Verläufe bei sexuellen Tötungen

This article summarizes main results of studies on forensic psychiatric court reports on 166 men who had been persecuted between 1963 and 1991 for a sexual offence leading to the death of the victim. Comparing perpetrators with a single victim and those with multiple victims we found similar results as in two previous studies with smaller samples: Multiple sexual homicide perpetrators showed more often sexual sadism and other paraphilias, as well as antisocial, schizoid and sadistic personality disorders. Follow-up data from the federal criminal records could be obtained for 139 offenders. Ninety perpetrators had been released after a mean detention of 12.2 years, whereas the 49 offenders who were still in prison or forensic psychiatric hospitals had been detained for a mean period of 20.6 years. The non-released offenders showed more often paraphilias as well as antisocial and sadistic personality disorders than the released perpetrators. Paraphilias and antisocial personality traits are empirically well proven risk factors for criminal recidivism with sexual reoffences. In addition, the non-released sexual homicide perpetrators had higher scores in all applied risk assessment instruments (PCL-R, HCR-20, SVR-20, Static-99). Among the released offenders only 1.1% (n=1) reoffended with a completed homicide and 2.2% (n=2) with attempted homicide. The recidivism rates with sexual and other violent reoffences in this sample of sexual homicide perpetrators were similar to those in a large meta-analysis on recidivism in sexual offenders by Hanson and Morton-Bourgon (4). Since well established risk factors had apparently been “used-up” for the decisions about release or non-release, in the follow-up data about the released offenders only age at the sexual homicide and age at the time of release were found as risk factors for recidivism with any violent (sexual or non-sexual) reoffence, i.e. the younger the offender at the time of the homicide and the younger at the time of release, the more likely is the risk of violent reoffending.     

Physical Attractiveness,Dangerousness, and the Canadian Criminal Code1

The Canadian Criminal Code contains provisions for labelling certain convicted criminal offenders as Dangerous Offenders. Sentences of indefinite duration are usually imposed on these offenders in place of the fixed sentences that would normally be imposed. The present study examined one potential source of bias in the use of the Dangerous Offender provisions, the physical attractiveness of an offender. Two hundred and eighty-four adults were given information about a hypothetical offender, including a facial photograph and a conviction record. They responded to questions about the dangerousness of the offender, including questions drawn from the Dangerous Offender criteria. Subjects perceived physically unattractive sexual offenders as significantly more likely to fulfill the Dangerous Offender criteria than average-looking and attractive sexual offenders. In particular, unattractive sexual offenders were seen as significantly less likely to restrain their behavior in the future. In light of the fact that there is currently no evidence that physical attractiveness is a valid predictor of sexual offender recidivism, this finding provides grounds to question whether the Dangerous Offender provisions of the Canadian Criminal Code, as they now stand, can be administered impartially.     

Differentiating Sexual Thoughts in Obsessive-Compulsive Disorder From Paraphilias and Nonparaphilic Sexual Disorders

Recurrent sexual thoughts characterize several different psychological disorders, most notably obsessive-compulsive disorder (OCD), paraphilias, and nonparaphilic sexual disorders (NPSDs). Many clinicians are aware of the rule of thumb that sexual thoughts in OCD are personally distressing, whereas sexual thoughts in paraphilias and NPSDs are not distressing to the individual experiencing these thoughts, and they rely on this heuristic to inform diagnosis. This is problematic because distress alone is not a reliable diagnostic differentiator; as a result, misdiagnosis is common. Given the negative consequences of misdiagnosis, including worsening of symptoms, treatment dropout, and potential harm to individuals experiencing these thoughts or those who are targets of these thoughts, the purpose of this paper is to help clinicians identify and differentiate repetitive sexual obsessions in OCD from repetitive sexual thoughts in paraphilias and NPSDs. A clinical case example is provided along with pivotal areas of questioning to aid in differential diagnosis.     

Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure

The phenomenon of adults who have sexual interests involving children as partners, or pedophiles, is considered among the most sociopathological of human conditions. Considerable literature is devoted to issues and problems associated with or related to pedophilia, including prevalence, etiology, treatment, and outcome studies. The sexual victimization of children, based upon data gathered from a number of sources, suggests an intractable problem that is national in scope. Recent manifestations of society's efforts to deal with the sexual victimization of children include the enactment of criminal sentencing laws that mandate the treatment of offenders with certain pharmaceutical agents, such as medroxy-progesterone acetate ("MPA"). Because sentencing laws as a rule vary widely from state to state, there is considerable variation as to who is subject to MPA treatment laws, and how such laws-including specific provisions, such as clinical criteria, if any, required for treatment; type and period of treatment plans; informed consent; etc-are implemented. Most important, these sentencing laws may have remarkably little relation to what is widely considered effective treatment for pedophilia disorders. We examine in detail the most recent sentencing laws pertaining to treatment of persons who have been convicted of sex offenses involving children as victims. Our critique may offer insight and suggestions as to how such sentencing laws can be more suitably tailored to the treatment needs of persons with pedophilia disorders.     

Sexual disorders not otherwise specified: compulsive, addictive, or impulsive?

Paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects. These paraphilias cause the suffering or humiliation of the patient or patient's partner, or children, or other nonconsenting persons. However, in many patients symptoms involve more culturally acceptable patterns (eg, repetitive masturbation, Internet pornography); such hypersexual symptoms have been labeled as compulsive, addictive, or impulsive. Growing evidence supports the existence of a discrete syndrome characterized by recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving patterns that fall outside the definition of paraphilia. There is, however, high comorbidity with paraphilia. While such symptoms have been labeled as sexual compulsion or addiction, these terms are problematic in this context. Modern nosology has neglected this entity, although the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), category of sexual disorders not otherwise specified includes hypersexual behaviors as an example. We suggest that the DSM-IV category of sexual disorders be modified to include explicitly diagnostic criteria for a disorder characterized by hypersexual symptoms involving patterns that fall outside of the current definition of paraphilia. The disorder might be classified as one of the paraphilias, or as paraphilia-related. In the absence of a comprehensive understanding of the pathogenesis of this disorder, we suggest that it simply be termed hypersexual disorder.     

SSRI Reduction of Nonparaphilic Sexual Addiction

The author presents two cases of nonparaphilic sexual addiction (NPSA) with comorbid depression and other psychiatric disorders in which symptoms were relieved during treatment with selective serotonin reuptake inhibitors. NPSA is defined and comorbid disorders, the neurotransmitter hypothesis of sexual function, treatment considerations, and evidence for an obsessive-compulsive disorder vs mood/affect dysregulation disorder etiology for these sexual symptoms are discussed.     

societal reaction to sex offenders: a review of the origins and results of the myths surrounding their crimes and treatment amenability

Examination of societal reaction to sexual offenders reveals a history of harshness exemplified by the sexual psychopath laws of the 1930s. The latest round of legal attempts to control sex offenders uses Severe sentencing laws, civil commitment procedures and community notification statutes to confine and shame sex offenders. This paper shows these laws to be based on popular beliefs about the predatory nature of these men, the probability of their re-offense and their amenability to treatment rather than the facts about the sex offenses and offenders. The severe reaction to sexual offenders is a vindictive one based on myth and misunderstanding that serves many interests. The paper exposes the contradictory myths and skewed emotions that guide our view of sex crimes and compares these with the facts about re-offense rates and the effects of treatment.     

Sexual sadism and sadistic personality disorder in sexual homicide

Controversies exist about the diagnostic validity of sexual sadism and its relation to sadistic personality disorder in sex offenders. The aim of this study was to investigate which diagnostic, developmental, and criminal characteristics differentiate sexual sadistic from non-sadistic sexual homicide perpetrators. Psychiatric court reports on 166 men who had committed a sexual homicide were evaluated regarding psychiatric, sexual and criminal history. Sixty-one offenders (36.7%) with sexual sadism (SeSd) were compared with 105 (63.3%) offenders without this diagnosis (NSeSd). Besides the sexual sadistic symptoms, there were seven factors that discriminated best between the two groups (sexual masochism, sadistic personality disorder, isolation in childhood, multiple sexual homicide, previous rape, previous tendencies for similar behavior, and long duration of the homicidal act). Sexual sadism is connected with circumscribed other characteristics and has to be considered in risk assessment and treatment of sex offenders.     

