STABLE-2007 Demonstrates Predictive and Incremental Validity in Assessing Risk-Relevant Propensities for Sexual Offending: A Meta-Analysis

Theories on the Etiology of Deviant Sexual Interests: A Systematic Review

Not much is known about the etiology, or development, of deviant sexual interests. The aim of this systematic review was to provide a broad overview of current theories on the etiology of sexual deviance. We conducted a systematic search of the databases PubMed and APA PsycInfo (EBSCO). Studies were included when they discussed a theory regarding the etiology or development of sexual deviance. Included studies were assessed on quality criteria for good theories. Common etiological themes were extracted using thematic analysis. We included 47 theories explaining sexual deviance in general as well as various specific deviant sexual interests, such as pedophilia and sadism/masochism. Few theories (k = 7) were of acceptable quality as suggested by our systematic assessment of quality criteria for good theories (QUACGOT). These theories indicated that deviant sexual interests may develop as the result of an interplay of various factors: excitation transfer between emotions and sexual arousal, conditioning, problems with "normative" sexuality, and social learning. Neurobiological findings could not be included as no acceptable quality neurobiological theories could be retrieved. The important roles of excitation transfer and conditioning designate that dynamic, changeable processes take part in the etiology of sexual deviance. These same processes could potentially be deployed to diminish unwanted deviant sexual interests.

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.

Emotional Congruence with Children: An Empirical Examination of Different Models in Men with a History of Sexually Offending Against Children

Emotional congruence with children (ECWC) is a psychologically meaningful risk factor for sexual offending against children (SOC). Based on previous research and theory, three models have been proposed to explain ECWC: Blockage, Sexual Domain, and Psychological Immaturity. Using structural equation modelling in a routine correctional sample of men adjudicated for sexual offences (n = 983), we found little support for all three of these models. Instead, we found that atypical sexual interests, alone, best explained ECWC, with a moderate relationship to ECWC. Using the predictors associated with each of the three models of ECWC, we identified three classes of men with a history of SOC who are high in ECWC using latent class analyses (n = 377). These three classes generally did not replicate the three models of ECWC. We instead propose three subgroups of men with histories of SOC who are high in ECWC, characterized respectively by: relationship deficits; youth and loneliness; and high sexual and general criminality. High levels of ECWC are predictive of a higher risk of sexual recidivism, regardless of class association; however, these subgroups are differentially at risk for some types of recidivism. Our findings suggest that ECWC is a multi-faceted construct, which is still not well understood.

Sexual Exploitation of Children in Travel and Tourism Perpetration: An Expansion of the Ecosystem Model

The sexual exploitation of children in travel and tourism (SECTT), also referred to as child sex tourism, involves engaging in sexual activity with someone under the age of 18 in the context of travel and/or tourism. Research on the perpetration of SECTT is vastly underdeveloped. The present review considers the operationalization of SECTT, its prevalence, and existing theoretical models. Existing theory on SECTT provides a good overview of environmental factors that contribute to SECTT, but the model is insufficient in fully accounting for individual-level risk factors related to sexual offending against children. The present paper expands an existing theoretical model of SECTT, the ecosystem model, to account for these individual risk factors and considers their interaction with environmental factors. The paper concludes by highlighting different avenues for future research.

Relationship Between Atypical Sexual Fantasies, Behavior, and Pornography Consumption

Paraphilia is a condition in which the sexual excitement relies on fantasizing and/or participating in unusual sexual behaviors although the line between "normal" and "abnormal" has been disputed. The project aimed to explore which sexual fantasies and behaviors are common and uncommon in the general population. Furthermore, the relationship between sexual fantasies, sexual behaviors, and problematic pornography consumption was examined. Finally, the impact of gender was assessed. Analyses were conducted on a sample of 139 participants. Correlations were found between fantasies, behaviors, and problematic pornography consumption. Furthermore, gender differences were found for both sexual fantasies and problematic pornography consumption. Finally, multiple regression revealed that age, gender [Men], fantasies, and behaviors were significant predictor of problematic pornography consumption. Those findings are in-line with previous studies which highlighted that the threshold to consider a sexual practice as being abnormal needs to be reconsidered on the basis of self-reported fantasies and behaviors in the general population.

Evaluating layperson interpretation of actuarial sexual violence risk data: A multi-method comparison of risk communication with attention to gender bias

Forensic clinicians are often called upon to help courts determine the likelihood that someone will continue to commit sexually violent acts in the future. The utility of these evaluations depends largely on how effectively the results are communicated to and understood by the trier of fact. Actuarial results, such as those commonly reported in sexual offense risk assessments, appear particularly challenging for laypersons to understand. Using a representative sample of 206 U.S. adults, this study examines three methods of communicating actuarial risk via simulated expert testimony on participants' ratings of a hypothetical evaluee's risk of sexual re-offending. The results suggested that all participants, regardless of how results were communicated, over-estimated the examinee's risk level relative to the expert's probabilistic findings, but tended to agree with the expert's categorical predictions. Participants who were only shown actuarial data consistently rated the evaluee as more dangerous and likely to commit future sexually violent acts. Additionally, it was found that gender significantly impacted participants' perceptions, such that women found the evaluee more dangerousness and desired greater social distance from him. This study has implications for best practices regarding expert communication of actuarial results in cases involving sexual violence.

Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample

A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.

