Diagnosing Criminal Defendants

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2Mental Illness and Criminal Behavior

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Learning Outcomes

After reading this chapter, you should be able to

• Define mental illness and distinguish between any mental illness and serious mental illness.

• Describe the subjective nature of psychiatric diagnosis.

• List the mental disorders that are most commonly associated with criminal behavior and describe their symptoms.

• Discuss psychological risk factors for criminal behavior.

• Identify common misperceptions about the association between mental illness and crime.

Section 2.1 Introduction

Introductory Case Study: Jessica Muñoz Ciro Jessica Muñoz Ciro was a pleasant and energetic child who had moved with her mother from South America to the Seattle area when she was a small child. They became U.S. citizens, and Ciro excelled in school. She became a star racquetball player; by the time she was in high school, she was part of the U.S. Junior National Team, winning an individual gold medal at the Inter- national Racquetball Federation Junior World Championships in 2009. Teachers and coaches described Ciro as hardworking, easygoing, and agreeable when given instructions or feedback on her performance. It appeared that Ciro had a bright future—until her behavior took a turn for the worse.

When she was about 16 years old, her mother and stepfather began to notice troubling changes in her mood and personality. Ciro had become withdrawn and excessively temperamental, but her parents attributed her behavior to that of a normal teenage girl going through adolescence.

Ciro began to exhibit signs of mental illness when she showed up at a classmate’s home behav- ing “erratically,” according to the friend’s description. Ciro’s parents rushed over to her friend’s home, but Ciro unexpectedly jumped into her stepdad’s car, sped off, and crashed the car into a tree. She was thrown through the windshield, cutting her face and severely bruising her legs. At the hospital, she was diagnosed with bipolar I disorder.

Unfortunately, this event kicked off many years of struggle for Ciro and her family, with Ciro being hospitalized while trying to find the right combination of medications to stabilize her. Sadly, when her manic episodes were particularly disruptive, Ciro found herself incarcerated in the county jail for petty crimes—an all-too-familiar scenario for many mentally ill individuals in the United States.

As you read this chapter, consider the following questions regarding this case:

1. Do you think Ciro’s symptoms made it easy for medical professionals to determine the reason for her behavior?

2. What is the association between bipolar disorder and criminal behavior? 3. Do you think it is likely that Ciro experienced traumatic experiences in childhood that

made her more vulnerable to developing bipolar disorder? Why or why not?

2.1 Introduction The link between criminal behavior and mental illness has been a focus of investigation for many decades, yet there remain seemingly as many questions as there are answers. Criminal behavior and mental illness have a complex relationship, partly because the link is still being researched, the mental illness classifications are continuously being tweaked, and under- standing and diagnosing mental illnesses is an ongoing process for mental health profession- als. To further explore this complex relationship, we’ll study theories and research from an interdisciplinary perspective to help define mental illness and explore psychological risk fac- tors for criminal behavior.

Section 2.2 Defining Mental Illness

There is a common perception that those who commit crimes must be mentally ill or that mentally ill individuals are prone to violent criminal behavior. We will explore and identify common misconceptions about the association between mental illness and crime.

That being said, some mental illnesses have more risk associations with criminal behav- ior than do others; therefore, we’ll explore relevant mental disorders based on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) classification system—a system that has been honed over a span of about 100 years.

Exploring these foundations of mental illness is important for understanding how they may or may not lead to criminal behavior and studying the context of crime.

2.2 Defining Mental Illness Mental illness, also referred to as mental disorder, is a medical condition hallmarked by dysfunction in cognition (thinking), affect (emotion), or behavior (APA, 2018). Individuals afflicted with mental disorders often experience co-occurring dysfunction in thinking, emo- tions, and behavior rather than being limited to just one problem area. This can impact one’s ability to overcome adversity (resilience), be productive at work or school, maintain healthy relationships, be a contributing member of society, and adapt to change.

Similar to physiological diseases, psychiatric diseases range in severity from mild to serious. The National Institute of Mental Health (2019) has two major categories for classifying men- tal illness: any mental illness and serious mental illness.

Any Mental Illness Any mental illness (AMI) includes all behavioral, emotional, or mental disorders, ranging from mild to severe impairment. For example, imagine that you occasionally have difficulty falling or staying asleep because you cannot stop dwelling on your sense of uncertainty over everyday events. However, this overthinking interferes with your sleep only a few times per month, and although you feel tired and irritable the next day, most of the time you manage to sleep through the night. Due to this occurring only intermittently, you are likely to seek out remedies other than seeing a doctor, such as changing your diet, exercising, and possibly even introducing an over-the-counter sleep aid. This type of psychological disturbance would likely fall under the mild to moderate range because the functional impairment is limited and manageable with no or minimal intervention.

However, in cases where the sleep disturbance and worry occur more frequently such that daily behavioral, emotional, and mental functioning is disrupted to the point of dysfunction, this may be classified as a mental illness under the moderate to severe range. This is largely due to the fact that greater intervention than in the previous loss of sleep example may be required to restore functioning to normal range. Such interventions may include seeing a physician or psychologist.

Section 2.2 Defining Mental Illness

Figure 2.1: Past year prevalence of any mental illness among U.S. adults, 2016

Nearly one fifth of the adult population in the United States is afflicted with mental illness—a significant proportion.

From “Mental Illness,” by National Institute of Mental Health, 2019 (https://www.nimh.nih.gov/health/statistics/mental -illness.shtml#part_154788).

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The Substance Abuse and Mental Health Services Administration (SAMHSA) and National Institute of Mental Health (2016) estimate that there are approximately 44.7 million adults in the United States suffering from AMI (see Figure 2.1). This represents 18.3% of the overall American adult population.

Regardless of the severity of the dysfunction, any identifiable mental illness or disorder is classified under the AMI category, even if it is also classified as serious mental illness (SMI). In other words, all SMIs are AMIs, but not all AMIs are SMIs.

Serious Mental Illness Serious mental illness (SMI) refers to mental, behavioral, or emotional dysfunction at a significantly impaired level. SMIs include but are not limited to major depressive disorder, bipolar disorder, schizophrenia, substance abuse disorders, or any mental illness that rises

https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154788

Section 2.2 Defining Mental Illness

Figure 2.2: Past year prevalence of serious mental illness among U.S. adults,

2016

Similar to AMI, the prevalence of SMI was higher among women than men, highest among young adults aged 18–25, and highest among adults reporting two or more races.

From “Mental Illness,” by National Institute of Mental Health, 2019 (https://www.nimh.nih.gov/health/statistics/mental- illness.shtml#part_154788).

to the level of such significantly impaired functioning that the individual may be considered disabled. For example, an individual with major depressive disorder will likely exhibit symp- toms so debilitating that he or she will not be able to function normally without intervention. These types of symptoms may include insomnia or hypersomnia (excessive sleeping), loss of interest in activities that were once enjoyable, a sense of hopelessness, failure to fulfill work obligations, and even planning or attempting to commit suicide (APA, 2013). The significant dysfunction that results, together with the increased risk or likelihood of self-harm, renders this an SMI.

