Emotion in the criminal psychopath: startle reflex modulation

Startle-elicited blinks were measured during presentation of affective slides to test hypotheses concerning emotional responding in psychopaths. Subjects were 54 incarcerated sexual offenders divided into nonpsychopathic, psychopathic, and mixed groups based on file and interview data. Consistent with findings for normal college students, nonpsychopaths and mixed subjects showed a significant linear relationship between slide valence and startle magnitude, with startle responses largest during unpleasant slides and smallest during pleasant slides. This effect was absent in psychopaths. Group differences in startle modulation were related to affective features of psychopathy, but not to antisocial behavior per se. Psychopathy had no effect on autonomic or self-report responses to slides. These results suggest an abnormality in the processing of emotional stimuli by psychopaths that manifests itself independently of affective report.

The elusive population: characteristics of attenders versus non-attenders for community mental health center intakes

The present investigation was an attempt to determine characteristics of those who appeared versus those who did not appear for initial intake evaluation appointments at a traditional community mental center. Subjects were 189 individuals contacting the center for service from November of 1989 to April of 1990. Data were collected via self-report questionnaire and blind rating by clinical social workers of presenting problem for diagnostic category. Data analysis involved Chi-square procedures and Analysis of Variance. Those who appeared for initial appointment versus those who did not were differentiated with respect to employment versus unemployment, length of unemployment, tenure at current job, number of jobs in the past year, number of residences in the past year, tenure at current residence and number of marriages. Groups did not differ with respect to age, gender, ethnicity, martial status, income, educational attainment, legal difficulties, public assistance, referral sources, alcohol/drug problems, and a variety of variables related to mental health or treatment history and diagnostic category. Results were interpreted as supporting the hypothesis that attendance was related to recent life stability as opposed to more general demographic and socioeconomic factors and clinically related variables. Implications for increasing treatment utilization, particularly by those who are underserved in community mental health, were discussed.

Patterns of exposure to sexually explicit material among sex offenders, child molesters, and controls

The Meese Commission Report claimed exposure to sexually explicit material leads to sex offenses and recommended examining developmental patterns and pornography experiences of offenders. This second phase of our study examines developmental patterns and sexually explicit material experiences of sex offenders, a subgroup of child molesters, and controls. Results indicate sex offenders (but not the child molester subgroup) began masturbating at a significantly younger age than controls. Sexually explicit material was used during the first masturbatory experience of 33.3% of sex offenders and 14% of controls. Child molesters were significantly older than controls when exposed to sexually explicit material. Frequency of adult use of sexually explicit material does not differ significantly among groups.

Underlying patterns of practice in a regional forensic psychiatric service

Using a sample of 306 consecutive referrals, the interactions were investigated between factors relating to patients, referral agencies, assessments and courts. Both the variations in referral rates of diagnoses and the psychiatric histories indicated that the service was being used largely for second opinions on the mentally ill, but for those with neurotic disorder or exacerbations of personality disorder it was more akin to a general psychiatric service. Those thought to pose a sexual risk to adults were particularly likely to have histories of violence, but the opposite was true for those considered a sexual risk to children. Reports initiated by the court are more likely to contain a treatment recommendation and are also more likely to be implemented than those in defence reports. Both the likelihood of a treatment recommendation and its acceptance by the court increased with the severity of diagnosis, with psychiatrist and court reaching full concordance in cases of mental illness. As many as 20 per cent of those seen in prison had mental illness and this was nearly seven times the out-patient rate. Forensic outpatient work was found to be independent of the provision of secure care. These and other findings are examined to help explore the nature of the service.