"One a Day Keeps the Prison Away": Understanding the Experiences of Individuals Convicted of Sexual Offences Receiving Anti-Androgens for the Treatment of Problematic Sexual Arousal

Problematic sexual arousal (PSA) is an umbrella term to describe a range of clinical presentations related to excessive sexual thinking (e.g., sexual preoccupation) and sexual behavior (e.g., hypersexuality). Although such concepts are known to affect sexual recidivism among individuals convicted of sexual offences, PSA is not routinely or directly targeted in offending behavior programs in England and Wales. However, in recent years, there have been moves to incorporate pharmacological interventions for addressing this among people with sexual offence histories. Although some work to understand the experiences of those taking SSRI medication for this purpose has emerged, little is known about the experiences of service users taking anti-androgen medication. In this study, we interviewed all individuals in prison taking anti-androgens for the treatment of problematic sexual arousal following convictions for sexual offences in England at the time of data collection (N = 10). Using a phenomenologically oriented thematic analysis, we established themes pertaining to "Differing needs: Motivations for treatment," "Medication as a risk management strategy," and how the medication helped the men in their pursuit of "Discovering a 'new me'." This work contributes important knowledge to inform the development of ethical and effective prescribing of anti-androgen medication with this population and offer recommendations for both future research and the development of clinical practice.

Dynamic Risk Scales Degrade Over Time: Evidence for Reassessments

Risk tools containing dynamic (potentially changeable) factors are routinely used to evaluate the recidivism risk of justice-involved individuals. Although frequent reassessments are recommended, there is little research on how the predictive accuracy of dynamic risk assessments changes over time. This study examined the extent to which predictive accuracy decreases over time for the ACUTE-2007 and the STABLE-2007 sexual recidivism risk tools. We used two independent samples of men on community supervision (NStudy 1 = 795; NStudy 2 = 4,221). For all outcomes (sexual, violent, and any recidivism [including technical violations]), reassessments improved predictive accuracy, with the largest effects found for the most recent assessment (i.e., those closest in time prior to the recidivism event). Based on these results, we recommend that ACUTE-2007 assessments occur at least every 30 days and that the STABLE-2007 assessments occur every 6 months or after significant life changes (e.g., successful completion of treatment).

Understanding the Risk of Sexual Reoffending in Adult Men: A Network-Based Model

The predominant approach to understand dynamic risk factors of sexual reoffending has been referred to as the Propensities Model (Thornton, 2016). According to this model, dynamic risk factors can be conceptualized as latent constructs whose change alters the risk of sexual reoffending. Despite its strengths and contributions to research, this model does not offer answers to the question of how dynamic risk factors contribute to the risk of sexual reoffending, or of how sustained change in risk might take place. In this paper we introduce the Network-Based Model of Risk of Sexual Reoffending (NBM-RSR), which addresses several limitations and constraints of the Propensities Model and offers empirically testable propositions regarding the nature and development of the risk of sexual reoffending. The NBM-RSR considers risk of sexual reoffending to involve a self-sustaining network of causally connected dynamic risk factors. Consistent with this, an increased risk of sexual reoffending is characterized through a network that contains more and stronger interconnected dynamic risk factors with a higher strength. Sustained change in risk of sexual reoffending occurs when activity in the network exceeds a critical point resulting in a new self-sustaining network. Propositions based on the NBM-RSR are introduced and translated into testable hypotheses. These propositions revolve around (a) risk of sexual reoffending resulting from the construction of a network of causally connected dynamic risk factors, (b) network stability, sudden changes, and critical transitions, and (c) dynamic risk factors' relative influence on risk of sexual reoffending.

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.

When Kinks Come to Life: An Exploration of Paraphilic Behaviors and Underlying Predictors

Paraphilia is defined as a condition in which sexual excitement relies on fantasizing about and/or participating in unusual sexual behavior. Although recent studies have assessed the concordance between paraphilic interests and paraphilic behaviors, few studies have studied which individual traits and demographics predict engaging in paraphilic behaviors, or the level of concordance between arousal and behavior. The current study replicated and expanded Joyal and Carpentier's 2022 study. We assessed concordance between paraphilic arousal and behavior. Further, we assessed the impact of Dark Tetrad traits, impulsivity, social desirability and demographic variables on engaging in paraphilic behaviors using self-report questionnaires in a sample from the general population and FetLife. Finally, we were interested in whether these individual differences moderated the concordance between arousal and behavior. Results indicated high concordance between paraphilic arousal and behavior for all paraphilias except pedophilia and hebephilia. Younger, male participants were more likely to engage in various paraphilias than women and older participants. Machiavellianism was linked with lower paraphilic behavior, particularly impulsive or risky ones. Psychopathy predicted engaging in more deviant or illegal paraphilias, whereas sadism only showed an association for engaging in frotteurism and narcissism was not a predictor for engaging in any paraphilia. For several paraphilias, individual traits moderated the effect of arousal on behavior. Implications of these findings and future directions are discussed.

The Effect of Missing Item Data on the Relative Predictive Accuracy of Correctional Risk Assessment Tools

Missing data are pervasive in risk assessment but their impact on predictive accuracy has largely been unexplored. Common techniques for handling missing risk data include summing available items or proration; however, multiple imputation is a more defensible approach that has not been methodically tested against these simpler techniques. We compared the validity of these three missing data techniques across six conditions using STABLE-2007 (N = 4,286) and SARA-V2 (N = 455) assessments from men on community supervision in Canada. Condition 1 was the observed data (low missingness), and Conditions 2 to 6 were generated missing data conditions, whereby 1% to 50% of items per case were randomly deleted in 10% increments. Relative predictive accuracy was unaffected by missing data, and simpler techniques performed just as well as multiple imputation, but summed totals underestimated absolute risk. The current study therefore provides empirical justification for using proration when data are missing within a sample.

