Stalkers and harassers of royalty: the role of mental illness and motivation.

BACKGROUND: Public figures are at increased risk of attracting unwanted attention in the form of intrusions, stalking and, occasionally, attack. Whereas the potential threat to the British Royal Family from terrorists and organized groups is clearly defined, there is a dearth of knowledge about that from individual harassers and stalkers. This paper reports findings from the first systematic study of this group. METHOD: A retrospective study was conducted of a randomly selected stratified sample (n=275) of 8001 files compiled by the Metropolitan Police Service's Royalty Protection Unit over 15 years on inappropriate communications or approaches to members of the British Royal Family. Cases were split into behavioural types. Evidence of major mental illness was recorded from the files. Cases were classified according to a motivational typology. An analysis was undertaken of associations between motivation, type of behaviour and mental illness. RESULTS: Of the study sample, 83.6% were suffering from serious mental illness. Different forms of behaviour were associated with different patterns of symptomatology. Cases could be separated into eight motivational groups, which also showed significant differences in mental state. Marked differences in the intrusiveness of behaviour were found between motivational groups. CONCLUSIONS: The high prevalence of mental illness indicates the relevance of psychiatric intervention. This would serve the health interests of psychotic individuals and alleviate protection concerns without the necessity of attempting large numbers of individual risk predictions. The finding that some motivations are more likely to drive intrusive behaviours than others may help focus both health and protection interventions.

The role of mental disorder in attacks on European politicians 1990-2004.

OBJECTIVE: The only systematic studies of attacks on public figures come from the USA. These studies de-emphasize the role of mental illness and suggest threats are of no predictive value. This study re-examines these questions through a study of attacks on European politicians. METHOD: All non-terrorist attacks on elected politicians in Western Europe between 1990 and 2004 were analysed. RESULTS: Twenty-four attacks were identified, including five involving fatalities, and eight serious injuries. Ten attackers were psychotic, four drunk, nine politically motivated and one unclassifiable. Eleven attackers evidenced warning behaviours. The mentally disordered, most of whom gave warnings, were responsible for most of the fatal and seriously injurious attacks. CONCLUSION: A greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention. Equally importantly, recognition would encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives.

Investigating the role of screen violence in specific homicide cases.

Despite a substantial body of research indicating a significant and causal empirical relationship between viewing what the authors label "screen violence" and behaving violently, little attention has been paid to the forensic psychological and psychiatric investigation of these phenomena in specific homicide cases. Through the analysis of seven cases of homicide, mostly committed by adolescents, the authors introduce five concepts--aggression immersion, theme consistency, scene specificity, repetitive viewing, and self-editing--for advancing such investigations.

Communicated threats and violence toward public and private targets: discerning differences among those who stalk and attack.

A computation of false positive and false negative rates concerning the probability that directly communicated written or oral threats predict subsequent violent behavior yields a striking difference between "public" and "private" targets. Among private targets, communicated threats appear to increase risk, but are so common that they have little predictive value. On the other hand, public targets are unlikely to receive a direct threat from those who approach to attack. The author suggests that the most parsimonious explanation for this difference is the type, or mode of violence, that is apparent. Private targets appear to be most likely victimized by affective violence, wherein the emotionally reactive subject will immediately shove, push, punch, slap, choke, fondle, or hair pull the victim without the use of a weapon, usually in response to a perceived rejection or humiliation. Public targets are most likely to be victimized by predatory violence, which is planned, purposeful, cognitively motivated, opportunistic rather than impulsive, and often involves a firearm. Implications for risk assessment are discussed.

Offender and offense characteristics of a nonrandom sample of adolescent mass murderers.

