TABLE 3 - uploaded by Judith V. Becker
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This article explores the demographic and criminal characteristics of a group of sex offenders currently residing in a facility for civilly committed sex offenders. Legal and clinical records were used and data coded. This sample is compared to published data on a group of civilly committed sex offenders in another state. Results indicated that the...
Context in source publication
Citations
... 4−6 For example, PNOS was diagnosed in 30−56% of individuals evaluated for civil commitment. 7,8 While SSD is relatively less common, the crimes committed by individuals with this condition are often more severe. SSD or CP+ may also result in harsher criminal justice measures, more intensive treatment programs, and violations of human rights for those diagnosed with the conditions. ...
Background
Valid and reliable diagnostic criteria are essential in forensic psychiatry and sexual medicine due to the severe implications of potential misdiagnoses. One challenge in this field is the poor operationalization of sexual sadism disorder (SSD) and coercive paraphilic disorder (CP+) definitions.
Aim
The aim of this scoping literature review is to provide a comprehensive overview of the key conceptual differences between SSD and CP+, as well as consider pragmatic and clinically useful approaches to their diagnostic formulation.
Methods
Arksey and O'Malley's methodological framework was followed. A literature search of Medline, PsychInfo, Web of Science, and Cumulative Index to Nursing and Allied Health Literature electronic databases was conducted. Publications in English describing the construct and/or operational definition of SSD or CP+ were included. Full-text studies were reviewed by 2 authors and data was charted and synthesized qualitatively.
Results
The initial search provided 1,271 records, after which 120 full-text papers were considered for eligibility and 48 studies were ultimately included. The most common sources of definitions for SSD and CP+ were the Diagnostic and Statistical Manual of Mental Disorders (n = 53) and the International Classification of Disease (n = 12). There was more variation of terms used for CP+ than SSD. Both CP+ and SSD are critiqued by reviewed literature for having low validity, reliability, and consistency, as well as being conflated with sexual crime. SSD is better described due to having diagnostic criteria and validated diagnostic tools.
Clinical Implications
Currently, clinicians rely mostly on the DSM to diagnose SSD or CP+. As applications of SSD and CP+ definitions vary, interpretations may not be generalizable between clinicians. Furthermore, specific diagnoses may be practically unhelpful and unreliable. It may therefore be beneficial for treatment to be determined by risk of harm. In addition to these concerns, the stigma associated with SSD and CP+ may also impact treatment.
Strengths & Limitations
Strengths of this study include duplicate review and charting to increase methodological rigor, transparent reporting to minimize publication bias, and encompassing a comprehensive scope. Limitations include the weaknesses of low strength of reviewed literature and risk of publication bias.
Conclusion
Despite their significant implications, the definitions of SSD and CP+ are inconsistent and lack reliability. Future research is necessary to develop stronger diagnostic criteria and tools.
Liu A, Zhang E, Leroux EJ et al. Sexual Sadism Disorder and Coercive Paraphilic Disorder: A Scoping Review. J Sex Med 2022;000:1–11.
... Studies examining the diagnostic practices of SVP evaluators reveal paraphilic disorders (e.g., pedophilic disorder or sexual sadism disorder) and/or personality disorders enumerated in past DSM manuals and the current fifth edition of DSM (DSM-5; American Psychiatric Association, 2013) as the most frequent acquired or congenital conditions (Becker et al., 2003;Levenson, 2004;Lieb, 1996;Perillo et al., 2014;Vess et al., 2004). The diagnostic practices of psychologist and psychiatrists retained by the defense in SVP commitment cases have not been examined empirically. ...
