amnesia_crime_07 - REGULAR ARTICLE Amnesia and Crime...

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Amnesia and Crime Dominique Bourget, MD, and Laurie Whitehurst, PhD Amnesia for serious offenses has important legal implications, particularly regarding its relevance in the contexts of competency to stand trial and criminal responsibility. Forensic psychiatrists and other mental health profes- sionals are often required to provide expert testimony regarding amnesia in defendants. However, the diagnosis of amnesia presents a challenge, as claims of memory impairment may stem from organic disease, dissociative amnesia, amnesia due to a psychotic episode, or malingered amnesia. We review the theoretical, clinical, and legal perspectives on amnesia in relation to crime and present relevant cases that demonstrate several types of crime-related amnesia and their legal repercussions. Consideration of the presenting clinical features of crime- related amnesia may enable a fuller understanding of the different types of amnesia and assist clinicians in the medico-legal assessment and diagnosis of the claimed memory impairment. The development of a profile of aspects characteristic of crime-related amnesia would build toward establishing guidelines for the assessment of amnesia in legal contexts. J Am Acad Psychiatry Law 35:469–80, 2007 The forensic literature is replete with reports of of- fenders who have claimed total or partial amnesia for violent crimes, including murder or attempted mur- der. 1–14 Claims of amnesia have been reported in an estimated range of 10 to 70 percent of homicides. Memory impairment during the commission of crimes has also been reported by perpetrators of do- mestic violence 15–19 and by sex offenders. 1–3,6 Dissociation and Dissociative Amnesia While memory disturbances are often associated with organic brain disease, crime-related amnesia raises the question of dissociation, a term that refers to the disruption of normally integrated functions of consciousness, memory, identity, or perception of the environment. A dissociative state is an altered state of consciousness concurrent with a traumatic experience. Dissociative amnesia, formerly termed psychogenic or functional amnesia, is a disorder characterized by the inability to remember important personal experiences and events after a traumatic ex- perience of psychological origin. 20 Current psychiatric diagnostic systems differ in their definition of the term dissociation and in the classification of dissociative disorders. These incon- sistencies have, in part, resulted in confusion sur- rounding how dissociation is conceptualized. Spitzer and colleagues 21 reviewed recent efforts to clarify the conceptualization of dissociation by distinguishing between types (pathologic versus nonpathologic dis- sociation) and related phenomena (detachment ver- sus compartmentalization). Pathologic dissociation has been viewed as a categorical phenomenon char- acteristic of individuals with dissociative disorder, 22 while nonpathologic dissociation has been conceptu- alized as a dimensional construct that may range
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amnesia_crime_07 - REGULAR ARTICLE Amnesia and Crime...

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