Psychiatric features of 36 men convicted of sexual offenses

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.

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.

Processing of emotional faces in sexual offenders with and without child victims: An eye-tracking study with pupillometry

Socio-affective dysfunction is a risk-factor for sexual offense recidivism. However, it remains unknown whether men who have sexually offended with and without child victims show differences in eye scan paths and autonomic responsivity while viewing facial expressions of emotion. We examined differences in accuracy of emotion recognition, eye movements, and pupil dilation responses between sex offenders with child victims, sex offenders without child victims, and a group of non-offenders living in the community. Sex offenders without child victims looked for longer at the eyes than sex offenders with child victims and non-offenders. Men without child victims also scored higher for psychopathy linked disinhibition, and these traits were associated with looking longer at the eyes of afraid faces. We found no evidence for group differences in accuracy, visual attention to the mouth, or pupil dilation responses. Our findings have implications for understanding the nature of socio-affective dysfunction in sexual offenders.

Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review

BACKGROUND

Different pharmacologic agents are used in the treatment of paraphilic disorders in sexual offenders or men with a risk of sexual offending, with luteinizing hormone-releasing hormone (LHRH) agonists being the agents introduced more recently to treatment regimens.

AIM

To summarize the relevant literature concerning LHRH agonist treatment of paraphilic disorders in sexual offenders and update the previously published systematic review by Briken et al (J Clin Psychiatry 2003;64:890-897).

METHODS

The PubMed and Google Scholar databases were searched for literature published from January 2003 through October 2017 using the following key words: LHRH agonists, GnRH agonists, antiandrogens AND paraphilia, pedophilia, sex offenders.

OUTCOMES

Evaluation of the effectiveness and side effects of LHRH agonist treatment of paraphilic disorders in sexual offenders.

RESULTS

After screening for duplicates and applying specific selection criteria, the search yielded 24 eligible studies reporting on a sample of 256 patients. There is increasing evidence that LHRH agonists are more effective than steroidal antiandrogens in lowering paraphilic sexual thoughts and behaviors. Current research also is based on methods that might be less susceptible to faking (eg, eye-tracking, brain imaging, and viewing-time measures). Side effects occurring most frequently are fatigue, hot flashes, depressive mood, weight gain, high blood pressure, diabetes, gynecomastia, loss of erectile function, and loss of bone mineral density.

CLINICAL IMPLICATIONS

Although LHRH agonists seem to be the most effective drugs in the treatment of paraphilic fantasies and behaviors, they should be reserved for patients with a paraphilic disorder and the highest risk of sexual offending because of their extensive side effects.

STRENGTHS AND LIMITATIONS

This systematic review considers all types of research on LHRH agonist treatment in patients with paraphilic disorders, thereby providing a complete overview of the current state of research. However, most studies are case reports or observational studies and randomized controlled clinical trials have not been conducted or published.

CONCLUSIONS

LHRH agonists are a useful treatment when combined with psychotherapy in patients with a paraphilic disorder and the highest risk of sexual offending. However, throughout treatment, close monitoring of side effects is needed and ethical concerns must always be kept in mind. Turner D, Briken P. Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review. J Sex Med 2018;15:77-93.

The Neuropsychological Function of Older First-Time Child Exploitation Material Offenders: A Pilot Study

Despite the growing incidence of child exploitation offences, there is little knowledge of the neuropsychological function of older child exploitation material offenders (CEMOs). Given that studies have reported that sex offenders demonstrate deficits attributed to frontal and temporal lobe function, the aim of this pilot study was to investigate the frontotemporal function of older first-time child exploitation material offenders (FTCEMOs). The neuropsychological performance of 11 older FTCEMOs was compared with 34 older historical sex offenders (HSOs) and 32 older nonsex offender (NSO) controls. Forty-five percent of FTCEMOs admitted to a pedophilic interest, which was significantly lower than those reported by HSOs. FTCEMOs provided significantly higher intellectual function scores than HSOs. Results revealed no evidence of mild or major neurocognitive disorder in FTCEMOs. Although the groups were not significantly different, compared with normative data, FTCEMOs reported a high incidence of impairment on a measure of decision making and on a measure of facial emotional recognition.

