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The relationship between mental disorders and different types of crime

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Criminal Behaviour and Mental Health
(2011)
Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/cbm.819

The relationship between mental

disorders and different types
of crime

DAVID J. VINKERS1, EDWIN DE BEURS1, MARKO BARENDREGT1,

THOMAS RINNE1 AND HANS W. HOEK2,3,4, 1Netherlands Institute
for Forensic Psychiatry and Psychology, Rotterdam, the Netherlands;
2
Parnassia Bavo Psychiatric Institute, The Hague, the Netherlands;
3
Department of Psychiatry, Groningen University Medical Centre, Groningen,
the Netherlands; 4Mailman School of Public Health, Department of
Epidemiology, Columbia University, New York, USA

ABSTRACT
Background Previous studies of relationships between mental disorder and crime have
tended to group the mental disorders, the crimes or both, leaving uncertainty about a
more specific mental disorder: crime relationships.
Objective To examine the relationship between types of mental disorder and types of
crime in pre‐trial defendants.
Method Data were extracted from 21,424 pre‐trial forensic psychiatric reports made
between 2000 and 2006 in the Netherlands. We compared the prevalence of axis I dis-
orders, personality disorders, intellectual functioning and substance abuse in defendants
charged with a range of crimes (homicide, attempted/threatened homicide, assault, bat-
tery, rape, sexual crimes, arson and/or property crimes) using chi‐square tests. Rela-
tionships with diminished accountability, reflecting a direct relationship with
underlying mental disorder, were calculated using multivariate regression models, ad-
justed for age, gender, ethnicity and history of judicial contact.
Results Arson had the strongest relationship with mental disorders in our sample, then
assaults, then homicidal attempts or threats. Sexual and property crimes had the weakest
relationship with diminished or absent accountability. Diminished accountability had the
strongest relationship with psychotic disorders, followed by organic psychosyndromes and
developmental disorders, whereas other axis I disorders, personality disorders or an IQ
score of <85 points were only moderately related. These relationships varied little
according to the type of crime, although tended to be weaker for defendants in property
crimes. Cannabis and hard drugs were significantly associated with decreased account-
ability only in respect of arson.

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
Vinkers et al.

Discussion Mental disorders are related to all types of crimes but especially to arson,
battery and homicidal attempts or threats, with a court finding of diminished account-
ability providing some validation for perceived links between the disorder and crime in
this study.
Implications for practice
• Psychiatric assessment is likely to be the most useful for defendants under charges of
arson, assault or attempted homicide, as these groups are most likely to suffer from a
psychiatric disorder related to the alleged offence.
• Psychotic, organic and some developmental disorders appear to have the strongest
relationship with diminished accountability.
• Findings with respect to illicit drug use are likely to have more varied implications be-
tween jurisdictions but, in the Netherlands, may sometimes be accepted as diminishing
accountability in defendants of arson. Copyright © 2011 John Wiley & Sons, Ltd.

Introduction

Patients suffering from mental disorders are more often convicted for crimes than
the general population (Wallace et al., 1998; Arseneault et al., 2000; Brennan
et al., 2000; Walsh et al., 2002), some showing that all types of crime are repre-
sented (Taylor and Gunn, 1984; Hodgins, 1992; Modestin and Ammann, 1995;
Mullen et al., 2000; Wallace et al., 2004) and others that there is only a relation-
ship with violent offences (Lindqvist and Allebeck, 1990; Wessely et al., 1994;
Tiihonen et al., 1997; Wessely, 1997; Silver et al., 2008). In line with the latter,
several studies found a relationship with sexual offences (Wallace et al., 2004;
Alden et al., 2007; Silver et al., 2008), whereas other studies could not confirm
this relationship (Modestin and Ammann, 1996; Wessely, 1997; Mullen et al.,
2000). A limitation, however, is that most analyses have been done either between
one type of disorder (e.g., schizophrenia) and various types of offending or between
one type of offence (e.g. homicide or sexual offending) and various types of disorder.
Moreover, offending is usually broadly categorised, such as “violent offending” and
“sexual offending”. Furthermore, associations between the presence of mental disor-
ders and criminal offences do not explain the relationships. A psychotic disorder
may be related to violent offences because a psychosis limits the cognitive ability
for making a rational choice between behavioural alternatives, but a property crime
by a psychotic patient may be caused by need for money (e.g. for drugs). Thus, even
if mental disorders are related to specific types of crime, the underlying mechanisms
may differ, and there is still uncertainty whether specific types of mental disorder are
related to specific types of offending.
In Dutch courts, accountability is considered to be diminished if there is a
clear relationship between a mental disorder and the crime committed (Van
der Leij et al., 2001). Five degrees of responsibility are recognised: complete re-
sponsibility, slightly diminished, diminished, severely diminished and total

