Recidivism rates among child molesters and rapists: a methodological analysis

The Effectiveness of Schema Therapy in Individuals Who Committed Crimes: A Systematic Review

Research suggests that individuals who commit crimes often exhibit various early maladaptive schemas (EMSs). EMSs are a broad and pervasive theme or pattern consisting of memories, emotions, cognitions, and bodily sensations concerning oneself and one's relationships with others. Furthermore, EMSs play a crucial role in the onset and maintenance of different types of offending behaviors, highlighting the need to implement schema therapy (ST) for perpetrators. Therefore, the present systematic review assesses the effectiveness of ST for individuals who committed crimes. Four databases (PubMed, Scopus, Web of Science, and Scielo) were searched for studies examining the effectiveness of ST for individuals who committed crimes. Seventeen studies were identified, but only 15 met the criteria for inclusion. Results showed that ST can lead to beneficial effects in EMSs, schema modes, personality symptoms, and risk factors to commit crimes (e.g., cognitive distortions). However, the studies, besides being scarce, revealed some methodological limitations. ST is a promising therapy for individuals who committed crimes, despite the studies' methodological shortcomings, which prevent us from drawing more firm conclusions. Although promising, more research is needed to enhance our understanding of the impact of ST therapies in forensic settings.

Recidivism risk in male adult sex offenders with psychopathic traits assessed by PCL-R: A systematic review

Psychopathy has been empirically associated with various forms of antisocial behavior including sexual assault. In fact, the lack of empathy characterizing psychopathic offenders may facilitate the perpetration of more extreme violence. This systematic review aims to explore the relationship between psychopathy traits in male adult sex offenders and the increase in recidivism risk for any type of reoffence, with a special focus on sexual recidivism. From an initial sample of 757 articles related to the topic, only 14 were selected from the current literature at the end of the inclusion process. Each of these assessed the relation between psychopathy traits (measured by PCL-R) and recidivism risk in male sex offenders (age > 18), providing an effect size (quantitative findings). The results of their analysis agree with the currently available literature: the presence of psychopathic traits in sex offenders would seem to correlate with an increased risk of recidivism of general but non-sexual. Furthermore, almost half of the included works highlighted a positive relationship between psychopathy and violent reoffences. However, the limited availability of studies and the unevenness in their results indicate the need to expand future research in this direction.

Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up

Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.

Improving Our Risk Communication: Standardized Risk Levels for Brief Assessment of Recidivism Risk-2002R

A Five-Level Risk and Needs system has been proposed as a common language for standardizing the meaning of risk levels across risk/need tools used in corrections. Study 1 examined whether the Five-Levels could be applied to BARR-2002R (N = 2,390), an actuarial tool for general recidivism. Study 2 examined the construct validity of BARR-2002R risk levels in two samples of individuals with a history of sexual offending (N = 1,081). Study 1 found reasonable correspondence between BARR-2002R scores and four of the five standardized risk levels (no Level V). Study 2 found that the profiles of individuals in Levels II, III, and IV were mostly consistent with expectations; however, individuals in the lowest risk level (Level I) had more criminogenic needs than expected based on the original descriptions of the Five-Levels. The Five-Level system was mostly successful when applied to BARR-2002R. Revisions to this system, or the inclusion of putatively dynamic risk factors and protective factors, may be required to improve alignment with the information provided by certain risk tools.

The problem with assumptions: Revisiting "The dark figure of sexual recidivism"

What is the actual rate of sexual recidivism given the well-known fact that many crimes go unreported? This is a difficult and important problem, and in "The dark figure of sexual recidivism," Nicholas Scurich and Richard S. John (2019) attempt to make progress on it by "estimat[ing] actual recidivism rates . . . given observed rates of reoffending" (p. 171). In this article, we show that the math in their probabilistic model is flawed, but more importantly, we demonstrate that their conclusions follow ineluctably from their empirical assumptions and the unrepresentative empirical research they cite to benchmark their calculations. Scurich and John contend that their analysis undermines what they call the "orthodoxy in academic circles" (p. 173) of low sexual recidivism rates among individuals convicted of sexual offenses, but we underscore that their article does not analyze data in the traditional sense; instead, it just interprets past scholarly work through the use of strong assumptions in a way that, for practitioners, is likely to be opaque and misleading (and, for us, strays into speculation, argument, or advocacy and away from objective research). Our simple calculations show that their findings are highly sensitive to their assumptions, and we conclude that courts and others should recognize Scurich and John's work for what it is-a set of complex hypotheticals that are no more reliable than what judges and lawyers accomplish on their own by simply recognizing the basic problem that not all sexual offenses are reported.

Illuminating the dark figure of sexual recidivism

Detected or reported ("observed") rates of sexual reoffending have long been recognized as underestimating the occurrence of actual sexual recidivism. Past attempts to bridge the gap between the two rates have been unsuccessful. Scurich and John try to reverse this course by presenting a simulation model to estimate the predicted actual sexual recidivism rates among individuals convicted of sexual offenses based on three parameters; they also apply these data to calibrate the sexual recidivism rates from four sexual recidivism studies. The accuracy of the predicted actual sexual recidivism rates is wholly dependent upon the reliability of the inputs to the model. This analysis relies upon scientific studies and literature to delve into the precision of the parameters of Scurich and John in relation to the accuracy of their predicted actual sexual recidivism rates and the validity of the calibration process. The results reveal that some of the assumptions by Scurich and John about the parameters are supported empirically, while others are not. Overall, the simulation model parameters suffer from significant deficiencies that likely produce inaccurate predicted actual sexual recidivism rates. Moreover, the methodologies of the comparison studies used in the calibration process do not actually meet the requirements of the analytic strategy of Scurich and John, which effectively invalidates their findings. Until computational strategies are employed that account for linear and nonlinear effects of model parameters, closing the gap between observed and actual sexual recidivism rates will remain elusive.

