中華心理衛生協會

Purpose: Persons with dissociative disorder experience involuntary disruption or discontinuity in integrating one or more of the following: memory, identity, affect, behavior, perception, thought, sensation, or control over bodily movements. The disorder remains poorly understood and is often underdiagnosed. Moreover, disagreements regarding diagnosis frequently occur. We quantified the extent to which dissociation is described in criminal cases in Taiwan, and examined whether there is concordance between court judgments and the conclusions and sentencing recommendations of forensic psychiatric evaluations. In addition, we sought to identify factors associated with sentence mitigation or exemption from criminal responsibility in such cases. Methods: We applied a cross-sectional study design by searching the Taiwan Judicial Yuan's database of almost 6 million criminal cases from 1999 to 2021 using the keyword dissociation. We then statistically analyzed the relevant variables of the identified cases. Results: We identified 233 cases mentioning dissociation (3.9 cases per 100,000). Of the 55 cases (23.6%) with forensic psychiatric assessments, 46 mentioned a dissociative disorder (83.6%) and included a recommendation for sentence mitigation or exemption from criminal responsibility due to the disorder. The concordance rate between court judgments and forensic psychiatric conclusions was 80% (44/55). Factors associated with not receiving sentence mitigation or exemption included being male, having a history of substance use prior to the offense, and the offense occurring in 1 of Taiwan's 6 major municipalities (p < 0.05). Conclusions: Although the term dissociation has low prevalence in criminal cases in Taiwan, it is important to understand this concept because of the role forensic assessment may play in the outcome for a defendant with a dissociative disorder. Defendants who received a formal assessment of dissociative disorder were more likely to receive a reduced sentence or to be exonerated. However, over 75% of the cases that mentioned dissociation did not include a forensic assessment. We expect that the gap in outcomes may arise due to a difference in the understanding of the concept of dissociation in the judicial context and the psychiatric diagnosis of a dissociative disorder. We recommend improving the knowledge of legal professionals regarding dissociative disorders and targeted efforts to enhance mental health literacy in the judicial system.