SAT, Oct 9 \ 9.00-11.00 \ Sexual Homicide

103
CONCEPTS OF SADISM AND MASOCHISM IN SEXUAL HOMICIDE

Wolfgang Berner
Institute for Sex Research and Forensic Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
berner@uke.uni-hamburg.de

Definitions of sexual sadism and masochism in ICD – 10 and DSM IV will be presented as well as the historical routes of the concepts. Today studies on differently selected clinical samples reveal a different distribution of sexual sadism versus masochism with masochism prevailing in general especially outpatient psychiatric facilities, and sadism prevailing in forensic settings, thus corroborating the concept of two separated diagnoses sadism versus masochism. In forensic settings the diagnosis of a sadistic character disorder (sadistic personality disorder SPD according DSM III-R) is found to a much higher degree than in other clinical samples (50fold). Berger at al.`s data will show the importance of the diagnosis of a sadistic paraphilia for follow-up prediction of sex offending (more important than personality disorders), while Hill et al`s comparison of single versus multiple sexual murderers will show also the importance of the diagnosis of sadism for prediction but stress the importance of SPD, antisocial and schizotypal PD as well as the combination with voyeurism as a second paraphilia too. Sadists in a sample of 166 sexual murderers showed only in 14% symptoms of masochism, but in 50% at least one more paraphilia (f.i. transvestic fetishism, or pedophilia) and a high comorbidity with personality disorders (SPD, antisocial, borderline and schizoid). However in masochism also more differentiation seems necessary to predict danger of massive self-harm. Normally sexual masochists are satisfied with symbolic harm and humiliation. Sometimes we meet persons with extremely sexualized self-harm (castration or choking) without any previous contact to psychiatric or psychological professionals and sometimes such actions are expression of highly pathological developments. I hope Huckers data will shed some light in this darkness.

104
JUVENILE SEXUAL HOMICIDE

Niels Habermann, Andreas Hill, Peer Briken, Wolfgang Berner
Institute of Sex Research and Forensic Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
n.habermann@uke.uni-hamburg.de

According to criminal statistics violent sexual delinquency by juvenile offenders is constantly rising in Germany. Although sexual homicide committed by young persons is still a rare phenomenon, it is necessary to analyze biographical data, criminal history, psychiatric diagnoses and offense characteristics of these offenders to find out what motivates their aggressive acts.
Psychiatric court reports on 19 juveniles (14-18 yrs.) who had committed a sexual homicide were analysed. Specific characteristics of sexually motivated homicides by juveniles are shown in comparison with data from 120 adult sexual homicide offenders (21-59 yrs.).
Regarding this special type of offense only a few but clear differences were found that differentiate juvenile from adult sexual homicide offenders. No differences were found in frequencies of serious problems among the relatives of their families of origin, problematic childhood behavior, their own traumatic experiences (victimization), criminal history and most of the psychiatric disorders. In contrast to the adult offenders at the time of the offence only very few juvenile offenders were without any employment and all of them were still living together with their parents. The most differences were found in sexuality: All juvenile offenders were singles and most of them never had any serious sexual relations with another person before the homicide. Juvenile offenders started to masturbate much earlier than the adults and showed a higher frequency of masturbation with sadistic fancies and also with killing fancies. In juveniles the development of this behavior was much faster than in adults.
In most of the offence characteristics the comparison groups didn´t differ, but more juveniles than adults fettered their victims during the offence. The juvenile offenders' victims were rarely of the same age but often much younger or older.
Preliminary conclusions: Juveniles who commit a sexual homicide are not very different from adult offenders, but the show an earlier paraphilic development. It seems that such aggressive sexual offending is a hint for serious disturbances regarding a young person's personality, mental health and sexuality.

