Prospective actuarial risk assessment: a comparison of five risk assessment instruments in different sexual offender subtypes

Self-report psychopathy-III facet scores predict sexual crimes, sexual preferences, and sexual deviance index validity more precisely than total scores

Understanding the profiles of sexual offenders, such as the presence of psychopathic traits, is key to preventing future sexual crimes. The self-report psychopathy-III (SRP-III) is a tool used to assess the characteristics of psychopathy, but improvements on its interpretation are required to maximize its precision. The SRP-III can be interpreted by examining the scores on each of the four facets (interpersonal manipulation, callous affect, erratic lifestyle, antisocial behavior), on each of two factors (factor 1, factor 2), or by examining the total score. Here, we investigate the interpretation of the results from the SRP-III using these three approaches of analysis of the data for predicting types of sexual crimes, sexually deviant preferences (measured via PPG), and the validity of the sexual deviance results. Logistic regressions were carried out using either the four facets, two factors, or the total score of the SRP-III. Data were previously obtained from 198 Canadian men who were convicted of, or who admitted to committing, at least one sexual crime, or who reported experiencing sexually deviant fantasies. We also examined the point-biserial correlations between each of the methods of interpreting the SRP-III results and each of the dependent variables. We find that SRP-III facet scores most precisely predict types of sexual crimes, sexually deviant preferences, and sexual deviance index validity, followed by SRP-III factor scores, and lastly SRP-III total scores. Additionally, significant correlations are only found between SRP-III scores and one dependent variable. Potential reasons for this are discussed. Based on these findings, we recommend that future studies consider facet and factor scores in addition to the standard practice of examining total scores.

Machine Learning and Risk Assessment: Random Forest Does Not Outperform Logistic Regression in the Prediction of Sexual Recidivism

Although many studies supported the use of actuarial risk assessment instruments (ARAIs) because they outperformed unstructured judgments, it remains an ongoing challenge to seek potentials for improvement of their predictive performance. Machine learning (ML) algorithms, like random forests, are able to detect patterns in data useful for prediction purposes without explicitly programming them (e.g., by considering nonlinear effects between risk factors and the criterion). Therefore, the current study aims to compare conventional logistic regression analyses with the random forest algorithm on a sample of N = 511 adult male individuals convicted of sexual offenses. Data were collected at the Federal Evaluation Center for Violent and Sexual Offenders in Austria within a prospective-longitudinal research design and participants were followed-up for an average of M = 8.2 years. The Static-99, containing static risk factors, and the Stable-2007, containing stable dynamic risk factors, were included as predictors. The results demonstrated no superior predictive performance of the random forest compared with logistic regression; furthermore, methods of interpretable ML did not point to any robust nonlinear effects. Altogether, results supported the statistical use of logistic regression for the development and clinical application of ARAIs.

Changes in the Risk of Sexual Reoffending: The Role and Relevance of Perceived Self-Efficacy and Adult Attachment Styles in Correctional Treatment

According to the Risk-Need-Responsivity (RNR) model, treatment effectiveness increases when treatment addresses all three associated core principles. While researchers have focused on the risk and need principles, responsivity remains under-investigated. The theoretical foundation of the RNR model and former research indicates low perceived self-efficacy and inadequate adult attachment styles as potential responsivity factors that can impede treatment of the underlying risk factors. This study assesses firstly whether these factors predict treatment attrition, and secondly changes in the assessed risk of sexual reoffending. Participants were N = 146 men sentenced for sexual offenses in a German social-therapeutic correctional facility. Younger age, higher number of previous convictions, and higher scores on the interpersonal facet of the Psychopathy Checklist-Revised are associated with a higher risk of treatment attrition. Unemployment prior to incarceration was found to be an aggravating factor, whereas substance abuse emerged as a mitigating factor, according reducing the risk of reoffending. Neither pre-treatment self-efficacy nor attachment styles revealed as responsivity factors in this study. Future studies should examine if the consideration of these factors during treatment might impact treatment outcomes.

