Sexual Addiction in Incarcerated Sexual Offenders

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.

Should problematic sexual behavior be viewed under the scope of addiction? A systematic review based on DSM-5 substance use disorder criteria

Despite similarities between compulsive sexual disorder and substance use disorder, the issue whether problematic sexual behavior should be viewed within an addiction framework continues to be a subject of debate with no consensus regarding its conceptualization and diagnosis criteria. Examining the presence of addiction criteria among clinical and no clinical samples in the existing literature could permit to ascertain clinical validity of sex addiction diagnosis and support its overlapping feature with other addictive disorders. The aim of this systematic review was to examine this issue by assessing DSM-5 criteria of substance use disorder among individuals engaged in problematic sexual activity. Methods: Using PRISMA criteria, three databases were comprehensively searched up to April 2022, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined problematic sexual behavior within the framework of DSM-5 addiction criteria. Results: Twenty articles matched the selection criteria and were included in this review. DSM-5 criteria of addictive disorders were found to be highly prevalent among problematic sex users, particularly craving, loss of control over sex use, and negative consequences related to sexual behavior. Exposition to sexual cues was also shown to trigger craving, with an association to problematic use and symptom severity. Conclusions: More studies should been done to assess homogeneously according to the DSM-5 criteria the addiction-like features of problematic sexual behaviors in clinical and no-clinical populations. Furthermore, this work argues for the need of further research to examine the extent to which anti-craving interventions could be effective in improving clinical outcomes.

Youth sexual offending in Hong Kong: examining the role of self-control, risky sexual behaviors, and paraphilic interests

Introduction

Little is known about the nature and prevalence of sexual offending among youth in Hong Kong.

Methods

Testing self-control theory and sexual health risk factors (i.e., risky sexual behaviors [general and two subtypes] and paraphilic interests [general and 14 subtypes]), the prevalence of self-reported sexual offending behaviors (i.e., threat of sexual assault, penetrative sexual assault, and nonpenetrative sexual offense) was examined in a community-based sample of 863 young people (aged 17 to 20) in Hong Kong.

Results

In this study, men reported significantly higher levels of threat of sexual assault and of general and 12 subtypes of paraphilic interests than women; and women reported a significantly higher level of a specific paraphilic interest subtype (i.e., transvestic fetishism) than men. Logistic regressions found that, in general, a low level of self-control and high levels of risky sexual behaviors and paraphilic interests were important factors in the participants' likelihood of issuing threats of sexual assault and engaging in penetrative and nonpenetrative sexual assault.

Discussion

Important practical implications for reducing the tendency of young people to engage in sexual offending behavior can be derived from this study.

Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study

The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (r_{general sexual responsiveness}=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.

Risky Sexual Behavior, Paraphilic Interest, and Sexual Offending: The Study of a Community Sample of Young Adults in Hong Kong

Limited information is available on the prevalence and nature of sexual offending in Hong Kong. This cross-sectional study seeks to explore the role of risky sexual behavior (RSB) and paraphilic interests in self-reported sexual offending behavior (i.e., nonpenetrative-only, penetrative-only, and nonpenetrative-plus-penetrative sexual assault) in a community sample of young adults in Hong Kong. Using a large sample (N = 1885) of university students, the lifetime prevalence of self-reported sexual offending was 18% (n = 342; 23% males (n = 166), 15% females (n = 176)). Based on the study subsample of 342 participants who self-reported sexual offending (aged 18-35), the findings indicated that males reported significantly higher levels of general, penetrative-only, nonpenetrative-plus-penetrative sexual assault; and paraphilic interest in voyeurism, frotteurism, biastophilia, scatophilia, and hebephilia than females; while females reported a significantly higher level of transvestic fetishism than males. No significant difference was found in RSB between males and females. Logistic regressions found that the participants who possessed a higher level of RSB, particularly penetrative behaviors, and paraphilic interest in voyeurism and zoophilia were less likely to engage in a nonpenetrative-only sexual offense. Conversely, the participants who possessed higher levels of RSB, especially penetrative behaviors, and paraphilic interest in exhibitionism and zoophilia, were more likely to engage in nonpenetrative-plus-penetrative sexual assault. The implications for practice in areas such as public education and offender rehabilitation are discussed.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

OBJECTIVES

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD.

METHODS

An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD.