The National Institute of Mental Health (2019) estimates that approximately 10.4 million adults have been diagnosed with SMI. This estimate is based on data gathered and analyzed by SAMHSA. The data in Figure 2.2 show that this group represents 4.2% of the overall popu- lation of adults in the United States, with most being women under age 25 and those who identify as multiracial (i.e., identifying as two or more races/ethnicities).

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*All other groups are non-Hispanic or Latino **NH/OPI = Native Hawaiian / Other Pacific Islander ***AI/AN = American Indian / Alaskan Native

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https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154788

Section 2.3 Diagnosing Mental Illness

Spotlight: The History of the DSM In 1917 the American Medico-Psychological Association (now the APA) identified the need to collect data from mental hospitals in order to understand just how many individuals were suf- fering from serious, debilitating mental illness and what their symptoms were.

The attempt to collect objective data actually began in the late 1800s, when the intellectually disabled were classified as “idiots” and the seriously mentally ill were officially referred to as “insane.” The term idiot is now an offensive word not used in formal psychiatric diagnosis, and insanity is no longer a psychological construct but solely a legal one (LaFortune, 2018).

The first DSM, published in 1952, was not nearly the comprehensive volume that it is today—it was heavily focused on mental illness as a dysfunction in personality “reaction” to biological, psychological, and social variables encountered in everyday life. The DSM-2 was similar to the first, but the view of mental disorder began to broaden and shift away from considering it merely a “reaction” to biopsychosocial factors. The DSM-3 was published in 1980 and was a remarkable change from the first two versions, since it was the first to provide a specific list of mental disorders and accompanying diagnostic criteria. In the DSM-4, published in 1994, dis- orders were removed and added, and diagnostic criteria were updated based on the scientific literature in the area. There were more than 1,000 individuals and organizations involved in crafting the DSM-4, and it required a 6-year-long effort to prepare this edition for publication.

By the time the DSM-5 was published in 2013, there was approximately 13 years’ work invested in revising the manual. Several work groups were formed to research and address each of the major diagnostic categories in an effort to ensure that gaps in the relevant scientific literature were addressed and that the revisions were subjected to rigorous review standards prior to publication.

2.3 Diagnosing Mental Illness Accurately assessing clients or patients for mental disorders can be a challenge. The DSM-5 provides an exhaustive list of mental health disorder classifications. It also serves as the pri- mary authority on diagnostic criteria for mental health issues ranging from mild behavioral issues to the most serious mental illnesses. It is used primarily by mental health professionals to assign a diagnosis to clients in order to be eligible to receive payment from health insur- ance companies for services rendered with regard to screening for, and later treating, any identified mental health condition.

Although the work groups and lengthy development time of the DSM-5 suggest that the man- ual is significantly improved over previous editions, there is some skepticism about the reli- ability of mental health diagnoses, given that there is a fair amount of subjectivity in the diag- nostic process. That is, regardless of what the DSM-5 classifies as bona fide mental disorders, what is considered a mental illness is somewhat subjective and often culture bound (Dowrick, 2013). The American Psychiatric Association (APA)—the primary professional organization of psychiatrists in the United States—acknowledged this in the DSM-5 and has emphasized the importance of clinicians becoming culturally competent practitioners so they can recog- nize cultural differences in how mental health issues are viewed, reported, and discussed. See Spotlight: The History of the DSM for a brief overview of the publication’s beginning in 1917 to its most recent version today.

Section 2.3 Diagnosing Mental Illness

Mental Condition Versus Mental Illness Although mental illness is classified as a medical condi- tion by the APA, the challenge in identifying mental disease (mental conditions) as a medical problem lies in the fact that mental illness is not generally diagnosable via the means and methods used to diagnose traditionally accepted and defined disease (physical conditions). That is, there are no conclusive X-rays or lab tests that show mental health con- ditions. However, competent medical professionals will use lab tests, X-rays, MRIs, and other traditional medical testing modalities to rule out any underlying physical disease that may contribute to dysfunction in thinking, behavior, and emotion regulation. When a patient presents with symp- toms that suggest mental dysfunction, it is expected that a competent physician will use laboratory testing to the extent possible to determine whether there are any physical illnesses present that may be the root cause of the observ- able mental disorder.

In the absence of any physical conditions that may account for mental health symptoms, psychologists and psychia- trists diagnose clients or patients using criteria set forth in the DSM published by the APA (2013). See Case Study: Comparing the Cases of Curtis Jacques and Jessica Muñoz Ciro for an example of how some individuals with mental

illnesses have underlying medical conditions that cause impairment in behavior, cognition, or emotions.

Jupiterimages/Thinkstock

While there are no conclusive X-rays or lab tests that show mental illness, medical professionals can use traditional tests such as X-rays and MRIs to rule out underlying physical disease.

Case Study: Comparing the Cases of Curtis Jacques and Jessica Muñoz Ciro

Curtis Jacques’s family began to notice a change in his personality when he was a young adult. Jacques exhibited aggressive and erratic behavior that was highly uncharacteristic of his more typical behavior as a friendly and thoughtful person. When Jacques crashed his truck, he reacted so aggressively toward first responders and hospital personnel that he was involun- tarily committed to a psychiatric hospital. However, doctors later discovered that Jacques had two small cancerous tumors pressing on his brain and that this was causing the disturbing behavioral and emotional changes. There was an underlying physical disease that accounted for the cognitive, behavioral, and affective dysfunction he exhibited.

This is in contrast to Jessica Muñoz Ciro, whom we learned about at the beginning of the chapter. She exhibited changes in temperament and reacted aggressively toward her parents. Although Ciro’s behavior resembles Jacques’s behavior, Ciro had no identifiable physical dis- eases to explain her psychological disturbance. This highlights the importance of performing a battery of laboratory tests to rule out physical disease when symptoms of mental illness are observed.

Section 2.3 Diagnosing Mental Illness

Issues With Diagnosing Unlike medical screening that may include objective tests such as X-rays and blood work to determine the presence of physical disease, psychological assessment relies mostly on the subjective clinical judgment of the licensed practitioner.

Subjectivity The inherent subjectivity in psychiatric diagnoses is a major criticism of psychol- ogy. Objective measures exist that a clini- cian may administer to screen for anxiety, depression, post-traumatic stress disorder (PTSD), intellectual disability, personality disorders, and so on. However, practitio- ners must purchase the measures from the publishers, and most insurance companies will not pay for these types of psychologi- cal evaluation, which average $1,500 each. Even in situations in which objective mea- sures are administered, such as in forensic settings, the scores must be interpreted by the clinician, thereby resulting in a subjec- tive interpretation of the test results.

