CBMH 14.2_3rd 21/5/04 11:33 am Page 122 122 Belfrage, Rying Introduction More attention than previously has been directed to spouse violence in recent years. It has been identified as a huge problem in our society; estimates indicate that between 3% and 14% of women in North America report assaults by their male partners every year (Johnson and Sacco, 1995). In the United States, the 1992 National Crime Victimization Survey indicated that more than a million women were victimized by their intimates (Healey and Smith, 1998). In Canada, spouse violence account for approximately 80% of all violence reported to the police, and 20–40% of all adult male offenders have a documented history of spousal assault (Kropp and Hart, 2000). In Sweden, where this study was conducted, approximately 20 000 cases of assault against women are reported to the police every year (Sweden has approximately 9 million inhabi- tants). Close to 80% of all violence against women in Sweden is performed by a perpetrator known to the victim (Rying, 2001). The dark figures in this area are expected to be high, and thus the cost of this violence to society is immense. Physical and psychological damage to the victims, deaths, increased healthcare costs, prenatal injury to infants, physical and psychological damage to children exposed to violence in their homes are just some of the effects leading to an increase in demand for social, medical and criminal justice services. New legislation, a batterer intervention programme and a victim protection programme are some of the strategies that society is working with in this area. One of the essential tasks in this field must be to identify women at high risk, and to develop strategies to reduce that risk. This implies a focus on the (potential) perpetrators. Who are they? What characteristics do they have? What risk factors are of particular importance when assessing risk for spouse violence? Can we identify certain batterer typologies, or are all men at equal risk? These are some questions that are essential to deal with. Important work has undoubtedly already been done in this area. The Spousal Assault Risk Assessment (SARA) Guide (Kropp et al., 1995), for example, is a validated and commonly used risk assessment guide in this field, and important work has been done by Campbell and co-workers on the specific issue of spouse homicide (e.g. Campbell, 1995). Despite the high prevalence of spouse assault the number of women who are actually killed by their batterers is comparatively small. Campbell (1995) reminds us that homicide occurs at a base rate of 9 in 100 000 in North America, while domestic violence is estimated to occur at a base rate of approx- imately 16 000 in 100 000. The corresponding figures for Sweden are a base rate of 0.36 homicides in 100 000 and 356 reported cases of spouse assault in 100 000 (Rying, 2001). Even though the prevalence of spouse violence is lower in Sweden compared with the US, the development during recent years is quite similar in the two countries: the number of spouse homicides is decreasing over time (US Department of Justice, 2000; Rying, 2001). It is speculated that an
CBMH 14.2_3rd 21/5/04 11:33 am Page 123 Characteristics of spousal homicide perpetrators 123 increased awareness of this problem in society, and consequently more compre- hensive protective actions taken against spousal assault, might be an important explanation for this decrease (Browne et al., 1999). The statistical consequence of the comparably small number of women being victims of spousal homicide is that prediction of spousal homicide based solely on a history of spouse violence is no better than chance. Not even as a group are battered women more likely to be killed than non-battered women, since approximately half of all women who are murdered by their partners were never physically abused prior to the homicide (see Walker and Meloy, 1998). This will be somewhat discouraging to professionals working with risk assessments and risk management in the field of spouse violence. In this study we have investigated all cases of spouse homicide in Sweden between 1990 and 1999 (n = 164), using all other cases of homicide in Sweden during the same period as the control group (n = 690). The aim has been to learn more about perpetrator characteristics in cases of severe spouse violence, and thus add to the research on risk assessment and risk management in spousal violence. Material and method The material consists of all material in police investigations, including inter- views with all of the police investigators; this included copies of police examinations of the suspects and forensic reports from the autopsies. All verdicts were also studied. The relation between the victims and the