~Involves sexual activity with a prepubescent child (generally age 13 or younger)
~Is over the age of 16
~Is at least 5 years older than child unless the pt is in his/her late adolescence, then age difference does not matter but need to assess age difference should be taken into account and the sexual maturity of the child should be considered
~Usually prefer children of a particular
~Some are gender specific others not
~If prefer females, usually child is between 8 and 10
~If prefer males, usually younger than the above
~Female victims is reported with more frequency
~If only attracted to children, called exclusive type
~If attracted to adults and children, called, nonexclusive types
~Some who act on their verges will only undress the child, look, expose themselves, masturbate in their presence, gentle rubbing, or fondling, others engage in intruding sexual activity, fellatio or cunnilingus, penetrate the child’s vagina, mouth, or anus with their fingers, foreign objects, or penis and use varying degrees of force
~Rationalizations are common
~Some limit activity to their own children, stepchildren, relatives or may victimize outside their families
~Some threaten the children to hide their behaviors
~Some develop complicated techniques for obtaining access, especially if they victimize frequently
~Sexual Sadism can be involved, in which the victimization is aggressive and violent in nature
~Usually begins in adolescence, although some report that children didn’t to become arousing stimuli until middle age
~Behavior, frequency usually
fluctuates with psychosocial stressors
~Course is usually chronic, especially those with attraction to males, their recidivism is roughly twice that of those who victimize females (DSM, 1994)
Sexual Preferences is conceptualized in terms of a sexual attraction gradient in which different categories of persons and type of behaviors are placed on a continuum according to the level of erotic arousal they generate, some categories are preferred over others, actual behaviors are not a direct function of sexual preference, availability and accessibility of preferred persons, perceived legitimacy (by self and others) of particular behaviors and partners, and societal sanctions are all factors that go into choosing a partner
Sexual preference can be manifested in a variety of ways: actual behaviors, in reported fantasies, in judgment of sexual attractiveness, or in sexual arousal
Male offender Typologies:
Groth: Developed typology in 1979, with two dimensions: the degree of behavioral entrenchment and the basis of the offense
First Dimension has
Fixated Pedophiles –have been attracted to children throughout their entire lives and have been unable to attain any sexual maturity
Regressed Pedophiles-are those who have related to appropriate aged peers sometime in their lives, but social stressors have resulted in a regression that causes them to seek sexual gratification from “safer” partners, children
Second Dimension has
Sex-Pressure Offender- attempt to persuade the victim to cooperate, this type of offender will usually stop if it becomes apparent that the victim is resistant
Sex-Force Offenders are often aggressive and intimidating, the child is seen solely as a sexual outlet, they may use verbal and physical threats or sadistically assault the child
Groth’s typology was expanded by the FBI in 1986, the Fixated pedophile was classified as the Preferential child molester and then subdivided into the following:
Seductive subtype often grooms and courts the child and is able to identify the child who will be least likely to keep the offense a secret
Introverted subtype does not have the social skills of the seductive pedophile and is unable to entice the victim, they typically molest strangers and very young children or may even marry women who have children in the age range of their preference
Sadistic subtype has merged the need to inflict pain in order to obtain sexual pleasure
The FBI re-termed the regressed pedophile as the Situational Offender with the following subtypes:
Regressed subtype is immature and socially inept, relates to children as if they were peers, due to social stressors, the offender turns to his or her own children or other readily available victims
Morally indiscriminate subtype is an ASP who chooses victims more due to their vulnerability and the opportunity and only coincidentally because they are children
Sexually indiscriminate subtype is the individual who is “polymorphous perverse”, they have vague sexual preference and will try any type of sexual activity for gratification
Inadequate subtype is an individual who may be mentally or developmentally disabled, having little contact with others, they see children as vulnerable objects that can be used to satisfy their own sexual curiosity
Female Sex offender typologies:
- Mccarty classification:
o independent offender- offends alone, troubled childhood, including sexual abuse, married as teenager, steady employment, average intelligence, serious emotional disturbances, substance abuse, most often daughter is victim and she views daughter as extension of herself
o Co-offender- actively participates in sexual abuse, troubled childhood, including sexual abuse, under or non employed, several marriages, neglectful apparent with strong need to be taken care of superseding her child’s needs, victim is often her son or daughter
o Accomplice – may not be present but is aware, takes no action to stop abuse or may assist in it or/and procuring victims, works outside the hoe and married as a teenager, average intelligence, powerful need to be cared for, most often victim is teenage daughter
- Mathew, Matthews & Spelitz classification:
o Teacher/lover – sexually involved with prepubescent and adolescent males for purpose of teaching sexuality, relates to victims as peers
o Predisposed offender- history of long-standing and severe sexual abuse, when she becomes a perpetrator, she acts alone and initiated the sexual abuse of victims, who are primarily children, seen as trying o experience emotional intimacy in a non-threatening way
o Male –Coerced offender-history of sexual abuse, acts in concert with a male who has a history of sexually abusing children, some go on to initiate the abuse of others, extremely dependent and non-assertive, abuses her own children as well as children outside the family
Theories of Sexual Molesting
Biological Determinism
-Most look to organic dysfunction (brain damage, head traumas, etc.), hormonal, neurological, hormones, genes, etc.
