Current issues in the assessment and treatment of sexual offenders

The present paper reviews what is currently known about sexual abuse and the treatment of the offenders. Sexual offending is primarily committed by males and as many as 50% of females and 33% of males are sexually victimized in some way during their life. While some of these acts involve minimally intrusive behaviours (e.g. exhibitionists), many involve forced vaginal or anal intercourse and varying degrees of associated physical violence and deliberate humiliation of the victim. The effects on the victim can be severe and long‐lasting. Current theories of the aetiology of these behaviours incorporate biological and developmental factors occurring within a socio‐cultural context that fails to discourage sexual abuse. Experience is said to create a vulnerability that in some men finds expression in sexually abusive behaviour. Appropriate assessment targets the issues that are addressed in treatment, including: cognitive distortions, sexual behaviours and attitudes, social functioning and substance abuse. In addition, treatment also attempts to generate a set of relapse prevention plans for each offender. While some reports have not found benefits for treatment, the majority of acceptable studies have demonstrated clear reductions in re‐offending among treated sexual offenders. Copyright © 2000 John Wiley & Sons, Ltd.     

Personality mechanisms of alcohol-related violence

Personality variables involved in alcohol-related violence were studied by comparing MMPI scores of four different groups (N = 259): (1) men who committed murder while intoxicated (violent while intoxicated condition); (2) men who committed murder while sober (violent while sober condition); (3) those who were admitted to a psychiatric unit with a nonalcohol and nonviolence related problem (nonviolent and nonintoxicated condition); and (4) those admitted to a detoxification unit with no evidence of violence prior to admission (nonviolent but intoxicated condition). The violent groups were found to be more paranoid but less manic than the nonviolent groups. Men who commit murder while sober tend to be less interpersonally sensitive (low MF scores) but more psychopathic (high PD scores) than those who commit murder while intoxicated. Those who commit murder while intoxicated tend to be less psychologically minded (high L scores) than those who become intoxicated but who do not kill. Suggestions for prevention and treatment of violence and future research directions are proposed in light of these results.     

Depression,alcohol use,and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town,South Africa

HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. We compared younger (18–24 years old) and older (≥25 years old) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test and the Edinburgh Postnatal Depression Scale (EPDS). Among 625 women initiating ART, 16 % reported risky alcohol use and 21 % alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37 % of 18–21 years old versus 20 % of 22–24 years old reported alcohol-related harm (p = 0.02). Overall, 11 % of women had EPDS scores suggesting probable depression, and 6 % reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11 % in younger and 4 % in older women (p = 0.002). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women, and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma and intimate partner violence may be moderating factors. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population.

     

Gender-specific differences in alcoholism: Implications for treatment

Summary ¶Alcohol abuse and alcoholism cut across gender, race and nationality. In general, more men than women are alcohol dependent or have alcohol problems, but women are at greater risk for adverse effects and alcohol-related diseases. Death rates among female alcoholics are 50 to 100 percent higher than those of men. Major physiological impairments, the diagnostic distribution, the psychosocial consequences and their implication on treatment will be outlined.Received February 3, 2003; accepted March 11, 2003 Published online June 26, 2003     

Sexuality and the commission of physical violence to partners and non-partners by men and women

In 2 studies of physical violence and sexuality among college students, more than 75% of men and more than 60% of women reported committing physical violence in the past year, including more women to partners and more men to non-partners. More than 90% of men who committed violence to partners were also violent to non-partners. In Study 1, among 193 men and 203 women, people who committed violence had higher scores on sexual depression and general depression than did people who were not violent. People violent to non-partners had more sexual preoccupation and more alcohol use problems than did other people. In Study 2, among 160 college men and 138 college women, people in 4 violence groups did not differ in total sexual fantasies or sexual functioning. The findings support the importance of differentiating between violence toward partners and toward non-partners among both men and women and suggest a role of depression in partner violence and antisocial features in violence toward non-partners.     