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
 Relationships between mental disorder and crime

absence of responsibility (Van Marle, 2000). A severe mental disorder, usually of

a psychotic nature, is a necessary condition for total absence of responsibility and
absolves guilt completely. Complete responsibility means that a defendant com-
mitted the crime while fully in his right mind either because of the absence of a
mental disorder or because the presence of a mental disorder is not related to the
crime.
We therefore examined the relationship between a range of specific mental dis-
orders and different types of crimes in a large sample of Dutch pre‐trial psychiatric
reports and also tested the extent to which the courts perceived mental disorder to
have been a factor in the crimes as charged.

Method

The sample
A total of 21,857 reports for 19,414 defendants were identified for 7 years,
2000–2006. The number of reports (n = 21,857) was used as unit of analysis,
because the interest was in the relationship between specified crime and the
disorder as diagnosed at that time. In fact, when we excluded the 2,430 people
with multiple reports, the results were similar (Vinkers et al., 2009).

The procedures
We extracted all pre‐trial reports made between 1 January 2000 and 31 December
2006 from the Forensic Report Information System (FRIS) database. The purpose
of a pre‐trial psychiatric report is to provide the Court with information about the
defendant’s mental state. In the Netherlands, the reporting psychiatrist is expected
to say whether the defendant suffers from a mental disorder or impairment in intel-
lectual development, and if the defendant is found guilty by the court, to what
extent such a condition is related to the crime, to what degree the defendant should
thus be held responsible and whether treatment may prevent the defendant from
repeating the crime. Suspicion that a defendant suffers from a mental disorder is
derived from information about the defendant and the nature of the crime for
which he or she is indicted (Van Kordelaar, 2002). The examining judge or public
prosecutor issues an order for a pre‐trial psychiatric report and the Netherlands
Institute for Forensic Psychiatry and Psychology (NIFP) then assigns one or more
of the 650 forensically trained psychiatrists or psychologists to do so. The NIFP
also reviews the quality of the reports and maintains the nationwide pre‐trial
report database (FRIS).
Demographic and psychiatric information is provided by the reporting psychia-
trist or psychologist by means of a form with fixed categories.
Demographic information consists of age, gender and history of judicial contact.

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
Vinkers et al.

Mental disorders are categorised as attention deficit hyperactivity disorder

(ADHD), affective disorders, developmental disorders, organic psychosyndromes,
paraphilia, psychotic disorders and other disorders. Personality disorders are differ-
entiated into personality disorders from cluster A, B or C, Not Otherwise Specified
or developing personality disorders. Intellectual functioning is grouped as above
average, average, below average and IQ score lower than 85 points. Substance abuse
is categorised as alcohol, cannabis or hard drug abuse. Diagnoses are based on mul-
tiple examinations of the defendant, the judicial and psychiatric history including
previous reports and, when applicable, information from relatives and psychological
tests. Pre‐trial reports were prepared by a psychiatrist (24.7%), by a psychologist
(42.8%) or by both a psychiatrist and a psychologist (32.5%).
Crimes were classified as homicide, homicidal assault or threat, assault, battery,
rape, sexual, arson and property crimes, which include fraud, theft and drug‐related
crimes.