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.

Non-Homicidal and Homicidal Sexual Offenders: Prevalence of Maladaptive Personality Traits and Paraphilic Behaviors

This study aims to examine the psychopathological profile of non-homicidal sexual offenders (NHSOs) and homicidal sexual offenders (HSOs). Using an incarcerated sample of 96 NHSOs and 74 HSOs in a federal penitentiary in Canada, these offenders are compared in terms of their offending process, maladaptive personality traits, and paraphilic behaviors. A number of cross-tabular and sequential logistic regression analyses are performed. Relative to their counterpart, findings indicate that a higher percentage of HSOs select a victim of choice, report deviant sexual fantasies, mutilate their victim, and admit to their offense upon apprehension, whereas a higher percentage of NHSOs select victims with distinctive characteristics. In addition, a higher percentage of HSOs manifest paranoid, schizotypal, borderline, histrionic, narcissistic, obsessive-compulsive, and impulsive personality traits, and overall odd and eccentric personality traits compared with NHSOs. Similarly, a higher percentage of HSOs engage in exhibitionism, fetishism, frotteurism, homosexual pedophilia, sexual masochism, and partialism compared with NHSO. These findings are discussed with their implications for offender profiling.

Juvenile Sex Offenders

Sexual offending by juveniles accounts for a sizable percentage of sexual offenses, especially against young children. In this article, recent research on female juvenile sex offenders (JSOs), risk factors for offending in juveniles, treatment, and the ways in which these youth may differ from general delinquents will be reviewed. Most JSOs do not go on to develop paraphilic disorders or to commit sex offenses during adulthood, and as a group, they are more similar to nonsexual offending juvenile delinquents than to adult sex offenders. Recent research has elucidated some differences between youth who commit sex offenses and general delinquents in the areas of atypical sexual interests, the use of pornography, and early sexual victimization during childhood.

Elderly Sexual Offenders

With the ever-aging population, the number of elderly sexual offenders are also on the rise. The courts and correctional system are increasingly faced with older individuals who have offended sexually. Previously, these older offenders were thought to be similar to younger sexual offenders. However, closer analysis suggests that many of these individuals pose a much lower risk to recidivate than the risk to recidivate of their younger counterparts. Still, an individualized approach to manage the risk of older offenders is required, as some may have particular risk factors relevant for their treatment and future stability, such as dementia or other mental health issues. Further, this population often has particular physical health issues and requires special consideration when being placed in the community. Assessment, treatment, and risk management in this special population of sexual offenders are discussed.

General Characteristics of Child Sexual Offenders in Hatay, Turkey

OBJECTIVE

Child sexual offenders are a poorly studied and relatively neglected population in our country. This study aims to evaluate the relationship between criminal behavior and socio-demographic characteristics of a series of child sexual offenders.

MATERIALS AND METHODS

The records of social worker interviews with 48 child sexual offenders between 2009 and 2013 were used. The reports issued by social workers regarding child sexual offenders were retrospectively examined, since these reports were relatively the most thorough documents including offenders' personal and familial characteristics, and criminal event information. Cases were investigated in terms of socio-demographic and psychosocial characteristics.

RESULTS

There were 48 children interviewed based on an alleged sexual crime, during four-year of study period. All of the cases were male and their ages ranged between 12 and 17 years. Of these, 50% were students at any grade of school. Five cases were living in social service facilities. Only two cases involved incest. Of all, three offenders were accused of repeated sexual crimes. Type of sexual assault was anal penetration in 20 (41.7%) cases. Of all cases, 19 were cigarette smoker, while 4 were drug abusers. The families of 12 (25%) cases suffered from low socio-economic status, while 23 (47.9%) offenders were members of broken families. According to social worker reports, 47 cases had criminal responsibility based on their psychosocial development. Out of all cases, 7 children were suspected of suffering from impulse control disorder and one was suspected to be mentally retarded. Twelve cases were reported to need consulting and social protective services.

