A clockwork orange: a case report in which aggression flows into sexual impulse.

The extreme psycho-motivational variability in perpetrators of heinous crimes with apparent sexual motives can complicate case definitions. This article presents a case illustrating the complex interplay between sexuality and aggression, involving the death of an elderly woman found in her home. External examination and autopsy revealed signs of asphyxiation caused by external neck compression. Additional findings, including multiple bruises, some general and others suggestive of sexual violence, led to the hypothesis of a violent anal assault. A young man was quickly apprehended and admitted respon-sibility, although he could not explain his actions, particularly the sexual assault. A dynamic crime reconstruction and clinical analysis of the perpetrator's personality prompted a reevaluation of the role of sexuality in the crime. Despite initial appearances, aggression was expressed through sexual behavior. The destructive violence inflicted upon the elderly victim was further manifested through acts of sexual degradation. These findings provided the basis for a comprehensive psychia-tric and forensic evaluation, which identified no signs of temporary mental illness. Instead, the perpetrator was found to have a disturbed personality significantly influenced by an affective disorder.