Psychoanalytic
Conceptualizations
- Unresolved Oedipal complex conflicts
- By raping a women getting back at mother, by raping a male the yare getting back at father
- Freud, Horney, Schizoid personality (Fairborn, Gunthrup), Kernberg, Meloy
- Propose that sexual deviations are learned responses, with masturbation as the reinforcement after an initial seduction, with each masturbation the fantasy becomes reinforced and may become more distorted, the mechanism for reinforcement may be operant or classical or modeling
- Offenders are prone to negative emotional states, the relieve these emotional states they engage in deviant fantasies and any behaviors that result form the fantasies are self-reinforcing by both the pleasure it induces and the emotions relieved. If the deviant fantasies and behavior become uncomfortable, the offender r\engages in minizing, justication, and rationalization their thoughts and actions, thus the distorted thought processes perpetratues the behavior
- C-B model is the most commonly used approach in dealing with sex offenders
Review the Wheel thing
Characteristics:
Freund studied sexual preference by measuring penile volume that occurred in response to still and moving pictures of males and females in varying age in the 50s and 60s, he found: From maximum response to less
Normal heterosexual males: young adult females, adolescent females, child females, then all male categories
Homosexual normal males: young males, adolescent males, child males, then all female categories
Bisexual normal males: same as homosexual males
Homosexual pedophiles: child males were most preferred, female children over other females
Heterosexual pedophiles: child females were most preferred, male children over adult males
USE HAND OUT
for comparing incest offenders to
pedophile offenders
Female molesters
- usually nonviolent
- power and authority is not as a factor as in father-daughter incest
- no psychosis
- usually involve a known victim
- usually separated form adult partner
- isolated
- lonely
- histories of abuse
- psychopathology
- substance abuse
- rationalize of needing the victim, not seen in males
o often assist a male or have assistance by a male (projective identification issue)
Adolescent Sex offenders Characteristics in general:
- emotionally immature
- Suppresses most emotions, especially anger
- Identifies with younger children
- Marked concern regarding sexual identify
- Marginal social development, limited social activities outside home
- Father emotionally distant, indifferent or uninvolved
- Open progression of offense (peeping to soliciting0
- Selects victims younger than self
- Protects self by using denial, rationalization, and projection
- Low self esteem ,feels inadequate about self
- Lack of communication with parents
- Avoids positive interactions with opposite gender peers
- Manipulative personal style
- Mother unaffectionate, demanding, intrusive, belittling
- H/o loneliness, school problems, antisocial or nonsocial behavior used to attract attention
- Sexual offense are frequently precede by a warning such as fantasias with similar age, gender victim
- Sexually deviant behavior is often the offender’s defense against anxiety
- Sex offenses are motivated by a need for recognition, approval, power
Risk Assessments:
Rapid Risk Assessment: the unscientific Cappeletty model
Prior Offense none=0, 1-2=1, 3+=2
Age of onset under 25=1, 25 and older = 0
Victim of gender males = 1, only females = 0
Relation to victim unrelated = 1, only related 0
Est. recidivism, 0= 6.5%, 1= 11.2%, 2=21.1%, 3=26.9%, 4=48.6% and 5=73.1%
Risk Assessment: Look at:
Type of Offense:
incest types (least) , non-familial female, non-
familia males (highest)
Number of victims:
The more victims the higher the risk
Relationship to victim:
First degree relatives, victim was friend or distant relative, victim was unknown (highest)
Selection of victim:
Victim not sought, victim sought (highest)
Impulsive or compulsive sexual behavior (related to
offense):
Evidence of history of impulsive behaviors
associated with the offense,
compulsive (strong desire) sexual behaviors
related to the offense (highest)
Sexual Offense history
Offenses which they were convicted of, plead
guilty,
or admit to committing, the more offenses the higher the risk
History of deviant sexual behavior (outside the
offense)Unknown
or less than 6 months, more than 6 months but less than 2 year, and more than 2
years (highest)
Deviant Sexual Arousal
Low deviant with high appropriate, equal deviant and appropriate, high deviant and low appropriate (highest)
Deviant sexual fantasies
If spoken oaf freely and openly as a problem,
deviant
sexual thoughts/fantasies are minimized and hidden, deviant sexual
thoughts/fantasies are denied
Presence of Paraphilia outside sexual offense, the
more there are the higher the risk
Age of first Offense (any offense)
The highest is for those 13 to 20 and those over
45
Non-sexual criminal history
The more offenses the worst
Violence in crimes