Testosterone-Lowering Medication and Its Association With Recidivism Risk in Individuals Convicted of Sexual Offenses

For a particular subgroup of individuals with severe paraphilic disorders and a high risk of sexual recidivism, the combination of sex drive-reducing medications and psychotherapy is a promising treatment approach. The present quasi-experimental study aims at comparing differences in clinical characteristics and dynamic risk factors between persons receiving (+TLM, n = 38) versus not receiving (-TLM, n = 22) testosterone-lowering medications (TLMs). Individuals receiving TLM were more frequently diagnosed with paraphilic disorders. Neither the criminal history nor average risk scores differed between the two groups. In the +TLM, Stable-2007 scores showed a stronger decrease after TLM treatment was started. This accounted especially for the general and sexual self-regulation subscales. Individual variations in risk, however, were not predicted by TLM but were significantly related to treatment duration and Psychopathy Checklist-Revised (PCL-R) Factor I. Paraphilic patients with problems in self-regulatory abilities seem to profit most from pharmacological sex drive-reducing treatment. Furthermore, therapists seem to underestimate deviant sexual fantasies in medicated patients.

Cross-Validation of the Revised Version of the Violence Risk Appraisal Guide (VRAG-R) in a Sample of Individuals Convicted of Sexual Offenses

The aim of the present study was to examine the psychometric properties of the German version of the revised Violence Risk Appraisal Guide (VRAG), the VRAG-R. Therefore, VRAG-R ratings were made retrospectively in an Austrian sample of 534 individuals convicted of a sexual offense who were followed up with an average of 7.62 years. The VRAG-R showed large effect sizes for the predictive accuracy of violent (AUC = .75) and general recidivism (AUC = .78) and significant but rather small effect sizes (AUC = .63 and .61, respectively) in predicting any sexual and sexual contact recidivism. Furthermore, for the prediction of violent recidivism but not for sexual recidivism the VRAG-R was incrementally predictive beyond the Sex Offender Risk Appraisal Guide (SORAG) and the Static-99. Finally, the VRAG-R absolute recidivism rates for the risk bins showed satisfactory calibration properties. Taken together, the results of the present study support the cross-national utility of the VRAG-R and its use in applied risk assessment settings also in German-speaking countries.

Mandated or Voluntary Treatment of Men Who Committed Child Sexual Abuse: Is There a Difference?

Child sexual abuse is associated with multiple and often severe consequences for people who are affected by it. From the perspective of indicative prevention, the treatment of people who have sexually abused children represents one important strategy, with the assumption that there is often a risk for sexual recidivism. However, there is still very limited knowledge about how men who have not been convicted of child sexual abuse but participate in voluntary treatment (here called non-forensic clients) differ from those who have been convicted and undergo mandated treatment (here called forensic clients). This study compared 22 forensic and 22 non-forensic clients regarding pedophilic interests, static and dynamic risk factors, responsivity features, and treatment progress during an individualized treatment based on the principles of risk, need, and responsivity. We found neither differences in the rates in the DSM-5 diagnosis of pedophilic disorder, nor in risk and responsivity associated scores at the beginning of treatment. In both groups, a low to moderate risk for sexual re-offending was estimated. Both groups improved their functioning on dynamic risk and responsivity factors under treatment, while age at the beginning of therapy also had a positive effect on all outcomes. Non-forensic clients had a higher amount of responsivity associated resources than forensic clients during treatment. The limitations of these results and their implications for further research and prevention approaches are discussed.

The relevance of sexual biographies in individuals convicted of child sexual abuse offenses for the development of pedosexual interests and sexual recidivism

In the literature concerning the etiology of pedosexual interests, the potential role of early sexual experiences in childhood and adolescence has been discussed. Several studies demonstrated a link between own sexually abusive experiences in childhood and sexual offending later in life which tends to be even stronger for pedosexual offenders. Furthermore, some findings indicate associations between other developmental factors and deviant sexual interests in adulthood. For the present study, sexual biographical data of N = 223 imprisoned men convicted of sexual offenses against children from Austria was analyzed to retrospectively examine whether own sexually abusive experiences and non-abusive forms of early sexual experiences and behaviors are linked to subsequent pedosexual interests and to sexual recidivism. Previous findings concerning the link between own sexually abusive experiences during childhood and subsequent pedosexual interests could partly be replicated. Furthermore, early masturbation behavior characteristics as well as non-abusive prepubescent sexual experiences were linked to indicators of pedosexual interests and also to sexual recidivism. Exclusively pedophilic men showed the strongest accumulation of early sexual experiences and behaviors. Implications of the findings for theory and risk assessment are discussed.