CONCLUSIONS

An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

Orgasm Frequency (Total Sexual Outlet) in a National American Sample

There has been renewed interest in the conceptualization and diagnosis of conditions marked by excessive sexuality. Researchers and clinicians have often utilized orgasm frequency (e.g., total sexual outlet) as an indicator of hypersexuality. Indeed, some have proposed seven or more (7+) orgasms by any means in a typical week as indicating hypersexuality. Most studies utilizing this criterion, however, have examined clinical or judicial samples of men, as opposed to general population samples. The purpose of the current study was to provide representative population data of total sexual outlet (TSO) for people varying in age, relationship status, and sex, while also examining the impact of the phrasing of the questions (i.e., time frame). A total of 1029 participants were recruited online via a Qualtrics panel, consisting of 442 males and 587 females, from diverse regions across the USA. Results indicated that between 10.3 and 16.7% of the sample met the 7+  criterion for hypersexuality, with considerable variation by age, relationship status, sex, and less variation by wording of the question. Results are discussed in terms of the applicability of the 7+ cut-off for identifying elevated TSO. Results from this survey could be useful to researchers and clinicians looking for comparison data for their research and clinical assessment results.

Effective psychological treatment of adult male sexual offenders

This paper describes psychological approaches to the treatment of sexual offenders. The empirically generated principles of effective treatment are outlined followed by the identification of the evidence-based issues that need to be addressed. The established important role of the therapists’ behaviors during treatment is then described along with the effectiveness of recruitment strategies and of tactics aimed at ensuring all entrants complete the program. Meta-analytic reports describing treatment efficacy are considered followed by an outline of the appraisal of the effectiveness of two large scale independent treatment programs. Finally, a brief description of a cost-benefit report indicates that when treatment of sexual offenders effectively reduces re-offense rates, it also saves a considerable amount of taxpayers’ money.

Screening Positive for Military Sexual Harassment or Assault Is Associated With Higher Compulsive Sexual Behavior in Men Military Service Members/Veterans

INTRODUCTION

Compulsive sexual behavior (CSB) is understudied in military service members/veterans despite elevated risk for psychological disorders that are associated with CSB, including posttraumatic stress disorder (PTSD), depression, and alcohol misuse. Civilian research shows that sexual trauma is associated with higher CSB. Among military service members/veterans, sexual trauma that occurred before military service is identified as a risk factor for CSB, but the impact of screening positive for sexual trauma that occurred during military service (military sexual harassment[MSH]/military sexual assault[MSA]) on CSB is unknown. Moreover, screening positive for MSH/A confers a higher risk for distress relative to sexual trauma that occurred before or after military service, suggesting that MSH/A may be a robust predictor of CSB. The current study examined whether screening positive for MSH/A was associated with higher CSB after accounting for mental health and demographic characteristics. The current study specifically focused on men service members/veterans given that men show higher engagement and distress associated with CSB relative to women.

MATERIALS AND METHOD

Male service member/veterans (n = 508) completed self-report measures of CSB, MSH/A, PTSD and depression severity, hazardous drinking, and age. CSB was regressed on MSH/A, PTSD and depression severity, hazardous drinking, and age to determine if MSH/A was uniquely associated with CSB after accounting for other risk factors.

RESULTS

A total of 9.25% to 12.01% of the sample reported scores suggestive of high levels of CSB. The regression of CSB on MSH/A screen status, PTSD, depression, alcohol use, and age explained 22.3% of the variance. Screening positive for MSH/A, higher PTSD symptoms, and higher depression symptoms were associated with higher CSB, but age or alcohol use were not.

CONCLUSION

Screening positive for MSH/A appears to be a unique risk factor for higher CSB above and beyond the effects of depression and PTSD. Since screening for CSB is not part of routine mental health care, clinicians may consider a positive screen for MSH/A as a possible indicator that CSB may be of clinical concern. Previous research on MSH/A and individual and sexual health outcomes suggest that distinguishing between MSH/A severities (harassment only vs. assault) is critical as the most dysfunction is observed with sexual trauma that involves assault. Owing to low endorsement of MSA, this study did not examine differences between MSA and MSH. Future research in this area would be strengthened by exploring MSH/A severities as a correlate of CSB.

Child Sexual Abuse and Compulsive Sexual Behavior: A Systematic Literature Review

PURPOSE OF REVIEW

Information on potential risk factors and clinical correlates of compulsive sexual behavior (CSB) may help inform more effective prevention and treatment measures. Sexual victimization, specifically, child sexual abuse (CSA), has been associated with CSB.

RECENT FINDINGS

This systematic review describes 21 studies on the relationship between CSA and CSB. Most studies identified a significant association between CSA and CSB. However, variability in measurements, potential differences in links among community versus clinical samples, relevance of research among college samples, lack of support for gender-related differences, and the need for more longitudinal designs were identified.

