and/or battering.

The authors compared the psychiatric symptoms, socioeconomic status, family structure, family size, and occurrence of treated parental mental illness in 136 children referred to a juvenile court and 82 children referred to a child guidance clinic. The prevalence of psychiatric and organic symptoms and treated parental psychopathology in both groups of children did not differ significantly. Juvenile court clinic children, however, tended to come from larger families and to lack a biological mother in the home. The authors explore explanations for the routing of sick children to the juvenile court rather than to a treatment facility.

The authors studied the first 88 adolescents boys who were placed on the secure unit of a correctional school during an 18-month period and found that 52 (59.1%) of the boys had previously received psychiatric residential treatment or psychiatric hospitalization. The authors hypothesize that many of these boys may have been transferred from a psychiatric setting to a correctional facility during adolescence when long-standing aberrant behaviors became more threatening to staff. At present the number of psychiatric hospital beds is decreasing and the criteria for hospitalization of children are becoming more stringent. The data indicate that correctional facilities are now expected to function as psychiatric treatment centers for disturbed adolescents no longer welcome in therapeutic settings.

This paper hypothesizes that a linkage exists between some delinquency and the schizophrenic spectrum of disorders. Data from retrospective studies, follow-up studies, family studies, and our clinical and epidemiologic studies are presented to support this hypothesis.

The medical histories of a matched sample of 81 incarcerated delinquents and 81 nondeliquent children from the same geographic area were compared. Incarcerated children had significantly more hospital visits, emergency roon visits, and head injuries and were more likely to have been abused than non-delinquents. Perinatal difficulties were more prevalent in the histories of incarcerated delinquents, especially in the histories of violent delinquents. It is hypothesized that a particular combination of biological and psychological factors contribute strongly to the development of serious delinquency.

This paper reports the neuropsychiatric status of a sample of incarcerated white female juvenile offenders and compares their status to a sample of incarcerated white male juvenile offenders. Males and females had a similar prevalence of psychiatric and neurological impairment. More violent males were significantly more impaired than less violent males. There was a tendency for more violent females to have greater impairment than less violent females. The paper questions the prevailing literature indicating greater psychopathology in female offenders than male offenders. It explores issues of sex and race bias in the assessment of the neuropsychiatric status of offenders. Journal of the American Academy of Child Psychiatry , 21, 2:190–196, 1982.

A follow-up study of 51 children who had previously been in residential treatment for an average of 25.5 months revealed that the majority had a poor outcome in terms of subsequent psychopathology and social adaptation. Differences in age, nature of psychopathology, and parental psychiatric illness were found between good-outcome and poor-outcome children. Numbers of prior placements did not distinguish the groups. Independent rating and documentation of life events were found to be more accurate measures of outcome than clinical assessments. Implications of the findings are discussed.

Clinical and epidemiological evidence is presented indicating that many more black delinquent children and their families fail to receive needed psychiatric and medical services than do white delinquents. Explanations and implications of the reluctance or inability of white mental health professionals to diagnose serious psychopathology in the black delinquent population are explored.

The authors investigated the discrepant treatment by a juvenile court of adopted versus neglected delinquents. Adopted delinquents received harsher dispositions in spite of the fact that neglected delinquents often faced more serious charges. The two groups are compared in terms of family structure and the criminal and psychiartic histories of their parents; none of these seems to account for the adoptees' harsher treatment. The authors hypothesize that an interplay of late adoption intrinsic vulnerabilities in the children, and weakness of parental bonds accounts for the differential outcomes.

Of 56 school age children admitted over a 1 year period to an urban inpatient psychiatric ward serving primarily lower socioeconomic class children, 12 were signed out against medical advice. These children were significantly more likely to have been seriously physically abused. They were more likely to have had previous psychiatric hospitalizations or residential placement. There was also a tendency for fathers to have had psychiatric treatment, be alcoholic and be drug abusers, and for the children to have higher IQs and be more violent. In addition, four particular characteristics of parents and one of children appeared clinically to be associated with these ill-advised discharges.