[Multidimensional personality assessment in penal measures. An evaluation questionnaire as the deciding factor of dangerousness prognosis]

Predicting dangerousness is both the explicit and implicit basis for the decision on derestrictions of penal measures (treatment of mentally ill offenders in psychiatric hospitals). However, recent publications either criticize the validity of the applied criteria or question whether a valid prognosis is in any way possible. Since 1985, the Westfälische Zentrum für Forensische Psychiatrie at Lippstadt has been applying a standardized rating questionnaire to defined derestrictions: The therapeutic team is approaching the prognostic evaluation with multidimensional patient data and ratings. In a population of 263 mentally ill offenders receiving inpatient psychiatric treatment according to section 63 of the German Penal Code (StGB), an interdisciplinary research program used 202 rating questionnaires to investigate the decision-making and prediction criteria of derestriction practice. Empirical data and multivariate statistical analyses revealed that the decisions based on the rating questionnaire were thoroughly explored and responsibly substantiated: The risk in performing derestrictions of penal measures is taken in an calculated and justifiable manner. It is pointed out that the prediction of dangerousness must be considered not only when approving the derestrictions but also during the derestriction itself.

Assessing suspected child molesters

Clinical evaluations can play a useful role in making a variety of dispositional decisions concerning child molesters provided they are done carefully, using relevant techniques, and their limitations are clearly understood. Assessment instruments and techniques that can differentiate child molesters from other persons, that are related to treatment planning, and that predict the commission of future sexual offending are the most useful. Sex offense history and phallometric assessments are useful in planning treatment and supervision programs and in assessing risk. The Psychopathy Checklist is also a strong predictor of sexual recidivism but its usefulness in treatment planning is equivocal. Measures of attitudes and beliefs that support child molestation are suitable for designing treatment programs but their prognostic significance remains to be established. More general measures of personality and psychopathology have not been established as predictors of recidivism but can be used to address collateral clinical issues.

Using humor in psychotherapy with a sex offender

Humor was used during psychotherapy with a 22-year-old child molester. The humor appeared to help establish rapport and led to his admission of desires to rape and torture adult women. Here exchange of humor seemed to be a helpful adjunct to psychotherapy.

Mentally ill sex offenders. The experience of a regional secure unit

Sex offenders suffering from psychotic illness formed an important small group of a regional secure unit's patients. Ten of the 11 such offenders had a diagnosis of schizophrenia. There was a complex relationship between their mental illness and offending.

Personality differences of sex offenders referred for treatment

Personalities of 64 sex offenders (rapists, molesters, and incestuous types) referred for treatment were compared. No significant differences on MMPI scores or IQ were noted among subgroups of molesters. Significant trait anxiety indicated that molesters of both males and females had higher anxiety than incestuous offenders. Also, a significant difference was noted on state anxiety; all groups decreased scores over treatment. A significant effect of brief therapy also occurred for trait anxiety. All groups but incestuous offenders decreased on trait anxiety over 5-wk. therapy. Male and female molester groups decreased in self-esteem whereas incestuous types and rapists increased in self-esteem. Implications are provided for these results.

The evaluation of truthfulness in alleged sex offenders' self-reports: 16PF and MMPI validity scales

The evaluation of response bias (i.e., minimization or exaggeration) is central to forensic psychological evaluations. Yet few studies have assessed forensic samples to investigate the ability of psychological tests to detect response bias. We studied the relationship between the Sixteen Personality Factors Questionnaire (16PF) and the Minnesota Multiphasic Personality Inventory (MMPI) validity scales for 65 alleged sex offenders and assessed the effects of different cutoff scores for the 16PF validity scales. Results indicate consistent significant correlations between the validity scales of the 16PF and the MMPI for measures of minimization and exaggeration. use of a priori cutoff scores resulted in the classification of our sample in proportions parallel to those found in previous research for the 16PF Fake-Good scale but not the Fake-Bad scale. Our results indicate that 16PF validity scales are useful, but interpretations must take into account different base rates of response bias between sex offenders and the general population.

Validity of phallometric measures with sex offenders: Comments on the Quinsey, Laws, and Hall debate

In a recent debate, Quinsey and Laws (1990) and Hall (1990) discussed several major methodological issues in research on the validity of phallometric tests. This article examines specific points of the debate more closely and uncovers questionable assumptions underlying some of the Quinsey and Laws criticisms. The implications of unresolved problems for the clinical use of phallometric measures are stressed.

