Paraphilia and Antisociality: Motivations for Sexual Offending May Differ for American Whites and Blacks

Coprophilia and Coprophagia: A Literature Review

BACKGROUND

Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia.

AIMS

The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia.

METHODS

Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English.

RESULTS

Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines.

CONCLUSIONS

Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

Sexual offenses and the brain

Sexual offenses are a great concern worldwide due to the devastating physical and psychological consequences the victims of such crimes often experience. It is an important task to investigate potential mechanisms that may underlie sexual offending and predispose an individual for such antisocial behavior. Advanced techniques in neuroscience are increasingly used to uncover biomarkers in psychiatric disorders and organic brain disease. As this type of research is flourishing, preliminary studies with the aim to explore the neural basis of sex offenders have started to appear. To this purpose, researchers began to study the brain's structural and functional changes and the neurocognitive profiles of sex offenders, in comparison to nonoffenders and nonsex offenders, or among different subtypes of sex offenders. Most of the research to date has focused on pedophilia, with some inconsistent findings, which hampers the translation of the results into the forensic and clinical context. Any attempt to increase convergent evidence may profit from the harmonization of data analysis and avoidance of methodological inconsistencies, which can account for the different results across studies. Today, uncovering the neural basis of sex offences has to become a priority, not only for clinical interventions, but might also be important knowledge for crime prevention.

Predictive Validity of Static-99R Among 8,207 Men Convicted of Sexual Crimes in South Korea: A Prospective Field Study

The accuracy of risk assessment tools for Asian populations has received relatively little research attention. This study evaluated one of the most widely used static risk assessment tools - Static-99R - for assessing the likelihood of recidivism among men convicted of a sexual crime in South Korea. Overall, this South Korean sample (N = 8207) appeared to have a higher risk (more paraphilic interests, more sexual/general criminality) than the Static-99R normative samples (who were mostly White individuals from Western countries). Despite the differences, Static-99R was able to discriminate recidivists from nonrecidivists in South Korea, with AUC values similar to that observed in the normative samples (e.g., 0.72 for sexual recidivism). In terms of calibration, the observed sexual recidivism rates of the current sample were higher than the international routine/complete normative samples but lower than the high-risk/high-need normative samples (E/O = 0.75 and 1.26, respectively). Consequently, evaluators in South Korea can have reasonable confidence in the ability of Static-99R to rank individuals according to their relative likelihood of sexual recidivism.

Why are individuals over age 60 still committed as sexually violent persons?

Civilly committed sexually violent persons (SVPs) are a select group of individuals designated as high risk for future sexual violence. Despite risk reduction in older age, SVP programs are seeing aging client populations, with many individuals remaining committed after age 60 (60+). Recent research found a sexual recidivism rate of 7.5% for 60+ individuals released from an SVP civil commitment program. The current paper follows up by examining reasons why individuals remain committed after age 60. It compares SVPs discharged after age 60 to those who are 60+ but remain civilly committed. Results of bivariate analyses reveal older SVPs who remain committed have significantly higher actuarial risk scores and are more likely to be of minority race. Multivariate logistic regression analyses found actuarial risk scores (Static-99R) predicted continued commitment, after controlling for other relevant variables. Barriers to community reintegration and suggestions for multi-disciplinary case management for older SVPs are discussed.

An Examination of the Latent Constructs in Risk Tools for Individuals Who Sexually Offend: Applying Multidimensional Item Response Theory to the Static-2002R

Multidimensional item response theory (MIRT) was used to study the construct validity of the Static-2002R, an actuarial scale for the assessment of reoffending among adult men who sexually offended. Using a sample of 2,569 individuals with a history of sexual crime, exploratory factor analysis (EFA) extracted three factors: Persistence/Paraphilia, General Criminality, and Youthful Stranger Aggression. MIRT confirmed the factor structure identified in the EFA model and provided item-level data on discrimination and difficulty. All Static-2002R items showed moderate to very high discrimination and covered a wide range of risk levels (i.e., difficulty). MIRT analyses attested to the construct validity of the scale, as no items were identified as problematic and the resulting factor structure was consistent with that of earlier studies. Considering the stability of results pertaining to the factor structure of the Static-2002R and the advantages of dimensional scoring, we recommend the integration of dimensional scores in the scale.

The use of substances in sexual offending in a United States sample

Substance use is often involved in sexual offending. Understanding the ways in which substances are used in sexual offending is critical for developing prevention strategies. The present study explored the ways that substances are involved in the perpetration of sexual abuse against adults and minors, including intoxication and supplying substances to victims by individuals convicted of sexual offenses. Data were collected from the records of 2803 individuals convicted of sexual offenses in the United States. A series of binary logistic regressions found that offenses against adults were more likely to have alcohol or drugs involved than offenses against minors, while supplying substances to victims was less likely in intrafamilial than in extrafamilial offenses against minors. Findings suggest that implementing sexual violence prevention strategies (e.g. bystander intervention) in adult drinking contexts and integrating education about problematic substance use behaviors (e.g. grooming) during childhood prevention programs can aid in sexual abuse prevention.