Improving the quality of sexual history disclosure on sex offenders: Emphasis on a polygraph examination

The increasing recidivism rate of sex offenders indicates potential problems in existing recidivism programs. The present study was conducted to determine whether the polygraph examination is a useful technique to obtain a sex offender’s concealed past sexual history. We collected fifty-two sex offenders’ data and analyzed it. Among the 52 participants, the court ordered 26 sex offenders to take the psychiatric evaluation and the polygraph test. The other half were prisoners at the hospital who were currently undergoing treatment. The participants in the polygraph group disclosed more deviant sexual behaviors and paraphilia interests/behaviors than the comparison group. Thus, the polygraph examination is a powerful tool that can encourage sex offenders to disclose hidden information to help create suitable psychological therapy programs for preventing recidivism in the future.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

Recidivism rates of sex offenders managed under the Dangerous Prisoners (Sexual Offenders) Act 2003: an evaluation of actuarial justice

According to the Dangerous Prisoners Sexual Offenders Act 2003 (DPSOA), an offender is considered 'dangerous' if there is an 'unacceptable risk' that he will commit 'serious sexual harm'. Current legislation operates within an actuarial justice framework, whereby increasing resources are spent on those considered at greater risk. There is limited research on the efficacy of this approach. The current study examines sexual recidivism rates of a sample of DPSOA offenders. Court files of 104 community-supervised dangerous sex offenders (M age = 50.7 SD = 10.8) were examined to determine date and type of re-offending. Recidivism was operationalised as time until arrest (for a sexual conviction/contravention). The overall level of sexual recidivism was low (7.69%). Kaplan-Meier analyses of survival curves identified no difference in rates between risk categories. While this likely suggests that they are not dangerous or an unacceptable risk, the strict conditions of supervision may be effective in preventing sexual re-offending. Further, limitations in empirically understanding the construct need to be considered.

Evaluating the legal assumptions of Victoria's Sex Offender Registration Act 2004 from a psychological perspective

The Sex Offender Registration Act 2004 was introduced in Victoria to decrease recidivism and aid in future investigations and prosecutions. This article reviews literature to evaluate four assumptions inherent to the Act: (a) sexual offenders are more dangerous than non-sexual offenders; (b) sexual offenders who target children are more dangerous than those who target adults; (c) recidivism risk can be accurately assessed for sexual offenders who target adults; and (d) the Act is a useful tool for investigations and prosecutions. The findings suggest that there is little evidence that supports the assumptions. Further, given the relatively narrow scope of the Act, it is unlikely to have a positive impact on the safety of the community.

The Etiology of Risk in Sexual Offenders: A Preliminary Model

Sexual offender risk assessment practice is considered by many to be atheoretical. The identification of the most predictive risk factors and tools has typically overshadowed questions about etiology. To gain insight into the origins of criminal behavior among sexual offenders, we developed and validated an etiological model of risk based on the theoretical framework of Beech and Ward. Our model focused on persistence rather than onset, and encompassed both the sexual and nonsexual criminal activity of these offenders. It comprised two pathways. The first was characterized by sexual victimization, social isolation, and early deviant sexual fantasies. It led to a prolific involvement in sexual criminality (especially toward children) and predicted sexual recidivism. The second pathway was characterized by externalization problems, sexual promiscuity, and physical/psychological victimization, and was associated with nonsexual offending and serious sexual offenses directed (mostly) toward women. It predicted all types of recidivism.

The dark figure of sexual recidivism

Empirical studies of sexual offender recidivism have proliferated in recent decades. Virtually all of the studies define recidivism as a new legal charge or conviction for a sexual crime, and these studies tend to find recidivism rates of the order of 5-15% after 5 years and 10-25% after 10+ years. It is uncontroversial that such a definition of recidivism underestimates the true rate of sexual recidivism because most sexual crime is not reported to legal authorities, a principle known as the "dark figure of crime." To estimate the magnitude of the dark figure of sexual recidivism, this paper uses a probabilistic simulation approach in conjunction with the following: (i) victim self-report survey data about the rate of reporting sexual crime to legal authorities; (ii) offender self-report data about the number of victims per offender; and (iii) different assumptions about the chances of being convicted of a new sexual offense given that it is reported. Under any configuration of assumptions, the dark figure is substantial, and as a consequence the disparity between recidivism defined as a new legal charge or conviction for a sex crime and recidivism defined as actually committing a new sexual crime is large. These findings call into question the utility of recidivism studies that rely exclusively on official crime statistics to define sexual recidivism, and highlight the need for additional, long-term studies that use a variety of different measures to assess whether or not sexual recidivism has occurred.

The Predictive Validity of the Static-99, Static-99R, and Static-2002/R: Which One to Use?

The use of Static tools (Static-99, Static-99R, Static-2002, and Static-2002R) in risk decision making involving sexual offenders is widespread internationally. This study compared the predictive accuracy and incremental validity of four Static risk measures in a sample of 621 Australian sexual offenders. Results indicated that approximately 45% of the sample recidivated (with 18.8% committing sexual offenses). All of the Static measures investigated yielded moderate predictive validity for sexual recidivism, which was comparable with other Australian and overseas studies. Area under the curve (AUC) values for the four measures across the 5-, 10-, and 15-year intervals ranged from .67 to .69. All of the Static measures discriminated quite well between low-risk and high-risk sexual offenders but less well for the moderate risk categories. When pitted together, none of the tools accounted for additional variance in sexual recidivism, above and beyond what the other measures accounted for. The overall results provide support for the use of Static measures as a component of risk assessment and decision making with Australian sexual offending populations. The limitations of this study and recommendations for further research are also discussed.