A more common approach to psychological evaluation is a clinical interview in which the mental health provider delves into the client’s biopsychosocial history and observes present- ing symptoms to render a diagnosis. You may have guessed that a fundamental problem with this approach is that it relies heavily on the client’s self-assessment of his or her own psycho- logical functioning, together with the preconceived expectations and biases of the practitio- ner. This may lead to an ineffective treatment plan for the client. In a courtroom setting the subjective judgment of the practitioner can have dire implications for the accused. That is, an incorrect diagnosis or one that differs from that of the other psychologist hired to evaluate the accused could lead to a lengthy prison sentence or worse, depending on the seriousness of the crime. Therefore, for enhanced precision, it is imperative that practitioners rely heavily on reliable diagnostic criteria, a structured clinical interview, and comprehensive data gath- ering on the client (Aboraya, Rankin, France, El-Missiry, & Collin, 2006).

Inconclusive Test Results Perhaps the biggest barrier to a greater reliability in diagnosing mental illness is the absence of conclusive and objective laboratory testing. There is some promising research to support the idea that certain mental disorders may be identifiable via medical laboratory testing; however, researchers are still working to validate this type of testing for use in diagnosing mental illness.

KatarzynaBialasiewicz/iStock/Getty Images Plus

Psychological assessment relies mostly on the subjective clinical judgment of the licensed practitioner.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

For example, a team of neuroscientists at Cambridge University in England examined whether a blood test might be able to aid in the diagnosis of schizophrenia. The research team, led by Dr. Sabine Bahn (Schwarz et al., 2010), tested a group of 250 schizophrenia patients and compared them to a group of 230 control participants to determine whether the team could identify specific blood biomarkers that were linked exclusively to schizophrenia patients. The team was successful in showing that these blood biomarkers do exist and that by admin- istering the blood test, physicians can predict who will develop schizophrenia long before psychological symptoms such as psychosis manifest themselves. Although the researchers were among the first to test this hypothesis, multiple studies on schizophrenia-related blood biomarkers had already been conducted.

Taking the results of these studies, Bahn and her team conducted a meta-analysis (a statistical analysis that combines the results of multiple studies) to validate their schizophrenia blood test. Due to inconclusive test results, issues still remain with diagnosing mental illness, but the researchers confirmed previous findings and successfully validated the blood biomarker panel, paving the way toward a blood test that could predict the development of schizophre- nia in certain individuals (Chan et al., 2015).

2.4 Mental Disorders Commonly Associated With Criminal Behavior The most commonly diagnosed mental disorders in criminal offenders fall under the catego- ries of schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, and antisocial personality disorder (Large, Ryan, Singh, Paton, & Nielssen, 2011; Peterson, Skeem, Kennealy, Bray, & Zvonkovic, 2014; Skeem, Kennealy, & Louden, 2014; Varshney, Mahapatra, Krishnan, Gupta, & Deb, 2016; Vogel, 2014). In reality, criminal behavior may be attributable to any mental disorder. This is particularly true when a defendant is facing serious criminal charges and mitigating culpability is the goal. For example, in the case of military veterans who commit serious or violent crimes, it is not uncommon to hear a defense attorney assert that the accused suffers from PTSD in an effort to get a reduced sentence. A less common but sensationalized mental disorder sometimes used as a defense in the courtroom is dissociative identity disorder, formerly and more commonly known as multiple personality disorder.

However, it is worth reinforcing that most individuals who are diagnosed with schizophrenia and other disorders that we discuss here do not act violently and do not engage in crimi- nal behavior. In addition, it’s equally important to be reminded that most criminals do not have schizophrenia (or any one particular mental disorder). We are exploring these disorders to shed light on situations in which individuals may commit crimes and how mental illness comes into play.

Let’s begin by taking a closer look at one of the more fascinating groups of mental illnesses: schizophrenia spectrum disorders.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

Schizophrenia Spectrum Disorders Schizophrenia is a chronic and severe mental disorder that affects how an individual behaves, feels, and thinks. It is an SMI most commonly associated with a state of psychosis, or a state in which sufferers experience significant impairment in thoughts and emotions exhibited via hallucinations, disorganized cognition and speech, delusions, flat affect, and even involuntary motor movements or catatonia. Schizophrenia, like many maladies, may present with just some of these symptoms. In fact, on each of the five domains of symptoms discussed in this section, an individual may receive a diagnosis of schizophrenia or other psychotic disorder if two or more of these symptoms are observable and physical disease has been ruled out. Let’s examine briefly the five domains of symptoms typically observed in these types of disorders.

Delusions A delusion is evident when an individual possesses fixed—and generally bizarre— beliefs that persevere even when presented with conflicting evidence. Many people can relate to believing something so strongly that no one is able to change their mind, but delusions are more than being stubborn. Types of delusions include grandiose, ero- tomanic, referential, persecutory, and nihil- istic. Importantly, bizarre delusions tend to be present when individuals are depressed and/or have low self-esteem.

Consider the case of Dave, a homeless man who lived in a tent on the side of a busy highway in his hometown. Dave had been involuntarily committed to a psychiatric hospital and diagnosed with schizophrenia. Dave experienced many symptoms, one of which was the persecutory delusion: He believed that he could not secure a job because his aunt and grand- mother were “working against” him to prevent him from being successful. A persecutory delusion is one in which the individual believes irrationally that people are out to harass, harm, and sabotage him or her (APA, 2013). However, his family was desperate to find ways to help Dave get and stay on his prescribed medications, as well as to help him live as normally as possible. Dave also experienced referential delusions (also known as delusions of refer- ence), as evidenced by his unwavering belief that a popular radio host was sending a special message meant only for him during a radio show.

Dave did not suffer from the other types of delusions, but let’s briefly discuss how each mani- fests itself. Erotomanic delusions refer to a person’s false belief that a celebrity or other famous person is in love with him or her, despite the fact that the delusional individual has never met the celebrity nor had any communication with him or her. (See Spotlight: Notori- ous Individuals With Erotomania for a peek into the cases of now well-known people who suffered from erotomanic delusions.) Nihilistic delusions refer to the erroneous belief that the real world does not exist or that the individual does not exist. This can even apply to the individual’s body parts. Finally, grandiose delusions refer to the false belief that one is wealthier, smarter, and more powerful than others—and perhaps omnipotent and famous— despite evidence to the contrary.

iStockphoto/Thinkstock

Delusions are beliefs that persist even in the face of conflicting evidence. They tend to be most common when individuals have depression or low self-esteem.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

Hallucinations The five major types of hallucinations, which are the perception of things that do not exist in reality, are auditory, visual, tactile, olfactory, and gustatory. A hallucination is a type of symp- tom often present in psychotic disorders, particularly schizophrenia.