Long Term Recidivism Rates Among Individuals at High Risk to Sexually Reoffend

Preventive detention provisions in the US and Canada assume we can identify, in advance, individuals at high risk for sexual recidivism. To test this assumption, 377 adult males with a history of sexual offending were followed for 20 years using Canadian national criminal history records and Internet searches. Using previously collected information, a high risk/high need (HRHN) subgroup was identified based on an unusually high levels of criminogenic needs (n = 190, average age of 38 years; 83% White, 13% Indigenous, 4% other). A well above average subgroup of 99 individuals was then identified based on high Static-99R (6+) and Static-2002R (7+) scores. In the HRHN group, 40% reoffended sexually. STATIC HRHN norms overestimated sexual recidivism at 5 years (Static-99R, E/O = 1.44; Static-2002R, E/O = 1.72) but were well calibrated for longer follow-up periods (20 years: Static-99R, E/0 = 1.00; Static-2002R, E/O = 1.16). The overall sexual recidivism rate for the well above average subgroup was 52.1% after 20 years, and 74.3% for any violent recidivism. The highest risk individuals (top 1%) had rates in the 60%-70% range. We conclude that some individuals present a high risk for sexual recidivism, and can be identified using currently available methods.

Cross-Cultural Validity of Sexual Recidivism Risk Assessments Using Static-99R, STABLE-2007, and the VRS-SO

PURPOSE OF REVIEW

The overrepresentation of certain racial/ethnic groups in criminal legal systems raises concerns about the cross-cultural application of risk assessment tools. We provide a framework for conceptualizing and measuring racial bias/fairness and review research for three tools assessing risk of sexual recidivism: Static-99R, STABLE-2007, and VRS-SO.

RECENT FINDINGS

Most cross-cultural research examines Static-99R and generally supports its use with Black, White, Hispanic, and Asian men. Preliminary research also supports STABLE-2007 with Asian men. Findings are most concerning for Indigenous men, where Static-99R and STABLE-2007 significantly predict sexual recidivism, but with significantly and meaningfully lower accuracy compared to White men. For the VRS-SO and the combined Static-99R/STABLE-2007 risk levels, predictive accuracy was not significantly lower for Indigenous men, for which we discuss several possible explanations. We offer considerations for risk scale selection with Indigenous men and highlight recent guidance produced for cross-cultural risk assessment.

"I Mean Who Likes Pedophiles"; Psychological Assessments of Men Who Have Sexually Offended. The Assessees' Experiences

Pre-sentence psychological assessments of men who have sexually offended can provide useful information regarding an individual's pathway to offending, risk of recidivism, and treatment needs. The outcome of the assessment can be used in court and has implications for the assessee and society at large. This research sought to explore offenders' opinions regarding the clinicians' approach to the assessment, to identify facilitative aspects of the clinicians' style and to understand how accuracy and honesty can be enhanced in these interactions. Six interviews were conducted with sex offenders on completion of a pre-sentence forensic assessment at a private practice. Applying Interpretative Phenomenological Analysis, the findings highlighted the relational nature of the assessments, the assessees' feelings of powerlessness, and their perceptions that the interaction helped them personally. The findings and approach advocated for by the assessees are discussed in terms of the associated ethical considerations and practice implications.

Empirically-based dynamic risk and protective factors for sexual offending

This review provides an overview and update of empirical evidence for psychologically meaningful dynamic risk factors and protective factors for sexual offending. Using the review by Mann et al. (2010) as a starting point, we reviewed relevant literature that has appeared since this publication, focusing on meta-analyses, systematic and scoping reviews of dynamic risk factors, recent evaluations of commonly used dynamic assessment tools, and studies of dynamic risk and protective factors in community samples in addition to clinical or forensic samples. Two risk factors previously deemed promising by Mann et al. (2010), hostility towards women and dysfunctional coping (conceptualized as hostile masculinity and emotional regulation deficits, respectively, in this review), could now be considered supported using this review's criteria of three or more studies demonstrating an effect size of 0.15 or greater. No new risk factors were identified. We conducted a broader search of protective factors in recognition of the relative newness of this literature: Positive social support was the only protective factor identified as empirically supported. We also discuss situational risk and protective factors.

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Fantasy Sexual Material Use by People with Attractions to Children

PURPOSE OF REVIEW

With the Internet allowing consumers easy access to fantasy and fictional sexual materials (FSM), it is becoming increasingly important to understand the context of their use among specific populations. Of particular, social, clinical, and legal interest is FSM use by people who are attracted to children and whether this may have a risk-enhancing or protective impact on their likelihood of committing a contact or non-contact sexual offence.

RECENT FINDINGS

There is a lack of data currently available in relation to the use of FSM by those with sexual attractions to children. Evidence from allied areas appears to show no meaningful associations between FSM use and sexual aggression. We propose a novel research program and some initial research questions that provide a theoretical framework for more evidence-based inquiry on FSM use by people who experience attractions to children.

