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返回卷期清單 (第39卷第1期 / 2026 / 3)
第39卷第1期
/
2026 / 3
/
pp. 105 - 129
DOI:
刑事案件中解離症對判決之影響
The Impact of Diagnosed Dissociative Disorders on Criminal Judgments
95
10
作者
郭宇恆 Yu-Heng Kuo
(（目前職位）衛生福利部嘉南療養院成癮暨司法精神科主治醫師；（最高學歷）國立中正大學法律系博士；專長領域與研究興趣為司法精神醫學、司法精神處遇、刑事法學。 (Current Position) Attending Physician, Department of Addiction and Forensic Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Taiwan.)
歐陽文貞 Wen-Chen Ouyang *
(（目前職位）高雄市立凱旋醫院老年精神科主治醫師兼教學研究部主任及高雄醫學大學醫學院精神學科教授、台灣社會與社區精神醫學會理事長；（最高學歷）國立陽明大學公共衛生研究所哲學博士及醫學系醫學士；專長領域與研究興趣為失智症及老年精神醫學、社區精神醫學、精神健康促進、思覺失調症、精神疾病流行病學及臨床試驗。†: 歐陽文貞及郭宇恆是相同貢獻的第一作者。 (Current Position) Attending Physician, Department of Geriatric Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Director, Department of Education and Research, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Professor, Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Taiwan; President, Taiwanese Society of Social and Community Psychiatry. †: Equal contribution authors (first author): Yu-Heng Kuo, Wen-Chen Ouyang.)
周立修 Li-Shiu Chou
(（目前職位）高雄市立凱旋醫院顧問醫師、高雄醫學大學醫學院精神學科講師、中華團體心理治療學會理事長；（最高學歷）高雄醫學大學健康科學院公共衛生研究所醫管碩士及中國醫藥大學醫學系醫學士；專長領域與研究興趣為團體心理治療、榮格取向分析心理治療、催眠治療、解離症相關研究。 (Current Position) Consultant Physician, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Lecturer, Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Taiwan; President, Chinese Association of Group Psychotherapy (Taiwan))
許玫琪 Mei-Chi Hsu
(（目前職位）義守大學醫學院護理學系教授；義大醫療財團法人義大醫院護理部兼任副部長；（最高學歷）澳洲 Griffith University 護理哲學博士；專長領域與研究興趣為精神衛生護理、司法精神護理、司法護理、思覺失調症、非藥物治療、暴力防治、臨床試驗。 (Current Position) Professor, Department of Nursing, College of Medicine, I-Shou University, Taiwan; Adjunct Deputy Director, Department of Nursing, E- Da Hospital, Taiwan.)
郭宇恆 Yu-Heng Kuo
（目前職位）衛生福利部嘉南療養院成癮暨司法精神科主治醫師；（最高學歷）國立中正大學法律系博士；專長領域與研究興趣為司法精神醫學、司法精神處遇、刑事法學。 (Current Position) Attending Physician, Department of Addiction and Forensic Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Taiwan.
歐陽文貞 Wen-Chen Ouyang *
（目前職位）高雄市立凱旋醫院老年精神科主治醫師兼教學研究部主任及高雄醫學大學醫學院精神學科教授、台灣社會與社區精神醫學會理事長；（最高學歷）國立陽明大學公共衛生研究所哲學博士及醫學系醫學士；專長領域與研究興趣為失智症及老年精神醫學、社區精神醫學、精神健康促進、思覺失調症、精神疾病流行病學及臨床試驗。†: 歐陽文貞及郭宇恆是相同貢獻的第一作者。 (Current Position) Attending Physician, Department of Geriatric Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Director, Department of Education and Research, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Professor, Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Taiwan; President, Taiwanese Society of Social and Community Psychiatry. †: Equal contribution authors (first author): Yu-Heng Kuo, Wen-Chen Ouyang.
周立修 Li-Shiu Chou
（目前職位）高雄市立凱旋醫院顧問醫師、高雄醫學大學醫學院精神學科講師、中華團體心理治療學會理事長；（最高學歷）高雄醫學大學健康科學院公共衛生研究所醫管碩士及中國醫藥大學醫學系醫學士；專長領域與研究興趣為團體心理治療、榮格取向分析心理治療、催眠治療、解離症相關研究。 (Current Position) Consultant Physician, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Taiwan; Lecturer, Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Taiwan; President, Chinese Association of Group Psychotherapy (Taiwan)
許玫琪 Mei-Chi Hsu
（目前職位）義守大學醫學院護理學系教授；義大醫療財團法人義大醫院護理部兼任副部長；（最高學歷）澳洲 Griffith University 護理哲學博士；專長領域與研究興趣為精神衛生護理、司法精神護理、司法護理、思覺失調症、非藥物治療、暴力防治、臨床試驗。 (Current Position) Professor, Department of Nursing, College of Medicine, I-Shou University, Taiwan; Adjunct Deputy Director, Department of Nursing, E- Da Hospital, Taiwan.
中文摘要

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。

英文摘要

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.

中文關鍵字

責任能力、精神鑑定、司法精神醫學、監護處分、精神健康知能

英文關鍵字

dissociative disorders, criminal responsibility, mental appraisal, forensic psychiatry, mental health literacy