Dave, for example, experienced auditory hallucinations and visual hallucinations. Dave’s auditory hallucinations occurred as a result of “angry voices” he heard telling him repeat- edly that his aunt and grandmother were a threat to his survival. While in the psychiatric hospital, he also heard the voices telling him that the nurses and doctors were laughing at him, despite the fact that it was the middle of the night and there was relative silence on the wing where he was housed. While Dave was living in his tent on the side of the highway, he experienced visual hallucinations. He claimed he “saw” tree roots coming out of the ground trying to strangle him.

Tactile hallucinations occur when the individual feels a sensation that does not exist. Consider Mary, another client in the psychiatric hospital, who gouged at her skin because she could not rid herself of the sensation that bugs were crawling all over her. Trying to rid herself of the nonexistent insects, Mary cut herself so deeply that she was bleeding and needed stitches to close some of the wounds.

Spotlight: Notorious Individuals With Erotomania Individuals who suffer from erotomania have the consistent delusion that they are deeply loved by some other individual. Moreover, it can happen with someone they’ve never met or barely know. Two famous cases of erotomania in the United States include John Hinckley Jr. and Mark David Chapman.

In 1981 John Hinckley Jr. shot President Ronald Reagan in an assassination attempt. Hinckley had erotomanic delusions that the actress Jodie Foster loved him, and to supposedly impress the actress, he decided to assassinate Reagan. Interestingly, Foster had starred in a movie (Taxi Driver) in which a male (played by Robert DeNiro) planned an assassination attempt on a political figure to impress the character played by Foster in the movie. To read more about Hinckley’s case, visit the following links:

• https://www.hollywoodreporter.com/news/flashback-what-john-hinckley-jr-914990 • https://www.youtube.com/watch?v=m0R2GHaaHUs

One year prior, in 1980, Mark David Chapman shot and killed John Lennon outside Lennon’s New York City home. Throughout Chapman’s life, he experienced delusions about Lennon and even imitated Lennon’s life. For example, Chapman intentionally married a woman of Japanese descent in an effort to mimic Lennon’s Japanese wife. In addition, he collected Beatles albums and played in a rock band. Chapman decided to retire from the band at age 25, because Lennon was also in retirement. Chapman reportedly turned against Lennon in 1966 because of Len- non’s well-publicized comment that the Beatles were “more popular than Jesus” (“When John Lennon’s ‘More Popular Than Jesus’ Controversy Turned Ugly,” 2016).

To learn more about Chapman’s case, visit the following links:

• https://www.youtube.com/watch?v=Nn_oFBrHAA4 • https://www.youtube.com/watch?v=OkmaGvdJIZU

https://www.hollywoodreporter.com/news/flashback-what-john-hinckley-jr-914990

https://www.youtube.com/watch?v=m0R2GHaaHUs

https://www.youtube.com/watch?v=Nn_oFBrHAA4

https://www.youtube.com/watch?v=OkmaGvdJIZU

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

Although they are the least common of hallucination types, gustatory hallucinations refer to tasting something that does not actually exist (or is not currently present). Consider the unpleasant experience of tasting rotten milk. Someone experiencing a gustatory hallucina- tion may describe a similarly unpleasant and odious taste, but the rotten milk or other offen- sive item is not actually present.

Finally, an olfactory hallucination involves an individual detecting an odor that is not actually present in the person’s environment. Odors that are most common include burning rubber, cigarette smoke, and a rotten or spoiled smell.

Disorganized Speech, Abnormal Motor Behavior, and Negative Symptoms The other three symptoms of psychotic disorders are disorganized speech, abnormal motor behavior, and negative symptoms.

Disorganized speech is the direct result of disorganized thinking. The individual’s dysfunc- tional cognitive patterns are typically reflected in his or her speech patterns. That is, the indi- vidual may jump from one topic to an unconnected other topic. This type of disorganization is referred to as derailment or loose associations (APA, 2013). In rare cases, speech may be so disorganized that it is completely incomprehensible. Though each word may be understood, the individual may string them together in an unrelated manner that has no meaning, such as “coffee dog sit leave sweet car”; this is referred to as word salad.

Abnormal motor behavior is observable via challenges in performing common activities related to daily living. This behavior can range from involuntary movements to catatonia, a complete lack of movement or lack of responsiveness to stimuli in the environment. This catatonic state may be accompanied by an abnormally rigid posture, unresponsiveness to instructions, staring, grimacing, and even echoing of speech (APA, 2013).

Finally, negative symptoms are quite literally the absence of symptoms, which is an indica- tor of the existence of schizophrenia. Specifically, individuals with schizophrenia will exhibit what can best be described as flat affect. Someone with flat affect shows almost no emo- tional expression, appears apathetic, exhibits diminished facial expressions, and uses mono- tone speech. In schizophrenia, the two main negative symptoms observed are diminished emotional expression and avolition. Diminished emotional expression is the absence of or significant reduction in observable eye contact; the absence of movements of the head, hands, and face that typically accompany normal speech patterns; and the absence of normal prosody of speech—that is, the natural rhythm and expression in spoken words (APA, 2013). Avolition refers to a state in which the individual has no observable motivation to perform self-directed activities. That is, he or she will not usually initiate activity.

Diagnosing Schizophrenia In order to diagnose schizophrenia, at least two or more of the previously discussed symp- toms (delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction) must be observed for a significant proportion of the time during a 1-month period. The individual must also exhibit significant dysfunction academically or occupationally, in interpersonal relationships, or in self-care. Although the symptoms should be exhibited for at least 1 month, the disturbance in occupational and

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

social dysfunctions should be observable for about 6 months. Additionally, other disorders, including drug abuse and other mental health disorders, should be ruled out as the cause of the symptoms.

Bipolar Disorder and Major Depressive Disorder Bipolar disorder is a type of mood disorder that was known for many years as manic depres- sive disorder. This is because there are significant mood swings in bipolar disorder in which the sufferer experiences a manic or hypomanic phase or a major depressive phase. Though bipolar disorder and major depressive disorder are not directly linked to crime, we study the disorders’ symptoms to more fully understand how these may lead to criminal behavior.

There are two major types of bipolar disorder: bipolar I disorder and bipolar II disorder. In order to be diagnosed with bipolar I disorder, an individual must have either a manic or hypomanic episode lasting anywhere from 4 days to 1 week in which the individual may feel

euphoric, highly energetic, or even agitated and irritable. Manic episodes are emotional states characterized by at least a 1-week period in which an unusually elevated, expan- sive, or irritable mood exists. Hypomanic epi- sodes are less severe forms of manic episodes, and both episode types can cause individuals to experience racing thoughts, an inability to sleep, pathologically heightened activity lev- els, and reckless decision making (including behaviors that can get the individual in trou- ble with the law).