CONCLUSION

The rate of offenders with interrupted education was considerably high. Interestingly the number of male victims and the frequency of cases involving anal penetration were high. Obtained results suggest that male children of broken and scattered families, and particularly those lacking father's supervision were more likely to commit a sexual crime.

Assessment of psychiatric disorders among sex offenders: Prevalence and associations with criminal history

BACKGROUND

Much of the research on the prevalence of psychiatric disorders among sex offenders has been conducted in the USA or Europe. Less is known about it in other regions, particularly in Asia.

AIMS

The objective of this study is to determine the prevalence of psychiatric disorders among sex offenders in Taiwan and their associations with offender characteristics and criminal history.

METHODS

Participants were randomly selected from men serving sentences in Taiwan's prison for serious sex offenders. Consenting men were assessed using the structured clinical interviews for DSM-IV-TR Axis I and II disorders. Demographics and criminal history were also recorded.

RESULTS

Over two-thirds of the 68 participants met criteria for one or more lifetime Axis I disorders, and nearly 60% met criteria for one or more Axis II disorder. The higher the number of Axis I and cluster B personality disorders, the higher was the total number of convictions.

CONCLUSIONS

Our study adds to the literature that suggests that psychiatric assessment is likely to have an important role in the management and treatment of sex offenders. The finding that multiple disorders are common in this group and associated with more convictions for sex offences suggests that failure to include psychiatric assessment in planning the management of sex offenders may increase the risk of recidivism.

Juvenile Sex Offenders

Public policy has tended to treat juvenile sex offenders (JSOs) as adult sex offenders in waiting, despite research that contradicts this notion. Although as a group, JSOs are more similar to general delinquents than to adult sex offenders, atypical sexual interests and sexual victimization during childhood may be a pathway for sexual offending that differentiates some JSOs from their nonsexually delinquent peers. Developmental considerations must be considered in risk assessment evaluations of these youth. This article reviews theories of sexual offending in youth, risk factors for juvenile offending and reoffending, psychopathology in JSOs, risk assessment, and treatment.

[Treatment management of sexual offenders]

In France, the Court can issue a medical treatment order only for criminally responsible persons. The nature of the treatment to be administered is at the discretion of the physician in charge of the sexual offender's care. Treatment management of sexual offenders relies essentially on psychotherapy, and preferentially cognitive behavioral therapy. For most severe sexual offenders, drug treatments, including hormonal treatment and selective serotonin reuptake inhibitors, are used to complement psychotherapy. This literature review aims at synthesizing practice changes in the treatment management of sexual offenders.

Sexual sadism in sexual offenders and sexually motivated homicide

This article gives a clinically oriented overview of forensically relevant forms of sexual sadism disorder and its specific relationship to sexual homicide. In sexual homicide perpetrators, peculiar patterns of sexual sadism may be a motivational pathway to kill. Sexual sadism increases the risk for reoffending in sexual offenders. Through psychotherapy and pharmacological interventions, treatment of sadistic sex offenders has to consider special characteristics that may be different from those of nonsadistic sex offenders. Many of these offenders share a combination of sexual sadistic motives and an intact self-regulation, sometimes combined with a high level of sexual preoccupation.

Assessment of the paraphilias

Paraphilias are recurrent, persistent, and intense sexual interests in atypical objects or activities. The most commonly encountered paraphilias in sexological or forensic settings are pedophilia, sexual sadism, exhibitionism, and voyeurism. Paraphilias are often comorbid with other sexual, mood, and personality disorders. Assessment and diagnosis require an integration of multiple sources of clinical information, given the limits and biases of self-report (through clinical interview or questionnaires). Clinicians ideally have access to more objective assessment methods, such as phallometric testing of sexual arousal. The accurate assessment and diagnosis of paraphilias is essential to effective treatment and management.

[Studying dysfunctional personality trends among sex offenders]

OBJECTIVE

A review of the literature reveals a consensus on the high prevalence of personality disorders among sexual offenders. Studies show that there is no unique personality profile for sex offenders. In France, little research has been conducted on this population with standardized assessment tools. The objective of the present study is to identify the distribution of personality disorders among sexual offenders using a new French questionnaire, i.e. the TD12. In view of the literature, we postulate that this tool will identify the diversity of personality disorders observed by various authors, but with a higher proportion of cluster B disorders.

