Forensic Assessment of Automatism
| Areas of Assessment | Elements to Assess |
|---|---|
| Presence of automatistic state | Corroborating 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 trigger | Severity of the triggering event |
| Source (did the eventual victim trigger the event?) | |
| Context (accused’s interpretation of the trigger) | |
| Priming or vulnerability factors | Substance use |
| Life stressors | |
| Sleep deprivation | |
| Amnesia | Presence and duration |
| Cause: organic, functional, alcohol blackout, conscious attempt to distort | |
| Incomprehension and possible horror on return to awareness | |
| Motive | Possible gains |
| Link between the victim and the trigger | |
| Specific concerns in sleep-related violence | History 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 psychosis | No 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 recurrence | Unique nature of the trigger |
| Treatment for disorder leading to automatism |
(Adapted from Glancy and Regehr29).