None, use of violence but no weapons, use of violence or threats or violence with weapons, use of extreme violence or sadism with or without weapons
General aggression
No history, history of verbal aggression with no physical violence, h/o physical aggression
Anger or revenge as motivating factor in behavior
is highest
Alcohol and drug use
If there is consistent use and related to crime higher than if there is consistent use not related to crime or none
Social supports
Criminal significant other vs. non-criminal
Work/School adjustment
Form stable to unstable
Discussion of offense
Do they refuse to talk about it or avoid aspects
of it
Acceptance
of responsibility for offense
Denial increases risk
Remorse of offense
Expressed
motivation for treatment
Empathy
for the victim
Personal esteem
Highest are when there is very low self esteem or very high self esteem
Mental disorder
How they do and what they do to
offend:
The setup
The pattern of behavior that the child molester uses to create opportunities to molest children, lays the groundwork to avoid detection and disclosure before the offending behavior begins but continues after the abuse begins
Set up barriers both physical and psychological
Physical barriers include places, getting the child
alone
Psychological barriers include isolating the
victim from their mothers, siblings and friends, such as pitting the
mother-child-siblings a part, causing issues between them, giving preferential
treatment to one or the other, threats, coercion, bribes, fabricating
information, special favors
Barriers with friends by not allowing friends over, not allowing child to visit friends, dressing the child, no makeup, no dating, or other control tactics to keep the child from forming bonds with others
Typically will look for isolated kids, those without friends, without close parental supervision or problems at home, problems in school, and the like
-Behaviors that are to cause less resistance in the child, make others not suspect, or to have them help the molester without knowing his intention
-Sometimes involves pleasurable activities, to reduce anxiety, fear, or concerns (causes confusion once the abuse begins)
-Providing favors, offering to baby-sit to take the child on activities they might not otherwise be able to do (games, camping, amusement parks)
-Physical grooming
-Starts with normal and appropriate behaviors, wrestling, tickling, cuddling, hugging, or playing games that involve touch often in the presence of others, including parents to add legitimacy of touch
-Leads to touching of private areas, often alone but sometimes carefully in front of others, over cloths, if child is young and feel or notice an erection they will exploit their curiosity, will reassure the child this is okay, this is normal for children and adults
-Discussing sexual relations, issues, and functioning in a matter of fact manner, educating the child to the normality, reassuring the child who is not responsive
-Moves to touching of offenders private areas, if child shows concern, he can withdraw the behavior or reassure the child
-Sexual discussions to touching is followed by rewarding behaviors or treats, such as a candy in his pocket
Psychological grooming
- Usually goes hand and hand with physical grooming
- May talk to them, engage in conversation while touching them, usually about something exciting to the child or making plans for both of them of something the child wants to do
- Invades their space, developing trust, and using his/her life experience to confuse the child, making them disbelieve what is happening to them, such as it is suppose to feel good not bad, we are doing what we always have done
- When the child questions or protests, the molester will turn this on the child to make them feel guilty, guilty of lying about them or of causing them to do this or that
- He/she learns how far they can go with a child, and when and how to push it more
- With older children more likely involves coercion, intimidation, threats, arguments, emotional appeals, blaming the victim, if you don’t I will leave and it will be your fault, I’ll go to prison, do you want that, I’ll tell them you made me do it, it was your fault,
- Molesters are good at picking out children who have abuse histories
- Telling child their own issues to increase their closeness and child’s feeling of special-ness, listening to the child, paying attention to the child, meeting the child’s emotional needs to be cared for, treating he child the way he or she thinks adults treat one another
- Often this grooming includes grooming of primary care giver, gaining trust, or using manipulations or using abusive techniques- verbal abuse isolating her/him, encouraging out side activities she/he engages in without him/her
Grooming
the social environment
-Grooming others around him to avoid being under suspicion, doing the dirty work, volunteering, being above reproach to other, and continues usually after the arrest, by denying history, minimizing the history, lying about it, etc.