METHODOLOGY

This study was conducted among 56 men, including 28 sex offenders aged from 21 to 70 years old, and a control group of 28 men without psychiatric disorders. The sex offenders in this study are men convicted or charged with sex offenses of various kinds: exhibitionism, the recording, distribution and possession of pornography depicting minors, aggravated corruption of a minor, sexual assault of a minor, or rape of a minor. They were examined using an inventory of dysfunctional trends recently developed by Rolland and Pichot with the aim of assessing dysfunctional personality styles. The TD-12 questionnaire is composed of 140 items describing thoughts, feelings and behaviors. It is based on the diagnostic criteria of Axis II of DSM IV-TR and consists of twelve scales that match the personality disorders described in this diagnostic manual (ten officially recognized disorders and two additional disorders).

RESULTS

From a categorical viewpoint, results indicate rigid dysfunctional trends with regard to avoidant personality disorder in sex offenders compared to the control group (Chi(2)=9.16; P=0.005). However, there were no significant differences between the two groups regarding the number of rigid dysfunctional trends. Potentially controllable dysfunctional personality trends are identified for the dependent personality (Chi(2)=6.72; P=0.02) and the depressive personality (Chi(2)=9.63; P=0.004). Moreover, the results show differences related to type of crime. The mean score on the Docile-Dependent scale is higher among subjects who had only downloaded images of child pornography (n=8) compared to subjects who had committed at least one sexual offense against a victim (n=20) (58.75±8.43 versus 49.55±11.66, P=0.04).

CONCLUSION

These results are somewhat in contradiction with previous studies. The often described cluster B personalities are not significantly observed in this study. These results show the prevalence of avoidant personality disorder, which in fact corresponds to a clinically observed sex offender profile characterized by inhibition, relationship difficulties with adults, fear of being judged or rejected, and social isolation. The study also shows the value of considering the personality profile in relation to the modus operandi. It is important to continue this research on larger groups in order to refine the results.

Personality disorders in men with sexual and violent criminal offense histories

Little is known about personality disorders (PDs) in offenders with histories of both sexual and (nonsexual) violent offenses. This study aimed to identify possible differences of PD profiles across three different offender groups with both sexual and violent (S+V), only sexual (S), and only violent (V) offenses. Nonviolent (N) offenders were used as a comparison group. Typing of individuals according to their offensive histories was performed on the basis of 259 psychiatric court reports that included the Structured Clinical Interview (SCID)-II for PD diagnostics. Men from the S+V group committed significantly more acts of rape and sexual coercion than the mere sexual offenders. Furthermore, S+V offenders showed the highest rates of PDs overall (68.3%), with every second offender being diagnosed with an antisocial PD and every third offender with a borderline PD. In summary, the results suggest that S+V offenders form a group of individuals with remarkable differences regarding PD profiles, the relatively highest frequencies of conduct disorders, familial addictive problems, and PDs overall.

Current concepts in the pharmacotherapy of paraphilias

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.

Reinforcement sensitivity of sex offenders and non-offenders: An experimental and psychometric study of reinforcement sensitivity theory

This study tested predictions of Gray's Reinforcement Sensitivity Theory (RST) in subgroups of sex offenders and male non-offenders using an experimental choice task consisting of a reward and a non-reward phase. In addition, RST-related psychometric measures were used. Both experimental and psychometric data were of interest to determine whether sex offenders could be reliably differentiated from non-offenders. Paraphilic (N=50) and impulse control-disordered (N=48) sex offenders showed greater sensitivity to continuous reward than male non-offenders (N=51). Impulse control-disordered sex offenders showed less behavioural adaptation under non-reward than both paraphilic sex offenders and male non-offenders. In addition, reward sensitivity, rash-spontaneous impulsivity, and anxiety measures discriminated sex offenders from male non-offenders. The results suggest that reinforcement sensitivity is a promising personality trait for differentiating subgroups of sex offenders from non-offenders. The experimental and psychometric results illustrate that predictive accuracy in forensic settings could be improved by combining several types of data.

Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities

OBJECTIVE

There have been many studies investigating paraphilias and sexual compulsion, but thus far little data about prevalence of unusual sexual practices that are subthreshold for these diagnoses. The associations between unconventional sexual behavior and sociodemographic and health parameters were investigated.

METHOD

A cross-sectional study of 7,022 individuals (45.4% of women) was carried out using a self-administered questionnaire that compared individuals carrying at least one reference of unconventional sexual behavior (group 1) with individuals without such reference (group 2).

RESULTS

Women's mean age was 35.0 vs. 35.9 years (p < 0.05) and men's mean age was 36.5 vs. 37.8 years (p < 0.05) being lower in group 1 than in group 2, respectively. More men (52.3%) than women (30.4%) (p < 0.001) presented unconventional sexual behavior. Fetishism (13.4%) and voyeuristic behavior (13.0%) were more frequent. Unconventional sexual behavior was associated with male gender, single or separated marital status, black or mulatto race, elementary and high school educational level, history of posttraumatic stress disorder treatment, alcohol dependence, emergency contraception, difficulty at the beginning of sexual life, sexual violence, bisexuality, and performance of anal or oral intercourse.

CONCLUSION

Unconventional sexual behaviors are important because they are associated with poorer health status and lower educational levels.

Sexual and other axis I diagnoses of 60 males arrested for crimes against children involving the Internet

OBJECTIVE

This study was conducted to describe Axis I sexual diagnoses of 60 males arrested for possession of child pornography obtained via the Internet and/or attempting to meet children via the Internet.

METHODS

Data was obtained from a chart review of evaluations conducted on 60 males referred for a psychosexual evaluation following an arrest for possession of child pornography and/or attempting to meet children. All crimes involved use of the Internet. Information obtained from the chart review was entered into SAS. All diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Simple descriptive statistics were computed and cross tabulations were tested for significance using chi2 or Fisher's Exact test.

RESULTS

Of the total sample, 40% had at least one paraphilia. Thirty-one percent had a diagnosis of pedophilia and 18% of a paraphilia not otherwise specified (NOS). Thirty-three percent had a sexual disorder NOS, characterized by hypersexuality. Seventy percent of the total sample had an Axis I disorder that antedated and was judged to be contributory to the behavior leading to their arrest.

CONCLUSIONS

This sample of men arrested for committing crimes against children and adolescents via the Internet has a high incidence of lifetime sexual and other psychopathology.

Personality disorders in a sample of paraphilic and nonparaphilic child molesters: a comparative study

This article renders the results of research that investigated personality disorders in a sample of paraphilic and nonparaphilic child molesters. The sample contained 36 paraphilic child molesters and a matched comparison group of 34 nonparaphilic child molesters. The analyses of the research results show that four personality disorders discriminate between both groups. Only the obsessive-compulsive personality disorder contributes significantly to the explanation of paraphilic child molestation. This result also contributes to the development and differentiation of the treatment of paraphilia-related disorders. For several child molesters, psychological approaches to the treatment of sexual offending (e.g., cognitive-behavioral treatment, psychotherapy in general) are limited and cannot be expected to immediately reduce risk. Interest has been expressed in medical approaches to reduce recidivism, in combination with psychotherapy.

A comparison of criminal sexual conduct defendants based on victim age

This study compared defendants charged with Criminal Sexual Conduct whose victims were <6 years of age with defendants whose victims were 12 or more years of age. The study included 163 men referred to the evaluation unit of a state center for forensic psychiatry. Thirty-eight men had younger victims (YVs) and 125 men had older victims (OVs). The variables of comparison were defendant demographic and psychiatric variables frequently identified in the sex offender literature. Controlling for other demographic and psychiatric variables by use of logistic regression modeling, elderly defendants (60 years or greater), and incest offenders were three times more likely to have YVs (Odds Ratio [OR] 3.08 and 3.11, respectively). Unlike previous studies defendants with serious psychiatric pathology (psychosis or mania) were no more likely to have YVs (OR 0.66) than were defendants without psychosis.