SUMMARY

Research would benefit from more formalized assessments of CSB across different populations. Prevention efforts should be aimed toward individuals who experienced CSA and/or other abuse, particularly if they report engaging in risky sexual behavior. Individuals with CSB who have experienced sexual abuse may benefit from trauma-focused treatment.

History of Childhood Abuse in Populations Incarcerated in Canada: A Systematic Review and Meta-Analysis

BACKGROUND

A history of childhood abuse may affect people's health and criminal justice system involvement. Understanding the prevalence of childhood abuse among individuals in prison is important to inform effective and appropriate correctional services.

OBJECTIVES

To review and summarize data on the prevalence of childhood abuse among people experiencing imprisonment in Canada.

SEARCH METHODS

We searched for studies in bibliographic indexes, reference lists, and gray literature, and we consulted experts.

SELECTION CRITERIA

We included studies published since 1987 that reported data on prevalence of a history of abuse before the age of 18 years among people in Canadian prisons, including any abuse, physical abuse, sexual abuse, emotional abuse, and neglect.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed titles and abstracts for eligibility and reviewed full texts for eligibility. Analyses included summary estimates and meta-regression with random effects.

MAIN RESULTS

The search identified 1429 records. We included 34 unique studies in our review and 29 nonoverlapping studies in our meta-analysis. The summary prevalence for any type of childhood abuse was 65.7% (95% confidence interval [CI] = 52.6, 77.7; range = 56.2% to 75.0%) among women; only one study reported the prevalence among men (35.5%). The summary prevalence of sexual abuse was 50.4% (95% CI = 33.5, 67.2; range = 9.9% to 77.3%) among women and 21.9% (95% CI = 15.7, 28.8; range = 8.3% to 55.6%) among men. The prevalence of neglect was 51.5% (95% CI = 43.1, 59.7; range = 45.5% to 65.1%) among women and 42.0% (95% CI = 12.7, 74.6; range = 6.8% to 99.0%) among men. The prevalence of physical abuse was 47.7% (95% CI = 41.3, 54.0; range = 16.3% to 83.0%), and the prevalence of emotional abuse was 51.5% (95% CI = 34.8, 67.9; range = 8.7% to 96.0%); we did not find differences according to gender. Prevalence estimates for all types of abuse showed high and unexplained variability across studies.

CONCLUSIONS

Half of people in prisons in Canada experienced abuse in childhood. Public Health Implications. Prisons should incorporate trauma-informed approaches. Research is required to understand the association between a history of childhood abuse and criminal justice system involvement and to prevent childhood abuse and mitigate its adverse effects. Systematic Review Registration. PROSPERO CRD42017056192.

Spanish validation of the Sexual Addiction Screening Test

BACKGROUND AND AIMS

Sexual addiction is a pathological behavior characterized by a combination of excessive sexual desire and impaired ability to control it. Its incidence ranges between 1.2% and 32.2%, although this number may vary depending on the screening tool used. This wide variability is largely due to the use of non-validated instruments (e.g., structural validity relying on exploratory analyses, instruments translated without an additional validation process, or instruments validated in another format). To deal with these limitations, this study tested the psychometric properties of the Spanish paper-and-pencil and online versions of the Sexual Addiction Screening Test (SAST).

METHODS

A total of 2,528 participants (1,163 males) completed the Spanish version of the SAST, along with other instruments assessing sexual compulsivity (1,585 = paper-and-pencil, 943 = online).

RESULTS

The exploratory factor analysis yielded a four-factor structure explaining 57.39% of the variance for the SAST paper-and-pencil version. This factor structure was then verified for the online version through the use of confirmatory factor analysis [χ2(264) = 441.59; χ2/df = 1.66; RMSEA = 0.02; CFI = 0.94; IFI = 0.94]. This methodology was also used to support measurement invariance (configural, metric, and scalar invariance) according to gender. The reliability of the total score ranged from .82 to .85. Similarly, correlations with related scales were positive and significant (r between .22 and .71). Temporal stability 1 year after the first application was 0.65 (paper-and-pencil format) and 0.60 (online version).

CONCLUSION

These results, together with the absence of questionnaires translated into Spanish to assess this construct, justify the use of the SAST in the evaluation of sexual addiction in Spanish-speaking countries.