The paraphilias. The extent and nature of sexually deviant and criminal behavior

This article presents data that indicate that paraphiliacs tend to carry out a variety of paraphilic behaviors and cross a number of boundaries within individual paraphilias. These data contradict earlier theories that postulated that paraphiliacs compulsively repeat the same category of paraphilia over time without crossing into other categories of paraphilic acts as a result of specific early life experiences or specific emotional conflicts. This article suggests that a more parsimonious explanation is that individuals with paraphilias have a general deficit of control, leading them to carry out a variety of paraphilic behaviors with a variety of victims.

The evaluation and treatment of sexual violence, necrophilia, and asphyxiophilia

At first sight the phenomena discussed in this paper may seem to have little in common. Yet on close scrutiny it becomes apparent that there is an interesting degree of overlap. Although sexual assaults in general clearly involve multiple causes or factors, social and cultural as well as individual, many sexual aggressors do show psychological or biologic abnormalities which require careful evaluation. Continued empiric study of the variables discussed in this paper is therefore important. The clinical as well as laboratory study of paraphilias with dangerous tendencies to themselves or others is also essential for a better understanding of the causes and relationships between these disorders.

The abstinence violation effect in sex offenders: a reformulation

It is argued that the central issue in the treatment of sexually aggressive behavior is the tendency to relapse shown by offenders. A model of the relapse process is presented along with what is described as its central feature, the abstinence violation effect (AVE). This construct is critically examined and its shortcomings identified. A brief description of Weiner's attributional theory is provided and this is used to reformulate the AVE. The advantages of the reformulated AVE are described, as are the clinical implications. Suggestions are then made for future research.

Juvenile sex offenders: similar to, or different from, other incarcerated delinquent offenders?

The purpose of the present study was to compare incarcerated juvenile sex offenders to incarcerated youth who committed confrontational but nonsex offenses, and to those youth who committed only nonconfrontational, nonsex offenses. Furthermore, comparisons were made between two subtypes of sex offenders: those youth convicted for rape or sodomy vs those convicted for child molestation. Eighty-three male juvenile delinquents served as participants. Teachers within the correctional facility completed an instrument which allowed the examination of the two areas of interest: externalizing problems and internalizing problems. The results indicated that sex offenders generally, and particularly those who had committed only sex offenses, were perceived as having fewer externalizing and internalizing problems. No differences emerged between the two subtypes of sex offenders. Implications, as well as limitations, of the findings are discussed.

Sex and gender and the impaired therapist

A brief review of the problem of impaired therapists is followed by a more comprehensive review of sexual relationships arising in and following psychotherapy. The prevalence of this latter problem is approximately 10%. Offenders are predominantly male, one half are said to be "ruthless" and "exploitative", whilst the remainder are often "lovesick". The author relates these phenomena to processes of repudiation of the relational/feminine self of the highly masculinised clinician. Characteristics of offenders and consequences for patients are presented and issues of detection, sanctions, legislation, and prevention are addressed. Studies suggest that the vast majority of patients are harmed by the experience and that neither improved training, licensing, personal therapy, nor supervision of therapists will guarantee against its occurrence.

Rapists' behaviour: a three aspect model as a basis for analysis and the identification of serial crime

In this paper it is proposed that the behaviour of an offender during a sexual assault can be considered as consisting of three main groupings or 'aspects'. These have been termed 'Modus Operandi', 'Sexual and Personal Gratification' and 'Attitude and Intimacy'. Although an oversimplification, such a model facilitates a preliminary description of the offender which can be of direct assistance to an investigating officer. Various factors affect the consistency and variability of behaviour and the model has formed a basis for the development of a concept as to which behaviours might be the more useful for identifying linked offences. This more systematic approach to the investigative and intelligence processes is reliant on a victim's statement containing very detailed information about the offender's actions, together with a record of as much of his speech as can be recollected. The material required is described using the model and the text is illustrated with case examples. Instances are quoted of the possible inferences and their relevance to the investigation of sexual offences.

Sex and the teacher--learner relationship in medicine

As the numbers of women medical students, residents, and faculty increase, sexuality in teacher-learner relationships will present challenges for individuals and institutions. Ethical and legal guidelines regarding sexual harassment and contact already exist for many medical schools, hospitals, and professional organizations, as well as state and federal law. Individuals and institutions can begin to address these issues through policy development and educational sessions addressing human sexuality, communication skills, and the process of becoming a physician.

