Forensic Implications of the Parasomnias

Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.

Efforts to Reify Other Specified Paraphilic Disorder (Nonconsent) and Their Implications

The concept of a paraphilic interest in rape was first described in the 1970s but became popular in the early 1990s with the advent of sexually violent predator laws. Today, the concept is described as other specified paraphilic disorder (nonconsent) (OSPD (nonconsent)) and is the second most common diagnosis of individuals committed to state facilities as sexually violent predators. This usage continues despite research indicating that OSPD (nonconsent) lacks scientific validity and has consistently poor interrater reliability. Furthermore, the concept of paraphilic rape has been repeatedly rejected from inclusion in the DSM over a span of decades. Despite obvious flaws in the construct, some experts continue to promote OSPD (nonconsent) and to present unresearched, unvalidated, and idiosyncratic criteria by which to assess individuals. This article reviews the history and development of the concept of a paraphilic interest in rape, describes its scientific flaws, reviews its proponents' efforts to reify it as a clinical entity, and considers the ethics, legal, and evaluative implications of experts' efforts to do so.

Psychedelic Psychiatry: Preparing for Novel Treatments Involving Altered States of Consciousness

The past decade has seen a renaissance of research interest into the psychotherapeutic potential of psychedelic compounds. In 2019, Oakland and Denver became the first two jurisdictions in the United States to decriminalize the possession of psychedelic-containing organisms. As research and public policy continue to evolve, it becomes increasingly plausible that psychedelics will become viable treatment options for psychiatric conditions. Psychiatrists should be integral to models of psychedelic prescription and patient management. The risk for adverse psychological and medical effects from psychedelic sessions necessitates psychiatric supervision. The literature on psychedelic-assisted psychotherapy may provide wisdom regarding practical aspects of managing patients' treatment sessions.

Bestiality Among Sexually Violent Predators

Bestiality, or sexual contact between humans and nonhuman animals, is a poorly understood aspect of sexual behavior. There is a dearth of scientific research on the prevalence of bestiality, the motivations for individuals to engage in the behavior, and the risk that such individuals pose for interpersonal sexual and nonsexual violence. This study is a descriptive analysis of bestiality in all individuals found to be sexually violent predators (SVPs) in the state of Virginia between the years 2003 and 2017. Of 1,248 SVPs, 33 (2.6%) had a history of engaging in bestiality. SVPs with a history of bestiality were significantly more likely to be victims of childhood sexual abuse (P < .005), to engage in nonsexual animal abuse (P < .0001), and to have committed child sexual abuse (P < .005). They were most likely to report sexual contact with dogs and demonstrated a breadth of other atypical sexual behavior. The lifetime prevalence of 2.6 percent is low compared with other published findings, suggesting that offenders may have intentionally minimized their history of atypical sexual behavior. The relationship between childhood sexual victimization and bestiality has not previously been reported in the literature and represents an important nidus for future investigation. Further research is necessary to characterize human-animal sexual interactions in SVPs and other populations.

The admissibility of other specified paraphilic disorder (non-consent) in sexually violent predator proceedings

Following the advent of sexually violent predator (SVP) legislation in the early 1990s, forensic evaluators began to apply diagnostic labels related to a paraphilic interest in rape as a mental condition predisposing individuals convicted of sexual offenses to recidivate. The most recent iteration of the concept, other specified paraphilic disorder (non-consent) (OSPD (non-consent)), is a commonly utilized diagnostic entity in SVP proceedings. Research on paraphilic interest in coercive sex has failed to define a valid methodology or set of criteria to make a diagnosis of OSPD (non-consent) and has repeatedly demonstrated that the diagnostic construct has poor interrater reliability. The state of the science pertaining to OSPD (non-consent) thus raises serious concerns regarding its admissibility in SVP proceedings. Indeed, there are recent cases in which courts have deemed it inadmissible. The forensic expert involved in SVP proceedings should understand admissibility concerns related to OSPD (non-consent) and how to address them in court.