Pharmacological interventions for sex offenders: A poor evidence base to guide practice

Although a significant proportion of prisoners and patients in secure hospitals are sex offenders and victim surveys reveal a high level of hidden sexual victimisation, the authors of this Cochrane review found only very limited support for pharmacological intervention with sex offenders. Given the nature and extent of the problem of sexual offending and the promise shown by new drugs, there is a need for clinical scientists, lawyers and ethicists to rise to the challenge of ascertaining the effectiveness and safety of drugs which are being used to treat sex offenders, some involuntarily, without the evidence base to justify confidence as to their effectiveness and safety.

A Longitudinal Outcome Evaluation of a Prison-Based Sex Offender Treatment Program

Sex offender outcome studies continue to produce mixed results. A common critique of these studies is their lack of methodological rigor. This study attempts to address this critique by adhering to the standards established by the Collaborative Outcome Data Committee (CODC) aimed at increasing the quality and confidence in outcome studies. We examined recidivism outcomes for a sample of formerly incarcerated sex offenders who participated in a state prison-based cognitive-behavioral-skills-based treatment program. We used propensity score analysis to compare treatment participants with a matched sample of non-participants. The final sample post-matching ( n = 512) was observed for a minimum of 4 years and a maximum of 14 years. Using survival analysis, findings indicate that there were no differences in recidivism rates between treatment participants and non-participants in sexual or violent crimes. However, participants demonstrated significantly lower rates of recidivism for non-violent crimes. We discuss strengths, limitations of the study, and implications of these findings.

The Development of In Vivo Measures to Assess the Impact of Sex-Drive Reducing Medications in an Offender with an Intellectual Disability

The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.

Examining the Continuity of Juvenile Sex Offending Into Adulthood and Subsequent Patterns of Sex and General Recidivism

Current sex offending legislation and public opinion present an image of sexual offenders as specialized predators who are likely to exhibit continued sexually deviant behavior over the life-course. Although sex offending continuity and post-release recidivism has been independently assessed in prior research, the potential link between sex offending continuity and post-release recidivism has yet to be investigated. Using data collected at two different time points from a sample of sex offenders who served a prison sentence for an adult sex offense, the present study examines the prevalence of sex offending continuity, and its potential linkages with subsequent sex and general recidivism as well as identifying risk factors related to these outcomes. The multivariate results indicate a low rate of sex offending continuity in general but suggest the presence of identifiable risk factors that predict sex offending continuity. Specifically, non-sexual juvenile offending is the most notable of the numerous risk factors found to be associated with those displaying sex offending continuity from adolescence into adulthood. Subsequent analyses also reveal a significant association between sex offending continuity and sexual recidivism but not general recidivism. Policy implications, study limitations, and directions for future research are also discussed.

The Effect of Social Bonds on Successful Adjustment to Probation: An Event History Analysis

Recent studies of the effect of social bonds on offenders' adjustment to probation have produced mixed results, with some suggestion that successful adjustment is the result of the deterrent effects of probation supervision rather than the stabilizing effects of social bonds. This article reports the results of a study of child molesters entering probation and is thus focused on an offender population that maximizes the physical and social estrangement from society. The article uses measures of employment and of the quality of social relationships with family and friends to test the hypothesis that social bonds will significantly affect successful adjustment to probation supervision. An event history analysis of the data provides rather uniform support for the hypothesis that positive social bonds enhance offenders' positive adjustment to supervision. Employment was found to have a significant effect on the length of time to an unsuccessful probation termination, and support of family and support of friends were found to affect both the time to a revocation petition and the time to an unsuccessful termination. These findings have important implications for offenders' ability to successfully adjust to the problems of community reentry.

Recidivism Rates of Sexual Offenders up to 7 Years Later

This article critically reviews the evidence on sex offender treatment and subsequently provides new estimates on short-term recidivism among sexual offenders released from prison in New Jersey. The sample of male sex offenders is drawn from the Adult Diagnostic Treatment Center (ADTC), New Jersey’s only sex-offender-specific prison, and the general population of nine prisons within the state of New Jersey. The ADTC sample receives treatment while incarcerated ( n = 495), whereas no treatment is provided to the offenders in the general population sample ( n = 223). Overall, 33% of the total sample ( N = 718) commits a new offense. Of the total sample, 14% commits a new sexual offense and 24% commits a new nonsexual offense. Significant differences exist between the ADTC and the general population samples with respect to nonsexual reoffending only. In the final analysis, treatment appears to matter in terms of a reduction in recidivism but not in conventionally expected ways.

Social Policies Designed to Prevent Sexual Violence

Sex crimes provoke fear and anger among citizens, leading to the development of social policies designed to prevent sexual violence. The most common policies passed in recent years have included sex offender registration, community notification (Megan's Law), residence restrictions, civil commitment, and electronic monitoring. This article reviews the history of current sexual offender policies, their development, and their implementation. These policies do not appear to be evidence based in their development and implementation because they are founded largely on myths rather than on facts. Little empirical investigation has been conducted to evaluate sex offender policies, but extant research does not suggest that these policies achieve their goals of preventing sex crimes, protecting children, or increasing public safety. The authors make recommendations for more effective legislative solutions, including enlisting media in the promulgation of evidence-based information, creating policies that use risk assessment strategies to identify high risk offenders, and facilitating a more efficient distribution of resources that reserves the most intensive restrictions and interventions for the most dangerous offenders.