The Broken Hill Psychopathology Project

The main objective of this study was to describe the psychiatric disorders seen in patients presenting for treatment in rural New South Wales. The patients were seen primarily in the community, in both public and private practice, but also in the local base hospital and prison. Seven hundred and seven patients were consecutively examined during the study period. The results of this study were compared with a previous Australia-wide study to identify specific disorders that were more prevalent in rural areas. Alcohol abuse and dependence stood out as being much more prevalent. Life problems such as domestic violence, sexual assault, and incest occurred commonly in women referred for psychiatric assessment. More than ten percent of the study patients were children aged under 17, who had similar prevalence rates of the various psychiatric disorders to a national comparison. It is concluded that alcohol abuse is very common in rural New South Wales, particularly in men, although there are also high rates in women, and this is probably related, in part at least, to the high rates of domestic violence, sexual assault and incest. It appears probable that there is a cycle of alcohol abuse in men leading to domestic violence and sexual abuse in women and children. This may contribute to the latter becoming anxious and depressed. The rates of the major functional psychiatric disorders were similar to those seen nationally. There is a great need for the maldistribution of psychiatrists between metropolitan and rural areas to be addressed.

MMPI taxonomies of child sexual and nonsexual offenders: a cross-validation and extension

In a court clinic sample of 107 child sexual and nonsexual offenders, Minnesota Multiphasic Personality Inventory (MMPI) profiles did not differ as a function of arrests for sexual versus nonsexual offending. However, a three-group cluster-analytic solution was generated. Two of these clusters replicated those derived by Hall, Graham, and Shepherd (1991). The first cluster was unelevated, with Scales 4 and 9 as high points. The second cluster had MMPI Scales 4, 8, 2, and 7 as the highest scales. The third cluster was even more elevated than the other two clusters, characterized by extreme elevations on MMPI Scales F, 2, 4, 6, 7, and 8. The somewhat different results of this study versus previous studies (e.g., Hall et al., 1991) may be a function of the different populations sampled. The results provide evidence of within-group heterogeneity among sexual and nonsexual offenders that may be as important as between-group differences.

Patterns of denial in sex offenders

Men convicted of sex offences (N = 102) were interviewed in two prisons. Cluster analysis was used to generate three groups according to pattern of denial; a fourth group was composed of men who denied their offence altogether. The groups differed in their ethnic make-up, offence type and past history of sexual offending.

[Child victims of sexual abuse in Cameroon]

Reports of sexual abuse in children are infrequent in the French-speaking nations of black Africa. This study was undertaken to determine the incidence of sexual abuse in children in Yaounde, describe the profile of victims, and identify factors associated with sexual abuse. Seventeen female rape or attempted rape victims were enrolled over an 8-month period. Most (57.05%) were 7 to 15 years of age and lived in underprivileged neighborhoods. Genital bleeding (12 cases), hymenal tears (14 cases) and/or perineal tears were the main lesions found. Most of the rapists were young adults (19-45 years old in 70.5% of cases) who were neighbors, relatives or friends of the family, and single (58.82%). The motivations of the rapists were unclear. This medicosocial reality which is new in Cameroon needs attention.

Differential effects of women's child sexual abuse and subsequent sexual revictimization

This study examines the differential effects of sexual revictimization in a community sample of 248 African-American and White American women, ages 18 to 36. Two classifications of sexual revictimization over the life course were used to assess the effects on later sexual and psychological functioning. The findings suggest that unintended pregnancies and abortions were significantly associated with sexual revictimization. Women who reported more than one incident in both childhood and adulthood were also likely to have multiple partnerships and brief sexual relationships. The findings are discussed within the context of the dynamics of sexual revictimization and its effects. Suggestions are offered for therapeutic strategies with survivors in order to minimize the effects of sexual revictimization.

A model for a rurally based day hospital treatment program for sex offenders

Services to perpetrators of child sexual abuse have been located primarily in larger urban centers. There has been a relative lack of services to family violence offenders, in general, and sex offenders, in particular, in rural Canada. This paper presents a model for sex offender treatment which has emerged out of a collaboration between federal and provincial justice agencies and a day hospital based in a rural mental health center. A preliminary group process evaluation is also included.

