Obsessive compulsive disorder and obsessive compulsive personality disorder and the criminal law

Abstract

Obsessive compulsive disorder (OCD) is a mental illness that has penetrated public consciousness. However, the extent to which OCD and obsessive compulsive personality disorder (OCPD) can constitute debilitating conditions that adversely affect most aspects of a person’s functioning and quality of life are not so well known, including as to how they can impair the capacity to give reasoned consideration to conduct options and the consequences of choices. Little scholarship exists about the legal repercussions of OCD and OCPD and, in particular, their potential relevance for both assessments of criminal responsibility and criminal culpability. This article commences to redress that deficit, outlining contemporary clinical knowledge about the disorders that is relevant to the legal context and identifying important judgments by courts in the United Kingdom, Ireland, Canada, Australia, New Zealand and India which have dealt with the potential impact of OCD and OCPD, in particular for decisions at the sentencing phase of criminal proceedings. It calls for better awareness of OCD and OCPD on the part of forensic mental health practitioners, criminal law practitioners and members of the judiciary.

Key words:

• autism spectrum disorder
• criminal culpability
• obsessive compulsive disorder
• obsessive compulsive personality disorder
• sentencing

Acknowledgements

The author acknowledges feedback and helpful suggestions on an earlier version of this manuscript from Professor Warren Brookbanks and Dr Patricia Molloy.

Ethical standards

Declaration of conflicts of interest

Ian Freckelton, QC has declared no conflicts of interest.

Notes

1 See, eg, C Purdon, ‘Assessing Comorbidity, Insight, Family and Functioning’ in G Steketee (ed) The Oxford Handbook of Obsessive Compulsive and Spectrum Disorders (OUP, New York 2012).

2 See OCDUK, ‘The Impact of OCD’ <https://www.ocduk.org/ocd/impact-of-ocd/> accessed 31 March 2020

3 For a review of such studies, see A Torres and others, ‘Epidemiology, Comorbidity, and Burden of OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, Oxford, 2017); see JS Abramowitz and RJ Jacoby, Obsessive-Compulsive Disorder in Adults (Hogrefe, Boston, 2015) 6; see F Penzel, ‘Clinical Presentation of OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017).

4 See, eg, P Sahoo, RR Sethy and D Ram, ‘Functional Impairment and Quality of Life in Patients with Obsessive Compulsive Disorder’ (2017) 39(6) Indian Journal of Psychological Medicine 760; GP Gururaj and others, ‘Family Burden, Quality of Life and Disability in Obsessive Compulsive Disorder: An Indian Perspective’ (2008) 54 Journal of Postgraduate Medicine 91. Bobes and others found that OCD in the Spanish population was associated with worse quality of life than for any other patient group (including physical groups), except for patients with schizophrenia: see J Bobes and others, ‘Quality of Life and Disability in Patients with Obsessive-Compulsive Disorder’ (2001) 16 European Psychiatry 239.

5 See, eg, JD Huppert and others, ‘Quality of Life and Functional Impairment in Obsessive-Compulsive Disorder: A Comparison of Patients With and Without Comorbidity, Patients in Remission, and Healthy Controls’ (2009) 26(1) Depression and Anxiety 39.

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46 See, eg, J Zijlmans and others, ‘Children with Obsessive-Compulsive Symptomology in the General Population: Different Subtypes?’ (2017) 38(7) Journal of Developmental and Behavioral Pediatrics 476; see also AR Torres and others, ‘Epidemiology, Comorbidity and Burden of OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017).

47 See, eg, I Freckelton, ‘Attention Deficit Hyperactivity Disorder (ADHD) and the Criminal Law’ (2019) 26 Psychiatry, Psychology and Law 817.

