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The Development of the Sexually Sadistic Serial Killer

The Development of the Sexually Sadistic Serial Killer

Natural Born Killers?: The Development of the Sexually Sadistic

Bradley R. Johnson, MD, and Judith V. Becker, PhD

Today's society seems enthralled with serial killers in the news and the media. Forensic psychiatrists often interview serial killers after they have been caught. There are retrospective studies and case reports of individuals who have com- mitted sexually sadistic serial . However, there exists a dearth of case reports on adolescents who have expressed serious fantasies about becoming serial killers prior to actualizing their fantasy. This article presents nine clinical cases of 14- to 18-year-olds who have clinically significant fantasies of becoming a serial killer. Similarities exist in these adolescent cases when compared with retrospective studies and case reports of serial killers on the role of sexually sadistic fantasies and actual killings. Since it has been established that sexual may develop at a young age, one can surmise that sadistic paraphilias may also develop in some adolescents. The question is posed, can we predict which of these adolescents may go on to actually become serial killers? This article focuses on how the sexually sadistic fantasy can eventually be acted out and possible motives for the act to be repeated multiple times. Finally, recom- mendations are made about assessing and treating a youngster who expresses violent sexually sadistic killing fantasies so that attempts can be made to interrupt the progression to actual killing.

Mickey and Mallory were young socio- were portrayed as being the product of paths in love, driving throughout the "bad genes" and a "bad environment." country and leaving dozens of bodies There is still little in the literature in strewn along the way. The movie, Natu- regard to the understanding of those who ral Born Killers (Warner Bros., 1994), commit . Even less is known inferred that these two were the product about a select subgroup, those who com- of their culture. They were killers with mit serial homicide. Case studies have childhoods of physical and , been collected on a small number of "se- bad parenting, and poor education. They rial killers," but we have not learned much that is applicable clinically. For ex- Dr. Johnson is in private practice in Tucson, AZ, and works part time for the Department of Correc- ample, we know little about identifying tions. Dr. Becker is affiliated with the Department of those children and adolescents who are at Psychology and Psychiatry, University of Arizona, Tuc- son. They are both affiliated with The Mind Compass high risk for becoming a serial killer. Are Group, LLC, in Tucson. Address correspondence to: there certain biologic predispositions and Bradley R. Johnson, MD, 6060 North Fountain Plaza Drive, Suite 120, Tucson, AZ 95704. sociocultural influences that help the cli-

J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 335 Johnson and Becker nician identify children who will grow up expressed homicidal fantasies to a prior to become serial killers? evaluator. As one looks back at the childhoods of Case 1 L. was a 14-year-old white such notorious killers as , John male who was admitted to a psychiatric Wayne Gacey, , David unit after attempting by hanging. Berkowitz, or , it is im- He reported feeling depressed and said. "I portant to see whether there were clues feel like I'm going crazy . . . every day I early in their lives that would have helped have to decide if I should live or kill identify their homicidal tendencies before myself." they had committed violent crimes. Al- Although initially hesitant, L. began to though many would believe that a serial speak about why he felt he was "going killer may not be treatable once he or she crazy." He reported having obsessional has begun to kill, one wonders whether, if thoughts of killing other people. In fact, they had been identified early enough, he admitted to having a plan of breaking treatment might have succeeded in pre- into a strange woman's house, capturing venting them from actually starting their her, raping her, and then stabbing her to streams of killing. death. He said, "I want to be a serial It appears that children and adolescents killer." are committing more and more violent L. admitted to using his BB gun as a crimes at an earlier age.' The authors teenager to kill various animals in the would propose that many adolescents are area around his house. At the time of his developing fantasies at early ages about admission, he had been killing up to 10 committing violent crimes such as mur- animals per day including birds, rabbits, der. As will be initially presented in case cats, and dogs. He would shoot them, examples, there are adolescents who are drown them, stab them. or light them on even experiencing fantasies of becoming fire while they were alive. to kill them. serial killers. One would wonder if these L. was intelligent, having tested at an individuals are at a high risk for acting IQ of 122. Despite his high IQ, he did out their homicidal fantasies. poorly in school. The evaluators felt that he was a clean-cut and attractive young Case Presentations man and very likable. He had fantasies of Nine adolescents who expressed a de- killing his mother by blunt force to the sire to commit serial killings have been head with a hammer until "her brains identified. Most of these youth were re- were completely exposed." He also dis- ferred to the authors for a forensic eval- cussed a recently released movie, "Si- uation after having committed a legal of- lence of the Lambs" (Orion Pictures, fense. A few were referred, secondary to 1990). He identified himself with the a mental health worker becoming con- character . seeing the por- cerned about an unusual behavior, for a trayed serial killer as having "total control psychological or psychiatric evaluation. over other people." He went on to express None were referred for having already that he wanted to be like him, killing over

336 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers?