The Psychedelic Renaissance and Its Forensic Implications

Recent years have seen a renaissance of research into the use of psychedelic compounds to address various psychiatric conditions. The study of these substances went dormant in 1970 when the United States government passed the Controlled Substances Act, which categorized lysergic acid diethylamide, commonly known as LSD or acid, as a Schedule I drug. The rise of psychedelics in research settings raises questions regarding their risks outside of clinical trials. The available data on the impact of psychedelic use on interpersonal violence and other criminal behavior remain scant. Although Timothy Leary's work of the 1960s failed to clearly demonstrate a reduction in criminal recidivism with psychedelic-assisted psychotherapy, recent studies suggest that the use of psychedelics may reduce individuals' risk of interpersonal violence. Forensic psychiatrists should be aware of this research, as well as the role that psychedelics may play in various forensic assessments. This article summarizes basic information that the forensic practitioner should know about psychedelic substances, including their various effects and proposed mechanism of action; describes historical and recent research into psychedelics and criminal behavior; and offers evaluators a practical means by which to assess individuals' psychedelic use in forensic contexts.

Bestiality: An introduction for legal and mental health professionals

Bestiality, or human-animal intercourse, has been a concern of the legal and mental health communities for many years. Ancient legal codes delineated punishments for those who engaged in the behavior, denoting a moral and general societal concern surrounding bestiality dating to ancient times. Despite this longstanding interest in and legal efforts to punish humans for having sex with animals, there has been little research on the behavior. Current available research has largely been siloed based on the populations studied, making it difficult to render any firm conclusions about bestiality's prevalence, frequency, and the risk posed by those who have sex with animals. It is important for clinicians to know the legal status of the behavior in their jurisdictions, to understand possible medical and psychiatric complications and comorbidities, and to know how to evaluate and treat individuals who engage in bestiality or have the related diagnosis of zoophilic disorder. This article provides an overview of the terminology and research pertaining to bestiality, summarizes legal and ethical considerations, and describes clinically relevant information for the evaluation and management of individuals engaged in sex with animals.

Trouble at teens' fingertips: Youth sexting and the law

The last decade has seen a rapid increase in the use of smartphones among young children and adolescents. One consequence of this phenomenon is sexting. Although researchers of sexting have yet to arrive at a single, cohesive definition for the behavior, it generally involves the transmission of text, pictures, or videos containing sexual material. Different definitions of the behavior have led to widely varying estimates of its prevalence, although some studies have documented relatively high rates of sexting among teenagers. As adolescence is the time period in people's lives where the psychological tasks of identity consolidation and the development of intimate relationships become primary, it is not surprising that many teens utilize sexting as one way of practicing skills associated with successful completion of these tasks. The criminal prosecution of sexting cases, then, raises many legal and ethical questions. Offenders may be prosecuted under state or federal child pornography laws or state-specific sexting laws. Sexting laws, particularly in instances of consensual sext exchange, call into question who they are meant to protect and from what. In this article we review the research on teen sexting, its prevalence, and its association with mental health problems; summarize legal responses to the behavior in the United States; and identify considerations for prosecutors and legal decision-makers facing sexting cases.

Mental health courts and forensic assertive community treatment teams as correctional diversion programs

Problem-solving courts (PSCs) developed as a means of mandating treatment and judicial supervision of certain types of court participants. PSCs have rapidly expanded in number and type over several decades. Mental health courts (MHCs) are a type of PSC that arose in response to the growing number of persons with mental illness within the criminal justice system. Their primary role is to divert individuals with mental illness from incarceration into psychiatric treatment and to reduce recidivism while improving psychosocial functioning of participants. Although different in history, philosophy, and program structure, forensic assertive community treatment (FACT) programs serve a similar goal of reducing recidivism and improving functioning in persons with mental illness who are involved with the criminal justice system. FACTs may be used as a standalone diversion option or be linked with a MHC as a form of intensive treatment and monitoring. Suggestions for future research and evaluation of these programs are offered.

