刑事案件中解離症對判決之影響

The Impact of Diagnosed Dissociative Disorders on Criminal Judgments

研究目的：探究刑案中有「解離」描述的比例、判決與司法精神醫學鑑定中建議「減刑或免責與否」的一致率及上述刑案中影響判決減刑的相關因子。研究方法：本研究為橫斷研究設計，透過司法院裁判書查詢系統搜尋1999年至2021年提及「解離」的刑案，逐篇檢視判決書內容並分析，轉譯相關變項後進行統計分析。研究結果：刑案中每10萬案件有3.9件（233／5，910，746）有「解離」的描述，司法精神鑑定建議被告有解離症減刑或免責者佔有「解離」刑案觸法者的83.6%（46／55）。有「解離」描述的刑案觸法者減輕刑責或無罪免責的判決與司法精神鑑定結論的一致率為80%（44／55）。「不因『解離』而被判決減刑或免責」相關因素有男性、此次觸法前有物質使用史及刑案發生地在六都等（p < 0.05）。研究結論：刑事案件中觸法者的解離症與其減刑或免責與否的議題，值得關注。由於司法情境中「解離」與精神醫學上的解離症診斷有明顯差距，建議提升司法精神鑑定人與法界人士有關解離症與責任能力判定的精神健康知能。

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.