OBJECTIVE: The authors conducted a descriptive, archival study of adolescent (< or =19 years of age) mass murderers-subjects who intentionally killed three or more victims in one event-to identify demographic, clinical, and forensic characteristics. METHOD: A nonrandom sample of convenience of adolescent mass murderers was utilized. RESULTS: Thirty-four subjects, acting alone or in pairs, committed 27 mass murders between 1958 and 1999. The sample consisted of males with a median age of 17. A majority were described as "loners" and abused alcohol or drugs; almost half were bullied by others, preoccupied with violent fantasy, and violent by history. Although 23% had a documented psychiatric history, only 6% were judged to have been psychotic at the time of the mass murder. Depressive symptoms and historical antisocial behaviors were predominant. There was a precipitating event in most cases--usually a perceived failure in love or school--and most subjects made threatening statements regarding the mass murder to third parties. The majority of the sample clustered into three types: the family annihilator, the classroom avenger, and the criminal opportunist. CONCLUSIONS: The adolescent mass murderer is often predatorily rather than affectively violent and typically does not show any sudden or highly emotional warning signs. Although the act of mass murder is virtually impossible to predict because of its extremely low frequency, certain clinical and forensic findings can alert the clinician to the need for further, intensified primary care, including family, school, community, law enforcement, and mental health intervention.

A Rorschach comparison of psychopaths, sexual homicide perpetrators, and nonviolent pedophiles: where angels fear to tread.

Nonsexually offending psychopaths (N = 32) were compared to sexual homicide perpetrators (N = 38) and nonviolent pedophiles (N = 39) on select Comprehensive System Rorschach variables (Exner et al., 1993). Results indicate similarities among the groups in pathological narcissism, formal thought disorder, and borderline level reality testing. Nonsexually offending psychopaths are distinguished by their lack of interest in and attachment to others and their seemingly conflict-free internal world. While both sexually deviant groups evidenced interest in others and appear to experience a very dysphoric internal world, the sexual homicide perpetrators are distinguished by high levels of obsessional thought and an inability to disengage from environmental stimuli. Pedophiles show significantly more characterological anger, which may stem from their general inadequacy, cognitive rigidness, less alloplastic (acting out) style, and their introversive inability to gratify their needs. Rorschach differences add to our understanding of sexual deviation and violence among these three groups.

A cross-cultural review of sudden mass assault by a single individual in the oriental and occidental cultures.

A nonrandom sample of North American cases of sudden mass assault by a single individual (SMASI, n = 30) is compared with a nonrandom sample of Laotian amok cases (n = 18) and other amok studies. Perpetrators in both studies show evidence of social isolation, loss, depression, anger, pathological narcissism, and paranoia, often to a psychotic degree. The term "innovative perpetrator" is reintroduced and expanded upon. Similarities among samples far outweigh differences, leading the authors to conclude that SMASI and its appearance in different cultures is not a culture-bound syndrome.

Clinical and forensic indicators of "suicide by cop".

This paper reviews the literature pertaining to the phenomenon of "suicide by cop"--any incident in which a suicidal individual attempts to get law enforcement to kill him. This article defines the term "suicide by cop," discusses the various motivations of individuals who engage in this type of behavior, presents the risk factors and indicators for suicide and violence, and describes specific indicators for suicide by cop. Proper recognition of these events, prior and subsequent to their occurrence, has important implications for prevention, officer safety, equivocal death analysis and psychological autopsy, civil litigation, criminal justice proceedings, and community stability. This paper presents seven case studies which demonstrate the clinical and forensic indicators of this phenomenon.

A replication study of obsessional followers and offenders with mental disorders.

The purpose of this study was to compare certain demographic, clinical, and criminal variables within subgroups of obsessional followers, and compare them to a group of offenders with mental disorders to attempt to replicate earlier findings. A static group archival design utilized a non-random group of convenience and a randomly selected comparison group. Sixty-five obsessional followers and 65 offenders with mental disorders were evaluated by psychiatrists and psychologists for court ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and generally for sentencing determinations. The obsessional followers were measured on demographic, diagnostic, pursuit, victim, threat, violence, emotional, motivational, and defense variables. Inferential comparisons that used parametric and nonparametric statistics were done within and between groups on select variables. The obsessional followers had significantly greater estimated IQ than the offenders with mental disorders, but were neither older nor better educated. There were no significant differences in the high prevalence of both DSM-IV Axis I and II diagnoses. Obsessional followers who stalked prior sexual intimates were significantly more likely to have a substance abuse or dependence diagnosis. Obsessional followers who stalked strangers or acquaintances were more likely to be delusional. The majority of the obsessional followers, primarily motivated by anger, both threatened and were violent toward person or property. The modal obsessional follower is an average or above IQ, unemployed, unmarried male in his fourth decade of life. chronically pursuing a prior sexually intimate female. He is diagnosed with substance abuse or dependence and a personality disorder NOS, and has a prior psychiatric, criminal and substance abuse history. He is angry, likely to threaten her, and assault her person or property without causing serious injury.