Understanding Pedophilia: A Theoretical Framework on the Development of Sexual Penchants

Pedophilia is a significant public health problem. Despite its cost to society, little effort has been directed toward understanding idiographic differences in the development and maintenance of pedophilia. Extant literature emphasizes biological underpinnings and predictors of re-offense. In this article, we posit that pedophilic penchants in males originate due to language, cognition, emotions, and emotion regulation. Adverse childhood experiences, such as emotional and sexual abuse, are posited as a major contributor to the etiology of pedophilia. However, not all individuals attracted to minors present with similar childhood adversities. The development of pedophilia, in the absence of such direct training (childhood adversities), is difficult to comprehend. Relational frame theory, a comprehensive account of human language and cognition, aids in deciphering the idiographic underpinnings of pedophilia. The role of maladaptive emotion regulation in maintaining pedophilia is also described. This article presents examples of how relational frames are established and activated in distressing contexts. Finally, implications for future research are discussed.

Consistency and Construct Validity of the Five-Level System for Risk Communication Using Static and Dynamic Tools: An Investigation Using the Static-99R and VRS-SO

This study examined the Council of State Governments' five-level system for risk communication, as applied to the Static-99R and Violence Risk Scale-Sexual Offense Version (VRS-SO). Aims of the system include increasing consistency in risk communication and linking risk categories to psychologically meaningful constructs. We investigated concordance between risk levels assigned by the instruments, and distributions of VRS-SO dynamic needs associated with Static-99R risk levels, among a multisite sample (n = 1,404) of persons who have sexually offended. Concordant categorical risk ratings were assigned in just over a third of cases, suggesting that consistency remains a concern with the system, particularly when conceptually disparate tools are applied. Densities of criminogenic needs varied widely among persons assigned the same risk level by the Static-99R and diverged from the descriptions ascribed by the system. These findings can inform clinical assessments and further refinement of the system.

Grievance-fueled sexual violence

The grievance fueled violence paradigm encompasses various forms of targeted violence but has not yet been extended to the theoretical discussion of sexual violence. In this article, we argue that a wide range of sexual offenses can be usefully conceptualized as forms of grievance fueled violence. Indeed, our assertion that sexual violence is often grievance fueled is unoriginal. More than 40 years of sexual offending research has discussed the pseudosexual nature of much sexual offending, and themes of anger, power, and control – themes that draw clear parallels to the grievance fueled violence paradigm. Therefore, we consider the opportunities for theoretical and practical advancement through the merging of ideas and concepts from the two fields. We examine the scope of grievance in the context of understanding sexual violence, and we look to the role of grievance in the trajectory toward both sexual and nonsexual violence, as well as factors that might distinguish grievance fueled sexual from nonsexual violence. Finally, we discuss future research directions and make recommendations for clinical practice. Specifically, we suggest that grievance represents a promising treatment target where risk is identified for both sexual and nonsexual violence.

Sexual assault in the inpatient psychiatric setting

Sexual assault in the inpatient psychiatric setting is a significant problem with serious, lasting consequences. It is important for psychiatric providers to appreciate the nature and magnitude of this problem to be able to provide an appropriate response when faced with these challenging scenarios, as well as to advocate for the implementation of preventive measures. This article provides a review of the existing literature regarding sexual behavior in the inpatient psychiatric unit, describing the epidemiology of sexual assaults in these settings, and exploring the characteristics of both victims and perpetrators, with a particular focus on factors of relevance to the inpatient psychiatric patient population. Inappropriate sexual behavior in inpatient psychiatric settings is common, however the varying definition of such throughout the literature serves as a challenge to clearly identifying the frequency of specific behaviors. The existing literature does not identify a way to reliably predict which patients are most likely to engage in sexually inappropriate behaviors on an inpatient psychiatric unit. The medical, ethical, and legal challenges that such cases present are defined, followed by a review of current management and prevention strategies, and suggested future directions for research.

Attending to the Positive: A Retrospective Validation of the Structured Assessment of Protective Factors-Sexual Offence Version

Sexual recidivism risk assessment tools focus almost exclusively on risk factors associated with increased rates of recidivism and do not attend to protective factors that might mitigate reoffense risk. The present study investigated the predictive validity of the Structured Assessment of Protective Factors - Sexual Offence version (SAPROF-SO), developed to assess hypothesised protective factors against sexual recidivism in adult males. The SAPROF-SO pilot version contains 24 items across two domains: Personal and Professionally Provided Support. SAPROF-SO scores were rated retrospectively from a review of archived case files of 210 men with convictions for child sexual offenses, using the SAPROF-SO pilot manual and a supplementary retrospective scoring guide developed for the current study. SAPROF-SO Total and Personal domain scores were significantly predictive of sexual recidivism after an average follow-up period of 12.24 years (AUC = .81), and to a lesser extent, violent and general recidivism. SAPROF-SO Total and Personal scores additionally provided significant incremental validity over Static-99R scores in the prediction of sexual recidivism. Results support the predictive validity of protective factors for reduced sexual recidivism and invite future research examining how to integrate the SAPROF-SO alongside contemporary sexual recidivism risk assessment tools.

Exploring the Psychological Characteristics and Risk-related Cognitions of Individuals Who Own Sex Dolls

The ownership of sex dolls has become an increasingly controversial social issue over the last five to ten years, with many in society (and academia) calling for the criminalization of such dolls. At the root of these calls is the implicit (and often explicit) assumption that sex doll ownership contributes to increases in negative social attitudes toward women, and sexual offense risk among doll owners. However, there are yet to be any empirical examinations of these claims. In this work we compared the psychological characteristics and comparative sexual aggression proclivities of sex doll owners (n = 158) and a non-owner comparison group (n = 135). We found no substantive differences in most psychological traits. Doll owners scored lower than comparators in relation to sexual aggression proclivity. They were, however, more likely to see women as unknowable, the world as dangerous, and have lower sexual self-esteem. They also had more obsessive and emotionally stable personality styles. We conclude that there is no evidence that sex doll owners pose a greater sexual risk than a non-owning comparison group, before highlighting the need for more evidence-informed social debates about the use of sex dolls in modern society.

