mental disorder Flashcards
Mental disorder
An abnormal pattern of thoughts, emotions, or behav caused by personal dysfunction and associated w/ significant personal distress or disability
Does NOT imply ‘illness’ and a person w/ a mental disorder can be culpable for criminal behav
Classification of mental disorder
DSM-5
Diagnostic and statistical manual of mental disorders (5th edition)
ICD- 11
International classification of diseases (11th edition)
WHO
DSM and ICD closely aligned now
Psychosis (schizophrenia)
Difficulty of distinguishing reality from fantasy
Primary symptoms are delusions and hallucinations
Delusions (5)
(false beliefs about the world)
Paranoid: other ppl are plotting against the person
Grandiose: one person holds special powers or unique knowledge
Thought withdrawal: thoughts removed from head
Thought insertion: beliefs placed inside one’s head
Somatic: something abnormal or improbably is happening in the body
Hallucinations
(sensing or perceiving things or events that others do not)
Most common ones are auditory
Command hallucinations→ false auditory perception of being ordered to do something
Compliance of a command hallucination is more likely if the voice is trustworthy, benevolent, or if the command matches a delusion
–> Quality of a voice and perception of a threat
positive symptoms?
delusions, hallucinations
negative symptoms (4) schizophrenia
Deficit of psychological functioning or the absence of expected behav or feelings
Flattened affect → lack of appropriate emotion in observable expression and behavs
Alogia → brevity or absence of speech, lack of content in communication (mind goes blank)
Avolution → lack of energy disinterest in usual activities
Disorganised symptoms (schizophrenia)
Bizarre behav or confusing speech that reflect severe underlying thought disturbances
Word salad → Nonsensical or unconnected words
Loosening of association→ shifting train of thought
Catatonia→ maintaining rigid posture or complete lack of movement
Waxy flexibility → Remaining in an uncomfortable position
Prevalence and etiology (of psychosis)
Around 1%
Affects both sexes, but men more
Manifests earlier in males
Significant genetic contributions, but no gene for schizophrenia
Pre- and perinatal environmental risk factors
Cannabis use when young can increase risk for developing psychosis
Differences in brain structure, functions and interactions
Schizophrenia and violence
Proportion of violence crimes is small
Level of violence might be higher
Excessive violence most common when hallucinations and delusions both present
Delusional disorder (included in schizo spectrum)
Presence of one or more non-bizarre delusions
Types of delusions (non bizarre, delusional disorder)
Delusional jealousy → belief that romantic/sexual partner is unfaithful (suicidal/homicidal ideations)
Erotomanic→ belief that someone of higher status is in love w/ the individual
–> Common in females but if in males more likely to act on it
Grandiose → megalomania behav (delusion of increased self importance)
Persecutory → Belief of being attacked or harassed (most common type of delusion)
Delusional distress → feelings of fear, sadness, and anxiety that can increase risk of violence
Belief maintenance→ increased likelihood of acting on delusions (confirmation bias)
Major Depressive disorder (MDD)
-Sadness and loss of enjoyment (anhedonia)
-Mood changes must be extreme
-Most common mood disorder (5-7%)
-Childhood abuse and trauma are influences (environmental, bio (genetic is 40%), psyc influences)
-Extremely depressed state and must last over 2 weeks
MDD and violence
-Relationship between depression and juvenile delinquency, esp in girls
-Very few crimes directly related to major depression
-May play a role in mass murders, school shootings, workplace violence and suicide-by-cop
-Situational or chronic? Hard to tell cause and effect
Bipolar disorder (BP) → manic depressive disorder
Alternate between manic phase and depressive phase
Recklessly engage in pleasurable activities w/ harmful consequences
Not implicated in violence, but at 15x higher risk of suicide
Very impulsive in manic phase, increased confidence/esteem
DID
-Characterized by disruption in normal integration of consciousness, memory, identity, perception, and behav
-Exhibit 2+ separate personalities or identities
-Experience memory gaps and fugue states (end up somewhere and don’t know how they got there)
-Transition between personalities may be sudden
-Generally triggered by a stimuli or trigger
-An ‘alter’ may be violent
ex. of DID case
Hillside strangler
Kenneth bianchi attempted to blame his crimes on an ‘alter’ personality, “steve”
Was unsuccessful and deemed a psychopath
PTSD → traumatic event is the cause
-Trauma-and-stressor related disorder that can lead to a dissociative state
-Only disorder w/explicit cause: trauma
