Journal of Trauma & Dissociation

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Dissociative Pathways to Homicide: Clinical and

Forensic Implications
a
Andrew K. Moskowitz PhD
a
Department of Psychology, University of Auckland, Auckland, New Zealand
Available online: 13 Oct 2008
To cite this article: Andrew K. Moskowitz PhD (2004): Dissociative Pathways to Homicide: Clinical and Forensic Implications,
Journal of Trauma & Dissociation, 5:3, 5-32
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Dissociative Pathways to Homicide:

Clinical and Forensic Implications
Andrew K. Moskowitz, PhD
ABSTRACT. In a earlier review, dissociation was found to be linked to

violence in a wide range of populations, including college students,
young mothers, psychiatric patients, and criminal offenders, and was of-
Downloaded by [ ] at 02:52 25 January 2012
ten expressed in the violent act itself, in the form of depersonalization or

subsequent amnesia (Moskowitz, 2004). While that review focused on
“state” dissociation–i.e., dissociation during an act of violence, this pa-
per looks at links between “trait” dissociation and violence–evidence
that long-term dissociative processes may predispose vulnerable indi-
viduals to violent behavior, and even homicide. Specifically, it is argued
that dissociation is related to the development of four “types” (probably
not mutually exclusive) of homicide offenders: (1) violent individuals
suffering from dissociative identity disorder, whose violence is ex-
pressed through certain dissociated personality states, (2) fantasy-
driven violence, often accompanied by some form of identity alteration,
(3) paroxysms of “dissociative rage” in individuals normally presenting
as polite or meek, characterized as “overcontrolled hostile” (Megargee,
1966), and (4) persons designated as psychopathic, whose emotional
numbing may be trauma-based and similar to that seen in depersonal-
ization disorder. While the last three areas are somewhat speculative,
research findings supporting each proposed link are presented. In con-
junction with Moskowitz (2004), this review strongly suggests a signifi-
cant role for dissociation not only in the commission of certain violent
acts, but also in the development of some violent individuals; the clinical
Andrew K. Moskowitz is affiliated with the Department of Psychology, University

of Auckland, Auckland, New Zealand.
Address correspondence to: Andrew K. Moskowitz, PhD, Department of Psychol-
ogy, University of Auckland, Private Bag 92019, Auckland, New Zealand (E-mail:
a.moskowitz@auckland.ac.nz).
Journal of Trauma & Dissociation, Vol. 5(3) 2004
http://www.haworthpress.com/web/JTD
 2004 by The Haworth Press, Inc. All rights reserved.
Digital Object Identifier: 10.1300/J229v05n03_02 5
6 JOURNAL OF TRAUMA & DISSOCIATION
and forensic implications of this are discussed. Further research system-

atically exploring the role of dissociative processes in violent and homi-
cidal behavior is called for. [Article copies available for a fee from The
Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:
<docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com>
 2004 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Dissociation, psychopathy, homicide, fantasy, deper-

sonalization
Having previously argued that dissociative episodes are commonly experi-

enced by individuals engaging in violent behavior, i.e., “state” dissociation
(Moskowitz, 2004), I suggest in this paper several ways by which dissociative
processes, i.e., “trait” dissociation, may lead to the development of homicidal

behavior in vulnerable individuals.
Broadly speaking, dissociation may relate to homicidal behavior in three
ways. The first involves individuals who report having experienced diss-
ociative symptoms, such as depersonalization or amnesia, while committing a
homicide, but show little evidence of ongoing dissociative pathology either
before or after the violent episode (Tanay, 1969). For example, studies previ-
ously reviewed (Moskowitz, 2004) suggest that up to a third of individuals
convicted of homicide claim total or partial amnesia for the violent attack,
many of whom nonetheless accept full responsibility for their actions. These
cases tend to involve extreme emotional states (Kopelman, 1987; Schacter,
1986), with the amnesia most often associated with the most emotionally
aroused segments of the violent act, a phenomenon which has been termed a
“red-out” (Swihart, Yuille, & Porter, 1999). As some of these individuals did
not appear dissociative either before or after the incident, the dissociative ex-
periences may result from the traumatic nature of the violent behavior on the
perpetrators themselves (Spitzer et al., 2001; Steiner, Garcia, & Matthews,
1997), or may only be expressed under the extreme, highly emotional, circum-
stances that led to the attack (Swihart et al., 1999). This point is made explic-
itly in a study of police officers involved in shooting incidents, in which over
90% reported experiencing dissociative symptoms at the time (Rivard, Dietz,
Martell, & Widawski, 2002):
(T)he occurrence of dissociative symptoms among such a high propor-

tion of shooting-involved officers casts serious doubt on the credibility
of those who argue that dissociation at the time of a crime is a mental dis-
ease or defect. . . . It would be more reasonable to believe that, in general,
dissociation is a normal response of some criminals to the traumatic
events they create. (p. 6)
Andrew K. Moskowitz 7
Such cases, in which there is evidence of dissociation at the time of the vio-
lent incident (“state”), but no ongoing dissociative pathology (“trait”), are ex-
plored in detail in Moskowitz (2004), and will not be discussed further here. It
contrast to Rivard et al., however, it is contended here that dissociation at the
time of a crime may in some cases indicate the presence of a dissociative disor-
der prior to the offense, and thus possibly a mental disease or defect for the
purposes of an insanity defense. 1
Thus, the second possible relationship between dissociation and homicide
involves individuals engaging in violent behavior who clearly met criteria for
a dissociative disorder–generally dissociative identity disorder–prior to the
incident (though possibly only in retrospect). These cases, in which there is evi-
dence of both state (i.e., at the time of the violent incident) and trait dissociation,
while also discussed in Moskowitz (2004), will be presented here as well.
Finally, in between these two extremes are cases, it is argued, in which dis-
sociative processes play a major role in the development of homicidal behav-

ior, in individuals who may or may not currently meet criteria for a dis-
sociative disorder, and may or may not have experienced dissociation at the
time of the crime. In this section, making up the bulk of the paper, three types
of violent offenders (possibly in the order of decreasing dissociative pathol-
ogy) are presented: (1) fantasy-driven homicide offenders, whose attacks are
preceded by some form of identity confusion or alteration, (2) meek or
mild-mannered individuals who erupt (usually on only one occasion) in a par-
oxysm of violence, characterized as “overcontrolled hostile” (Megargee,
1966), and (3) violent persons characterized as psychopathic, whose emo-
tional numbing may be similar to that seen in depersonalization disorder.
There is no assumption that these groups are necessarily mutually exclusive.
VIOLENCE AND HOMICIDE IN PERSONS

