Wolfgang Berner

Psychiatric Disorders in Single and Multiple Sexual Murderers

Background: Sexual homicides – and particularly offenders with multiple victims – receive much attention in the general public as well as among forensic experts. The aim of this study was to assess psychiatric disorders in a large sample of sexual murderers and to identify disorders related to multiple sexual homicides. Sampling and Methods: Psychiatric court reports from 20 German forensic psychiatrists on 166 men who had committed a sexual homicide were evaluated for psychiatric disorders according to DSM-IV, including standardized instruments for personality disorders (criteria from the Structured Clinical Interview) and psychopathy (Psychopathy Checklist-Revised). Offenders with a single sexual homicide victim (n = 130) were compared to those with multiple victims (n = 36). Results: High lifetime prevalence rates were found for substance abuse or dependence, paraphilias (especially sexual sadism), sexual dysfunctions and personality disorders (especially antisocial, borderline, sadistic and schizoid). In the multiple sexual murderer group sexual sadism, voyeurism, sadistic, antisocial and schizoid personality disorders were more frequent than in the single-victim group; none of the multiple offenders was diagnosed with a mood disorder. Conclusions and Limitations: Multiple sexual murderers are characterized by disorders in three major psychopathological domains: sexual as well as ‘character’ sadism, antisociality and schizoid personality. A thorough diagnostic evaluation of Axis I as well as Axis II disorders should be part of risk assessments in sexual homicide perpetrators. Although the study was a retrospective investigation on psychiatric court reports, the size of the sample and consistency with results from previous studies give confidence that the identified group differences are unlikely to be due to methodological limitations.

Differential Pharmacological Treatment of Paraphilias and Sex Offenders

This article gives an overview of current pharmacological treatment of paraphilias and sex offenders focusing on the situation in Germany. Information about selective serotonin reuptake inhibitors (SSRI) is followed by data about established antihormonal substances (cyproterone acetate/CPA, and medroxyprogesterone acetate/MPA), as well as a more detailed account on luteinizing hormone-releasing hormone agonists (LHRH agonists). The results of open, uncontrolled clinical studies with SSRIs (n = 16) and LHRH agonists (n = 11) in paraphilic outpatients confirm the positive effects of these substances. A survey about the use of CPA and LHRH agonists in forensic hospitals in Germany shows that half of the patients treated with any kind of (anti-) hormonal agents received an LHRH agonist. The authors present a protocol on side effects, contraindications, and monitoring of CPA and LHRH agonists and develop an algorithm for differential pharmacotherapy of paraphilias.

The influence of brain abnormalities on psychosocial development, criminal history and paraphilias in sexual murderers.

The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.

XYY chromosome abnormality in sexual homicide perpetrators

In a retrospective investigation of the court reports about sexual homicide perpetrators chromosome analysis had been carried out in 13 of 166 (7.8%) men. Three men (1.8%) with XYY chromosome abnormality were found. This rate is much higher than that found in unselected samples of prisoners (0.7–0.9%) or in the general population (0.01%). The three men had shown prepubescent abnormalities, school problems, and had suffered from physical abuse. The chromosome analysis in all cases had been carried out in connection with the forensic psychiatric court report due to the sexual homicide. However, two men had earlier psychiatric referrals. All were diagnosed as sexual sadistic, showed a psychopathic syndrome or psychopathy according to the Psychopathy Checklist‐Revised [Hare RD, 1991, The Hare Psychopathy Checklist‐Revised, Toronto, Ontario, Canada: Multi‐Health Systems]. Two were multiple murderers. Especially forensic psychiatrists should be vigilant of the possibility of XYY chromosome abnormalities in sexual offenders.

