The prevalence of mental disorders in incarcerated contact sexual offenders

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.

Paraphilias, Sociodemographic and Forensic Profiles of Men Convicted of Sexual Offenses in Turkey

This study investigated the psychiatric, paraphilic, and forensic profiles of men who were convicted of sexual offenses. It also examined childhood trauma exposure in the group with potential paraphilia. The study was performed in the closed prison located in the Istanbul Silivri Penal Institutions Campus. The interview data of 100 men convicted of sexual offenses were obtained from the psychiatric interview notes based on the DSM-5 criteria, the results of the 28-item Childhood Trauma Questionnaire administered to the participants with paraphilia, and the forensic profiles from examination files. It was found that 39% of individuals were drug users and 36% were alcohol users. Considering the crime scenes, 42% of men convicted of sexual offenses committed the offense in their own house. Pedophilia was the most common among men with paraphilia (59%). The victim age was significantly lower (p < .001), and the male victim ratio was higher (p < .05) in the group with paraphilia than in the group without paraphilia. Sexual offenses against children aged 10 years and below and against males may be suggestive of paraphilia and an increased risk of recidivism.

Coprophilia and Coprophagia: A Literature Review

BACKGROUND

Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia.

AIMS

The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia.

METHODS

Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English.

RESULTS

Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines.

CONCLUSIONS

Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

The prevalence of mental disorders among incarcerated adult men convicted of child sexual exploitation material offences

OBJECTIVE

Despite the growing body of research on individuals convicted of child sexual exploitation material (CSEM), relatively little is known about the prevalence of mental disorders in this population. The aim of the present study was to describe the prevalence of mental disorders among individuals convicted of CSEM offenses.

METHODS

This cross-sectional study examined data from 66 individuals serving a sentence for CSEM offenses in the Austrian prison system who underwent a clinical assessment between 2002 and 2020. Diagnoses were based on the German version of the Structured Clinical Interview for Axis I and Axis II disorders.

RESULTS

In the total sample, n = 53 individuals (80.3%) were diagnosed with a mental disorder. Twenty-seven individuals (40.9%) had an Axis I disorder and n = 47 (71.2%) had an Axis II disorder. More than two-thirds of the sample, n = 47 (71.2%), had a personality disorder diagnosis, with cluster B personality disorders being the most frequent mental disorders. More than half of the sample, n = 43 (65.2%), had a diagnosis of pedophilic disorder, of which n = 9 (13.6%) were of the exclusive type. Twenty-eight persons (42.4%) showed evidence of a hypersexual disorder.

CONCLUSIONS

In line with previous research, the present sample of convicted CSEM offenders showed a comparatively high prevalence of personality disorders and paraphilic disorders, particularly pedophilic disorders. Additionally, the rate of hypersexual disorder symptoms was considerably high. These findings should be considered for the development of successful risk management strategies for this population.

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

Contribution of a Cluster Approach to Identify the Profiles of Men Sentenced for Sexual Violence According to Their Risk of Reoffending

INTRODUCTION

The aim of this study is to propose a typology of recidivism risk profiles based on the criminogenic needs of a population of men sentenced for sexual violence. Their socio-demographic, criminological, psychological, and psychiatric factors and vulnerabilities are compared. This classification will respond to the need for a better identification of the factors involved in the risk of recidivism of men sentenced for sexual violence, in order to develop more effective management.

METHOD

Several psychological and psychiatric scales (personality traits, impulsivity, cognitive distortions, empathy, and psychiatric disorders) were completed by 86 men incarcerated for sexual violence. Their socio-demographic and criminological characteristics were also recorded, and the investigator rated three recidivism scales for all participants. Results: Cluster analysis led to identification of two significantly different needs groups. In contrast to the "Lower needs" profile (n = 54, 64%), the men with a "Higher needs" profile (n = 32, 36%) were significantly younger and less educated had more adult and extra-familial victims, scored higher on Neuroticism and lower on Conscientiousness and Empathy, and presented with more past and current psychiatric disorders.

