Diagnostic and risk profiles among civilly committed sex offenders in Washington State

Since 1990, 17 states have passed legislation allowing for the civil commitment of a small number of sex offenders who are deemed at a particularly high risk for reoffense. Despite the very public and controversial nature of these laws, little is known about the individuals who are detained pursuant to them. The current article presents data on 190 civilly committed and detained sexually violent predators in Washington State. These sexual offenders suffer from a variety of mental illnesses. The modal offender is diagnosed with both an Axis I and an Axis II disorder. Furthermore, these offenders are at moderate to high risk for reoffense and present with a significant degree of psychopathy.     

Intimate partner violence and post-traumatic stress disorder symptoms in women: what we know and need to know

This article presents a review of knowledge regarding post-traumatic stress disorder (PTSD) in women experiencing intimate partner violence. Knowledge related to the prevalence and predictors of PTSD in battered women, the association between PTSD and physical health, and the emerging science regarding PTSD and physiological and immune parameters is addressed. Primary recommendations for future research includes the need for longitudinal and intervention research that incorporates a range of psychosocial and physiologic health outcomes.     

Executive functioning profiles of adult and juvenile male sexual offenders: A systematic review

Evidence regarding biological correlates of sexual offending, which might enhance the understanding, research, and treatment of these offenders, is rather emerging or in the embryonic stage. In this study, our main objective is to identify specific executive functioning (EF) processes that are commonly impaired in sexual offenders, and to further determine whether these differ as a function of offender subtypes. A search is conducted in ProQuest, Criminal Justice Abstract, EBSCOhost, and Social Science Citation Index electronic journal databases for studies published spanning the period 1990–2015. Google Scholar and Google search engines were also searched and the reference lists of the retrieved papers were searched for additional papers. A total of 1303 papers were retained for consideration. After removing duplicates, and subjecting the retrieved papers to inclusion and exclusion criteria, 24 papers (19 published and 5 unpublished) were deemed appropriate for the review. While several EF processes have been investigated, the available evidence implicates deficits in cognitive flexibility and inhibition of interference as commonly reported among adult male sexual offenders. This finding may be due to the sensitivity of tests of cognitive flexibility (e.g. the Wisconsin Card Sorting Test) and inhibition of interference (e.g. the Stroop Test) to frontal lobe lesions, and also because these tests are among the most frequently administered EF tests as revealed by this study. Juvenile sexual offenders, however, exhibit no distinct EF profiles. The findings of the study, implications for treatment, and recommendations for future studies are succinctly discussed.     

The psychological effects of solitary confinement on prisoners in supermax units: reviewing what we know and recommending what should change

This article examines the psychological consequences of short- and long-term solitary confinement for prisoners in the United States subjected to administrative or disciplinary segregation. Particular attention is paid to the use of secure housing units, alternatively known as control units or supermax units. These correctional entities allow for the isolation of convicts under conditions that offer little sensory stimulation and minimal opportunities for interaction with other people. The circumstances typically found in these units and the heightened potential for the abuse of prisoners are described. The connections between internment and mental illness-as well as isolation and race, gender, and class-are explored. A set of recommendations for the reform of secure housing is presented.     

Crime profiles and conditional release performance of psychopathic and non‐psychopathic sexual offenders

Purpose. This study investigated the influence of psychopathy and sex offender subtype on criminal history, probability of being granted conditional release, and performance while on conditional release in a diverse group of violent offenders. We predicted that psychopathic sexual offenders would be associated with relatively prolific violent and sexual offending, a high probability of successful conditional release applications despite their past behaviour (resulting from ‘putting on a good show’ in a parole hearing), and poor performance in the community. Methods. Information was gathered via a correctional file review of 310 Canadian male federal offenders. Offenders were categorized into groups based on their sexual offence history (non‐sex offender, rapist, child molester, or mixed rapist/molester) and Psychopathy Checklist – Revised (PCL‐R; Hare, 2003) ratings. Their offences (sexual, violent, or non‐violent) and their complete conditional release histories were coded. Results. Psychopathy was associated with more violent and non‐violent, but not sexual, offences. A significant interaction between psychopathy and offender subtype revealed that psychopathy was associated with a greater number of sex offences within child molesters. High‐psychopathy offenders (both sexual and non‐sexual offenders) were about 2.5 times more likely to be granted conditional release than non‐psychopathic offenders. Conclusions. Psychopathy is associated with more prolific sexual offending among child molesters and – despite their extensive criminal histories and high recidivism rate – a great proficiency in persuading parole boards to release them into the community. Specialized education and training in dealing with psychopathic offenders is urgently needed.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Comparing females acquitted by reason of insanity,convicted, and civilly committed in Florida 1977–1984