Analyses
To examine the relationship between mental disorders and different types of
crimes, the prevalence of indicted crime per grade of accountability was com-
pared using chi‐square tests. We examined the relationship between types of
crimes and diminished accountability, valuing absent accountability at 1,
strongly diminished accountability 0.75, diminished accountability 0.5, slightly
diminished accountability 0.25 and undiminished accountability 0. Differences
in means were tested with an ANOVA test. In multivariate regression models
with diminished accountability as the dependent variable, we adjusted for age,
gender, ethnicity and history of judicial contact. The relationship is expressed
by a beta, which reflects the strength of the correlation between mental disorder
and diminished accountability. The regression models for mental disorders and
accountability include all mental disorders. The analyses were performed with
SPSS 16.0 (IBM Corp., Somers, NY, USA).

Results

A total of 21,424 reports were available for analysis, because information on

nature of charge was missing in 433. We compared the characteristics of these
two groups on sex, age, ethnic origin and history of judicial contact and found
that there were no significant differences between them on these measures, and
thus no indication of major bias from loss of these cases [19,654 (91.7%) vs
392 (90.5%) males, X2 = 1.052491, p = 0.59; 14,680 (68.5%) vs 324 (74.8%) per-
sons with Dutch ethnicity, X2 = 14.142, p = 0.078; 10,002 (46.7%) vs 174
(40.2%) persons with a history of judicial contact, X2 = 1.179, p = 0.278; median

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
 Relationships between mental disorder and crime

age is 27 years (interquartile range 18–38 years) vs 30 years (interquartile range

19–38 years) ANOVA p = 0.29].
Table 1 shows the frequency of mental disorders according to the 21,424 pre‐
trial psychiatric reports. The total prevalence of mental disorders was highest
where the main charge was a property crime (58.0%) and lowest where it was
murder (40.0%; X2 = 5325.6, p < 0.001). More specifically, the prevalence of psy-
chotic disorders was relatively high in relation to battery (17.6%) and/or man-
slaughter charges (16.0%) and relatively low in respect of sexual crimes (3.2%)
and rape (5.6%; X2 = 5325.6, p < 0.001). Developmental disorders were especially
prevalent in defendants of sexual crimes (6.9%; X2 = 5325.6, p < 0.001). Person-
ality disorders were most common in defendants of battery (53.5%) and property
(51.7%) and least common in defendants of sexual crimes (46.1%) and assault
(48.2%; X2 = 122.01, p < 0.001). Cluster B personality disorders were more com-
mon in defendants charged with violent crimes (20.9–23.0%), whereas cluster C
personality disorders were more common in respect of sexual crimes (7.3%;
X2 = 122.01, p < 0.001). An IQ score of 85 and below, or intellectual functioning
estimated as being below average, was more common in rape defendants (14.7%
vs 24.4%; X2 = 200.62, p < 0.001). Alcohol abuse was more common in defen-
dants charged with arson (27.3%) and less common in defendants where the
charges were sexual (8.9%) or property related (7.8%; X2 = 2120.4, p < 0.001).
Abuse of both cannabis (13.0%) and hard drugs (24.3%) was especially high in
relation to property crimes (X2 = 2120.4, p < 0.001).
Table 2 presents the prevalence of the different grades of accountability in
pre‐trial reports as recorded by the psychiatrist or psychologist depending on
the crime as charged. Accountability was most often considered to be undimin-
ished in respect of sexual (23.5%) or homicide (25.4%) charges and least often
in arson (13.4%) and battery (15.1%; X2 = 720.14, p < 0.001). A slightly dimin-
ished accountability was more common proposed with respect to property
(44.2%) and assault charges (42.7%; X2 = 720.14, p < 0.001). Strongly dimin-
ished or absent accountability was more common in arson (7.5% and 7.8%), bat-
tery (7.5% and 7.0%) and homicidal attempt or threat (6.0% and 7.8%;
X2 = 720.14, p < 0.001).
Figure 1 shows the relationship between type of crime and diminished ac-
countability, valuing absent accountability at 1, strongly diminished accountabil-
ity 0.75, diminished accountability 0.5, slightly diminished accountability 0.25
and undiminished accountability 0 (ANOVA, X2 = 27.101, p < 0.001). Arson
was most strongly associated with diminished accountability (mean 0.40, SD
0.27), followed by battery (mean 0.37, SD 0.27) and homicidal attempt or threat
(mean 0.27, SD 0.28). Sex‐related and property crimes had the weakest associa-
tion with diminished accountability (mean 0.28, SD 0.22 and mean 0.29, SD
0.22, respectively).
Table 3 presents the relationship between mental disorders and diminished
accountability in the defendants of different types of crimes, adjusted for age,