DISCUSSION

The overall findings of this study are consistent with the literature on the characteristics of men sentenced for sexual violence with high needs. The assessment and management of men who have committed sexual violence must consider: criminogenic factors, which should be prioritized; past or present psychiatric disorders, which may act as acute risk factors; and non-criminogenic needs, which should not be prioritized, but which may (when linked to criminogenic needs) impact the effectiveness of management.

Serious Mental Illness and Sexual Offending in Forensic Psychiatric Patients

The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999-2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them.

The Relation Between the Paraphilias and Anxiety in Men: A Case-Control Study

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

How Plausible are the Accounts of Child Victims of Sexual Abuse? A Study of Bizarre and Unusual Scripts Reported by Children

Child sexual abuse is a serious social problem. In reports of sexually abused children, victims' narratives often contain elements that suggest the abuse was recorded to create images for child pornography with sadistic, bizarre, or perverted details. The presence of unusual or bizarre elements in the accounts of abused children affects their credibility. The purpose of this paper is to assess the presence and prevalence of these elements in the reports of children with suspected sexual abuse and to examine their consistency with verified cases of child abuse. We conducted two studies. In Study 1, we developed a list of 16 categories of unusual and bizarre scripts reported by children in reports of sexual abuse. In Study 2, we validated the list by examining the presence of the identified scripts in the actual experiences of both individuals convicted of crimes related to child pornography and Italian police officers who were involved with child pornography as part of their official duties. Our findings suggest that children's accounts of sexual abuse should be considered credible even if they contain unusual or bizarre elements that also occur in child pornography and therefore may reflect events actually experienced rather than merely the child's fantasy or imagination.

Merkmale und Perspektiven der (psycho–)‌therapeutischen Behandlung im Justizvollzug

Zusammenfassung. Hintergrund: Sozialtherapeutische Einrichtungen des Justizvollzugs (SothEn) dienen der Behandlung von (Sexual‐ und Gewalt–)‌Straftätern, um deren Rückfallrisiko nachhaltig zu reduzieren. Fragestellung und Methode: Die vorliegende Studie erfasste unterschiedliche Merkmale der gesprächsbasierten therapeutischen Behandlung in allen 71 SothEn in Deutschland. Gesprächsbasierte Behandlung wurde dabei definiert als durch Gespräche vermittelte Behandlung, die auf eine Besserung der psychischen Gesundheit sowie auf eine Reduktion des Rückfallrisikos abzielt. Ergebnisse und Schlussfolgerungen: Aus der Sicht der befragten Einrichtungen wird die Wirksamkeit der gesprächsbasierten Behandlung durch eine hohe Fluktuation des Personals, mangelnde Qualifikationsmöglichkeiten sowie die eingeschränkte Autonomie der Behandlungseinrichtung von der Gesamtanstalt eingeschränkt. Die Wirksamkeit der Behandlung ließe sich demnach durch einen gezielten Ausbau empirisch abgesicherter therapeutischer Maßnahmen sowie durch erhöhte Ressourcen und Alltagsnähe für Lockerungen, Übergang und Nachsorge steigern.

[Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory]

Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory Objectives: The main aim of the present study was to empirically examinate the psychodynamic-founded perversion theory of Robert D. Stoller (1979), particularly his assumption of a transformation of aggressive impulses into sexual deviant fantasies due to traumatic experiences. Methods: In the present study different aspects of the theory were examined by using a sample (N = 954) of individuals convicted of sexually motivated offenses who had been clinically and forensically assessed between 2002 and 2018 at the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. As a part of the psychological testing procedure, German-speaking questionnaires for the assessment of aggressiveness and assertiveness were applied. Results: The results indicated that participants with a diagnosis of paraphilia showed significantly less spontaneously expressed aggression and less social competence compared to individuals without such a diagnosis. Conclusions: The findings of the present study are in line with the core assumptions of Stoller's perversion theory by demonstrating an inverse relationship between the diagnosis of paraphilia and self-reported aggression.