100 people, being apprehended, going to ending in strangulation, , and prison, and seeing himself on TV. He body mutilation. He fantasized about said, "then, I'd be famous." He denied keeping the sexual organs and skulls as any sexual excitement when having trophies. He also described other sexually thoughts of killing and denied any para- sadistic fantasies that always ended in philic fantasies or behaviors. death. Additional paraphilic fantasies in- Case 2 S. was a 16-year-old white cluded , . uro- male who was referred by a concerned philia, fetishistic cross dressing, frotteur- social worker after he had admitted to ism, and bestiality. He had a long history multiple animal killings. He gained an of to pornographic materi- interest in dissecting animals following a als. worm exercise in his sixth Finally, S. had a long history of mild grade science class. In the eighth grade, depression, and vague paranoid delusions he stole a fetal pig from his class and described occasionally hearing ill- and dissected it on his own. He became defined voices. curious about the textures of the animal Case 3 D. was a 17-year-old Hispanic tissues, tasted parts of it, and recalled male who claimed a history of ingesting becoming sexually excited by the dissec- human blood. He liked to prick his own tion. S. volunteered at an emergency finger or lick the bleeding wound of a room near his house where he eventually friend or family member. He had a sub- asked to witness a human , but stantial history of assaulting other adoles- this experience was denied him. He had a cents and adults, explaining that such sit- juvenile court history including shoplift- uations made him feel in "total control." ing and runaway. D. reported being rather intelligent but S. tested at an above-average IQ of dropped out of school secondary to poor 125, although he did relatively poorly in grades. He denied being depressed but school. He abused , sleeping pills, admitted to having frequent thoughts of and marijuana when he became a teen- death. He had a questionable history of ager. panic attacks or possible dissociative ep- At the age of 15, S. began to kill ani- isodes. Additionally, he had an extensive mals. First, he killed a cat, and went on to history of polysubstance abuse including kill rabbits, birds, dogs, ducks, and other paint sniffing. cats. He usually killed via strangulation D. recalled seeing the movie "Silence or stabbing. The animals skulls were pre- of the Lambs" where he became very pared and proudly mounted as trophies in emotionally "excited" by the scene show- his bedroom. On one occasion, he became ing a human that had been cut open. hung sexually excited while killing an animal up, and the internal organs of the body and placed his erect penis inside the open displayed. Since then, he admitted to hav- wound of the animal and masturbated. ing become enthralled by the viscera of S. admitted to fantasies of killing hu- humans. mans including recurrent thoughts of D. described having fantasies of killing

J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 337 Johnson and Becker multiple people in a fashion like "Dah- ity, however, she had experienced a sig- mer." He discussed fantasies of cutting nificant history of abuse including being them open, playing with the viscera, cut- sexually molested by her mother's boy- ting the appendages off, and burying the friend at the age of 6 and raped by an various body parts in specific locations adolescent boy at the age of 13. As a around the town in which he resided. child, she witnessed her father brutally Furthermore, he had fantasies of eating rape and beat her mother including force- parts of the corpses. ful insertion of foreign objects into her D. became sexually active at the age of mother's vagina and anus. Her father 12 and had had over 100 sexual partners. served time for attempted and had He denied any history of sexual para- a significant history of killing neighbor- philias. hood dogs by running them over on pur- Case 4 B. was a 14-year-old Hispanic pose. female who was referred for a presentenc- B. expressed having fantasies of wish- ing evaluation for grand theft auto and ing to "tar and feather" others until they runaway. She expressed that one of her died or tying individuals up to a tree. goals in life was to become the "first cutting and peeling their skin off with a teenage serial killer." knife while they were alive. She also fan- B. had been previously diagnosed with tasized about killing people by stabbing. bipolar disorder, although the diagnosis She denied ever becoming sexually ex- appeared to be questionable given her cited by these fantasies and denied that history and presentation. It was apparent she had ever killed any animals. that she suffered from dysthymia and had Case 5 S. was a 14-year-old white low self-esteem and a history of occa- male who had been showing aggressive sional suicidal ideation. Furthermore, she behaviors since the age of four. He was was diagnosed with a conduct disorder diagnosed with attention deficitlhyperac- and cannabis dependence. There was no tivity disorder and was reported to have history of . suffered from frequent mood swings. B. had been an average student in At the age of 12, he developed homi- school and had never undergone any type cidal fantasies about killing multiple peo- of psychological testing. She became sex- ple via strangulation or purposefully frac- ually active at the age of 12 and admitted turing as many of their bones as he could to a history of with many until they died. boys. She also enjoyed watching sexually S. was the product of a pregnancy explicit movies. She reported that her best caused by rape. His biological father be- friend was a 40-year-old woman who al- came angry when his mother refused to lowed her to watch as she engaged in have any continued relationship with him lesbian sexual encounters. and followed her around the country B. reported having a recurrent dream stalking her. about someone trying to chase her and S. did rather well in school, receiving stab her repeatedly with a knife. In real- above-average grades in most of his

