A Test of Three Different Explanations for Low Stimulus Response Discrimination in Phallometric Testing

Phallometric assessment is used to assess men's sexual interest in children and to assist in risk assessment and treatment planning. A common response pattern, especially when the assessment is conducted in a forensic context, is an indiscriminate pattern of penile responses: No sexual stimulus seems to produce a substantially higher response than another. This indiscriminate response profile could be the result of (1) faking good (in particular, reducing the responses to child stimuli); (2) floor or ceiling effects caused by low or high arousability, or (3) non-exclusivity (the individual is similarly sexually interested in both children and adults). In this study of 2,858 adult male patients who underwent volumetric phallometric assessment for sexual interest in children between 1995 and 2011, we tested these three possible explanations. Results showed support for each of the explanations, but the variance accounted for in response discrimination was quite small when considering each explanation (separately or when considered together). We discuss avenues for future research to better discern the causes of indiscriminate responding in phallometric assessment.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

Use of penile plethysmography in the court: A review of practices in Canada, the United Kingdom and the United States

Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribution to the assessment and treatment of adult men with paraphilic interests and men who have committed sex crimes. PPG contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. There is strong support for the utility of PPG within clinical and legal contexts. This article addresses ways in which PPG has been utilized in the courts as part of expert clinical opinion. History of its use, details regarding admissibility in court, and case law are explored within the legal systems of Canada, the UK and the USA. Support for the inclusion of PPG as expert evidence is provided and judicial misunderstandings on the rationale for PPG use and its clinical utility in forensic assessments are discussed.

Stimuli used in the measurement of problematic sexual interests

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.

Sexual Interests of Child Sexual Exploitation Material (CSEM) Consumers: Four Patterns of Severity Over Time

This study analyzed the evolution over time of the activity of consumers of child sexual exploitation material (CSEM). To this end, images and metadata were extracted from the hard drives of 40 individuals convicted of possession of child pornography and analyzed. A sample of these images ( N = 61,244) was categorized by the age of the subjects depicted and-using the Combating Paedophile Information Networks in Europe (COPINE) scale-by severity of the acts depicted. Collecting activity was observed to follow four patterns. The most prevalent pattern was a progressive decrease in the age of the person depicted and a progressive increase in the severity of the sexual acts. In light of the results, we propose four explanations of the nature of, and variations in, child-pornography collections.

Age Diversity Among Victims of Hebephilic Sexual Offenders

Hebephilia refers to sexual interest in pubescent children who are beginning to show early signs of sexual development but are sexually immature. The present study examined the relationship between hebephilia and victim age choice in a sample of 2,238 adult male sexual offenders. On average, offenders were 39 years old at the time of their assessments, and approximately half (48%) were referred by probation or parole offices. Assessment data included self-report, sexual arousal measured by volumetric phallometry, and victims' ages. Results suggested that, similar to pedophilia, hebephilia had a medium sized association with a greater number of victims under age 11 and a small sized association with a greater number of victims ages 11 to 14. Unlike pedophilia, a small positive association was consistently found between hebephilia and a greater number of victims ages 15 or 16. Furthermore, a small positive association was observed between victim age polymorphism and hebephilia and pedophilia. The present results suggested that hebephilia was associated with a greater number of victims age 14 or younger and had similar victim age correlates to pedophiles.

Validity in Phallometric Testing for Sexual Interests in Children: A Meta-Analytic Review

Valid assessment of pedohebephilic interests (i.e., sexual interest in children) is fundamental to forensic clinical practice. Phallometric testing-which measures changes in penile circumference or volume, while stimuli depicting different ages and sexual activities are presented-is widely used in clinical and research settings to detect such interests. This meta-analysis summarizes studies comparing sexual offenders against children and various types of controls on phallometric tests for pedohebephilic interests (37 samples; N = 6,785) and studies examining the relationship between phallometric test scores and sexual reoffending (16 samples; N = 2,709). The findings suggest that several phallometric testing procedures are valid indicators of pedohebephilic interest. Certain methodological features of phallometric tests were associated with greater validity, such as, slide or audio-plus-slide stimuli and z-score-based indices. In addition, phallometric tests for pedohebephilic, pedophilic, and hebephilic interests predicted sexual reoffending which provides further evidence that phallometric test scores are valid indicators of sexual interest in children. In general, the interpretation of phallometric test scores as indicators of pedohebephilic interests is supported.

