Altemative psychopharmacological interventions in the treatment of paraphilic disorders have previously been limited. This article briefly reviews previous psychopharmacological treatment as well as more recent therapeutic advances. During the past 5 years there have been 14 case reports or open trials documenting the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of paraphilics. The authors discuss the hypothetical role of serotonin in human sexual behavior and review the results of the efficacy of SSRIs in the treatment of these disorders. The limitations and possible indications of these medications are discussed. Although no double-blind placebo-controlled studies have been completed, the results seem to hold new promise for these alternative medications in the treatment of the paraphilic disorders and, possibly, in individuals with an inappropriately high sexual drive.
The purpose of this study is to examine the predictive accuracy of the Risk Matrix 2000 on an independent sample of 351 sexual offenders, followed in the community for an average duration of 11.4 years (range 0-20 years, SD = 4.4 years). For comparison purposes, this study also examines the predictive accuracy of two other risk assessment instruments, specifically modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide (SORAG). Results indicate that the Risk Matrix 2000 demonstrates convergent validity by correlating with the other risk assessment instruments. Moreover, the Risk Matrix 2000 is predictive of recidivism above chance levels, exhibiting medium to large effect sizes, although in general, the other two instruments, particularly the SORAG, are superior. Results also indicate differences in predictive validity when comparing 2-year, 5-year, and variable follow-up periods. Finally, a cumulative meta-analysis compares and integrates current findings with those obtained from the accumulation of previous studies, and new cumulative estimates are provided.
Exhibitionists have traditionally been regarded as nuisance offenders. However, empirical studies show that some offenders can be highly recidivistic and can escalate to incidents of Hands-on sexual assault. The objective of this study was to investigate predictors of recidivism in exhibitionists and clarify the differences between Hands-on and Hands-off sexual recidivists. Two hundred and twenty-one exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data came from medical files and police files. The Psychopathy Checklist - Revised (PCL-R) was assessed retrospectively. Results indicated that over a meanfollow-up period of 6.84 years, 11.7, 16.8, and 32.7% of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Sexual reoffending recidivists were less educated, and had more prior sexual and criminal offenses. Violent, recidivists were also less educated, had lower Derogatis Sexual Functioning Inventory (DSFI) scores, higher PCL-R Totals, and more prior sexual, violent, and criminal offenses. Criminal recidivists were younger, less educated, had lower DSFI scores, higher PCL-R scores, higher Pedophile Indices, and more prior sexual, violent, and criminal offenses. Hands-on sexual recidivists demonstrated higher PCL-R ratings, higher Pedophile and Rape indices, and more prior sexual, violent, and criminal offenses than did Hands-off counterparts.
The predictive validity of 2 risk assessment instruments for sex offenders, modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide, was examined and compared in a sample of 258 adult male sex offenders. In addition, the independent contributions to the prediction of recidivism made by each instrument and by various phallometric indices were explored. Both instruments demonstrated moderate levels of predictive accuracy for sexual and violent (including sexual) recidivism. They were not significantly different in terms of their predictive accuracy for sexual or violent recidivism, nor did they contribute independently to the prediction of sexual or violent recidivism. Of the phallometric indices examined, only the pedophile index added significantly to the prediction of sexual recidivism, but not violent recidivism, above the Static-99 alone.