Brief detection and co-occurrence of violence,depression and alcohol risk in prenatal care settings

Summary The purpose of the study was to examine the rates and inter-relationships among violence receipt, alcohol use problems, and depression in women seeking prenatal care. While waiting for their prenatal care appointment, women (n = 1054) completed measures of past year partner and non-partner violence receipt, alcohol misuse (TWEAK and quantity and frequency of alcohol use in past year), and depression (Center for Epidemiological Studies Depression Scale – CESD and prior history of depression). Over 30% of women reported either violence receipt, alcohol use problems or depression risk. Significant inter-relationships among all measured risk variables were found. Although violence receipt was significantly related to alcohol misuse, cigarette use, less education, and scoring above the cutoff on the CESD (≥ 16) was most strongly associated with violence. Practitioners should be well-equipped to provide assessment, interventions, or referrals as needed to the high numbers of women encountered in prenatal care settings experiencing psychosocial and behavioral problems that may affect their pregnancy.     

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.     

Offense type and two-point MMPI code profiles: discriminating between violent and nonviolent offenders

Offense data and MMPI profiles were examined for 67 men who had been remanded by the courts to a psychiatric hospital forensic unit for pretrial assessment. They were classified as violent or nonviolent offenders based upon the nature of their offenses. Violent offenders were those charged with assault, robbery, sexual assault, and all degrees of homicide. Nonviolent offenders were those charged with break, enter and commit, uttering threats, and fraud. The controversial issue of two-point MMPI code types (4-3, 4-8/8-4) was addressed. Neither of these commonly employed two-point types successfully discriminated between violent and nonviolent offenders.     

Gender differences in alcohol and substance use relapse

This review explores gender differences in relapse and characteristics of relapse events in alcohol and substance use. For alcohol, relapse rates were similar across gender. Although negative mood, childhood sexual abuse, alcohol-related self-efficacy, and poorer coping strategies predicted alcohol relapse, gender did not moderate these effects. Gender did moderate the association between marriage and alcohol relapse. For women, marriage and marital stress were risk factors for alcohol relapse; among men, marriage lowered relapse risk. This gender difference in the role of marriage in relapse may be a result of partner differences in problem drinking. Alcoholic women are more likely to be married to heavy drinking partners than are alcoholic men; thus, alcoholic women may be put at risk of relapse by marriage and alcoholic men may be protected by marriage. There are fewer studies documenting gender differences in substance abuse relapse so conclusions are limited and tentative. In contrast to the lack of gender differences in alcohol relapse rates, women appear less likely to experience relapse to substance use, relative to men. Women relapsing to substance use appear to be more sensitive to negative affect and interpersonal problems. Men, in contrast, may be more likely to have positive experiences prior to relapse.     

Mental health and HIV risk in men who have sex with men

Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as syndemic conditions), what is probably needed are combination prevention efforts, or prevention "cocktails," similar to treatment "cocktails," that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM.     

Amnesia for criminal offences

Nearly 10% of a sample of men charged with a variety of offences claimed amnesia for their offence. The amnesia occurred only among those who had committed violence and was most frequent following homicide. All the amnesics had a psychiatric disorder, four having a primary depressive illness and the remainder being almost equally divided between schizophrenia and alcohol abuse. None of the amnesias had any legal implications. The circumstances of the offences suggested a variety of mechanisms to account for the amnesia, including repression, dissociation and alcoholic black-outs. Psychological defence mechanisms were probably of some importance, even when alcohol was an important factor.     