Therapie mit dem LHRH-Agonisten Leuprorelinacetat bei Paraphilien und sexuell aggressiven Impulshandlungen

ZusammenfassungBisher gibt es im deutschsprachigem Raum keine publizierten Erfahrungen in der Therapie von Paraphilien (Pädophile, Sadismus) und sexuell aggressiven Impulshandlungen mit LHRH-(Lutein-Releasing-Hormon-)Agonisten. In dieser Untersuchung beschreiben wir 11 Patienten, die in einem Untersuchungszeitraum von 12 Monaten mit dem LHRH-Agonisten Leuprorelinacetat behandelt wurden. Im Behandlungszeitraum kam es zu keinen weiteren sexuell aggressiven Handlungen und nach Angaben der Patienten zu einer deutlichen Reduktion von Erektion, Ejakulation, Masturbation, sexuell devianten Drangzuständen und Fantasien. Ein Patient verstarb durch Suizid. Insgesamt scheinen LHRH-Agonisten in Kombination mit anderen therapeutischen Verfahren eine viel versprechende Alternative zum Cyproteronacetat mit seinen möglichen karzinogenen Effekten zu sein.SummaryUp to now there are no published results of therapy of paraphilia (Pedophilia, Sadism) and sexual aggressive impulsiveness with LHRH-(luteinizing hormone-releasing hormone) Agonists in the Germanspeaking countries. In this report we describe 11 patients which were treated with the LHRH-Agonist Leuprolide Acetate in a period of 12 months. The patients showed no tendency of sexuell aggressive behaviour and reported an evident reduction of penile erection, ejaculation, masturbation, sexual deviant impulsiveness and phantasies. One patient died from suicide. In combination with other treatments LHRH-Agonist seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.

Sexual Murderers With Adult or Child Victims: Are They Different?

This study investigates characteristics differentiating sexually motivated murderers targeting child victims (CV; n = 35) from those with only adult victims (AV; n = 100). In the initial phase, psychiatric court reports were evaluated using standardized instruments (SCID-II, PCL-R, HCR-20, SVR-20, Static-99). In the second phase, data on duration of detention and reconviction rates were obtained from German federal criminal records. The CV group showed more often diagnostic criteria of pedophilia (43% vs. 4%) and less often alcohol abuse and drug dependency (31% vs. 55%), sexual dysfunctions (9% vs. 29%) and narcissistic personality disorder (0% vs. 13%). No significant differences were found regarding PCL-R and total risk assessment scores. Child victim perpetrators were more likely to have committed acts of sexual child abuse before the sexual homicide (46% vs. 16%) but were less likely to have committed rape or sexual assault (17% vs. 42%) or caused bodily injury (26% vs. 50%). The CV group was detained more frequently in forensic psychiatric hospitals (59% vs. 26%), but the two groups showed the same rates of release and reconviction for sexual (22% for both groups), nonsexual violent (CV 25% vs. AV 15%) and nonviolent offenses (CV 63% vs. AV 59%). Although well-known differences between nonhomicidal sexual child abusers and rapists were replicated in this study on sexual homicide perpetrators, the groups showed more similarities than differences. The high prevalence of violence and antisocial personality disorder in both groups seem to be important risk factors for committing a (sexual) homicide and might have outweighed other differences.

Comparison of sexual murderers in forensic psychiatric hospitals and in prison

Empirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.ZusammenfassungEs gab bislang keine Untersuchungen darüber, wie sich im Strafvollzug inhaftierte und im psychiatrischen Maßregelvollzug untergebrachte Täter sexueller Tötungsdelikte (sog. Sexualmörder) unterscheiden. Anhand psychiatrischer Gutachten sowie Auszügen aus dem Bundeszentralregister wurden in einer psychiatrischen Klinik untergebrachte (n=45) und im Strafvollzug inhaftierte (n=89) Sexualmörder bez. diagnostischer, kriminologischer und prognostischer Merkmale sowie der Legalbewährung miteinander verglichen. Im Maßregelvollzug Untergebrachte waren durch eine höhere psychiatrische Morbidität und ein leicht erhöhtes Risiko hinsichtlich zukünftiger sexueller wie nichtsexueller Gewaltdelinquenz gekennzeichnet. Sie wurden seltener entlassen als inhaftierte Täter, aber nicht häufiger mit Sexual- oder anderen Gewaltdelikten rückfällig.SummaryEmpirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.

