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The relationship between psychopathy and sexual offending has been empirically established, but it is little understood. The author proposes nine explanations to provide a conceptual basis for this empirical relationship: (1) search polygyny, (2) callousness and a lack of empathy, (3) a lack of attachment or bonding, (4) sensation seeking as a product of chronic cortical underarousal, (5) grandiosity, (6) entitlement, (7) a predominance of part-object relations, (8) a high frequency of predatory violence, and (9) the leaving by consensual sex partners when the psychopathy is identified. These explanations, constructed from anthropological, psychobiological, attachment, psychoanalytic, and aggression research, find some direct and indirect empirical support in the extant literature. They contribute to understanding the "polymorphously perverse" sexuality of the psychopath.

Comparisons are made between a nonrandom sample of 18 glossolalists and 130 non-glossolalists admitted to a maximum-security forensic hospital. The glossolalic mentally disordered offender exhibited a predominance of diagnoses in the manic spectrum, and was typically psychotic. The delusions, hallucinations, and crimes were predominately of a religious and sexual nature. Glossolalist perpetrators tended to be female. We review the extant research on glossolalia in both normal and clinical samples. and integrate our findings, the first study of glossolalia in a forensic setting.

The case of a 63-year-old man who killed his 52-year-old wife and then staged a sexual homicide at a distant location is reported. A review of all evidence, a forensic psychological interview, and psychological testing indicated that the murder was the result of a narcissistic rage reaction during which the subject beat his wife to death with a paint can, a clothing iron, and a rock. He then drove her body to a field 87.3 miles away, and positioned it in a manner that exposed her breasts and her underwear. He turned himself into the police two days later. There is no controlled empirical research on staging, although this single case supports the criminal investigative theory that staging exists, and is done to deliberately mislead homicide investigations (Douglas et al., 1992).

Despite a substantial body of research indicating a significant and causal empirical relationship between viewing what the authors label "screen violence" and behaving violently, little attention has been paid to the forensic psychological and psychiatric investigation of these phenomena in specific homicide cases. Through the analysis of seven cases of homicide, mostly committed by adolescents, the authors introduce five concepts--aggression immersion, theme consistency, scene specificity, repetitive viewing, and self-editing--for advancing such investigations.

A computation of false positive and false negative rates concerning the probability that directly communicated written or oral threats predict subsequent violent behavior yields a striking difference between "public" and "private" targets. Among private targets, communicated threats appear to increase risk, but are so common that they have little predictive value. On the other hand, public targets are unlikely to receive a direct threat from those who approach to attack. The author suggests that the most parsimonious explanation for this difference is the type, or mode of violence, that is apparent. Private targets appear to be most likely victimized by affective violence, wherein the emotionally reactive subject will immediately shove, push, punch, slap, choke, fondle, or hair pull the victim without the use of a weapon, usually in response to a perceived rejection or humiliation. Public targets are most likely to be victimized by predatory violence, which is planned, purposeful, cognitively motivated, opportunistic rather than impulsive, and often involves a firearm. Implications for risk assessment are discussed.

Objective: The authors conducted a descriptive, archival study of adolescent (< or =19 years of age) mass murderers-subjects who intentionally killed three or more victims in one event-to identify demographic, clinical, and forensic characteristics., Method: A nonrandom sample of convenience of adolescent mass murderers was utilized., Results: Thirty-four subjects, acting alone or in pairs, committed 27 mass murders between 1958 and 1999. The sample consisted of males with a median age of 17. A majority were described as "loners" and abused alcohol or drugs; almost half were bullied by others, preoccupied with violent fantasy, and violent by history. Although 23% had a documented psychiatric history, only 6% were judged to have been psychotic at the time of the mass murder. Depressive symptoms and historical antisocial behaviors were predominant. There was a precipitating event in most cases--usually a perceived failure in love or school--and most subjects made threatening statements regarding the mass murder to third parties. The majority of the sample clustered into three types: the family annihilator, the classroom avenger, and the criminal opportunist., Conclusions: The adolescent mass murderer is often predatorily rather than affectively violent and typically does not show any sudden or highly emotional warning signs. Although the act of mass murder is virtually impossible to predict because of its extremely low frequency, certain clinical and forensic findings can alert the clinician to the need for further, intensified primary care, including family, school, community, law enforcement, and mental health intervention.