Konsum von Missbrauchsabbildungen: Prävalenz, Ätiologie, Fallpriorisierung und Prognose

Der Konsum von Missbrauchsabbildungen hat sich im Hellfeld in den letzten Jahren immer wieder verdoppelt. Dieses erhöhte Fallaufkommen stellt Polizei, Bewährungshilfe und forensische Therapeuten vor eine Vielzahl neuer Herausforderungen. In diesem Beitrag sollen daher aktuelle theoretische Modelle und empirische Erkenntnisse dargestellt werden, um Praktiker in ihrer täglichen Arbeit zu unterstützen. Im Einzelnen sollen das Ausmaß der Problematik und ätiologische Erklärungsmodelle dargestellt werden. Darauffolgend werden empirische Erkenntnisse zu Konsumenten von Missbrauchsabbildungen aufgeführt und diese mit Tätern, die zusätzlich auch Hands-On-Delikte begehen, verglichen. Ferner wird die Problematik von „Crossover“-Tätern diskutiert. Abschließend werden Ansätze vorgestellt, um Fälle in der polizeilichen Ermittlungsarbeit zu priorisieren sowie um das Rückfallrisiko von Konsumenten von Missbrauchsabbildungen vorherzusagen.

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.

Manifestations of sexual sadism in child sexual assault and the associated victim, offender, and offense characteristics: A latent class analysis

BACKGROUND

Although sadistic child sexual abuse (SCSA) is rare, existing typologies of child sexual abuse have identified the existence of sadistic subtypes in child molestation, as well in the sexual homicide of children. Nonetheless, no study has sought to determine whether there is heterogeneity in the manifestation of sexual sadism between sadistic child abusers.

OBJECTIVE

The present study seeks to examine how SCSA manifests differently between offenders, and whether these differences are associated with specific victim, offender, and offense characteristics.

PARTICIPANTS AND SETTING

The current sample includes adult males (N = 101) who were involved in a child sexual assault and scored at least a 4 on the Severe Sexual Sadism Scale (SeSas). All offenses take place in France between 1990 and 2018.

METHODS

Latent class analysis was used to analyze the sample for heterogeneity. Bivariate analyses were conducted to identify external variables associated with each of the latent classes.

RESULTS

Three distinct latent classes were found: the sadistic kidnapper; the sadistic torturer; and the sadistic ritualist. External validity testing also revealed distinctive characteristics associated with each class.

CONCLUSIONS

SCSA involves a heterogenous population with distinctive sadistic behavioral manifestations that vary in severity and relate to differences in crime-commission processes and offender characteristics. These findings offer important insights for crime prevention and correctional practice.

Effects of testosterone suppression on desire, hypersexuality, and sexual interest in children in men with pedophilic disorder

Effects of testosterone withdrawal on significant correlates of paedophilic disorder (PeD) are largely unknown. The purpose of this study was to explore in detail the effects of testosterone suppression from degarelix as compared to placebo on desire, hypersexuality, and subjectively experienced sexual interest in participants with PeD.We compared the sexual effects of degarelix, a GnRH antagonist, on men with PeD assigned to degarelix (n = 26) or placebo (n = 26) in a double-blind randomised clinical trial. Sexual Desire Inventory scores decreased significantly at two weeks (between-group difference p = 0.001, d = -0.96 [-0.38 to -1.55) and ten weeks (p < 0.001, d = -1.30 [-0.69 to -1.91) in participants assigned degarelix, whereas HBI ratings did not differ significantly at two weeks (p = 0.07, d = -0.52 [0.05 to -1.08), but did so at ten weeks (p = 0.01, d = -0.72 [-0.15 to -1.29). Fifteen out of 26 (58%) individuals in the group assigned degarelix and 3 out of 26 (12%) in the group assigned to placebo reported no further sexual interest in children at ten weeks (Fisher's exact test, p < 0.0001), an effect unmodified by autistic, antisocial, or impulsive traits, age, age at onset of, or duration of paedophilic attraction.

Prediction of reoffending risk in men convicted of sexual offences: development and validation of novel and scalable risk assessment tools (OxRIS)

BACKGROUND

Current risk assessment tools have a limited evidence base with few validations, poor reporting of outcomes, and rarely include modifiable factors.

METHODS

We examined a national cohort of men convicted of sexual crimes in Sweden. We developed prediction models for three outcomes: violent (including sexual), any, and sexual reoffending. We used Cox proportional hazard regression to develop multivariable prediction models and validated these in an external sample. We reported discrimination and calibration statistics at prespecified cut-offs.

FINDINGS

We identified 16,231 men convicted of sexual offences, of whom 14.8% violently reoffended during a mean follow up of 38 months, 31.4% for any crime (34 months), and 3.6% for sexual crimes (42 months). Models for violent and any reoffending showed good discrimination and calibration. At 1, 3, and 5 years, the area under the curve (AUC) was 0.75-0.76 for violent reoffending and 0.74-0.75 for any reoffending. The prediction model for sexual reoffending showed modest discrimination (AUC = 0.67) and good calibration. We have generated three simple and web-based risk calculators, which are freely available.