An individual must experience at least three of the following symptoms to constitute a manic or hypomanic episode: grandiosity or ele- vated self-esteem; decreased need for sleep; extreme talkativeness; racing thoughts as evi-

denced by speech pattern; distractibility easily caused by irrelevant stimuli; elevated goal- directed activity in social, occupational, and/or academic domains; and excessive engage- ment in high-risk activities, such as sexual indiscretions and shopping sprees well beyond the individual’s means.

In addition to the manic or hypomanic episode, for a diagnosis of bipolar I disorder the individual must also demonstrate a major depressive phase, which represents the patho- logical “lows” that occur when the individual’s mood swings from mania or hypomania to major depression. This diagnosis requires at least five of the following symptoms over a 2-week period: depressed mood most of the day every day (reporting feelings of intense sadness/emptiness and/or presenting as excessively tearful); significantly diminished par- ticipation or interest in participating in any activities; remarkable weight loss not due to diet; insomnia or hypersomnia; psychomotor dysfunction; severe fatigue; excessive feelings of worthlessness; inability to concentrate; and suicidal ideation with or without a specific plan to end one’s life.

Big Cheese Photo/SuperStock

Manic episodes can include periods of heightened activity and reckless decision making.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

Bipolar II disorder is considered a milder condition than bipolar I disorder. A diagnosis of bipolar II disorder is appropriate in cases in which the individual has never had a full-blown manic episode but rather only a hypomanic episode and a major depressive episode as described for bipolar I disorder. The criteria and symptoms are identical otherwise.

In cases in which an individual has never experienced a manic or hypomanic episode but has only exhibited the symptoms of a major depressive phase, a diagnosis of major depressive disorder is appropriate. Major depressive disorder is characterized by loss of interest in activities and a persistently depressed mood, causing significant impairment in an individ- ual’s daily life. See Case Study: Katherine P. for a real-life example of the connection between bipolar disorder and major depressive disorder.

Case Study: Katherine P. Katherine P. was diagnosed with bipolar I disorder in 2000, while she was still in college. She had been sexually assaulted and was also experiencing significant life stressors. The diagnosis was shameful to her, and she resisted medication and did not heed doctors’ orders.

In 2006 she had her first manic episode, in which she became so obsessed with religion that she had religious delusions. She created religious shrines in the home she shared with her hus- band that she believed were necessary to ward off Satan. Katherine trashed their apartment. Her husband was terrified, and he called the police. Katherine was restrained and taken away by the police to a psychiatric hospital, where she was held in restraints in her hospital bed and was plied with sedatives to keep her from harming herself or others.

Several months later, Katherine had another manic episode, in which she suffered from delu- sions and also invited a homeless man she had just met to stay with her and her husband in their apartment. Her husband was furious and threw the man out of their home. Katherine described being aware that her husband was angry, but she could not understand why. When there was police intervention, she felt ashamed but nevertheless was unable to control her behavior without medical intervention and was hospitalized again.

Katherine’s bizarre manic episodes were always followed by major depressive episodes in which she experienced suicidal ideation. Although it took a long time, she has finally gotten her medication dosages correct, and when she remains medication compliant, she does not experience manic episodes. Katherine describes her experience with bipolar disorder as feel- ing invincible when in the throes of a manic phase and feeling suicidal when in a depressive phase.

Regardless of the symptoms, keep in mind that a diagnosis for these SMIs is appropriate only when the impairment is so significant that it creates pathological dysfunction. That is, when the previously described symptoms exist; impair the person’s daily functioning to the extent that he or she experiences disruptions at work, home, or school; and there is no underlying medical cause for these symptoms, then a diagnosis of one of these disorders is appropriate, depending on where the individual falls along the specified diagnostic criteria.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

Antisocial Personality Disorder Antisocial personality disorder is perhaps the most common mental illness diagnosis of indi- viduals who commit crimes. This mental disorder falls under the AMI category, since it is not an SMI like schizophrenia, psychotic disorders, and mood disorders (e.g., bipolar disorder and major depressive disorder). Antisocial personality disorder (APD) is hallmarked by a pervasive pattern of blatant disregard for the rights of others that becomes evident in ado- lescence and continues throughout the adult life span. Typically, an individual who exhibits these patterns is referred to as a psychopath or a sociopath: someone who exhibits traits including but not limited to superficial charm, manipulation, a lack of empathy for the feelings or plight of others, a shallow emotional response, an extraordinarily high level of self-esteem, and pathological lying (Hart & Hare, 1997). (We’ll discuss psychopathy further in Chapter 3.)

The first step in diagnosing APD is to ensure that there are no other underlying mental or medical illnesses to account for the symptoms. If this is the case, then according to the diag- nostic criteria set forth in the DSM-5, three or more of the following criteria need to be met beginning in adolescence for a diagnosis of APD: failure to conform one’s behavior to the laws and norms of society (committing crimes), conning and deceitfulness for pleasure or profit, extreme impulsiveness, repeated physical aggression, reckless disregard for one’s own safety or that of others, failure to meet financial and other important obligations, and lack of empa- thy and/or remorse (APA, 2013).

PTSD and Dissociative Identity Disorder Although significantly less likely to be men- tal illnesses associated with criminal behav- ior, post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID) have made their way into the courtroom as miti- gating mental illnesses for serious criminal behavior, including homicide.

PTSD may occur as a trauma response to a significantly traumatizing event that an indi- vidual experiences or witnesses directly, such as sexual violence, actual death of another or threatened death of another or self, or seri- ous injury of another or self. PTSD is hall- marked by recurrent and intrusive memo- ries of the event(s), which cause such intense psychological distress that the individual experiences significant changes in cognition, affect, and behavior. PTSD can include dissociation—the individual may be so traumatized that he or she no longer experiences an emotional connection, almost as though he or she is an outside observer of events. As always, in order to attain this diagnosis, the individual’s symptoms may not be attributable to underlying medical conditions, drug or alcohol abuse, or another mental disorder. The symptoms must be exclusively the result of the experienced trauma.

KatarzynaBialasiewicz/iStock/Getty Images Plus

Witnessing violence, injury, and death can lead to lingering mental trauma known as PTSD.

Section 2.4 Mental Disorders Commonly Associated With Criminal Behavior

DID is also a trauma response but is a much more extreme diagnosis than PTSD. DID is specifically characterized as possessing two or more distinct personalities or identities. The individual, when in his or her primary personality state, will not recall personal infor- mation, behaviors, events, and other stimuli experienced while in a secondary or tertiary personality state.

The DID disorder is perhaps one of the most fascinating of all mental health disorders and is often mistaken for all of the previous disorders we have covered in this section of the chapter. It is also one of the most culturally bound disorders described in the DSM-5. In some cultures, this type of disorder is described as “being possessed.” The prevalence of this disorder in the United States is low, at approximately 1.5% of the population (APA, 2013). DID is accompa- nied by a high risk of suicide (approximately 70% of those diagnosed with DID attempt sui- cide) and a high risk of misdiagnosis due to its difficulty to observe and diagnose, and thus it often receives inappropriate or no treatment.

