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Kişilik Bozukluklarında Tanı Güvenirliği ve Cezai Sorumluluk

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Abstract

Devlet gücünün en çarpıcı yönü olan “cezalandırma hakkı” ve bu doğrultudaki “ceza” kavramıdır. Cezada ölçü, suçlunun kasıt ve kusur derecesi ile işlenen suçun ağırlığıdır. Psikiyatrinin ceza hukukuna yardımcı olduğu nokta ise suçun manevi öğesinin gerçekleşip gerçekleşmediğidir. “Cezai Sorumluluk” kavramı bir ruh sağlığı uzmanı için açık ve belirgindir. Akut ya da kronik bir zihinsel hastalık hukuki anlamda da ispat edilebilir bir tanıdır. Ancak buradaki soru tanısal orijin de değildir. Hukuki ya da cezai sorumlulukta fonksiyonel azalmayı tespit etmektir. Adli psikiyatri uygulamalarına bakıldığında -belli başlı akıl hastalıklarından farklı olarak- kişilik bozuklukları, genel olarak cezai sorumluluğu ortadan kaldıran bir fenomen olarak görülmemektedir. Elbette suç davranışları sadece kişilik bozukluğu nedeniyle meydana gelmemektedir. Araştırma bulguları, kişilik bozukluklarının genetik yatkınlıkla beraber çevresel koşullar ve olumsuz yaşam deneyimlerinin etkileşimi ile meydana geldiğine işaret etmektedir. Peki bu genetik –ya da- diğer faktörler bir insanın cezai sorumluluğunu azaltmakta mıdır? Burada tartışılması gereken, kişilik bozukluğuna sahip şüphelilerin cezai sorumlulukları ile ilgili ruhsal değerlendirme sürecinde kullanılan ölçütlerin işlevselliğidir. Adli sürece bakıldığında tanı koyma işlemi için psikiyatrın elindeki en önemli enstrüman sınıflamadır. DSM IV tarafından tanımlanmış olsa da kişilik bozuklukları kriterlerinin hepsinin birden bugüne kadar tam olarak oturtulamadığı da görülmektedir. DSM sistemi kısmi hastalıkların yarattığı fonksiyonel işlev kayıpları ile ilgili olarak bilgi vermez dolayısıyla buradaki ilgili tanılar hukuki zeminde adli sorunları çözemez. Böyle bir durumda, kişilik bozukluklarının yol açtığı, sosyal normlara uyma yeteneğindeki azalmaya nasıl karar verilecektir?

Kişilik Bozukluklarında Tanı Güvenirliği ve Cezai Sorumluluk

Derya Deniz
İstanbul Kültür Üniversitesi Psikoloji Bölümü, İstanbul
DERLEME / REVIEW
Özet
    
 
-
   -




-
-
    
-
-

  
-
   -
  
       -
  
       


-


Anahtar Kelimeler:

Abstract
The most striking aspect of the state power is the “right to punish”
and the concept of “punishment” in that notion. The level of punishment
is determined by the degree of intent and fault, and the level of the crime
committed. The point that psychiatry assisting criminal law is whether or
not the “mens rea” has taken place. The concept of “Criminal Respon-
sibility” is clear and obvious for a mental health professional. A diagno-
sis about an acute or chronic mental illness can be proven in the legal
sense. But the question here is not the diagnostic origin. It is to detect the
functional reduction in legal or criminal responsibility. Judging from the
practice of forensic psychiatry personality disorders - unlike some major
mental illnesses - are generally not seen as a phenomenon that dispose
criminal responsibility. Of course, criminal behavior is not merely due to
  -
ders are caused by the interaction of environmental conditions and poorly
life experiences as well as genetic vulnerability. Are these genetic factors
or other factors reducing the criminal responsibility of a person? What
should be discussed here is the functionality of the criteria used in the
moral/mental assessment process for criminal responsibility of suspects
with personality disorder. From the judicial process point of view, the
-

none of the personality disorders criteria could be fully settled today. The
DSM system does not provide information on dysfunctions caused by
partial diseases, so the related diagnoses cannot solve judicial problems
in legal cases. In such a case, how will it be decided whether the ability
to comply with social norms has been reduced by personality disorders?
Keywords-
sic Psychology.
doi: 10.17986/blm.2017228029
Sorumlu Yazar: Yrd. Doç. Dr. Derya Deniz
İİstanbul Kültür Üniversitesi Psikoloji Bölümü, İstanbul
E-mail: d.deniz@iku.edu.tr
Geliş:30.01.2017 Düzeltme:26.05.2017 Kabul:08.06.2017
1. Giriş ve Cezai Sorumluluk

-
   -
     
     


      -


  
-
  -
-

       -
  


-
- 125 -Deniz / Adli Tıp Bülteni, 2017; 22 (2): 124-129
     
    



      -
      -
      

  -
      

-
     -

      


-
-
-
-

      
      -

-

     
-

      

-

-
-
 -

 -

     
  -

    


-



       
      

 
-
     
      
     -
-
     
     -
      
 -
-


      


       
  
     
  -

  -

2. Kişilik Bozuklukları ve Cezai
Sorumluluk

         
-
  
       
     
       
      
      
-



-

-
 -

-

  

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-
 
      

     
      -
     
    

-

     

-
-

     
-
-
    


-

  


    

      -
      
-

-
      
 -
      
     -
  
-

-

      
     -
       
      
     
     


-


     
-

     
  -





      
  
 
-
 -

-

     

-
-
     
     -
-
-
-



  
 -

 
       -
-

      



-
-



      

Deniz D / Adli Tıp Bülteni, 2017; 22 (2): 124-129
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-
     
 
-
-

      -
    
       
    