Community-based co-occurring disorder (COD) intermediate and advanced treatment for offenders

Against a backdrop of increasing concern about the adequacy of treatment for co-occurring substance use and mental disorders (typically known as "co-occurring disorders," or COD) in the criminal justice system, this article attempts to provide empirical evidence for a typology of levels of COD treatment for offenders in both prison and community settings. The paper investigates two levels of treatment programs for COD; "intermediate" programs, in which treatment programming has been designed primarily for offenders with a single disorder, and "advanced" programs, in which programming has been designed to provide integrated substance abuse treatment and mental health services. Findings from a national survey of program directors indicated that both intermediate and advanced COD treatment programs were similar in their general approach to substance abuse treatment, but differed considerably in their treatment of mental disorders, where the advanced programs employed significantly more evidence- and consensus-based practices. Results provide support for the distinction between intermediate- and advanced-level services for offenders with COD and support a typology that defines advanced programs as integrating a range of evidence- and consensus-based practices so as to modify treatment sufficiently to address both diseases.     

Treatment of Anxiety Disorders With Comorbid Depression: A Survey of Expert CBT Clinicians

Cognitive-behavioral therapy (CBT) is an empirically supported psychological treatment for anxiety disorders. These treatments have primarily been developed to target primary anxiety disorders, despite the fact that these disorders frequently co-occur with a diagnosis of depression. Empirical evidence provides guidance regarding how to treat an individual with a primary anxiety disorder with comorbid depression; however, there is limited data regarding how to translate these findings into clinical practice. Improving our understanding of how CBT is currently being used in practice among experts is integral to learning whether modifications to protocols lead to more or less effective treatments. Accordingly, we surveyed expert CBT clinicians about their assessment and treatment approaches and what challenges they face in formulating and treating mood and anxiety comorbidity. Most experts reported that their assessment includes a semistructured interview and self-report measures to determine breadth and hierarchical ordering of comorbidity severity. Symptom severity, client's goals, temporal onset of disorders, presence of suicide risk, and potential for early treatment success were reported as factors to consider when deciding where to begin treatment. Almost three quarters of experts surveyed indicated that they usually take some type of sequential treatment approach when treating primary anxiety disorders with comorbid depression. The top three reported challenges associated with treating comorbid presentations were client's motivation/energy, hopelessness/pessimism, and ongoing need for risk assessment. Implications for the nature and timing of CBT interventions in “real-world” clinical practice are discussed.     

Impact of personality disorders on treatment outcome for female assault survivors with chronic posttraumatic stress disorder

This study examined the impact of comorbid personality disorders on the outcome of cognitive behavioral treatment for women with chronic posttraumatic stress disorder (PTSD). Seventy-five adult women with PTSD resulting from rape or nonsexual assault in adulthood or sexual abuse in childhood were treated with prolonged exposure with or without cognitive restructuring. Assessment of personality disorders found that 39% of participants met DSM-IV criteria for some personality disorder diagnosis. No difference was found between women with and without personality disorders on the prevalence of PTSD at the end of treatment. Participants with a personality disorder were less likely to attain good end-state functioning, but this may be attributable to the fact that they started off slightly worse than those without personality disorders. Finally, the comorbid patients treated by community therapists fared as well or better than those treated by cognitive behavioral treatment experts in posttreatment prevalence of PTSD and end-state functioning.     

Social learning,sexual and physical abuse,and adult crime

This research examines the relationship between childhood physical and sexual abuse and the types of crimes committed by male adult offenders. We use the method of discriminant prediction to determine whether independent and dependent variables are related in ways that theories predict. Our analyses of data from the Survey of Inmates in State and Federal Correctional Facilities suggest that offenders model specific behaviors to which they have been exposed. Male offenders who were sexually abused as a child are more likely to commit sexual offenses, particularly sexual offenses against children, than nonsexual offenses. Offenders who were physically abused are more likely to engage in violent offenses than nonviolent offenses. Further analyses show that sexual offenders, and to a lesser extent violent offenders, are likely to specialize in those offenses. Our results are consistent with a social learning approach. They address a heretofore neglected issue: what exactly do children model when they are mistreated. Aggr. Behav. 35:489–501, 2009. © 2009 Wiley‐Liss, Inc.     

Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents

Despite high comorbidity rates and potential clinical implications, the influence of co-occurring attention-deficit/hyperactivity disorder (ADHD) on outcomes of cognitive-behavioral treatment (CBT) for anxious youth remains poorly understood. In this qualitative review, the current literature on the influence of comorbid ADHD on CBT of youth with diverse anxiety disorders is explored. Peer-reviewed studies examining ADHD, at the diagnostic and symptom level, received highest priority. In addition, inasmuch as some studies did not isolate the effects of ADHD from other disruptive behavior disorders (DBDs: oppositional defiant disorder, conduct disorders), studies with the three DBDs were explored as well. Ten studies met our specified methodological criteria. Findings are discussed in relation to the following two factors: type of anxiety disorder and measurement of ADHD (diagnostic or symptom level) in these studies. There was evidence that youth with a variety of anxiety disorders and with co-occurring ADHD fared worse than their counterparts without ADHD. Additionally, grouping ADHD with other DBDs tended to obscure the negative impact of ADHD on treatment outcomes. Additional research is needed to delineate the influence of comorbid ADHD specifically on treatment outcomes for the various anxiety disorders. Clinical implications of treating anxious youth with comorbid ADHD are explored.     

Rape and sexual assault in investigative psychology: the contribution of sex offenders' research to offender profiling

Research on sex offenders has mainly guided clinical practice for risk assessment and therapeutic intervention. However, the current scientific knowledge on these offenders and their crimes is, in many aspects, of great importance to criminal investigations. Consequently, there is a need to build bridges between investigative psychology and the research being conducted on sex offenders. Four areas of research on sex offenders that have clear implications to investigative psychology can be identified: (1) the consistency or ‘crime‐switching’ patterns of sex offenders; (2) the recidivism patterns of different types of sex offenders; (3) the police response to specific victim characteristics; and (4) the A → C equation of sexual assaults. This paper argues for a need to establish a dialogue between these two fields of research so that knowledge about sex offenders keeps growing whilst being able to inform policing practices in investigative psychology. Copyright © 2009 John Wiley & Sons, Ltd.     

Behavioural Profiles and Offender Characteristics across 111 Korean Sexual Assaults

Although the potential usefulness of the offence action–offender characteristic (A–C) relationships is widely accepted and operational ‘offender profiling’ units now exist around the world, few such relationships have been empirically established. To explore this, the offending action patterns within 111 sexual assault cases from South Korea were coded in terms of 16 distinctive, objective crime scene criteria and subjected to an agglomerative hierarchical cluster analysis. Background psychiatric and general characteristics, Personality Assessment Inventory (PAI) scale scores, and criminal histories were described for each cluster. The cluster analysis drew attention to six clusters or behavioural profiles within the sexual assaults. Cluster 1 included serial offenders who aggressively raped and robbed adult women, with some pseudo‐intimate sexual behaviour, in their homes. Two thirds of these offenders had histories of sexual assault. Cluster 2 included offenders who again targeted adults in their homes, but without pseudo‐intimate sexual behaviour. Cluster 3 included offenders who targeted adults outdoors at night. These offenders showed high antisocial personality PAI scores and psychiatric histories of sexual sadism. Cluster 4 included unarmed offenders who targeted adults in their homes without robbery. These offenders often had psychiatric histories of depression. Cluster 5 included offenders who targeted adults outdoors with a blitz‐style attack, and Cluster 6 included offenders who targeted minors outdoors, without weapons, using a confidence‐trick style of approach. Paedophilia and histories of psychiatric treatment were prominent amongst these offenders. The results indicate therefore some of the key empirical relationships that future research may develop as the basis for sexual assault ‘profiles’. Copyright © 2014 John Wiley & Sons, Ltd.