For the “schizophrenia as consequence of offending” explanation, it has been proposed that schizophrenia may be a consequence of the associated stress and trauma brought about by committing an offence, particularly a violent offence. There is some support for this, with research showing that committing a violent offence is associated with suicide and self/harm and victimisation among people with schizophrenia (Hillbrand, 2001; Nicholls, Brink, Desmarais, Webster, & Martin, 2006).
With respect to the third explanation, research shows that similar factors are associated with both schizophrenia and violent behaviour, such as negative life experiences relating to families, relationship problems, low socioeconomic status, and loss of employment (Elbogen & Johnson, 2009; Walsh, Buchanan, & Fahy, 2002). Therefore, it has been suggested that experiencing stressful life events can lead to both schizophrenia and offending/violence for individuals with a predisposing vulnerability. The role of comorbid substance misuse has also been highlighted (Elbogen & Johnson, 2009; Van Dorn et al., 2012). Use of alcohol and drugs is likely to exacerbate the psychotic symptoms of schizophrenia, and may also lead to a reduced compliance with medication. Substance misuse is also associated with an elevated risk of offending in its own right (Mills, Kroner, & Hemmati, 2003). Offenders with a diagnosis of schizophrenia may also have other mental health problems, further complicating the picture.
Depression can be split into two types: unipolar (major) depression and bipolar depression. Major depression is characterised by a pervasive sad mood, feeling of guilt and self-blame, disturbed appetite, tiredness, lethargy and recurring thoughts of suicide. In bipolar depression individuals experience alternating periods of mania and depression. Of these, major depression is the most common and affects 8% of the general population, with bipolar experienced by about 1%. In contrast, research among offenders has found the prevalence of depression to be higher. For example in Fazel and Seewald’s (2012) review, the prevalence of major depression was 10.2% among male prisoners and 14.1% among women prisoners.
There are a number of ways in which depression and offending may be linked: first, an individual may offend because they are depressed; second, depression may be triggered by guilt after an offence; and third, an individual may be depressed when they committed an offence, but the depression did not cause the offence. It is also possible that imprisonment for an offence may trigger depression.
Most attention has focused on the first and third explanations. The research suggests that the link between depression and offending is much weaker than for schizophrenia and personality disorder (e.g., Grann et al., 2008). With respect to the third explanation, it is also important to consider what factors may have triggered the depression. Social and environmental factors are often precursors to a depressive episode, such as losing a job or relationship problems (Kendler, Karkowski, & Prescott, 1999). As noted above these factors are themselves also associated with an increased risk of offending.
Overall, for both schizophrenia and depression, mental illness may not be the only factor to consider when explaining the link with offending. Account should also be taken of the complex interactions between the individual, their mental state, their predispositions, and social and environmental factors. The exacerbating influence of substance misuse should also not be ignored. Furthermore, the influence of each of these factors may vary for different people at different times.
CASE STUDY 1.2 A VIOLENT ACT: MENTAL ILLNESS OR SOCIAL ISOLATION?
In recent years there has been a spate of mass killings by gunmen in the US. A high-profile case occurred at Virginia Tech University in April 2007, in which a 23-year-old student (Seung-Hui Cho) shot 32 other students and staff before killing himself. In the days following the shootings, it emerged that the gunman had experienced mental health problems, and had shown suicidal tendencies since he was 13 years old. However, a closer look at his history reveals other issues that were implicated in what happened.
Cho’s family had moved to the US when he was 8 years of age. Not knowing much English led to social isolation, and even once his language skills improved Cho remained quiet, and even withdrawn. At age 12, he was diagnosed with social anxiety disorder, specifically selective mutism. He was prescribed antidepressants, which seemed to help, but was taken off these after about a year. Cho is reported as not having a good relationship with his father, and not speaking much to his parents. However, how much this was normal teenage behaviour rather than problematic is not clear.
At high school his teachers developed a programme to help him complete his school week and he continued to attend counselling. As a result, he graduated in 2003 with good grades. Although the school suggested he go to college close to home, he chose to apply to Virginia Tech. His counsellor gave Cho the name of someone there for him to call if he needed help; however, he never used this.
PHOTO 1.3 In recent years there has been a spate of mass killings by gunmen in the US.
Source: © Pressmaster/Shutterstock
The first few years at college appeared to go fine, with Cho achieving good grades and being in regular contact with his family. However, in autumn 2005 problems started to appear. He stopped writing home, argued with his teachers, and complaints were received from female students about receiving harassing emails, text messages and phone calls. As a result he was referred to counselling. A roommate also reported that after one warning to stop contacting a woman Cho said, “I might as well kill myself now”. A psychiatric evaluation followed, along with a few brief phone calls with a counsellor.
Reviewing these facts, it would appear that Cho certainly had mental health problems. However, it is also clear that his social isolation and lack of social skills were also contributory factors to what happened. The strong support system that acted as a safety net at high school was simply not there at university, and he gradually became more isolated. These environmental factors were clearly important in the deterioration in Cho’s mental health and the associated increase in his antisocial behaviour – and provide a good example of the complex nature of the mental illness/offending relationship.
