Cerebral white matter deficiencies in pedophilic men

The present investigation sought to identify which brain regions distinguish pedophilic from nonpedophilic men, using unbiased, automated analyses of the whole brain. T1-weighted magnetic resonance images (MRIs) were acquired from men who demonstrated illegal or clinically significant sexual behaviors or interests (n = 65) and from men who had histories of nonsexual offenses but no sexual offenses (n = 62). Sexual interest in children was assessed by participants' admissions of pedophilic interest, histories of committing sexual offenses against children, and psychophysiological responses in the laboratory to erotic stimuli depicting children or adults. Automated parcellation of the MRIs revealed significant negative associations between pedophilia and white matter volumes of the temporal and parietal lobes bilaterally. Voxel-based morphometry corroborated the associations and indicated that the regions of lower white matter volumes followed, and were limited to, two major fiber bundles: the superior fronto-occipital fasciculus and the right arcuate fasciculus. No significant differences were found in grey matter or in cerebrospinal fluid (CSF). Because the superior fronto-occipital and arcuate fasciculi connect the cortical regions that respond to sexual cues, these results suggest (1) that those cortical regions operate as a network for recognizing sexually relevant stimuli and (2) that pedophilia results from a partial disconnection within that network.

The role of male sexual arousal in rape: Six models

This article examines men's sexual arousal to rape cues and its possible role in sexual assault. The article presents six different models that have been described in the literature to account for men's sexual arousal to descriptions of rape. The models are divided into two broad categories, response control models and stimulus control models, and are further divided into models postulating a "trait" that might distinguish rapists from other men and those postulating a "state" that might be present in men while they commit a sexual assault. A number of the models are supported by empirical data, and some of these data are reviewed. The article suggests that different models may be operating in different men when they commit sexual assault. These models are discussed in relation to the current literature on the classification and diagnosis of sexual offenders.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

The screening scale for pedophilic interests predicts recidivism among adult sex offenders with child victims

The Screening Scale for Pedophilic Interests (SSPI; Seto & Lalumière, 2001), a brief measure of sexual attraction to prepubescent children that is based on victim characteristics, was used in two samples of 113 and 145 adult male sex offenders with child victims. In both samples, the SSPI was significantly and positively correlated with an index of phallometrically-measured sexual arousal to stimuli depicting prepubescent children. It was also significantly and positively correlated in both samples with violent recidivism (meaning either nonsexually violent offenses or sexual offenses involving physical contact with a victim), and positively correlated with sexual recidivism, significantly so in the second, larger sample. Focusing on the larger sample, the SSPI added to the predictive accuracy of a measure of general antisociality (the Psychopathy Checklist-Revised), while the phallometric index of sexual arousal did not add predictive accuracy once the other two measures were entered. The SSPI also yielded the same interaction between anomalous sexual interests and psychopathy we had previously reported using phallometric data (Rice & Harris, 1997). These findings suggest that the SSPI has predictive utility among adult male sex offenders with child victims, and accounts for variance in sexual offending that is not explained by phallometric testing.

A comparison of volume and circumference phallometry: response magnitude and method agreement

Penile circumference and penile volume phallometry are laboratory methods of assessing sexual arousal. Volume phallometry is reportedly more sensitive to responses, but comparative studies have been inconclusive and beset with methodological problems. In this study, 42 self-professed heterosexual volunteers were assessed with both methods simultaneously, employing a standard test for erotic partner preference. Pearson correlations between test outcome profiles were very high (r > .80) for subjects whose circumferential increase was > 2.5 mm [10% of a full erection (FE)]. However, among lower responders the agreement dropped precipitously (mean r = -.15). Moreover, as a group higher responders differentiated adult and pubescent age female stimuli from each other and all other categories with either method, but lower responders made this differentiation only with the volume method. We conclude that (l) at high levels of response both methods are equally good, (2) at low levels of response volumetric phallometry is a more accurate measure of arousal, and (3) 10% FE, or a 2.5-mm circumference increase, should be the minimum response criterion for the circumferential measure.

Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

Background

Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally.

Methods

Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry.

Results

Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence.

Conclusions

The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.

Sex offenders' response to treatment and its association with recidivism as a function of psychopathy

This study examined the relationship between recidivism and ratings of response to specialized cognitive behavioral treatment conducted in a prison setting among 418 sex offenders released to the community for an average follow-up period of over 5 years. As well as testing for a main effect for treatment ratings, the potential role of psychopathy assessed using the Psychopathy Checklist--Revised (PCL-R) as a moderator of response to treatment was investigated. Ratings of response to treatment failed to predict either serious (violent including sexual) or sexual recidivism. For the more inclusive outcome of serious recidivism, there was no significant interaction between psychopathy and treatment ratings; however, the ubiquitous effect of psychopathy on recidivism was found to be significant. For sexual recidivism, psychopathy was not significant as a main effect, but a significant interaction between psychopathy and treatment ratings was found. Among sex offenders with PCL-R scores of 25 or higher, those with ratings reflecting a more negative response to treatment recidivated sexually at a faster rate than others. This interaction effect was not significant when treatment noncompleters were removed from the data set. The results were discussed in terms of the methodology involved in the assessment of response to treatment among sex offenders.