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
 Vinkers et al.

Table 1: Mental disorders in defendants charged with different types of crimes

All Homicide Homicidal attempt Assault Battery Rape Sexual Arson Property
(n = 21424) (n = 1020) of threat (n = 4375) (n = 4084) (n = 1532) (n = 1492) (n = 2039) (n = 1455) (n = 5427)

Axis I disorders 11717 (54.7) 408 (40.0) 2337 (53.4) 2337 (57.2) 815 (53.2) 696 (46.6) 1137 (55.8) 825 (56.7) 2985 (55.0)
(total)

Copyright © 2011 John Wiley & Sons, Ltd.

ADHD 896 (4.2) 20 (2.0) 184 (4.2) 189 (4.6) 57 (3.7) 40 (2.7) 50 (2.5) 60 (4.1) 288 (5.6)
Affective 1736 (8.1) 96 (9.4) 420 (9.6) 327 (8.0) 129 (8.4) 93 (6.2) 117 (5.7) 181 (12.4) 318 (6.2)
disorders
Conduct 2906 (13.6) 53 (5.2) 413 (9.4) 739 (18.1) 151 (9.9) 138 (9.2) 91 (4.5) 139 (9.6) 1153 (22.4)
disorder
Developmental 953 (4.4) 21 (2.1) 148 (3.4) 171 (4.2) 59 (3.9) 90 (6.0) 140 (6.9) 71 (4.9) 245 (4.8)
disorders
Organic 312 (1.5) 14 (1.4) 71 (1.6) 40 (1.0) 29 (1.9) 32 (2.1) 33 (1.6) 26 (1.8) 59 (1.1)
psychosyndrome
Paraphilia 670 (3.1) 1 (0.1) 12 (0.3) 7 (0.2) 14 (0.9) 103 (6.9) 518 (25.4) 2 (0.1) 9 (0.2)
Psychotic 2666 (12.4) 115 (11.3) 702 (16.0) 562 (13.8) 270 (17.6) 83 (5.6) 65 (3.2) 211 (14.5) 607 (11.8)
disorders
Other disorders 1578 (7.4) 88 (8.6) 387 (8.8) 302 (7.4) 106 (6.9) 117 (7.8) 123 (6.0) 135 (9.3) 306 (5.9)
No disorder 7066 (33.0) 446 (43.7) 1497 (34.2) 1176 (28.8) 503 (32.8) 637 (42.7) 764 (37.5) 417 (28.7) 1554 (30.2)

DOI: 10.1002/cbm
(2011)
 Personality 10744 (50.1) 519 (50.9) 2253 (51.5) 1969 (48.2) 819 (53.5) 677 (45.4) 940 (46.1) 759 (52.2) 2808 (51.7)
disorder (total)
Cluster A 367 (1.7) 20 (2.0) 87 (2.0) 74 (1.8) 43 (2.8) 19 (1.3) 32 (1.6) 28 (1.9) 64 (1.2)
Cluster B 4275 (20.0) 216 (21.2) 1008 (23.0) 853 (20.9) 348 (22.7) 227 (15.2) 218 (10.7) 307 (21.1) 1098 (20.2)
Cluster C 679 (3.2) 58 (5.7) 112 (2.6) 81 (2.0) 39 (2.5) 45 (3.0) 149 (7.3) 74 (5.1) 121 (2.2)
NOS 3919 (18.3) 198 (19.4) 843 (19.3) 614 (15.0) 310 (20.2) 291 (19.5) 466 (22.9) 279 (19.2) 918 (16.9)

Copyright © 2011 John Wiley & Sons, Ltd.