Characteristics of Misdemeanants Treated for Competency Restoration

There are an estimated 60,000 evaluations annually for competence to stand trial for felony indictments and likely more for misdemeanor indictments. Thus, there is an increasing interest in determining factors associated with a defendant's likelihood of being restored to competence to stand trial. Although previous studies have found that a misdemeanor charge predicts significantly less likelihood of restoration of competence when compared with felony charges, states typically allow treatment facilities less time to restore misdemeanor defendants than felony defendants. As there are no studies examining factors associated with restoration of competence to stand trial for misdemeanor defendants, separately from felony defendants, we conducted a retrospective study to examine demographic, clinical, and forensic characteristics associated with restoration of competence to stand trial of misdemeanor defendants. Almost 70 percent of defendants regained competence to stand trial during the study period. When restorable, defendants regained competence in less than three weeks, on average, which addresses a current question in the field regarding time limits for restoration of competence to stand trial. Single marital status and length of stay in the treatment facility during restoration of competence to stand trial were significantly associated with restorability. States may consider such factors when developing and reviewing time limit policies in consideration of the Jackson v. Indiana ruling and when designing interventions aimed at restoring competence to stand trial to misdemeanor defendants in a cost-efficient manner.

Bestiality in Forensically Committed Sexual Offenders: A Case Series

Although bestiality has occurred since prehistoric times, it remains a poorly understood aspect of human sexuality. Prevalence studies in the mid-20th century suggested that bestiality was a relatively common phenomenon. Since that time, researchers have studied bestiality among specific populations, including self-identified "zoophiles" and inmates who report a history of bestiality. Findings from inmate research suggest that bestiality may represent a risk factor for future interpersonal violence. This study presents a case series of bestiality among sexual offenders committed under forensic commitment schemes. The case series demonstrates the range of animal partners, sexual acts, and comorbid paraphilic and nonparaphilic diagnoses in individuals who report a history of bestiality. In addition, it helps clarify potential motivations for sex with animals and how such motivations may influence the forensic psychiatric assessment of offenders who have sex with animals.

Between Belief and Delusion: Cult Members and the Insanity Plea

Cults are charismatic groups defined by members' adherence to a set of beliefs and teachings that differ from those of mainstream religions. Cult beliefs may appear unusual or bizarre to those outside of the organization, which can make it difficult for an outsider to know whether a belief is cult-related or delusional. In accordance with these beliefs, or at the behest of a charismatic leader, some cult members may participate in violent crimes such as murder and later attempt to plead not guilty by reason of insanity (NGRI). It is therefore necessary for forensic experts who evaluate cult members to understand how the court has responded to such individuals and their beliefs when they mount a defense of NGRI for murder. Based on a review of extant appellate court case law, cult member defendants have not yet successfully pleaded NGRI on the basis of cult involvement, despite receiving a broad array of psychiatric diagnoses that could qualify for such a defense. With the reintroduction of cult involvement in the DSM-5 criteria for other specified dissociative disorder, however, there may be a resurgence of dissociative-type diagnoses in future cult-related cases, both criminal and civil.

Zoophilia and the law: legal responses to a rare paraphilia

Although societies' responses to bestiality have varied internationally, the response in the United States has typically involved condemnation and prosecution. Currently, there are 31 states with statutes prohibiting human-animal sexual contact. Despite the prevalence of antibestiality legislation, there is limited case law in the United States. Most commonly, bestiality arises in legal cases involving sexually violent predator (SVP) civil commitments. Identifying offenders who commit acts of bestiality is important, since these individuals may be at increased risk of committing a variety of other sexually and nonsexually violent acts against humans. Because of the different laws among the states, however, commonly used forensic risk assessment tools for sexual recidivism can yield different scores for individuals charged with or convicted of bestiality offenses. Forensic evaluators should consider this factor when conducting risk assessments. State legislatures should also consider modernizing their bestiality statutes to accord with current terminology and objectives for such laws.