Nonsexually offending psychopaths (N = 32) were compared to sexual homicide perpetrators (N = 38) and nonviolent pedophiles (N = 39) on select Comprehensive System Rorschach variables (Exner et al., 1993). Results indicate similarities among the groups in pathological narcissism, formal thought disorder, and borderline level reality testing. Nonsexually offending psychopaths are distinguished by their lack of interest in and attachment to others and their seemingly conflict-free internal world. While both sexually deviant groups evidenced interest in others and appear to experience a very dysphoric internal world, the sexual homicide perpetrators are distinguished by high levels of obsessional thought and an inability to disengage from environmental stimuli. Pedophiles show significantly more characterological anger, which may stem from their general inadequacy, cognitive rigidness, less alloplastic (acting out) style, and their introversive inability to gratify their needs. Rorschach differences add to our understanding of sexual deviation and violence among these three groups.

A nonrandom sample of North American cases of sudden mass assault by a single individual (SMASI, n = 30) is compared with a nonrandom sample of Laotian amok cases (n = 18) and other amok studies. Perpetrators in both studies show evidence of social isolation, loss, depression, anger, pathological narcissism, and paranoia, often to a psychotic degree. The term "innovative perpetrator" is reintroduced and expanded upon. Similarities among samples far outweigh differences, leading the authors to conclude that SMASI and its appearance in different cultures is not a culture-bound syndrome.

A case of homicide by a 29-year-old male with erotomanic delusional disorder and various personality disorders is reported. Following a month of pursuit of a female stranger with whom he had briefly conversed in a local bar, he assaulted an automotive plant where she worked, delusionally believing that she was at imminent risk and needed to be rescued. One plant manager was killed and two police officers were wounded. The case illustrates the phenomenon of triangulation, where rage toward the rejecting object is displaced onto a third party, which is then perceived as impeding access to the victim and may be at risk for violent assault.

Stalking is an old behavior, but a new crime. The author has reviewed what is currently known about the epidemiology, demography, psychiatry, psychology, pursuits and outcomes, threatening communications, violence, and clinical risk management of stalking cases. But this "dark heart of romantic pursuit" (p 7) extends beyond the paradigm of science and is often an aggressive and aberrant expression of unrequited love. In 1579, John Lyly wrote "As the best wine doth make the sharpest vinegar, so the deepest love turneth to the deadliest hate" (Euphues: The Anatomy of Wit).

An especially dangerous behavior observed in some forensic and security hospital populations is assaultive eye gouging. Although a number of case reports in the literature concern auto-enucleation, gouging out the eyes of another is virtually unmentioned. We present a case series of eye gougers (n = 10) gathered through clinical contributions from several forensic populations in the United States and Russia. Four subjects were psychotic during the eye-gouging episode, one was only mentally retarded, and five, who were neither psychotic nor retarded, deliberately injured victims' eyes during acts of extreme sexual violence.

A nonrandom sample (N = 30) of mass murderers in the United States and Canada during the past 50 years was studied. Data suggest that such individuals are single or divorced males in their fourth decade of life with various Axis I paranoid and/or depressive conditions and Axis II personality traits and disorders, usually Clusters A and B. The mass murder is precipitated by a major loss related to employment or relationship. A warrior mentality suffuses the planning and attack behavior of the subject, and greater deaths and higher casualty rates are significantly more likely if the perpetrator is psychotic at the time of the offense. Alcohol plays a very minor role. A large proportion of subjects will convey their central motivation in a psychological abstract, a phrase or sentence yelled with great emotion at the beginning of the mass murder; but in our study sample, only 20 percent directly threatened their victims before the offense. Death by suicide or at the hands of others is the usual outcome for the mass murderer.

A nonrandom sample (N = 41) of inmates from a maximum security prison were classified as either psychopathic or nonpsychopathic (using the Psychopathy Checklist-Revised (PCL-R)) and violent or sexually violent. Sadism was measured using the Millon Clinical Multiaxial Inventory-II (MCMI-II) Scale 6B, the Personality Disorder Examination (PDE) items for sadistic personality disorder, and the sexual sadism criteria of DSM-IV. Psychopaths were found to be significantly more sadistic than nonpsychopaths (MCMI-II and PDE). Overall power was relatively high. Sadism did not differentiate the violent and sexually violent groups. A diagnosis of sexual sadism was too infrequent (n = 3) for meaningful statistical analysis. The trait measures of sadism and psychopathy measures (PCL-R, Factor 1 and Factor 2) significantly and positively correlated. Results provide further empirical validity for the theoretically proposed and clinically observed relationship between sadistic traits and psychopathic personality.