Drawing a Connection from Victim to Victimizer

1. The biological basis of the altered alarm/dissociative process during and after sexual trauma impedes the development of information processing essential for discerning intention, personal responsibility, sense of control over events, and trust in others. 2. Once this imbalance occurs, the child is restricted in developing cognitive schema to deal with interpersonal intimacy. This in turn results in secondary patterns of aggressiveness or avoidance. 3. The implication of this biological understanding of trauma and information processing for treatment underscores the necessity of reducing arousal, thus lessening the dissociative process. Drawings of the criminal act and the victim experience elicit cues connecting the two events, facilitating an increase in personal control over repeated aggressive acts.

Media distortion of the public's perception of recidivism and psychiatric rehabilitation

OBJECTIVE

The public's perception about the success or failure of psychiatric rehabilitation is frequently dependent upon information received through the news media. The primary objective of this report is to present an example of how the news media can distort public perceptions of treatment outcome.

METHOD

Verbatim quotations were presented from a television news series that alleged criminal recidivism by nine patients purportedly treated for various paraphilias at a large, community-based sexual disorders clinic. Brief case vignettes about each of the nine were then reviewed. This allowed for comparisons between what the media had alleged and what had actually occurred.

RESULTS

Two of the nine cases were relatively minor instances of recidivism involving no genital contact, although the media presentation had either failed to report this or had suggested otherwise. A third case of alleged recidivism involved a patient who was evaluated but never actually treated by the clinic in the community. A fourth patient had refused recommended clinic treatment upon prison release, and a fifth patient had been discharged from treatment at the clinic because of noncompliance years before recidivating. Other cases presented contained additional misleading information. None of the nine cases was reported by the media in the context of a balanced approach that included treatment successes. Clinic staff were constrained from responding publicly to correct certain misinformation because of patient-psychiatrist privilege.

CONCLUSIONS

Inaccurate media presentations about psychiatric rehabilitation that ignore treatment successes and focus only on alleged failures do a disservice to patients, mental health workers, and society at large.

Parental identification of rapists and pedophiles

It is well documented that sex offenders experience a higher incidence of sexual abuse and are more likely to have been reared in dysfunctional families than are individuals in most comparison groups. It is unclear, however, whether growing up in an abusive or dysfunctional family affects the extent to which the potential sex offender would subsequently identify with his parents. Sixteen rapists, 18 pedophiles, 9 general offenders, and 11 college students completed the Parental Identification Scale to assess their parental identification. It was predicted that the rapists and pedophiles would identify less with their parents than would college students or general offenders. Analysis indicated a strong and significant correlation between group membership and parental identification. Rapists and pedophiles identified less with their mothers and fathers than did members of corresponding control groups.

Perceptions of submissiveness: implications for victimization

Some researchers have suggested that a precondition of affective submissiveness may increase the likelihood of female victimization in sexual assault, whereas others have suggested that criminal offenders use perceptions of vulnerability when selecting a victim. In this study, based on American college students, men (decoders) rated videotaped women (encoders) dominant versus submissive using a semantic differential instrument. Cue evaluators analyzed the body language and appearance of the videotaped women using a Likert instrument. The results suggest that (a) men form differentiated perceptions of dominant versus submissive women, (b) such perceptions substantially rely on nonverbal cues, (c) dominant and submissive women display visually different behaviors and appearances, and (d) men tend to select submissive females for exploitation.

The attribution of blame and type of crime committed: transcultural validation

This study examines the relationship between type of offence and the attributions offenders make about their criminal act. The subjects were 98 Icelandic criminals who had completed the Gudjónsson Blame Attribution Inventory. Significant differences in attribution were found between offender groups. Sex offenders and those who had committed acts of interpersonal violence reported most guilt about their offence and they attributed cause for their offence more to mental factors (eg, loss of self-control) than other types of offender. Violent offenders had the highest external attribution and sex offenders the lowest. The findings with regard to the three attributions are remarkably similar to those found previously for British offenders.

