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.

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

This review summarizes the brain mechanisms controlling sleep and wakefulness. Wakefulness promoting systems cause low-voltage, fast activity in the electroencephalogram (EEG). Multiple interacting neurotransmitter systems in the brain stem, hypothalamus, and basal forebrain converge onto common effector systems in the thalamus and cortex. Sleep results from the inhibition of wake-promoting systems by homeostatic sleep factors such as adenosine and nitric oxide and GABAergic neurons in the preoptic area of the hypothalamus, resulting in large-amplitude, slow EEG oscillations. Local, activity-dependent factors modulate the amplitude and frequency of cortical slow oscillations. Non-rapid-eye-movement (NREM) sleep results in conservation of brain energy and facilitates memory consolidation through the modulation of synaptic weights. Rapid-eye-movement (REM) sleep results from the interaction of brain stem cholinergic, aminergic, and GABAergic neurons which control the activity of glutamatergic reticular formation neurons leading to REM sleep phenomena such as muscle atonia, REMs, dreaming, and cortical activation. Strong activation of limbic regions during REM sleep suggests a role in regulation of emotion. Genetic studies suggest that brain mechanisms controlling waking and NREM sleep are strongly conserved throughout evolution, underscoring their enormous importance for brain function. Sleep disruption interferes with the normal restorative functions of NREM and REM sleep, resulting in disruptions of breathing and cardiovascular function, changes in emotional reactivity, and cognitive impairments in attention, memory, and decision making.

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Control of Sleep and Wakefulness

Theories of sexual aggression and victimization have increasingly emphasized the role of rape myths in the perpetuation of sexual assault. Rape myths are attitudes and generally false beliefs about...

Rape Myths In Review

Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.

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Assessing Risk for Sexual Recidivism: Some Proposals on the Nature of Psychologically Meaningful Risk Factors:

Structural equation modeling was used to study the characteristics of college men (N = 2,652) who aggressed against women either sexually, nonsexually, or both. According to the model, hostile childhood experiences affect involvement in delinquency, leading to aggression through two paths: (a) hostile attitudes and personality, which result in coerciveness both in sexual and nonsexual interactions, and (b) sexual promiscuity, which, especially in interaction with hostility, produces sexual aggression. In addition, sexual and nonsexual coercion were hypothesized to share a common underlying factor. Although its development was guided by integrating previous theory and research, the initial model was refined in half of the sample and later replicated in the second half. Overall, it fitted the data very well in both halves and in a separate replication with a sample for whom data were available about sexual but not about nonsexual aggression.

Characteristics of aggressors against women: testing a model using a national sample of college students.

This meta-analytic review examined the effectiveness of psychological treatment for sex offenders by summarizing data from 43 studies (combined n = 9,454). Averaged across all studies, the sexual offence recidivism rate was lower for the treatment groups (12.3%) than the comparison groups (16.8%, 38 studies, unweighted average). A similar pattern was found for general recidivism, although the overall rates were predictably higher (treatment 27.9%, comparison 39.2%, 30 studies). Current treatments (cognitive–behavioral, k = 13; systemic, k = 2) were associated with reductions in both sexual recidivism (from 17.4 to 9.9%) and general recidivism (from 51 to 32%). Older forms of treatment (operating prior to 1980) appeared to have little effect. Future directions for improving the quality of sex offender treatment outcome evaluations are discussed.

First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders.

Sexual aggression against children and adults is being recognized both by professionals and by the public as a significant problem for society (Badgley, 1984; Koss, Gidycz, & Wisniewski, 1987; Russell, 1982). In an attempt to address the problem, there have been attempts to more fully understand the individuals who perpetuate such abuse and to determine relevant target areas for treatment. This literature has produced numerous descriptive studies, personality assessment studies, and classification systems which have been well-reviewed previously (Knight, Rosenberg, & Schneider, 1985; Levin & Stava, 1987; Murphy & Stalgaitis, 1987; Prentky, Cohen, & Seghorn, 1985; Quinsey, 1984, 1986). All of these approaches provide some understanding of sex offenders, although they do not always clearly translate into specific treatment programs.

Assessment and Modification of Cognitive Distortions in Sex Offenders

Serial Multiple-Site Biopsies in Patients with Bladder Cancer

Findings of the Supreme Court in Kansas v. Hendricks (1997) raise a number of issues related to public policy, law, and mental health. The purpose of this article is not to reargue these issues, which are covered in a number of articles in this special issue. Instead, the purpose is to review the clinical literature, empirical literature, and standards of assessment and treatment within the sex offender field and to examine how these impact implementation of the laws. This article outlines an approach to operationalizing the concept of mental abnormality and describes accepted assessment approaches, validated risk criteria, and currently acceptable treatment approaches. Limitations of researchers current knowledge about implementing sexual predator laws are also discussed.

What we know and do not know about assessing and treating sex offenders.

The current study was designed to provide further information on characteristics of adolescent sexual offenders who have and have not experienced abuse. The subjects were approximately 300 adolescent offenders seen in a clinical treatment program. Abused and nonabused adolescent offenders were compared on a number of offense-specific variables and standardized instruments including the MMPI, Interpersonal Behavior Survey, Family Adaptation and Cohesion Evaluation Scale, and Self-Reported Delinquent Behavior Checklist. Results indicated that those offenders who were sexually abused had an earlier onset of their offending, had more victims, were likely to abuse both males and females, and tended to show more psychopathology and interpersonal problems, although no differences were found in terms of self-reported delinquent behavior of family functioning. The data are discussed in terms of their possible etiological significance and clinical implications.

William D. Murphy

Papers

First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders.

Assessment and Modification of Cognitive Distortions in Sex Offenders

Serial Multiple-Site Biopsies in Patients with Bladder Cancer

What we know and do not know about assessing and treating sex offenders.

Characteristics of Abused and Nonabused Adolescent Sexual Offenders