WITH DISSOCIATIVE IDENTITY DISORDER (DID)
Dissociation researchers have long wondered about a relationship between

dissociation and violence. Some have argued that the overwhelming prepon-
derance of women among those diagnosed with dissociative disorders could
partly be due to males with dissociative disorders being funneled into the
criminal justice system and their diagnoses missed, and have called for a system-
atic exploration of this important area (Carlson & Putnam, 1993; Steinberg,
1995). Indeed, while there is an extensive literature on the relationship
between mental disorders and violence (see Monahan, 1992, and Eronen,
Angermeyer, & Schulze, 1998 for useful reviews; and Woodward, Nursten,
Williams, & Badger, 2000, specifically on homicide), dissociative disorders
are not among the mental disorders assessed in such studies (diagnoses gener-
ally include psychoses such as schizophrenia and affective disorders such as

bipolar disorder and major depression, along with substance abuse and per-
sonality disorders). Of interest, posttraumatic stress disorder (PTSD), also
rarely assessed in this literature, was found in almost 10% of a large sample of
New Zealand male and female prisoners; schizophrenia was found in just over
4% (Brinded, Simpson, Laidlaw, Fairley, & Malcolm, 2001). As PTSD is
closely related to dissociative disorders (Bremner et al., 1992; Carlier, Lam-
berts, Fouwels, & Gersons, 1996), such findings support calls for research ex-
ploring dissociation in prison samples.
Such calls have recently been answered with six studies published since
2000 assessing the prevalence of dissociation or dissociative disorders in
prison, jail or offender populations (Campbell, 2000; Carrion & Steiner, 2000;
Friedrich et al., 2001; Simoneti, Scott, & Murphy, 2000; Stein, 2000; Walker,
2002). This spate of recent studies has allowed a review of the area, which re-
vealed that approximately 25% of prison or jail inmates demonstrate “patho-

logical” levels of dissociation (primarily determined by DES scores of 30 or
above), and that a somewhat smaller percentage meet diagnostic criteria for a
dissociative disorder (see Moskowitz, 2004, for more details). A few studies
specifically addressed dissociative identity disorder (DID), with the most con-
servative finding a prevalence of 6.3% in a hospitalized (psychiatric and medi-
cal) male prison sample, most of whom had been convicted of violent offences
(Stein, 2000). In addition, scores above 50 on the DES have been found in be-
tween 7.0 and 9.5% of prison or jail populations (Graham, 1993; Moskowitz,
2001; Snow, Beckman, & Brack, 1996), a substantial portion of whom would
have likely met criteria for DID (Carlson et al., 1993). These results, in con-
junction with several mental health professionals reporting finding more than
a dozen inmates with DID in their clinical samples (Carlisle, 1991; Lewis,
Yeager, Swica, Pincus, & Lewis, 1997; Snow et al., 1996), suggest that DID
may not be an uncommon phenomenon in prisons. Unfortunately, no study to
date has determined whether such diagnoses are more common among homi-
cide and violent than non-violent offenders.
The parallel literature, exploring violence and homicide in persons diag-
nosed with DID, has no such shortcomings, but does suffer from a lack of vali-
dation of reported violent behavior. Several studies have examined violent and
homicidal behavior in individuals diagnosed with DID, as well as the preva-
lence of violent or homicidal “alters.” It has been suggested that such alters, or
personality states, may develop through a process of identification with an
abuser, or as a “protector” personality which has become aggressive over time
(Putnam, 1989). Putnam et al. (1986) found violent alters in 70 out of 100 DID
patients, only eight of whom were male. Twenty percent claimed to have com-
mitted a sexual assault, and six percent claimed to have committed homicide.
In a study of adolescents with DID, 82% had aggressive “persecutor” alters,
and over a third reported having been violent or threatened violence (Dell &
Eisenhower, 1990). In the largest study of men with DID to date, Loewenstein
and Putnam (1990) compared 21 men with DID to a sample of female DID pa-
tients from the Putnam et al. (1986) study. Violent alters were more common
in the male (90%) than female (74%) participants, but there was no difference
in the rate of homicidal alters (present in about a third of each gender). In addi-
tion, a history of criminal conviction was more common in the male than the
female DID participants (47% compared to 35%). All of the convicted men
had been incarcerated; for more than 40% of them (20% of the entire male
sample), and for 20% of the incarcerated women, the convictions were report-
edly for committing homicide. Unfortunately, these were all clinically gener-
ated samples, with no reported external validation for the claims of homicidal
or violent behavior.2 Nonetheless, it is worth noting that the homicide rates re-
ported in these two DID samples, 6% for the women and 20% for the men
(Loewenstein & Putnam, 1990; Putnam et al., 1986), is considerably higher

than those reported for individuals with schizophrenia, less than 0.5% over a
12-year period in one study (Tiihonen, Hakola, Eronen, Vartiainen, & Ryynanen,
1996).
Thus, while there are clear gaps in both sets of literature, taken together
they suggest that violent alters may express violent or even homicidal behav-
ior in a significant minority of individuals with DID. As suggested below, and
as seen in cases of PTSD, such violence may occur in situations (or towards
persons) that are reminiscent of an earlier traumatic event (Silva, Derecho,
Leong, Weinstock, & Ferrari, 2001). Nonetheless, it is important to note that
there is no evidence to suggest that most persons with DID are violent to oth-
ers; many are violent to themselves, and others manage to avoid engaging in
any form of violent behavior whatsoever.
Dorothy Otnow Lewis, in her book Guilty by Reason of Insanity (1998),
discusses one such case (see also Keyes, 1981, for a famous treatment of an in-
dividual with DID who committed a violent crime and was acquitted by reason
of insanity) in which an elderly nun was raped and murdered by a young man
initially considered by her and almost all parties involved to be suffering from
schizophrenia. Only after several years of contact (during which time he was
found guilty and sentenced to death), numerous interviews in which personal-
ity shifts were observed, and the confirmation of childhood sexual abuse by
other family members, did Lewis conclude that he was actually suffering from
dissociative identity disorder.3 Her final thoughts on this case provide a fitting
close to this discussion of DID and violence:
We shall never know for sure who among Johnny’s alters actually mur-
dered the aged nun. Was it Aaron? Aunt Barbara? My own guess is that
it was the powerful, controlling figure with the fiery eyes–the one who
most intimidated Aaron, the one who refused to give me his name. We
can be fairly certain, however, that whoever committed the murder,
whoever slashed the throat of the innocent nun, did not see Sister
Catherine’s face when he did it. He saw instead the face of Granny. Al-
ters, stuck in time, are always mistaking one situation for another, for-
ever confusing someone with someone else. (Lewis, 1998, pp. 235-236)
FANTASY-DRIVEN VIOLENCE IN SERIAL

