Comorbidity of both substance misuse and antisocial personality disorder is common in mentally ill people who offend. Whether acting to predispose, precipitate, or perpetuate violence the combination of mental illness with substance misuse, or mental illness with antisocial personality disorder, is likely to lead to criminal behaviour. Hiday(6r> also cites the evidence supporting neurobiological pathology as providing a common basis for mental illness, substance misuse, and antisocial personality disorder.
In the assessment of mentally disordered offenders we need to exercise caution in the attribution of causality to psychiatric disorder. Unfortunately, courts seek black-and-white answers to questions that would be more appropriately answered in shades of grey. That is the nature of the judicial process, and all who provide psychiatric testimony must learn to live with the forced choices imposed by the courts. However, it would be naive to pretend that what is established in criminal courts as the 'truth' is necessarily the 'clinical truth'. The multifactorial causes of offending by the mentally ill is of crucial importance in relation to treatment where the range of contributory factors requires detailed evaluation. These caveats and qualifications are important in considering specific psychiatric disorders and criminal behaviour.
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