Sex Offender Risk Assessment and Management

Sexual violence is common and can have profound effects on victims compared with other forms of violence. This violence includes unwelcome and forced sexual contact on adults or children. Assessment of individuals who perpetrate sexual violence starts with a comprehensive biopsychosocial evaluation after a finding of guilt. Clinicians should then evaluate risk. Based on this assessment, a risk management plan should be developed, directed at the specific risk of the offender. Management options include external control (eg, incarceration, probation), psychotherapeutic interventions, pharmacologic interventions, and treatment of comorbidity. This organized approach aids in reducing the risk of future sexual violence.

The Relation Between Compulsive Sexual Behaviors and Aggression in a Substance-Dependent Population

Research supports a high comorbidity between compulsive sexual behaviors (CSBs) and SUDs, which are both classified by increased impulsivity. Literature has also indicated that increased impulsivity and substance use are associated with aggression. However, no known research has examined the relationship between CSBs and aggression among a substance dependent population. The purpose of the current study was to examine this relationship. Participants included 349 male patients in treatment for SUDs. Results indicated that after controlling for alcohol and drug use and problems and age, CSBs were significantly associated with total aggression, aggressive attitudes, physical aggression, and verbal aggression. This is the first known study to examine this relationship, thus continued research is needed to extend and replicate these findings.

Are Sex Drive and Hypersexuality Associated with Pedophilic Interest and Child Sexual Abuse in a Male Community Sample?

Although much is currently known about hypersexuality (in the form of excessive sexual behavior) among sexual offenders, the degree to which hypersexual behavior is linked to paraphilic and especially pedophilic interests in non-forensic populations has not been established.The purpose of the present study was to elucidate the associations between total sexual outlets(TSO) and other sex drive indicators, antisocial behavior, pedophilic interests, and sexual offending behavior in a large population-based community sample of males. The sample included 8,718 German men who participated in an online study. Hypersexual behavior as measured by self-reported TSO, self-reported sex drive, criminal history, and pedophilic interests were assessed. In moderated hierarchical logistic regression analyses self-reported contact sexual offending against children was linked to sexual fantasizing about children and anti sociality.There was no association between aggregated sex drive, and sexual abusive behaviour in the multivariate analyses. In contrast, self-reported child pornography consumption was associated with sex drive, sexual fantasies involving children, and anti sociality. Nevertheless, in convicted sexual offenders anti sociality, sexual preoccupation (like hypersexuality), and pedophilic interest are important predictors of sexual reoffending against prepubescent children.Therefore, in clinical practice an assessment of criminal history and pedophilic interests in hypersexual individuals and vice versa hypersexuality in antisocial or pedophilic men should be considered [corrected].

Treatment of sexually compulsive adolescents

We clarified the nature of sexual compulsivity in adolescence, addressed who is labeled as "sexually compulsive youth," conceptualized the underlying factors of sexual compulsivity, and outlined a treatment format. We focused on trauma, dissociation, attachment, and self-concept. We questioned the conventional perceptions of who is included in this group. We reiterated that the belief that sexually compulsive adolescents are abusive males is no longer considered accurate. The evolution and accessibility of the Internet only raises greater concerns about compulsive sexual behavior, as more adolescents are brought into therapy because of Internet use to seek sexual interaction or stimulation. The sexually compulsive youth is as likely to be the clean-cut, high-achieving, intelligent student as is the economically deprived, juvenile delinquent on the street. This article began with the observation that adolescents rarely receive any direct, accurate information about sexuality and intimacy. The messages taken in through music, television, movies, politicians, popular press, clergy, and school are polarizing and contradictory. Beyond this are the implications as to how we, as a society, treat the youths that do present with sexual behavior problems. We have tended to treat these youth (as well as adults) with disdain and to designate sexually abusive youth the same as adult offenders with harsher, more punitive treatment interventions. Research and clinical experience now strongly question this type of response. This article is consistent with this leaning. Early psychological injury, from sexual abuse, physical abuse, exposure to violence, attachment trauma, or early sexualization, is at the root of sexually compulsive behavior. While it is necessary to reign in out-of-control and destructive behaviors, if we acknowledge that the source of the behavior is psychological injury, then it is cruel and inconsistent to treat the individual with disdain or as a pariah. The same dilemma is present with adult sexual addicts and offenders. Our society must develop a response to sexually compulsive or offensive behavior that can protect those who need protection, while implementing a rational legal response and providing treatment options for the underlying injury. Perhaps even more importantly, our society must learn how to educate adolescents about sexuality with clear, accurate information that includes not only reproduction but sexual response and intimacy as well.