Developing 1504 (7.0) 27 (2.6) 203 (4.6) 347 (8.5) 79 (5.2) 95 (6.4) 75 (3.7) 71 (4.9) 607 (11.2)
Intellectual functioning
Above average 1613 (7.5) 89 (8.7) 361 (8.3) 226 (5.5) 361 (8.3) 121 (8.1) 216 (10.6) 112 (7.7) 356 (6.6)
Average 5281 (24.6) 276 (27.1) 1348 (30.8) 819 (20.1) 385 (25.1) 360 (24.1) 390 (19.1) 357 (24.5) 1346 (24.8)
Below average 3165 (14.8) 129 (12.6) 784 (17.9) 485 (11.9) 199 (13.0) 219 (14.7) 197 (9.7) 217 (14.9) 935 (17.2)
IQ < 85 points 3312 (15.5) 93 (9.1) 582 (13.3) 555 (13.6) 181 (11.8) 364 (24.4) 385 (18.9) 228 (15.7) 924 (17.0)
Substance abuse 8462 (39.5) 420 (41.1) 2010 (45.9) 1548 (37.9) 622 (40.6) 399 (26.7) 299 (14.7) 713 (49.0) 2356 (43.4)
(total)
Alcohol 3148 (14.7) 204 (20.0) 854 (19.5) 605 (14.8) 278 (18.1) 206 (13.8) 182 (8.9) 397 (27.3) 422 (7.8)
Cannabis 1961 (9.2) 75 (7.4) 414 (9.5) 390 (9.5) 124 (8.1) 72 (4.8) 67 (3.3) 111 (7.6) 708 (13.0)
Hard drugs 3353 (15.7) 141 (13.8) 742 (17.0) 553 (13.5) 220 (14.4) 121 (8.1) 50 (2.5) 205 (14.1) 1321 (24.3)

ADHD = attention deficit hyperactivity disorder; NOS = Not Otherwise Specified.

Chi‐square for all characteristics, p < 0.001.
Relationships between mental disorder and crime

DOI: 10.1002/cbm
(2011)
 Vinkers et al.

Table 2: Accountability in defendants charged with different types of crimes

Homicidal assault
All Homicide of threat Assault Battery Rape Sexual Arson Property

Copyright © 2011 John Wiley & Sons, Ltd.

Accountability (n = 21424) (n = 1020) (n = 4375) (n = 4084) (n = 1532) (n = 1492) (n = 2039) (n = 1455) (n = 5144)

Undiminished 3984 (18.6) 259 (25.4) 720 (16.5) 782 (19.1) 232 (15.1) 291 (19.5) 479 (23.5) 195 (13.4) 975 (19.0)
Slightly 8392 (39.2) 309 (30.3) 1564 (35.7) 1743 (42.7) 588 (38.4) 565 (37.9) 775 (38.0) 486 (33.4) 2273 (44.2)
diminished
Diminished 526 (23.9) 239 (23.4) 1140 (26.1) 908 (22.2) 400 (26.1) 361 (24.2) 517 (25.4) 448 (30.8) 1048 (20.4)
Strongly 1068 (5.0) 63 (6.2) 264 (6.0) 179 (4.4) 115 (7.5) 18 (1.2) 68 (3.3) 109 (7.5) 183 (3.6)
diminished
Absent 1018 (4.8) 58 (5.7) 340 (7.8) 202 (4.9) 107 (7.0) 39 (2.6) 23 (1.1) 113 (7.8) 120 (2.3)

Chi‐square per grade of accountability, p < 0.001.