Serial murder of six victims by an African-American male.

A case of a 22-year-old African-American male who sexually assaulted and murdered six African-American females who were strangers to him is reported. Formal study of the subject eight years after the homicides revealed a mildly mentally retarded individual who had, at various times, diagnosable anxiety and depressive disorders. His diagnosed paraphilia was sexual sadism. He also met criteria for both Antisocial and Schizoid Personality Disorder, which are discussed in the context of the comorbidity of psychopathy and schizotypy among some serial murderers. Traumagenic events from his childhood and adolescence included an absent father, sexual and physical abuse, the witnessing of adult sex, and the viewing of violent pornography.

Offender and offense characteristics of a nonrandom sample of mass murderers.

A nonrandom sample (N = 30) of mass murderers in the United States and Canada during the past 50 years was studied. Data suggest that such individuals are single or divorced males in their fourth decade of life with various Axis I paranoid and/or depressive conditions and Axis II personality traits and disorders, usually Clusters A and B. The mass murder is precipitated by a major loss related to employment or relationship. A warrior mentality suffuses the planning and attack behavior of the subject, and greater deaths and higher casualty rates are significantly more likely if the perpetrator is psychotic at the time of the offense. Alcohol plays a very minor role. A large proportion of subjects will convey their central motivation in a psychological abstract, a phrase or sentence yelled with great emotion at the beginning of the mass murder; but in our study sample, only 20 percent directly threatened their victims before the offense. Death by suicide or at the hands of others is the usual outcome for the mass murderer.

Sadism and psychopathy in violent and sexually violent offenders.

A nonrandom sample (N = 41) of inmates from a maximum security prison were classified as either psychopathic or nonpsychopathic (using the Psychopathy Checklist-Revised (PCL-R)) and violent or sexually violent. Sadism was measured using the Millon Clinical Multiaxial Inventory-II (MCMI-II) Scale 6B, the Personality Disorder Examination (PDE) items for sadistic personality disorder, and the sexual sadism criteria of DSM-IV. Psychopaths were found to be significantly more sadistic than nonpsychopaths (MCMI-II and PDE). Overall power was relatively high. Sadism did not differentiate the violent and sexually violent groups. A diagnosis of sexual sadism was too infrequent (n = 3) for meaningful statistical analysis. The trait measures of sadism and psychopathy measures (PCL-R, Factor 1 and Factor 2) significantly and positively correlated. Results provide further empirical validity for the theoretically proposed and clinically observed relationship between sadistic traits and psychopathic personality.

Erotomania, triangulation, and homicide.

A case of homicide by a 29-year-old male with erotomanic delusional disorder and various personality disorders is reported. Following a month of pursuit of a female stranger with whom he had briefly conversed in a local bar, he assaulted an automotive plant where she worked, delusionally believing that she was at imminent risk and needed to be rescued. One plant manager was killed and two police officers were wounded. The case illustrates the phenomenon of triangulation, where rage toward the rejecting object is displaced onto a third party, which is then perceived as impeding access to the victim and may be at risk for violent assault.

Stalking. An old behavior, a new crime.

Stalking is an old behavior, but a new crime. The author has reviewed what is currently known about the epidemiology, demography, psychiatry, psychology, pursuits and outcomes, threatening communications, violence, and clinical risk management of stalking cases. But this "dark heart of romantic pursuit" (p 7) extends beyond the paradigm of science and is often an aggressive and aberrant expression of unrequited love. In 1579, John Lyly wrote "As the best wine doth make the sharpest vinegar, so the deepest love turneth to the deadliest hate" (Euphues: The Anatomy of Wit).

