Resiliency in the Victim–Offender Cycle in Male Sexual Abuse

The prevalence of childhood sexual abuse in child molesters is considerably higher than that in the general population. This finding had led to the victim–offender cycle being popularized as an explanation for sexual offending. However, not all child molesters were victimized as children, so it is of interest to examine the factors that contribute to the victim–offender cycle or, conversely, resiliency. This study examined the moderating factors that may prevent a male victim of sexual abuse from entering the victim–offender cycle. Two groups were interviewed as part of the study: a resilient group (n = 47) and a victim–offender group (n = 41). After correction for age and education level, the resilient group were less likely to have fantasized and masturbated about the abuse, less likely to report deriving pleasure from the abuse, more likely to have had frequent social contact with adolescent peers and to have had more family and nonfamily support during childhood. The findings support the need for multifactorial models of resiliency, the victim–offender cycle, and sexual offending. Recommendations about the prevention of the victim–offender cycle are made, including the need for a thorough systemic assessment of all male victims of sexual abuse and the involvement of their family system in counseling.     

The Nature of Sexual Offenders' Affective Empathy: A Grounded Theory Analysis

The aim of this research was to investigate the nature of sexual offenders' affective empathy. Thirty-one men participating in a residential treatment program for child abusers constructed victim apology letters as a way of measuring/examining empathy deficits. The task was videotaped, transcribed, and subject to grounded theory techniques. It was discovered that intrafamilial offenders were more likely to minimize their behavior while exhibiting illicit power and control, whereas extrafamilial offenders were more likely to directly blame their victims and exhibit overtly explicit offense detail. From these open-coded categories, the axial categories of self as nonoffender, external blaming, and secondary victimization were derived. These results may have implications for the delivery of victim empathy components of sexual offender treatment programs.     

Emotional Congruence in Sexual Offenders Against Children

The tendency of some sexual offenders against children to display an exaggerated cognitive and emotional affiliation with childhood has been labeled emotional congruence by Finkelhor (1984) and as overidentification with childhood by others. This study consisted of an evaluation of emotional congruence in 194 men—homosexual and heterosexual pedophiles (N's = 41 and 31), heterosexual nonpedophilic incest offenders (N = 62), sexual offenders against women (N = 27), and nonsexual offender criminals (N = 33). A revised version of the Child Identification Scale (CIS-R) was used in combination with a semistructured interview (SSI) also intended to measure the construct. Maximum-likelihood factor analysis of the CIS-R generated eight factors. All subjects, particularly the nonsexual offenders, scored high on a factor indicating a wish to restart their lives. With respect to emotional congruence, results showed that only the homosexual pedophiles' scores indicated a preference for interacting with children on the child's level, while the incest offenders seemed to prefer to elevate their victims to adult status rather than fixating on the child role themselves. The group of heterosexual pedophiles, however, seemed to be motivated more by sexual gratification than by an emotional or relationship interest in their victims or children.     

Do Child Molesters Deliberately Fake Good on Cognitive Distortion Questionnaires? An Information Processing-Based Investigation

Researchers and clinicians hypothesize that child molesters hold offence- supportive beliefs or cognitive distortions that require restructuring for successful rehabilitation. However, there is little empirical evidence to support this hypothesis. Current questionnaire measures of both untreated and treated child molesters cognitive distortions show that these men typically disagree with cognitive distortions. Such findings, especially prior to treatment, are often interpreted to mean that child molesters are faking good. In this study we drew on personality-related research showing that when participants intentionally respond in a socially desirable way on questionnaires, they make faster item responses than when answering honestly. Untreated child molesters, treated child molesters, and two types of controls (nonsexual offenders and nonoffenders) were administered a computerized cognitive distortion questionnaire and their responses and response times were recorded. Consistent with previous research, all groups tended to disagree with the cognitive distortions. However, response time data were surprising; only the treated child molesters displayed the fake-good pattern of responding significantly faster in rejecting cognitive distortions. We speculate about the implications of these results for the cognitive distortion hypothesis, and for understanding how current treatment programs effect cognitive distortion change.     

Implications for Treatment of Sexual Offenders of the Ward and Hudson Model of Relapse

A group of 59 child abusers were classified as having either an avoidant (n = 15) or an approach (n = 44) goal regarding deviant sexual activity with children. Level of distorted beliefs about sexual activity with children (cognitive distortions) and distorted beliefs about their own victims (victim blaming attitudes) in both groups were measured before and after treatment. Results indicate that there was an overall reduction in the level of these distorted beliefs at the posttreatment stage in the approach group. Reductions were not found in the avoidant offenders as men in this group did not have distorted beliefs prior to treatment. Results are discussed in terms of appropriate targeting of treatment.     