DOI: 10.1002/cbm
(2011)
 Relationships between mental disorder and crime

Figure 1: The relationship between type of crime and diminished accountability, valuing absent
accountability at 1, strongly diminished accountability 0.75, diminished accountability 0.5, slightly
diminished accountability 0.25 and undiminished accountability 0 (ANOVA, X2 = 27.101,
p < 0.001)

gender, ethnicity and history of judicial contact. The beta reflects the strength of
the relationship between mental disorder and diminished accountability. For all
crimes, psychotic disorders have a strong relationship with diminished account-
ability [β = 4.35 (4.22–4.48), p < 0.001], followed by organic psychosyndromes
[β = 2.91 (2.64–3.18), p < 0.001] and developmental disorders [β = 2.20
(2.04–2.36), p < 0.001]. Affective disorders [β = 1.62 (1.50–1.74), p < 0.001],
ADHD [β = 1.32 (1.16–1.48), p < 0.001] and an IQ lower than 85 points
[β = 1.13 (1.04–1.22), p < 0.001] were moderately strong related to diminished
accountability for all different types of crimes.
From the specific psychiatric disorders, psychotic disorders were associated
with all different types of crimes, except rape [β = 1.46 (0.99–1.93),
p < 0.001]. Developmental disorders were most strongly associated with homi-
cide [β = 3.28 (2.71–3.84), p < 0.001]. Paraphilia was specifically associated with
rape [β = 2.57 (1.72–3.42), p < 0. 001], assault [β = 1.90 (0.37–3.43), p < 0.001]
and homicide [β = 1.46 (0.99–1.93) p < 0.001]. Personality disorders were espe-
cially associated with sexual crimes [β = 1.49 (1.21–1.76), p < 0.001] and homi-
cide [β = 1.25 (0.97–1.54), p < 0. 001]. An IQ lower than 85 points was most
strongly related to sexual crimes [β = 1.64 (1.32–1.97), p < 0. 001]. Cannabis
and hard drugs were only significantly associated with decreased accountability
in arson [β = 0.28 (0.08–0.48), p < 0.001 and β = 0.22 (0.02–0.41), p < 0.001,
respectively].

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
 Vinkers et al.

Table 3: Relationship between mental disorders and diminished accountability in defendants charged with different types of crimes

All Homicide Homicidal attempt Assault Battery

(n = 21,424) (n = 1020) or threat (n = 4375) (n = 4084) (n = 1532)

a
Axis I disorders

Copyright © 2011 John Wiley & Sons, Ltd.

ADHD 1.32 (1.16–1.48)** 1.35 (0.60–2.10)** 1.51 (1.17–1.85)** 1.23 (0.85–1.61)** 1.49 (0.87–2.12)**
Affective disorders 1.62 (1.50–1.74)** 1.43 (0.92–1.94)** 1.85 (1.60–2.09)** 1.77 (1.48–2.06)** 1.32 (0.88–1.76)**
Conduct disorder 0.71 (0.60–0.82)** 1.02 (0.57–1.48)** 0.93 (0.67–1.19)** 0.53 (0.26–0.79)** 0.46 (−0.01–0.93)
Developmental disorders 2.20 (2.04–2.36)** 3.28 (2.71–3.84)** 2.28 (1.89–2.67)** 1.63 (1.23–2.03)** 2.53 (1.89–3.17)**
Organic psychosyndrome 2.91 (2.64–3.18)** 2.57 (1.72–3.42)** 2.54 (2.01–3.07)** 2.50 (1.74–3.27)** 2.60 (1.77–3.43)**
Paraphilia 0.98 (0.81–1.16)** 1.46 (0.99–1.93)** 1.09 (−0.10–2.27) 1.90 (0.37–3.43)* 0.94 (−0.11–1.98)
Psychotic disorders 4.35 (4.22–4.48)** 4.80 (4.20–5.41)** 4.85 (4.58–5.11)** 4.11 (3.81–4.42)** 4.77 (4.30–5.24)**
Other disorders 0.98 (0.86–1.11)** 0.73 (0.24–1.22)* 1.12 (0.88–1.37)** 0.87 (0.54–1.20)** 1.00 (0.53–1.48)**
Personality disorder 0.92 (0.85–0.99)** 1.25 (0.97–1.54)** 1.00 (0.84–1.15)** 0.92 (0.72–1.11)** 0.97 (0.69–1.25)**
IQ < 85 points 1.13 (1.04–1.22)** 1.34 (1.03–1.65)** 1.13 (0.92–1.33)** 1.02 (0.77–1.27)** 0.88 (0.50–1.25)**
Substance abuse
Alcohol −0.16 (−0.12–0.09) 0.02 (−0.37–0.41) −0.14 (−0.34–0.06) −0.32 (−0.58–0.05)* −0.22(−0.59–0.15)
Cannabis 0.15 (0.32–2.62)* 0.37 (−0.17–0.91) 0.25 (0.01–0.49)* 0.09 (−0.21–0.38) 0.07 (−0.39–0.54)
Hard drugs −0.07 (−0.17–0.03) 0.32 (−0.14–0.07) −0.06 (−0.26–0.14) −0.26 (−0.54–0.01) 0.08 (−0.30–0.47)