Assaultive eye injury and enucleation.

An especially dangerous behavior observed in some forensic and security hospital populations is assaultive eye gouging. Although a number of case reports in the literature concern auto-enucleation, gouging out the eyes of another is virtually unmentioned. We present a case series of eye gougers (n = 10) gathered through clinical contributions from several forensic populations in the United States and Russia. Four subjects were psychotic during the eye-gouging episode, one was only mentally retarded, and five, who were neither psychotic nor retarded, deliberately injured victims' eyes during acts of extreme sexual violence.

Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murderers.

There appear to be no brain imaging studies investigating which brain mechanisms subserve affective, impulsive violence versus planned, predatory violence. It was hypothesized that affectively violent offenders would have lower prefrontal activity, higher subcortical activity, and reduced prefrontal/subcortical ratios relative to controls, while predatory violent offenders would show relatively normal brain functioning. Glucose metabolism was assessed using positron emission tomography in 41 comparisons, 15 predatory murderers, and nine affective murderers in left and right hemisphere prefrontal (medial and lateral) and subcortical (amygdala, midbrain, hippocampus, and thalamus) regions. Affective murderers relative to comparisons had lower left and right prefrontal functioning, higher right hemisphere subcortical functioning, and lower right hemisphere prefrontal/subcortical ratios. In contrast, predatory murderers had prefrontal functioning that was more equivalent to comparisons, while also having excessively high right subcortical activity. Results support the hypothesis that emotional, unplanned impulsive murderers are less able to regulate and control aggressive impulses generated from subcortical structures due to deficient prefrontal regulation. It is hypothesized that excessive subcortical activity predisposes to aggressive behaviour, but that while predatory murderers have sufficiently good prefrontal functioning to regulate these aggressive impulses, the affective murderers lack such prefrontal control over emotion regulation.

Bombing and psychopathy: an integrative review.

A review of the research on the motivations and behaviors of bombers is presented. The methodology consisted of a computer search of eight databases, book reviews, and telephonic interviews with local and federal law enforcement. The data were then compared to the substantial research on psychopathy. The authors conclude that a federally funded research effort is necessary, and should incorporate various structured interviews, history gathering, and psychological and physiological tests of incarcerated bombers, theoretically guided by the concordance between the known motivations and behavior of bombers and the concurrent and predictive validity of the construct, psychopathy.

The clinical risk management of stalking: "someone is watching over me....".

I have offered ten guidelines for the clinical risk management of stalking: a team approach, personal responsibility for safety, documentation and recording, no initiated contact, protection orders, law enforcement and prosecution, treatment if indicated, segregation and incarceration, periodic violence risk assessment, and the importance of dramatic moments. Although criminal stalking is not expected in mental health practice, the interpersonal anguish that often erupts in psychotherapy, and the reporting of relational intrusions that disrupt the safety of treatment, may foreshadow such distressing and potentially dangerous behavior. It is my hope that the clinician will be prepared for such untoward events, and these guidelines will shape an appropriate professional response. For as Racine wrote in 1667, "The heart that can no longer love passionately, must with fury hate." (Andromache, 1, trans. Robert Henderson).

Predatory violence during mass murder.

A case of mass murder by a 35-year old male is reported. Following a week of separation from his spouse and temporary loss of custody of his son, the subject went to his wife's worksite and murdered her and the store manager, wounded a passerby in a car, and murdered a police officer arriving on the scene. Weapons used were a .32 caliber revolver, a 9-mm pistol, a 7.62-mm assault rifle, and a .50-caliber rifle. The fact pattern of the case is shown to be quite consistent with a predatory mode of aggression-violence that is planned, purposeful, emotionless, and not preceded by autonomic arousal. The forensic importance of considering mode of violence, whether predatory or affective, independently of psychiatric diagnosis, is emphasized.