Table 2

Forensic Assessment of Automatism

Areas of AssessmentElements to Assess
Presence of automatistic stateCorroborating witnesses
Corroborating history of dissociative states
Consideration of possible malingering
Nature of the automatistic state (disease of the mind?)Presence of psychiatric illness
Presence of medical illness
Presence of sleep disorder
Effects of alcohol/drugs
Medical and psychiatric history
Family history
Laboratory results
Precipitant or triggerSeverity of the triggering event
Source (did the eventual victim trigger the event?)
Context (accused’s interpretation of the trigger)
Priming or vulnerability factorsSubstance use
Life stressors
Sleep deprivation
AmnesiaPresence and duration
Cause: organic, functional, alcohol blackout, conscious attempt to distort
Incomprehension and possible horror on return to awareness
MotivePossible gains
Link between the victim and the trigger
Specific concerns in sleep-related violenceHistory of sleepwalking or other parasomnias
Evidence the individual was asleep prior to the offense
Duration of sleep
Concurrent factors (fatigue, drugs, alcohol)
Source of arousal (touch, noise)
Proximity of offense to arousal
Specific concerns in severe intoxication and substance-induced psychosisNo independent psychotic disorder
Symptoms did not precede substance use
Symptoms do not persist after the cessation of acute withdrawal or severe intoxication
Disturbance does not occur exclusively during the course of a delirium
Risk of recurrenceUnique nature of the trigger
Treatment for disorder leading to automatism
  • (Adapted from Glancy and Regehr29).