DOI: 10.1002/cbm
(2011)
 b
Axis I disorders Rape (n = 1492) Sexual (n = 2039) Arson (n = 1455) Property (n = 5427)
ADHD 1.35 (0.60–2.10)** 1.43 (0.68–2.17)** 1.34 (1.05–1.63)** 1.37 (1.07–1.67)**
Affective disorders 1.43 (0.92–1.94)** 1.18 (0.73–1.63)** 1.36 (1.10–1.62)** 1.35 (1.07–1.63)**
Conduct disorder 0.44 (−0.46–1.33) 0.88 (0.26–1.50)* 0.85 (0.66–1.04)** 0.88 (0.63–1.07)**
Developmental disorders 1.02 (0.57–1.48)** 2.49 (1.97–3.02)** 2.10 (1.78–2.42)** 2.11 (1.78–2.44)**
Organic psychosyndrome 3.28 (2.71–3.84)** 4.87 (3.76–5.97)** 3.57 (3.00–4.15)** 3.66 (3.05–4.27)**

Copyright © 2011 John Wiley & Sons, Ltd.

Paraphilia 2.57 (1.72–3.42)** 1.07 (0.79–1.35)** 1.28 (0.18–2.38)* 1.40 (0.05–2.74)*
Psychotic disorders 1.46 (0.99–1.93)** 4.76 (3.88–5.63)** 3.61 (3.36–3.86)** 3.58 (3.32–3.84)**
Other disorders 4.80 (4.20–5.41)** 0.92 (0.45–1.39)** 0.74 (0.46–1.02)** 0.70 (0.42–0.99)**
Personality disorder 0.73 (0.24–1.22)* 1.49 (1.21–1.76)** 0.62 (0.48–0.77)** 0.62 (0.47–0.77)**
IQ < 85 points 1.34 (1.03–1.65)** 1.64 (1.32–1.97)** 1.27 (1.10–1.45)** 1.32 (1.14–1.49)**
Substance abuse
Alcohol 0.02 (−0.37–0.41) −0.15 (−0.57–0.27) 0.07 (−0.19–0.33) 0.07 (−0.20–0.34)
Cannabis 0.37 (−0.17–0.91) −0.29 (−0.93–0.35) 0.28 (0.08–0.48)* 0.27 (0.06–0.48)
Hard drugs 0.32 (−0.14–0.77) −0.04 (−0.73–0.64) 0.22 (0.02–0.41)* 0.18 (−0.11–0.38)

*p < 0.05.
**p < 0.001. Estimated betas from regression models adjusted for age, gender, ethnicity and history of judicial contact, valuing absent accountability at 1,
strongly diminished accountability 0.75, diminished accountability 0.5, slightly diminished accountability 0.25 and undiminished accountability 0.
ADHD = attention deficit hyperactivity disorder.
Relationships between mental disorder and crime

DOI: 10.1002/cbm
(2011)
Vinkers et al.