Prenatal alcohol exposure produces a broad range of primary disabilities that lead to adverse life course outcomes in children raised in adverse environments. Inappropriate sexual behaviors are a commonly occurring secondary disability, with a large minority of individuals with fetal alcohol spectrum disorder (FASD) displaying sexual aggression. Adults with FASD who commit repeated criminal sexual acts may be subject to legal proceedings for indefinite involuntary civil confinement as sexually violent predators/persons (SVP) in certain jurisdictions in the United States. Studies about the diagnostic practices among psychologists and psychiatrists retained by states to evaluate individuals as SVP do not recognize FASD as a mental disorder, despite the likelihood that hundreds of individuals petitioned for involuntary commitment suffer from FASD. Establishing an FASD diagnosis may provide exculpatory evidence to refute a government petition that an individual suffers from a mental condition that affects emotional or volitional capacity by predisposing the person to committing criminal sexual behavior. This article provides a framework for identifying, assessing, and deciding whether individuals with the FASD diagnosis suffer from the legally defined mental disorder that is necessary to indefinitely confine individuals as SVP.
... Common mental disorders associated with SVP evaluations include paraphilic, substance use, and personality disorders (Becker et al., 2003;McLawsen et al., 2012;Packard & Levenson, 2006). Pedophilic disorder and antisocial personality disorder (ASPD) were among the more commonly found diagnoses in studies of SVP cases across several states (McLawsen et al., 2012;Perillo et al., 2021). ...
Tests and diagnoses used in sexually violent predator (SVP) evaluations must be reliable, as reliability is foundational to validity. The current study contained a stratified sample of evaluations of 395 individuals referred as potential SVPs between 2012 and 2017. Each individual was initially evaluated by at least two experts. The sample included three groups: individuals not meeting SVP criteria ( N = 200, or 400 evaluations), individuals meeting SVP criteria ( N = 95, with 190 evaluations), and individuals where evaluators disagreed ( N = 100, with 200 evaluations). The sample also included 200 subsequent independent evaluations on these “disagree” cases. Static-99R score intraclass coefficient (ICC) interrater reliability was good to excellent within each group and overall. Evaluators scored the Static-99R within one point of each other 87% of the time. Cohen’s kappa diagnostic agreement for Pedophilic Disorder was substantial. ASPD and substance abuse kappa were in the “fair” range, while OSPD diagnoses in the positive group were at the “moderate” level of agreement. Ethnic differences in diagnoses were consistent with other studies, with equivalent Static-99R ICC values across ethnic groups. There were no significant differences between state civil servants versus contracted experts in Static-99R ratings or final determinations. The results suggest that Static-99R scores have acceptable reliability in these evaluations, and Pedophilic Disorder (the most common paraphilic disorder in our study) and OSPD can be reliably diagnosed. We discuss limitations of the study, as well as the need for care in high-stakes evaluations given the imperfect reliability of psychological measurements.
... Given this number, it is estimated between 58 and 1412 individuals housed in SVP civil confinement facilities suffer from FASD. However, FASD appears virtually unrecognized among individuals petitioned or committed as SVP when examining the diagnostic practices of evaluators who support petitions by states' attorneys for SVP civil commitment (Becker, Stinson, Tromp, & Messer, 2003;Levenson, 2004;Lieb, 1996;Perillo, Spada, Calkins, & Jeglic, 2014;Vess, Murphy, & Arkowitz, 2004). ...
... This experience revealed many instances where FASD was not recognized in respondents who likely had the disorder. 376 Consistent with the previously mentioned SVP diagnostic studies (Becker et al., 2003;Levenson, 2004;Lieb, 1996;Perillo et al., 2014;Vess et al., 2004), SVP evaluators who have concluded respondents meet legal criteria for involuntary civil commitment either failed to identify FASD or, when FASD was established by history, failed to appreciate the etiological significance of the disorder in explaining the history of sexual offending that provoked a petition for civil commitment. Instead, these evaluators contorted the primary and secondary disabilities in respondents' FASD to fit the symptom picture of a paraphilic disorder and/or personality disorder because such acquired or congenital conditions appeared logically linked to the emotional or volitional capacity that presumably predisposed people to committing criminal sexual acts. ...