Predictive Validity of the Static-99 and Static-99R in Switzerland

This study evaluated the validity of the Static-99 and Static-99R in assessing sexual recidivism in Switzerland, based on a sample of 142 male sex offenders. Both tools showed predictive validity, but the Static-99R had better discrimination (OR = 1.82, AUC = .81) and calibration (Brier = .078, P/E = 0.96) than the Static-99. A cut score of four on the Static-99R maximized sensitivity (92.9%) and specificity (60.2%). However, although most offenders (98.7%) with a score < 4 did not commit sexual offenses in the 5-year follow-up period, only one in five (20.3%) offenders with a score ≥ 4 actually recidivated. Furthermore, the predicted number of recidivists in the well above average risk category (Static-99R ≥ 6) was 24% higher than expected in routine samples. The results suggest that the Static-99R may be a useful screening tool to identify low-risk individuals but offenders with scores ≥ 4 should be subjected to a more thorough assessment.

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.

Sexual Violence Risk Prediction in a Police Context

Adoption of evidence-based approaches by police services offers a practical and scientific solution to ensure public safety and proper allocation of resources. Advances in the field of sexual violence risk prediction have the potential to inform policing practices. The present study examines the validity of existing actuarial measures to predict the future sexual violence behavior of 290 identified male perpetrators of sexual assault against adult victims (ages 16 and older). The Static-99R and Static-2002R were coded from police documentation, and the sample was followed up for at least 1 year with an average of 3.6 years. Both measures showed large effects for predicting any offending, violent offending, and sexual offending in the form of charges and convictions. The findings suggest that existing sex offender research can extend to police practice, and criminogenic factors used to predict recidivism among convicted offenders may apply to assessing the risk posed by perpetrators of police-reported sexual assaults.

Dynamic Risk Assessment of Sexual Offenders: Validity and Dimensional Structure of the Stable-2007

In this study, the predictive and incremental validity of the Stable-2007 beyond the Static-99 was evaluated in an updated sample of N = 638 adult male sexual offenders followed-up for an average of M = 8.2 years. Data were collected at the Federal Evaluation Center for Violent and Sexual Offenders (FECVSO) in Austria within a prospective-longitudinal research design. Scores and risk categories of the Static-99 (AUC = .721; p < .001) and of the Stable-2007 (AUC = .623, p = .005) were found to be significantly related to sexual recidivism. The Stable-2007 risk categories contributed incrementally to the prediction of sexual recidivism beyond the Static-99. Analyzing the dimensional structure of the Stable-2007 yielded three factors, named Antisociality, Sexual Deviance, and Hypersexuality. Antisociality and Sexual Deviance were significant predictors for sexual recidivism. Sexual Deviance was negatively associated with non-sexual violent recidivism. Comparisons with latent dimensions of other risk assessment instruments are made and implications for applied risk assessment are discussed.

An Evaluation of the Reliability, Construct Validity, and Factor Structure of the Static-2002R

The fundamental psychometric properties of the subscales found in the Static-2002R, an actuarial measure of sexual recidivism risk, were evaluated in the current study. Namely, the reliability, concurrent and construct validity, and factor structure of the Static-2002R subscales were examined with a sample of 372 adult male sex offenders. In addition to using validated measures of sexual violence risk to examine concurrent validity, construct-related measures taken from extant risk measures and psychometric tests were correlated with three of the subscales to assess overall construct validity. Moderate support was found for the reliability of the Static-2002R. The concurrent and construct validity of the General Criminality, Persistence of Sexual Offending, and Deviant Sexual Interest subscales were supported. Generally, these findings further support the Static-2002R as a valid sex offender risk appraisal instrument that encompasses multiple distinct, clinically relevant, risk domains.

