Criminal diversity and paraphilic interests among adult males convicted of sexual offenses against children

Official demographic and offense history data (n = 362) and confidential self-report data on paraphilic interests and behavior (n = 221) obtained on adult males convicted of sexual offenses against children were analyzed. Considerable criminal diversity was observed, with all standard categories of offenses represented in offenders' criminal histories. Most (86%) of the offenders' previous convictions were for nonsexual offenses, and most (92%) of the recidivist offenders had previously been convicted of at least one nonsexual offense. The prevalence of diagnosable paraphilias was low, with only 5% meeting formal diagnostic criteria for multiple (two or more) paraphilias other than pedophilia. Sexual offenders' paraphilic interests were unrelated to the extent of their sexual offense convictions but were significantly related to the extent of their nonsexual offense convictions. The results are better explained by a general theory of crime than by traditional clinical conceptions linking sexual offenses specifically with sexual psychopathology.     

The relationship between serial sexual murder and autoerotic asphyxiation

This case series documents and examines the association between autoerotic asphyxiation, sadomasochism, and serial sexual murderers. Autoerotic asphyxiation, along with other paraphilias found in this population, is reviewed. Five cases of serial sexual killers who engaged in autoerotic asphyxiation were identified worldwide: four from the United States and one from Russia. Case reports for each are provided. All (100%) were found to have sexual sadism in addition to autoerotic asphyxiation. Furthermore, two (40%) had bondage fetishism, and two (40%) had transvestic fetishism, consistent with these paraphilias co-occurring in those with autoerotic asphyxiation. Overall the group averaged 4.0 lifetime paraphilias. Some possible relationships were observed between the offenders' paraphilic orientation and their modus operandi, e.g., all of these serial killers strangled victims-suggesting an association between their sadistic and asphyxiative paraphilic interests. The overlap of seemingly polar opposite paraphilias in this sample--sexual sadism and autoerotic asphyxiation--is explored from a historical and clinical perspective. Multiple commonalities shared between these five offenders and serial sexual murderers in general are addressed. A primary limitation of this study is its small sample size and empirical basis; the results may not be generalizable beyond the sample. The findings from this study support the supposition that crime scene behaviors often reflect paraphilic disturbances in those who commit serial sexual homicides.     

Treatment of paraphilia in young adults with leuprolide acetate: a preliminary case report series

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.     

Differential pharmacological treatment of paraphilias and sex offenders

This article gives an overview of current pharmacological treatment of paraphilias and sex offenders focusing on the situation in Germany. Information about selective serotonin reuptake inhibitors (SSRI) is followed by data about established antihormonal substances (cyproterone acetate/CPA, and medroxyprogesterone acetate/MPA), as well as a more detailed account on luteinizing hormone-releasing hormone agonists (LHRH agonists). The results of open, uncontrolled clinical studies with SSRIs (n = 16) and LHRH agonists (n = 11) in paraphilic outpatients confirm the positive effects of these substances. A survey about the use of CPA and LHRH agonists in forensic hospitals in Germany shows that half of the patients treated with any kind of (anti-) hormonal agents received an LHRH agonist. The authors present a protocol on side effects, contraindications, and monitoring of CPA and LHRH agonists and develop an algorithm for differential pharmacotherapy of paraphilias.     

DSM-5 proposed diagnostic criteria for sexual paraphilias: tensions between diagnostic validity and forensic utility

In order to prevent sexual crimes, “sexual predator” laws now allow indefinite preventive civil commitment of criminals who have completed their prison sentences but are judged to have a paraphilic mental disorder that makes them likely to commit another crime. Such proceedings can bypass the usual protections of criminal law as long as the basis for incarceration is the attribution of a mental disorder. Thus, the difficult conceptual distinction between deviant sexual desires that are mental disorders versus those that are normal variations in sexual preference (even if they are eccentric, repugnant, or illegal if acted upon) has attained critical forensic significance. Yet, the concept of paraphilic disorders - called “perversions” in earlier times - is inherently fuzzy and controversial and thus open to conceptual abuse for social control purposes. Consequently, the criteria used in diagnosing paraphilic disorders deserve careful scrutiny.The DSM-5 sexual disorders work group is proposing substantial revisions to the paraphilia diagnostic criteria in the DSM-5 nosology. It is claimed that the new criteria provide a reconceptualization that clarifies the distinction between normal variation and paraphilic disorder in a way relevant to forensic settings. In this article, after considering the logic of the concept of a paraphilic disorder, I examine each of the proposed changes to the DSM-5 paraphilia criteria and assess their conceptual validity. I argue that the DSM-5 proposals, while containing a kernel of an advance in distinguishing paraphilias from paraphilic disorders, nonetheless would yield criteria for paraphilic disorders that are conceptually invalid in ways open to serious forensic abuse.     