Dangerous mistakes

The shortening of the periods of detention for treatment, deterrence or retribution have made a live issue of whether (or when) it is justifiable to detain violent and sexual offenders solely for the protection of others. Anti-protectionist arguments have made 'dangerousness' a dirty word, but are based either on actuarial statistics of doubtful relevance or on confused moral reasoning. A typology of 'dangerousness' is tentatively offered, and the impossibility of adequately supervising some dangerous offenders in the community is emphasised. That said, offenders detained solely for the sake of others are entitled to more than merely 'humane containment'.

Sexual recidivism among child molesters released from a maximum security psychiatric institution

The recidivism of 136 extrafamilial child molesters who had received phallometric assessment in a maximum security psychiatric institution from 1972 to 1983 was determined over an average 6.3-year follow-up. Fifty had participated in behavioral treatment to alter inappropriate sexual age preferences. Thirty-one percent of the subjects were convicted of a new sex offense, 43% committed a violent or sexual offense, and 58% were arrested for some offense or returned to the institution. Subjects convicted of a new sex offense had previously committed more sex offenses, had been admitted to correctional institutions more frequently, were more likely to have been diagnosed as personality disordered, were more likely to have never married, and had shown more inappropriate sexual preferences in initial phallometric assessment than those who had not. Behavioral treatment did not affect recidivism.

A practitioner's notes on treating sexual deviance

Considerable controversy exists regarding the treatment of sexual offenders. Often incarceration masks the environmental stimuli, resulting in not only early release but a false clinical prognosis for success. The paper looks at treatment strategies applicable to both the diagnostic and treatment components of sexual deviance. Specifically, what factors contribute to the symptoms associated with intense sexual urges and are there any viable treatment programs which carry over into the home world environment?

[Anti-androgen treatment in a retrospective evaluation of 19 sex offenders]

Of 54 sexual delinquents treated with Cyproteron, 19 were followed up 2-16 years later. Though treatment was initiated under pressure of detention, the subsequent sexual and social development and the opinions of the patients on treatment were surprisingly favorable.

Patterns of sexual arousal and history in a "normal" sample of young men

Sexual histories and arousal patterns of 60 college men were sampled in a rural area to better evaluate the role of sexual arousal in males typically used as nonoffender controls in sex research. Nearly two-thirds of the sample (65%) had engaged in some form of sexual misconduct in the past, ranging from sexual contacts with children and coercive sex with women to voyeurism and frottage. Even more subjects expressed a desire for such activities. Previous experience with frottage, obscene phone calls, and pedophilic contacts was associated with higher subjective arousal to depictions of these activities. Previous experience with coercive sex or voyeurism did not appear to be associated with greater arousal to these activities. There was considerable variability in the arousability of subjects to the variety of deviant stimuli presented, thus blurring the distinction between pathological and normal arousal patterns. These results suggest that young men are easily aroused sexually by a variety of stimuli, and seek out a variety of sexual experiences, some of which are punishable by law.

Regional differences in sodomy laws

As of 1989, 24 states prohibited either heterosexual or homosexual sodomy. This raises for study the following question: in what ways do states with sodomy laws differ from states without sodomy laws. It was hypothesized that states with sodomy laws are more punitive (as measured by the rate of adults under correctional supervision and the number of restricted civil rights for a felony conviction), rural, and southern. Although the first two hypotheses were rejected, states with sodomy laws scored significantly higher than states without such laws on Gastil's Index of Southerness. Sodomy laws may be more commonly found in the South given regional differences in social values about sex, morality, and family life.

The incidence of depressive symptomatology in juvenile sex offenders with a history of abuse

Depressive symptomatology was assessed in a sample of 246 male juvenile sex offenders using the Beck Depression Inventory. Of these participants, the racial composition was black = 147, Hispanic = 62, Caucasian = 34. Three adolescents elected not to identify their racial origin. Subjects were divided according to their self-reports of having been sexually or physically abused. The mean Beck score across all subjects was 14.3, a value markedly higher than published norms and indicative of mild depression. Forty-two percent of subjects attained scores indicative of appreciable depressive symptomatology. A history of sexual or physical abuse was significantly related to high Beck scores; abused subjects had a mean Beck score of 16.4, as contrasted to 12.3 for nonabused subjects (Wilcoxon test: z = 2.82; p less than .005). This relationship was apparent across all racial groups. While Hispanic subjects tended to have higher Beck scores and Caucasians lower scores, racial differences were not statistically significant. Results indicate that juveniles who have committed sexual crimes, particularly those with a history of abuse, should be evaluated for depression.