Identifying sexual preferences in intrafamilial and extrafamilial child sexual abusers

Twenty-seven erotic and sexually neutral movie clips were shown to 191 men, consisting of 62 heterosexual intrafamilial child sexual abusers, 57 heterosexual and 25 homosexual extrafamilial child sexual abusers and 47 community controls. The stimuli depicted males and females from ages 6 to 25 years. Maximum penile volume changes were recorded during the 30 second stimulus presentations. Analyses showed that the phallometric test had high internal consistency (alpha=0.93) and revealed the expected erotic preference profiles for controls and extrafamilial offender groups. The homosexual group reacted most to 13–15 year old boys which made them more easily discriminated from the other groups. The intrafamilial offenders, however, overlapped considerably with controls and only 10% showed a pattern of penile responses expected for the classical pedophile, i.e., largest responses to female children. The pattern of results supported the accumulating evidence that child sexual abusers are heterogeneous in terms of their sexual preference profiles.     

Mnemonic distortion following behavior observation: Interactions of negative versus positive behavior valence,diagnostic label,and relative behavior frequency

To study how diagnostic labels, positive or negative behavior valence, and high versus low behavior frequencies affect distortion of memory for behavior, 72 undergraduates used an observation system to record occurrences of 10 negative and 10 positive behaviors shown on one of two videotapes of a child. Pilot testing had verified that one tape showed many negative but few positive behaviors, and that the other tape showed few negative but many positive behaviors. Just before viewing the tape, subjects were told either that the child was behaviorally disturbed or normal, or had been given no label. Exaggeration of observed frequencies at a 1-week recall was shown by significant and separate interactions of behavior valence and frequency, and of behavior valence and label. Specifically, negative behavior frequencies were exaggerated significantly at recall when the behaviorally disturbed or no label was present for both high and low frequencies of the negative behaviors. However, recalled frequencies of negative behaviors were exaggerated for the normal label only when they were low in frequency relative to positive behaviors. Positive behavior frequencies were exaggerated significantly in memory only if the normal label was used and then only if the positive behaviors had occurred at low frequencies relative to negative behaviors. No significant underestimation of previously observed behavior frequencies was found for either positive or negative behaviors. Implications of these findings for cognitive theories of memory and behavior, and for minimization of mnemonic stigma, are noted.We thank Laurie Kaslove for composing the videotapes used in this study, and Chris Beebe, Gail Morganstein, and Eric Pedersen for serving as experimenters.     

The concept of “baby lung”

Background The baby lung concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300–500 g aerated tissue).Discussion The respiratory system compliance is linearly related to the baby lung dimensions, suggesting that the acute respiratory distress syndrome lung is not stiff but instead small, with nearly normal intrinsic elasticity. Initially we taught that the baby lung is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the baby lung is a functional and not an anatomical concept. This provides a rational for gentle lung treatment and a background to explain concepts such as baro- and volutrauma.Conclusions From a physiological perspective the baby lung helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V_T/kg ratio but instead the V_T/baby lung ratio. The practical message is straightforward: the smaller the baby lung, the greater is the potential for unsafe mechanical ventilation.     

A Prospective Study of the Impact of Polygraphy on High-Risk Behaviors in Adult Sex Offenders

This study examined whether polygraph testing would result in sex offenders engaging in fewer high-risk behaviors. Fifty adult male sex offenders taking part in community treatment programs were allocated into 2 groups: Polygraph Aware subjects were told they would receive a polygraph examination in 3 months regarding their high-risk behaviors, while Polygraph Unaware subjects were told their behavior would be reviewed in 3 months. Relevant behaviors for each subject were established at baseline interviews, following which both groups were polygraphed at 3 months. All subjects were polygraphed again at 6 months. The hypothesis was that subjects in the Polygraph Aware group would have engaged in fewer high-risk behaviors, based on their self-report during the examination. Thirty-two subjects (64%) attended the first polygraph examination, with 31 (97%) disclosing an average of 2.45 high-risk behaviors each previously unknown to supervising probation officers. There was no significant difference between the two groups. Because of the high failure rate, all subjects were told to expect a second polygraph. Twenty-one subjects (42%) completed the second polygraph test, with 71% disclosing an average of 1.57 behaviors, a significant decrease compared with the first test. Disclosures to treatment providers and probation officers also increased. It was concluded that polygraph testing resulted in offenders engaging in less high-risk behavior, although the possibility that offenders fabricated reports of high-risk behaviours to satisfy examiners is also considered; similarly, offenders seemed to be more honest with their supervisors, but this only occurred after experience of the test itself. Feedback from offenders who completed the study, taken together with the high drop out rate, suggested that those motivated not to reoffend found polygraphy useful, while those less motivated sought to avoid it.     