48 See, eg, I Freckelton and D List, ‘Asperger’s Disorder, Criminal Responsibility and Criminal Culpability’ (2009) 16 Psychiatry, Psychology and Law 16; I Freckelton, ‘Asperger’s Disorder and the Criminal Law’ (2011) 18(4) Journal of Law and Medicine 677; I Freckelton, ‘Autism Spectrum Disorder: Forensic Issues and Challenges for Mental Health Professionals and Courts’ (2013) 26(5) Journal of Applied Research in Intellectual Disabilities 420.

49 See, eg, I Freckelton, ‘Tourette’s Disorder and the Criminal Law’ (2019) 27(2) Journal of Law and Medicine 223.

50 RE Accordino and others, ‘Differentiating Autism Spectrum Disorder and OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017) 643.

51 Accordino and others (n 50) 646.

52 See, eg, SN Haber, ‘Neurocircuitry Underlying OCD: Neural Networks Underlying Reward and Action Selection’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017).

53 See AM Graybiel and SL Rauch, ‘Toward a Neurobiology of Obsessive-Compulsive Disorder’ (2000) 28(2) Neuron 343; HGM Westenberg, NA Fineberg and D Denys, ‘Neurobiology of Obsessive-Compulsive Disorder: Serotonin and Beyond’ (2007) CNS Spectrums 14; JT Ting and G Feng, ‘Neurobiology of Obsessive-Compulsive Disorder: Insights into Neural Circuitry Dysfunction Through Mouse Genetics’ (2011) 21(6) Current Opinions in Neurobiology 842; JB Barahona-Correa and others, ‘From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder’ (2015) 6 Frontiers in Psychology 1798.

54 See LF Fontenelle and others, ‘Role of Stressful and Traumatic Events in Obsessive-Compulsive Disorder’ (2011) 1(1) Neuropsychiatry 61; see, too, N Morina and others, ‘Obsessive-Compulsive and Postraumatic Stress Symptoms Among Civilian Survivors of War’ (2016) 16 BMC Psychiatry, art no 115, https://doi.org/10.1186/s12888-016-0822-9

55 See L Fostick, N Nacasch and J Zoklnar, ‘Acute OCD in Veterans with PTSD – A Case Series’ (2012) 13(4) World Journal of Biological Psychiatry 312.

56 Z Wang and others, ‘Childhood Trauma Experience and Obsessive-Compulsive Disorder in Chinese Population: A Case Control Study’ (2011) 26 (suppl 1) European Psychiatry 981.

57 1996, CanLII 1670 (BC SC).

58 NA Fineberg and others, ‘Pharmacotherapy of Obsessive-Compulsive Disorder: Evidence-based Treatment and Beyond’ (2013) 47(2) Australian and New Zealand Journal of Psychiatry 121.

59 See Abramowitz and Jacoby, Obsessive Compulsive Disorder in Adults (n 15); AT Beck, DD Davis and A Freeman (eds), Cognitive Therapy of Personality Disorders (3rd edn, Guilford Press 2015); HB Simpson, ‘Overview of the Treatment of OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017); JS Abramowitz, ‘Exposure and Response Prevention in OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017); M Whittal, ‘Cognitive Therapy in OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017); JE Reid and others, ‘Standard Evidence-Based Pharmacological Treatment for OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017).

60 See DM Hezel and HB Simpson, ‘Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Review and New Directions’ (2019) 61 (suppl 1) Indian Journal of Psychiatry S85.

61 KT Eddy and others, ‘A Multidimensional Meta-Analysis of Psychotherapy and Pharmacotherapy for Obsessive-Compulsive Disorder’ (2004) 24 Clinical Psychology Review 1011, https://doi.org/10.1016/j.cpr.2004.08.004; see, too, GM Soomro and others, ‘Selective Serotonin Re-uptake Inhibitors (SSRIs) Versus Placebo for Obsessive Compulsive Disorder (OCD)’(2008) 23(1) The Cochrane Database of Systematic Reviews CD001765.