AND MASS MURDERERS
Several authors have identified fantasy as an important factor in the de-

velopment of homicidal behavior, particularly with regard to serial or mass
murderers (MacCulloch, Snowden, Wood, & Mills, 1983; Meloy, Hempel,
Mohandie, Shiva, & Gray, 2001; Prentky et al., 1989; Ressler, Burgess, &
Douglas, 1988). This has been stated perhaps most clearly by Ressler, Douglas,
and others from the United States FBI (Prentky et al., 1989; Ressler et al.,
1988; Ressler & Shachtman, 1992). Following a detailed study of 36 murder-
ers whose crimes all had sexual components, many of whom were serial kill-
ers, Ressler et al. (1988) concluded that the murders were motivated by
detailed fantasies, which often had “strong visual components.” Importantly,
violent fantasies were much more commonly reported in serial (86%) than in
single (23%) sexual murderers (Prentky et al., 1989).
In exploring the histories of serial and mass murderers, high levels of child-
hood abuse and neglect have been found (Levin & Fox, 1985; Ressler et al.,
1988). Several authors have speculated that the intense fantasy lives reported
by these individual may emerge out of their traumatic childhood experiences
(Dietz, Hazelwood, & Warren, 1990; MacCulloch, Gray, & Watt, 2000;
Prentky et al., 1989). Ressler and colleagues (1988) provide an example of
how this might happen:
A child abused by an adult caretaker begins to think about being hit ev-
ery time an adult comes near him, dwelling on the hitting. He may imag-
ine (fantasize) about someone coming to help him by beating up the
adult. This thinking pattern may bring relief, because someone has pro-
tected him in his fantasy. (pp. 34-35) 4
When the serial murderers in Ressler’s study were asked what led to their
first murder, they commented on their “long-standing preoccupation and pref-
erence for a very active fantasy life,” which was primarily violent and sexual
in nature (Ressler et al., 1988; p. 33). Of interest, the murderers who had been
sexually abused began fantasizing significantly earlier, on average three and a
half years, than the men who did not report sexual abuse. Crimes were often
rehearsed in these fantasies; as Ressler (1992) states, “they murdered to make
happen in the real world what they had seen over and over again in their minds
since childhood and adolescence” (p. 84). A similar pattern was found in stud-
ies of adolescent mass murderers, in which 44% reported daily indulgence in
violent fantasies (Meloy et al., 2001).
Fantasy is a common childhood experience that several authors have con-
sidered to be a developmental substrate for dissociation (Kluft, 1994; Putnam,
1989). While most children with active fantasy lives do not go on to develop
dissociative disorders, several recent studies have strongly linked “fantasy
proneness” with dissociative pathology, in both substance abuse and uni-
versity undergraduate populations (Merckelbach, Horselenberg, & Schmidt, 2002;
Merckelbach, Rassin, & Muris, 2000; Pekala, Angelini, & Kumar, 2001;
Pekala et al., 1999; Rauschenberger & Lynn, 1995; Waldo & Merritt, 2000).
All studies, with a combined total of over 4000 participants, found DES
scores to be strongly related to “fantasy proneness,” as measured on the Inven-
tory of Childhood Memories and Imaginings (Wilson & Barber, 1983, cited in
Rauschenberger & Lynn, 1995) or the Creative Experiences Questionnaire
(Merckelbach, Horselenberg, & Muris, 2001). Further, a recent study found
fantasy proneness highly predictive of dissociation, considerably more so than
a diagnosis of PTSD (Muris, Merckelbach, & Peeters, 2003). These results
support an early study’s claim that a “growing body of evidence” pointed to
“parallels between imagination and fantasy-based activities and dissociative
experiences and symptoms” (Rauschenberger & Lynn, 1995, p. 378).
With regard to possible etiological mechanisms, Rhue and Lynn found that
participants scoring high on fantasy proneness reported having experienced a
greater frequency and intensity of physical punishment, and more revenge
fantasies, than participants scoring in the medium or low ranges (Rhue &
Lynn, 1987). They speculated that fantasy proneness in the individuals they
studied developed either through encouragement from an important adult to
fantasize, or as a means of escaping from child abuse, harsh punishment, or
other aversive environments.
It can thus be proposed that the active fantasy lives seen in many serial and
mass murderers, developing in response to childhood abuse and neglect (Dietz
et al., 1990; MacCulloch et al., 2000; Prentky et al., 1989), is explicitly
dissociative in nature, or progresses to dissociative pathology at some point.
What remains to be determined, however, is how and under what circum-
stances violent fantasies lead to violent behavior.
One possibility has been proposed by Carlisle (1991, 1993), who describes
a progression from fantasy to violence as resulting from a dissociation of iden-
tity, produced through intense immersion in violent fantasies. He describes the
way in which fantasy can drive the development of an “evil” alternative iden-
tity or personality, often referred to as the “shadow,” “beast,” or “dark side.”
Based on interviews with a number of serial murderers, Carlisle (1993) de-
scribes a dialectical process, a tension between fantasy and reality, ultimately
leading to the development of a more violent personality state and the expres-
sion of violent behavior:
As the person shifts back and forth between the two identities in his at-
tempt to meet his various needs, they both become an equal part of him,
the opposing force being suppressed when he is attempting to have his
needs met through the one. Over time, the dark side (representing the
identity or entity the person has created to satisfy his deepest hunger) be-
comes stronger than the “good” side, and the person begins to experi-
ence being possessed, or controlled by this dark side of him. This is
partly because the dark side is the part anticipated to meet the person’s
strongest needs, and partly because the good side is the part that experi-
ences the guilt over the “evil” thoughts, and therefore out of necessity is
routinely suppressed. Thus, the monster is created. (p. 27)
This fantasy world becomes of great importance to these individuals, taking

over more and more of their lives (Carlisle, 1993). As it does, the person be-
comes more secretive and concerned about protecting the fantasy world from
discovery from others (through diaries, books, magazines, etc.), further driving
the compartmentalization process. Such a process can be seen in a number of
adolescent mass murderers, including those at Columbine (Meloy et al., 2001).
Thus, the existence of an intense violent fantasy world, developing in re-
sponse to childhood abuse or neglect, has been found to be common in adoles-
cent and adult sexual, serial and mass murderers. Persons who intensively
fantasize may be highly dissociative, particularly when those fantasies have
strong visual as well as verbal components (Rauschenberger & Lynn, 1995).
Finally, there is evidence that ongoing indulgence in violent fantasies can lead
to the expression of murderous impulses in vulnerable individuals, or as
Carlisle has described, the emergence of a “dark side.”
In contrast to violent individuals with DID, the fantasy-driven violent indi-
vidual described above would likely not have met criteria for a dissociative
disorder prior to the violence (though their fantasies may well have been
dissociative in nature), but likely exhibited dissociative symptoms at the time
of the crime (such as derealization and depersonalization), and may (due to the
identity alteration process described above) meet criteria for a dissociative
disorder, such as dissociative disorder, not otherwise specified (DDNOS),
subsequently.
“OVERCONTROLLED” HOSTILITY AND DISSOCIATED RAGE