338 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers? classes. He began to abuse alcohol and her as he had wished, because she fought marijuana. back. He grabbed a knife. stabbed her, At the age of 14, S. began to stalk a and attempted to kill her. At the age of 16, female peer. Although she asked that he he engaged in his first consensual sexual not follow her. he referred to her as his activity which he described as "" girlfriend and did such things as follow and "sadistic acts" with a slightly older her home or befriend her mother in order female. to gain entrance to her home. He admitted Case 7 H. was an 18-year-old white to stealing her underwear, which he male who had suffered from AD/HD and would use when he masturbated. He also chronic depression. He was of below av- admitted to numerous situations of frot- erage intelligence with possible learning teurism. Finally, he admitted that he had disabilities. At an early age. he recalled become sexually active at the age of six having been severely physically abused and recalled having been involved in sex- by his mother. including beating and ual activity with two other females since whipping. Furthermore, he recalled his that time. mother being very sexually provocative S. admitted to having killed two dogs throughout his youth, exposing herself to by snapping their necks while they were him or watching him undress and making alive. However. he reported that his con- erotic comments. His parents once en- tinuing fantasies were about killing hu- gaged in sexual intercourse in front of mans rather than animals. him, and he recalled his mother moaning Case 6 M. was an 18-year-old white in what he felt was a haunting and death- male who had been diagnosed with atten- like manner. tion deficithyperactivity disorder (AD/ At the age of 14, H. began to fantasize HD) and treated with Ritalin since an about having sexual intercourse with his early age. As an adolescent, he began to mother while listening to her moan. kill- abuse the Ritalin, often crushing the tab- ing her, and continuing to have inter- lets and sniffing it. He admitted to having course with her corpse. He admitted that feelings of depression. He was an above- he was masturbating approximately eight average student. times a day to this fantasy, often using his M. began to develop homicidal fanta- mother's underwear as an erotic aid. sies at the age of 12: they involved killing He expressed confusion as to sexual multiple humans via stabbing or strangu- orientation, but generally preferred het- lation. He admitted that he was mastur- erosexual activities. He had had over 100 bating approximately 15 times a day female sexual partners, often exchanging while fantasizing about bondage. control. money for sex. He had also been sexually and killing. abused by a 16-year-old baby sitter at the At the age of 15, M. broke into the age of 10. He admitted to fantasies or home of a strange woman and attempted prior acts of voyeurism, fetishism, cross- to rape her. He wore a mask so as to not dressing, sadism and rape. He had a sig- be identified. He was unable to penetrate nificant history of alcohol and drug