perpe- trators is given in Table 1. The 164 perpetrators who had been intimate partners with their victims (see Table 1), were selected as our study group. As a control group we used all other perpetrators of homicide in Sweden during the same period, i.e. cases of homicide not committed in the context of spouse violence (n = 690). The term ‘intimate partner’ is here defined as current or former married, cohabitants, or boyfriend-girlfriend. Table 1: Relation between female victims and their perpetrators in all cases of homicide in Sweden 1990-99 (numbers and percentages) Category n % Children age < 15 40 12 Unsolved cases 26 8 Stranger 20 6 Known but not family 40 12 Family excluding (ex)spouse 36 11 (Ex)spouse 164 51 Total 326 100
CBMH 14.2_3rd 21/5/04 11:33 am Page 124 124 Belfrage, Rying Having identified the perpetrators in the study group, data on all registered criminality regarding these perpetrators, except for those who committed suicide in connection with the crime, were collected from the National Police Register. The reason for leaving out the suicide group is that all data concerning dead people are deleted from the Swedish Police Register (see Belfrage, 1998). In this study, 40 (24%) perpetrators were deceased, and thus data on their crimi- nality are not available. All of these perpetrators, except one, committed suicide in connection with the homicide, which is in line with previous studies (Easteal, 1994; Gillespie et al., 1998). In cases where the perpetrators in the study group had been subject to forensic psychiatric examinations, data on principal psychiatric diagnoses in those reports were brought in from the Swedish National Board of Forensic Medicine (n = 96, 58%). Forensic psychiatric examinations were performed on 79% of the perpetrators in the study group who did not commit suicide in connection with the homicide. The proportion of personality disorders among the perpetrators in the study group was high (44%, n = 35), and subject to a closer analysis by us. We considered it unsatisfactory that nearly half of the cases where personality disorder was the main diagnosis were labelled ‘personality disorder UNS’ (not specified). We therefore looked at all the full forensic psychiatric reports of all perpetrators labelled ‘personality-disordered’ in the study group. The aim was to identify psychopathic and borderline personality traits, which are the person- ality traits often linked to spousal violence according to the literature (e.g. Kropp et al., 1995). The diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, 1994). Additionally, psychopathy was measured using the Psychopathy Checklist- Revised: Screening Version (PCL:SV, Hart et al., 1995). The PCL:SV is a 12-item rating scale of psychopathic personality traits (Figure 1). Items are scored on a three-point scale, based on the extent to which they are applicable to the individual (0 = does not apply, 1 = partially applies, 2 = definitely applies). A total score, ranging from 0 to 24, reflects the extent to which the examinee matches the description of a prototypical psychopath. A cut-off of 18 and above is typically used to delineate ‘psychopathy’. Items also are scored to yield two subscale scores. Part 1 represents interpersonal and affective characteristics of psychopathy such as lack of remorse and empathy, egocentricity and manipula- tiveness, whereas part 2 addresses behavioural and lifestyle factors such as impulsivity and antisocial behaviours. The psychometric properties of the PCL:SV are well established (Hart et al., 1995), and it has been used as a measure in other studies, e.g. in the MacArthur Study (Monahan et al., 2001). The PCL:SV ratings were performed by author HB, and discussed with an experienced forensic psychiatrist (Dr Göran Fransson). Drs Belfrage and Fransson have together performed more than 300 real-life psychopathy assess-
CBMH 14.2_3rd 21/5/04 11:33 am Page 125 Characteristics of spousal homicide perpetrators 125 Part 1 Part 2 1. Superficial 7. Impulsive 2. Grandiose 8. Poor behavioural controls 3. Deceitful 9. Lacks goals 4. Lacks remorse 10. Irresponsible 5. Lacks empathy 11. Adolescent antisocial behaviour 6. Doesn’t accept responsibility 12. Adult antisocial behaviour Figure 1: The PCL:SV items. Source: After Hart et al. (1995). ments in the Swedish correctional system, and their inter-rater reliability has been checked in previous studies (e.g. Strand et al., 1999; Belfrage et al., 2003). We are usually sceptical about diagnosing and/or performing ratings of psycho- pathic traits using files alone. However, in this study 11 of the 36 personality- disordered perpetrators had been subject to previous real-life assessments by Drs Belfrage and Fransson, so we considered our ratings