INTERPRETATION

Scalable evidence-based risk assessment tools for sexual offenders in the criminal justice system and forensic mental health could assist decision-making and treatment allocation by identifying those at higher risk, and screening out low risk persons.

Predicting Risk of Reoffending in Persons with Child Sexual Exploitation Material Offense Histories: The Use of Child Pornography Offender Risk Tool in a Scottish Population

In the past decade, there has been an increase in child sexual exploitation material (CSEM) offenses and convictions. Although research shows that individuals with CSEM offence histories generally are at low risk of reoffending, certain factors do increase in CSEM convictions, in order to assist with case prioritization, management and supervision, risk assessment is helpful across agencies. The Child Pornography Offender Risk Tool (CPORT) was created specifically for this population and shows significant predictive validity for various outcomes. This study aimed to validate the use of the CPORT in a Scottish sample of 141 adult males who were convicted of CSEM offenses. Receiver Operating Characteristic (ROC) and logistic regression analyses indicated that the CPORT significantly predicted any recidivism (Area Under the Curve = .81), any sexual recidivism (AUC = .78) and CSEM recidivism (AUC = .74), suggesting that it is a valid risk assessment tool for Scottish populations. Recommendations for further research and clinical implications are discussed.

Exploring Risk for Sexual Recidivism and Treatment Responsivity Through the Lens of Early Trauma

Adverse childhood experiences (ACE) are common in the histories of individuals who have sexually offended. Many risk factors for sexual recidivism resemble symptoms of early trauma, and early trauma may present a responsivity barrier to engagement in offense-focused treatment. Using the ACE scale, the current study aimed to (i) examine relationships between ACE scores and static and dynamic risk assessment scores, (ii) examine whether ACE scores differ between treatment completers versus noncompleters, and finally (iii) examine whether ACE scores predict treatment noncompletion. ACE scores were retrospectively coded from files of adult men receiving community-based assessment and/or treatment in New Zealand for sexual offenses against children (N = 491; n = 185-411 for individual analyses). Although effect sizes were generally small, static risk and general self-regulation dynamic risk factors correlated positively with ACE scores, ACE scores were higher for treatment noncompleters versus completers, and higher dynamic risk assessment scores and ACE scores increased the odds of treatment noncompletion. Implications for future research and enhancing treatment responsivity are discussed.

Dignity, Social Reintegration of Prisoners, and the New Penal Power: European Human Rights, Experiences of Belgian Prisoners, and Professional Practices

Over the last 30 years, prisoners' dignity and fundamental rights have increasingly been protected by European human rights bodies such as the European Court of Human Rights and the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. This protection is aimed particularly at the traditional power relations between prisoners and uniformed staff. More recently, social reintegration of prisoners has also been recognized by these European human rights standards as a fundamental element of human dignity and an equally important aim of imprisonment as retribution and deterrence. However, it is also accepted that some offenders may be too dangerous to be returned back to society. Psychiatric/psychological assessments are a major element in this decision-making. This "new penal power" receives much less attention in human rights protection. This article compares three intertwining perspectives on this issue: the European human rights perspective on dignity and social reintegration; the experiences and mental suffering of Belgian prisoners who find themselves being stuck in prison as a result of structural problems in the risk assessment and risk management practices; and the professional perspective on how professional standards and good practices based on scientific insights might alleviate some of these threats to human dignity.

Balancing Political and Criminogenic Needs: Evaluating the New Zealand Department of Corrections' Response to Men Assessed With a Below Average Risk for Sexual Recidivism

Current research provides little evidence for the effectiveness of treatment in reducing sexual offence recidivism amongst low-risk populations. However, in real-world correctional settings, program delivery rarely occurs in a vacuum, treatment may be politically mandated and unidimensional measures of program success may preclude recognition of broader benefits. The current study investigated the effectiveness of a low-intensity treatment program, both in terms of participants' recidivism outcomes and in terms of broader organizational/systems impacts. The results demonstrated low base rate recidivism across both program participants (n = 311) and a comparison group of men who were assessed as demonstrating similar static sexual offence recidivism risk (n = 391), and little evidence of reduced recidivism following treatment. However, program administration led to many potential participants being identified as demonstrating higher levels of dynamic risk and overridden to more intensive treatment options (n = 101). Given evidence that such options do effectively reduce recidivism in higher risk populations, these findings may suggest an overall positive net effect.

Understanding the Latent Structure of Dynamic Risk: Seeking Empirical Constraints on Theory Development Using the VRS-SO and the Theory of Dynamic Risk

The present study is part of a larger project aiming to more closely integrate theory with empirical research into dynamic risk. It seeks to generate empirical findings with the dynamic risk factors contained in the Violence Risk Scale-Sexual Offense version (VRS-SO) that might constrain and guide the further development of Thornton's theoretical model of dynamic risk. Two key issues for theory development are (a) whether the structure of pretreatment dynamic risk factors is the same as the structure of the change in the dynamic risk factors that occurs during treatment, and (b) whether theoretical analysis should focus on individual dynamic items or on the broader factors that run through them. Factor analyses and item-level prediction analyses were conducted on VRS-SO pretreatment, posttreatment, and change ratings obtained from a large combined sample of men (Ns = 1,289-1,431) convicted and treated for sexual offenses. Results indicated that the latent structure of pretreatment dynamic risk was best described by a three-factor model while the latent structure of change items was two dimensional. Prediction analyses examined the degree to which items were predictive beyond prediction obtained from the broader factor that they loaded on. Results showed that for some items, their prediction appeared to be largely carried by the three broad factors. In contrast, other items seem to operate as funnels through which the broader factors' predictiveness flowed. Implications for theory development implied by these results are identified.

