Les auteurs de violences sexuelles en unité pour malades difficiles

RésuméL’étude des auteurs de violences sexuelles au sein de la population admise en unité pour malades difficiles (UMD), en raison d’un état dangereux majeur, aboutit à des résultats surprenants. Loin du « portrait » habituel mais rare du « pervers sexuel inamendable », les auteurs relèvent une fréquence élevée d’auteurs de violences sexuelles en UMD, des diagnostics divers et des comorbidités variées chez ces sujets. Ils concluent à la nécessité d’une plus grande attention à porter sur les antécédents de violences sexuelles, d’autant que des prises en charge spécifiques sont possibles.

IntroductionLiterature concerned with the care of the mental patients perpetrators of sexual violence in psychiatric high security care unit is sparse and fragmented. According to studies, it is reported that a small proportion of such patients that suffer are between 3 and 5%. These patients are described as perverse and incurable and no subject to any treatment with the exception of surveillance in institutional settings. Based on the observation of an ancient literature and limited, our aim was to realize a study covering the year 2010. This proportion, has it changed? What are the profiles of sexual offenders in this care unit?Material and methodWe realized a retrospective study with all patients who were hospitalized in care unit for dangerous patients covering the year 2010 in Sarreguemines. We studied a sample of 124 patients who were all in forced hospitalization. We identified forensic history, judicial history, and sexual violence history for every patients who were studied.ResultsSexual violence concerns only 10% of transfers in care unit for dangerous patients over the period studied. In this case, it's mainly sexual assaults occurring in community settings and not psychiatric. Sexual violence constitutes an indication of the forced hospitalization then transfer in this care unit. However, we find history of sexual violence in nearly 30% of patients being hospitalized in the care unit. It's primarily mental retardation closely followed by schizophrenia. These patients with history of sexual violence have important comorbidities: consumption of toxic and personality disorder. Finally, the prevalence of paraphilias remains low and only concerns 16% of sexual offenders in psychiatric high security care unit.DiscussionIt was admitted in literature that patients perpetrators of sexual violence were infrequent in dangerous patient care unit especially sexual perverts. Against all odds, one third of patients hospitalized in this care unit have committed sexual assault (a large proportion). More than half of these patients with mental retardation, schizoaffective disorder, bipolar disorder or personality disorder. Only 13% of schizophrenic patients have committed sexual violence: it's a small proportion compared to other mental illnesses.ConclusionThe profile of sexual pervert exists in psychiatric high security care unit (sexual homicide with torture and barbaric act) but it's an uncommon cases. Sexual violence is frequent among hospitalized patient in psychiatric high security care unit (sexual violence found are varied: sexual touching, attempted rape of a nurse).