Male victims and post treatment risk assessment among adult male sex offenders.

The use of actuarial instruments to predict sex offender recidivism has gained increasing credibility in recent years. This paper is one in a series examining the impact of dynamic inpatient group therapy upon the predictive influence of static risk factors on recidivism among adult sex offenders. Successful completion of the Phoenix Program (Alberta Hospital Edmonton) has been shown to ameliorate the influence of static risk factors on sexual offense recidivism. Many studies have reported that sex offenders who have male victims are more likely to re-offend than those who do not have male victims. A sample of N=513 convicted adult male sex offenders was examined regarding the relationship between the static risk factor of having male victims, subsequent re-offense, and treatment impact. Interestingly, ever having had a male victim did not significantly correlate with sex offense recidivism, for either treatment completers, non-completers, or the combined group. However, having exclusively male victims was correlated with sex offense recidivism, but only among non-completers of the program (r=.155; p=.017). Analysis of a subset of 422 child molesters yielded a similar result, in that having male victims exclusively was only associated with sex offense recidivism among treatment non-completers (r=.189, p=.009).

Elevated prolactin levels among adult male sex offenders.

A sample of 528 successive admissions to the Phoenix Program, a voluntary inpatient treatment program for sex offenders, was studied in regards to serum prolactin levels. Serum prolactins were obtained as part of a battery of endocrine tests. A substantial number of patients had prolactin levels above the normal range, i.e., 21.0 microg/L. In this sample, fully 10.0% of the men showed elevated prolactin levels (the maximum being 41.0 microg/L), compared with an expected 2.5% according to laboratory norms. None of these individuals had clinical manifestations of prolactinoma. The significance of this increased rate of hyperprolactinemia in this sample of sexual offenders is unclear. There was a negative correlation with age and no correlation with other endocrine tests.

Pedophilia: the problem with diagnosis and limitations of CBT in treatment.

This paper asserts two main points. First, there is little reason to include pedophilia among the mental disorders of the Diagnostic and Statistical Manual (DSM). The diagnostic criteria as specified in the DSM-IV-TR (2000) are both over-inclusive in that all acts of child molestation warrant diagnosis, and under-inclusive in that individuals who have not acted upon, and who are not distressed by their sexual interest in children do not meet diagnostic criteria. On both sides of this debate there are problems. A diagnosis of pedophilia seems to "medicalize" an illegal behavior, or "criminalize" fantasy; depending on the diagnostic criteria used, or the use made of the diagnosis. Secondly, the typical CBT-based relapse prevention treatment for pedophilia, which represents current best practice, is reviewed. It is suggested that this, as a stand alone therapy, is suboptimal. CBT components are necessary but not sufficient for comprehensive therapy. It is imperative that process issues are given primacy in treatment programs. The common factors literature makes it clear that the therapeutic relationship is at least as potent a factor promoting change as the system or techniques that clinicians employ. Diagnosis per se is not required for adequate treatment of these individuals. For the CBT components, some offence specific information is required but that is a far cry from true diagnosis.

Testosterone, sexual offense recidivism, and treatment effect among adult male sex offenders.

The relationship between serum testosterone and sexual violence was examined in a sample of 501 convicted adult male sex offenders attending an intensive in-hospital group psychotherapy treatment program. It was found that men with higher testosterone tended to have committed the most invasive sexual crimes (p < .001, two-tailed). Further, a positive partial correlation (controlling for age) between testosterone and sexual offense recidivism over a lengthy follow-up period (mean = 8.9 years) was found. When the sample was separated into one group that completed treatment and one group that did not, an important ameliorating treatment effect was observed. Although controlling for age, serum testosterone remained significantly predictive of sexual recidivism for the treatment noncompleter group (p < .05, two-tailed). For those who completed treatment testosterone was no longer predictive of sexual reoffense (p > .05, two-tailed). Among convicted sex offenders, higher serum testosterone appears to be associated with greater likelihood of further sexual violence. Effective therapy, however, appears able to intercede in the influence of testosterone on sexually deviant behavior. It is suggested that serum testosterone may be an informative static risk factor and completion of intensive treatment should be accorded significance in future actuarially based risk prediction instruments.