... However, by convention SVP evaluators rely upon the DSM as foundation to substantiate the presence of an acquired or congenital condition (First & Halon, 2008). Categories of paraphilic disorders and/or personality disorders enumerated in past DSM manuals and the current fifth edition of DSM (DSM-5; APA, 2013) typically are specified as the acquired or congenital condition (Becker et al., 2003;Levenson, 2004;Lieb, 1996;Perillo et al., 2014;Vess et al., 2004). ...
Prenatal alcohol exposure (PAE) produces a broad range of primary disabilities (i.e., cognitive deficits) that lead to adverse life course outcomes (“secondary disabilities”) in children raised in adverse environments. Inappropriate sexual behaviors are a commonly occurring secondary disability, with a large minority of individuals with fetal alcohol spectrum disorder (FASD) displaying sexual aggression. Adults with FASD who commit repeated criminal sexual acts may be subject to legal proceedings for indefinite involuntary civil confinement as sexually violent predators (SVPs) in 21 of the United States and in federal jurisdictions. Studies that have examined the diagnostic practices of psychologists and psychiatrists retained by states to evaluate individuals as SVPs do not recognize FASD as a mental disorder, although extrapolated data reported in this chapter suggest hundreds of individuals petitioned for involuntary commitment as SVPs suffer from undetected FASD. Establishing an FASD diagnosis may provide exculpatory evidence to refute a government petition that an individual suffers from a mental condition affecting emotional or volitional capacity by predisposing the person to committing criminal sexual behavior. This chapter provides a framework for determining whether an FASD diagnosis in persons subject to possible SVP determination meets the legal requirements of a mental condition necessary to indefinitely commit people to civil confinement as SVPs. Recommendations are made for conducting a comprehensive forensic evaluation of this legal issue.
... At present, in addition to the presence of a persistent paraphilia (Criterion A) whose intrinsic intensity may vary over time, there are additional risk factors or characteristics that have been reported associated with repetitively enacted paraphilic sexual offending. These factors fall into five general domains: 1. Gender (male) 2. Age (inverse relationship) 3. Significant developmental adversity (especially in hands-on offenders) 4. Axis I psychopathology 5. Axis II psychopathology Although the research literature on sexual offenders, especially sexually violent repeat offenders, has focused on Axis II psychopathology (2)(3)(4), salient non-sexual Axis I psychopathology has also been noted. There are several reasons to assume that "non-sexual" Axis I psychopathology, especially if known to be associated with other manifestations of behavioral disinhibition (i.e., impulsivity), could be important to consider during the assessment and treatment of paraphilic sexual offenders. ...
Background
Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively).
Objective
The aim of this study was to describe the characteristics of the users of the Troubled Desire app.
Methods
The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire.
Results
The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities.
Conclusions
The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending.
... SVP-committed persons are, on average, approximately in their mid-forties (Jumper, Babula, & Casbon, 2012), with some variability across jurisdictions. SVPcommitted persons in Minnesota, for example, were found to be slightly younger at admission than were those in Arizona (Becker, Stinson, Tromp, & Messer, 2003;Janus & Walbek, 2000). Findings related to the victims of SVP-committed persons have been particularly variable: having adult, stranger victims (Janus & Walbek, 2000); having child victims (Levenson, 2004); and having both related and unrelated victims (Wrighten, Al-Barwani, Moran, McKee, & Dwyer, 2015) have all been associated with SVP commitment. ...