Intoxication and violent women

Alcohol and drugs have been linked to severe violent offending among women as well as men. The purpose of this study was to make a contribution to the limited knowledge of characteristics related to the state of intoxication in violent female offenders. The putative differences in the characteristics of female offenders and their violent offenses in relation to the state of intoxication at the time of the violent offending were examined. Of a nation-wide sample of 109 female offenders found guilty of homicide and other violent crimes and incarcerated in 1999–2000 in Finland, 60 offenders participated in the study. Of these offenders 49 (81.7%) had been intoxicated at the time the of index offenses. These were compared with 11 (18.3%) non-intoxicated offenders using a structured interview, the Structured Clinical Interview II for DSM-IV (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). The prevalence of substance abuse or dependence (73.3% and 0%), personality disorder (89.6% and 36.4%), particularly antisocial personality disorder (66.7% and 0%), as well as a history of criminality (69.4% and 0%) were significantly higher among the intoxicated women than among the non-intoxicated. The PCL-R scores were also significantly higher among the intoxicated offenders than among non-intoxicated offenders. The victims of the intoxicated women (23.9%) were less often emotionally close to the perpetrator than were the victims of the non-intoxicated women (66.6%). No differences emerged between the groups in experiences of childhood and adulthood abuse or stressful life events prior to the index crime. The findings indicate that intoxicated violent female offenders exhibit more of the characteristics previously found in violent men, than do the non-intoxicated female offenders. Moreover, the non-intoxicated group comprises both psychotic non-responsible and non-psychotic, fairly well-adjusted women, who are educated, working or studying at the time of the offense and has no history of criminality. Substance misuse constitutes an obvious risk factor for violent behavior in women, and therefore the prevention should include substance abuse treatment.     

The occurrence of male-to-female intimate partner violence on days of men's drinking: the moderating effects of antisocial personality disorder

In this study, the moderating effects of antisocial personality disorder (ASPD) on the day-to-day relationship between male partner alcohol consumption and male-to-female intimate partner violence (IPV) for men entering a domestic violence treatment program (n=170) or an alcoholism treatment program (n=169) were examined. For both samples, alcohol consumption was associated with an increased likelihood of nonsevere IPV among men without a diagnosis of ASPD but not among men with ASPD (who tended to engage in nonsevere IPV whether they did or did not drink). Drinking was more strongly associated with a likelihood of severe IPV among men with ASPD compared with those without ASPD who also drank. These results provide partial support for a multiple threshold model of intoxication and aggression.     

Trauma-Informed HIV Prevention and Treatment

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the USA and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified eight studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention, interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the USA or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV-infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.     

Gender differences in factor structure of the Self-Administered Alcoholism Screening Test

Recent studies have revealed differences between men and women alcoholics in symptoms, consequences, and help-seeking behavior related to alcohol usage. Based on these findings, it was hypothesized that gender differences also would appear on alcohol screening instruments. The Self-Administered Alcoholism Screening Test (Colligan, Davis, & Morse, 1988; SAAST: Swenson & Morse, 1975) of 1,920 men and 1,775 women was subjected to a within-gender, principle–components, factor analysis with a varimax rotation. Gender differences at the component level were revealed. Men endorsed the “help-seeking for alcohol-related problems” component while women endorsed the “help-seeking for emotional problems” component. In addition, men expressed concern about receiving a psychiatric label while women expressed concern about receiving a drinker label. The results suggest that different items need to be used in screening women for alcohol-related problems. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 439–445, 1998.     

Characteristics of Child Maltreatment,Psychological Dissociation,and Somatoform Dissociation of Canadian Inmates

