Sadomasochistic Representations in a Rage Murderer: An Integrative Clinical and Forensic Investigation

Abstract

This study used the Adult Attachment Interview (AAI), and the Rorschach Inkblot Method (RIM; Rorschach, 1921/1942) to investigate the personality structure and internal dynamics of a rage murderer. Contrasting AAI and Rorschach findings, interpreted within an attachment-oriented framework, suggested the presence of a borderline spectrum, dual personality organization, characterized by a split between a more benign, overcontrolled upfront, and a self, fused by sexualized urges and sadistic rage. I present inferences regarding the murder and discuss issues related to future violence risk and treatment.

Acknowledgments

For their suggestions regarding preparation of the manuscript, I thank Patricia Crittenden, Nicola Sahhar, Ellen Hartmann, Cato Grønnerød, Jim Kleiger, Nicolay Nørbech, and the reviewers.

Notes

1 Cartwright seems to use the term narcissistic in a broad sense, referring to the presence of an all-good, ideal self. The shallow or narcissistic quality of this self-structure is evident in such offenders’ continuous search for confirmation and mirroring experiences of themselves as good to maintain their defensive idealized self-structure, or narcissistic exoskeleton.

2 The terms attachment pattern, attachment organization, and self-protective strategy are synonyms, and used interchangeably throughout this article.

3 Blizard’s (2003) usage of the term masochistic refers to a submissive, self-defeating, attachment-based relational position developed for self-protective purposes, and is not necessarily accompanied by a desire to be victimized or humiliated, as the term often is associated with.

4 Crittenden’s theory was developed under the guidance of Ainsworth. The compulsive caregiving, compulsively promiscuous, and compulsively self-reliant attachment patterns are based on Bowlby’s (1980) original work.

5 The DMM–AAI coding system includes both explicit and implicit memory types. For instance, semantic and episodic memory (explicit) involves generalized statements in verbal form and event-specific integrations about an event that occurred, whereas procedural and imaged memory involves implicit knowledge encoded as patterns of behavior, habits, skills, and so forth, reflected in the AAI through dysfluencies of speech, expressed affect, the speaker’s relationship with the interviewer (e.g., cooperative, compliant, confrontational), or sensory images that represent affect and include memories of sounds, smells, visual images, and bodily states (see Crittenden & Landini, 2011, for a thorough presentation including psychometrics).

6 The AAI was coded by two certified coders, blinded to demographic, clinical, and Rorschach data.

7 Because the Rorschach was administered before the publication of the R-PAS, the administration followed the Comprehensive System (CS; Exner, 2003) administration procedure. The R-PAS was chosen because it only uses those Rorschach variables with the strongest empirical and clinical support, and because it has included variables, such as such as the Mutuality of Autonomy Scale, that might be valuable for describing aspects of the participant’s internalized model of relating not captured by the CS system (Meyer et al., 2011). The protocol was coded by certified R-PAS coders.

8 Identifying information has been disguised to protect the confidentiality of the patient.

9 The assessment data were gathered as part of a research project on offenders. Although I was privy to the test data before treatment, at the time of testing I had no training in using AAI or Rorschach data to develop a treatment plan.

10 Because of the CS administration, without the prompts of the R-PAS administration, R-PAS R8910% ratio would not be valid to report,  but computing the CS Affective ratio (Afr = 3/12 = .25), using CS International Adult norms (Meyer, Erdberg, & Shaffer, 2007; M = .53, SD = .20), places Afr on the very low end and outside 1 SD of the mean, which provide further support for the notion of emotional constriction in Paul’s record.

11 After giving this response during inquiry, Paul suddenly became quiet and seemed to have lost his grounding in the Rorschach task. I asked whether he was experiencing a panic attack and he nodded. I then decided to halt the administration.

12 Due to space limits, only a partial sequence analysis is presented, with a specific focus on Paul’s sexualized responses.

13 Although Space responses have been associated with anger and opposition, the empirical evidence for this assumption is weak (Meyer et al., 2011). Smith (1997, pp. 203–204) noted that Space responses might indeed reflect very different processes, and might function to relieve tension, stimulation, or conflict that could have been triggered by something overwhelming in the blot.

14 Confabulation refers to “overelaborated responses and involve maladaptive immersion in fantasy” (Kleiger, 1999, p. 172).

15 At the time I did not realize that I had identified myself as a potential victim of Paul, and that I, unconsciously, had developed alertness to his underlying rage to protect myself. This process likely ensued in response to his unfiltered account of the murder he committed (recall the clinical interview).

Additional information

Funding

This research was supported by a grant from Akershus University Hospital, and by The National Program for Integrated Clinical Specialist and PhD Training for Psychologists in Norway. The program is a joint cooperation between the Universities of Bergen, Oslo, and Tromsø, The Norwegian University of Science and Technology (Trondheim), the Regional Health Authorities, and the Norwegian Psychological Association. The program is funded jointly by the Ministry of Education and Research and the Ministry of Health and Care Services.