J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 339 Johnson and Becker abuse. He had been diagnosed with a reported having become sexually active at borderline personality disorder. He de- the age of 13 and having had between 10 nied any history of killing animals. and 15 sexual partners. He denied any At the age of 17, he committed his first history of paraphilic fantasies. killing of an unknown woman via stran- Case 9 T. was a 17-year-old white gulation and continued to commit necro- male referred for a psychiatric evaluation philic acts with the corpse for at least after having admitted to experiencing au- three days. ditory and visual hallucinations of "de- Case 8 K. was a 14-year-old white mons and the devil." He reported hearing boy who was referred for a presentencing voices instructing him to kill other people evaluation for charges of disorderly con- and, by the age of eight, felt that if he did duct, criminal damage, theft, carrying a not follow through with these prompt- concealed weapon, runaway, and domes- ings, he would be hurt or would kill him- tic violence. He had a poor relationship self. He then attempted to kill his brother. with his mother and indeed had attempted but only stabbed him in the arm. At about to hit her and threatened to kill her on that time. he was abandoned by his bio- many occasions. He had lit many fires as logical parents and grew up in foster a youngster and hid a knife under his bed homes. at all times. He was diagnosed with a T. reported that he had the desire to kill conduct disorder, alcohol dependence, many people; he again attempted to kill cannabis dependence, and a possible de- another person at the age of 13 but merely pression. At the time that he entered pu- cut the person with a knife under the berty, he admitted having developed fan- armpit. On another occasion, while living tasies of "," but he described in a group home, he attempted to kill his having thoughts of killing many people roommate, but missed and cut the room- over time (i.e., serial killing). mate's hand with a knife. Finally. he un- K. fantasized two to three times a day successfully attempted to kill his foster about killing. His fantasies increased dur- mother, chasing her with a butcher knife ing times when he was angry or de- and a hatchet. pressed. His killing fantasies included T. had occasional feelings of paranoia shooting other people or tying people up and often felt that the television instructed and cutting their fingers, toes, or other him to kill other people. At times, he had limbs off while they were alive. He ad- feelings of depression and in the past had mitted to killing by gunshot another ado- been diagnosed with ADIHD. lescent who was in an opposing gang. He T. claimed that he had been sexually denied becoming sexually excited when molested at the age of six and suffered thinking about his fantasies or about prior from recurrent dreams about the molesta- acts of killing. tion until just a few years prior to his K. reported having been molested at psychiatric evaluation. He admitted that the age of eight by a 30-year-old homo- as a teenager he enjoyed watching sex- sexual relative who later died of AIDS. K. ually explicit movies that depicted indi-

340 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers? viduals who were eventually killed. He ~ietz~believes that before a man be- fantasized about exhibitionism and voy- comes a serial killer, the offense has al- eurism. He admitted to becoming sexu- ready been committed in fantasy in his ally excited while watching "horror mov- own mind. He states that the fantasy may ies" that depicted naked women. originate in things that have happened to At the age of eight, T. began to kill him. things he imagined happened to him, snakes with a knife and later went on to or things he has seen. When killers are killing rabbits and searching for animals young, Dietz believes, they may express that had previously died or been killed on their early aggression by torturing ani- the side of the road. He enjoyed looking mals or being exceptionally cruel to other at the internal organs or cutting them children, showing that they are already open. He reported that he would not feel thinking about committing adult-like vio- or shame if he were to kill a human. lent acts. A few of the cases presented In fact, he went on to say that he would here demonstrate those tendencies. "laugh at the body and then leave it to The serial killer is often identified as an rot." offender who kills others in three or more Sexually Sadistic Serial Killing: separate incidenk5 This is distinguished The Literature from a inass murderer who kills multiple victims during a single in~ident.~In the Do any of these adolescents show any 1980s, the Federal Bureau of Investiga- of the same characteristics as those who tion calculated that there were approxi- have actually committed serial killings? mately 35 serial killers operating in the There appears to be a surge of publica- tions and films in the popular media about United States. Others have estimated, serial killings in today's society. Articles however, that there may be as many as in magazines, comic books, and 300 serial killers at large in the United even serial killer trading cards are dedi- States alone.7 Although the United States cated to the topic of serial killers. It has has only about five percent of the world's been said that "a significantly prolific population, some feel it may have as murderer is likely to find a good agent many as 75 percent of the world's serial more valuable than a good lawyer."2 killers. Many debate the hypothesis that One well-known serial killer com- the United States is a breeding ground for mented on the portrayal of Hannibal serial killers, while others believe there is Lecter, a fictitious serial killer, in the no empirical evidence that the frequency book Silence of the Lambs. He stated that of serial killers is increasing or is higher the depiction was a "fraudulent fiction," in the United States than in other coun- explaining that portrayal of a serial killer tries.'. Despite the latter views, the num- who has power and manipulation may ber of male serial killers captured and please the public, but is not accurate. He recorded as such in the United States has said that his own offenses arose from a been increasing in recent years8; this "feeling of inadequacy."" could be due to better crime-solving and