The previous two sections discussed violent individuals meeting diagnostic
criteria for DID, and those individuals driven to murder through long-term vi-
olent fantasies, often highly visual in nature, ultimately leading to the develop-
ment of a violent personality state. Dissociation can also be linked to a type of
homicide offender who in most circumstances appears anything but violent,
what Megargee (1966) has termed the “overcontrolled hostile” offender.
Megargee (1966) argued that there are primarily two types of violent of-
fenders, those whom he characterized as being “undercontrolled” with regard
to hostility and aggression, and those whom he described as being “over-
controlled.” The anger and hostility of undercontrolled individuals is obvious
to those around them, and they often engage in violent incidents (usually
non-lethal) when provoked (Megargee, 1966). In contrast, those characterized
as overcontrolled are uncomfortable with openly expressing, or even ac-

knowledging, anger or frustration and are often seen as quiet or even meek.
Paradoxically, if they do ultimately explode, the crime is often more violent
than those committed by the undercontrolled group (Megargee, Cook, &
Mendelsohn, 1967). These are the individuals whose violence appears to
come “out of the blue,” and about whom media, acquaintances, and possibly
even friends and family express “amazement” over their actions. Megargee
and colleagues (1967) describe these violent individuals as follows:
[They are] characterized by excessive inhibitions against the expression

of aggression in any form. Since even the normal socially approved out-
lets for anger are unavailable, people of the chronically overcontrolled
type are often subjected to extreme frustrations as they are exploited by
spouses, co-workers, and peers. In the absence of outlets, instigation to
aggression may build up over time to the point where, in some cases,
even the most massive defenses are overwhelmed and an aggressive act
takes place. Because of the extreme amount of instigation which this en-
tails, the aggressive act is likely to be of extreme or homicidal intensity.
Hence, a person who has never been known to speak a harsh word may
suddenly become a murderer. (p. 520)
Megargee’s theory led to the development of an MMPI scale designed to

identify such overcontrolled offenders, known as the Overcontrolled Hostility
or O-H Scale (Megargee et al., 1967), which has been largely validated by sub-
sequent research (Greene, Coles, & Johnson, 1994; Lane & Kling, 1979;
Quinsey, Maguire, & Varney, 1983; White & Heilburn, 1995). One recent
study (Verona & Carbonell, 2000) found a majority of violent female inmates
to fit this profile. The group scoring high on the O-H MMPI-2 Scale had sig-
nificantly shorter criminal records, but the crimes they had committed were
more violent, and included a larger percentage of the homicides, than the
group scoring low on the O-H scale. Many of the homicides committed by the
high O-H group were of abusive partners. Verona and Carbonell (2000) con-
cluded that this group was a majority in the violent female offenders, as op-
posed to a minority in the violent men (Megargee et al., 1967) because O-H
behaviors fit gender stereotypes of appropriate female behavior (i.e., not ex-
pressing anger or frustration openly).
The process Megargee describes can be conceptualized as dissociative in
nature. In this formulation, the anger, frustration, and rage of an overcon-
trolled individual, unable to be tolerated consciously, would be split-off or dis-
sociated from the individual’s normal state of awareness or sense of identity,
where it would remain (possibly increasing) until released cataclysmically under
extreme provocation. Alternatively, this rage could be thought of as a dissociated
“part” of the individual, emerging only under the extreme circumstances previ-
ously noted.
Support for this thesis comes from Tanay (1969), whose “dissociative ho-
micides” (over two-thirds of his sample of 53 homicidal men) are described as
having an “overdeveloped” superego (due to “violent child-rearing practices”)
that is “intolerant of any overt expressions of aggression” (p. 151). Tanay ex-
plicitly links this group of men to Megargee’s overcontrolled aggressive
group. Cartwright’s (2001) review of “rage-type homicides” is also consistent
with this conception. He concludes that a “pattern of overcontrol” best ex-
plains the “apparent normality” of the rage-type offender, whose violence is
attributed to “dissociated split-off aspects of the personality” (Cartwright,
2001, p. 15).
Over the years, a number of other categories of violent or homicide offend-
ers have been proposed which appear similar to Megargee’s concept of
overcontrolled aggression, and could be linked to dissociation, such as the
“sudden” murderer (Weiss, Lambert, & Blackman, 1960), catathymic vio-
lence (Kirschner & Nagel, 1996; Schlesinger, 1996), and the DSM-IV catego-
ries of Intermittent Explosive Disorder and the culture bound syndrome Amok
(American Psychiatric Association, 2000). While the emphasis differs some-
what between these categories, the largely unplanned and spontaneous violent
behavior subsumed under each is broadly consistent with the expression of
dissociated rage in individuals who do not easily express aggression or hostil-
ity (Felthous, Bryant, Wingerter, & Barratt, 1991; Weiss et al., 1960). Of the
above categories, only Amok will be discussed, as it is often results in homi-
cide, and is characterized in the DSM-IV as a dissociative disorder.
Amok, which is most common in individuals from Southeast Asian coun-
tries (the term comes from Malaysia), is important for this discussion as it is
the only disorder in the DSM-IV in which the concepts of dissociation and vio-
lence are linked. It is defined as: “a dissociative episode characterized by a pe-
riod of brooding followed by an outburst of violent, aggressive, or homicidal

behavior directed at people and objects” (APA, 2000; p. 899). Amnesia for the
episode is also common. Cases of Amok often involve multiple, frenzied,
apparently indiscriminate, homicidal attacks, with no immediate warning–though
there is often a perceived insult or slight experienced over the preceding days
(Hatta, 1996). Similar to the overcontrolled individuals described above, Ma-
lay society has traditionally been characterized as tremendously polite, with
essentially no normal channels for expressing frustration or aggressive im-
pulses (Gaw & Bernstein, 1992; Raffles, 1965, cited in Hatta, 1996). It has
been suggested that Amok may be a “culturally prescribed” form of violent
behavior, allowing an outlet for the expression of normally suppressed aggres-
sive impulses (Carr & Tan, 1976).
Certainly, in individuals who rarely allow themselves to express negative
affect, the emergence of intense feelings of anger or rage are likely to feel for-
eign–producing sensations of depersonalization. In addition, if negative affect
is not dealt with in the normal course of daily life, an individual’s capacity to
modulate that affect will be limited, leading to the increased likelihood of their
becoming overwhelmed and driven by the affect when it surfaces.
In overcontrolled violent individuals, it is primarily the expression of anger
or frustration that is not normally tolerated; the individual may have some
fleeting awareness of the negative feelings, and may have little difficulty ex-
periencing or expressing other emotions. In contrast, individuals classified as
psychopathic have “deadened” emotions, and are sometimes characterized as
being unable to feel almost anything.
PSYCHOPATHY AND DEPERSONALIZATION
James Gilligan, in his book Violence: Our Deadly Epidemic and Its Causes
(1996), offers an apt description of men he calls “the living dead,” who would
likely be classified as “psychopathic.”
Many murderers, both sane and insane, have told me that “they” have
died, that their personality has died, usually at some identifiable time in
the past, so that they feel dead, even though their bodies live on. When
they say they feel dead they mean they cannot feel anything–neither
emotions nor even physical sensations. I have seen many who admit to
killing others without so much as a flicker of remorse or any other emo-
tion. (p. 33)
Gilligan describes the extraordinarily violent childhoods experienced by