Risk Assessment in Child Sexual Abusers Working With Children

Child sexual abuse occurring in a child- or youth-serving institution or organization has attracted great public and scientific attention. In light of the particular personal and offense-related characteristics of men who have abused children within such an institution or organization, it is of special importance to evaluate the predictive performance of currently applied risk assessment instruments in this offender population. Therefore, the present study assessed the risk ratings and predictive performance of four risk assessment instruments and one instrument assessing protective factors concerning any, violent and sexual recidivism in child sexual abusers working with children (CSA-W) in comparison with extra-familial child sexual abusers (CSA-E) and intra-familial child sexual abusers (CSA-I). The results indicate that CSA-W mostly recidivate with a sexual offense. Although all included risk measures seem to function with CSA-W, the Static-99 seems to be the instrument that performs best in predicting sexual recidivism in CSA-W. CSA-W had the most protective factors measured with the Structured Assessment of PROtective Factors (SAPROF). While the SAPROF could not predict desistance from recidivism in CSA-W, it predicted desistance from any recidivism in all CSA. As CSA-W frequently hold many indicators for pedophilic sexual interests but only a few for antisocial tendencies, it can be suggested that CSA-W are at an increased risk for sexual recidivism and thus risk measures especially designed for sexual recidivism work best in CSA-W. Nevertheless, CSA-W also hold many protective factors; however, their impact on CSA-W is not clear yet and needs further study.

Sadism and Violent Reoffending in Sexual Offenders

A diagnosis of sadism in sexual offenders is commonly regarded as indicative of high risk for violent reoffending. The purpose of the current two studies was to evaluate whether sadism is indeed associated with higher rates of violent (including sexual) reoffending. In Study 1 (meta-analysis), the rate of violent and sexual recidivism was assessed across seven samples of male sex offenders (total N = 2,169) as a function of diagnoses of sexual sadism. In Study 2 (N = 768) the outcome (violent recidivism yes/no) was regressed on sadism, along with behavioral indicators of sexually sadistic offending, and scores from violence risk assessment instruments. In Study 1 (meta-analysis), the overall risk of sadists compared with nonsadists with respect to violent (including sexual contact) reoffending was slightly elevated (by a factor of 1.18), yet not significantly increased. Similarly, the risk of sexual reoffending among sadists was slightly, but not significantly, higher than among nonsadists (factor 1.38). According to Study 2, only a measure of sadistic behavior, not the clinical diagnosis, was associated with violent reoffending. This association, however, was not present once age and customary risk assessment instruments for violence risk were included in the regression. A clinical diagnosis of sexual sadism and behavioral measures of sadism are related to the risk of violent reoffending in sexual offenders. These associations, however, are weak and do not hold once variables relevant for the prediction of violence are controlled for. At the individual level, the risk for future violence in sadists can therefore be adequately described by customary risk assessment instruments.

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.

Response inhibition in pedophilia: an FMRI pilot study

BACKGROUND

The failure to inhibit pleasurable but inappropriate urges is associated with frontal lobe pathology and has been suggested as a possible cause of pedophilic behavior. However, imaging and neuropsychological findings about frontal pathology in pedophilia are heterogeneous. In our study we therefore address inhibition behaviorally and by means of functional imaging, aiming to assess how inhibition in pedophilia is related to a differential recruitment of frontal brain areas.

METHOD

Eleven pedophilic subjects and 7 nonpedophilic controls underwent fMRI while performing a go/no-go task composed of neutral letters.

RESULTS

Pedophilic subjects showed a slower reaction time and less accurate visual target discrimination. fMRI voxel-level ANOVA revealed as a main effect of the go/no-go task an activation of prefrontal and parietal brain regions in the no-go condition, while the left anterior cingulate, precuneus and gyrus angularis became more activated in the go condition. In addition, a group × task interaction was found in the left precuneus and gyrus angularis. This interaction was based on an attenuated deactivation of these brain regions in the pedophilic group during performance of the no-go condition. The positive correlation between blood oxygen level-dependent imaging signal and reaction time in these brain areas indicates that attenuated deactivation is related to the behavioral findings.