Predictive validity of Stable-2007 in incarcerated samples

Some are unclear whether risk assessment instruments, specifically dynamic risk instruments, have demonstrated utility in the risk estimation, treatment recommendations, and monitoring change over time in men at risk for or under sentence of Indeterminate Detention (ID) for sexual offenses. We compare two datasets, the first consisting of individuals representing a routine sample of persons convicted of a sexual offense and the second of men representative of a high risk/needs sample. These two distinct samples (n = 442, mean Static-99R score = 2.4; n = 168, mean Static-99R score 4.5) were then also scored on the Stable-2007. For both groups this scoring occurred in an institutional setting. The Stable-2007 predicted sexual recidivism in Sample 1 independently and in conjunction with the Static-99R. In the high-risk sample the results were the same. In both samples a compound outcome variable (Sexual + Violent reoffense) was also calculated with the Stable-2007 predicting the compound outcome variable in Sample 1 but not Sample 2. This is interesting in that it suggests that the Stable-2007 assesses constructs specific to sexual re-offense in higher risk offenders and not general traits of violence or common anti-social behaviour. Limitations and directions for further research are discussed.

Assessing dynamic risk factors in institutional settings using STABLE-2007

Assessing dynamic risk factors for persons who reside in an institution can be a challenge. Conceptualizing and scoring dynamic risk factors is more difficult when environments are restricted and opportunities for those being assessed to demonstrate changes in behaviour may be few and far between. Additionally, because dynamic risk measures rely partly on file information scoring is dependent on the training and backgrounds of the people who record information and their personal decisions as to what they consider important enough to include in records. This may mean that scoring under research conditions based only on file review does not reflect the reliability of the measure under clinical conditions. Despite these challenges the present paper argues that there is sufficient evidence to support the use of STABLE-2007 as a reliable and valid measure of dynamic risk factors in institutional settings under both clinical and research conditions. Tips are provided on how to conceptualize institutional behaviours in a manner relevant to dynamic risk factors and how to weigh historical versus more recent information. Finally, recommendations are made for implementing a thoughtful system of checks and balances relevant to the assessment process in institutional settings.

Forensic application of static and dynamic risk factors: Is it the right time?

It is common, accepted clinical practice to conduct risk assessments of individuals who commit sexual offenses using the combination of sexual violence risk actuarial measures and dynamic risk factors. This assessment approach has utility when identifying treatment targets, assessing progress in sexual offender treatment, and forming risk management plans. Little research has examined this method in forensic contexts such as deciding whether individuals who suffer from mental disorders are likely to engage in sexually dangerous behavior as defined by sexually violent predator or persons (“SVP”) involuntary civil confinement laws in the USA. In particular, it is uncertain whether the combination of sexual violence risk actuarial measures and dynamic risk factors (DRF) produces sufficiently reliable, relevant, and probative evidence for the trier of fact to properly evaluate the SVP legally defined likelihood of sexual dangerousness. This article explores the efficacy of combining actuarial measures of sexual violence risk and dynamic risk factors as applied in SVP risk assessments based on some commonly observed forensic practices among evaluators. Based on the analysis, recommendations for forensic practice and future research are offered.

Stable-2007 and indeterminate detention

Public safety is the primary reason to assess future risk in men with a history of sexual offending. Over the last twenty-five years our knowledge of, and ability to assess, dynamic risk factors in men with a history of sexual offending has meaningfully improved, but understanding, adoption, utilization, and reasonable implementation of the fruits of this new knowledge is not universal. This article presents a brief overview of the development of dynamic risk assessment for men with a history of sexual offending, primarily following the work of R. Karl Hanson and his associates. This is followed by a review of a meta-analysis on the reliability and validity of STABLE-2007 and two other independent studies that provide useful ancillary information. Utilizing STABLE-2007 with men faced with, or under sanction of indeterminate detention is the focus of this paper and we will review how mental health diagnoses affect recidivism assessment, some concerns about implicit assessment biases, how to employ stable dynamic assessment in secure facilities, address treatment implications resulting from dynamic assessment, and present ideas for future research. I will close by presenting nine (9) arguments why using STABLE-2007 is recommended practice with indeterminate detention populations.

Testing the Static-99R as a Global Screen for Risk of Sex Crime Recidivism in a Norwegian Routine Sample

The Static-99R has been recommended for use as a first global screen for sorting out sex-convicted persons who are in need of further risk assessment. This study investigated the Static-99R's predictive validity based on a nonselected Norwegian sample (n = 858) of persons released from prison after having served a sex crime sentence. After a mean observation period of 2,183 days, 3.4% (n = 29) had recidivated to a new sex offense. A higher number of recidivists were found among those with higher Static-99R total scores. The predictive contribution from each of the ten Static-99R risk items was investigated using standard logistic regression, proportional hazard regression, and random forest classification algorithm. The overall results indicate that the Static-99R is relevant as a risk screen in a Norwegian context, providing similar results concerning predictive accuracy as previous studies.

The Structure, Covariates, and Etiology of Hypersexuality: Implications for Sexual Offending

PURPOSE OF REVIEW

A substantial increase in research on the structure, covariates, and etiology of hypersexuality has emerged during the last decade. It is the goal of this review to summarize and integrate this research and to indicate some practical implications for clinical and forensic practice, especially as applied to those who have sexually offended.