Biastophilia,raptophilia, and somnophilia: the blurred distinction and comorbidity of sexual paraphilias in a homicidal offender

Somnophilia has previously been recognised by some as a sleep disorder rather than, correctly, as a sexual paraphilic disorder. Correct recognition, however, then necessitates cognisance of the overlap between somnophilia and arousal to rape and sexually violent acts (biastophilia and raptophilia). Such overlap needs to be recognised by clinicians when the ramifications of the comorbidity and intersection of these paraphilias, left unchecked, can stretch as far as homicide.     

The association between childhood sexual abuse and sexual coercion in men: a test of possible mediators

ABSTRACT

We examined the associations between childhood sexual abuse (CSA), childhood physical abuse (CPA), sexual domain variables, antisocial tendencies, and sexually coercive behaviour in a non-forensic sample of 173 heterosexual men. CSA was associated with paraphilic interests and experiences, a more extensive sexual life history, and early antisocial tendencies. CPA was associated with paraphilic interests and experiences, more self-reported delinquency, higher sensation seeking, and early antisocial tendencies. Sexual domain variables (e.g. number of sexual partners, sexual interest in sadomasochism) mediated the link between CSA and sexually coercive behaviour, but antisocial domain variables (e.g. delinquency, sensation seeking) did not. Of the two sexual domains examined, extensive sexual life history rather than paraphilias mediated the association between CSA and sexually coercive behaviour. These results suggest CSA and CPA are associated with both sexual and antisocial outcomes, and that, for some victims of CSA, having an extensive sexual life history may account for the association between CSA and sexually coercive behaviour later in life.     

A case of factitious pedophilia

Factitious disorder involves feigning, exaggerating, or self-inducing physical and/or psychological ailments with the goal of assuming the "sick" or "patient" role. In turn, the sick role entitles the factitious disorder patient to care, nurturance, and protection; it also exempts one from usual responsibilities. In this paper, we present the first reported case of factitious pedophilia. Although it seems counterintuitive, this middle-aged man has falsely claimed or exaggerated sexual desire for minors ostensibly to remain in a state hospital; indeed, he has remained in the same inpatient facility for more than 20 years as a result of his deceptions. At times, his reports have included disconfirmed claims of bizarre accidents and other physical travails. This case enlarges the literature on factitious psychological disorders and shows that some individuals may falsify paraphilic behaviors, although clearly minimization of these behaviors remains more common.     

Undetected and detected child sexual abuse and child pornography offenders

Current knowledge about risk factors for child sexual abuse and child pornography offenses is based on samples of convicted offenders, i.e., detected offenders. Only few studies focus on offenders not detected by the criminal justice system. In this study, a sample of 345 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia or hebephilia (paraphilia not otherwise specified), were assured of confidentiality, and self-reported lifetime sexual offending against prepubescent and/or pubescent children. Two sets of group comparisons were conducted on self-report data of risk factors for sexual reoffending. Measures of risk factors address the following dimensions identified in samples of convicted offenders: sexual preferences (i.e. co-occurring paraphilias), sexual self-regulation problems, offense-supportive cognitions, diverse socio-affective deficits, and indicators of social functioning (e.g., education, employment). Men who admitted current or previous investigation or conviction by legal authorities (detected offenders) were compared with those who denied any detection for their sexual offenses against children (undetected offenders). Group comparisons (detected vs. undetected) were further conducted for each offense type separately (child pornography only offenders, child sexual abuse only offenders, mixed offenders). Although there were more similarities between undetected and detected offenders, selected measures of sexual-self regulation problems, socio-affective deficits, and social functioning data demonstrated group differences.     

The paraphilia-related disorders: an investigation of the relevance of the concept in sexual murderers

Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors-so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.     

Transphobic discourse and moral panic convergence: A content analysis of my hate mail

Recently, new social anxieties about transgender people have begun to emerge, framed as an issue of “grooming”—a term typically used in the context of child sexual abuse. In this way, moral panic about transgender people seems to be merging with oft-repeated social fears about pedophilia, resulting not only in policies criminalizing trans people and their allies but also in escalating hatred and threats toward trans-affirming educators. This pattern requires further inquiry. As a trans academic who has been at the center of moral panic, my own hate mail can provide material for this exploration. I conducted a content analysis of 231 letters and e-mails sent to me containing messages of hate, to answer the following research questions:

1. What beliefs and understandings did my correspondents indicate having about me and my research?
2. To what extent did my correspondents’ beliefs and understandings about me reflect intersecting contemporary moral panics around trans and queer people, pedophilia, and educators?
3. What stated or implied goals did my correspondents aim to achieve by writing to me?