Discussion

Using a large database of psychiatric pre‐trial examinations, we examined the

relationship between mental disorders and different types of crimes. We found
that all types of mental disorder were related to all types of criminal charge but
that some specific crime : disorder relationships could be identified which were
much stronger than others. Specifically, the presence of any mental disorder
among pre‐trial forensic patients is most strongly associated not only with arson
and battery and homicidal attempts or threats but also with sexual crimes (Wallace
et al., 2004; Alden et al., 2007; Silver et al., 2008) and violent crimes (Lindqvist
and Allebeck, 1990; Tiihonen et al., 1997; Silver et al., 2008). These findings are
in line with published literature showing evidence of a broad relationship be-
tween mental disorders and all types of crimes (Taylor and Gunn, 1984; Hodgins,
1992; Modestin and Ammann, 1995; Mullen et al., 2000; Wallace et al., 2004).
From the specific psychiatric disorders, psychotic disorders were associated with
all different types of crimes, except rape. Developmental disorders were most
strongly associated with homicide. Personality disorders were especially associ-
ated with sexual crimes and homicide. An IQ lower than 85 points was most
strongly related to sexual crimes. Cannabis and hard drugs were only significantly
associated with decreased accountability in arson, in line with the culpa in cause
principle.

Mental disorder: crime relationships and the nature of the sample

The fact that there was a relationship between mental disorder and crime gener-
ally was perhaps not surprising as this sample had been selected for the likelihood
of serious mental disorder, given that the major criterion for inclusion was that
the defendants needed a psychiatric assessment for the court. When we extrapo-
lated from prevalence figures in our sample, we did find a selection bias, which
leads to overestimation of the frequency of mental disorders. For example, the
prevalence of axis I psychiatric disorders in a non‐selected sample of Dutch
defendants was 22% (Bulten et al., 2009), as compared with a prevalence of
55% in our study. Furthermore, we found a prevalence of psychotic disorders of
15% in defendants of violent crimes, whereas earlier studies found that only
5–10% of the violent offenders suffer from psychotic disorders (Eronen et al.,
1996; Wallace et al., 1998; Arseneault et al., 2000; Brennan et al., 2000; Wallace
et al., 2002).
An important strength of this study is that the direct relationship between men-
tal disorders and different types of crimes is examined through the accountability
considered in the pre‐trial psychiatric examination. Even when a relationship
can be established between mental disorder and crime, this is not much use in prac-
tice, unless there is some understanding of that relationship and, in particular,
whether the crime may be directly attributed to the disorder or whether there is

Copyright © 2011 John Wiley & Sons, Ltd. (2011)

DOI: 10.1002/cbm
 Relationships between mental disorder and crime

only an indirect association, for example through low socio‐economic status, previ-
ous institutionalisation or substance abuse (Monahan and Steadman, 1983;
Robertson, 1988; Arboleda‐Florez et al., 1998; Brennan et al., 2000; Wallace
et al., 2004) or a common antecedent. Furthermore, mentally ill offenders are
more easily caught by the police than healthy persons (Teplin, 1984; Robertson,
1988). Underlying mental disorders in defendants are thus not automatically re-
lated to the indicted crime. For example, the shoplifting of an addicted person
suffering from schizophrenia may be caused by poverty and not by psychotic
symptoms. In defendants of property crimes, we indeed found a high prevalence
of mental disorders, but the odds ratio of a diminished accountability is low. This
suggests that mental disorders do not in themselves lead to property crimes but
through confounding factors. Defendants of homicide have a low prevalence of
mental disorders, but they are relatively often considered as diminished account-
able. This is in line with the deviance hypothesis, which states that severe crimes
are more often related to mental disorders (Silver et al., 2008). Defendants of
rape and sexual crimes are more often considered as accountable in comparison
with other defendants and suffer less often from mental disorders, with the excep-
tion of paraphilia, development disorders and impaired intellectual functioning.

Conflict of Interest

All authors declare that they have no conflicts of interest.

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Address correspondence to: David J. Vinkers, Netherlands Institute for Forensic

Psychiatry and Psychology, the Netherlands, Noordsingel 113, 3035 EM, Rotterdam,
the Netherlands. Email: d.vinkers@dji.minjus.nl

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DOI: 10.1002/cbm

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