DID is a disorder that captivates the masses and creates controversy among the relevant psy- chiatric community. Many psychologists and psychiatrists reject the notion that this disorder exists (see Spotlight: Skepticism of DIDs). The challenge is that without acceptance of the rel- evant psycho-medical community of the disorder’s existence, it is all but impossible to pro- vide any evidence-based therapeutic interventions for those who may actually suffer from this disorder.

Spotlight: Skepticism of DIDs In the late 1970s a much-anticipated television movie aired based on the real-life story of Shirley Ardell Mason, featuring Sally Field in the starring role. Mason, called Sybil in order to protect her identity, was a severely abused child who was reported to have developed DID with 16 distinct personalities. The story, adapted from the case notes of Mason’s psychiatrist, Dr. Wilbur, had the nation transfixed, while many in the mental health field were skeptical.

Wilbur arrived at the conclusion that Mason suffered from DID when she observed Mason “transition” into different personalities right before her very eyes. The transitions were some- times to personalities much younger than Mason’s current age and sometimes to different genders. Wilbur documented many of the sessions via audio recording, yet there was signifi- cant disagreement as to whether Mason actually had multiple personalities or the whole thing was a hoax. Another psychiatrist, Dr. Spiegel, treated Mason when Wilbur was on vacation, and he asserted that Mason was merely a “brilliant hysteric” who manipulated Wilbur. Some wondered whether the difference in diagnostic opinion was due to gender differences. Spiegel categorized Mason as “hysterical” and “manipulative,” terms used most often in that time to describe women, whereas Wilbur believed her patient was suffering from the effects of signifi- cant trauma and that to deal with the trauma, Mason had developed different personalities.

After the publicity surrounding Mason’s case that resulted from the book and television movie, there were additional cases of DID diagnosed and reported widely in the press.

• To learn more about the Shirley Mason case, check out the Retro Report on the case at the following link: https://www.retroreport.org/video/sybil-a-brilliant-hysteric

• Read more about DID and the controversy among mental health professionals at the following link: https://www.psychologytoday.com/us/blog/think-well/201112/why -did-or-mpd-is-bogus-diagnosis

https://www.retroreport.org/video/sybil-a-brilliant-hysteric

https://www.psychologytoday.com/us/blog/think-well/201112/why-did-or-mpd-is-bogus-diagnosis

Section 2.5 Psychological Risk Factors for Criminal Behavior

2.5 Psychological Risk Factors for Criminal Behavior Duke University psychologists Swanson and Belden (2018) assert that “the media-driven notion that mentally ill people pose a danger to others appears to be encrusted like a barnacle on the concept of mental illness submerged in the public mind” (p. 669). It is true that there is strong public perception that seriously mentally ill individuals are responsible for com- mitting most crimes—especially violent crimes (Varshney et al., 2016). For example, a 2011 meta-analysis published in the Harvard Review of Psychiatry showed that individuals with schizophrenia are vulnerable to being incorrectly classified as being a high risk for perpetrat- ing violent crimes but that most will never actually do so (Large et al., 2011). This perception

is perpetuated by media reports and depic- tions in television and movies of individuals with this and other disorders, as Swanson and Belden (2018) point out.

Empirical data contradict this perception and show that seriously mentally ill indi- viduals are significantly more likely to be victims of crime than they are to perpetrate crimes. That is, of the 44.7 million adults diagnosed with mental illness in the United States, approximately 1 in 4 are crime vic- tims each year (Teplin, McClelland, Abram, & Weiner, 2005). Considering that poverty is a well-established risk factor for victim- ization and that most seriously mentally ill individuals live at or below the poverty level, it is no surprise that these individu- als are at high risk for victimization.

Despite the data that support this finding, the perception persists of mentally ill individuals as potentially dangerous. In order to debunk this myth, it is necessary to briefly examine com- mon risk factors for committing crimes in both mentally ill and non–mentally ill individuals. (A more comprehensive look at situational/environmental risk factors can be accessed in Chapter 4 and biological factors in Chapter 5.)

Risk Factors for the Mentally Ill Versus the Non–Mentally Ill Research shows that the risk factors that lead to criminal behavior are quite similar for both non–mentally ill and mentally ill individuals (Peterson et al., 2014). Generally speaking, there are biological and situational/environmental risk factors that may contribute to whether someone is more likely to commit crimes. Biological risk factors are those that can be attrib- uted to genetics, hormones, brain development and/or injury, and other biological influences. Situational risk factors may be learned behaviors, poverty, illiteracy, single-parent house- holds, lack of obedience to perceived authority, lack of social support, and anything else that may be part of an individual’s situation rather than his or her genetic or biological makeup. These risk factors are not unique to non–mentally ill individuals versus the mentally ill.

paulprescott72/iStock/Getty Images Plus

Poverty is one situational risk factor that can lead to criminal behavior. However, it is important to remember that mentally ill individuals are more likely to be victims of crimes than they are to commit crimes themselves.

Section 2.5 Psychological Risk Factors for Criminal Behavior

Psychosis One key risk factor for those with mental illness is whether they are symptomatic at the time the crime is committed. For example, research shows that individuals with disorders in which psychosis is a feature are more likely to commit crimes when experiencing hallucinations, delusions, and an overall loss of touch with reality than when not exhibiting these symptoms (Peterson et al., 2014). Depending on the type of mental illness, psychosis may be considered either a biological risk factor, as in schizophrenia, or a situational risk factor, as in psychosis resulting from drug or alcohol abuse.

In fact, research suggests that violent crimes such as homicide seem to be more likely to be perpetrated by seriously mentally ill individuals who are experiencing a psychotic episode (see Appelbaum, Robbins, & Monahan, 2000; Douglas, Guy, & Hart, 2009; Häkkänen & Laa- jasalo, 2006; Naudts & Hodgins, 2005; Tengström, Hodgins, Grann, Langstrom, & Kullgren, 2004). Still, this percentage is relatively low overall.

Comorbidity Comorbidity, or the simultaneous existence of two chronic conditions or diseases in an indi- vidual, has a higher chance of leading to criminal behavior than does having only one disor- der. For example, the relationship between violent behavior and psychosis is complex; it is rare that psychosis alone will result in violent crime. Data show that those with psychosis who perpetrate a violent crime also suffer from substance abuse disorder (Fazel, Hayes, Bar- tellas, Clerici, & Trestman, 2016; Fazel, Lichtenstein, Grann, Goodwin, & Långström, 2010). In a national comorbidity study, Kessler, Chiu, Demler, and Walters (2005) found that approxi- mately half of all schizophrenia and bipolar disorder patients had comorbid drug and alco- hol dependence; for those who have a diagnosable substance abuse disorder, this appears to increase their risk of perpetrating violent crimes.