There appear to be no brain imaging studies investigating which brain mechanisms subserve affective, impulsive violence versus planned, predatory violence. It was hypothesized that affectively violent offenders would have lower prefrontal activity, higher subcortical activity, and reduced prefrontal/subcortical ratios relative to controls, while predatory violent offenders would show relatively normal brain functioning. Glucose metabolism was assessed using positron emission tomography in 41 comparisons, 15 predatory murderers, and nine affective murderers in left and right hemisphere prefrontal (medial and lateral) and subcortical (amygdala, midbrain, hippocampus, and thalamus) regions. Affective murderers relative to comparisons had lower left and right prefrontal functioning, higher right hemisphere subcortical functioning, and lower right hemisphere prefrontal/subcortical ratios. In contrast, predatory murderers had prefrontal functioning that was more equivalent to comparisons, while also having excessively high right subcortical activity. Results support the hypothesis that emotional, unplanned impulsive murderers are less able to regulate and control aggressive impulses generated from subcortical structures due to deficient prefrontal regulation. It is hypothesized that excessive subcortical activity predisposes to aggressive behaviour, but that while predatory murderers have sufficiently good prefrontal functioning to regulate these aggressive impulses, the affective murderers lack such prefrontal control over emotion regulation.

A review of the research on the motivations and behaviors of bombers is presented. The methodology consisted of a computer search of eight databases, book reviews, and telephonic interviews with local and federal law enforcement. The data were then compared to the substantial research on psychopathy. The authors conclude that a federally funded research effort is necessary, and should incorporate various structured interviews, history gathering, and psychological and physiological tests of incarcerated bombers, theoretically guided by the concordance between the known motivations and behavior of bombers and the concurrent and predictive validity of the construct, psychopathy.

A case of mass murder by a 35-year old male is reported. Following a week of separation from his spouse and temporary loss of custody of his son, the subject went to his wife's worksite and murdered her and the store manager, wounded a passerby in a car, and murdered a police officer arriving on the scene. Weapons used were a .32 caliber revolver, a 9-mm pistol, a 7.62-mm assault rifle, and a .50-caliber rifle. The fact pattern of the case is shown to be quite consistent with a predatory mode of aggression-violence that is planned, purposeful, emotionless, and not preceded by autonomic arousal. The forensic importance of considering mode of violence, whether predatory or affective, independently of psychiatric diagnosis, is emphasized.

I have offered ten guidelines for the clinical risk management of stalking: a team approach, personal responsibility for safety, documentation and recording, no initiated contact, protection orders, law enforcement and prosecution, treatment if indicated, segregation and incarceration, periodic violence risk assessment, and the importance of dramatic moments. Although criminal stalking is not expected in mental health practice, the interpersonal anguish that often erupts in psychotherapy, and the reporting of relational intrusions that disrupt the safety of treatment, may foreshadow such distressing and potentially dangerous behavior. It is my hope that the clinician will be prepared for such untoward events, and these guidelines will shape an appropriate professional response. For as Racine wrote in 1667, "The heart that can no longer love passionately, must with fury hate." (Andromache, 1, trans. Robert Henderson).

A comparative analysis of psychotic versus nonpsychotic stalking is presented. Archival files of 25 forensic subjects whose alleged criminal offenses met a legal definition of stalking behavior were studied for demographic characteristics, stalking dynamics, psychosocial history, and current psychological variables. Although nearly one-third of all subjects had an Axis I psychotic disorder and were delusional, only one of these subjects had erotomanic delusions. The psychotic subjects' pursuit of victims was associated with other delusions and symptoms of psychosis. Nonpsychotic subjects tended to exhibit an Axis I disorder (usually major depression, adjustment disorder, or substance dependence) as well as a variety of Axis II personality disorders. The nonpsychotic subjects' pursuit of victims was influenced by various psychological factors, including anger and hostility, projection of blame, obsession, dependency, minimization and denial, and jealousy. Psychotic subjects visited the victims' homes significantly more often than nonpsychotic subjects. Nonpsychotic subjects made more verbal threats and "acted out" violently more often than psychotic subjects. While all subjects exhibited some similarities in stalking behaviors and demographic variables, including childhood attachment disruptions, no single profile of a "stalker" emerged. These findings provide information about factors contributing to stalking violence, as well as diagnostic issues that should be considered in the assessment and treatment of this criminal population.