-A characteristic of virtually all sex offenders, here the term is used to imply denying the responsibility of his/her crime, not a psychological defense mechanism
-Most deny initially, some for ever deny their offense
- Denial is not just a means of escaping responsibility
- Denial is also fueled by societies attitudes towards molesters, furthers their need to cover up their crime, to not be caught, convicted, or incarcerated
- Often people fail to understand how unwittingly they encourage the denial even after a conviction, which is a determent to everyone, by:
o Example of man telling others it is due to a divorce or break up or revenge of partner and people ,say too bad versus asking what was the evidence or confront it
o When these exchanges occur the offender distorts the interaction and perceives support for his denial or for the offense
- no treatment can work as long as the offender denies his crime
- the best thing friends, acquaintances, etc. can do to an offender when he is engaging inn denial is to refer them to their therapist, otherwise miscommunication will occur and the offender uses this to his advantage
- polygraphs can establish that classification of guilty can be made with 75-97% accuracy but the rate of false positive are also high so it can not be counted on as the only proof, but effectively can be used in treatment of offenders
- Support needs to follow admission of guilt
Secrecy
-for molesters secrecy means recovery after the offense is known
- there are five stages of secrecy they use:
o Total denial
o Misunderstood intentions
o Minimal admission with an explanation
o Partial disclosure
o Full disclosure
- dismantling secrecy is not easy because it has become a habitual part of the offenders life, but necessary for the safety of others
-
Total denial
o at first tests his ability to set up the offense and groom those around him, will it work and will they believe him
o sometimes the denial is so strong that they can convince others they were innocent
o therapy with denials are a waste of time essentially and most get prison time, but then they are out again, often still denying
-Misunderstood intentions
o when denial fails they use this
o a variety of explanations can occur, usually the most plausible
o Apologizes and promises are included
o Example of misunderstood intentions:
§ Trying to educate about sex
§ I was drunk or stoned
§ I was just playing, they misunderstood
§ Wanted to know if anyone had done it before
§ Preparing them for what they should defend against
§ Trying to wake from a bad dream
§ Thought it would comfort him/her
-
Minimal Admission with an
explanation
o Involves admitting usually the a small part, usually the least offensive part, and deny the rest
o Then offers are variety of explanations and blames others
o Examples include
§ I did go to her bed but I never touched her
§ I did touch her breasts but not anything else
§ I only did it once, then she asked for it
§ I had to , my wife wasn’t giving me any
o blaming others is intended to confuses others as well as shifts responsibility
o minimizing their behavior is because they prefer to focus on the problems of others instead of themselves
o generalizing the problem brings others into the chaos’s and making their own behavior smaller than the others
o very good at pointing out issues of those around them, this is what the studied during the set up,
o uses manipulative verbal techniques to maintain some form of innocent and manipulate others & they get better at it the more they do it
-Partial Disclosure
- Usually occurs after he has exhausted the others
- Usually occurs with a trained therapist
- Continues to include minimization of offense: example
o the frequency
o duration of abuse
o no resistance by the offender
- partial disclosure is due to
o wanting to avoid prosecution
o wanting to hide his deed
o knowing it is his word against the victim, plays the odds
o knows if others find out it is true, he will be ostracized and offenders does look for approval from others
o also to hide the truth form himself
o this is often a plea bargain stage, which can actually play into his manipulation, I plead guilty because….I didn’t really do it
o plea bargain also confuses others regarding the harm done
-Full disclosure
-Need as much collateral information
to confirm the offender is fully disclosing, usually they do not
Blaming
-Blaming the victim
-Blaming the care giver
-Blaming substances, alcohol or illicit drugs
-important to note that their distortions of the behavior may cause them to believe
others are to blame, the trick is to challenge there distortions, until they can perceive reality accurately and accept responsibility and see how the distortions developed
Paraphilias in the DSM
Essential features are:
A)Recurrent,
Intense sexual arousing fantasies, sexual urges or behaviors
generally involving:
Nonhuman objects
The suffering or humiliation of oneself or partner
Children or nonconsenting partner
That occurs over the last 6 months
B) The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning: obligatory, results in sexual dysfunction, require participation of nonconsenting partners or children, led to legal complications, interfere with social relations
Most apprehended of paraphilias is pedophile, voyeur, and exhibitionist
Most come in to Tx involuntary bases
Preferred stimulus maybe highly specific
Individuals who can not find willing partners may purchase prostitutes or act out fantasies on unwilling suspects
Likely to select occupations that involve contact with stimulus, selling shoes, lingerie, working with children, driving an ambulance (Sexual Sadism)
May view, read, purchase, or collect photographic films, and textual depictions that focus on their preferred type or paraphiliac stimulus.