these men, which he believes led to their state of “deadness.” As can be seen in
this section, psychopathy and depersonalization share this emotional “numb-

ness,” and may share etiology as well. In addition, their responses to emotional
stimuli appear to be quite similar. It will be argued that these two concepts,
while clearly not identical, are close enough in several important ways to war-
rant further investigation.
Psychopathy is an old concept first re-popularized by Cleckley in his book
The Mask of Sanity (1941), and modernized by Hare with the development of
the Psychopathy Checklist (PCL; Hare, 1980). As originally envisioned by
Cleckley, the psychopath is an individual who suffers from a deficit in emo-
tional experience, which expresses itself in symptoms such as general poverty
of affect, lack of insight, absence of nervousness, superficial charm, patholog-
ical lying, egocentricity, inability to love, and an inability to establish close or
intimate relationships. He felt that the behavioral features of psychopathy
(e.g., impulsivity, antisocial acts, etc.) were secondary to this affective deficit.
Cleckley believed that psychopaths could be found in many areas of life, and
did not see violence as one of their core characteristics.
Of interest, Cleckley, who was also an author of the first popular book on
multiple personality, The Three Faces of Eve (Thigpen & Cleckley, 1957), ac-
tively considered, in the early editions of The Mask of Sanity, dissociation as a
potential explanation for psychopathy. In a several page discussion of dissoci-
ation, Cleckley (1950) comments on Janet’s use of the concept, and then
states, “Let us for the moment refer to that which is missing in the psycho-
path’s response to life (i.e., a deficit in emotional experience) as dissociated
instead of using terms that would imply with insistence that it has been dy-
namically repressed or, on the other hand, absent through congenital defect”
(p. 402). While he ultimately does not, in these early editions, clearly embrace
(or clearly reject) the concept of dissociation as an explanatory principle for
psychopathy, the fact that it is considered as potentially relevant is signifi-
cant.5
With the development of the Psychopathy Checklist (PCL; Hare, 1980),
which was originally designed to identify Cleckley-type psychopaths within a
prison population, the concept of psychopathy was broadened, with antisocial
behaviors being given equal weight with the affective deficiency. Factor anal-
yses of the PCL have most often revealed two factors, which have been labeled
“emotional detachment” and “antisocial behavior” (Harpur, Hakstein, & Hare,
1988; Harpur, Hare, & Hakstein, 1989; Patrick, Bradley, & Lang, 1993).6 In-
dividuals called “psychopaths” are currently identified on the basis of high
scores on the PCL or PCL-Revised (PCL-R; Hare, 1991). These individuals
have consistently been found to be more violent that persons scoring low on
the PCL or PCL-R both inside institutions and in the community (Hart, Hare,
& Forth, 1994; Patrick & Zempolich, 1998). They also commit a significant
portion of homicides ⫺27% in one study covering two large Canadian prisons
(Woodworth & Porter, 2002). Of interest, almost all the homicides committed
by the psychopathic participants in this study were planned, i.e., not reactive
or spontaneous in nature, and not associated with emotional arousal, which led
the authors to refer to the crimes as “cold-blooded” (Woodworth & Porter,
2002).
There is some evidence that the “emotional detachment” factor (which cor-
responds largely to Cleckley’s concept of psychopathy) predicts violence
equally as well as, if not better than, the “antisocial behavior” factor (Serin,
1996). This is consistent with the thesis presented here, if the “emotional de-
tachment” or “deficient affective experience” (Cooke & Michie, 2001) factor
of psychopathy is equated with the dissociative symptom of depersonaliza-
tion. The basis for such a position is provided below.
The author who has most prominently linked the concepts of dissociation
and psychopathy is J. Reid Meloy, in his book, The Psychopathic Mind
(1988). Meloy, coming from a strongly psychoanalytic perspective, dedicates

over thirty pages of the book to a discussion of “splitting and dissociation,”
where he addresses topics such as “depersonalization and derealization,”
“psychopathy and hysteria,” and “psychopathy and multiple personality disor-
der.” Meloy reviews a number of cases of apparently dissociative experiences
in murderers such as Ted Bundy and others, and concludes that dissociation is
“ubiquitous” in the psychopath. He argues that dissociation relates to the psy-
chopathic process in four ways: (1) it is common in the highly aroused
emotional states that psychopaths seek out to alleviate their base state of under-
arousal; (2) the psychopath’s impaired capacity to form attachments make
dissociative experiences unusual but tolerable; (3) during acts of violence dis-
sociation allows the victim to be seen as an object; and (4) memories of
dissociative experiences can be used as rationalizations for avoiding responsi-
bility, because they seem dreamlike or unreal (Meloy, 1988, p. 164). Thus, he
seems here to be primarily describing experiences of depersonalization and
derealization.7 Meloy (1988) concludes, “[T]here is a growing empirical basis
for the hypothesis that some varieties of dissociative states are significantly re-
lated to psychopathy . . .” (p. 164).
While Meloy argues for links between psychopathy and dissociation on
largely phenomenological grounds, there is some basis to conclude that etiol-
ogy may be shared as well. Porter (1996) makes an explicit argument to this ef-
fect, noting that childhood abuse can produce difficulties in experiencing
affect that could lead to a form of psychopathy, which he calls “secondary”
psychopathy, “phenotypically (and diagnostically) indistinguishable” from
“classic” or “fundamental” psychopathy (p. 183). Porter argues that, while the
“secondary” type is due to abusive childhood experiences, the “fundamental”
psychopath is inborn. This argument is premised on the position that “most
psychopaths do not come from obviously dysfunctional backgrounds” (p.182).
However, this position has been disputed by several recent studies. Koivisto
and Haapasalo (1996) and Weiler and Widom (1996) both found a correlation
between a history of documented childhood abuse and neglect and high scores
on the PCL-R. Moeller and Hell (2003), while not focusing on childhood
trauma per se, also found a strong correlation (r = .62) between the number of
reported traumatic experiences and PCL-R scores in a young male prison pop-
ulation, and Forth (1994, cited in Forth, 1995) found a variety of childhood
variables, including physical punishment, to predict scores on a version of the
PCL modified for use with adolescents (Hare, Forth, & Kosson, 1994). Fur-
ther, Weiler and Widom (1996) found psychopathy to significantly mediate
the relationship between childhood abuse and later violent behavior. Non-
etheless, it is possible that these positive results could be due to a subgroup of per-
sons meeting criteria for psychopathy, perhaps Porter’s “secondary” psycho-
paths, with strong trauma histories, and that others diagnosed as psychopathic
do not have such histories. This remains to be explored, as none of these stud-
ies was designed to address that possibility.
The form of dissociation most relevant to an understanding of psychopathy
is depersonalization. Depersonalization Disorder (DD), an uncommon and
relatively poorly researched dissociative disorder, is defined in the DSM-IV as
“persistent or recurrent experiences of feeling detached from . . . one’s mental
processes or body” (APA, 2000; p. 490). According to the DSM-IV-TR, per-
sons with DD often experience “sensory anesthesia, lack of affective response,
and a sensation of lacking control of one’s actions” (APA, 2000; p. 488).
While transient episodes of depersonalization are frequent after exposure to
severe stress (APA, 2000), individuals suffering from DD are reported to typi-
cally have such experiences on a chronic basis (Phillips et al., 2001). An in-
creased prevalence of childhood emotional abuse (but not physical abuse or
neglect) was found in one study comparing persons with DD to “healthy con-
trols” (p < .001; Simeon et al., 2001). In addition, a link between trauma and
depersonalization experiences explicitly exists in the DSM-IV criteria of
Acute Stress Disorder and PTSD (APA, 2000). A PTSD diagnosis may in-
clude aspects of depersonalization, such as “feeling detached or estranged
from others” or experiencing a “restricted range of affect” (i.e., unable to have
loving feelings; APA, 2000; p. 468). It is thus well established that experi-
ences of trauma and abuse can lead to a reduced capacity to experience
emotion.
Further, baseline autonomic hypoarousal has been found in both adults
classified as psychopathic (Pham, Philippot, & Rime, 2000) and as suffering
from DD (Stanton et al., 2001). In addition, persons diagnosed with DD and
psychopathy show strikingly similar patterns of brain functioning in response
to emotional stimuli. Specifically, there is evidence of limbic under-activation
and frontal hyperactivity in both DD and psychopathic participants when ex-