Females who had been acquitted by reason of insanity (N=41), convicted of comparable offenses (N=41), and involuntarily hospitalized without criminal involvement (N=41) were matched for age and race. The psychiatric histories of the acquitted and civilly committed women were similar, and significantly more extensive than the convicted group. The acquitted women had been arrested significantly more often than the civilly committed women but less frequently than the convicted women. Total length of stay (hospitalization or imprisonment) reflected a similar pattern, with civilly commited women hospitalized for the shortest period, acauitted women an intermediate period, and convicted women the longest. Regression-based prediction of length of stay reflected a number of common predictors for the acquitted and convicted women, with offense type one of the most powerful for both groups.     

Sexualization and lifestyle impulsivity: clinically valid discriminators in sexual offenders

Following clinical observations in this study a comparison was undertaken between nonsexualized rapists, sexualized rapists, and pedophilic child molesters in terms of psychometric measures, criminological data, and DSM-IV diagnoses following the authors' hypotheses that nonsexualized and sexualized rapists differ in respect of psychiatric comorbidity and criminal history and sexualized rapists and pedophilic child molesters are more similar as regards to psychiatric comorbidity (anxiety, depression, and aggression) and criminal history variables than nonsexualized and sexualized rapists are. Preliminary findings confirmed the hypotheses: the authors found significant differences between paraphilic and sexualized sex offenders on one hand--regardless whether they had offended against minors or adults--and a group of sex offenders exhibiting a history of high lifestyle impulsivity on the other hand. From a psychiatric clinical point of view, paraphilic or sexualized rapists could be shown to resemble more the pedophilic child molesters. Therapeutic approaches should take these findings into account.     

The relationship between physical and sexual abuse and drug use in a sample of juvenile detainees in Florida and a sample of committed youthful offenders in Colorado

The relationships between child physical and sexual abuse and illicit drug use are little understood and underinvestigated. Data gathered from a study of youths located in two different institutions for detained (Florida) and committed (Colorado) youthful offenders permitted an examination of this issue. The results indicate the youths' physical and sexual abuse experiences are significantly and positively related to their use of illicit drugs. The implications of these findings for further research are drawn.     

Vicarious trauma: a comparison of clinicians who treat survivors of sexual abuse and sexual offenders

This study compared vicarious trauma in a random sample of male and female clinicians who treat survivors (n=95) and those who treat offenders (n=252). A national survey was conducted with members of the Association for the Treatment of Sexual Abusers (ATSA) and the American Professional Society on the Abuse of Children (APSAC). These data were used to test the relative contribution of variables theorized to contribute to two vicarious trauma effects (avoidance and intrusions) using the Impact of Event Scale. The sample reported high levels of avoidance and intrusions. Variables associated with vicarious trauma differed based on client population served. Sequential regression analyses were used to examine theoretically derived variables. Implications for practice and further research are discussed.     

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM³), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.     