Pornographie und sexuelle Gewalt im Internet

ZusammenfassungDie Frage, ob Pornographie im Internet sexuelle Gewalt fördert oder eher als Sicherheitsventil dient, ist ein gesundheits-, medien- und kriminalpolitisch wichtiges Thema. Studien zur Wirkung von Pornographie generell zeigen, dass Softcore-Pornographie und gewaltfreie Pornographie als harmlos gelten, während gewaltfreie Hardcore und Gewaltpornographie Aggressivität steigern können. Personen mit hohem Risiko für sexuelle Gewalt haben mehr Interesse an gewalttätiger Pornographie und werden durch diese stärker negativ beeinflusst. An 2 Fallbeispielen werden die besonderen Merkmale von Internetpornographie und Cybersex veranschaulicht: leichter Zugang von zu Hause, Anonymität, niedrige Kosten, Mannigfaltigkeit und Devianz des Materials, grenzenloser Markt, Auflösung der Grenzen zwischen Konsument und Produzent, interaktive Kommunikation, Experimentierraum zwischen Fantasie und realem Verhalten, virtuelle Identitäten, leichte Kontaktaufnahme zwischen Täter und Opfer bzw. verschiedenen Tätern sowie niedriges Entdeckungsrisiko. Dem Phänomen sexueller Sucht (oder Paraphilie-verwandte Störung) kommt beim problematischen Umgang mit Internetpornographie eine besondere Bedeutung zu. Neben präventiven Maßnahmen zum Schutz potenzieller Opfer werden für die Täterseite Behandlungsstrategien vorgestellt, die außer einer Beschränkung des Zugangs zu Internetsexualität die Therapie komorbider psychischer Störungen und Probleme (soziale Isolation, Trauerprozesse, Stress- und Wutmanagement, Schuld und Scham, Kindheitstraumata, kognitive Verzerrungen, Opferempathie), eventuell auch medikamentöse Behandlung und die Förderung einer integrativeren und beziehungsreicheren Sexualität umfassen.AbstractInternet pornography has been regarded as either stimulating sexual aggression and abuse or as serving as a safety valve. This controversy is an important issue in health, media and legal politics. According to empirical studies on pornography in general, soft-core pornography and nonviolent pornography can be regarded as harmless, whereas non-violent hard-core pornography and violent pornography may increase aggression. Individuals with a high risk for sexual aggression show more in terest in violent pornography and are stimulated more strongly through such material. Two case histories illustrate the characteristics of internet pornography and cybersex: easy access, anonymity, affordability, wide range and deviancy of the material, unlimited market, blurring the borders between consumer and producer, interactive communication, space for experi menting between fantasy and in- reallife behavior, virtual identities, easy contact between offender and victim or among offenders, and low risk of apprehension. The phenomenon of sexual addiction (or paraphilia- related disorder) is particularly relevant for the problematic use of internet pornography. Preventive measures to protect possible victims are presented as well as treatment strategies for offenders. Beside limiting access to the internet, these include therapy of comorbid psychiatric disorders and psychological problems (social isolation, bereavement, stress- and anger-management, guilt and shame, childhood traumata, cognitive distortion, victim empathy), psychopharmacotherapy and the enhancement of a more integrative and relationshiporiented sexuality.