posed to emotional stimuli (Kiehl et al., 2001; Phillips et al., 2001).
With regard to depersonalization disorder, one prominent theory has ar-
gued that the core components of DD, “vigilant alertness” and “emotional
inhibition,” are produced by frontal activation and amygdala inhibition, respect-
ively (Sierra & Berrios, 1998). Support for this theory has been found in sub-
sequent studies, in which individuals with DD, in comparison to controls, have
demonstrated significantly reduced arousal to aversive pictures (Sierra et al.,
2002), and increased frontal and reduced limbic functioning in response to
“disgusting” pictures (Phillips et al., 2001). This pattern has been interpreted
in the latter study as the prefrontal cortex inhibiting the “normal” limbic re-
sponse to emotional stimuli (Phillips et al., 2001).
Some depersonalization researchers have begun to recognize that a similar
pattern has been documented in psychopathy (Sierra et al., 2002). Notably, re-
duced amygdala functioning has been argued to be central to the emotional de-
tachment seen in psychopathy (Blair, 2003), and has been found in an fMRI
study in an affectively “negative” but not a “neutral” task (i.e., pictures of fa-
cial expressions; Kiehl et al., 2001). Increased frontal activity, relative to con-
trols, was also found in the affectively “negative” task of that study (Kiehl et
al., 2001); a similar result was found in a study using affectively “negative”
and “neutral” words instead of pictures (Intrator et al., 1997). While the results
in that latter study were attributed to psychopathic participants requiring “ad-
ditional resources” (i.e., increased frontal activation) to process emotion-
ally-charged words, an alternative explanation would be the one proposed for
DD participants above (Phillips et al., 2001). That is, the increased prefrontal
activity seen in both psychopathic and DD participants compared to controls
might represent a shared mechanism, namely an increased “scanning” of the
environment for salient stimuli, akin to the “hypervigilance” (albeit less obvi-
ous) seen in PTSD patients, in order to preemptively inhibit the “normal”
limbic response to such stimuli, thereby producing the “detached” sensation.
An important difference between the groups, however, is that while they both
experience aversive stimuli as “affectively neutral,” psychopathic individuals
can correctly label these stimuli as aversive while DD participants cannot
(Christianson et al., 1996; Phillips et al., 2001). This latter finding has led one
researcher to conclude that psychopathic individuals can use “emotional
descriptors” for subjective states they “do not actually experience as emo-
tional” (Christianson et al., 1996; p. 442).
In summary, the concepts of psychopathy and DD appear similar with a
central focus in each on emotional detachment. Persons with these disorders
show similar patterns of baseline autonomic underarousal, and, in response to
emotional stimuli, frontal hyperarousal and limbic underarousal. One intrigu-
ing potential difference is that “psychopaths” may be better at identifying
emotional stimuli than persons with depersonalization disorder, despite both

groups sharing an impaired response. If this were to be replicated, it could help
to explain how “psychopaths” can “talk the talk” without “walking the walk,”
as it were, perhaps leading to the development of manipulative traits not seen
in persons with DD. Alternatively, there may be other differences, perhaps in
temperament or early childhood experiences, to explain why individuals with
DD do not appear to demonstrate the “arrogant and deceitful” interpersonal
styles or the “impulsive and irresponsible” behavioral styles seen in psychopa-
thy (Cooke & Michie, 2001), and do not appear to be at high risk for violent or
homicidal behavior.
DISCUSSION
Three “types” of homicide offenders, in addition to those with pre-existing

DID, have been proposed as having links to dissociation–“fantasy-driven,”
“overcontrolled,” and “psychopathic.” As noted above, these types need not
be mutually exclusive; it is theoretically possible, for example, that some indi-
viduals characterized as psychopathic might also frequently engage in violent
fantasies, or those characterized as fantasy-driven or overcontrolled might de-
velop a diagnosable dissociative disorder through the process which resulted
in their homicides. It is even conceivable that a homicidal personality state in
an individual with DID could meet criteria for psychopathy. Further, as DID is
undoubtedly underrecognized in this population, it is quite possible that some
offenders characterized as belonging to one of the three groups discussed
above actually suffered from DID or DDNOS prior to the crime. This is most
likely to be the case for some individuals characterized as “overcontrolled,” as
the violence–profoundly uncharacteristic of their usual mode of functioning–
could be the expression of a dissociated personality state.
Thus, for some individuals, these pathways, though conceptually distinct,
may merge in practice. Perhaps it would be more accurate to consider these as
distinct dissociative processes linked to homicidal behavior, as opposed to
ideal types. This appears most true for the fantasy-driven offenders, for whom,
despite the connection with sexual and multiple homicide, little is known
about the pre-existing personality state. Nonetheless, there appears to be little
doubt that there are violent individuals who closely match the individual pro-
files described above. Therefore, these dissociative patterns will continue to
be discussed as “types,” with the caveat that they may blend.
It should first be noted that there is no suggestion here that the violent
types discussed above exhaust the range of homicidal behavior. There
are undoubtedly violent individuals, such as those classified as “under-
controlled” (Megargee, 1966), whose violence has no apparent connec-
tion to any dissociative process. However, only a rigorous exploration of