Incorporating Feminist Theory and Insights Into a Restorative Justice Response to Sex Offenses

Sex offenses, particularly nonpenetration sex offenses and acquaintance sexual assault, are all too common. Because these crimes reinforce women’s fear of crime and restrict spatial and social freedom, it is paramount for the justice system to act affirmatively; however, it does not. This article identifies several failures in the current response to these sex offenses. We describe the research demonstration project, RESTORE, operating in Pima County, Arizona, which uses a restorative justice response as a way of remedying some of those failures. Identifying central feminist insights that guided the development of that project, the article addresses concerns raised by feminists about the use of restorative justice for gendered violence. We conclude that most if not all of these concerns apply to cases of on going domestic violence—cases specifically excluded from the RESTORE program—rather than to cases of acquaintance sexual assault or nonpenetration sex offenses.

Will They Do It Again?

This article reviews the empirical research on the prediction of reoffending among sexual offenders. The major predictors of sexual-offense recidivism are factors related to sexual deviance (e.g., deviant sexual preferences, previous sex crimes) and, to a lesser extent, criminal lifestyle (e.g., antisocial personality disorder, total number of prior offenses). The factors that predict general recidivism among sex offenders are the same as the factors that predict general recidivism among nonsexual criminals (e.g., juvenile delinquency, prior violent offenses). Given that there are special predictors of sexual recidivism, evaluators should consider separately the risk for sexual and non-sexual recidivism.

Elderly Sexual Offenders

With the ever-aging population, the number of elderly sexual offenders are also on the rise. The courts and correctional system are increasingly faced with older individuals who have offended sexually. Previously, these older offenders were thought to be similar to younger sexual offenders. However, closer analysis suggests that many of these individuals pose a much lower risk to recidivate than the risk to recidivate of their younger counterparts. Still, an individualized approach to manage the risk of older offenders is required, as some may have particular risk factors relevant for their treatment and future stability, such as dementia or other mental health issues. Further, this population often has particular physical health issues and requires special consideration when being placed in the community. Assessment, treatment, and risk management in this special population of sexual offenders are discussed.

Less Is More: Using Static-2002R Subscales to Predict Violent and General Recidivism Among Sexual Offenders

Given that sexual offenders are more likely to reoffend with a nonsexual offense than a sexual offense, it is useful to have risk scales that predict general recidivism among sexual offenders. In the current study, we examined the extent to which two commonly used risk scales for sexual offenders (Static-99R and Static-2002R) predict violent and general recidivism, and whether it would be possible to improve predictive accuracy for these outcomes by revising their items. Based on an aggregated sample of 3,536 adult male sex offenders from Canada, the United States, and Europe (average age of 39 years), we found that a scale created from the Age at Release item and the General Criminality subscale of Static-2002R predicted nonsexual violent, any violent, and general recidivism significantly better than Static-99R or Static-2002R total scores. The convergent validity of this new scale (Brief Assessment of Recidivism Risk-2002R [BARR-2002R]) was examined in a new, independent data set of Canadian high-risk adult male sex offenders (N = 360) where it was found to be highly correlated with other risk assessment tools for general recidivism and the Psychopathy Checklist-Revised (PCL-R), as well as demonstrated similar discrimination and calibration as in the development sample. Instead of using total scores from the Static-99R or Static-2002R, we recommend that evaluators use the BARR-2002R for predicting violent and general recidivism among sex offenders, and for screening for the psychological dimension of antisocial orientation.

Juvenile Sex Offenders

Public policy has tended to treat juvenile sex offenders (JSOs) as adult sex offenders in waiting, despite research that contradicts this notion. Although as a group, JSOs are more similar to general delinquents than to adult sex offenders, atypical sexual interests and sexual victimization during childhood may be a pathway for sexual offending that differentiates some JSOs from their nonsexually delinquent peers. Developmental considerations must be considered in risk assessment evaluations of these youth. This article reviews theories of sexual offending in youth, risk factors for juvenile offending and reoffending, psychopathology in JSOs, risk assessment, and treatment.

Psychological Treatment of Sexual Offenders Against Children: A Meta-Analytic Review of Treatment Outcome Studies

Numerous meta-analyses and reviews have been conducted on the effectiveness of psychological treatment of sexual offenders in reducing recidivism, but no meta-analysis has been done on sexual offenders against children (SOAC) specifically. A moderate treatment effect has been shown in several evaluations of general sexual offenders, while many scholars maintain that the question remains unanswered until an adequate number of effectiveness studies with a strong research design have been carried out. In this meta-analysis, we evaluated 14 studies selected and coded according to Collaborative Outcome Data Committee (CODC) criteria. They included 1,421 adult offenders in psychotherapy and 1,509 nontreated controls, with a minimum average follow-up period of 3 years, published in peer-reviewed journals in 1980 or later. Recidivism was defined as rearrest or reconviction. Study quality was classified into strong, good, weak or rejected. The analysis revealed a treatment effect size of r = .03 for nine studies evaluated as Good or Weak, while all studies yielded an effect size of r = .08, including five studies classified as Rejected. The results show that the available research cannot establish any effect of treatment on SOAC. Despite a large amount of research, only a tiny fraction of studies meet a minimum of scientific standards, and even fewer provide sensible and useful data from which it is possible to draw conclusions.