J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 341 Johnson and Becker profiling techniques or to a true surge in about what a sexual murderer looks like the actual number of offenders. or how helshe behaves, Brittain retro- There have been a number of different spectively saw many similarities based on serial killer typologies proposed in the his clinical observations. In his study. literat~re.~,~Although each can be help- many sexually sadistic killers had devel- ful in gaining perspective and insight into opmental histories demonstrating an am- this small population of offenders, the bivalent relationship with their mothers, typology proposed by ~ietz~appears authoritarian fathers, and social ineptness. most helpful. He identified the following Their personalities were often introspec- five categories: (I) psychopathic sexual tive, solitary, studious, obsessional, prud- sadists (i.e.. Ted Bundy, ish, vain, and hypochondriacal. Although Gacey): (2) crime spree killers (i.e., Bon- they rarely showed outward violence. nie and Clyde): (3) functionaries of orga- there was evidence of deep hidden ag- nized criminal operations (i.e., contract gression. Sexually, many felt inferior, killers, gangs): (4) custodial poisoners were often impotent, and had a rich fan- and asphyxiators (i.e., nurses and physi- tasy life. Cross-dressing and fetishisms cians); and (5) probable psychotics (i.e., were not uncommon, and a number en- ). In fact. although some gaged in homosexual activities. There older reports state that sexually motivated were commonalities in some killers such killers are often psychotic,10 newer evi- as an interest in power. enjoyment of dence shows the only true category of a cruelty as depicted in books or films, an prolific serial killer is likely to be the overt interest in weapons, and a history of sexually sadistic serial kille~.~Dietz said, . Many had an interest "these men enjoy killing pe~ple."~ in . , black magic, As early as 1886, Richard von Ksafft- Naziism. , and "escapology." Most bin^" described many sexual perver- had experienced little or no psychiatric sions in his book Psyclzop~tlziaSexualis. intervention. and although a few suffered He was the first to describe the terms from depression or anxiety. most could "" and "murder through sa- not be diagnosed with schizophrenia. dism." The sexual killers were more likely to Years later. in his classic article "The offend when their self-esteem was low. Sadistic Murderer," ~rittainl~attempted They often planned their crimes. which to draw a profile of the sexually sadistic frequently included killing via asphyxia- killer in hopes of beginning to identify tion or stabbing. Physical injury to the unique characteristics of sexual murder- sexual organs and engaging in violent ers. He felt that the more precise the sexual acts were not uncommon. Brittain description could be, the greater the like- wrote that although the sexual killer may lihood that sadistic murderers could be be a model patient or prisoner. given the identified before they had killed. Al- opportunity, he is "likely to murder again though warning all involved profession- and he knows thi~."'~ als to refrain from preconceived notions MacCulloch et a1.13 identified the ex-

342 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers? perience of power and control in the act histories of psychiatric, criminal, sexual, of sexually sadistic killings to be the most or alcohol or drug abuse problems. Many important factor. They proposed that "the had a personal history of physical, sexual, wish to control another" by such means as and . Most impor- "domination, denigration, or inflicting tantly. most of them demonstrated a his- pain" is what produces the tory of suffering from multiple sexual for a sadist. Thirteen of the 16 cases that paraphilias. In adolescence. 75 percent of they reviewed had fantasized about their the 36 cases reported histories of day sadistic offense prior to its actuality. They dreaming, compulsive masturbation, iso- often masturbated to thoughts of rape, lation, chronic lying, rebelliousness, kidnap, sodomy. bondage, whipping, tor- stealing, and on adults. Over 50 ture, or fantasies of killing many times percent had a history of , night- prior to committing their first actual of- mares. destruction of property. fire set- fense. Interestingly. the mean age that ting, cruelty to children. and poor body these fantasies occurred was 16 years image. Nearly one-half of them demon- (range. 13 to 20 years old), and each strated a history of cruelty to animals. subject had an increase in his masturba- ~ietz%oncluded that serial killers of- tory activity once his fantasies took on a ten kill by strangulation. beating, or stab- sadistic content. The acting out of the bing. He attributes these choices to the fantasy occurred less than one year after greater "intimacy" demonstrated with the the development of the sadistic fantasy in use of contact weapons, which in turn 1 l of the 13 cases. The authors proposed reflects the sexual component of the kill- that if a person begins to try out his sa- er's motivation. He stated that. based on distic fantasy little by little in actuality, there is a higher risk for it to progress his own clinical experience. prolific serial toward the act of killing as part of the killers are usually male and can be diag- eventual sexual act.'" nosed with antisocial personality disorder Levin and FOX'^ concluded that most and sexual sadism.' Furthermore. Dietz et serial killers are male, Caucasian, and in a1.I7 concluded that most sexually sadis- their 30s. They demonstrated that most tic criminals carefully plan their offenses serial killers did not have a conviction in detail, even to the point of preparing a record and in fact were arrested for the "torture kit" to use on their victim. They first time for their serial murders. also stated that personal items of the vic- ~ickey" found that of identified serial tim may be kept that could be used as killers from 1800 to 1980, 14 percent stimuli for future arousal. Douglas et al.Is were female. Ressler et ul.'" studied 36 categorized sexual as orga- sadistic killers who had murdered a total nized, disorganized, or mixed. The orga- of 118 people. Of the 36, all were male. nized crime is highly planned and may 33 were Caucasian, 20 were the eldest include staging the crime scene. whereas son, and 27 had an average or greater than the disorganized is spontaneous and may average intelligence. Many had family represent youthfulness, use of alcohol or