this area will determine whether the homicide types portrayed here consti-
tute a majority, or a substantial minority, of those demonstrating signifi-
cantly violent behavior.
Proposed similarities and differences between DID, fantasy-driven,
overcontrolled, and psychopathic violent individuals, with regard to their
dissociative symptom “profile” are presented in Table 1, with those considered
most salient for a particular type highlighted. In addition, the presence of a
dissociative disorder diagnosis before, during, and after the violent episode is
considered. It is hypothesized that the level of ongoing dissociative pathology
decreases from left to right in the table, that is from DID, through fan-
tasy-driven and overcontrolled (these two might be reversed), to psychopathic
individuals.
As can be seen from the table, individuals with DID who commit homicide
in a violent or homicidal personality state would have likely experienced epi-

sodes of identity alteration and amnesia before, during, and after the homicide
(while they would also have likely experienced depersonalization and de-
realization, these symptoms are left out as they have a less direct connection to
the development or expression of violence). In contrast, those homicides clas-
sified as fantasy-driven would be most prominently characterized by an alter-
ation of identity coincident with (and possibly subsequent to) the violent
episode. Thus they, in addition to those classified as overcontrolled, might
TABLE 1. Proposed Types of Dissociation-Based Homicide Offenders
Violent alters/ Fantasy-driven Overcontrolled Psychopathic

DID
Dissociation at the
time of the homicide
Amnesia + ? + ⫺
Depersonalization ⫺ ? + ⫺
Derealization ⫺ + ? +
Identity alteration + + ⫺ ⫺
Dissociative disorder
diagnosis
Before homicide + ⫺ ⫺ ⫺
During or after + ? ? ⫺
homicide
Bold = of primary significance for particular type
meet criteria for a dissociative disorder subsequent to the violence, but most
likely not before. In addition, amnesia and symptoms of depersonalization
may occur in the fantasy-driven offender, who has spawned a violence-con-
gruent identity, but are more likely in, and central to the nature of, the
overcontrolled offender, whose homicide is affect-driven and apparently not
contained within a discrete personality state. It is proposed that symptoms of
derealization, such as feeling as though one were watching a movie or a video
game while committing a homicide, are more common in the fantasy-driven
and psychopathic individuals, highlighted by Meloy (1988) in his description
of the latter. Finally, chronic depersonalization is hypothesized to be central to
the development of psychopathic individuals, but acute depersonalisation is
likely not experienced at the time of the crime; it is further not expected that
individuals classified as psychopathic would meet diagnostic criteria for a

dissociative disorder, either before or after the crime.
An additional difference, not listed in the table, relates to the distinction be-
tween organized and disorganized crime scenes proposed by the FBI (Ressler
et al., 1988). There is some evidence that fantasy-driven and psychopathic ho-
micide offenders tend to leave organized crime scenes, while overcontrolled
homicide offenders are more likely to leave disorganized scenes (Meloy,
2000; Woodworth & Porter, 2002).
RESEARCH IMPLICATIONS
Several implications for future research arise from this review. Studies of
violent populations, such as prison inmates convicted of homicide or other vi-
olent crimes, should routinely include a screen for dissociation, such as the
Dissociation Experiences Scale (DES; Carlson & Putnam, 1986), and ideally a
structured interview, such as the SCID-D (Steinberg, 1994) for those scoring
highly on the DES. While there have been several recent studies using the DES
in prison or jail populations (reviewed in Moskowitz, 2004), no data on rates
in homicide offenders, or even violent versus non-violent offenders, have
been reported. Such studies are required to more firmly identify the prevalence
of pathological dissociation and dissociative disorders among those who com-
mit homicide.
Following such basic prevalence studies, more sophisticated studies could
be mounted to explore the different types of homicide offenders discussed
here. To specifically address some of the hypotheses presented in this review,
dissociation scores and diagnoses could be generated for the homicide types
described above, identified by means of the PCL-R for psychopathic (Hare,

1991), MMPI O-H Scale for overcontrolled (Megargee et al., 1967), and the
Inventory of Childhood Memories and Imaginings (Wilson & Barber, 1983,
cited in Rauschenberger & Lynn, 1995) or the Creative Experiences Question-
naire (Merckelbach et al., 2001) for fantasy-driven offenders. The extent of
dissociation experienced both currently and at the time of the crime could be
explored, the latter through the Peritraumatic Dissociative Experiences Ques-
tionnaire (Marmar, Weiss, & Metzler, 1997), the Dissociative Violence Inter-
view (Simoneti et al., 2000), or a modified version of the State Scale of
Dissociation (Kruger & Mace, 2002). In such a way, the hypotheses that fan-
tasy-driven and overcontrolled homicide offenders would demonstrate higher
levels of current and crime-related dissociation than offenders classified as
psychopathic (but less than those with DID) could be tested. In addition, hy-
potheses that specific dissociative symptoms would differ across the types,
such as amnesia and identity alteration, could be tested by means of the
SCID-D.
Third, research projects directly comparing persons classified as psycho-
pathic with those diagnosed as suffering from depersonalization disorder
(DD) could be designed to address a number of issues, including: (1) compara-
tive scores on the PCL-R–DD individuals should score highly on the affective
component but low on the other factor(s), (2) emotional reactivity–similar to
those which have been reviewed but directly comparing both groups–using
both psychometric and brain scanning approaches, and (3) the prevalence of
specific forms of childhood trauma and experiences in each group. Given un-
derstandable concerns about the validity of self-report data, particularly in
groups such as those designated as psychopathic, all efforts should be made to
confirm reports of childhood trauma, and validity scales, such as those used in
the MMPI, should be employed wherever possible.
Research projects using clinical samples of individuals with DID should
have two primary aims–to attempt to validate reports of perpetrated violence
and homicide, and to isolate factors which distinguish individuals with DID
who have been violent from the majority who have not. It is unfortunate that
the studies to date have not validated reports of violence; were the extremely
high levels of violence and homicide confirmed by sources other than self-re-
port, a diagnosis of DID would have to be seen as a significant risk factor for
violent behavior. As this possibility may well eventuate, it is absolutely essen-
tial that the mitigating and aggravating factors associated with violent behav-
ior in DID be identified, so that the majority of non-violent individuals with
DID not become stigmatized.
Finally, it is crucial that studies exploring the relationship between mental