Sexual offender recidivism among a population-based prison sample

The present study examines recidivism rates in sexual offenders using officially registered reconvictions in a representative data set of N = 1,115 male sexual offenders from Austria. In general, results indicate that most sexual offenders do not reoffend sexually after release from prison. More detailed, within the first 5 years after release, the sexual recidivism rate was 6% for the total sample, 4% for the rapist subgroup, and 8% for the child molester subgroup. The findings confirmed previous studies about sex offender recidivism which have shown that first-time sexual offenders are significantly less likely to sexually reoffend than those with previous sexual convictions. With regard to the relationship between age and sexual recidivism, the results challenged the traditional assumption of a clear linear function between age and recidivism. Taken together, compared with previous studies, the recidivism rates found in the present investigation are substantially lower than previous research has indicated.

Pharmacological interventions for those who have sexually offended or are at risk of offending

BACKGROUND

Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence levels and it is accepted that there is a high proportion of hidden sexual victimisation. Surveys report high levels of psychiatric morbidity in survivors of sexual offences.Biological treatments of sex offenders include antilibidinal medication, comprising hormonal drugs that have a testosterone-suppressing effect, and non-hormonal drugs that affect libido through other mechanisms. The three main classes of testosterone-suppressing drugs in current use are progestogens, antiandrogens, and gonadotropin-releasing hormone (GnRH) analogues. Medications that affect libido through other means include antipsychotics and serotonergic antidepressants (SSRIs).

OBJECTIVES

To evaluate the effects of pharmacological interventions on target sexual behaviour for people who have been convicted or are at risk of sexual offending.

SEARCH METHODS

We searched CENTRAL (2014, Issue 7), Ovid MEDLINE, EMBASE, and 15 other databases in July 2014. We also searched two trials registers and requested details of unidentified, unpublished, or ongoing studies from investigators and other experts.

SELECTION CRITERIA

Prospective controlled trials of antilibidinal medications taken by individuals for the purpose of preventing sexual offences, where the comparator group received a placebo, no treatment, or 'standard care', including psychological treatment.

DATA COLLECTION AND ANALYSIS

Pairs of authors, working independently, selected studies, extracted data, and assessed the risk of bias of included studies. We contacted study authors for additional information, including details of methods and outcome data.

MAIN RESULTS

We included seven studies with a total of 138 participants, with data available for 123. Sample sizes ranged from 9 to 37. Judgements for categories of risk of bias varied: concerns were greatest regarding allocation concealment, blinding of outcome assessors, and incomplete outcome data (dropout rates in the five community-based studies ranged from 3% to 54% and results were usually analysed on a per protocol basis).Participant characteristics in the seven studies were heterogeneous, but the vast majority had convictions for sexual offences, ranging from exhibitionism to rape and child molestation.Six studies examined the effectiveness of three testosterone-suppressing drugs: cyproterone acetate (CPA), ethinyl oestradiol (EO), and medroxyprogesterone acetate (MPA); a seventh evaluated two antipsychotics (benperidol and chlorpromazine). Five studies were placebo-controlled; in two, MPA was administered as an adjunctive treatment to a psychological therapy (assertiveness training or imaginal desensitisation). Meta-analysis was not possible due to heterogeneity of interventions, comparators, study designs, and other issues. The quality of the evidence overall was poor. In addition to methodological issues, much evidence was indirect.

PRIMARY OUTCOME

recividism. Two studies reported recidivism rates formally. One trial of intramuscular MPA plus imaginal desensitisation (ID) found no reports of recividism at two-year follow-up for the intervention group (n = 10 versus one relapse within the group treated by ID alone). A three-armed trial of oral MPA, alone or in combination with psychological treatment, reported a 20% rate of recidivism amongst those in the combined treatment arm (n = 15) and 50% of those in the psychological treatment only group (n = 12). Notably, all those in the 'oral MPA only' arm of this study (n = 5) dropped out immediately, despite treatment being court mandated.Two studies did not report recidivism rates as they both took place in one secure psychiatric facility from which no participant was discharged during the study, whilst another three studies did not appear directly to measure recividism but rather abnormal sexual activity alone.

SECONDARY OUTCOMES

The included studies report a variety of secondary outcomes. Results suggest that the frequency of self reported deviant sexual fantasies may be reduced by testosterone-suppressing drugs, but not the deviancy itself (three studies). Where measured, hormonal levels, particularly levels of testosterone, tended to correlate with measures of sexual activity and with anxiety (two studies). One study measured anxiety formally; one study measured anger or aggression. Adverse events: Six studies provided information on adverse events. No study tested the effects of testosterone-suppressing drugs beyond six to eight months and the cross-over design of some studies may obscure matters (given the 'rebound effect' of some hormonal treatments). Considerable weight gain was reported in two trials of oral MPA and CPA. Side effects of intramuscular MPA led to discontinuation in some participants after three to five injections (the nature of these side effects was not described). Notable increases in depression and excess salivation were reported in one trial of oral MPA. The most severe side effects (extra-pyramidal movement disorders and drowsiness) were reported in a trial of antipsychotic medication for the 12 participants in the study. No deaths or suicide attempts were reported in any study. The latter is important given the association between antilibidinal hormonal medication and mood changes.

AUTHORS' CONCLUSIONS

We found only seven small trials (all published more than 20 years ago) that examined the effects of a limited number of drugs. Investigators reported issues around acceptance and adherence to treatment. We found no studies of the newer drugs currently in use, particularly SSRIs or GnRH analogues. Although there were some encouraging findings in this review, their limitations do not allow firm conclusions to be drawn regarding pharmacological intervention as an effective intervention for reducing sexual offending.The tolerability, even of the testosterone-suppressing drugs, was uncertain given that all studies were small (and therefore underpowered to assess adverse effects) and of limited duration, which is not consistent with current routine clinical practice. Further research is required before it is demonstrated that their administration reduces sexual recidivism and that tolerability is maintained.It is a concern that, despite treatment being mandated in many jurisdictions, evidence for the effectiveness of pharmacological interventions is so sparse and that no RCTs appear to have been published in two decades. New studies are therefore needed and should include trials with larger sample sizes, of longer duration, evaluating newer medications, and with results stratified according to category of sexual offenders. It is important that data are collected on the characteristics of those who refuse and those who drop out, as well as those who complete treatment.