Discriminating Coercive from Sadomasochistic Sexuality

Sadomasochistic (SM) sexual interest is reported by a wide range of individuals. Within the sex offender literature, the presence of SM interest is often viewed as a herald of criminal sexual behavior; however, research indicates that SM interests are not predictive of coercive sexual behavior. In the current study, we measured a range of sexual fantasies and behaviors, and then applied cluster analyses to determine (1) if individuals endorsed elevated SM interests also endorsed coercive fantasies and, (2) to explore cluster membership correlates using measures of sensation seeking, externalizing and antisocial behaviors, attitudes toward rape, and empathic capacity. A total of 550 participants were recruited through a variety of on-line discussion areas. A four cluster solution best fit the data with distinct clusters observed for those endorsing SM behaviors and those reporting coercive sexual behavior. Additional analyses revealed greater endorsement of victim blaming attitudes and lower empathic concern among members of the coercive sexual behavior cluster. Elevated sensation seeking and externalizing behaviors were reported by members of clusters marked by SM and coercive sexual behavior. Results provide further support for the differentiation between SM and coercive sexual behaviors as representative of individuals with divergent attitudes, traits, and behaviors.

Future Directions in the Assessment and Treatment of Sexual Offenders

Sexual offences against women and children constitute a serious and distressingly prevalent social problem. The psychological and emotional costs to victims and their families, the high reoffending rates of some types of offenders, and the financial costs of incarceration all highlight the urgent need for effective research and treatment of this problem behaviour. In the past two decades, a number of innovations have led to improved treatment of these difficult men. In addition, theories and models have been developed with the aim of furthering our understanding of sex offenders. In this paper we identify a number of issues within the broad areas of assessment and treatment that we believe to be problematic, and make some suggestions about ways of resolving these problems in the future.

Child sexual abuse in the context of the Roman Catholic Church: a review of literature from 1981-2013

Child sexual abuse in the Catholic Church has been increasingly recognized as a problem not limited to individual institutions. Recent inquiry commission reports provide substantial information on offense dynamics, but their conclusions have not been synthesized with empirical research to date. The aim of this systematic literature review was to bring together key findings and identify gaps in the evidence base. The three main focus points were (a) types of publications and methodology used, (b) frequency information on child sexual abuse in the Catholic Church, (c) individual factors in offending, and (d) institutional factors in offending. It was found that reports, legal assessments, and research on child sexual abuse within the Catholic Church provide extensive descriptive and qualitative information for five different countries. This includes individual psychological factors (static risk predictors, multiple trajectories) and institutional factors (opportunity, social dynamics) as well as prevalence rates illustrating a high "dark figure" of child sexual abuse.

Phallometric assessments of sexual interests: an update

This paper reviews recent evidence on the value of phallometric (i.e., erectile) measures of sex offenders plus earlier crucial papers. Distinctions are made between types of measuring devices with the volumetric instrument appearing to be the most sensitive. Considering the meaning of responses it is concluded that arousal below 10 % of full erection is not reliably interpretable and that only deviant profiles (those displaying equal or greater arousal to deviant sex) can be confidently interpreted. The specificity and sensitivity of phallometry is satisfactory with child molesters but not with other types of sex offenders, although there remains a need to satisfactorily distinguish among subtypes of child molesters. There are enduring disagreements concerning the meaning of rapists' responses and no test has yet reliably identified deviance among exhibitionists. It is concluded that despite its long history, problems remain with phallometric assessments and clinicians should be cautious in interpreting the meaning of these responses.