J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 343 Johnson and Becker drugs, mental deficiency, or lack of so- possibly even end in killing the sexual phistication of the offender. partner. Prentky et nl. also refer to sexual Prentky et al." compared 25 serial sex- homicide as an actual . making ual murderers with 17 sexually motivated it easier for one to see that, as with other murderers who killed only once. The se- paraphilias. the experience is often re- rial murder group was almost exclusively peated over and over. In fact. Warren et Caucasian. while only 80 percent of the proposed that actual murders likely single murder group was Caucasian. Fif- become the fantasy material for subse- ty-eight percent of the serial killers com- quent masturbation. reinforcing the sadis- pared with 29 percent of the single killers tic arousal pattern. Those ideas likely had a higher than average IQ. They pro- give a more probable explanation than posed that intelligence may somehow in- psychodynamic theories offered about se- fluence how well the sexually sadistic rial ki~lers.~',22 paraphiliac fantasy is translated into ac- ~angevin~\ompared sexual killers tual behavior. This may explain how well with sexually aggressive nonkillers as thought out and organized many sexual well as with nonsexual killers. The vic- killer's crimes really are. Eighty-six per- tims of sexual killers were more often cent of the serial killers had fantasies of strangers and had been killed via strangu- rape, murder or both. compared with 29 lation. He proposed the use of strangula- percent of the single killers. Seventy per- tion to be a means of prolonging the sa- cent of the serial killers had a history of distic suffering of the victim and in turn compulsive masturbation, 75 percent had causing a prolonged feeling of pleasure a history of voyeurism, 7 1 percent had a and control by the offender. This may be history of fetishism, and many had a his- due. in part, to the offender's own narcis- tory of cross-dressing. Although mem- sistic needs. In fact, this could be consis- bers of both groups had equally planned tent with ~azelwood's' belief that the their crimes, the serial killers often had most common three personality disorders more scenes. seen in serial killers are narcissism. para- Prentky et a1.l" proposed that when a noia, and antisocial. sexually sadistic fantasy has been acted ~rukteinis~~sees sexual sadism as a out for the first time, the offender is likely spectrum that goes from mild forms of to engage in a series of sexually sadistic "culturally sanctioned rituals" to "bizarre acts. Each sexual act comes closer to ac- and grotesque" serial killings. The ele- tually enacting the particular paraphiliac ment of total control that a sexually sa- fantasy. However, since it is difficult to distic killer has over his victim may be a ever exactly match the sadistic fantasy, critical piece to the puzzle.25 ~rittain'~ there is an impetus to begin restaging the interviewed sadists who had interest in fantasy over and over, each time reinforc- things that mixed cruelty, sex. and power ing the deviant fantasy with orgasm. The over others. One sexually sadistic serial fantasy could eventually develop to in- killer interviewed by one of the current clude paraphilias with violence that could authors said: "It's the killer's need to