Risk of Recidivism Individuals who find themselves incarcerated regardless of a mental disorder diagnosis will be assessed for risk of reoffending by most prison systems. Risk factors for reoffending, or recidivism, are often referred to in criminal behavior literature as criminogenic needs. Crimi- nogenic needs are any individual traits, issues, or characteristics that relate directly to the likelihood that an individual will commit future crimes.

The three general categories of risk assigned to an individual who undergoes a risk assess- ment are “low risk of reoffending,” “moderate risk of reoffending,” and “high risk of reoffend- ing.” The most desirable category is low risk, while those in the high-risk category are pre- dicted to be the least likely to lead successful lives outside of prison.

For the mentally ill, what seems to emerge from the research on recidivism rates is the exis- tence of symptoms that make it difficult for a mentally ill individual on probation or parole to comply with the conditions of release. That is, it may not be the case that the mentally ill individual actually goes out and commits another crime. However, failure to meet cer- tain requirements—such as obtaining employment upon release from jail or prison, seeking mental health treatment, checking in with the parole or probation department, and taking

Section 2.5 Psychological Risk Factors for Criminal Behavior

prescribed psychotropic medications—is likely to result in the mentally ill individual being returned to prison because he or she has not met the requirements of probation or parole. Consider once again the case of Jessica Muñoz Ciro, who cycled in and out of jail due to her inability to remain asymptomatic (or lacking symptoms). That is, Ciro continues to experience psychotic episodes, commits crimes (or simply violates probation), and thus gets arrested again.

The two main categories of risk factors for criminal behavior are static factors and dynamic factors. Static factors are those that stay the same and are generally historical, such as age at first offense, prior mental health issues, history of violating parole or probation terms, history of disciplinary records in jail or prison, history of substance abuse, and any other historical factor that occurred and thus cannot be changed. Dynamic factors are those that are change- able, such as current age, current employment or ability to be gainfully employed, educa- tion level, ability to maintain stable residence, marital status, and mental health treatment or intervention that helps mitigate or resolve mental health issues (James, 2018).

The distinction between static and dynamic factors has helped professionals focus on poten- tially causal factors, since it is typically easier for professionals to determine how dynamic risk factors increase recidivism risk. Unfortunately, the relationship of many static risk factors to recidivism is less clear. Understanding why risk factors predict recidivism can be greatly helpful in determining appropriate management and intervention strategies, as well as evalu- ating changes in risk levels over time.

Risk Assessment Evaluations Individuals who are on trial may occasionally have an assessment ordered by a creative defense team that hires a risk assessment psychologist for the purpose of arguing in court that the person is not a risk to society if set free. A risk assessment is conducted using a variety of psychometric measures—a combination of objective actuarial data and subjective clinical evaluative data. These can include structured clinical interviews designed to elicit information about the defendant’s biopsychosocial history, as well as official records (crimi- nal, civil, mental health, school, medical, etc.) and interviews of other credible sources who have spent time with the individual being evaluated.

There are important questions about the validity of these risk assessment measures. Reli- ability (the extent to which a procedure yields the same results on repeated trials) and valid- ity (the extent to which a tool measures what it intends to measure) are the minimum basic requirements for a sound scientific measure. Although there is a high level of subjectivity in most psychological evaluations, the use of official records from credible sources—records that document the history of the individual in question and certain risk factors that have been demonstrated by empirical research to be highly predictive of future risk for reoffending— gives the impression that risk assessment results are a valid and highly reliable predictor of future dangerousness (Yang, Wong, & Cold, 2010). However, the fundamental issue with risk assessment algorithms is that they have not been subjected to the rigors of validity studies by independent third parties to determine their effectiveness. For example, the companies that develop the risk assessment tools used in jails and prisons are for-profit corporations that make a lot of money selling their product. Precision and accuracy may not be a consideration.

Section 2.5 Psychological Risk Factors for Criminal Behavior

James (2018) points out that there are no perfect measures of future risk. That is, there is always room for error; a risk assessment may yield a false positive such that someone desig- nated as high risk may never recidivate. Likewise, someone labeled as low risk may be a false negative such that he or she goes on to commits more crimes. Angwin, Larsen, Mattu, and Kirchner (2016) conducted a thorough investigation of bias in risk assessment and concluded that the risk assessment systems used in prisons are biased against minorities, yielding a high level of false positives when the offender is African American. See Spotlight: Risk Assessment and Race: A Question of Validity to read more on the Angwin et al. (2016) findings. These find- ings are a cause for concern and warrant additional research to determine the nature and extent of the impact of bias on individuals based on recognizable characteristics such as race, gender, age, and other socioeconomic factors.

At the heart of risk assessment is the desire to keep communities safe from harm. However, crimes continue to occur despite risk assessment and other psychological evaluations. There- fore, as much as we want to believe that we can implement measures and mechanisms to predict and control the behaviors of others, this may not always be the case.

Spotlight: Risk Assessment and Race: A Question of Validity In May 2016 the nonprofit, nonpartisan news organization ProPublica published a piece on the use of risk assessment in jails and prisons. The findings were deeply troubling. The authors of the piece—Julia Angwin, Jeff Larson, Surya Mattu, and Lauren Kirchner—obtained data from the Broward County, Florida, area on more than 7,000 arrestees who were subjected to a computer-generated risk score upon entering the county jail. The researchers found that the algorithm predicted that Black offenders were significantly more likely than White offend- ers to commit future crimes, and the predictions were significantly inflated for both groups. However, Angwin et al. (2016) found that the reliability of the algorithm was only slightly greater than that of a simple coin toss. The researchers discovered that false positives were disproportionately higher for Black defendants than for White defendants; the algorithm pre- dicted that only 23.5% of Whites would reoffend and that 44.9% of Blacks would reoffend. In these groups, none of these “high-risk” individuals reoffended.

To put these findings in perspective, consider the cases of Gregory Lugo and Mallory Williams. Lugo, a White male, was charged with drunk driving on three different occasions and also with battery in another case. In the most recent drunk driving case, Lugo crashed his vehicle into another car. The jail’s risk algorithm generated a score of 1 on “future dangerousness” for Lugo. That is, Lugo was deemed to be at low risk for reoffending but went on to commit the crimes of domestic violence and battery. Mallory Williams, a Black female, was arrested on two separate occasions for misdemeanor driving under the influence. She never committed another crime; yet at the same county jail, she was classified by the algorithm as medium risk for reoffending with a score of 6.

(continued on next page)

Summary and Conclusion

Spotlight: Risk Assessment and Race: A Question of Validity (continued)

Lugo’s and Williams’s cases illustrate a common situation that is problematic, even devastat- ing, for people of color. Judges consider future risk in many jurisdictions and may sentence in accordance with this information. Prisons also use these scores to determine inmates’ eligibil- ity for jobs and available programs, as well as whether to award time off of a sentence for good behavior. In Broward County the algorithm was virtually useless in predicting future risk yet was significantly damaging to defendants’ abilities to get shorter sentences, good jobs, and possibility of parole.

