The increasing recognition of the large number of people victimized by sexual assault has focused considerable attention on methods for deterring its perpetrators. In particular, law enforcement and mental health professions alike seek ways to prevent sex offenders from repeating their criminal behavior. Some evidence suggests sex offenders often continue offending even after incarceration or clinical treatment. However, recidivism rates for sex offenders are unusually hard to establish, owing to gross underreporting of sex crimes. This article presents a comprehensive review of empirical studies of sex offender recidivism. It brings together data from a wide variety of studies on both treated and untreated sex offenders of all types. Because of the variety and gravity of methodological problems in these studies, guidelines are discussed for sample selection and description, study design, criterion assessment, and data analysis. With these methodological principles in mind, the results of some 42 studies are examined for what they can tell us about sex offender recidivism and efforts to reduce it.

Sex offender recidivism: A review.

This article will present data gathered by the authors through structured clinical interviews of 561 paraphiliacs regarding demographic characteristics, frequency and variety of deviant sexual acts, and number and characteristics of victims. Results show that nonincarcerated sex offenders (1) are well educated and socioeconomically diverse; (2) report an average number of crimes and victims that is substantially higher than that represented in the current literature; and (3) sexually molest young boys with an incidence that is five times greater than the molestation of young girls. The relevance of these findings is discussed.

Self-Reported Sex Crimes of Nonincarcerated Paraphiliacs

Treatment outcome with sex offenders

Objectives. The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. Methods. The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990–2009 for SSRIs) (1969–2009 for antiandrogen treatments), supplemented by other sources, including published reviews. Results. Each trea...

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The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias.

We review a variety of theories that have been proposed to explain why adults become sexually interested in and involved with children All the theories appear to be directed to explaining one of four factors: (a) emotional congruence—why the adult has an emotional need to relate to a child; (b) sexual arousal—why the adult could become sexually aroused by a child; (c) blockage—why alternative sources of sexual and emotional gratification are not available; or (d) disinhibition—why the adult is not deterred from such an interest by normal prohibitions We illustrate how these four factors can be combined to explain more of the diversity in pedophilic behavior than is usually explained by single factor theories We also introduce the idea of viewing types of pedophilia on a continuum rather than in the traditional way of treating them as dichotomies

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Explanations of pedophilia: A four factor model

Sexual deviation disorders, or paraphilias, are diagnosable psychiatric syndromes manifested by 1) recurrent fantasies about deviant sex, 2) intense associated cravings, and 3) stereotypic behavioral responses. Pedophiles seek out children in response to their erotic thoughts and urges, whereas exhibitionists expose themselves. Paraphiliac syndromes ordinarily follow a chronic course and may be associated with biological pathology, but etiological factors are poorly understood. Treatment becomes a consideration when the well-being or rights of others are compromised. Proposed treatments have included psychotherapy, behavior therapy, surgery, and medication. Medroxyprogesterone acetate, which reduces testosterone, may diminish sexual preoccupation and urges, making self-control easier.

Carl F. Meinecke

Papers

Treatment of Sex Offenders with Antiandrogenic Medication: Conceptualization, Review of Treatment Modalities, and Preliminary Findings