Intra- and extra-familial child molestation as pathways building on parental and relational deficits and personality disorders

This article addresses the intra- and extra-familial pathways of child molestation. The data presented show preliminary evidence that the difference between the intra- and extra-familial routes can be explained by schizoid and avoidant (intra-familial) and antisocial and passive-aggressive (extra-familial) personality structures. This study also reveals that the amount of warmth and autonomy received during childhood is associated with both intra- and extra-familial child-molesting behaviour. These findings contribute to a further explanation of this deviant sexual conduct and to the development and differentiation of the treatment of child molesters.

Penile-response profiles of sexual aggressors during phallometric testing

This study analyzes sexual-preference profiles in a sample of 420 sexual aggressors who exhibited a valid profile during their initial phallometric assessment. The sexual stimuli used in the process were audiotapes describing sexual-offending scenarios. Two types of sexual stimuli sets were used: one developed for sexual aggressors against women and a second developed for sexual aggressors against children. Penile responses were recorded during stimulus presentation using a mercury-in-rubber strain gauge. Classification analyses (hierarchical and K-means clustering combination) were conducted separately for three groups of sexual aggressors: (a) sexual aggressors against children (n = 253), (b) sexual aggressors against women (n = 138), and (c) mixed sexual aggressors (n = 29). The sexual aggressors against children exhibited four penile-response profiles, the sexual aggressors against women two penile-response profiles, and the mixed sexual aggressors only one penile-response profile. In addition, analyses carried out on randomly split subsamples established that the generated profiles for sexual aggressors against children and sexual aggressors against women were stable.

Psychometric assessment of dynamic risk factors for child molesters

To explore the relationship between dynamic risk factors and recidivism in child molesters, we studied a sample of men (N=495) who completed an intensive, prison-based treatment program in New Zealand. During the follow-up period (M=5.8 years), 9.9% were reconvicted for a sexual offense. A self-report psychometric battery was administered at pre-treatment that assessed a range of variables related to sexual attitudes and beliefs, emotional functioning, and interpersonal competency. Factor analysis showed that individual differences in the battery could be described by four dimensions-Social Inadequacy, Sexual Interests, Anger/Hostility, and Pro-Offending Attitudes. Factor scores for each dimension were significantly correlated with sexual recidivism. Logistic regression analyses confirmed that the Sexual Interests and Pro-Offending Attitudes factor scores, as well as an Overall Deviance score which combined the dimensions, provided significant additional validity for predicting recidivism beyond the Static-99 (Hanson and Thornton Law and Human Behavior 24:119-136, 2000). When added to the Static-99, the Overall Deviance score increased the area under the Receiver-Operating Characteristic curve (AUC) from 0.72 to 0.81. These results show that psychometric self-reports can provide valid measures of dynamic risk factors, and that inclusion of such measures can improve risk prediction beyond that achievable by static factors alone.

Developmental factors related to deviant sexual preferences in child molesters

The aim of this study was to investigate the relationship between developmental factors and deviant sexual preferences in child molesters. In total, 146 adult males having committed a sexual offence against a child were included in the study. Three types of factors were investigated: negative experiences during childhood, behavior problems during adolescence, and sexual criminal activity in adulthood. Negative experiences and behavior problems were assessed through a semistructured interview. The sexual criminal activity was determined using police records. Sexual preferences towards children were assessed using phallometric assessment. Hierarchical regression analyses suggested the presence of two developmental pathways. The psychosocial deficits pathway is related to a sexual interest for nonviolent sexual stimuli involving children. The sexualization pathway is associated with a sexual interest for violent sexual stimuli involving children. These two pathways are discussed in light of previous empirical findings related to the development of deviant sexual preferences in child molesters.