A case of pseudonecrophilia by a 26-year-old male following the multiple stabbing death of his wife is reported. Intoxicated with alcohol at the time, the man positioned the corpse of his spouse to facilitate vaginal intercourse with her in the lithotomy position while he viewed soft core pornography on television. Clinical interview, a review of history, and psychological testing revealed diagnoses of antisocial personality disorder and major depression (DSM-IV, American Psychiatric Association 1994). There was no evidence of psychosis, but some indices of mild neuropsychological impairment. The motivations for this rare case of pseudonecrophilia are discussed in relation to extant research, and a cautionary note is offered in assuming sexual causality in the investigation of homicides when there is evidence of sexual arousal or activity by the perpetrator.

Objective: The purpose of this study was to compare certain demographic and clinical variables in a group of obsessional followers and in a group of offenders with mental disorders., Method: A static group design comprised of a nonrandom group of convenience and a randomly selected comparison group was used. Twenty obsessional followers in custody and 30 offenders with mental disorders in custody were evaluated by psychiatrists and psychologists for court-ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and for the same psycholegal reasons. The group of obsessional followers was measured on demographic, clinical, and victim variables. Inferential comparisons that used nonparametric statistics were done between groups on selected demographic and clinical variables., Results: The obsessional followers were significantly older, more intelligent, and better educated than the offenders. There were no significant differences in DSM-III-R axis I diagnoses. Axis II diagnoses showed significant differences, with the obsessional followers more likely to have a personality disorder other than antisocial personality disorder and less likely to have antisocial personality disorder., Conclusions: The likelihood of obsessional followers having a nonantisocial axis II personality disorder (related to attachment pathology) distinguishes them from offenders with mental disorders in general. They are also likely to be older, smarter, and better educated, consistent with their resourcefulness and manipulativeness. Idiographic aspects of the obsessional followers further illuminate their psychological defenses and object relations.

This study compares Psychopathy Checklist-Revised (PCL-R) scores, DSM-III-R diagnoses, and select behavioral indices between hospitalized insanity acquittees (N = 18) and hospitalized insanity acquittees who successfully malingered (N = 18). The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger. The malingerers were also significantly more likely to be verbally or physically assaultive, require specialized treatment plans to control their aggression, have sexual relations with female staff, deal drugs, and be considered an escape risk within the forensic hospital. These findings are discussed within the context of insanity statutes and the relevance of malingering, psychopathy, and treatability to future policy concerning the disposition of insanity acquittees.

A sample of incarcerated sexual homicide perpetrators (n = 18) were compared to a sample of non-sexually offending but violent male psychopaths (n = 23) on select Rorschach variables using the Comprehensive System (Exner, 1991). Results suggest that sexual homicide perpetrators are similar to psychopaths in their attachment abnormality, characterological anger, pathological narcissism, moderate and pervasive formal thought disorder, and borderline reality testing. They are distinguished, however, by a more frequent affectional hunger, a tendency to engage in more dysphoric rumination, and abnormal elevations of nonvolitional ideation (obsessional thoughts) due to unmet instinctual need states. They also show a greater interest in others as whole, real, and meaningful objects. Five psychodynamic factors, supported by the empirical findings, are proposed to partially explain the intrapsychic mechanisms involved in an act of sexual homicide.

The case of a 21-year-old White man who committed a robbery and homicide is presented. His Rorschach is analyzed and interpreted using both psychostructural (Exner, 1986a) and psychodynamic (Cooper, Perry, & Arnow, 1988; Gacono & Meloy, 1992; Kwawer, 1980) methodologies. Findings are used to understand the presence and interaction of both psychopathic character and borderline personality organization in this explosive and sadistic young man.

Rorschach data were used to psychometrically "map" the internal psychological operations of three Cluster B personality disorders, listed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987), all of which may be organized at a borderline level. Psychopathic antisocial subjects (P-APDs) and narcissistic subjects (NPDs) were highly narcissistic. NPD subjects, however, produced more indices of anxiety and attachment capacity and fewer scores related to borderline object relations and damaged identity. P-APDs and borderline subjects (BPDs) produced similar mean numbers of borderline object relations; however, the BPDs were more anxious, produced more unsublimated aggressive and libidinal drive material, and evidenced greater potential for attachment. BPDs were also less narcissistic than both P-APDs and NPDs. Nonpsychopathic antisocial subjects (NP-APDs) were less borderline than P-APDs and BPDs, less narcissistic in terms of a stable grandiose self-structure than NPD and P-APDs, produced less evidence of attachment capacity than NPDs and BPDs but more than P-APDs, and were similar to BPDs in their proneness to anxiety. The outpatient NPDs and BPDs produced more idealization responses than the incarcerated antisocial personality disorder (APD) groups. We conclude that the behavioral descriptions offered for these three Cluster B personality disorders, when used in conjunction with information such as level of personality organization (Kernberg, 1984), level of psychopathy (Hare, 1980, 1985), and outpatient versus inpatient research settings, may have greater intrapsychic specificity than previously thought.