Male adolescent sexual offenders: exhibitionism and obscene phone calls

Clinical assessment of 19 male adolescent sexual offenders who had committed exhibitionism or telephone scatologia showed that the majority were maladjusted, had committed numerous sexual offenses and came from multi-problem families. Several of them appeared to be sexually deviant, although they did not meet DSM-III-R criteria for a diagnosis of paraphilia. Anti-social traits, sexual deviance in the family, homosexual conflicts, repressed sexuality and sexual deviance were considered to be contributory factors.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

King's theory of goal attainment applied in group therapy for inpatient juvenile sexual offenders, maximum security state offenders, and community parolees, using visual aids

Group psychotherapy has been considered the treatment of choice by many therapists working with offenders within the criminal justice system. However, there has been little written by nurses regarding this special population. This article's purpose is to illustrate how King's theory of goal attainment may be used in conducting group psychotherapy with offender populations. The application of King's model is demonstrated in three milieus: an inpatient setting for juvenile sexual offenders, a state maximum security prison, and a halfway house for offenders involved in a work-release program. The methodology and use of visual aids in actualizing King's theory of mutual goal setting and goal attainment are discussed.

Psychopathology and denial in alleged sex offenders

To investigate whether patients accused of having committed acts of sex offense manifest symptoms of psychopathology and whether they minimize or deny such symptoms during clinical evaluations, we administered the MMPI to 53 alleged sex offenders. We compared patients along two dimensions: a) whether they admitted or denied deviant sexual behavior, and b) whether they faced legal charges for sex offenses. Results indicated the following: a) Patients who denied deviant sexual behavior were significantly more likely to minimize psychopathology than were those who admitted to deviant sexual behavior (p less than .05). b) Patients facing no active legal charges showed significantly more psychopathology than did those facing legal charges (p less than .05). c) The most frequent forms of psychopathology shown by these patients were antisocial attitudes, depression, somatization, and cognitive disorganization. These findings suggest that many alleged sex offenders may experience, and deny, severe psychopathology in addition to their sexual disorders. Clinicians should be alert to subtle signs of psychopathology when evaluating alleged sex offenders who deny deviant sexual behavior, because these patients may be especially likely to minimize symptoms.

Sexual harassment of nursing students

This article reports the findings of 21 subjects, a subset of 277 subjects, who experienced some form of sexual harassment while enrolled in a nursing program. The physical and emotional effects of the experience on academic performance and subsequent relationships are described. Support systems used by students at the time of the experience are identified. Only a small number of subjects reported the experience to persons in academic authority. These subjects also reported that no legal or academic sanctions were imposed on the faculty members.

A female sex offender with multiple paraphilias: a psychologic, physiologic (laboratory sexual arousal) and endocrine case study

A 20 year old female pedophile exhibiting multiple paraphilias and who had been both a victim of incest and an active participant, undertook extensive clinical, psychometric, endocrine and laboratory sexual arousal studies. Her psychiatric, psychometric and physiologic arousal profiles showed similarities to those of a sizable proportion of male child molesters, especially incestors. It is suggested that laboratory arousal tests (using the vaginal photoplethysmograph) may have a role in the assessment of some female sex offenders.

Sexual assault and psychiatric disorders among a community sample of women

The authors examined the relationships between sexual assault and psychiatric disorders in a sample of 1,157 women 18-64 years old in the North Carolina site of the NIMH Epidemiologic Catchment Area Program. The results suggest that sexual assault is a risk factor for a number of psychiatric disorders. In addition, several characteristics of the assault among sexual assault victims were significantly related to one or more psychiatric disorders. However, there was no clear pattern relating characteristics of the assault to the risk of specific psychiatric disorders.