Assessing the generalization of relapse-prevention behaviors of sexual offenders diagnosed with an intellectual disability

The generalization of relapse-prevention skills of 10 males residing at a state facility for sexual offenders diagnosed with an intellectual disability was assessed in the community using three different experimental probes: (a) treatment staff (TS), (b) nontreatment staff (NTS), and (c) community adults (CAs). Results indicated a decrease in compliance from the TS to NTS and CAs, with the lowest levels of generalization displayed by offenders who were older and displayed a wider range of paraphilias. The degree of generalization also varied as a function of the contingencies for prevention-plan noncompliance, with higher rates of generalization occurring for violations that were more severely consequated. The implications of the findings for future research in promoting the generalization of relapse-prevention skills of sexual offenders, in general, and those who also exhibit intellectual disabilities, in particular, are discussed.

Does volunteering for sex offender treatment matter? Using propensity score analysis to understand the effects of volunteerism and treatment on recidivism

A common critique of program evaluations of prison-based sex offender treatment holds that the samples inherently show selection bias because the participants typically volunteer for treatment. To address this critique, we used propensity score analysis to assess the influence of volunteerism on treatment effects. We examined recidivism outcomes for a sample of participants who volunteered for treatment, of whom some participated in treatment (n = 161) and some did not (n = 282) and compared these outcomes to the recidivism rate of a matched sample of nonvolunteers for treatment (n = 443). The primary finding is that offenders who volunteered for treatment did not demonstrate any differences in recidivism rates when matched with and compared to inmates who did not volunteer to participate in treatment. Furthermore, our results revealed that there were a number of significant differences between unmatched volunteers and unmatched nonvolunteers, perhaps most importantly in their risk for future recidivism as measured by the STATIC-99 risk assessment. We discuss study strengths and limitations and present the implications of the findings for policy, practice, and research.

Sexually violent predators: toward reasonable estimates of recidivism base rates

The sexual recidivism rate of sex offenders is a controversial issue. Perhaps as controversial is the sexual recidivism rate of the select group of sex offenders who are examined pursuant to sexually violent predator (SVP) statutes. At present, reliable estimates of SVP recidivism are unavailable. We propose that reasonable estimates of SVP recidivism can be reached by considering three available pieces of data: (i) a likely recidivism rate of the general population of sex offenders; (ii) procedures typically followed by jurisdictions that civilly commit sex offenders; and (iii) classification accuracy of procedures. Although sexual recidivism rates vary across jurisdictions, the results of our analyses suggest sex offenders referred for examination pursuant to SVP statutes recidivate at substantially higher rates than typical sex offenders. Our results further suggest that sex offenders recommended for commitment as SVPs recidivate at even greater rates than SVP respondents who are not recommended for commitment. We discuss practice and policy implications of these findings.

Adolescent and young adult male sex offenders: understanding the role of recidivism

The current review explores the complex paths that can lead to adolescent and young adult males becoming sexually abusive. Because sexual abuse is an ongoing issue in our society that is often oversimplified, this article distinguishes between the various risk factors that predict sexually abusive behavior and types of sex offenders, particularly recidivistic offenders. It is imperative to focus on adolescents and young adults who sexually abuse because they represent a particularly important intervention point in preventing sexual abuse in comparison to older age groups and address the importance of differentiating among youths who sexually abuse, particularly between one-time offenders and recidivistic offenders. Implications for addressing these differences are discussed.

Psychological interventions for adults who have sexually offended or are at risk of offending

BACKGROUND

Sexual offending is a legal construct that overlaps, but is not entirely congruent with, clinical constructs of disorders of sexual preference. Sexual offending is both a social and a public health issue. Victim surveys illustrate high incidence and prevalence levels, and it is commonly accepted that there is considerable hidden sexual victimisation. There are significant levels of psychiatric morbidity in survivors of sexual offences.Psychological interventions are generally based on behavioural or psychodynamic theories.Behavioural interventions fall into two main groups: those based on traditional classical conditioning and/or operant learning theory and those based on cognitive behavioural approaches. Approaches may overlap. Interventions associated with traditional classical and operant learning theory are referred to as behaviour modification or behaviour therapy, and focus explicitly on changing behaviour by administering a stimulus and measuring its effect on overt behaviour. Within sex offender treatment, examples include aversion therapy, covert sensitisation or olfactory conditioning. Cognitive behavioural therapies are intended to change internal processes - thoughts, beliefs, emotions, physiological arousal - alongside changing overt behaviour, such as social skills or coping behaviours. They may involve establishing links between offenders' thoughts, feelings and actions about offending behaviour; correction of offenders' misperceptions, irrational beliefs and reasoning biases associated with their offending; teaching offenders to monitor their own thoughts, feelings and behaviours associated with offending; and promoting alternative ways of coping with deviant sexual thoughts and desires.Psychodynamic interventions share a common root in psychoanalytic theory. This posits that sexual offending arises through an imbalance of the three components of mind: the id, the ego and the superego, with sexual offenders having temperamental imbalance of a powerful id (increased sexual impulses and libido) and a weak superego (a low level of moral probation), which are also impacted by early environment.This updates a previous Cochrane review but is based on a new protocol.