May assert that their behavior causes them no distress and that their only problem is social dysfunction as a result of the reaction of others to their behavior.
Others report extreme guilt, shame, and depression at having engage in an unusual sexual activity that is socially unacceptable or that they regard as immoral.
There is often impairment in the capacity for reciprocal, affectionate sexual activity, and sexual dysfunctions may be present
Personality is also frequent
Depression may be present and may exacerbate the frequency and intensity of the paraphiliac behavior
LAB Findings:
Penile Plethysmography (penile meter) is used by measuring an
individuals sexual arousal in response to visual and auditory stimuli.
Clinical experience suggests that subjects can simulate response by
manipulating mental images
~Associated medical conditions- STDs
~Certain fantasies and behaviors associated with paraphilias may begin in childhood or early adolescence but become better defined and elaborated during adolescence and early adulthood
~Elaboration and revision of paraphiliac fantasies may continue over the lifetime
~Fantasies are recurrent but frequency and intensity vary amongst people
~Disorders tend to be chronic and lifelong but fantasies and behaviors often diminish with advancing age
~Behaviors may increase in response to psychosocial stressors, in relation to other mental disorders, or with increased opportunity to engage in paraphilia
They are:
302.4 Exhibitionism exposing genitals to unsuspecting stranger, sometimes masturbates, usually no other attempt at sexual contact
302.81 Fetishism nonliving object for sexual arousal, most common are women’s underpants, bras, stockings, shoes, boots, frequently masturbates while holding, rubbing or smelling the fetish object and in absence maybe sexual dysfunction
302.89 Frotteruism touching or rubbing against a nonconsenting person, usually occurs in crowded place from which the person can easily escape often accompanies having a caring relationship with the person they are rubbing their genitals against or fondling
302.2 Pedophilia
302.83 Sexual Masochism real or stimulated acts of being humiliated, beaten, bound, or otherwise made to suffer, not always acted on, fantasies during consensual sex or masturbation typically of being raped.
302.84 Sexual Sadism involves real, not stimulated in which the individual derives sexual excitement form the psychological or physical suffering of the victim
302.3 Transvestic Fetishism not dx when occurs during Gender Identity Disorder
302.82 Voyeurism
302.9 Paraphilia NOS, examples include telephone scatologia, necrophilia, partialism (body parts), zoophilia, coprophilia (feces), klismaphilia (enemas), and urophilia (urine)
Defense Mechanisms
Distortion- grossly reshaping external reality to suit inner needs
Projecting- projecting one’s own feelings or attributes to someone else and acting on the projection
Denial – seeing but refusing to see what is there, not repression
Acting out-expression of unconscious wish or desire
Neurotic Defenses
Displacement- purposely an consciously shifting form one object to another in the interest of solving a conflict
Externalization – tendency to perceive in the external world and in external objects components of one’s own personality
Intellectualization – controlling affect and impulses by thinking about them instead of experiencing them
Rationalization – justification of attitudes, beliefs, or behavior that may otherwise by unacceptable by an incorrect application of justifying reasons
Mature Defense:
Altruism, Anticipation, Humor, Sublimation, Suppression
References:
Sarah’s Brain
Diagnostic & Statistical Manual, IV by American Psychiatric Association
Understanding Child Molesters: Taking Cahrge by Eric Leberg
Assessment of Sexual Offenders Against Children, by Quinsey V.l, & Lalumiere,
M.L.
Female Sex Offenders by Davin, P.A., Hislop, J. C.R., & Dunbar, T.