ASD, OCD and violence – a forensic case study

Pages1-8
DOIhttps://doi.org/10.1108/JIDOB-07-2019-0015
Published date24 January 2020
Date24 January 2020
AuthorHolly Edwards,Lorraine Higham
Subject MatterHealth & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders
ASD, OCD and violence a forensic
case study
Holly Edwards and Lorraine Higham
Abstract
Purpose The purpose of this paper is to illustrate the formulation and psychological treatment of a
complex case whereby a combination of autism spectrum disorder (ASD) and obsessive compulsive
disorder(OCD) has resulted in violent and aggressive behaviour.
Design/methodology/approach This paper provides a brief summaryof literature in relation to ASD,
OCD and risk-offending behaviour followed by a case study of a man (referred to as ‘‘John’’) with a
diagnosis of ASD and OCD who has an extensive history of institutional violence and aggressive
behaviour.
Findings This paper highlights the complexity of a case that may support research suggesting that
impaired theory of mind,poor emotional regulation and problems with moral reasoningincrease the risk
of an individualwith ASD engaging in violence, in addition to a comorbidityof ASD and OCD resulting in a
more severeand treatment-resistant form of OCD.
Originality/value This paper highlights the challenges faced when working with a patient with
Asperger’s syndromeand OCD with entrenched beliefs that lead to the use of violenceas a compulsion
to temporarilyovercome unpleasant thoughtsrelated to low self-esteem.
Keywords Violence, Autism, Autism spectrum disorder, Aspergers syndrome, Anxiety,
Obsessive compulsive disorder
Paper type Case study
Introduction
Autism is defined by the National Autistic Society (NAS) (2015) as “a lifelong,
developmental disability that affects how a person communicates with and relates to other
people and how they experience the world around them”. The prevalence of adults with
autism spectrum disorder (ASD) in England is estimated at 1 per cent (Brugha et al., 2011),
and in the western countries, prevalenceis generally regarded to be approximately 1 in 100
(Baird et al., 2006), with males outnumbering females four to one (Chakrabarti and
Fombonne, 2005). Autism is a spectrum condition that affects people differently, though
core key difficulties aretypically shared. The diagnostic manual, ICD-10, presentsa number
of possible autism profiles under the heading of Pervasive Developmental Disorders,
defining it as “a group of disorders characterized by qualitative abnormalities in reciprocal
social interactions and in patterns of communication, and by a restricted, stereotyped,
repetitive repertoire of interests and activities. These qualitative abnormalities are a
pervasive feature of the individuals functioning in all situations” (National Autistic Society,
2015). A core cognitive feature of ASD is a deficit in the theory of mind (ToM), which refers
to the person’s inability to recognise that others hold different beliefs to their own. Clements
(2005) suggested that some individualswith ASD who struggle to interpret others’ intentions
and have difficulties in communicatingemotions may experience intense rage as a result.
In the past, it has been suggested (Maras et al.,2015;King and Murphy, 2014;Mouridsen,
2012;Mouridsen et al.,2008;Lerner et al.,2012) that individuals with ASD are at low risk of
Holly Edwards and Lorraine
Higham are both based at
St Andrews Healthcare,
Birmingham, UK.
Received 25 July 2019
Revised 2 January 2020
Accepted 2 January 2020
DOI 10.1108/JIDOB-07-2019-0015 VOL. 11 NO. 1 2020, pp. 1-8, ©Emerald Publishing Limited, ISSN 2050-8824 jJOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDINGBEHAVIOUR jPAGE 1

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