CONCLUSION

Slower reaction time and less accurate visual target discrimination in pedophilia was accompanied by attenuated deactivation of brain areas belonging to the default mode network. Our findings thus support the notion that behavioral differences might also derive from self-related processes and not necessarily from frontal lobe pathology.

Pedophilic sexual interests and psychopathy in child sexual abusers working with children

Research has identified stable and dynamic characteristics in child sexual abusers working with children (CSA-W) that may distinguish them from other child sexual abusers (CSA). However, in previous research CSA-W have usually been included in the group of extra-familial CSA (CSA-E). Two hundred and forty-eight forensic-sexological reports about CSA conducted by the Federal Evaluation Centre for Violent and Sexual Offenders in the Austrian Prison System were evaluated retrospectively. One hundred and nineteen intra-familial CSA (CSA-I), 66 CSA-E, and 38 CSA-W were compared with regard to static risk factors, indicators of psychopathy, and pedophilic sexual interests. CSA-E had the highest risk of recidivism as measured by the Static-99 total score, followed by CSA-W. Furthermore, CSA-E had more previous convictions than CSA-W. Both CSA-E and CSA-I had higher total scores on the Psychopathy Checklist-Revised than CSA-W. CSA-W had the highest prevalence of pedophilia diagnoses according to DSM-IV-TR criteria, as well as the highest rate of pedophilia with an orientation toward male children, and the highest frequency of male victims. CSA-W also had the highest total scores in the Screening Scale for Pedophilic Interests. CSA-W seem to constitute a group with particular risk factors and criminogenic needs, that is, they show more indicators of pedophilic sexual interests but less general antisociality and psychopathy, and would thus seem to be distinguishable from other CSA. Future research should focus in particular on evaluating differences in the grooming strategies used by CSA-W to commit and disclose child sexual abuse, as well as on the resources of this particular offender group.

Psychopathy and Violent Reoffending in German-Speaking Countries

The Psychopathy Checklist-Revised (PCL-R) and its screening version, the PCL:SV, are clinical assessment instruments for the observer rating of psychopathic personality in offenders. Given the link between PCL-R/SV total scores and violent offending, these instruments have been incorporated into various risk assessment protocols in forensic psychology. The purpose of the present study was to examine the predictive validity of the PCL-R/SV instruments in German-speaking countries. We collated data from 11 published studies (total-N = 2,412 offenders). Based on suitable diagnostic cutscores for prototypical psychopathy, the proportions of true-positive and false-positive cases with respect to violent reoffending were compared. Overall, sensitivity was estimated at 27% and specificity at 88% for the PCL-R (or at 28% and 90% for the PCL:SV, respectively). At critical score levels, the odds for violent offense recidivism were more than two times higher than at subcritical levels for both instruments. A decision-theory analysis suggested that the implicit utility of false-positive risk assessments was about halfway between the minimal utility of false-negative assessments and the maximal utility of correct assessments. Both the PCL-R and its screening version are viable instruments for the prediction of violent offense recidivism in German-speaking countries.

Assessment of Psychopathy in Austria

The Psychopathy Checklist-Revised (PCL-R) is a clinician rating instrument for psychopathic personality disorder. Although the instrument is routinely used in forensic assessment in Austria, Germany, and Switzerland, data on its psychometric properties in German-speaking countries are lacking. Based on a national sample of adult male sexual offenders assessed at a federal evaluation unit in Austria (N = 1,046), reliability and factor structure were estimated. More specifically, measurement invariance was assessed with respect to the North American normative data of male offenders. In the sample, the PCL-R achieved similar levels of reliability as those reported in the manual for North American male offenders. According to confirmatory factor analysis, a four-factor model of psychopathy described the data well. More specifically, weak measurement invariance (i.e., equivalence of loadings, not of thresholds) held in comparison with the North American data. The present findings support the suitability of the PCL-R for assessment purposes in German-speaking countries. However, the total score is not directly comparable to North American data given that only weak measurement invariance was observed.