We examined statewide data of persons evaluated for sexually violent predator (SVP) commitment and compared risk-relevant data of three groups: those committed as SVPs (n = 374), those not recommended for commitment (n = 2,707), and those nearly committed (recommended for commitment but ultimately not committed; n = 117). Consistent with legal language for SVP commitment, binary and multinomial regression analyses revealed that risk scores predicted SVP commitment recommendations in addition to some historical factors (e.g., psychiatric history, never being married, prior sex offenses). For those recommended for commitment, prior sexual offenses predicted ultimate commitment. Those nearly committed had significantly higher sexual recidivism rates than did others who were not committed; however, these recidivism rates were still low (11.5%). Findings suggest that evaluators’ SVP decisions incorporate risk data and follow empirically supported trends; however, the observed recidivism rates of a subset of people that SVP commitment appears to target suggests that the potential for reducing sexual recidivism effectively and efficiently through commitment appears to be quite limited.
... Similarly, a study from Washington found the highest diagnoses to be pedophilia at 56.3%, and paraphilia not otherwise specified (nonconsent) was the second most common at 42.6% (Jackson & Richards, 2007). Becker et al. (2003) reported another familiar pattern among their civilly committed population, with the two most common diagnoses being pedophilia (63%) and paraphilia not otherwise specified (56%). McLawsen et al. (2012) found that Nebraska's SVP population was most likely to be diagnosed with pedophilia (76.9%), though still followed by ASPD (29.1%). ...
While military veterans have a lower overall rate of incarceration for criminal offenses than civilians, they have a higher rate of incarceration for violent sexual offenses. Despite military veteran overrepresentation among individuals adjudicated for violent sexual offenses, little is known about their risk factors for sexual offending. This study compared military veterans and civilians who had been involuntarily hospitalized and discharged pursuant to California’s Sexually Violent Predator Act. Pedophilic disorder appeared nearly twice as often among veterans than civilians (62.7% vs. 38.7%), whereas antisocial personality disorder was twice as common among civilians compared to veterans (48.1% vs. 23.9%). Consistent with the result for pedophilic disorder, veterans were more likely to target male victims age 13 and below, while civilians tended to target female victims over the age of 13. The results suggest different risk profiles for veterans compared to civilians who have been convicted of sexually violent offenses.
... SVPs are on average approximately in their midforties (Jumper et al., 2012), with some variability across jurisdictions. SVPs in Minnesota, for example, were found to be slightly younger at admission than those in Arizona (Becker et al., 2003;Janus & Walbeck, 2000). Findings related to the victims of those committed as SVPs have been particularly variable; having adult, stranger victims (Janus & Walbeck); having child victims (Levenson, 2004); and having both related and unrelated victims (Wrighten et al., 2015) have all been associated with SVP commitment. ...
We examined state-wide data of persons evaluated for Sexually Violent Predator (SVP) commitment and compared risk-relevant data of three groups: those committed as SVPs ( n = 374), those not recommended for commitment ( n = 2,707), and those nearly committed (recommended for commitment but ultimately not committed; n = 117). Consistent with legal language for SVP commitment, binary and multinomial regression analyses revealed risk scores predicted SVP commitment recommendations in addition to some historical factors (e.g., psychiatric history, never being married, prior sex offenses). For those recommended for commitment, prior sexual offenses predicted ultimate commitment. Those nearly committed had significantly higher sexual recidivism rates than others who were not committed; however, these recidivism rates were still low (11.5%). Findings suggest evaluators’ SVP decisions incorporate risk data and follow empirically supported trends; however, the observed recidivism rates of a subset of those SVP commitment appears to target suggests SVP commitment’s potential for reducing sexual recidivism effectively and efficiently appears to have a low ceiling.
... This perception of the "evil sex offender" would imply the belief that sex offenders choose to sexually offend. As with crime overall, however, there is no singular theory that can fully explain sex offending, but multiple explanations and risk factors for sex offending have been offered in the extant literature including explanations related to biological defects or imbalances (Aigner et al., 2000;Corley, Corley, Walker, & Walker, 1994;Wong & Gavel, 2018), mental illness (Ahlmeyer, Kleinsasser, Stoner, & Retzlaff, 2003;Becker, Stinson, Tromp, & Messer, 2003;Dunseith et al., 2004;Stinson & Becker, 2011;Vess, Murphy, & Arkowitz, 2004), past abuse sustained by the sex offenders (Dhawan & Marshall, 1996;Glasser et al., 2001;Groth, 1979;Levenson, Willis, & Prescott, 2016;Salter et al., 2003), exposure to pornographic materials (Dworkin, 1981;Morgan, 1977), and a lack of moral reasoning (Fernandez & Marshall, 2003;Van Vugt et al., 2012). ...