OBJECTIVES

To assess the effects of psychological interventions on those who have sexually offended or are at risk of offending.

SEARCH METHODS

In September 2010 we searched: CENTRAL, MEDLINE, Allied and Complementary Medicine (AMED), Applied Social Sciences Index and Abstracts (ASSIA), Biosis Previews, CINAHL, COPAC, Dissertation Abstracts, EMBASE, International Bibliography of the Social Sciences (IBSS), ISI Proceedings, Science Citation Index Expanded (SCI), Social Sciences Citation Index (SSCI), National Criminal Justice Reference Service Abstracts Database, PsycINFO, OpenSIGLE, Social Care Online, Sociological Abstracts, UK Clinical Research Network Portfolio Database and ZETOC. We contacted numerous experts in the field.

SELECTION CRITERIA

Randomised trials comparing psychological intervention with standard care or another psychological therapy given to adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or who are seeking treatment voluntarily for behaviours classified as illegal.

DATA COLLECTION AND ANALYSIS

At least two authors, working independently, selected studies, extracted data and assessed the studies' risk of bias. We contacted study authors for additional information including details of methods and outcome data.

MAIN RESULTS

We included ten studies involving data from 944 adults, all male.Five trials involved primarily cognitive behavioural interventions (CBT) (n = 664). Of these, four compared CBT with no treatment or wait list control, and one compared CBT with standard care. Only one study collected data on the primary outcome. The largest study (n = 484) involved the most complex intervention versus no treatment. Long-term outcome data are reported for groups in which the mean years 'at risk' in the community are similar (8.3 years for treatment (n = 259) compared to 8.4 in the control group (n = 225)). There was no difference between these groups in terms of the risk of reoffending as measured by reconviction for sexual offences (risk ratio (RR) 1.10; 95% CI 0.78 to 1.56).Four trials (n = 70) compared one behavioural programme with an alternative behavioural programme or with wait list control. No meta-analysis was possible for this comparison. For two studies (both cross-over, n = 29) no disaggregated data were available. The remaining two behavioural studies compared imaginal desensitisation with either covert sensitisation or as part of adjunctive drug therapy (n = 20 and 21, respectively). In these two studies, results for the primary outcome (being 'charged with anomalous behaviour') were encouraging, with only one new charge for the treated groups over one year in the former study, and in the latter study, only one new charge (in the drug-only group) over two years.One study compared psychodynamic intervention with probation. Results for this study (n = 231) indicate a slight trend in favour of the control group (probation) over the intervention (group therapy) in terms of sexual offending as measured by rearrest (RR 1.87; 95% CI 0.78 to 4.47) at 10-year follow-up.Data for adverse events, 'sexually anomalous urges' and for secondary outcomes thought to be 'dynamic' risk factors for reoffending, including anger and cognitive distortions, were limited.

AUTHORS' CONCLUSIONS

The inescapable conclusion of this review is the need for further randomised controlled trials. While we recognise that randomisation is considered by some to be unethical or politically unacceptable (both of which are based on the faulty premise that the experimental treatment is superior to the control - this being the point of the trial to begin with), without such evidence, the area will fail to progress. Not only could this result in the continued use of ineffective (and potentially harmful) interventions, but it also means that society is lured into a false sense of security in the belief that once the individual has been treated, their risk of reoffending is reduced. Current available evidence does not support this belief. Future trials should concentrate on minimising risk of bias, maximising quality of reporting and including follow-up for a minimum of five years 'at risk' in the community.

The utility of risk assessment instruments for the prediction of recidivism in sexual homicide perpetrators

To examine the predictive accuracy of four well established risk assessment instruments (PCL-R, HCR-20, SVR-20, and Static-99) in an important subgroup of sexual offenders, these instruments were assessed retrospectively based on information from forensic psychiatric court reports in a sample of 90 released male sexual homicide offenders (out of an original sample of 166) in Germany. Follow-up information about criminal reconvictions after release were obtained from the federal criminal records. Total scores as well as subscales and single items of these risk assessment instruments did not predict sexual recidivism, and only some of them had moderate predictive power regarding nonsexual violent recidivism. Possible explanations for these unexpected results are the retrospective study design with missing information about influences during the long duration of detention and time after release, the small sample size as well as the possibility that the risk assessment instruments investigated were valid for general sex offender samples, but not for the particular subgroup of offenders with sexually motivated homicides.

Lifetime criminal history of sex offenders seen for psychological assessment in five decades

A sample of 2,190 sex offenders seen between 1966 and 2009 was compared on lifetime sexual and all offending, using charges, convictions, court appearances, and self-report as criteria. Of these various criteria, between 47.4% and 81.1% reoffended. Canadian child abuse reporting laws, which came into effect in the 1980s, were associated with increased charges and convictions for offenders, who victimized children, and with a reduction in their longer term reoffense rates. Immigration and population mobility, use of aliases, study follow-up time, and self-reported undetected sex crimes influenced reoffense rates. Results indicate that sex offenders continued to have short prison sentences and/or spend little or no time incarcerated during the latter part of the 20th century.