62 See, eg, M Kellner, ‘Drug Treatment of Obsessive-Compulsive Disorder’ (2010) 12(2) Dialogues in Clinical Neuroscience 187; see, too, Simpson (n 59) 405; Abramowitz and Jacoby, Obsessive-Compulsive Disorder in Adults (n 15) 22.

63 See C Pittenger, ‘The Pharmacological Treatment of Refractory OCD’ in C Pittenger (ed), Obsessive-Compulsive Disorder: Phenomenology, Pathophysiology and Treatment (OUP, New York 2017).

64 W Simon, ‘Follow Up Psychotherapy Outcome of Patients with Dependent Avoidant and Obsessive-Compulsive Personality Disorders: Meta-analytic Review’ (2009) 13(2) International Journal of Psychiatry in Clinical Practice 153; P Skapinakis and others, ‘Pharmacological and Psychotherapeutic Interventions for Management of Obsessive-Compulsive Disorder in Adults: A Systematic Review and Network Meta-analysis’ (2016) 3 Lancet Psychiatry 730.

65 National Collaborating Centre for Mental Health, Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder, NICE. Clinical Guideline 31 (2005).

66 See, eg, Williams, ‘When Clients Confess to Crimes They Did Not Commit’ (n 13).

67 See, eg, MT Williams, ‘Could I Be a Pedophile? The Worst Kind of OCD’ (25 December 2012) Psychology Today <https://www.psychologytoday.com/au/blog/culturally-speaking/201212/could-i-be-pedophile-the-worst-kind-ocd> accessed 31 March 2020

68 See MT Williams and SG Farris, ‘Sexual Orientation Obsessions in Obsessive-Compulsive Disorder: Prevalence and Correlates’ (2011) 187 (1–2) Psychiatry Research 266; A Pinto, JL Eisen and MC Mancebo, ‘Taboo Thoughts and Doubt/Checking: A Refinement of the Factor Structure for Obsessive Compulsive Disorder Symptoms’ (2007) 151 Psychiatry Research 255; MT Williams and others, ‘Assessing Sexual Orientation in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)’ (2018) 49(5) Behavior Therapy 715; MT Williams and others, ‘Domains of Distress Among People with Sexual Orientation Obsessions’ (2015) 44(3) Archives of Sexual Behavior 783.

69 See MS Bhatia and J Kaur, Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report’ (2015) 9(1) Journal of Clinical and Diagnostic Research VD01-VD02, https://doi.org/10.7860/JCDR/2015/10773.5377; JS Abramowitz, Getting Over OCD: A 10-Step Workbook for Taking Back Your Life (2nd edn, Guilford Publications 2018) 198.

70 [2016] NSWSC 1244.

71 R v Quinn (No 2) NSWSC 1244 at [280].

72 [2014] NZCA 297 at [68].

73 [2017] NZHC §1814 at [44]–[47]. See, too, Mackley v Police [2014] NZHC 1561; Mail v Police [2012] NZHC 3049.

74 French v The Queen [2014] NZCA 297 at [50].

75 [2011] NZHC 975.

76 Veale and others (n 13) 332, 341.

77 Crime No 299/2018 of Kasaba v By Adsv Sri Babu S Nair, unreported, High Court of Kerala at Ernakulam, 19 July 2018.

78 Kasaba v By Adsv Sri Babu S Nair (n 77) at [4].

79 [2006] VSC 216.

80 [2006] VSC 216 at [5].

81 2016, SKQB 203. See, too, R v Fort [2013] EWCA Crim 2332; R v Craw [2006] NZHC 642.

