Sexual Murder - Justicia Forense

5.3 Differential DiagnosisAcute catathymic homicides are more complex acts than murders triggeredby stressful situations, anger, temper, or jealousy. Much deeper feelings aretapped in the acute catathymic process, where powerful conflicts regardinginadequacy — primarily sexual inadequacy — are the causes of the violentoutbursts. Individuals who experience a catathymic explosion often do nothave a background of violence or impulsivity but, instead, are secretly strugglingwith a more ominous underlying issue. Notwithstanding these distinctions,diagnostic problems often occur in differentiating catathymichomicides and catathymic attacks from severe violence that is simply a resultof anger and loss of control.Diagnostic clarification is not helped by reference to the literature onimpulse-control disorders. In fact, the many classification systems of dyscontrolsyndromes have been inconsistent, confusing, and sometimes even incorrect.The earlier work of Monroe (1970, 1974, 1978), which expanded onMenninger and Mayman’s (1956) initial description of episodic dyscontrol,is an example of confusion in terminology. Monroe described two generaltypes of dyscontrol based on different causes. One type involves a completeabsence of “reflective delay”; Monroe referred to these spontaneous acts,without much cognitive modulation, as being cases of “primary dyscontrol.”In the other type, the offender hesitates and resists the impulse, so there issome premeditation; Monroe labeled these acts “secondary dyscontrol.” Hebelieved that primary dyscontrol is a result of “faulty equipment,” mainly aneurophysiological deficit. “Faulty learning,” found in secondary dyscontrolcases, is a result of life experiences, which can also lead to aggressive outburstsabsent neurological disinhibition. He argued that primary dyscontrol canalso be called epileptoid dyscontrol, while secondary dyscontrol can bereferred to as hysteroid dyscontrol (see Table 5.2).Although the Diagnostic and Statistical Manual is only a guideline, itscoverage of impulse-control disorders since 1980 has also been quite confusingand perhaps even, at times, inaccurate. Coles (1997) among others (e.g., Cartwright,2001), also commented on the lack of clarity in the DSM with regardto the explosive disorders. For instance, the DSM-III (1980) described “IsolatedExplosive Disorder” as involving an individual’s “failure to resist an impulse thatTable 5.2Monroe’s View of Episodic DyscontrolPrimary DyscontrolNeurophysiological deficit“Faulty equipment”Absence of reflective delayEpileptoid dyscontrolSecondary DyscontrolDisturbed life experiences“Faulty learning”Hesitation and resistance of impulseHysteroid dyscontrol