Pharmacological treatments for paraphilic patients and sexual offenders

PURPOSE OF REVIEW

This review addresses testosterone-lowering and other psychotropic medications for the treatment of paraphilic patients or sexual offenders.

RECENT FINDINGS

Randomized controlled studies are still lacking, and only a few new studies were reported during the past year. On the other hand, there is substantial scientific knowledge about the wide range of psychiatric comorbidity associated with paraphilias and in sexual offenders. Empirically based treatment of these patients, especially of impulsivity, anxiety and mood disorders, may also ameliorate sexual impulsivity.

SUMMARY

Medication interventions, either substantially lowering serum testosterone or treating axis I comorbidities, show definite promise as a significant component of the management of sexual offenders. Pharmacotherapy should be combined with other therapeutic treatment modalities, most commonly cognitive-behaviour based psychotherapy and intensive community supervision.

Schizophrenia sex offenders: a clinical and epidemiological comparison study

While the incidence of criminal offense in individuals with schizophrenia does not necessarily differ from that of the normal population, in contrast, the rate of sexual crimes among individuals with schizophrenia is relatively low. Due to low numbers, description of sexual criminal behavior among schizophrenia patients remains relatively unexplored. In order to investigate clinical, socio-demographic and sexual factors associated with deviant sexual behavior in schizophrenia sex offenders we retrospectively compared a large subgroup of schizophrenia sex offenders with a group of schizophrenia patients incarcerated for other criminal behaviors and a group of sex offenders without schizophrenia. Results indicated significant differences distinguishing schizophrenia sex offenders from schizophrenia non-sex offenders, the former of whom were more likely to be married, employed, non-heterosexual (homosexual and bisexual orientations) and demonstrated less hospitalization, antisocial personality, substance abuse, negative symptoms and overall illness severity. Individuals with schizophrenia had a tendency towards female victims compared to non-schizophrenia sex offenders whose victims tended to be male. Study observations indicate important differences between the 3 subgroups suggesting that the schizophrenia sex offender subpopulation may be a unique subgroup of comorbid conditions.

The relationship between DSM-IV cluster B personality disorders and psychopathy according to Hare's criteria: clarification and resolution of previous contradictions

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders. To clarify some contradictions among several previous studies on this issue, individual cluster B PDs were looked at alone, excluding any cases of comorbidity with other PDs of this cluster. We found highly significant relationships between antisocial and borderline PD and Factor II of the PCL and a highly significant correlation between narcissistic PD and Factor I of the PCL. These results were to be expected from the theoretical basis of the development of the PCL and provide a contribution to the construct validity of the PCL, which until now has not been validated on such a large sample in Germany.

Prevalence of mental disorders among sexual offenders in forensic psychiatry and prison

The objective of this study was to compare the prevalence of mental disorders among sexual offenders in forensic psychiatry (SF) with the prevalence of such disorders among sexual offenders in prison (SP) and violent offenders in prison (VP). In a cross-sectional study, 40 of 47 SF detained in forensic psychiatry in Baden-Wuerttemberg, Germany, could be included. They were compared with 30 SP and 26 VP. All study participants were interviewed by means of SCID I and SCID II and assessments of functioning (GAF, BSS). There was a high prevalence of mental disorders (DSM-IV: Axis I) in all three groups (SF: 80%, SP: 63%, VP: 73%). Among SP and VP, this was attributed mainly to substance use disorders. The prevalence and comorbidity of personality disorders was significantly higher in the group of the SF (prevalence: SF: 85%, SP: 27%, VP: 39%). In a psychopathological view, SP were all together more similar to the imprisoned non-sexual delinquent VP than to the SF.