... While there is no specific mental illness that makes someone prone to sex offending, multiple studies have found high rates of various disorders among sex offender populations including anxiety disorders, depression, substance abuse disorders, and personality disorders (Ahlmeyer et al., 2003;Becker et al., 2003;Dunseith et al., 2004;Stinson & Becker, 2011;Vess et al., 2004). ...
Research is plentiful on perceptions toward sex offenders and the policies used to manage them, yet no studies have focused on belief in the cause of sex offending despite the role this may play in shaping attitudes toward sex offenders and support for sex offender policies. The present study examines the beliefs of community corrections professionals (n=209) and members of the general public (n=254) toward the cause of sex offending. Results showed little agreement amongst the community corrections professionals toward any particular cause, but with past abuse receiving the most support. The general public agreed with several potential causes of sex offending, but showed the most support for low morality among sex offenders. Also, for each potential cause of sex offending, the general public showed significantly greater belief than the community corrections professionals. Finally, several variables were shown to correlate with various beliefs in the cause of sex offending for both samples, but in different ways.
... Similarly, Elwood, Doren, and Thornton (2008) compared the diagnostic and risk profiles of 331 SVPs in Wisconsin held under that state's sexual offender statute with committed and referred sexual offender SVP samples from Washington (Jackson & Richards, 2007), Arizona (Becker, Stinson, Tromp, & Messer, 2003), and Florida (Levenson, 2004). This study found notable differences between the sexual offenders held in Wisconsin and those held in other states, including the frequency of pedophilia and paraphilia "not otherwise specified" (NOS) diagnoses and psychopathy scores. ...
... We then compared the Illinois SVP sample with available published data from seven other state civil commitment programs on available variables using appropriate 842 International Journal of Offender Therapy and Comparative Criminology 56 (6) statistical procedures (two sample t tests, π 2 , etc.). These studies included samples of individuals evaluated and referred for consideration in Texas (Boccaccini et al., 2008) and Florida (Levenson, 2004) or pursued for civil commitment in Wisconsin (Elwood et al., 2008), Washington (Jackson & Richards, 2007), California (Vess et al., 2004), Arizona (Becker et al., 2003), and Minnesota (Janus & Walbeck, 2000). For discussion purposes, we present a composite data set on available variables by averaging the findings from all eight states included in the study. ...
... For comparison purposes, SVPs were categorized as either White or all other racial minority groups. Using this approach, the Illinois sample was found to have a comparable percentage of racial minorities to that observed in Arizona (Becker et al., 2003), California (Vess et al., 2004), and Wisconsin (Elwood et al., 2008) but fewer racial minorities than Florida and Texas, χ 2 (2, N = 927) = 13.83, p < .001, ...
The records of 377 men civilly committed under Illinois’ Sexually Violent Persons Act were compared with similar published samples from seven other states. Civilly committed sexual offenders in Illinois were more likely to be diagnosed with any personality disorder and more likely to exceed the cutoff score for psychopathy than similar offenders in other states. We then present a national composite of demographic, victim and diagnostic information on men referred or pursued for civil commitment in eight states to better understand how these individuals differ from sex offender populations in correctional settings. Results suggest there may be less victim specificity in Sexually Violent Person (SVP) populations, as although nearly 50% of SVPs are diagnosed with pedophilia, 80% had committed at least one sexual offense against a child or adolescent victim. Across all samples, 72.7% of SVPs were diagnosed with a personality disorder, with Antisocial Personality Disorder the most prevalent.