to be more accurate than is usual in file ratings alone. It has also been shown that file-only ratings of psychopathy might be at least somewhat adequate (Grann et al., 1998). The statistical method used was an ordinary chi-squared test. Results Motives In more than 40% (n = 60) of the cases in the control group, where the motive was known (n = 150), the crime was committed in relation to a separation between the victim and the perpetrator. This is probably a minimum figure, since sometimes there was a lack of information about this in the police files. In 20% (n = 30) of cases, ‘jealousy’ was noted as the motive. This corresponds to previous research where the perpetrators’ need for control is found to be a main motive (Gelles, 1972; Daly and Wilson, 1988; Dobash and Dobash, 1992; Dawson and Gartner, 1998). Past threats and violence The police investigations also showed that in 42% of the cases in the study group the victims had been threatened, and in 36% they had been physically assaulted, by the perpetrators before the actual crime. In approximately half of these cases, the victims themselves had reported this to the police. Again, these are probably minimum figures owing to the lack of information. We had, for example, no
CBMH 14.2_3rd 21/5/04 11:33 am Page 126 126 Belfrage, Rying access to any information from social services or hospital files. This might explain why other studies, from the US, report comparatively higher numbers than found in this investigation (e.g. Moracco et al., 1998; Smith et al., 1998). Substance abuse In the study group, a total of 44% (n = 72) of the perpetrators and 37% (n = 61) of the victims were influenced by alcohol at the time of the crime. Even though these figures in themselves can be considered as high, since they represent almost half of the cases, they are lower than those found overall in cases of homicide in Sweden, where 61% (n = 543) of the perpetrators and 51% (n = 477) of the victims were influenced by alcohol at the time of the crime (perpetrators: chi- squared = 79.59, df = 1, p < 0.001, victims: chi-squared = 57.97, df = 1, p < 0.001) These figures are also lower than is usually reported in studies of spouse assault in general (e.g. Gondolf, 1988; Walker, 1989; Saunders, 1993). We have to keep in mind, however, that this study concerns cases of spousal homicide, where other risk factors might be more prominent, e.g. mental disorder. Crime scenes A majority of the spousal homicides occurred in the homes of either the victim or the perpetrator, or in their joint home (85%). This high figure may be due to the fact that a high proportion of the homicides occurred in connection with a separation. When the separation process is over, the probability of the violence occurring outdoors increases (Dawson and Gartner, 1998). Modus operandi The method of spousal homicides was much the same as in all cases of homicide in Sweden, except for strangulation. This was twice as common in the study group (21%), compared with all cases (11%, chi-squared = 11.15, df = 1, p < 0.001). Use of firearms was relatively uncommon (20% in the study group), while stabbing was the commonest method (40%). There was a strong corre- lation between use of firearms and suicide (in two-thirds of the cases). Immigrant background Nearly 40% of the perpetrators and 30% of the victims in the study group were born in a country other than Sweden. This is about four times the expected rate (Rying, 2001). However, as found in other studies (e.g. Goetting, 1995; Smith et al., 1998), the victims and the perpetrators commonly came from the same ethnic background (83%). The immigrants represented two main groups: those who originated from other Nordic countries (Finland represents 10% of all immigrants), and those
CBMH 14.2_3rd 21/5/04 11:33 am Page 127 Characteristics of spousal homicide perpetrators 127 who originated from the Middle East and former Yugoslavia. The latter group are, to a great extent, refugees with traumatizing war experiences and/or somewhat different cultural values. Previous criminality In total, 61% (n = 75) of the perpetrators in the study group had a criminal record, which was a somewhat lower proportion than in the control group (72%, n = 497, chi-squared = 41.43 df = 1, p < 0.001). The commonest previous crimes were illegal threat, various acts of violence, property crimes and traffic crimes. There was in the study group no clear correlation between criminality and substance abuse. Those perpetrators who were substance abusers were more likely to have a criminal record (75%, n = 123 vs 54%, n = 373, chi-squared = 23.87 df = 1, p < 0.001) and they had more commonly been sentenced for violent crimi- nality (45%, n = 74 vs 33%, n = 228, chi-squared = 8.35, df = 1, p < 0.01). Suicide In 24% (n = 39) of the cases in the study group the perpetrators committed suicide soon after the homicide. This is four times higher than in the control group (6%, n = 39, chi-squared = 50.14, df = 1, p < 0.001). If attempted suicides are included, nearly one third (n = 50) of the study group is represented. These results correspond well with previous research, where it has found that suicide in connection with homicide is particularly common when the homicide victims are women or children (Wolfgang, 1958; Easteal, 1994; Gillespie et al., 1998). Those perpetrators who committed suicide (n = 39) differed from the others (n = 125) in the study group. They were older (10 years, M), they were more commonly born in Sweden (90%, n = 35 compared with 13%, n = 16, chi- squared = 19.74, df = 1, p < 0.001), they were more commonly employed (80%, n = 31 vs 51%, n = 64, chi-squared = 10.26 df = 1, p < 0.01), they were more rarely under the influence of alcohol or drugs at the time of the homicide/suicide (26%, n = 10 vs 44%, n = 55, chi-squared = 4.02, df = 1, p < 0.05), and they were less known to have previously threatened or used violence towards their victims (10% ,n = 4 vs 42%, n = 53, chi-squared = 13.49, df = 1, p < 0.001). Thus, those perpetrators who committed suicide soon after the crime can be said to have been less socially marginalized compared with the other perpetrators. Psychiatric morbidity In 79% (n = 130) of the cases in the study group the perpetrators were subject to forensic psychiatric examinations, compared with 60% (n = 366) 366/690 = 53% in the control group (chi-squared= 36,78 df = 1, p < 0.001). Swedish forensic psychiatric examinations are comprehensive, and carried out during a period of approximately 4–6 weeks at forensic psychiatric clinics
CBMH 14.2_3rd 21/5/04 11:33 am Page 128 128 Belfrage, Rying (see Belfrage and Fransson, 2000; Grann and Holmberg, 1999). All but five (5%) in the study group were given at least one psychiatric diagnosis, whereas 41 (34%) were sentenced to forensic psychiatric treatment. Thus, there was a substantial amount of psychiatric morbidity in this group. Additionally, it could be hypothesized that the psychiatric morbidity was substantial among those 39 perpetrators (24%) who committed suicide in relation to the homicide. There is a well-known link between dangerousness to self and dangerousness to others (e.g. Menzies et al., 1985). Consequently, suicidal ideation is considered as an important risk factor for spousal violence (Kropp et al., 1995). If those who committed suicide are added to the group considered as mentally disordered, 80% (130) of all perpetrators of spousal homicide during the study period can be characterized as such. In Table 2 the distribution of principal diagnoses according to the forensic psychiatric examinations is given. From Table 2 it can be seen that the study group displayed a substantial psychiatric morbidity. More than one-third (36%) were thought to be psychotic and 21% received other serious diagnoses (dementia, mental retardation, post- traumatic stress syndrome, etc.). Psychopathy The PCL:SV ratings had a mean of 11.27, which is less than usually found in criminal populations (Hart et al., 1995). Only seven perpetrators in the study group met the diagnostic criteria for psychopathy, i.e. received a score above 17. This is seven out of those 35 personality-disordered perpetrators who were subject to a closer analysis by us, i.e. 20%. However, in comparison with all the other perpetrators in the study group who were subject to forensic examinations and received principal psychiatric diagnoses other than personality disorders, the proportion is seven out of 96, i.e. 7%. Additionally, if we hypothesize that none of those who committed suicide fulfilled the diagnostic criteria for psychopathy (suicide is regarded as unusual among psychopaths, e.g. Hare, 1993), the proportion goes down to seven out of 136, i.e. 5%. Thus, Hare psychopathy in this study group was rare, while other psychiatric disorders were common. Our findings in this respect might at a first glance be seen as somewhat surprising, since psychopathy is said to be over-represented among men who commit spousal violence (e.g. Hart et al., 1993; Kropp et al., 1995). However, the commonest personality trait displayed in this group was a trait very much considered as ‘non-psychopathic’, namely depressiveness. In all cases, except for the seven psychopathic perpetrators, the forensic psychiatric reports displayed a history of depressive episodes throughout their lives that had resulted in contacts with psychiatrists or psychologists. Thus, spousal homicide may be one area of crime where psychopathic perpetrators are not over-represented.