Non-intimate Relationships and Psychopathic Interpersonal and Affective Deficits as Risk Factors for Criminal Career: A Comparison Between Sex Offenders and Other Offenders

Sex-offenders are at risk of criminal recidivism. For the treatment to be truly effective, it must be individualized. For this purpose, an accurate assessment should focus on criminological, psychological, and psychopathological features. The present study compared sex offenders with other offenders on historical experiences (i.e., problems with violence, anti-social behaviors, problems with personal relationships, problems with substance use, traumatic experiences, and parenting style). In addition, given the association between life events and psychopathy, we explored whether the relation between life events and crime type (sexual crime vs. other types of crime) might be moderated by psychopathy traits (interpersonal and affective deficits and antisocial behavior). Eighty-eight sex offenders (76% of whom child molesters) and 102 other offenders were included. The Historical, Clinical and Risk Management - 20 item Version 3 (HCR-20V3) and Psychopathy Checklist-Revised (PCL-R) were administered. The scores of the HCR-20V3 Historical scale items were computed to assess life events. The scores of the PCL-R factors, F1 Interpersonal affective deficits and F2 Antisocial behavior, were recorded. The presence of a history of problems with non-intimate relationships was the only significant risk factor for sexual crime compared with other crimes. Interpersonal and affective deficits provided an increased likelihood of being sex offenders as compared with other offenders when problems with non-intimate relationships were possibly/partially or certainly present.

DSM-5 personality trait facets amongst child molesters: an exploratory comparison with other types of offenders

Background

DSM-5 provided a dimensional model of personality disorders which may be more clinically informative for the assessment and management of prisoners than a categorical one, as diagnoses of personality disorders alone cannot explain the type of violence. The role of DSM-5 personality facets is however understudied in child molesters, and no study compared these clinical features between individuals who have committed sex crime against children and those who have committed other types of crime. The present study compared DSM-5 personality trait facets between prisoners who had committed sex crime against children, prisoners who had committed property crime (i.e., robbery, fraud) and those who had committed crime against the person (i.e., homicide, assault or violence not implying a sexual element). A further aim was to explore which facets were associated with sex crime against children as compared with the other types of crime, controlling for socio-demographics (age, gender), psychiatric comorbidity (presence of any psychiatric diagnoses) and general psychopathy traits.

Methods

One hundred sixty-seven prisoners participated (91 had committed sex crime against children, 25 property crime, and 51 committed a crime against the person) and completed the Personality Inventory for the DSM-5 and the Psychopathy Checklist-Revised.

Results

Prisoners who had committed sex crime against children reported higher Restricted Affectivity traits than those who had committed property crime and crime against the person and higher Irresponsibility traits than those who had committed property crime. The results of a multinomial logistic regression analysis showed that on the one hand being a man, having a higher age, and the presence of a psychiatric comorbidity were more likely to be related to sex crime than property crime, on the other hand higher Irresponsibility personality traits, being a man, and the presence of a psychiatric comorbidity were more likely to be related to sex crime against children than crime against the person.

Conclusions

The Irresponsibility facet might be specific to child molesters and can differentiate this group from offenders who have committed other crime types. This facet might be considered a key target of a tailored assessment and treatment planning during clinical practice with child molesters.

[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]

Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.

Testosterone-Lowering Medication and Its Association With Recidivism Risk in Individuals Convicted of Sexual Offenses

For a particular subgroup of individuals with severe paraphilic disorders and a high risk of sexual recidivism, the combination of sex drive-reducing medications and psychotherapy is a promising treatment approach. The present quasi-experimental study aims at comparing differences in clinical characteristics and dynamic risk factors between persons receiving (+TLM, n = 38) versus not receiving (-TLM, n = 22) testosterone-lowering medications (TLMs). Individuals receiving TLM were more frequently diagnosed with paraphilic disorders. Neither the criminal history nor average risk scores differed between the two groups. In the +TLM, Stable-2007 scores showed a stronger decrease after TLM treatment was started. This accounted especially for the general and sexual self-regulation subscales. Individual variations in risk, however, were not predicted by TLM but were significantly related to treatment duration and Psychopathy Checklist-Revised (PCL-R) Factor I. Paraphilic patients with problems in self-regulatory abilities seem to profit most from pharmacological sex drive-reducing treatment. Furthermore, therapists seem to underestimate deviant sexual fantasies in medicated patients.