Victim age-based subtypes of juveniles adjudicated for sexual offenses: comparisons across domains in an outpatient sample

Adolescents adjudicated for sexual offenses are a heterogeneous group. The identification of more homogeneous subgroups of offenders may enable improved treatment, as the specific risks and needs presented by each group could be more effectively targeted. The current study examines three subgroups derived based on the age of victim(s), a popular method of subtyping that has mixed empirical support, using a sample of 176 males adjudicated for a sexual offense and court-ordered to participate in a community-based collaborative intervention program that integrates treatment and probationary services. Differences expected between groups based on theories regarding victim-age based subtypes are examined, in addition to differences consistently identified in prior research. Results indicate that these three subgroups are more similar than different, although some expected differences were found. Juveniles with child victims were more likely to have male victims and biologically related victims. Juveniles with peer/adult victims were more likely to have poor monitoring by their parents and more likely to have been arrested again. Juveniles with mixed types of victims appeared similar to juveniles with child victims on some variables and similar to those with peer/adult victims on others. Treatment implications and future directions for research are discussed. Typologies based on clinical characteristics of the youth rather than offense characteristics may have more promise for identifying meaningful subgroups.

The significance of offending behavior for predicting sexual recidivism among sex offenders of various age groups

Based on a sample of 682 male sex offenders, this study investigated variables of the offending behavior for predicting sexual recidivism in different age groups. The sex offenders were allocated into four age groups. For each group, those characteristics of offending behavior showing a significant bivariate correlation with sexual recidivism were extracted. Using logistic regression, we then analyzed their incremental validity above and beyond a previously developed Crime Scene Behavior Risk (CBR)-Score, which measures the risk of sexual recidivism without taking into account the offenders' age (Dahle, Biedermann, Gallasch-Nemitz, & Janka, 2010). Age-specific offending behavior variables with incremental validity were combined with the general CBR-Score into age-specific scores and examined for their predictive accuracy. We also analyzed the extent in which these age-specific scores showed incremental validity above and beyond the Static-99 (Hanson & Thornton, 1999). For three of the four age groups, age-specific Crime Scene Behavior Risk-Scores could be determined which were incrementally valid above and beyond the Static-99. Predictive accuracy varied between AUC=.74 and AUC=.90 (r=.28 to r=.49) depending on age group. The results are discussed within context of recent findings on the latent dimensions of actuarial risk assessment variables.

The Assessment of Dangerous Behaviour: Research and Clinical Issues

Mental health professionals in forensic settings are increasingly called upon to assess the probability of dangerous behaviour, or level of risk, that certain individuals pose to the community. These assessments may inform decisions concerning the containment and management of violent offenders within forensic settings, sentencing options, and whether or not to grant bail or parole. In this paper we provide an overview of the key issues associated with the assessment of dangerous behaviour. Specifically, we briefly consider the debate on clinical versus actuarial assessments of dangerous behaviour and risk, and provide a synopsis of the current research on dangerous behaviour, focusing on the key areas of mental disorder, psychopathy, and substance use. Finally, we outline guidelines for addressing specific content areas in the clinical risk-assessment process and discuss areas for future research.

A comparative analysis of Australian sex offender legislation for sex offender registries

Australia has followed the course taken by other English-speaking countries in recent years of enacting legislation that requires convicted sexual offenders to register personal details with law enforcement agencies. These laws have been enacted to protect the public from the perceived threat posed by sex offenders, but have been written with little apparent reference to the available research literature about the nature and extent of this threat. In addition, there is no empirical evidence supporting the effectiveness of legislatively based sex offender registries to either reduce sexual offending or to enable the police to investigate sex crimes and apprehend offenders. This article compares and contrasts the current laws governing sex offender registration enacted by the various states and territories in Australia, and offers a critical analysis of their provisions in light of the research literature on sexual offending.

Psychopathy, ADHD, and brain dysfunction as predictors of lifetime recidivism among sex offenders

This study examines the best predictor of lifetime recidivism among Hare's psychopathy scores (PCL-R), attention deficit hyperactivity disorder (ADHD) diagnosis, and brain dysfunction measures in a sample of 1,695 adult male sexual, violent, and nonviolent offenders. Results indicated that most variables were associated with significantly more frequent recidivism. The best predictor of overall recidivism was the PCL-R, but more specifically, it was its items on criminal history that were associated with recidivism. Sexual offense recidivism was predicted by the presence of learning disorders; however, all measures were poor predictors. General recidivism was primarily associated with past criminal history and secondarily with learning disorders and ADHD. Results suggest that ADHD and brain dysfunction with criminal history measures are the best predictors for addressing the problem of criminal recidivism.

Sexual murderers with adult or child victims: are they different?

This study investigates characteristics differentiating sexually motivated murderers targeting child victims (CV; n = 35) from those with only adult victims (AV; n = 100). In the initial phase, psychiatric court reports were evaluated using standardized instruments (SCID-II, PCL-R, HCR-20, SVR-20, Static-99). In the second phase, data on duration of detention and reconviction rates were obtained from German federal criminal records. The CV group showed more often diagnostic criteria of pedophilia (43% vs. 4%) and less often alcohol abuse and drug dependency (31% vs. 55%), sexual dysfunctions (9% vs. 29%) and narcissistic personality disorder (0% vs. 13%). No significant differences were found regarding PCL-R and total risk assessment scores. Child victim perpetrators were more likely to have committed acts of sexual child abuse before the sexual homicide (46% vs. 16%) but were less likely to have committed rape or sexual assault (17% vs. 42%) or caused bodily injury (26% vs. 50%). The CV group was detained more frequently in forensic psychiatric hospitals (59% vs. 26%), but the two groups showed the same rates of release and reconviction for sexual (22% for both groups), nonsexual violent (CV 25% vs. AV 15%) and nonviolent offenses (CV 63% vs. AV 59%). Although well-known differences between nonhomicidal sexual child abusers and rapists were replicated in this study on sexual homicide perpetrators, the groups showed more similarities than differences. The high prevalence of violence and antisocial personality disorder in both groups seem to be important risk factors for committing a (sexual) homicide and might have outweighed other differences.