CBMH 14.2_3rd 21/5/04 11:33 am Page 129 Characteristics of spousal homicide perpetrators 129 Table 2: Distribution of principal diagnoses in forensic psychiatric examinations (FPE) on perpetrators of spousal homicide in Sweden 1990–99 (numbers and percentages) Category Total n % Paranoid schizophrenia 3 3 Schizophrenia syndrome 2 2 Schizo-affective syndrome 1 1 Delusional syndrome 10 11 Depression 10 11 Bipolar syndrome 1 1 Alcohol-induced psychotic syndrome 1 1 Psychotic syndrome unspecified 7 7 Psychoses total 35 36 Paranoid personality disorder 1 1 Antisocial personality disorder 5 5 Borderline personality disorder 4 4 Histrionic personality disorder 1 1 Narcissistic personality disorder 6 6 Personality disorder unspecified 14 15 Dissociative syndrome 1 1 Dystymia 3 3 Sexual sadism 1 1 Personality disorders total 36 38 Dementia 2 2 Mental retardation 2 2 Post traumatic stress syndrome 2 2 Maladaptive stress reaction 6 5 Substance abuse 6 5 Other diagnoses 2 2 Other diagnoses total 20 21 No diagnosis 5 5 Total 96 100 Note: Twenty-six perpetrators (21%) were not subject to forensic psychiatric examinations; 39 perpetrators (24%) committed suicide in connection with the homicide; one perpetrator died as a result of a fire that he caused in connection with the crime. Two cases were missing (1%). Discussion Studies from several countries show that violence towards women is a frequent phenomenon and committed by men with different personalities from different social classes, e.g. Canada (Statistics Canada, 1993), Finland (Heiskanen and Piispa, 1998) and Sweden (Lundgren et al., 2001). Among spouse assaulters generally, it is found that many men are personality disordered (Hamberger and Hastings, 1988; Hart et al., 1993), and that they often display psychopathic personality traits (Huss and Langhinrichsen-Rohling, 2000). When it comes to
CBMH 14.2_3rd 21/5/04 11:33 am Page 130 130 Belfrage, Rying homicidal violence, however, this study clearly indicates that the perpetrators, to a great extent, have comparatively severe psychiatric disturbances but rarely psychopathic personality traits. This finding is supported by the results from a previous study of a Swedish sample of psychiatrically examined spousal assaulters, containing a sub-group of spousal homicide offenders, where it was found that Hare psychopathy and a general antisocial lifestyle were highly predictive of spouse assault recidivism (Grann and Wedin, 2001) but, among those who were sentenced for spouse homicide, only one reoffended (the case was described as an upper-end outlier). Thus, very few, if any, were probably diagnosed as psychopaths. Furthermore, published lists of risk factors to be considered when assessing risk for lethal spouse violence commonly contain factors not usually related to the psychopathic personality. Hart (1988), for example, lists suicide ideation, obsessiveness and depression as important such factors. Our results do not indicate that the psychopathic batterer is at low risk of committing spouse violence. On the contrary, his violence is well known to be strongly repetitive, but it rarely seems to be homicidal in the context of spouse violence. There have been several recent attempts to construct typologies of spouse assaulters. One commonly used typology is the one proposed by Holtzworth- Munroe and Stuart (1994), which includes three major groups: family only batterer, dysphoric/borderline batterer and generally violent/antisocial batterer. The study group described here corresponds, to a great extent, to the dysphoric/ borderline group. As described by Holtzworth-Munroe and Stuart, these men show high levels of anger, aggression and severe violence. They express low to moderate extrafamiliar and general violence and their alcohol/drug abuse can be seen as moderate. As previously described, the commonest personality trait displayed in our study group was a trait very much considered as ‘non- psychopathic’, namely depressiveness. It is of importance that this group, the dysphoric/borderline group, is generally regarded as benefiting from treatment (e.g. Bateman and Fonagy, 2000), unlike the psychopathic batterer (e.g. Harris et al., 1991). This means that risk assessment