[The Influence of Occupational Group and Experience with Regard to the Criteria-Based Assessment of Culpability for Paraphilic Disorders - A Randomized Control Trial]

OBJECTIVE

This study examines whether occupation and level of experience have an impact on criteria-based assessment of criminal responsibility in paraphilic disorders.

METHODS

Two different sets of criteria were tested for predictive validity by three different professional groups (psychologists, psychiatrists and lawyers), each with different levels of prior experience. For this purpose, 349 raters evaluated the criteria of one of two criteria catalogs on the basis of one of two exemplary case vignettes. Group assignment was randomized.

RESULTS

The variables degree of experience and professional affiliation did not show a connection with the prediction performance regarding the estimation of the severity of the disorder and the diminished capacity, respectively, with respect to either of the two sets of criteria.

CONCLUSION

Using a criteria based approach, the methodology used in the present study (presentation of short case vignettes) did not reveal any significant influence of professional group and experience on the assessment in questions of criminal responsibility related to paraphilic disorders. The use of criteria catalogs may be able to contribute substantially to predictive performance relatively independent of relevant prior experience in the area of the assessment of criminal responsibility, but should not be considered the sole source of assessment.

[Interrater reliability of the criteria-based assessment of criminal responsibility in paraphilic disorders]

BACKGROUND

For the assessment of criminal responsibility in the context of sexual delinquency, the evaluation of the severity of a paraphilic disorder and the ability to be controlled are of particular importance. Established assessment criteria are insufficiently operationalized.

AIM AND METHODS

The existing criteria were tested by experts of various professional groups with respect to the reliability. For this purpose, 14 experts assessed the criteria of 2 different sets of criteria based on 2 case vignettes (see electronic supplementary material).

RESULTS AND CONCLUSION

The interrater reliability (IRR) with reference to the criteria of Briken and Müller was higher than the previously established criteria of Boetticher et al. The evaluation of the subjective importance of the criteria of both assessment scales showed that all criteria were rated as at least of average importance. It could thus be useful to initially include both sets of criteria for a greater transparency in the assessment process and to investigate this procedure in further studies.

Predictive Validity of Operationalized Criteria for the Assessment of Criminal Responsibility of Sexual Offenders With Paraphilic Disorders-A Randomized Control Trial With Mental Health and Legal Professionals

The prevention of sexual violence is a major goal of sexual health. In cases of accused sexual offenders, the assessment of diminished criminal responsibility of the accused is one of the most important procedures undertaken by experts in the German legal system. This assessment follows a two-stage method assessing first the severity of a paraphilic disorder and then second criteria for or against diminished capacity. The present study examines the predictive validity of two different sets of criteria for the assessment of criminal responsibility in the context of paraphilic disorders combined with sexual offending. Two exemplary case vignettes of two suspected sexual offenders were developed to assess the criteria. For each participant, one of the two exemplary case vignettes was randomly presented. The presentation of the two different sets of criteria was also randomized, so that each participant was assigned only one of the two criteria sets to rate one of the presented cases. N = 349 participants from different professional backgrounds (mental health and legal professionals) completed their assessments and were included in the data analysis. The data were evaluated using logistic regression. Results show that the more recently published criteria set (Briken and Müller, 2014) predicts both the severity of the disorder as well as the diminished capacity twice as good as the older criteria set of Boetticher et al. (2005) currently used regularly for forensic court reports. In preliminary conclusion, the new criteria of Briken and Müller (2014) form an empirically based assessment of criminal responsibility. However, the proposed criteria cannot replace an extensive exploration of the accused person and a careful file analysis. Validity and reliability of the results are also limited due to the methodical choice of a vignette study.

Do psychological features distinguish those who sexually offend against different age groups from those who are stable in victim age?

Aim/Background

Victim age polymorphism occurs when someone offends against victims that span multiple age groups (e.g., child and adult victims). There is a need to better understand the correlates of age polymorphism, as clinicians are often asked about risk of offending against victims who may differ from the index offence victim as part of their risk formulation. The present study examines several potential correlates of age polymorphism: psychopathy, sexual preoccupation, multiple paraphilias, psychosis, and substance use disorders.