344 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers? have ultimate control over his victim that search is linking recurrent or obsessional causes the sexual excitement. He proba- paraphilic fantasies with low serotonin bly does this because of his own poor levels.32 ~radford" and others have ac- feelings of self-worth and inadequacies. tually shown the use of selective seroto- Complete control is the only way to over- nin reuptake inhibitors as being helpful in come this inadequacy." The issue of con- some individuals who suffer from para- trol may lead to the sexual excitement and philias. Also commonly used are antian- the actual death itself could be anticli- drogens for the treatment of paraphilias.34 mactic. ~angevin~~states that the of- ~thers"~"have seen improvement with fender can '-do what he wants" including use of other psychotropics such as car- mutilation and sexual abuse, demonstrat- bamazepine, buspirone, or lithium. ing an "ultimate control" over the victim. Abel er a1." have shown that it is gen- Hazelwood et quoted an offender erally common for an individual to suffer who stated, "the pleasure of the complete from multiple paraphilias rather than just domination over another person is the one. Additionally. they showed that para- very essence of the sadistic drive." philiac behaviors often begin prior to 18 Biological predispositions may also be years of age." Therefore, multiple sexual a contributing factor. ~angevin'~showed paraphilias can and often do develop dur- it to be more common in both sexual ing adolescence. There is evidence based killers and in sexually aggressive nonkill- on the cases presented in this article that ers to have abnormalities in the right tem- the paraphiliac fantasy of sexual homi- poral horn area of the brain as seen on cide may also develop in some adoles- scans. He also noted elevated testosterone cents. This supports the assumption oth- in both of these groups. Gosselin and ers have made who have interviewed ~ilson~~argued that left hemispheric serial killers and claimed that their killing dysfunction was more commonly seen in behaviors began in adoles~ence.~,"' individuals who suffered from deviant or Furthermore, there have been a few case bizarre paraphiliac fantasies. However, studies in the literature of juvenile homi- ~angevin*~noted temporal horn lobe cides that have included a type of sexual damage in many individuals who suffer contact before, during, or after the kill- from fetishism and cross-dressing, the ing-"2p4" However, the circumstances of two paraphilias that Prentky and Bur- these murders and whether or not they ge~s~~saw more commonly in serial kill- were secondary to a sexually sadistic fan- ers. Prentky and Burgess also proposed tasy is uncleas. the coexistence of dominant hemisphere dysfunctions in the limbic system as a Discussion possible contributing factor. one^" It is important to ask adolescents who proposed a relation between lust murders have been referred for violent crimes or and temporal lobe seizures. Many known sexual offenses about the nature of their serial killers have suffered from head in- sexual fantasies and to take a very thor- jury or trauma when younger." New re- ough and detailed sexual history. This

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history should include asking whether the summarized that some juvenile killers adolescent becomes sexually excited demonstrated animal cruelty, suffered when experiencing or fantasizing about from stuttering or impulse control, or had violence. The subjects should also be run away. ~almquist"discussed adoles- questioned about fantasies or actions cent prekilling prodromal signs such as involving sexual sadism and killing. behavioral changes, "cries for help," use aske el"" recommends that the inter- of drugs, adolescent losses, "threats to viewer be familiar with paraphilias, com- manhood," somatization, an "emotional fortable with listening to material pre- crescendo," and homosexual threats. Fi- sented, and should allow for ample time nally, Cornell et ~71.~~identify three when interviewing adult sexual s ad' ists. groups of adolescents at high risk for The authors believe this should also apply homicidal behaviors: psychotic adoles- when interviewing youth. Once the ado- cents, those engaged in interpersonal con- lescent realizes the interviewer is com- flict, and those who commit homicide in fortable with the topic, they are often the course of committing another lesser willing to talk openly and divulge infor- crime. Despite the above guidelines, mation that has been bothering them for a Holmes and ~olmes~do not believe there prolonged period of time. However, this is a presently clear set of indicators that may not occur if the interviewer is unfa- help one identify children who will kill. miliar with what questions to ask or cuts The authors would propose that the the interview off prematurely because of evolving nature of the sexually sadistic time constraints. Nevertheless. even the fantasy often begins in adolescence and is best interviewers may have difficulty a possible key factor that must be looked eliciting the complete truth in many for in identifying youth who are at risk for cases. l7 becoming sexually sadistic serial killers. Many "normal" people experience de- Adolescents who demonstrate sexually viant sexual fantasiesA7 including sa- sadistic fantasies, especially of a violent dism. However, not everyone who suffers nature that end in killing. should be "red from sexually sadistic paraphilic fantasies flagged." followed closely, and offered goes on to act them out. Brittain said that treatment to help extinguish or control the most sadists restrict themselves to fantasy deviant fantasy before it becomes a real- alone.I2 Few take their fantasies to the ity. If cognitivehehavioral and psycho- point of murder and even less to the point pharmacologic treatment is offered early of multiple murder. enough in the development of the sexu- Hellman and lackm man^^ discussed the ally sadistic and homicidal fantasy. one triad of enuresis, fire setting, and animal would hope to decrease or prevent the cruelty as predictors of youth violence. eventual possible outcome of serial homi- Lewis et ~1."~found that juveniles who cide. murder are often more neuropsychiatri- One cannot assume that the adolescents cally impaired when compared with non- in the cases presented in this article will violent delinquents. Langevin et 01."' actually become serial lullers. However,