      
   -
     -


3. Kişilik Bozukluklarını Saptamada
Kullanılan Ölçütler ve Tanı Güvenirliği
-

    
-
-
    -
  
     
-
       
-
-
   
-
  
 -

     
     
  
    -
   -
      
-
-


-
     
    
      -


    
     

      
  -
     
  


     
     

  -
      
-
    
   -

   -
      
     
     
   
 -

     -

  -
    
     
-
 
-
      -



-

-
-

-

-
-

-
   -

  
Deniz D / Adli Tıp Bülteni, 2017; 22 (2): 124-129
- 128 -
-
       
       

-

 

    
      
      


  
-
     
-
-

4. Sonuç ve Öneriler
-

       

     -



    

-
     -
 

-

-
-

     
     
-
        -
   -


     

     
  
-
 
-
      
 -
     


-
-

Kaynaklar
        
-


   
      

 

 -

 -

 -


         
       
     

 


        
      -
     

-


      

   
       

     -
       

  -
  -
   

-

Deniz D / Adli Tıp Bülteni, 2017; 22 (2): 124-129
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     

-
-
     
     
-

       -
    

-

     
-
-
     
-

-
-



    -

  
-



-
cohol and other drug abuse results from ECA Study. JAMA,

   
:


        
      



-
-

Deniz D / Adli Tıp Bülteni, 2017; 22 (2): 124-129
... In the clinical sample, the diagnostic criteria guidelines such as DSM V and ICD-10, which are used as a diagnostic tool for psychopathology, do not always fully meet the needs for examinations in the forensic process. It is clearly stated in the preface of DSM V that the diagnostic criteria in the book may not be able to meet the need in the forensic evaluation and that there is a need for information gathering and additional measurement and evaluation tools other than the diagnostic criteria [39]. In forensic mental examination; to take into account the characteristics of some disorders that may lead to criminal behavior and to examine the temporal intersection of the criminal act and mental health of the perpetrator in this context will contribute greatly to legal processes. ...
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Most criminology theories and criminologists explain questions such as “why do some people deviate from legal and social norms?” or “why do people commit crimes?” at the factual level. Criminology does not only treat crime as a set of actions or inaction defined within the legal parameters. Understanding what lies beneath the cognitive, emotional, and social aspects of the criminal act is highly dependent on the information available about the nature of the illegal act and the criminal. Criminal law also needs a broader perspective because of this need. In that sense, to understand the individual and socio-psychological aspects of crimes, it is vital to understand the details of current crimes and their perpetrators. For the perpetrator to be held accountable for their criminal act or inaction; they must have committed the said crime deliberately, knowing the consequences of their actions, must be aware that they will be punished as a result, and must have the ability to control their impulses. It is the basis of the law approach that individuals cannot be held responsible for their actions and cannot be punished if they cannot control their behavior. The perpetrator’s mental health at the time of the criminal act is evaluated by mental health professionals. While there is no relationship between the majority of people with mental disorders and criminal behavior, it can be said that certain disorders may be a risk factor in some criminal acts. However, even if a relationship can be established between some mental disorders and the criminal acts, it should also be investigated how this relationship was indirectly affected by variables such as low socioeconomic status, previous arrest records, or substance abuse. Therefore, it should be noted that mental disorders that affect perpetrators do not lead them to criminal acts.
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The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20,291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.
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ÖZET Amaç: Atakl›¤›n (impulsivity) ruhsal bozukluklardaki rolü- nü a盤a ç›karan baz› çal›flmalar olmas›na karfl›n, atakl›¤›n nas›l belirlenecei ve tan›mlanaca¤›, literatürde halen tar- t›flmal› bir konudur. Atakl›k, davran›fl›n ölçülebilir bir özelli- ¤i olarak bir dürtüye ya da uyar›ya karfl› koymadaki baflar›- s›zl›k veya bir kiflilik boyutu olarak kiflinin kendisine ya da baflkalar›na zarar verme istemine engel olamama durumu- dur. Bu tan›mlaman›n yan›s›ra, atakl›k ifllevsel olan ve ol- mayan biçiminde birbirinden ba¤›ms›z olumlu ve olumsuz sonuçlar› olan bir kavram olarak tan›mlanmaktad›r. DSM- IV'te ayr›nt›l› bir flekilde tan›mlanmamas›n›n yan›s›ra, bir- kaç ruhsal bozukluk için tan› ölçütü olarak atakl›ktan söz edilmektedir. Bunlar, dürtü kontrol bozukluklar› (patolojik kumar oynama, aral›kl› patlay›c› bozukluk, piromani, klep- tomani ve trikotilomani), atak-sald›rgan kiflilik bozukluklar› (borderline, antisosyal, histriyonik ve narsisistik), bipolar bozukluun mani dönemi, dikkat eksiklii hiperaktivite bo- zukluu (DEHB), davran›fl bozukluklar›yla giden nörolojik bozukluklar ve madde kötüye kullan›m›d›r. Yap›lan çal›fl- malarda davran›m bozukluu, dikkat eksiklii hiperaktivite bozukluu, kiflilik bozukluklar›, madde ve alkol kullan›m bozukluklar›, psikotik bozukluklar, bipolar bozukluk, yeme bozukluklar› ve bunama (demans) gibi ruhsal bozukluklar› olan olgularda, atakl›¤›n karfl›laflt›rma gruplar›ndaki sal›kl› kiflilere göre daha fazla görüldü¤ü gösterilmifltir. Bu yaz›da literatür taramas› yap›larak bir kavram ve klinik belirti ola- rak atakl›¤› tan›mlamak, ruhsal bozukluklarla iliflkisini tar- t›flmak, bu bozukluklarla atakl›k aras›ndaki iliflkinin biyolo- jik dayanaklar›n› göstermek amaçlanm›flt›r.
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