1.4.2.2 Intellectual disabilities
Individuals with intellectual disabilities (ID) are characterised by impairments of intelligence and social functioning. While there are no legal criteria of IQ score for ID, in clinical practice an IQ of 70 is normally seen as “borderline”. When this is combined with below average social functioning, a diagnosis of LD is applied. An IQ of less than 50 represents a substantial amount of impairment. Intellectual disability can be present from birth or can result from hypoxia (lack of oxygen) at birth, serious illness or brain damage.
Within the general population, 2–2.5% of people have IQs of less than 70 (Holland, 2004). A recent systematic review by Fazel, Xenitidis, and Powell (2008) of ten studies from four countries reported that between 0% and 2.8% of prisoners were diagnosed with intellectual disabilities, from which they concluded that the typical percentage of ID diagnosis was 0.5–1.5%. However, this figure may be low due to offenders with intellectual disabilities receiving hospital orders under the Mental Health Act or being dealt with in the community, rather than being imprisoned. Other studies have examined the prevalence of offending among individuals known to services for intellectually disabled people. Again, these have shown low levels of offending, ranging from 2% (Lyall, Holland, Collins, & Styles, 1995) to 5% (McNulty, Kissi-Deborah, & Newsom-Davies, 1995). A UK study by Wheeler et al. (2009) found that 4.6% of people with intellectually disabled people in their sample were referred to community services for adults with learning disability for antisocial behaviour or offending, although only 0.8% exhibited behaviour leading to contact with the criminal justice system.
Notwithstanding these figures, it is not at all clear how intellectual disabilities and offending are linked. The term “intellectual disability” covers a wide range of individuals who can differ on a number of characteristics. As a result there is no clear definition of the term, particularly within the bo
rderline area. Research suggests that there are two groups of offenders with intellectual disabilities (Holland, 2004). First, there are offenders with a mild intellectual disability who are not known to services, and often come from disadvantaged homes in which other family members are offenders and share many characteristics in common with general offenders. Second is a more heterogeneous group of offenders who are known to intellectual disability services. These offenders are thought to commit fewer offences, but it is thought that they may be more dangerous.
While people with intellectual disabilities commit a variety of offences, there appears to be a disproportionate number convicted for sexual offences (Law, Lindsay, Quinn, & Smith, 2000). However, there appear to be distinct differences between the sexual offences committed by offenders with intellectual disabilities and the general sexual offender population. Compared to the general sexual offender population, the sexual offences committed by offenders with intellectual disabilities typically involve less planning and the victim often does not know the offender. This has led to suggestions that sexual offences by offenders with intellectual disabilities may represent inappropriate and impulsive behaviour towards other people, rather than being deliberate acts of sexual aggression. It may be that the person with intellectual disabilities is not aware of the social rules governing acceptable behaviours in such situations, but lacks the social competence to express their feelings and the social skills required to make acceptable sexual approaches to people.
Similar explanations have been suggested with regard to offenders with intellectual disabilities who have committed violent offences. Here, it may be that the violent behaviour is a result of impulsivity or frustration, or a lack of social skills in dealing with provocative situations. The care and treatment of offenders with intellectual disabilities is discussed in Chapter 21.
1.4.2.3 Personality disorders
A personality disorder is a persistent disorder that impacts on how the individual relates to themselves, others and their environment, leading to major problems in their social functioning. There are ten personality disorders that are classified into three categories by DSM-V (American Psychiatric Association, 2013). Cluster A (odd-eccentric) includes paranoid, schizoid and schizotypal personality disorders; Cluster B (dramatic-erratic-emotional) includes antisocial, borderline, histrionic and narcissistic personality disorders; and Cluster C (anxious-fearful) includes avoidant, dependant and obsessive-compulsive personality disorders.
Coid, Yang, Tyrer, Roberts, and Ullrich (2006) reported a prevalence of 4.4% for at least one personality disorder among adults in the general population in Great Britain (5.4% of men and 3.4% of women). The most prevalent was obsessive compulsive personality disorder (2.6%), with the least prevalent being dependent and schizotypal personality disorders. These figures are considerably higher in forensic settings. Findings from the Prisoner Cohort Study in England and Wales found that 72.9% of male prisoners met the criteria for at least one personality disorder (Roberts, Yang, Zhang, & Coid, 2008). Antisocial personality disorder (64.5%) was the most prevalent followed by paranoid personality disorder (21.7%), with histrionic and dependent personality disorders the least prevalent (1.2% and 0.7% respectively). Within the prisoner sample there were also considerable levels of comorbidity with other personality disorders and mental illness.