The findings of this study can add to understanding of how moral panics can converge, and the consequences of their convergence for marginalized groups in academia and beyond.     

Self-reported versus diagnosed paraphilias in outpatient sexual offenders

Literature has repeatedly reaffirmed sexual deviance as a risk factor for sexual recidivism, making it an important subject to examine. Yet, not all studies confirm the relevance of sexual deviance and there is a lack of consensus regarding the assessment of it. In the current study, 499 Dutch adult male subjects, admitted for sexual misconduct (possession of child abuse material, child molestation and other types of inappropriate sexual behaviour) to an outpatient forensic treatment facility, were compared regarding sexual paraphilias using self-reports from clients and official DSM-IV-TR diagnoses assessed by professionals. Analyses revealed a relatively low similarity between self-reports and diagnoses, self-reports generating considerably more information. Furthermore, correlating the paraphilias revealed paedophilia associated minimally with the other paraphilias. Lastly, the different types of offenders varied significantly in number of self-reported and diagnosed paraphilias, with the miscellaneous group presenting the most. Considering these outcomes may help assessment and target treatment goals in forensic psychiatry.     

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.     

The influence of brain abnormalities on psychosocial development, criminal history and paraphilias in sexual murderers

The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.     

Osteoporosis associated with the treatment of paraphilias: a clinical review of seven case reports

Osteoporosis and long-term androgen suppression in the treatment of paraphilias has been documented with surgical castration and the use of gonadotropin-releasing hormone agonists. The literature has suggested that the use of cyproterone acetate (CPA) may be protective against osteoporosis, although there are case reports of osteoporosis in men treated with CPA. This pilot study represents a case series of seven patients diagnosed with severe paraphilias and treated with CPA, leuprolide, or surgical castration. Two of the four patients treated with CPA developed significant osteoporosis, while the other two had normal bone density studies. The remaining three patients, one treated with leuprolide and two with surgical castration, had osteopenia. Based upon the current literature, the finding of significant osteoporosis in two of four patients treated with CPA, but not those treated with leuprolide or castration, is surprising. Monitoring of all patients treated with long-term androgen suppression for osteoporosis is suggested.     

Disorders of sexual preference and medicolegal issues thereof

Disorders of sexual preference or paraphilias are bizarre patterns of sexual behavior that have diverse manifestations and are of complicated sexual orientations. Some of these are harmless, while others are not, robbing sufferers and possibly their partners of loving sexual relationship. At least 40 paraphilias have been named, but the full extent of the field, perhaps, is still undiscovered. Recent studies have reported many paraphilias as long-term effects of sexual abuse in childhood, and the more frequent and persistent the abuse is, the worse the long-term psychologic, behavioral, and relationship problems. Psychopathology within this group of disorders may lead to criminal behavior, ranging from infringement of decency to some of the most heinous crimes known.     

Pedophilia on the Internet

The Internet provides adults and children with a medium for professional and personal communication throughout the world. As widespread communication in cyberspace grows exponentially, the potential for Internet-related crimes, such as cyberstalkng, has accelerated. Children are particularly vulnerable to sexual predators, such as pedophiles, on the Internet. This article reports cases of pedophiles who used the information superhighway to exploit child victims. Two models of pedophilia on the Internet are discussed: a trust-based seductive model and a direct sexual model. This article explores the role that mental health professionals may play in the assessment of Internet pedophilia. For example, mental health professionals may provide psychiatric treatment to victims of Internet pedophiles. Psychiatrists may be involved in the evaluation of perpetrators of Internet crimes in a clinical or forensic setting. Governmental agencies, the criminal justice system, school, or the media may request consultations by mental health professionals as part of a multi-disciplinary approach to prevention. Methods of government intervention are discussed.     

Depressive symptoms among female college students experiencing gender-based violence in Awassa, Ethiopia

Little epidemiologic research has focused on the mental health effects of gender-based violence among sub-Saharan African women. The objective of this study was to assess risk of depression and depressive symptoms among 1,102 female undergraduate students who were victims of gender-based violence. Students who reported experience of any gender-based violence were nearly twice as likely to be classified as having moderate depression during the academic year (OR = 1.98, 95% CI = 1.39-2.82) as compared with nonabused students. Compared with nonabused students, those who had experienced both physical and sexual abuse were 4 times more likely to report either moderately severe (OR = 4.32, 95% CI = 2.00-9.31) or severe depressive symptoms (OR = 4.19, 95% CI = 1.01-17.43). Our findings, consistent with previous studies, support the thesis that women's mental health status is adversely affected by exposure to gender-based violence.