The case of a 33-year-old White male with a history of sexual assault is presented. His Rorschach is analyzed and interpreted using both psychostructural (Exner, 1986) and psychodynamic (Cooper & Arnow, 1986; Kwawer, 1980; Meloy & Gacono, in press-b) methodologies. Findings are used to understand the presence and interaction of both psychopathic character and psychotic personality organization in this mentally ill, sadistic, and sexually predatory young man.

The published Rorschach (Kaiser, 1970) of Sirhan Sirhan, the man who assassinated presidential aspirant Robert F. Kennedy in 1968, was studied. Psychostructural and psychodynamic analyses were conducted using reliable and valid methodology that was unavailable at the time of examination. In contrast to the defense experts at trial who diagnosed paranoid schizophrenia, the data suggest a depressed and suicidal individual organized at a borderline level of personality. Character pathology is hysterical, paranoid, and dependent. When the Rorschach findings are compared to the development history of Sirhan and the behavior around the time of the assassination, the data are somewhat consistent with the theme of psychic trauma, are very consistent with the theme of recurrent loss and pathological mourning, and validate a characterological distrust and hatred of, yet hysterical dependence on, the object world. Rorschach indices of predatory violence (Meloy, 1988a) in relation to the planned and purposeful assassination are also discussed.

This study utilized the Rorschach as a psychometric measure for understanding Antisocial Personality Disorder (American Psychiatric Association, 1987). Comprehensive System (Exner, 1986) Rorschach data for a sample of 60 ADP subjects and Rorschach object relations and defensive operations for 22 psychopathic APD (P-APD) and 21 nonpsychopathic APD (NP-APD) subjects are presented and discussed. The data support the absence of anxiety and attachment and the presence of pathological narcissism and borderline personality organization in P-APDs. The Rorschach's ability to differentiate antisocial groups based on level of psychopathy (Hare, 1980, 1985) strongly supports the need to use psychopathy as an independent measure when one is studying APD.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.

We propose the addition of four aggressive indices for Rorschach scoring: aggressive content, aggressive potential, aggressive past, and sado-masochism scores. Interrater agreement is presented and ranges from 92-100%. Nomothetic comparisons are made between groups with higher base rates for violence with mixed results, although the sado-masochism frequency was significantly higher in severe psychopaths than in moderate psychopaths. Idiographic use of the aggression indices is emphasized, with a particular focus upon inferring the quality, intensity, and directionality of intrapsychic aggression in relation to self and object representations.

We investigated the constructs of anxiety and attachment in a group of 42 offenders who met the DSM-III-R criteria for antisocial personality disorder. Each antisocial subject's level of psychopathy was assessed with the Hare Psychopathy Checklist (PCL). Three Rorschach variables related to attachment, anxiety, and coping were compared between subjects scoring greater than or equal to 30 (N = 21) on the PCL and subjects scoring less than 30 (N = 21). Comparison Rorschach variables are also presented from a sample of 60 antisocial personality-disordered offenders. Moderate psychopaths (PCL score, less than 30) produced texture and diffuse shading responses at a significantly greater frequency than severe, or primary, psychopaths (PCL score, greater than or equal to 30). There was no significant difference in the two groups' propensity for producing vista responses. Although there were no significant differences between the coping index scores, the trend suggests less conflictual functioning in the severe psychopaths. A virtual absence of texture responses in the severe psychopaths, and a significantly greater frequency of diffuse shading responses in the moderate psychopaths, add construct validity to the lack of attachment in psychopaths and the role of anxiety in differentiating secondary from primary psychopathy. We view the presence of vista responses in this population as a measure of a failed grandiose self-structure, and note that it often occurs in the records of moderate psychopaths who also present achromatic color responses.