Exhibitionistic and voyeuristic behavior in a Swedish national population survey

We examined the prevalence and correlates of self-reported sexual arousal from exposing one's genitals to a stranger (exhibitionistic behavior) and spying on others having sex (voyeuristic behavior) in a representative national sample. In 1996, 2,450 randomly selected 18-60 year-olds from the general population of Sweden were interviewed in a broad survey of sexuality and health. A total of 76 (3.1%) respondents reported at least one incident of being sexually aroused by exposing their genitals to a stranger and 191 (7.7%) respondents reported at least one incident of being sexually aroused by spying on others having sex. Exhibitionistic and voyeuristic behaviors were examined for possible associations with 9 sociodemographic, 5 health, 4 risk-taking, and 17 sexuality variables. Both paraphilia-like behaviors were positively associated with being male and having more psychological problems, lower satisfaction with life, greater alcohol and drug use, and greater sexual interest and activity in general, including more sexual partners, greater sexual arousability, higher frequency of masturbation, higher frequency of pornography use, and greater likelihood of having had a same-sex sexual partner. Consistent with previous research in clinical samples of men with paraphilias, respondents who reported either exhibitionistic or voyeuristic behavior had substantially greater odds of reporting other atypical sexual behavior (sadomasochistic or cross-dressing behavior). There was evidence both for general and specific associations between sexual fantasies and their corresponding paraphilia-like behaviors. The implications of these findings for research on atypical sexual interests, atypical sexual behavior, and paraphilias are discussed.

Juvenile Sex Offenders: a Complex Population

Individuals who engage in sexual offending behavior represent a heterogeneous population. Recent research has found some success in categorizing sexual offenders based on a number of variables, particularly the type of victim. For example, differences have been found between those offenders who victimize adults when compared with those who victimize children. However, the research in this area has been conducted predominantly with adult samples. As the adult sex offender literature has progressed, it has become evident that risk assessment, treatment effectiveness, and risk management are dependent on such offender characteristics. Unfortunately, the relevance to juveniles of characteristics deemed to be important with adult sex offenders is limited due to the complexity of developmental processes, particularly with respect to mental disorders and personality formation. As such, the formulation and implementation of treatment and risk management strategies that will be effective with juvenile sex offenders are challenging. The goal of this paper is to review some of the complexities inherent in the juvenile sex offender population by focusing on specific areas of complication, including: classification systems, comorbid paraphilias and other mental illnesses, and maladaptive personality traits.

Disorders characterized by poor impulse control

BACKGROUND

Impulse Control Disorders (ICDs) are an eclectic group of conditions in which a person has a drive, urge, or temptation, to perform a potentially harmful act, or fails to resist an impulse.

METHODS

Authors reviewed the current medical literature addressing this diverse group of disorders.

RESULTS

Although the behaviors associated with these conditions can cause a great deal of suffering for patients and their families, they have remained relatively under-researched and poorly characterized.

CONCLUSIONS

Recent studies have explored both pharmacological and psychosocial treatments, giving rise to greater hope for the development of more effective treatments for these challenging disorders.

Psychiatric disorders and recidivism in sexual offenders

Research on psychiatric morbidity in sexual offenders (SOs) has mostly been based on small, selected samples. We studied psychiatric disorders and their relationship with criminal recidivism in a nationwide, representative cohort of SOs. Data on ICD-9 and -10 psychiatric and neurologic morbidity diagnosed during hospital admissions 1987-1997, but prior to sexual offending, were retrieved for all adult male SOs released from Swedish prisons 1993-1997 (N = 1215). Preoffending disorder prevalence and associations between morbidity and criminal reconvictions during a 5-year postdetainment follow-up were explored. Alcohol use disorder was the most frequent diagnosis, followed by drug use disorder, personality disorder, and psychosis. Morbidity requiring admission to hospital was more common in rapists as compared to child molesters. Alcohol use disorder, drug use disorder, personality disorder, and psychosis all increased the risk for sexual recidivism whereas alcohol use disorder and personality disorder predicted violent nonsexual recidivism. Controlling for sociodemographic confounds changed the risk estimates only marginally. Because disorders were identified among only those who had been admitted to psychiatric hospitals as inpatients, underestimation of true prevalence rates was inevitable. However, our findings support psychiatric consultation for improved assessment and management of mental health needs and recidivism risk in SOs.