Genital Abnormalities in Early Childhood in Sexual Homicide Perpetrators

INTRODUCTION.: The present study investigates the relevance of genital abnormalities (GA) like cryptorchidism, hypospadias, and phimosis usually diagnosed in early childhood for the development of psychosexual problems and deficits in a sample of Nu2009=u2009163 convicted sexual homicide perpetrators. AIMS.: The first aim was to investigate the prevalence of early childhood GA in a sample of sexual homicide perpetrators. The second was to explore differences in the psychosexual development of participants with GA in early childhood compared with those without GA. It was expected that offenders with GA show specific problems in their psychosexual development compared with offenders without GA. METHODS.: The data for the present study were obtained by reanalyzing an existing database derived from a large-scale research project about sexual homicide. Using a predominantly exploratory design we, therefore, divided the total sample into two subgroups (with vs. without indicators of GA). MAIN OUTCOME MEASURES.: Main outcome measures were the number of sexual homicide perpetrators showing GA in early childhood and the differences of subjects with and without GA with regard to their psychosexual development (i.e., according to sexual deviant interests or sexual dysfunctions). RESULTS.: The prevalence of GA is substantially higher in this sample than epidemiological studies indicated in the normal population. This result provided first support for the importance of GA in the population of sexual homicide perpetrators. Further analyses indicate significant differences between both subgroups: Offenders with GA in early childhood showed indicators for more sexual dysfunctions (e.g., erectile dysfunction) in adulthood and a distinct tendency of more masochistic sexual interests. CONCLUSION.: Even if the exploratory design of the present investigation allows no causal conclusions between GA and sexual homicide offenses, the result provided support for the relevance of early childhood sexual diseases in the assessment (and treatment) of offenders who have committed severe sexual violence.

Pornography and sexual abuse in the Internet

ZusammenfassungDie Frage, ob Pornographie im Internet sexuelle Gewalt fördert oder eher als Sicherheitsventil dient, ist ein gesundheits-, medien- und kriminalpolitisch wichtiges Thema. Studien zur Wirkung von Pornographie generell zeigen, dass Softcore-Pornographie und gewaltfreie Pornographie als harmlos gelten, während gewaltfreie Hardcore und Gewaltpornographie Aggressivität steigern können. Personen mit hohem Risiko für sexuelle Gewalt haben mehr Interesse an gewalttätiger Pornographie und werden durch diese stärker negativ beeinflusst. An 2 Fallbeispielen werden die besonderen Merkmale von Internetpornographie und Cybersex veranschaulicht: leichter Zugang von zu Hause, Anonymität, niedrige Kosten, Mannigfaltigkeit und Devianz des Materials, grenzenloser Markt, Auflösung der Grenzen zwischen Konsument und Produzent, interaktive Kommunikation, Experimentierraum zwischen Fantasie und realem Verhalten, virtuelle Identitäten, leichte Kontaktaufnahme zwischen Täter und Opfer bzw. verschiedenen Tätern sowie niedriges Entdeckungsrisiko. Dem Phänomen sexueller Sucht (oder Paraphilie-verwandte Störung) kommt beim problematischen Umgang mit Internetpornographie eine besondere Bedeutung zu. Neben präventiven Maßnahmen zum Schutz potenzieller Opfer werden für die Täterseite Behandlungsstrategien vorgestellt, die außer einer Beschränkung des Zugangs zu Internetsexualität die Therapie komorbider psychischer Störungen und Probleme (soziale Isolation, Trauerprozesse, Stress- und Wutmanagement, Schuld und Scham, Kindheitstraumata, kognitive Verzerrungen, Opferempathie), eventuell auch medikamentöse Behandlung und die Förderung einer integrativeren und beziehungsreicheren Sexualität umfassen.AbstractInternet pornography has been regarded as either stimulating sexual aggression and abuse or as serving as a safety valve. This controversy is an important issue in health, media and legal politics. According to empirical studies on pornography in general, soft-core pornography and nonviolent pornography can be regarded as harmless, whereas non-violent hard-core pornography and violent pornography may increase aggression. Individuals with a high risk for sexual aggression show more in terest in violent pornography and are stimulated more strongly through such material. Two case histories illustrate the characteristics of internet pornography and cybersex: easy access, anonymity, affordability, wide range and deviancy of the material, unlimited market, blurring the borders between consumer and producer, interactive communication, space for experi menting between fantasy and in- reallife behavior, virtual identities, easy contact between offender and victim or among offenders, and low risk of apprehension. The phenomenon of sexual addiction (or paraphilia- related disorder) is particularly relevant for the problematic use of internet pornography. Preventive measures to protect possible victims are presented as well as treatment strategies for offenders. Beside limiting access to the internet, these include therapy of comorbid psychiatric disorders and psychological problems (social isolation, bereavement, stress- and anger-management, guilt and shame, childhood traumata, cognitive distortion, victim empathy), psychopharmacotherapy and the enhancement of a more integrative and relationshiporiented sexuality.