We all want it, but we don't know what it is: toward a standard of affordability for health insurance premiums

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148), or ACA, requires that U.S. citizens either purchase health insurance or pay a fine. To offset the financial burden for lower-income households, it also provides subsidies to ensure that health insurance premiums are affordable. However, relatively little work has been done on how such affordability standards should be set. The existing literature on affordability is not grounded in social norms and has methodological and theoretical flaws. To address these issues, we developed a series of hypothetical vignettes in which individual and household sociodemographic characteristics were varied. We then convened a panel of eighteen experts with extensive experience in affordability standards to evaluate the extent to which each vignette character could afford to pay for one of two health insurance plans. The panel varied with respect to political ideology and discipline. We find that there was considerable disagreement about how affordability is defined. There was also disagreement about what might be included in an affordability standard, with substantive debate surrounding whether savings, debt, education, or single parenthood is relevant. There was also substantial variation in experts' assessed affordability scores. Nevertheless, median expert affordability assessments were not far from those of ACA.     

Attachment styles and psychological profiles of child sex offenders in Ireland

When 29 child sex offenders, 30 violent offenders, 30 nonviolent offenders, and 30 community controls were compared, a secure adult attachment style was 4 times less common in the child sex offender group than in any of the other three groups. Ninety-three percent of sex offenders had an insecure adult attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control. With respect to anger management, the child sexual offenders' profile more closely approximated those of nonviolent offenders and community controls than that of violent offenders.     

Substance abuse among sexual offenders: review of research and clinical implications*

Substance abuse, and in particular alcohol abuse, has been linked to the aetiology and maintenance of violent offending generally and sexual offending specifically. The current paper reviews the literature pertaining to substance abuse among sexual offenders and highlights theoretical developments in the area. An emphasis on issues associated with the therapeutic alliance is stressed when working with high-risk clients who present with multiple needs, including alcohol abuse. The discussion concludes with some practical suggestions regarding assessment and treatment of groups of moderate- to high-risk offenders.     

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.     

Hope in the treatment of sexual offenders: the potential application of hope theory

Abstract

The present paper attempts to demonstrate how hope theory is conceptually consistent with current positive approaches to sexual offender treatment. Hope theory and its components of goals, pathways thinking, and agentic thinking is reviewed as defined by Snyder and his colleagues. A theoretical relationship exists between the role of hope and many aspects of sexual offending and treatment. Developmental course, attachment style, and the formation and maintenance of coping styles are reviewed as they relate to hope and sexual offending. A framework by which to apply hope theory to pre-treatment, treatment, and more specifically, self-management or relapse prevention for sexual offenders is proposed. Emphasis is placed on the use of techniques that target hope components, particularly in pre-treatment programs.     

Revisiting the use of pornography by sexual offenders: Implications for theory and practice

Abstract

Summary: This article examines the extant research on the use of pornography by sexual offenders and some of the debates engendered by such use. The analyses should assist in clarifying a number of issues of concern for all who work in the field of sexual offending.     

Sexual fantasy in paedophile offenders: Can any model explain satisfactorily new findings from a study of Internet and contact sexual offenders?

Purpose. There is widespread acceptance that sexual fantasy plays a role in sexual offences but little clarity as the nature of this relationship. This paper seeks to understand better the role of fantasy in offending behaviour through the study of sexual fantasy in Internet child pornography offenders when compared with contact offenders. Differences in the patterns of sexual fantasy associated with the different offender types are explored in order to understand how fantasy content is associated with contact offences with children and desisting from such direct acting out. Methods. Participants were all convicted of child sexual offences and recruited with the help of the probation and prison services. Out of these, 16 were Internet‐only offenders, 25 were contact offenders with no history of Internet offending and 10 were offenders with a mixed contact and Internet offending history. A variety of self‐completion questionnaires including fantasy were completed on an individual basis together with a detailed interview. Results. The most common sexual fantasies were typical adult‐male heterosexual fantasies though a variety of child‐oriented and other fantasies were also common. Contact offenders reported fewer girl‐oriented sexual fantasies although the groups did not differ in terms of terms of boy‐oriented fantasies. There was evidence that confrontational fantasies were commoner among contact offenders than Internet offenders. There are relationships between early sexual experiences and fantasy but peer sexual contacts seemed to be important rather than sexual abuse. Conclusion. Generally, the contact offenders seem to have less sexual fantasy pertinent to their offending than did Internet offenders. Fantasy deficit may be involved in contact offending against children.