Effects of a Relapse Prevention Program on Sexual Recidivism: Final Results From California’s Sex Offender Treatment and Evaluation Project (SOTEP)

Final results from a longitudinal investigation of the effectiveness of cognitive-behavioral treatment with sexual offenders are presented. The study was a randomized clinical trial that compared the reoffense rates of offenders treated in an inpatient relapse prevention (RP) program with the rates of offenders in two (untreated) prison control groups. No significant differences were found among the three groups in their rates of sexual or violent reoffending over an 8-year follow-up period. This null result was found for both rapists and child molesters, and was confirmed in analyses using time to reoffense as the outcome and those controlling for static risk differences across the groups. Closer examination of the RP groups performance revealed that individuals who met the programs treatment goals had lower reoffense rates than those who did not. Although our results do not generally support the efficacy of the RP model, they do suggest a number of ways in which this kind of treatment program can be improved. This study also emphasizes the importance of including appropriate control groups in treatment outcome research. Additional controlled investigations are needed to address the many questions that remain about when and how treatment works for sexual offenders.     

An evaluation of the Empat as a measure of victim empathy with civilly committed sexual offenders

Enhancement of victim empathy is a common component in the treatment of sexual offenders. However, consensus about the definition of empathy and the best instrument to measure empathy in sexual offenders is lacking. This paper evaluates the Empat as a measure of empathy with patients civilly committed under California's Sexually Violent Predator law. Rapists and child molesters in the current sample scored significantly higher in victim empathy than any of the original sex offender groups, with rapists scoring higher than the control group cited by M. McGrath, S. Cann, and R. Konopasky (1998). Clinicians have found the Empat to be too face valid and easily manipulated by patients within this population. The construct of empathy as applied to sex offenders is reviewed and the properties of a more adequate measure of this construct are suggested.     

Identifying violence-proneness in sex offenders

A total of 118 sex offenders were compared on two measures of violence-proneness (the Clarke Violence Scale or CVS and the Forensic Assessment of Violence or FAV) and the AECOM Coping Scales. The sex offenders were divided into 29 violent and 89 nonviolent cases, based on their criminal histories of sexual and assault offences. Both the CVS and FAV discriminated violent and nonviolent cases but improvements in the measures are needed. The AECOM Minimization, Mapping, and Reversal Coping Scales discriminated the two groups as well. The FAV results, especially, were influenced by test-taking response set. Distinctions between self-perceptions of violence and violent behavior are highlighted and discussed.     

Early evaluation of coagulase negative staphylococcus in blood samples of intensive care unit patients

Of 2160 intensive care unit patients, 36 patients with positive blood cultures had coagulasenegative staphylococcus in one blood bottle, whereas the organism was present in two or more bottles in 38 cases. The groups were not significantly different in 27 clinical variables, obtained at the time of their first positive blood culture. There was also no significant difference in the antimicrobial sensitivities. No initial clinical data supported the classification of coagulase-negative staphylococcus as either pathogen or contaminant.When the 74 patients with blood culture positive coagulase-negative staphylococcus were compared with three control groups (absent septicemia, probable septicemia and proven septicemia) they were not different from those with probable septicemia. A discriminant analysis was performed comparing patients with absent septicemia and with proven septicemia in an attempt to classify patients with isolates of coagulase-negative staphylococcus in one of these groups at an early stage. Patients with two or more positive blood cultures were not statistically classified more frequently as septicemic than patients with one blood bottle positive for this organism. However, patients categorized as septicemic had a significantly higher mortality (59%) than those classified as non-septicemic (35%) (p<0.05).     

Studies on the ultrastructure of blood cells and the microaggregate fraction in stored human blood

Electron microscopy of citrate-phosphatedextrose (CPD) buffered bank blood performed over 21 days shows that the normal architecture of erythrocytes, platelets and leucocytes disappears and that deformed organelles, leucocyte ghosts, cell fragments and microaggregates accumulate. Leucocytes and platelets emerge as the most sensitive indicators of blood deterioration showing profound morphological changes from the first day. Microaggregates which passed through a 20-m high capacity transfusion filter were identified as platelet conglomerates, leucocyte ghost and platelet-leucocyte ghost coaggregates with diameters of 6–20, 20–30 and 30–40 m respectively. of these aggregates present in the filtrate, 62% fell into the size range of 20–40 m. The composition of microaggregates varies with storage time, the platelet conglomerates appear first during or after Day 1, leucocyte ghosts after Day 5 followed by platelet-leucocyte ghost coaggregate formation. At this stage the number of intact leucocytes and platelets is reduced and the filtrate shows an abundance of leucocyte debris. Microfiltration would thus appear to reduce but not eliminate the danger of microembolism and damage to capillary endothelium.     

