A meta-analysis of 82 recidivism studies (1,620 findings from 29,450 sexual offenders) identified deviant sexual preferences and antisocial orientation as the major predictors of sexual recidivism for both adult and adolescent sexual offenders. Antisocial orientation was the major predictor of violent recidivism and general (any) recidivism. The review also identified some dynamic risk factors that have the potential of being useful treatment targets (e.g., sexual preoccupations, general self-regulation problems). Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism.

/pdf/the-characteristics-of-persistent-sexual-offenders-a-meta-19hgzia124.pdf

The Characteristics of Persistent Sexual Offenders: A Meta-Analysis of Recidivism Studies.

In order to facilitate comparisons across follow-up studies that have used different measures of effect size, we provide a table of effect size equivalencies for the three most common measures: ROC area (AUC), Cohen's d, and r. We outline why AUC is the preferred measure of predictive or diagnostic accuracy in forensic psychology or psychiatry, and we urge researchers and practitioners to use numbers rather than verbal labels to characterize effect sizes.

Comparing effect sizes in follow-up studies: ROC Area, Cohen's d, and r.

Context Psychopaths belong to a larger group of persons with antisocial personality disorder and are characterized by an inability to have emotional involvement and by the repeated violation of the rights of others. It was hypothesized that this behavior might be the consequence of deficient fear conditioning. Objective To study the cerebral, peripheral, and subjective correlates of fear conditioning in criminal psychopaths and healthy control subjects. Design An aversive differential pavlovian delay conditioning paradigm with slides of neutral faces serving as conditioned and painful pressure as unconditioned stimuli. Setting The Department of Medical Psychology at the University of Tubingen, Tubingen, Germany. Participants Ten male psychopaths as defined by the Hare Psychopathy Checklist–Revised and 10 age- and education-matched healthy male controls. The psychopaths were criminal offenders on bail and waiting for their trial or were on parole. The healthy controls were recruited from the community. Main Outcome Measures Brain activation based on functional magnetic resonance imaging, electrodermal responses, emotional valence, arousal, and contingency ratings. Results The healthy controls showed enhanced differential activation in the limbic-prefrontal circuit (amygdala, orbitofrontal cortex, insula, and anterior cingulate) during the acquisition of fear and successful verbal and autonomic conditioning. The psychopaths displayed no significant activity in this circuit and failed to show conditioned skin conductance and emotional valence ratings, although contingency and arousal ratings were normal. Conclusion This dissociation of emotional and cognitive processing may be the neural basis of the lack of anticipation of aversive events in criminal psychopaths.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/208744/yoa40213.pdf

Deficient Fear Conditioning in Psychopathy A Functional Magnetic Resonance Imaging Study

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

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.

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

Ethical Use of Antiandrogenic Medications

OBJECTIVE: Reporting of child sexual abuse is mandatory in all 50 states. Conceptual distinctions between privileged communications and mandatory reporting are reviewed, and the impact of recent changes in Maryland's reporting laws is examined. METHOD: Beginning in 1964 Maryland law required reporting if abuse was suspected when a physician examined a child. In 1988 reporting of disclosures by adult patients about child sexual abuse that occurred while they were in treatment was mandated. In 1989 all patient disclosures, even about such abuse that occurred before treatment, became reportable. During the period of statutory changes, the Johns Hopkins Sexual Disorders Clinic had kept track of adult patients who referred themselves for treatment and adult patients' disclosures of child sexual abuse. This allowed analysis of the impact produced by changes in the reporting requirements. RESULTS: 1) Mandatory reporting of disclosures about prior child sexual abuse deterred undetected adult abusers from entering treatment. The rate of self-referrals when such reporting became mandatory in 1989 dropped from approximately seven per year (73 over a 10-year period) to zero. This may have caused some unidentified children to remain at risk. 2) Mandatory reporting deterred patients' disclosures about child sexual abuse that occurred during treatment. In 1988 the disclosure rate during treatment dropped from approximately 21 per year to zero. This deprived clinicians of information important for early intervention. 3) Mandatory reporting failed to increase the number of abused children identified. The number identified secondary to such disclosures was zero. CONCLUSIONS: Optimal protection of children, as well as treatment for adult patients, may be better accomplished by legislation that supports options other than reporting. Language: en

Effects of statutes requiring psychiatrists to report suspected sexual abuse of children.

Paraphilias and the Internet.

Some have argued that actuarial methods such as the RRASOR, the MNSOST-R, and the Static-99, can outperform clinical judgments when utilized at a civil commitment hearing to make a prediction. Although actuarial data can be used to identify a group of persons to be considered for possible civil commitment, at present it cannot be used to accurately predict the likelihood of future acts of sexual violence with respect to any specific individual within such a group. For that reason, it might be best to restrict the use of actuarial data to the initial screening process, rather than introducing it at the commitment hearing itself.

Fred S. Berlin

Papers

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

Ethical Use of Antiandrogenic Medications

Effects of statutes requiring psychiatrists to report suspected sexual abuse of children.

Paraphilias and the Internet.

The use of actuarials at civil commitment hearings to predict the likelihood of future sexual violence.