Of the 37 juveniles currently condemned to death in the United States, all of the 14 incarcerated in four states received comprehensive psychiatric, neurological, neuropsychological, and educational evaluations. Nine had major neurological impairment, seven suffered psychotic disorders antedating incarceration, seven evidenced significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve had been brutally physically abused, and five had been sodomized by relatives. For a variety of reasons the subjects' vulnerabilities were not recognized at the time of trial or sentencing, when they could have been used for purposes of mitigation.

Of 55 children admitted to a children's psychiatric service, 21 were homicidally aggressive. Psychiatric symptoms and diagnoses did not distinguish these children from the nonhomicidal children, but the homicidally aggressive children were significantly more likely to 1) have a father who behaved violently, often homicidally, 2) have had a seizure, 3) have attempted suicide, and 4) have a mother who had been hospitalized for a psychiatric disorder. The authors explore explanations for the contribution of these factors to juvenile violence.

The medical histories of 12 abused and 69 nonabused incarcerated delinquent children from the same geographic area were compared. Children who were abused had significantly more hospital visits, emergency room visits, ward admissions, accidents, (especially head and face trauma), and respiratory illnesses through age 16. Perinatal difficulties and psychiatric symptoms were more prevalent in the histories of abused delinquents than in those of nonabused delinquents. The authors discuss the role of child abuse in the development of serious delinquent behaviors.

The neuropsychiatric status and reading grade level of 59 adolescent incarcerated male delinquents were studied. Contrary to expectation, there were no significant neurological differences between the severely reading-disabled subjects and the better readers, although abnormal EEGs, choreiform movements, and inability to skip were somewhat more characteristic of the poorer readers. The most striking differences were psychiatric in that paranoid ideation, illogical thought processes, and visual hallucinations were significantly more prevalent in the group of especially poor readers. They also had problems with calculation and short-term memory. Poor readers were more violent than better readers. The findings of severe behavior problems and reading disability are considered in relation to Piagetian cognitive theory.

As presently constituted, juvenile courts serve neither the interests of society nor those of children. Partly as a response to this criticism, a child psychiatric clinic composed of a part-time child psychiatrist, social worker, and psychologist was introduced into an established juvenile court. This paper focuses on the process and difficulties of such an undertaking. The significance of this work for the future of the juvenile justice system is discussed.

In an effort to explore the association of delinquent behavior and psychopathology, a roster of all male children referred to the New Haven, Conn, Juvenile Court during two years approximately 20 and 25 years ago was gathered and compared with the roster of persons known to two local state psychiatric facilities. A total of 78 of 682 referrals to the court were subsequently known to one or both of the psychiatric facilities, 60 as inpatients. Incidence of psychiatric hospitalization during 1972 was found to be significantly greater than that of the general population of Connecticut, or of Connecticut males in the 25 to 44 age range. Incidence of psychiatric hospitalization and/or treatment was similarly found to be significantly greater than the incidence in a demographically similar random sample from the New Haven area.

• The medical histories (based on hospital records) of matched samples of nonincarcerated delinquent girls, incarcerated delinquent girls, and nondelinquent girls were compared. Numbers of visits, timings of visits, services used, and reasons for hospital contacts were compared for the three groups. Delinquent girls in general had significantly more adverse medical histories than nondelinquent girls; they made significantly more hospital visits and had significantly more accidents and injuries through age 21 years. Perinatal difficulties did not distinguish these two groups. Although incarcerated and nonincarcerated delinquent girls made similar numbers of hospital visits, their histories differed qualitatively. Accidents and injuries, head and face injuries, perinatal difficulties, neurologic abnormalities, and child abuse were found more frequently in the histories of incarcerated girls. These findings have etiologic importance to the development of seriously delinquent behav ior.