disorders and homicide (as well as non-homicidal violence) include dissociative
disorders among the diagnoses they consider. This is particularly important as
two of the three symptoms identified as being particularly predictive of violence
among mentally-disordered individuals–the so-called “threat/control-override”
symptoms (e.g., paranoia, delusions of control, and delusions of thought inser-
tion; Link, Monahan, Stueve, & Cullen, 1999; Link & Stueve, 1994; Link,
Stueve, & Phelan, 1998) are frequently found in individuals with DID (Kluft,
1987; Ross et al., 1990). Indeed, there is some evidence that the “control-
override” symptoms of delusions of control and thought insertion, are more com-
monly reported in DID than in schizophrenia, where they are generally interpreted
as being due to alter personalities influencing the behavior or thinking of the
“host” personality (Kluft, 1987; Ross et al., 1990). Without the inclusion of the
SCID-D (Steinberg, 1994) or some other instrument to assess the presence of
dissociative disorders, it is impossible to rule out that some of the violent indi-
viduals classified as psychotic, and experiencing these symptoms, would be
more accurately diagnosed as suffering from DID.
FORENSIC AND CLINICAL IMPLICATIONS
The forensic implications of this thesis have been alluded to before. While
individuals experiencing dissociation at the time a homicide is committed may
have no ongoing dissociative pathology, it is also possible that they may meet
criteria for a dissociative disorder either before or after the crime. Lack of a
history of dissociation prior to the homicide does not necessarily mean that
clinical criteria for a dissociative disorder, or legal criteria for insanity, have
not been met. Certainly, such experiences should not be dismissed out of hand
as being due solely to the trauma of the act itself (though these cases undoubt-
edly exist; Rivard et al., 2002). Rather, a rigorous examination of all relevant
data, before, during and after the crime, as is standard for criminal responsibil-
ity evaluations, should be employed before any conclusions are made about
ongoing dissociative pathology.
There are also important clinical implications, which can be divided into
assessment and treatment issues. To the extent that dissociative experiences
and violent behavior are linked, as demonstrated here and in a previous paper
(Moskowitz, 2004), those working with violent individuals and persons who
have committed homicide should have them assessed for dissociative experi-
ences, and those working with dissociative individuals should carefully assess
their violence potential. With regard to treatment, it should be recognized that

individuals whose homicide was dissociation-driven may require treatment
protocols distinct from those usually seen in a prison environment. Specifi-
cally, successful treatment is likely to require addressing the dissociative
symptoms, as well as identifying and targeting stimuli likely to induce a
dissociative state. Classic correctional treatments, such as “anger manage-
ment,” “relapse prevention,” or “victim empathy” may have little efficacy in
reducing future violent episodes if the state in which the individual receives
these treatments differs dramatically from the state in which the homicide was
perpetrated. On the other hand, appropriate, dissociation-based treatment of
these violent individuals is likely to be more effective, and could potentially
prevent future violence, even homicides, from occurring again.
NOTES
1. The relation between dissociative disorders and the legal concept of criminal re-
sponsibility is a complex and contentious issue, which will only be touched on here in
passing (see Hall, 1989 and McSherry, 1998 for more thorough treatments).
2. One study did find corroboration of reports of violence in 20% of persons diag-
nosed with DID (Kluft, 1994). It was not reported whether any of the violent acts were
homicides.
3. It is important to note that dissociation researchers have long claimed that DID is
often misdiagnosed as schizophrenia (Bliss, 1980; Rosenbaum, 1980). In addition, and
of particular relevance to this thesis, is the position of Link and Stueve (1994; Stueve &
Link, 1997), who claim that three symptoms are highly predictive of violence in psy-
chotic individuals–delusions of control, delusions of thought insertion, and paranoia.
As the first two symptoms are commonly reported in individuals with DID (Kluft,
1987; Ross et al., 1990), the possibility that some violent persons with these symptoms
may have been misdiagnosed as psychotic cannot be dismissed.
4. Note the similarities to Kluft’s (1994) discussion of DID as developing through a
“brutalized child’s whimpering in the night and wishing with desperate earnestness
that he or she were someone else, somewhere else, and that what had befallen him or
her had befallen someone else” (p. 16).
5. These comments were expunged from later editions of the book (Cleckley, 1976).
6. While some recent studies have argued for three factors underlying the psychop-
athy construct as opposed to two, one of the proposed factors, “deficient affective ex-
perience,” remains quite similar to the “emotional detachment” factor described above
(Cooke & Michie, 2001; Skeem, Mulvey, & Grisso, 2003). The other two factors pro-
posed are: “arrogant and deceitful interpersonal style,” and “impulsive and irresponsi-
ble behavioral style” (Cooke & Michie, 2001).
7. There is reason to believe that amnesia for violent behavior is relatively infre-
quent in those classified as psychopathic (Porter, Birt, Yuille, & Herve, 2001), perhaps
in contrast to overcontrolled individuals.
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Dissociative Pathways to Homicide: Clinical and

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Dissociative Pathways to Homicide:

ABSTRACT. In a earlier review, dissociation was found to be linked to

ten expressed in the violent act itself, in the form of depersonalization or

Andrew K. Moskowitz is affiliated with the Department of Psychology, University

and forensic implications of this are discussed. Further research system-

KEYWORDS. Dissociation, psychopathy, homicide, fantasy, deper-

Having previously argued that dissociative episodes are commonly experi-

processes, i.e., “trait” dissociation, may lead to the development of homicidal

(T)he occurrence of dissociative symptoms among such a high propor-

sociative processes play a major role in the development of homicidal behav-

VIOLENCE AND HOMICIDE IN PERSONS

Dissociation researchers have long wondered about a relationship between

ally include psychoses such as schizophrenia and affective disorders such as

vealed that approximately 25% of prison or jail inmates demonstrate “patho-

(Loewenstein & Putnam, 1990; Putnam et al., 1986), is considerably higher

FANTASY-DRIVEN VIOLENCE IN SERIAL

Several authors have identified fantasy as an important factor in the de-

This fantasy world becomes of great importance to these individuals, taking

“OVERCONTROLLED” HOSTILITY AND DISSOCIATED RAGE

as overcontrolled are uncomfortable with openly expressing, or even ac-

[They are] characterized by excessive inhibitions against the expression

Megargee’s theory led to the development of an MMPI scale designed to

riod of brooding followed by an outburst of violent, aggressive, or homicidal

PSYCHOPATHY AND DEPERSONALIZATION

Gilligan describes the extraordinarily violent childhoods experienced by

this section, psychopathy and depersonalization share this emotional “numb-

(1988). Meloy, coming from a strongly psychoanalytic perspective, dedicates

and frontal hyperactivity in both DD and psychopathic participants when ex-

emotional stimuli than persons with depersonalization disorder, despite both

Three “types” of homicide offenders, in addition to those with pre-existing

tion to any dissociative process. However, only a rigorous exploration of

in a violent or homicidal personality state would have likely experienced epi-

TABLE 1. Proposed Types of Dissociation-Based Homicide Offenders

Violent alters/ Fantasy-driven Overcontrolled Psychopathic

individuals classified as psychopathic would meet diagnostic criteria for a

described above, identified by means of the PCL-R for psychopathic (Hare,

Finally, it is crucial that studies exploring the relationship between mental

FORENSIC AND CLINICAL IMPLICATIONS

their violence potential. With regard to treatment, it should be recognized that

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental

sic psychiatric population. Dissertation Abstracts International: Section B: the Sci-

Megargee, E.I. (1966). Undercontrolled and overcontrolled personality types in ex-

Biological Psychiatry, 44, 898-908.

Steinberg, M. (1995). Handbook for the assessment of dissociation: A clinical guide.

homicidal behavior among discharged forensic psychiatric patients. Forensic Sci-

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