346 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Natural Born Killers? it is evident that they are showing behav- 7. Holrnes RM, Holmes ST: Serial murder, in Murder in America. Thousand Oaks, CA: iors and fantasies at an early age that are Sage, 1994, pp 92-128, 173-200 similar to the behaviors. studied retro- 8. Hickey EW: Serial Murderers and Their Vic- spectively. of actual serial killers-there tirns. Belmont, CA: Wadsworth, 129-33, 199 1 are many obvious similarities. 9. Holrnes RM, DeBurger J: Serial Murder. Newbury Park, CA: Sage, 46-60, 1988 10. Revitch E: Sex murder and the potential sex Conclusion murder. Dis Nerv Sys 26:640-48, 1965 The study of the development of sexu- 1 1. von Krafft-Ebing R: Psychopathia Sexualis. New , NY: Bell, 351-61, 1965 ally sadistic paraphilias that lead to serial 12. Brittain RP: The sadistic murderer. Med Sci killing is still in its infancy. Children and Law 10: 198-207, 1970 adolescents who develop sexually sadistic 13. MacCulloch MJ, Snowden PR, Wood RJW, Mills HE: Sadistic fantasy, sadistic behaviour fantasies and talk about single or serial and offending. Br J Psychiatry 143:20-9, killings need to be followed over time in 1983 a prognostic manner to help researchers 14. Levin J, Fox J: Mass Murder: America's Growing Menace. New York: Plenum, 1985 and clinicians better understand the de- 15. Hickey EW: The female serial murderer. J veloping nature of the sexual serial killing Police Crim Psycho1 2:2, 1986 fantasy. doing so, one would hopefully 16. Rcssler RR, Burgess AW, Douglas JE: Sexual In Homicide: Patterns and Motives. Lexington, begin to better understand whether there MA: Heath, 1988 are specific subtleties that would help one 17. Dietz PE, Hazelwood RR, Warren J: The sex- ually sadistic criminal and his offenses. Bull identify those who go on to kill and those Am Acad Psychiatry Law 18: 163-78, 1990 who would not. Further studies will need 18. Douglas JE, Burgess AW, Burgcss AG, to occur to help identify whether standard Ressler RK: Crime Classification Manual: A Standard System for Investigating and Classi- treatment for sexual offenders, or a mod- fying Violent Crimes. New York: Lexington. ified version thereof, could be helpful in pp 123-44, 1992 treating this specific population. 19. Prentky RA, Burgess AW, Rokous F, et nl: The presumptive role of fantasy in serial sex- ual homicide. Am J Psychiatry 146987-91, References 1989 20. Warren J, Hazelwood RR, Dietz P: The sex- 1. Hazelwood RR, Warren J: The sexually sadis- ually sadistic serial killer. Submitted for pub- tic serial killer. Workshop presentation, Asso- lication ciation for the Treatment of Sexual Offenders 21. Leslie L: The silence of the lambs: hardly Annual Conference, San Francisco, CA, 1994 wolves in sheep' clothing. J Psychohistory 2. Vachss A: The psychopaths anlong us. New 20:47-5 1, 1992 York Times Book Review. March 14, 1993, 22. Sears DJ: To Kill Again: The Motivation and PP ~19~20 Development of Serial Murder. Wilmington, 3. Masters B: Dahmer's inferno. Vanity Fair. DE: Scholarly Resources, 1991 November 1991, p. 185 23. Langevin R: The Sex Killer, in Rape and 4. Dietz PE: Mind of a serial killer. NOVA Sexual . Part 111: A Research Hand- bl-oadcast No. 1912, October 18, 1992 book. Edited by Burgess AW. New York: 5. Dietz PE: Patterns in human violence, in Psy- Garland, 257-73, 199 1 chiatric Update: American Psychiatric Asso- 24. Drukteinis A: Serial murdel--the heart of ciation Annual Review. Edited by Hales RE, darkness. Psychiatr Ann 22532-8, 1992 Frances AJ. Washington, DC: American Psy- 25. Weinberg T, Levi Kanel GW: S and M: chiatric Press, 6:465-90, 1987 Studies in . New York: 6. Dietz PE: Mass, serial and sensational hotni- Prometheus, 1983 cides. Bull NY Acad Med 62:492-6, 1986 26. Hazelwood R, Warren J, Dietz P: Compliant

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