Ottis Toole was an American drifter and also a serial killer who was in the late 1990s was convicted for different counts of murder. Toole made a confession when he was apprehended which he later recanted. On his conviction Toole received two death sentences but after an appeal was made the same was overturned and he was sentenced to a life imprisonment. To understand the mental state of the patient it is important to understand their background. Toole was raised by a father who was an alcoholic who abandoned him while he was very young, his father would dress him in women clothes and call him women name (Chiriboga, 2019). The patient was a victim of sexual harassment and specifically incest in the hands of many relatives and even acquaintances. His grandmother was also a Satanist who introduced him to different satanic practices including grave robbing and self-mutilation. The patient was considered to be suffering from mental retardation and he had an intelligence quotient of 75. The patient also suffered from epilepsy which in many cases made him to suffer from many grand mal seizures. In his childhood, the patient always run from their home and spend days and nights in abandoned houses. Different tests that were done on him by different psychiatrists discovered that the patient was considered to be extremely- impulsive and this made him to show antisocial- behavior and this was as a result of a personality disorder and that he was pyromaniac, there was enough evidence that supported the fact that the patient was diagnosed with a personality disorder. (Azevedo et al., 2020).



The patient was raised in a family and a community that was not caring and loving and this to a greater extent contributed to the different crimes that he committed. When the patient was only five years old, he was forced by his father to have sex with his friend’s father. When he was twelve years old, he already was having sexual relationships with his neighbor who was a boy and in the process; he ended up dropping out of school when he was in the ninth grade and started attending gay bars and abusing different substances in the process. The fact that he was not raised up in a loving manner and his father not instilling values in him, this made him to be a very different child. As a teenager he was already a male prostitute and at the same time he was obsessed with gay pornography (Chiriboga, 2019). Due to him not being supported by his family at his young age, he had decided to look for other means of supporting himself and this led to him to start drifting around the southwestern United States and he supported himself through panhandling and prostitution. From the different stories that were given to this patient, or the serial killer seemed not to have seek any mental health help until he was convicted and arrested. It was at this time that he was introduced to different psychiatrist who diagnosed different kinds of mental problems that were associated with his unlikely behavior.


Looking at the patient in my own thoughts the different issue that the patient had even though he had different issues that were biological in terms of his mental health, many issues that he had can be attributed to the way that he was raise. Looking at the experiences that the patient went through when he was a child, this shows the struggle that he had especially in knowing his identity, the fact that he didn’t receive enough love from his parents made him even more exposed to the different issues that he had (DeLisi et al., 2019). Dropping out of school when he was young


and finding ways of providing for himself and his needs are also some of the things that accelerated the need of him committing the different crimes that were attributed to him. Being a male prostitute while he was still a minor to satisfy his needs is only an indication of how the community and the relatives that he had were not supportive (Azevedo et al., 2020). Being sexually harassed by his relatives and neighbors also might have been the reason that built up the anger in him and decided to avenge this on other people by killing them and when he found love from his first relationship that he had with his lover who he committed more than 100 murder crimes with him. In my own thoughts therefore, I can conclude and say that the crimes and the behavior that Ottis Toole had committed were all as a result of the community and relatives that he had. They were not loving and caring and those mistreating him only accelerated the need for him to commit more murders.


The most obvious cognitive concerns that were seen in this patient was an antisocial personality disorder. This was seen throughout his lifetime, he was an antisocial child who was brutally abused by both his parents and even relatives, and this therefore caused him to be reserved and to be extremely antisocial.


The basic intervention to this condition is psychotherapy, which is also known as talk therapy, this is used to treat people with antisocial personality disorder. In this kind of therapy, it might include violence and anger management, treatment for substance and alcohol abuse and treatment for other mental conditions that the patient in this case had.


Another intervention that can be used to prevent the patient or treat him of the mental health problem that he had is through the Dialectical Behavior Therapy (DTB). This kind of therapy is basically one that does usually put together the different strategies that are used in treating antisocial behaviors, these different strategies may include emotional regulation, mindfulness and acceptance (Chagoya, 2018). These strategies could easily work keeping in mind that many of the problems that the patient had were attributed to the fact that he was gay and when he exposed his sexual identity to his relatives was when he was rejected. The patient had issues with acceptance and if this could be used on him it could be an intervention that could work perfectly on him. Other resource that can be used by the community or the patient in treating similar conditions include the American psychiatric association, anxiety and depression association of America or even the depression and bipolar support alliance.



Azevedo, J., Vieira-Coelho, M., Castelo-Branco, M., Coelho, R., & Figueiredo-Braga, M. (2020). Impulsive and premeditated aggression in male offenders with antisocial personality disorder. Plos one15(3), e0229876. Retrieved 9/1/2021 from

Chagoya, M. Á. Q. (2018). Relationship between mindfulness skills, estimation and frequency of consumption of healthy foods in young universities. Revista Electrónica de Psicología Iztacala21(3), 941-962. Retrieved 9/1/2021 from IDREVISTA=287&IDTCULO=83171&IDPUBLICACION=7995

Chiriboga Aldáz, M. (2019). Relationship between childhood traumas and serial killers (Bachelor’s thesis, Quito). Retrieved 9/1/2021 from

DeLisi, M., Drury, A. J., & Elbert, M. J. (2019). The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive psychiatry92, 1-6. Retrieved 9/1/2021 from



Develop a Care plan in a Word Document format with Three Diagnosis (Evidenced By & Related To) based on this criminal mind paper attached (Ottis Toole) including the following points;

· a) What is the diagnosis related to?

· b) Evidence that supports the chosen nursing diagnoses.

· c) Planned outcomes that are patient-centered.

· d) Nursing interventions that are evidence-based and include rationales.

· e) How will you evaluate the effectiveness of the plan?

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