Quantitative reanalysis of aggregate data on IQ in sexual offenders

General intelligence has been the most commonly studied neuropsychological characteristic of sexual offenders for over 70 years. Results, however, have been highly inconsistent. To assess whether sexual offenders score lower in IQ than nonsexual offenders and to explore which sexual offense characteristics relate to IQ, the authors reanalyzed all reports providing sufficient information. Data spanned 236 samples, comprising 25,146 sexual offenders and controls. The literature contained sufficient information to permit comparison of adult versus juvenile sexual offenders, offenders targeting children versus adults, offenders targeting their own versus unrelated children, and offenders targeting boys versus girls. Results confirm the association between IQ and sexual offending and suggest that previous discrepancies are attributable to how many pedophilic individuals were in each sample.

Constructing and testing a framework for dynamic risk assessment

This paper describes the construction and testing of a framework for dynamic risk assessment. A review of previous studies identified 4 domains into which dynamic risk factors for sexual offending seem to fall. These were sexual interests, distorted attitudes, socioaffective functioning, and self-management. Psychometric indicators for 3 of the domains were identified, and 2 studies are reported using these indicators to test the framework. Study 1 divided men serving a prison sentence for a sexual offense against a child into 2 groups--those with a previous conviction of this kind (Repeaters) and those for whom this was the only time they had been sentenced for such an offense (Current Only). The Repeaters were found to show more distorted attitudes, worse socioaffective functioning, and poorer self-management than did the Current Only group. Study 2 used a simple algorithm to combine these psychometric indicators into an overall "Deviance" classification. Reconviction data was obtained for offenders classified as high, moderate, or low on Deviance. Sexual reconviction was found to be monotonically associated with the Deviance classification. Logistic regression analysis showed that both static variables (Static-99) and the Deviance classification made independent contributions to prediction. It is suggested that risk assessment procedures should combine these 2 approaches.

Prediction of recidivism in extrafamilial child molesters based on court-related assessments

One hundred ninety-two convicted extrafamilial child molesters were followed for an average of 7.8 years after their conviction. The percentage of men who had committed a sexual, a violent, or any criminal offense by the 12th year was 15.1, 20.3, and 41.6, respectively. The sexual recidivists, compared with the nonrecidivists; demonstrated more problems with alcohol and showed greater sexual arousal to assaultive stimuli involving children than to mutually consenting stimuli with children. The violent recidivists, compared with the nonrecidivists, were more likely to have a history of violence in the families in which they were raised and were rated significantly more psychopathic on the Psychopathy Checklist--Revised (PCL-R). They also showed more sexual arousal to stimuli depicting mutually consenting sexual interactions with children than to adult stimuli. In terms of any criminal recidivism, recidivists were younger, had completed fewer years of school, and were raised in psychologically more harmful family environments compared with nonrecidivists. They also reported that, before 16 years of age, they were more likely to have been physically abused and were more likely to have been removed from their homes compared to those that did not recidivate. In addition, recidivists demonstrated more general hostility on the Buss-Durkee Hostility Inventory and were rated significantly more psychopathic on the PCL-R. The phallometric assessments revealed, that the criminal recidivists, compared to the nonrecidivists, showed more sexual arousal to stimuli depicting coercive sexual activity with children than consenting sexual activities with children. In addition, they showed more sexual arousal to scenes depicting adult rape then adult mutually consenting sex. Finally, the recidivists also had more charges or convictions for violence and any criminal acts. The small number of significant differences between recidivists and nonrecidivists in the sexual and violent categories precluded an attempt to determine which combination of factors meaningfully predicted reoffending. However, for criminal recidivism, a stepwise discriminant function analysis to assess the combination of factors that most successfully distinguished between groups in terms of criminal recidivism was significant, with subjects' age, total number of criminal convictions, and pedophile assault index being retained for optimal prediction. The procedure correctly classified 70.6% of the original group, 82.8% of the nonrecidivists, and 52.6% of the recidivists. PCL-R Total Score alone was equally successful in a similar discriminant function.