82 R v Ozipko, 2016, SKQB 203 at [39].

83 R v Ozipko (n 32) at [50].

84 Unreported, High Court of Kerala at Ernakulam, 6 December 2019, per Hariprasad and Anil Kumar JJ.

85 JT Reese, ‘Obsessive Compulsive Behavior: The Nuisance Offender’ (1979) 48(8) FBI Law Enforcement Bulletin 6.

86 See, eg, J Craissati and R Blundell, ‘A Community Service for High-risk Mentally Disordered Sex Offenders: A Follow-up Study’ (2013) 28 Journal of Interpersonal Violence 1178; D Kingston and others, ‘The Relationship Between Mental Disorder and Recidivism in Sexual Offenders’ (2015) 14 International Journal of Forensic Mental Health 10.

87 See, eg, Y Chen, C Chen and D Hung, ‘Assessment of Psychiatric Disorders Among Sex Offenders: Prevalence and Associations with Criminal History’ (2016) Criminal Behaviour and Mental Health 30.

88 See, eg, DPP (WA) v Griffiths [2015] WASC 393; DPP (WA) v McGarry [2009] WASC 226.

89 See, eg, DPP v Doherty [2016] VCC 639.

90 See SJ Stockburger and HA Omar, ‘Firesetting Behavior and Psychiatric Disorders’ in H Omar and others (eds), Playing with Fire (Nova Science Publishers 2014).

91 [2007] QCA 249; see, too, Boase & Parker v The Queen [2010] VSCA 316.

92 [2018] NZHC 610.

93 See OF Wahl, ‘Obsessive-Compulsive Disorder in Popular Magazines’ (2000) 36 Community Mental Health Journal 307.

94 JR Meloy, ‘The Psychology of Stalking’ in JR Meloy (ed), The Psychology of Stalking: Clinical and Forensic Perspectives (Academic Press, New York 1998); See, too, SF Farber, ‘My Patient, My Stalker: Empathy as a Dual-edged Sword: A Cautionary Tale’ (2015) 69(3) American Journal of Psychotherapy 331, https://doi.org/10.1176/appi.psychotherapy.2015.69.3.331

95 R v Williams [2006] EWCA Crim 3300 at [4].

96 Unreported, Delhi District Court, 6 October 2012 per Dr Kamini Lau.

97 [2010] QCA 42.

98 R v Grehan [2010] QCA 42 at [28], [37].

99 R v Grehan (n 98) at [38].

100 R v Grehan (n 98) at [40]–[41].

101 [2005] EWCA Crim 1811.

102 Evans v The Queen [2005] EWCA Crim 1811 at [13].

103 Evans v The Queen (n 102) at [16]–[17].

104 [2004] JRC 105.

105 (2007) 16 VR 269; [2007] VSCA 102.

106 [2006] VSC 216 at [50]. Compare R v EN [2019] ACTSC 354.

107 See, eg, R v K [2017] SASC 6.

108 [2017] IECA 71.

109 DPP v PC [2017] IECA 71 at [17].

110 It observed (at [19]) that: ‘This Court asks itself how can the applicant now complain about the adequacy of his original legal advice at the police station when this matter was not complained about at his trial although it is fair to say that the appellant’s own evidence suggests that he felt that he had not then got adequate advice. How does one square the finding in the psychological report of suggestibility with the other finding that the applicant is not easily dissuaded from his own position? The applicant gave evidence as to why he responded to his daughter’s allegations in the way he did during the garda interviews. He denied that he had sexually assaulted or raped her. There was no suggestion that the answers he gave in the course of his garda interviews were suggested to him by the gardaí. Finally it is the case that the applicant makes no complaint about his legal representation at the second trial when he was convicted on all counts on the indictment by a unanimous jury verdict’.

111 See, eg, V Singh, ‘Busting the Myths about OCD’ Sane.org (10 October 2017) <https://www.sane.org/information-stories/the-sane-blog/mythbusters/busting-the-myths-about-ocd> accessed 31 March 2020; J Bernstein, ‘Expert Discusses Common OCD Misconceptions’ Baylor College of Medicine (27 June 2017) <https://www.bcm.edu/news/psychiatry-and-behavior/obsessive-compulsive-disorder-misconceptions> accessed 31 March 2020