Research shows there to be some relationship between personality disorders and offending, especially antisocial personality disorder and violent offences (Roberts & Coid, 2010). Less research has examined other personality disorders and offending, although Roberts and Coid (2010) report a number of relatively small correlations of other personality disorders with a range of offence types. While the exact nature of this relationship is not fully understood, as noted by Hart (2001) there are a number of personality traits common to many personality disorders that are associated with offending. These traits include anxiety, emotional instability, insecure attachments, depressiveness, hostility, impulsivity and lack of empathy. Furthermore, being aggressive and a history of antisocial behaviour are diagnostic criteria for antisocial personality disorder. However, care should be taken when attributing causality of offending to personality disorder, as there may be factors other than the personality disorder that increase the risk of offending, including comorbidity of substance abuse, other personality disorders and other mental illness.
1.4.3 Psychopathy and Offending
When considering personality disorder, the terms “psychopathy”, “psychopathic disorder” or “psychopathic offenders” are often referred to. However, although there are overlaps, psychopathy and personality disorder are not the same thing, although some psychopaths show traits similar to a personality disorder, specifically antisocial personality disorder (ASPD).
There have been attempts to develop diagnostic criteria for psychopathy. Some of the most important work in this area is that of Cleckley (1976) and Hare (1980). This work highlighted a number of characteristics as defining psychopaths. These include a lack of guilt and remorse, impulsiveness, irresponsibility, pathological lying, manipulativeness, shallow affect, egocentricity, glibness, superficial charm, and a failure to learn from experience. Hare went on to develop a clinical assessment tool, the Psychopathy Checklist-Revised (Hare, 1991; 2003) comprising 20 items:
Superficial charm
Grandiose sense of self-worth
Need for stimulation/easily bored
Pathological lying
Manipulative
Lack of remorse or guilt
No emotional depth
Callous
Parasitic lifestyle
Poor behavioural control
Promiscuous sexual behaviour
Early behaviour problems
Lack of long-term planning
Impulsive
Irresponsible
Failure to accept responsibility for own actions
Frequent marital failures
Juvenile delinquency
Poor record on probation or conditional release
Criminal versatility
To be classified as a psychopath on the PCL-R, a cut-off score of 30 is used, although 25 has been suggested as more appropriate in some jurisdictions. Research suggests that these items assess three inter-related aspects of psychopathy: (1) an arrogant and manipulative interpersonal style; (2) affective deficits; and (3) an impulsive and irresponsible behavioural style (Cooke & Michie, 1998; Cooke, Michie, Hart, & Clark, 2004).
A large body of research exists showing that offenders with psychopathy (as assessed using the PCL-R) are persistent and serious offenders, with a particularly strong relationship between psychopathy and violence (see meta-analyses by Blais, Solodukhin, & Forth, 2014; Campbell, French, & Gendreau, 2009; Edens, Campbell, & Weir, 2007; Kennealy, Skeem, Walters, & Camp, 2010; Leistico, Salekin, DeCoster, & Rogers, 2008). However, less is known about the mechanisms of this relationship. Three suggestions have been put forward by Hart (1998), relating to cognition, affect and behaviour. First, psychopaths exhibit a cognitive pattern that includes a hostile attributional bias, attentional deficits, and beliefs that support the reinforcing nature of violence. Second, they show affective deficits in guilt, empathy, and fear that can increase the likelihood of offending regardless of the consequences for the safety of themselves or other people. Third, psychopaths exhibit behavioural impulsiveness, often acting without thinking. The nature and treatment of psychopathy is discussed in greater detail in Chapter 3.
1.5 CONCLUSIONS
This chapter has considered how psychological theory and research has contributed to our understanding of offending. As has been shown, some theories such as moral reasoning theory and social information-processing approaches have been applied to general offending. Psychology has also been applied to the specific areas of violent offending, sexual offending and arson, in an attempt to provide a greater understanding of these more serious crimes.
Mentally disordered offenders provide another challenge to psychol
ogy, in that a range of individuals with different problems falls under this umbrella. Considering these offenders by types of mental disorder allows us to begin to understand the associations between these disorders and offending. This research provides some clarification of the question of whether mental disorder causes offending or if the association can be explained with reference to other factors. As has been shown, while it is true that an association does exist, it is often difficult to disentangle issues of causality. Finally, the special case of the psychopathic offender was considered. This highlighted the problems with the legal definition of psychopathic disorder and its relationship to the concept of psychopathy as defined by Hare (1991).
Overall, it can be seen that psychology can make an important contribution to our understanding of why people offend. However, there remain a number of issues that we do not yet fully understand, and further research is required in these areas. Examples of these include the developmental precursors to sexual offending, a coherent theory of arson and firesetting, and the true nature of the link between mental disorder and offending. The importance of this knowledge is in how it can be translated into practice with offenders, in terms of informing future developments in both working with offenders to reduce their likelihood of reoffending and designing strategies to prevent the development of offending behaviour in the first place.
1.6 SUMMARY
This chapter has considered how psychological theories and research has contributed to our understanding of offending.
Theories such as Kohlberg’s theory of moral reasoning and social information-processing approaches have been applied to offending behaviour.
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