We analyzed the contemporary empirical and theoretical literature concerning the two predominant approaches for scoring formal thought disorder on the Rorschach, the Comprehensive System special scores, and the methodology of Rapaport, Gill, and Schafer (1946/1968). The psychoanalytic research related to selected special scores is reviewed, and some linkages to psychoanalytic developmental theory and psychopathology are made. Recommendations are presented to bridge the gap between these two important avenues of Rorschach research, with an emphasis on empirical rigor and intrapsychic contextual meaning.

We investigated Rorschach responses associated with narcissism and hysteria in a group of antisocial personality disordered offenders. The Rorschach protocols of 42 subjects who met the criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) for antisocial personality disorder were analyzed using Exner's (1986) criteria for pairs, reflections, and personal responses, and Gacono's (1988) criteria for the impressionistic response. Severe, or primary psychopaths (n = 21), scoring greater than or equal to 30 on the Hare (1980) Psychopathy Checklist (PCL), were compared to moderate, or secondary pscyhopaths (n = 21), scoring less than 30 on the PCL. The mean number of pair and impressionistic responses did not significantly differ for the two antisocial groups. The highly psychopathic group, however, did exhibit a significantly greater mean number of reflection and personal responses. We discuss pair and reflection responses and their relationship to narcissism in psychopathic disturbance. We recommend interpreting the personal response within the context of the psychopathic character and view personal responses as expressions of narcissism and omnipotence in highly psychopathic subjects. We also hypothesize that the impressionistic responses are indicative of primitive dissociative processes and hysteria in psychopathic subjects, and that their presence provides construct validity for the work of Guze (1976) and others who suggested an underlying histrionic dimension to psychopathy.

The authors studied 37 male schizophrenics in a county jail psychiatric unit. Subjects were classified as impaired or not according to Luria-Nebraska Neuropsychological Battery criteria. Twelve of the 37 patients were impaired. Violence ratings were made on inpatient behavior and adult criminal records. Impairment status was related to adult history of violence but not inpatient violence. The most violent patients (by criminal record) were from the impaired category.

We studied the thought and affective disturbance of Megargee and Bohn's (1979) most psychopathological Minnesota Multiphasic Personality Inventory (MMPI) subtypes, the "How" and "Charlie" profiles. 75 subjects, consisting of three groups of How and Charlie subtypes in inpatient and outpatient forensic settings and two control groups, are tested using the Whitaker Index of Schizophrenic Thinking (WIST) and Profile of Mood States (POMS). Results indicate both How and Charlie subtypes have mild formal thought disorder, with the former showing greater variance of thought disorder. Charlie subtypes, however, are more angry, less depressed, more vigorous, and more constricted and defensive than the How subtypes. We conclude that the How subtype needs further actuarial refinement to be diagnostically useful.

The nature of the relationship between thought organization and primary process was explored by correlating clinical indicators of thought disorder on the Rorschach and formal primary process mechanisms in the dreams of 14 parents of schizophrenics recorded during a two-week period. The relationship between variability of primary process intensity and the Thought Disorder Index produced a negative correlation at the 0.05 level of significance. Variability of primary process intensity was not found to be significantly related to the length or frequency of the dreams. This inverse relationship between formal thought disorder and variability over time of primary process in the dreams of biological relatives of schizophrenics suggested that dream constriction could be a regressive marker in the heritability of schizophrenia.

This article presents a standard of care for the prediction of violence in outpatient psychotherapy. Major individual and situational correlates of violence are reviewed to provide an actuarial matrix for the further assessment of the patient's intrapsychic experience and interpersonal behavior during the psychotherapy hour.

The author hypothesizes that erotomania, or de Clérambault's syndrome, occurs in two forms: the clinically accepted delusional erotomania, in which patients believe that another person is in love with them; and borderline erotomania, in which no delusion is present, yet an extreme disorder of attachment is apparent in the pursuit of, and in the potential for violence toward, the unrequited love object. The author reviews the empirical literature concerning erotomania and then develops an object relations understanding of the disorder, focusing on the presence of narcissistic, hysterical, paranoid, and psychopathic traits in the erotomanic individual.

I have presented a psychodynamic construct that is useful in the assessment of violent and homicidal behavior. It further refines diagnostic and treatment endeavors when combined with other individual and situational correlates of homicide and violence. Object relations, reality testing, and mode of aggression are the three variables within the construct that can be empirically measured through the use of the clinical interview, psychodiagnostic testing, and corroborative history. They should contribute to our further psychoanalytic understanding of violent and homicidal behavior in primitive mental states.