A study of the generation-of-alternatives process in social problem solving

This study evaluated three principles that have been recommended for generating alternatives in social problem solving: (1)quantity (i.e., the more alternatives generated the better), (2)deferment of judgment (i.e., it is better to generate alternatives without critically evaluating them at the same time),and (3)strategy-tactics (i.e., it is better to first generate a list of general approaches to the problem and then go back and generate specific means for implementing them).The results showed strong support only for the quantity principle. Data also suggested, however, that research should be done using more difficult test problems and subjects with greater deficits in social problem-solving ability before abandoning deferment of judgment and strategy-tactics procedures in social problem-solving training.     

Urinary excretion of cyclic AMP in bacterial infections

Summary Urinary cyclic AMP excretion was found to be increased in patients with severe bacterial infections and normal renal function. The observed changes appeared due to a combination of an increased filtered load plus augmented nephrogenous production in some patients; while in others, only an increase in the apparent nephrogenous production of cAMP could be found to account for the elevation in the total urinary excretion. Since total serum calcium was found to be low in most of these patients, increased PTH secretion to reduce urinary excretion of calcium may have been responsible for an increase in renal parenchymal production, and subsequent excretion of cyclic AMP. Although speculative, this theory is tenable in that ionized hypocalcemia exists in septic patients.Abbreviations cAMP cyclic 3, 5-adenosine monophosphate - PTH parathormone - ADH andidiuretic hormone - GFR glomerular filtration rate     

The Effects of Technology-Enhanced Anchored Instruction and Situated Learning on Preservice Teachers in a Special Education Methods Course: An Exploratory Study

This study measured the effects of a technology innovation termed anchored instruction or integrated media on the quality of examples used by students to support their answers on essay tests. Potential affects of anchored instruction on the ability of the students to remember examples of teaching strategies and student satisfaction were also measured. Results suggest the anchored instruction improves the quality of work for those students who received B's and C's in the course, but had little effect for those receiving A's. Student satisfaction relating to the anchored instruction was high. A focused interview of four of the 13 students who participated was conducted after student teaching. The information from these students suggests that the anchored instruction helped them to maintain the visual images over time and to better understand the instructional strategies learned during the course.     

Learning about new anesthetics using a model driven,full human simulator

Objective.New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. Methods.Patients and clinical settings in which remifentanil might provide clinical advantages over existing anesthetics were identified. A simulator curriculum was developed to demonstrate the use of remifentanil in the sample cases. The simulation was designed to highlight the clinical advantages and potential side effects of remifentanil. A screen displaying the concentrations of remifentanil in plasma and in the hypothetical effector site was developed. A simulator was modified (addition of an infusion pump and a pharmacokinetic screen display) and transported to several cities in the U.S.A. An instructor guided small groups of anesthesiologists and anesthetists through a structured program that enabled participants to observe drug effects in simulated patients. Results.There were 836 participants in the remifentanil program, which was offered in 58 cities in the U.S.A. Surveys were completed by 574 anesthesiologists. There was a significant difference in comfort level for using remifentanil after the session compared to before (Chi-square, p< 0.001.) The statement: Clinical simulation experience is a means to learn about new agents like remifentanilwas rated as excellent by 81% and as good by 19% of participants. No participant found the experience to be not useful. Conclusions.Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.     

A new method for the diagnosis of acute hemorrhagic-necrotizing pancreatitis using contrast-enhanced CT

Twenty-eight consecutive patients with a first attack of alcohol-induced pancreatitis were studied using contrast-enhanced CT. The findings on CT were then related to the course of the disease. The patients with acute hemorrhagic-necrotizing pancreatitis showed significantly lower enhancement values of the pancreatic parenchyma than those with milder forms of the disease.The next 20 patients with severe pancreatitis were scanned using a slightly modified procedure. The enhancement values were calculated and plotted on the graphs for the 2 former groups.Two categories of pancreatic enhancement were found: low enhancement and high enhancement. In all 10 patients with low-enhancement values surgery revealed hemorrhagic-necrotizing pancreatitis. In the 10 patients with highenhancement values conservative treatment was continued, and the clinical course was nonfulminant in all of them.     

Attitudes Toward Persons with Down Syndrome: The Impact of Television

This study examined the impact of different styles of television portrayal of a young adult male with Down Syndrome upon the attitudes of 92 undergraduate students. Their attitudes were considered using measures of beliefs, feelings of comfort, behavioral intentions, volunteering intentions, social desirability and variables associated with previous contact (quality and quantity of contact and media exposure). Participants were assigned to experimental conditions based on television viewing preferences. They viewed one of three programs: Man Alive: David (documentary), Life Goes On (drama), or My So Called Life (control). A multiple stepwise regression yielded a number of predictors of attitudes including: gender, experimental condition, quality and quantity of previous contact, prior media exposure, and social desirability.