Because of continuing reservations about the insanity defense but with the underlying consensus that a defendant’s mental disorder at the time of the offense should in some cases be relevant when determining criminal responsibility, various iterations of and alternatives to the insanity defense have been recognized. Chapter 9 addresses a number of these variations, such as the deific decree defense, the PTSD defense, the battered spouse/child syndrome defense, and the urban psychosis defense, as well as the abolition of the insanity defense or related mental health evidence, shifting the burden of proof to the defendant, heightening the level of proof required to establish the defense, the guilty but mentally ill verdict, the diminished capacity defense, and the so-called temporary or “he/she snapped” defense. This chapter also discusses other criminal responsibility issues that a defendant’s mental disorder may impact, namely, the mens rea (criminal intent) and actus reus (criminal act) elements of a criminal prosecution. For example, if a defendant lacked control over his or her actions, a crime is not considered to have occurred. Thus, the law recognizes an automatism or unconsciousness argument, which may encompass epilepsy, a concussion, or a fugue state. More controversial are the sleep-walking defense and the “multiple personality disorder” defense. This chapter also addresses the two USSC rulings germane to these various iterations and alternatives.