Fraternal birth order and sexual orientation in pedophiles

Whether homosexual pedophiles have more older brothers (a higher fraternal birth order) than do heterosexual pedophiles was investigated. Subjects were 260 sex offenders (against children age 14 or younger) and 260 matched volunteer controls. The subject's relative attraction to male and female children was assessed by phallometric testing in one analysis, and by his offense history in another. Both methods showed that fraternal birth order correlates with homosexuality in pedophiles, just as it does in men attracted to physically mature partners. Results suggest that fraternal birth order (or the underlying variable it represents) may prove the first identified universal factor in homosexual development. Results also argue against a previous explanation of the high prevalence of homosexuality in pedophiles (25% in this study), namely, that the factors that determine sexual preference in pedophiles are different from those that determine sexual preference in men attracted to adults. An alternative explanation in terms of canalization of development is suggested.

Exhibitionists: sexual preferences for exposing

An assessment of the sexual preferences of exhibitionists and matched non-offenders, revealed greater arousal to scenes of exposing among the offenders but the actual degree of deviant preferences was not marked. Closer analyses of the individual response profiles, using various criteria for deviance, indicated that only a small proportion of exhibitionists displayed deviant arousal. We take these results, along with the findings from previous research, to deny the primacy of sexual motivation in exhibiting behavior. We also consider these results to indicate that there is little value in determining the sexual preferences of exhibitionists when planning treatment or estimating their risk to re-offend.

Differentiating rapists and non-offenders using the rape index

Some studies have suggested that phallometrically derived rape indices can differentiate groups of rapists and non-offenders. There are other studies however which cast doubt on this assertion, at least in so far as it applies to all but those few rapists who are sadistic. These studies have used rape indices which are derived from rapists' sexual responses to audiotaped descriptions of mutually consenting sex and brutal sexual assaults. It was hypothesized however, that stimuli which put more emphasis on the degrading and humiliating elements of rape would improve discriminability. Stimuli were compiled to test this hypothesis. The results indicate that neither rape indices derived from the physically brutal elements nor the degrading elements of rape were able to discriminate between rapists and non-offenders. Furthermore, these indices were not related to offence histories. The results are discussed in terms of their implications for the assessment of rapists and theoretical considerations of their behaviour.

The effects of the z-score transformation on measures of relative erectile response strength: a re-appraisal

In studies of stimulus control of sexual arousal, some researchers transform raw data to z-scores. Earls, Quinsey and Castonguay [Archives of Sexual Behavior, 16, 493-500 (1987)] have argued that the proportion of variance due to stimulus presentations was greater in z-scores than in the raw data or in a percent score. We present analyses of sexual arousal data that show that z-score transformations may distort the information inherent in the raw data and may increase random error. In addition, we present Monte Carlo analyses indicating that the z-score transformation compromises the estimates of Type I error, and, depending on specific circumstances, sometimes increases and sometimes decreases the power of the statistical test. Transformation of raw data to percent of full erection does not distort the information in the raw data, does not compromise the data analyses and, therefore, is the preferred transformation.

Psychopathy, treatment behavior, and recidivism: an extended follow-up of Seto and Barbaree

Seto and Barbaree reported the unexpected finding that adult male sex offenders who scored higher on psychopathy and exhibited better behavior in treatment were almost four times more likely to commit a new serious offence than other offenders once released. The present study reexamined this sample after a longer follow-up time using more complete recidivism data from a national police database. Although psychopathy continued to be a significant predictor of general and serious recidivism, treatment behavior was no longer related to either general or serious recidivism, and there was no statistically significant interaction between psychopathy and treatment behavior. Additional analyses ruled out the possibility that the differences between studies could be accounted for by the different average length of follow-up. A direct comparison of the two sources of recidivism data showed that differences in recidivism between subgroups were reduced by using the more complete recidivism data.

Different actuarial risk measures produce different risk rankings for sexual offenders

Percentile ranks were computed for N=262 sex offenders using each of 5 actuarial risk instruments commonly used with adult sex offenders (RRASOR, Static-99, VRAG, SORAG, and MnSOST-R). Mean differences between percentile ranks obtained by different actuarial measures were found to vary inversely with the correlation between the actuarial scores. Following studies of factor analyses of actuarial items, we argue that the discrepancies among actuarial instruments can be substantially accounted for by the way in which the factor Antisocial Behavior and various factors reflecting sexual deviance are represented among the items contained in each instrument. In the discussion, we provide guidance to clinicians in resolving discrepancies between instruments and we discuss implications for future developments in sex offender risk assessment.

The factor structure of static actuarial items: its relation to prediction

Principal components analysis was conducted on items contained in actuarial instruments used with adult sex offenders, including: the Rapid Assessment of Sex Offender Risk for Recidivism (RASORR), the Static-99, the Violence Risk Appraisal Guide (VRAG), the Sex Offender Risk Appraisal Guide (SORAG), and the Minnesota Sex Offender Screening Tool-Revised (MnSOST-R). In a data set that included child molesters and rapists (N = 311), six interpretable components were identified: Antisocial Behavior, Child Sexual Abuse, Persistence, Detached Predatory Behavior, Young and Single, and Male Victim(s). The RRASOR was highly correlated with Persistence, and the VRAG and SORAG were highly correlated with Antisocial Behavior. Antisocial Behavior was a significant predictor of violent recidivism, while Persistence and Child Sexual Abuse were significant predictors of sexual recidivism.