Materials/Method

Analyses were conducted using secondary clinical assessment data from a provincial forensic sexual behaviour program. The sample included 387 men with two or more contact sexual offence victims. The assessment data in the archival database included comprehensive information about victim age, as well as standardized assessment measures and diagnostic/clinical impressions.

Results

There were no significant associations between age polymorphism and psychopathy, multiple paraphilias, sexual preoccupation, psychosis, and substance use disorders. The only significant difference that emerged was that men who offended against victims 16 or older had a higher mean score on a measure of drug misuse than those who offended against victims 6 to 11. Most of the analyses produced small effects.

Conclusion

Our findings did not identify significant correlates of age polymorphism when restricting analyses to those men who offended against two or more victims. We consider key methodological differences that may have impacted our findings, as well as the need for rigorously designed research to develop a comprehensive model of age polymorphism.

Assisting decisions in child protection service institutions with the RIC - The Risk Indication in Child sexual abuse

BACKGROUND

The RIC (Risk Indication in Child sexual abuse) and its screening version (RIC:SV) are actuarial risk assessment instruments, developed at the Austrian Federal Evaluation Centre for Violent and Sexual Offenders and designed for child protection services to assess the likelihood of sexual recidivism in male contact child sexual abusers who still or again live within a family including children.

OBJECTIVE

The RIC was designed to require a minimum of forensic information, with the RIC:SV completely waiving such information.

PARTICIPANTS

Nine factors related to sexual recidivism could be identified by analyzing five-year follow-up data of N = 324 male contact child sexual abusers.

SETTING

The data was collected retrospectively from files between the years 2002 and 2011.

METHOD

Chi-Square Tests and ROC-analyses were calculated.

RESULTS

The RIC and the RIC:SV were found to significantly predict sexual recidivism with AUC values of .84 (RIC) and .78 (RIC:SV). The items of the RIC are: (a) offender has never had a live-in relationship, (b) unstable family background of the offender, (c) impulsivity of the offender, (d) previous psychiatric treatment(s) of the offender, (e) offender has prior prison sentence/s, (f) problems of the offender to accept rules and norms, (g) offender was a stranger to his former victim(s), (h) offender had at least one male victim, and (i) offender has ever committed an extrafamilial contact child sexual abuse offense.

CONCLUSION

The RIC and the RIC:SV need no extensive training to be used. The results may help CPS workers to justify risk related interventions.

Operationalisierte, kriteriengeleitete Beurteilung der Schuldfähigkeit bei paraphilen Störungen – Stand und Ausblick

Die vorliegende Arbeit beschäftigt sich mit der operationalisierten, kriteriengeleiteten Beurteilung für die Begutachtung der Schuldfähigkeit bei paraphilen Störungen. Zunächst werden frühere Überlegungen und Ansätze dargestellt und um neue empirische, vorläufige Ergebnisse, welche erste Annahmen zu Reliabilität und Validität des Vorgehens ermöglichen, erweitert. Anschließend werden kurz die Ergebnisse einer Expertendiskussion zum Thema ergänzt, um vorläufige Schlussfolgerungen und einen Ausblick darzustellen. Insgesamt wird mit der operationalisierten, kriteriengeleiteten Beurteilung für die Begutachtung der Schuldfähigkeit bei paraphilen Störungen ein Verfahren vorgeschlagen, das als vielversprechend angesehen werden kann und zu einer Erweiterung des Vorgehens, den weiteren interdisziplinären Dialog und die weitere empirische Prüfung animiert.