RECENT FINDINGS

Studies from the last half-decade converge on the conclusion that hypersexuality has both problematic and high sexual drive components. Both aspects have consistently been found to be distributed dimensionally and not categorically. Each subdimension covaries differentially with specific types of impulsivity. In addition to sexual abuse, psychological or emotional abuse has emerged to be a potent developmental antecedent of hypersexuality. Current research has focused on the problematic dimension of hypersexuality and has neglected to specify the criteria for high sexual drive. Lacking are large-scale representative and clinical samples that provide determination of optimal cutoffs for treatment and dispositional decisions for both dimensions of hypersexuality. Research on the etiology of both aspects of hypersexuality is in its infancy, and more differentiated assessments of developmental abuse histories are required.

Estimating the probability of sexual recidivism among men charged or convicted of sexual offences: Evidence-based guidance for applied evaluators

Risk assessment is routinely applied in forensic decision-making. Although relative risk information from risk scales is robust across diverse samples and settings, estimates of the absolute probability of sexual recidivism are not. Nonetheless, absolute recidivism estimates are still necessary in some evaluations. This paper summarizes research and offers guidance on evidence-based practices for assessing the probability of recidivism, organized largely around questions commonly asked in court. Overall, estimating the probability of sexual recidivism is difficult and should be undertaken with humility and circumspection. That being said, research favours empirical-actuarial risk tools for this task, more structured scales, and the use of multiple scales. Professional overrides of risk scale results should not be used under any circumstances. Paradoxically, however, professional judgement is still required in some circumstances. Risk scales do not consider all relevant risk factors, but the added value of external risk factors reaches a point of diminishing returns and may or may not be incremental (or worse, can degrade accuracy). There are reasons actuarial risk scales may both underestimate recidivism (e.g., undetected offending, short follow-ups) and overestimate recidivism (e.g., inclusion of sex offences not of interest in some referral questions, data on declining crime and recidivism rates, newer studies demonstrating overestimation of recidivism). Given all these considerations and the need for humility, in the absence of exceptional circumstances, I would not deviate too far from empirical estimates.

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.

Risk Factors for Sexual Offending in Self-Referred Men With Pedophilic Disorder: A Swedish Case-Control Study

Background

The risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown.

Methods

We recruited a consecutive sample of 55 help-seeking, non-correctional adult men diagnosed with DSM-5 PD at a university-affiliated sexual medicine outpatient unit in Sweden. PD participants were compared with 57 age-matched, non-clinical control men on four literature-based dynamic risk domains and self-rated child sexual abuse risk.

Results

PD participants scored higher than controls on all tested domains (0-3 points); expectedly so for pedophilic attraction (2.5 vs. 0.0, Cohen's d = 2.40, 95% confidence interval (CI): [1.91-2.89]), but also for sexual preoccupation (1.6 vs. 1.0, d = 1.11, 95% CI: [0.71-1.51]), impaired self-regulation (1.4 vs. 1.0, d = 0.44, 95% CI: [0.06 to 0.81]), impaired cognitive empathy and antisocial traits (0.9 vs. 0.1, d = 1.18, 95% CI: [0.78-1.59]), and self-rated child sexual abuse risk (1.0 vs. 0.0, d = 1.56, 95% CI: [1.13-1.98]). When summarizing all five domains into a pre-specified composite score (0-15 points), PD subjects scored substantially higher than matched control men (7.5 vs. 2.1, d = 2.12, 95% CI: [1.65-2.59]). Five (9%) PD participants self-reported any previous conviction for a contact child sexual offense and eight (15%) for possession of child sexual abuse material or non-contact sexual offending (adult or child victim). Eighteen subjects (34%) acknowledged past week, child-related sexual behaviors.

Conclusion

Self-referred, help-seeking men with PD scored higher (small to very large effect sizes) than non-clinical control men on psychiatric measures of dynamic risk of child sexual abuse suggested in prior research with correctional samples diagnosed with PD. Our findings, including the composite risk measure, might inform clinical practice, but needs validation against actual sexual offending behavior.

Variables influencing the case prioritisation of men convicted of internet child abuse material offences

The differentiation between men convicted of child abuse material offences, known as Internet Child Abuse Material (I/CAM), and Contact (CO) child sex offenders is an ongoing area of research. Current research indicates there are differences between men convicted of I/CAM and CO offences. This article highlights key variables that may indicate clinically and/or statistically significant differences between I/CAM and CO populations, as identified in current published research. Identified key variables may contribute to the case prioritisation of men under investigation for I/CAM offences to assist timely investigation. Post conviction, key variables may contribute to targeted treatment, reducing recidivism and protecting the global community. Articles containing variables differentiating I/CAM and CO populations were reviewed; articles that did not include any comparative analysis were excluded. The final sample of articles (n = 10) was reviewed using a literature review methodology to collate trend variables and directionality between the two populations. Demographic variables with critical differences between men convicted of I/CAM offences when compared to CO offences are younger age, White ethnic background, employed, lower use of alcohol and drugs, and less or no recorded criminal history but higher self-reported history of offending. Key psychological variables identified are lower impression management, lower demonstrations of antisociality, higher sexual deviancy and higher levels of victim empathy when compared to men convicted of CO offences. The findings will be considered in line with existing risk assessment and case prioritisation tools. This research can contribute to community safety through a specific focus on prioritising the investigation, case management, and treatment of men convicted of I/CAM offences and signals future pathways for targeted risk assessment.