Preventive detention in Germany: an overview and empirical data from two federal states

Eighty years ago, preventive detention for dangerous offenders was implemented in the German Penal Code (Section 66). In 2011, about 500 individuals were incarcerated under a preventive detention order in Germany. Through semi-structured clinical interviews and/or collateral file review, the present investigators assessed the sociobiographic, criminological, and clinical characteristics of 58 men for whom preventive detention had been ordered in two German federal states. In addition, risk assessment instruments were administered. The majority of the inmates were sexual offenders. The main mental health problems were antisocial personality disorder (APD), substance abuse/disorder, and paraphilias. Most individuals had a history of poor socialization. Structured clinical judgment as well as actuarial risk assessment instruments identified all inmates as high-risk offenders. Future development of preventive detention in Germany must emphasize treatment interventions. Given the life histories and the mental health problems of the detainees assessed in the present study, the implementation of effective treatment will prove difficult.

Current obstacles in replicating risk assessment findings: a systematic review of commonly used actuarial instruments

An actuarial risk assessment instrument can be considered valid if independent investigations using novel samples can replicate the findings of the instrument's development study. In order for a study to qualify as a replication, it has to adhere to the methodological protocol of the development study with respect to key design characteristics, as well as ensuring that manual-recommended guidelines of test administration have been followed. A systematic search was conducted to identify predictive validity studies (N = 84) on three commonly used actuarial instruments: the Violence Risk Appraisal Guide (VRAG), the Sex Offender Risk Appraisal Guide (SORAG), and the Static-99. Sample (sex, age, criminal history) and design (follow-up, attrition, recidivism) characteristics, as well as markers of assessment integrity (scoring reliability, item omissions, prorating procedure), were extracted from 84 studies comprising 108 samples. None of the replications matched the development study of the instrument they were attempting to cross-validate with respect to key sample and design characteristics. Furthermore none of the replications strictly followed the manual-recommended guidelines for the instruments' administration. Additional replication studies that follow the methodological protocols outlined in actuarial instruments' development studies are needed before claims of generalizability can be made.

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.

Predicting reoffense for community-based sexual offenders: an analysis of 30 years of data

This study contributes to the area of risk prediction by exploring whether the Static-99R is useful for predicting reoffense in community-based samples, and for noncontact offenders with and without identified victims. A total of 744 participants drawn from an outpatient sex offender treatment program in a large metropolitan area were followed for a period of up to 30 years. Multiple Cox Regressions were run; covariates included length of treatment, status in treatment, Static-99R items, and number of technical probation violations. Overall, reoffending was an infrequent occurrence in this sample regardless of how it was defined, with sexual reoffenses identified in 13% of the sample and any criminal reoffense identified in 20% of the sample. Consistent with previous research, the Static-99R was a better predictor of sex-related reoffenses than of nonsexual reoffenses. However, in no case were more than a couple of the items significantly related to reoffending and these items differed depending on reoffense definition.

Dynamic risk assessment in sexual offenders using STABLE-2000 and the STABLE-2007: an investigation of predictive and incremental validity

The predictive accuracy of STABLE-2000 and STABLE-2007 was examined within a prospective research design in a German-speaking sample of 263 adult male prison-released sexual offenders followed up for an average of 6.4 years. The STABLE-2007 was significantly related to all outcomes (AUC = 0.67-0.71), whereas the STABLE-2000 demonstrated only weak predictive accuracy for sexual reoffense (AUC = 0.62). Supporting the results of the construction sample, the STABLE-2007 incrementally added to the predictive accuracy of the STATIC-99 for violent and general reoffense (conviction and incarceration). Moreover, the STABLE-2007 total scores and the nominal risk/need categories made significant incremental contributions over the SORAG for predicting sexual reoffense.

Current concepts in the pharmacotherapy of paraphilias

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.