Severe mental illness diagnoses and their association with reoffending in a sample of men adjudicated for sexual offences

The current study examined the relationship between mental illness and recidivism in a sample of 409 men adjudicated for sexual offences who scored higher than average on an established risk assessment tool (Static-99R). Participants were from all provincial correctional systems (except Prince Edward Island) and all regions of the Correctional Service of Canada. Severe mental illness diagnoses, with the exception of some personality disorders, were not associated with recidivism (after an average follow-up of 11 years). While some personality diagnoses were initially related to recidivism, this relationship often disappeared or was attenuated after controlling for substance misuse and risk score on the Static-99R. There were two exceptions: Histrionic and narcissistic personality disorders continued to predict sexual recidivism after controlling for Static-99R and substance misuse history. In sum, the current study suggests that severe mental illness diagnoses are not associated with higher rates of recidivism after accounting for risk score and substance misuse in men with sexual offences, with the exception of histrionic and narcissistic personality disorder diagnoses. For this reason, risk judgements that weigh both known risk factors and severe mental illness may overestimate an individual’s risk to reoffend.

The relevance of sexual biographies in individuals convicted of child sexual abuse offenses for the development of pedosexual interests and sexual recidivism

In the literature concerning the etiology of pedosexual interests, the potential role of early sexual experiences in childhood and adolescence has been discussed. Several studies demonstrated a link between own sexually abusive experiences in childhood and sexual offending later in life which tends to be even stronger for pedosexual offenders. Furthermore, some findings indicate associations between other developmental factors and deviant sexual interests in adulthood. For the present study, sexual biographical data of N = 223 imprisoned men convicted of sexual offenses against children from Austria was analyzed to retrospectively examine whether own sexually abusive experiences and non-abusive forms of early sexual experiences and behaviors are linked to subsequent pedosexual interests and to sexual recidivism. Previous findings concerning the link between own sexually abusive experiences during childhood and subsequent pedosexual interests could partly be replicated. Furthermore, early masturbation behavior characteristics as well as non-abusive prepubescent sexual experiences were linked to indicators of pedosexual interests and also to sexual recidivism. Exclusively pedophilic men showed the strongest accumulation of early sexual experiences and behaviors. Implications of the findings for theory and risk assessment are discussed.

Coercive Sexual Sadism: a Systematic Qualitative Review

PURPOSE OF REVIEW

Coercive sexual sadism can be distinguished from consensual BDSM (bondage discipline/dominance submission/sadism masochism) role-play and from everyday sadism, a personality trait. The purpose of this paper is to provide a systematic qualitative review of the pertinent literature on coercive sexual sadism from the last three years.

RECENT FINDINGS

Clinical assessment of sexual sadism can be made more objective through behavioral checklists based on crime scene actions. The latent structure of sexual sadism is likely dimensional, placing the disorder at the upper end of a continuum of sexually aggressive behavior. Sexual sadism does not seem to increase the risk of violent offense recidivism (including sexual contact offenses) above and beyond the risk implied by established risk factors of delinquency. Coercive sexual sadism denotes a disposition for sexually aggressive behavior. Whether this disposition is put into practice is likely due to other trait and state variables. Treatment studies are completely lacking in the recent literature.

The Predictive Properties of Psychiatric Diagnoses, Dynamic Risk and Dynamic Risk Change Assessed by the VRS-SO in Forensically Admitted and Released Sexual Offenders

Psychiatric diagnoses, static risk factors, and criminogenic needs at time of admission and release were examined in a mentally ill sample of psychiatrically detained sexual offenders. Although clinically found to be at low or even very low risk at discharge, 12% reoffended sexually over an average follow-up of 7 years. Psychotic disorders were present in only 5% of offenders, whereas 93% had a personality disorder diagnosis and 76% a paraphilic disorder diagnosis. Only exhibitionism and alcohol misuse were associated with relapse. Static risk factors captured by the Static-99 also did not significantly predict recidivism; however, the VRS-SO-a structured risk assessment tool that assesses criminogenic needs and changes in risk from treatment or other change agents, rated retrospectively on the present sample-predicted sexual recidivism as well as any new imprisonment or psychiatric placement. In particular, the sexual deviance factor of the VRS-SO had large in magnitude predictive associations with sexual reoffending, while treatment related changes assessed on this factor were significantly related to non-reoffending. Findings corroborate the advantages of structured risk assessment and structured change monitoring, particularly for complex clientele such as mentally ill sexual offenders.