At the recent South African Biological Psychiatry Congress, which took place in September 2022, Prof Ugasvaree Subramaney presented in the session entitled ‘Focus on trauma and the interaction with forensic psychiatry’. Her talk was entitled ‘Exploring trauma histories among forensic state patients charged with murder’.
Statistically, in South Africa, rate of the murder is 35.8 per one hundred thousand individuals. In adults, there is a high burden of sexual, physical, and emotional trauma, and high rates of abuse. South Africans also commonly experience gender inequality, domestic violence, and parental conflict, and these traumas have been repeatedly proven to be associated with dysfunctional behaviour in adulthood.
Trauma has a biological impact on many neurological structures, including the neuroendocrine system (HPA axis), the neurochemical system (including dopamine and Brain-Derived Neurotrophic Factor) and the neuroanatomic system.
Early life trauma is the leading cause of illness in those who are genetically vulnerable and is associated with an increased risk for violent and antagonistic behaviour later in life. These behaviours are increased in those with pre-existing severe mental illness, and in general, this increase in mental illness increases rates of victimization. Subsequently, exposure to violent behaviour in childhood increases the rates of encountering the criminal justice system, and an increased population of the mentally ill are arrested when compared to the general population.
The risk of aggressive behaviour peaks shortly before hospitalization and, interestingly, the period shortly after hospitalization.
A retrospective local study of 152 individuals over a twenty year period examined trauma exposure amongst mental health care users charged with murder. As mentioned above, trauma histories revealed physical, sexual, and emotional abuse, with physical trauma being more prolific. The study population had a history of mental illness, most notably psychotic disorders, substance use disorders and neurocognitive disorders. Approximately half the population studied used substances.
In terms of the relationship between the murderer and the victim, 37% were first-degree relatives, 31% were strangers and 15% were acquaintances.
The relationship between trauma, mental illness and violent offending behaviours is complex. Treatment models should not solely focus on the offence – early life issues, and in particular the lingering effects from early life trauma, need to be addressed.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