Seventeen extrafamilial homicidal child molesters (HCM) were compared to 35 convicted extrafamilial child molesters (CM) who had not murdered, or attempted to murder, their victims. The two groups did not differ on age, IQ, education, history of marriage, or family history, although marriage rates of both groups were well below the national average. Similarly, both groups had high rates of features representing family instability. HCM more frequently victimized strangers. The results on the self-report psychological inventories, the Derogatis Sexual Functioning Inventory (DSFI) and the Buss-Durkee Hostility Inventory (BDHI), did not distinguish between the groups, although the DSFI revealed sexual inadequacy in both groups. The BDHI did not describe the groups as pathological. The Psychopathy Checklist—Revised Total Score, Factor 1, and Factor 2 described both groups as demonstrating high levels of psychopathy, with the HCM scoring significantly higher. Factor 1 and Factor 2 scores placed the HCM group in the 93rd and 82nd percentiles, respectively, compared to published norms for forensic patients. A greater proportion of HCM suffered from antisocial personality disorders and paraphilias, especially sexual sadism. Over 53% of the HCM, and none of the CM, were comorbid for pedophilia and sexual sadism. Significantly more HCM received three or more DSM III-R diagnoses. The phallometric assessments generally supported DSM diagnoses. The HCM demonstrated significantly higher levels of deviant arousal to pedophilic and adult assault stimuli. Police files revealed that, prior to the index offense, a significantly greater proportion of HCM had been charged with, or convicted of, violent nonsexual, and sexual offenses. The HCM had been charged with, or convicted of, more than 2.5 times as many criminal charges than the CM. A discriminant function analysis revealed that two variables, Factor 1 of the PCL-R and the number of violent entries in the police records, correctly predicted 78.6% of the HCM and 97.1% of the CM. Implications for understanding homicidal child molesters and for future research are discussed.
One hundred ninety-two convicted extrafamilial child molesters were followed for an average of 7.8 years after their conviction. The percentage of men who had committed a sexual, a violent, or any criminal offense by the 12th year was 15.1, 20.3, and 41.6, respectively. The sexual recidivists, compared with the nonrecidivists, demonstrated more problems with alcohol and showed greater sexual arousal to assaultive stimuli involving children than to mutually consenting stimuli with children. The violent recidivists, compared with the nonrecidivists, were more likely to have a history of violence in the families in which they were raised and were rated significantly more psychopathic on the Psychopathy Checklist—Revised (PCL-R). They also showed more sexual arousal to stimuli depicting mutually consenting sexual interactions with children than to adult stimuli. In terms of any criminal recidivism, recidivists were younger, had completed fewer years of school, and were raised in psychologically more harmful family environments compared with nonrecidivists. They also reported that, before 16 years of age, they were more likely to have been physically abused and were more likely to have been removed from their homes compared to those that did not recidivate. In addition, recidivists demonstrated more general hostility on the Buss-Durkee Hostility Inventory and were rated significantly more psychopathic on the PCL-R. The phallometric assessments revealed, that the criminal recidivists, compared to the nonrecidivists, showed more sexual arousal to stimuli depicting coercive sexual activity with children than consenting sexual activities with children. In addition, they showed more sexual arousal to scenes depicting adult rape then adult mutually consenting sex. Finally, the rcidivists also had more charges or convictions for violence and any criminal acts. The small number of significant differences between recidivists and nonrecidivists in the sexual and violent categories precluded an attempt to determine which combination of factors meaningfully predicted reoffending. However, for criminal recidivism, a stepwise discriminant function analysis to assess the combination of factors that most successfully distinguished between groups in terms of criminal recidivism was significant, with subjects' age, total number of criminal convictions, and pedophile assault index being retained for optimal prediction. The procedure correctly classified 70.6% of the original group, 82.8% of the nonrecidivists, and 52.6% of the recidivists. PCL-R Total Score alone was equally successful in a similar discriminant function.
This study examined whether there were variables that moderated the relationship between denial and recidivism among adult male sexual offenders. The first study (N=489) found that the relationship with sexual recidivism was moderated by risk (as measured by the Rapid Risk Assessment for Sexual Offense Recidivism) but not by psychopathy (as measured by the Psychopathy Checklist-Revised). Contrary to expectations, denial was associated with increased sexual recidivism among the low-risk offenders and with decreased recidivism among the high-risk offenders. Post hoc analyses suggested that the risk item most responsible for the interaction was "relationship to victims". For incest offenders, denial was associated with increased sexual recidivism, but denial was not associated with increased recidivism for offenders with unrelated victims. These interactions were substantially replicated in two independent samples (N=490 and N=73). The results suggest that denial merits further consideration for researchers as well as those involved in applied risk assessment of sexual offenders.