After publication of the piece, researchers at various universities—including Stanford, Har- vard, Cornell, Carnegie Mellon, and the University of Chicago—and even Google took up the task of trying to find ways to make the algorithm less biased and more accurate. Despite initial findings showing some of the inherent issues in the formula and how to improve its accuracy, the company that generated the algorithm and markets its products to prisons nationwide has refused to acknowledge the scientific research or its findings. Perhaps even more troubling, the Broward County jail system, where much of the data came from for the original piece, has made no changes in its risk assessment approach.

To read more about the initial studies and the follow-up work in this area, visit the following links:

• https://www.propublica.org/article/machine-bias-risk-assessments-in-criminal -sentencing

• https://www.propublica.org/article/bias-in-criminal-risk-scores-is-mathematically -inevitable-researchers-say

Summary and Conclusion

In this chapter, we have learned about mental illness and how to identify the existence of mental disorder. Defining and diagnosing mental illness is a complex and often subjective process, but one that is important to understanding the complexity of human beings.

Each mental disorder has specific markers and proven symptoms, according to the DSM. Studying symptoms of mental disorders that are more commonly associated with criminal behavior—such as schizophrenia spectrum disorders, bipolar disorder and major depres- sive disorder, APD, PTSD, and DID—allows researchers and students to get a better grasp on how individuals suffering from these illnesses might be more prone to committing crime.

An important point to remember is that mentally ill individuals do not pose a danger to soci- ety; in fact, research shows clearly that these individuals are more at risk of being victims of crime than of being offenders. Nevertheless, these individuals are disproportionately repre- sented in the criminal justice system, perhaps due to an inability to function normally or due to factors that hinder their ability to remain asymptomatic. These are considered risk fac- tors of recidivism. There are inherent challenges faced by mental health professionals who are tasked with rendering conclusions about factors that may contribute to an individual’s risk of reoffending. These assessments are in no way perfect, but they do serve as a starting point for evaluating risk factors and assessing risk of reoffending.

https://www.propublica.org/article/machine-bias-risk-assessments-in-criminal-sentencing

https://www.propublica.org/article/bias-in-criminal-risk-scores-is-mathematically-inevitable-researchers-say

Summary and Conclusion

Key Terms antisocial personality disorder (APD) A disorder hallmarked by a pervasive pattern of blatant disregard for the rights of others that becomes evident in adolescence and continues throughout the adult life span.

any mental illness (AMI) A category of mental illness that includes all behavioral, emotional, or mental disorders, ranging from mild to severe impairment.

avolition A state in which the individual has no observable motivation in performing activities that are self-directed.

bipolar disorder A disorder associated with episodes of mood swings ranging from manic highs to depressive lows. The two types are bipolar I disorder and bipolar II disorder.

catatonia An apparent lack of responsive- ness to stimuli in the environment that may be accompanied by an abnormally rigid pos- ture, unresponsiveness to instructions, star- ing, grimacing, and even echoing of speech.

comorbidity The simultaneous existence of two chronic conditions or diseases in an individual.

criminogenic needs Any individual traits, issues, or characteristics that relate directly to the likelihood that an individual will com- mit future crimes.

derailment/loose associations Dysfunc- tional cognitive patterns typically reflected in speech patterns in which the individual may jump from one topic to an unconnected other topic.

diminished emotional expression The absence of or significant reduction in observable eye contact; the absence of movements of the head, hands, and face that typically accompany normal speech pat- terns; and the absence of normal prosody of speech.

dynamic factors Potentially changeable features—such as age, employment, and education level—of an individual that pre- dict recidivism.

erotomanic delusions An individual’s false beliefs that a celebrity or other famous person is in love with him or her, despite the fact that the delusional individual has never met the celebrity nor had any communica- tion with him or her.

flat affect Little to no emotional expression; manifests itself in monotone speech, appear- ing apathetic, and exhibiting diminished facial expressions.

grandiose delusions The false belief that one is wealthier, smarter, and more powerful than others—and perhaps omnipotent and famous—despite evidence to the contrary.

Critical Thinking Questions

1. Why do you think there is a common perception that mental illness leads to criminal behavior?

2. Describe the key differences in testing for mental illness versus testing for medical illness or conditions.

3. Risk assessment is conducted most often in prison and jail settings. What are the inherent issues with this type of testing?

Summary and Conclusion

hallucinations A symptom of schizophre- nia spectrum disorders in which an indi- vidual perceives things that do not exist in reality. The five major types are auditory, visual, tactile, olfactory, and gustatory.

hypomanic A dysfunctional state of emo- tional highs in which the individual may feel euphoric, highly energetic, or even agitated and irritable. Hypomanic episodes are less severe than manic episodes.

major depressive disorder A disorder characterized by loss of interest in activities and a persistently depressed mood, causing significant impairment in an individual’s daily life.

major depressive phase A phase that consists of extreme lows in which the indi- vidual may have sleep disturbance, may have intense feelings of hopelessness or sadness, and may even be frequently tearful. An indi- vidual must experience this for a diagnosis of bipolar I or II disorder.

manic Relating to dysfunctional emotional states characterized by at least a 1-week period in which an unusually elevated, expansive, or irritable mood exists.

mental illness/mental disorder A medi- cal condition hallmarked by dysfunction in cognition (thinking), affect (emotion), or behavior.

nihilistic delusions The erroneous belief that the real world does not exist or that the individual does not exist.

persecutory delusion A type of delusion whereby an individual believes irrationally that people are out to harass, harm, and sabotage him or her.

psychopath/sociopath An individual who exhibits traits including but not limited to superficial charm, manipulativeness, a lack of empathy for the feelings or plight of others, a shallow emotional response, an extraordinarily high level of self-esteem, and pathological lying.

psychosis Significant impairment in thoughts and emotions, exhibited via hallu- cinations, delusions, incoherent speech, and excessive agitation.

recidivism The tendency of a person with a felony conviction to reoffend.

referential delusions/delusions of ref- erence Delusions whereby an individual mistakenly believes that ordinary events and human behavior have special or hidden meanings that relate to him or her.

schizophrenia A chronic and severe mental disorder that affects how an individual behaves, feels, and thinks.

serious mental illness (SMI) A category of mental illness that includes only the most serious behavioral, emotional, or mental disorders, including bipolar disorder and schizophrenia.

static factors The features of an indi- vidual that predict recidivism but cannot be changed. These features are generally historical (such as age of first offense, prior mental health issues, etc.).

word salad A symptom of schizophrenia spectrum disorder in which speech may be so disorganized that it is completely incomprehensible.