ABSTRACT

Data are presented on childhood maltreatment characteristics, psychological dissociation, somatoform dissociation, and offense types with a sample of 93 Canadian inmates (62 males and 31 females), with a mean age of 34 years (SD = 9.5). The present study includes findings based on the Child Maltreatment Interview Schedule-Short Form (CMIS-SF), the Detailed Assessment of Posttraumatic States (DAPS), the Multidimensional Dissociation Inventory (MDI), the Somatoform Dissociation Questionnaire (SDQ-20), and indices of violent and sexual offending during adulthood. Chi-square, Cohen's d, and regression analyses were conducted with the data. Results showed that women reported more childhood sexual abuse (CSA) than men, and men committed more violent and sexual offenses than women. Mean comparisons using Cohen's d statistic showed that inmates (N = 62) reported more trauma-related dissociation (DAPS) and more MDI dissociation compared to normative data for these instruments; however, inmates had lower somatoform dissociation scores when compared to published means of dissociative disorder, somatoform disorder, and eating-disorder patients. Inmates with CSA histories had higher SDQ-20 scores than those who did not. No differences were found between sex offenders and non-sex offenders in terms of probable PTSD, probable DID, MDI scales, or the SDQ-20. CSA that involved penetration predicted MDI dissociation and also predicted later sexual offending. Of the MDI scales, derealization and memory disturbance predicted sexual offending. Neither MDI scales nor any of the CMIS-SF maltreatment types predicted violent offending. Results are discussed in terms of treatment implications for incarcerated individuals with histories of child maltreatment.     

Patterns of denial in sex offenders.

Men convicted of sex offences (N = 102) were interviewed in two prisons. Cluster analysis was used to generate three groups according to pattern of denial; a fourth group was composed of men who denied their offence altogether. The groups differed in their ethnic make-up, offence type and past history of sexual offending.     

Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years

This article reports a comparison on outcomes of 26-year-old males who were defined several years ago in the Dunedin longitudinal study as exhibiting childhood-onset versus adolescent-onset antisocial behavior and who were indistinguishable on delinquent offending in adolescence. Previous studies of these groups in childhood and adolescence showed that childhood-onset delinquents had inadequate parenting, neurocognitive problems, undercontrolled temperament, severe hyperactivity, psychopathic personality traits, and violent behavior. Adolescent-onset delinquents were not distinguished by these features. Here followed to age 26 years, the childhood-onset delinquents were the most elevated on psychopathic personality traits, mental-health problems, substance dependence, numbers of children, financial problems, work problems, and drug-related and violent crime, including violence against women and children. The adolescent-onset delinquents at 26 years were less extreme but elevated on impulsive personality traits, mental-health problems, substance dependence, financial problems, and property offenses. A third group of men who had been aggressive as children but not very delinquent as adolescents emerged as low-level chronic offenders who were anxious, depressed, socially isolated, and had financial and work problems. These findings support the theory of life-course-persistent and adolescence-limited antisocial behavior but also extend it. Findings recommend intervention with all aggressive children and with all delinquent adolescents, to prevent a variety of maladjustments in adult life.     

Intimate partner violence during pregnancy in Vietnam: role of husbands

Intimate partner violence (IPV) perpetrators are often husbands. Understanding factors pertaining to women’s male partners is essential for programming interventions against IPV. The objective of the study was to describe husband-related social and behavioural risk factors and assess how they are associated with IPV during pregnancy. Cross-sectional data were collected among 1309 pregnant women with husbands in Dong Anh district, Vietnam. Information on sociodemographic characteristics of husbands, the husband’s behaviour and the husband’s involvement in pregnancy care was indirectly collected via women’s report at first antenatal care visit. Data on exposure to intimate partner violence during pregnancy were collected when the women returned for antenatal care in 30–34 gestational weeks. Logistic regression analyses were used to measure the relationships between IPV during pregnancy and risk factors from the husband. Pregnant women who had husbands who were younger or blue-collar worker/farmer/unemployed had more likelihood to be exposed to IPV. Women with husbands who drank alcohol before sexual intercourse and gambled were more likely to be exposed to IPV repeated times. Those with husbands who had intentions of having a child had over three times increased OR to be exposed to IPV once (AOR = 3.2, 95% CI 1.1–9.7). If the husband had a preference for sons, the woman had 1.5 times increased OR (AOR = 1.5; 95% CI 1.1–1.9) to be exposed to IPV repeated times during pregnancy. This study highlights significant associations between IPV and maternal perceptions of husbands’ behaviours and involvement in pregnancy. Findings may help to identify at-risk pregnant women to IPV and guide the development of targeted interventions to prevent IPV from husbands.

     

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.