procedures have to consider different risk-management strategies, depending on what type of batterer is dealt with. Improvement may prevent future spousal homicides. The very high prevalence of mental disorders among perpetrators who commit spouse homicide makes it important for professionals who are engaged in risk assessment and risk management in this context to incorporate this knowledge in their decision-making. This must be regarded as essential also for the police, who often comprise the first player in the chain. It is sometimes argued that the police should do purely police work and not try to function as street-corner psychiatrists. However, studies in Sweden indicate that not only can the police have a reasonable conception of whether a suspect has mental
CBMH 14.2_3rd 21/5/04 11:33 am Page 131 Characteristics of spousal homicide perpetrators 131 problems or not but they are also comparatively successful in initiating adequate protective actions (Belfrage, 2001; Kropp and Belfrage, 2002; Belfrage, 2003). Thus, it is essential that checklists for risk assessment and risk management in the area of spousal assault incorporate clinical, dynamic risk factors as well, and not just statistical, static risk factors. This is regardless of who is performing the risk assessment, since mental disorder seems to be a too strong risk factor to leave out of an assessment in this context. Consequently, the police version of the SARA, named the B-SAFER (Kropp et al., 2003), incorporates such a clinical item – ‘mental disorder’ – that the police have to consider provisionally. Finally, we would like to stress that this study is based on all cases of spouse homicide in Sweden during a 10-year period. The generalizability of our findings in a Swedish context is thus great. We believe that there might be a decreased generalizability in North America, not at least concerning use of firearms, immigrant background and modus operandi. However, we cannot see why there should be any differences with regard to the prevalence of mental disorders, and the proportion of psychopathic perpetrators, among spouse homicide offenders. References American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: Author. Belfrage H (1998) A ten-year follow-up of criminality in Stockholm mental patients: new evidence for a relation between mental disorder and crime. British Journal of Criminology 38: 145–155. Belfrage H (2001) Police-based spousal violence risk assessment: the Swedish experience. Paper presented at the International Conference ‘Violence Risk Assessment and Management: Bringing Science and Practice Closer Together’, Sundsvall, 28–30 November. Belfrage H (2003) Development of a risk assessment guide for use by law enforcement officers. Presentation at the 3rd Annual Conference of the International Association of Forensic Mental Health Services, Miami, 9–12 April. Belfrage H, Fransson G (2000) Swedish forensic psychiatry: a field in transition. International Journal of Law and Psychiatry 23: 509–514. Belfrage H, Fransson G, Strand S (2003) Management of violent behaviour in the correctional system using qualified risk assessments: violence reducing effects possible without significant decrease of important risk factors for violence? Legal and Criminological Psychology (in press). Browne A, Williams K, Dutton D (1999) Homicide between intimate partners. In: Smith, MD, Zahn MA, eds. Studying and Preventing Homicide. Thousand Oaks, CA: Sage Publications. Campbell J (1995) Prediction of homicide of and by battered women. In: Campbell J, ed. Assessing dangerousness: violence by sexual offenders, batterers, and child abusers. Thousand Oaks, CA: Sage Publications, pp 96–113. Daly M, Wilson M (1988) Homicide. New York: Aldine de Gruyter. Dawson M, Gartner R (1998) Differences in the characteristics of intimate femicides: the role of relationship state and relationship status. Homicide Studies 2: 378–399. Dobash RE, Dobash RP (1992) Women, Violence & Social Change. Chatham: Routledge. Easteal P (1994) Homicide between adult sexual intimates in Australia: implications for prevention. Studies on Crime and Crime Prevention 3(1).
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