105
PERSONALITY & MOTIVES IN MEN COMMITING SERIAL SEXUAL HOMICIDE

Michael Howard Stone, MD
N Y City, USA
mstonemd@aol.com

The author has studied the full-length biographies of 123 men who have committed serial sexual homicide. In addition, the author has examined five men who have committed sexual homicide: four serial killers and one sexual sadist with one known and other suspected victims.
Of the biographied serial killers (78% were American), the majority (59%) came from lower-middle class families; many (53%) had been victims of parental brutality and had come from broken homes (45%). As to personality configuration: almost all met Hare criteria for psychopathy (89%); a few more had some psychopathic traits (6.5%). The most remarkable finding was that schizoid personality, though rare in the general population (1%), was present in 51% of the serial killers: half, that is, were asocial introverts. Serious juvenile delinquency was the rule (77%) and might include murder, rape, or arson. Sexual paraphilias were common (75%); more than a fourth (28%) exhibited sexual sadism (some subjecting their victims to prolonged torture). One in six practiced necrophilia.
Among the serial killers examined in a forensic hospital, all had been brutalized extremely by one or both parents. Their main motive was revenge against the offending parent(s): the same motive as was dominant in at least 42% of the biographied killers. One man had been mocked by his father and threatened with castration - for being homosexual. When he turned to sexual sadism, he cut off and cannibalized the genitals of a male adolescent. Hospitalized now for 25 years, he has shown no remorse or insight. The author will give other examples from this highly treatment-resistant group.

106
PSYCHIATRIC DISORDERS AS PREDICTORS FOR RECIDIVISM IN SEXUAL MURDERERS

Andreas Hill, Peer Briken, Niels Habermann, Wolfgang Berner
Institute of Sex Research and Forensic Psychiatry, University Hospital Hamburg-Eppendorf, hill@uke.uni-hamburg.de

Only scarce data – and virtually no follow-up studies - exist about prognostic factors in sexually motivated homicide.
Psychiatric court reports on 166 men (mean age at the time of the first sexual homicide 26 yrs) who committed a sexual homicide between 1945 and 1992 in Germany were analyzed by three raters using standardized instruments (SCID-II, PCL-R, HCR-20, SVR-20, Static-99). Interrater reliability ranged between acceptable and high. Follow-up data were obtained from the federal criminal records.
High prevalence rates were found for substance abuse/dependency (alcohol 47.0%, illegal drugs 10.2%), paraphilias (51.8%, esp. sexual sadism 36.7%), sexual dysfunctions (21.7%) and personality disorders (78.3%), particularly antisocial (27.1%), Borderline (18.7%), sadistic (17.5%), NOS (13.9%), schizoid (16.3%), avoidant (12.7%) and narcissistic PD (9.6%). To establish possible prognostic indicators we compared offenders with a single victim (78.3%) with those who had killed more than one victim (21.7%). The two groups did not differ in sociodemographic characteristics and IQ. Multiple sexual murderers were more often diagnosed with sexual sadism (66.7% vs. 28.5%, OR 5.0, p<.001), voyeurism (19.4% vs. 2.3%, OR 10.2, p<.001), antisocial PD (47.2% vs. 21.5%, OR 3.3, p<.01), sadistic PD (38.9% vs. 11.5%, OR 4.9, p<.001) and schizoid PD (27.8% vs. 13.1, OR 2.56, p<.05). First follow-up data about release from prisons or forensic hospitals and subsequent offenses will be presented.
Preliminary conclusions: Sexual sadism and character sadism (sadistic PD) as well as antisocial and schizoid personality traits can be seen as predictive indicators for multiple sexual murderers.

107
THE ROLE OF BRAIN ABNORMALITIES IN SEXUAL MURDERERS

Peer Briken, Andreas Hill, Niels Habermann, Wolfgang Berner
Institution: Institute of Sex Research and Forensic Psychiatry, University Hospital Hamburg-Eppendorf, hill@uke.uni-hamburg.de

Little is known about the role of brain abnormalities in sexual murderers. The objective 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=106).
Sexual murderers with brain abnormalities suffered more from early behavior problems. During the sexual homicide they were less likely to cohabitate with the victim and had more victims that were younger than six years. Psychiatric diagnoses according to DSM-IV 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 to belong to the group with brain abnormalities: transvestic fetishism and paraphilias not otherwise specified, insertion of foreign objects into the victim's vagina, victims that were 6 years or younger, the absence of alcohol abuse and addiction. These factors accounted for 46.8% of the variance explaining the presence of brain abnormalities.
Our results suggest the importance of a precise neurological and psychological examination of this special offender group.