Sexual Murder - Justicia Forense

9.8 Differential Diagnosis: Catathymicvs. Compulsive HomicidesThe differential diagnosis of catathymic and compulsive homicides is sometimesproblematic. Both catathymic and compulsive homicides have a basisin underlying sexual conflict. However, the nature of the sexual conflict isquite different. Catathymic homicides are (usually) single explosions triggeredby some type of challenge to the individual’s sense of sexual competence.Compulsive homicides, on the other hand, stem from a long-standingand developing urge to kill, which itself is eroticized. Catathymic homicidestypically stem from feelings of inadequacy extending into the sexual area,while compulsive homicides involve a fusion of sexual and aggressive drives.Meloy (2000) lists some additional differentiating characteristics in Table 9.2.9.8.1 Acute Catathymic and Unplanned Compulsive HomicidesAcute catathymic homicides may be confused with unplanned compulsivemurders since both involve a sudden attack. However, they have a numberof distinguishing characteristics (see Table 9.3). Individuals who commitacute catathymic homicides have no preexisting compulsion to kill or priorsadistic fantasies. They do not harbor an underlying urge to act out but ratherexplode when victims trigger poorly defended sexual conflicts that theoffenders have been secretly struggling with. On the contrary, compulsiveoffenders who act out spontaneously have been harboring sadistic fantasies,usually in simple, undifferentiated form, for years. Although they have hadan urge to kill for quite some time, they do so only when an opportunitypresents itself.The victim of the acute catathymic perpetrator is often a stranger, whilethe individual who commits an unplanned compulsive homicide (especiallyhis first murder) typically kills someone whom he has had a connection with.Table 9.2 Meloy’s Distinctions between Compulsive and CatathymicHomicidesCharacteristics Compulsive CatathymicNature of sexual homicide Organized DisorganizedAxis I diagnosis Sexual sadism Mood disorderAxis II diagnosisAntisocial/narcissisticpersonality disorderVarious traits andpersonality disordersPsychopathy Severe (primary) Mild–moderateAttachment pathology Chronically detached Attachment hungerAutonomic nervous system Hyporeactive HyperreactiveEarly trauma Often absent Often presentSource: From Meloy, J.R., Aggression and Violent Behavior, 5, pp. 1–22, 2000. With permission.