-Symptoms include: flashbacks where the individ relives the event and is unaware of current situation
-May act violently during flashback
-May mitigate responsibility in cases of battered women
-Partial defense
Not Criminal Responsible on Account of Mental Disorder (NCRMD)
-No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong
-At the time of the offense, a disturbance of the mind rendered the offender incapable of knowing the act was wrong
-3 outcomes: absolute discharge, conditional discharge, custody order
-Lack of mens rea
-DEFENSE
NCRMD myths
-Removes culpability → unique incarceration
-Is dangerous→ more likely to dmg property than ppl
-Sentenced to life in psychiatric hospital → treatment, medications, therapy, rehab
-Likely to reoffend and end up bad in CJS → 17% of reoffending
Fitness to stand trial
State of accused mind at time of trial
Offender must demonstrate their mental disorder prevents them from understanding the possible consequences
–> Understanding the nature or object of the proceedings
–>Communicating w/counsel
Mental disorder and violence
-Mental disorder in criminal pop
-Crime in psychiatric pop
-Mental health and crime in a community sample
MD in criminal pop
Prevalence of MD in incarcerated pops is 50-80% higher than in general pops
Rates vary by study as some include personality disorders and substance use disorders
Direct comparisons of major mental disorders 2-3x higher in incarcerated pops
Depression is the most common MD
Psychotic disorders do not exceed 5% of offending pop
Crime in psychiatric patients
Early perspectives believed psychiatric patients were less violent
Research indicates this group has higher rates of arrest and conviction
May be because they are caught more easily and less well defended
Violence may be connected to substance abusers with MD, but not MD alone
MD + crime in a community sample
Previous 2 perspectives are biased to specific pops
Compare behav of community members w/ MD to those w/o MD
Problems regarding sampling and measures
Research shows community members w/MD are more likely to have criminal and violent convictions
Mental disorder and Crime
On its own is not a good predictor
Schizzo most associated w/ violence but the group is heterogenous
Males who develop schoizo and exhibit early antisocial behav are persistent offenders
History of violence can predict current violence
Risk factors are similar for mental disordered and non mentally disordered people
Crimes committed by the seriously mentally ill are generally not a direct result of their illness
No single factor is a strong predictor
Most ppl w/ an MD do not engage in crime/violence
Criminalization of mental disorder
Ppl w/ mental disorders are more likely to be processed as offenders in the CJS than as patients in the mental health system
They engage in nuisance or disruptive behave
Not more likely to offend just more likely to be arrested, convicted and imprisoned
Deinstitutionalization
Inverse relationship w/ pops in psychiatric and prison instit
Goal of deinstit to provide community based care did not manifest
Many ppl w/mental disorder ended up unhoused or in CJS
Police discretion
Arrest 20% more ppl with MD symptoms than without
Almost always law enforcement who responds to mental health emergencies
Ppl w/MD less likely to conceal crimes or deny involvement, so clearance is higher
threat /control-override symptoms
Symptom based theory of crime where crim behav of person w/ MD is attributed to their altered perceptions
Principle of rationality-within-irrationality is that violence committed by person w/ MD is a rational response to irrational symptoms
Threat symptoms cause smo to feel like they are going to be harmed
Control-override symptoms leave a person w/ diminished feeling of self control and free will
Substance abuse
MD + Substance abuse = increased risk of criminal behav
Substance use may be higher in ppl with MD due to nature of their symptoms
Substances may be more intoxicating to minds of people whose perceptions are already impaired
Social situation (socioeconomic)
Higher rates of MD (mental disorder) among those of low SES
Higher violence in psychiatric patients in poorer neighbourhoods
Good social support networks can minimize violence
Larger networks can be detrimental
Victimization
More likely to be victims of violence than engage in crime
Can increase risk of violent behav
Witnessing a crime is a risk factor
Treatment
Reduced risk of violence when following a prescribed medication regimen
Medication can lessen effects of symptoms, but cannot ‘cure’ MD
Challenges w/ compliance
Insight is a person’s appreciation for their mental disorder
Tense Situations
MD → Violence
Threat/control override symptoms → violence
Bizarre symptoms → violence
Substance use → violence
Antisocial personality → Violence
Neurobio factors → violence
Social environment factors → Violence