A Brunswikian evolutionary-developmental theory of adolescent sex offending

A Brunswikian Evolutionary-Developmental model was developed to relate the sex offending behavior of adolescents to other forms of social deviance, tracing a history of repeated frustration and failure in various competitive sexual strategies and escalation to more extreme means of obtaining sexual gratification. Four hypothetical constructs were proposed as stages in the development of sexual criminality: (1) Psycho-Social Deficiency (PSD); (2) Non-Criminal Sexuality (NCS); (3) Non-Sexual Criminality (NSC); and (4) Sexual Criminality (SC). Significant direct and indirect pathways led from PSD to SC through both NCS and NSC, each time facilitated by an interaction with PSD. Although the causal orders between stages remain equivocal, the current results are consistent with our theory and establish the heuristic value of our theoretical approach, providing empirical support for otherwise counterintuitive predictions. This interpretation also offers hope for focusing preventative intervention at one major root cause of this unfortunate cascade of consequences, Psycho-Social Deficiency.

The relationship between self-esteem and deviant sexual arousal in nonfamilial child molesters

Changes in self-esteem as a result of direct treatment were evaluated in 12 nonfamilial child molesters, and the relationship between these changes and reductions in deviant arousal was assessed. Treatment enhanced self-esteem, and these improvements were significantly correlated with reductions in deviant arousal even though deviant fantasies were not targeted in treatment. Implications of these findings for theoretical analyses of sexual offending and for treatment are discussed.

The effects of the z-score transformation on measures of relative erectile response strength: a re-appraisal

In studies of stimulus control of sexual arousal, some researchers transform raw data to z-scores. Earls, Quinsey and Castonguay [Archives of Sexual Behavior, 16, 493-500 (1987)] have argued that the proportion of variance due to stimulus presentations was greater in z-scores than in the raw data or in a percent score. We present analyses of sexual arousal data that show that z-score transformations may distort the information inherent in the raw data and may increase random error. In addition, we present Monte Carlo analyses indicating that the z-score transformation compromises the estimates of Type I error, and, depending on specific circumstances, sometimes increases and sometimes decreases the power of the statistical test. Transformation of raw data to percent of full erection does not distort the information in the raw data, does not compromise the data analyses and, therefore, is the preferred transformation.

The relationship between phallometrically measured deviant sexual arousal and clinical characteristics in juvenile sexual offenders

The current study examined the relationship between clinical characteristics and a phallometrically derived deviance quotient index in two samples of 44 and 54 juvenile sex offenders. Results support an association between higher measured deviant arousal and having a male victim only, consistent with the literature on adult child molesters. However, results reflected greater fluidity in the offense patterns of the juvenile offenders, and generally less correspondence between measured arousal and offense histories than what has been cited for adults. The authors review whether there is empirical support for a conditioning model of deviant arousal onset in juveniles, and suggest caution in the interpretation of phallometric data with this population.

Expert psychological testimony in cases of alleged child sexual abuse

Concurrent with the rapid rise in allegations of child sexual abuse, psychologists are increasingly assuming the role of experts for the courts. In this position, a new and more controversial role is often assumed by the expert, that of psychological investigator. A review of the common legal contexts for such a role as well as the theoretical and empirical basis for the investigatory role is presented. Ethical issues are also considered. A literature review reveals that many assessment instruments do not meet jurisprudential standards. Suggestions for improving the role of psychological experts in the courtroom include educating the legal audience regarding the limits of psychological testimony, providing standards for qualifications of experts, and emphasizing the data-based probabilistic nature of psychological expert testimony.

Sexual preference assessment of sexual aggressors: predictors of penile response magnitude

A current method used to assess the sexual preference of sexual aggressors is the recording of their penile responses during the presentation of erotic stimuli. This method is ineffective in subjects who do not obtain sufficient penile responses. Whether variables related either to the subjects or their crimes would correlate with the magnitude of penile responses during sexual preference assessment was studied. The penile responses of 92 subjects were recorded. Older and pre-sentencing subjects showed a lower maximum penile response magnitude than younger and sentenced subjects. Results are discussed as they relate to the validity of physiological assessment of sexual preference.

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.

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.