What Keeps Them Together? Insights into Sex Offender Couples Using Qualitative Content Analyses.

Research on sex offenders' relationships is scarce. The aim of this qualitative study was to investigate sex offenders' relationships as well as their female partners' adjustment strategies by means of interview analysis. Both partners profit from the relationship in terms of mutual support and acceptance. The sexual offense is a taboo subject, and the female partners were found to demonstrate cognitive distortions. The imbalance of power found in the sex offenders' relationships is discussed, as is the finding that those sexual offenders interviewed live out their need for dominance and sometimes their aggression. The women interviewed were found to cling to their partners as a result of their insecure attachment style. We discuss couples counseling and therapy as possibilities for addressing the imbalance of power and casting light upon the sexual aspect of the relationship.

The cyproteronacetat treatment of sexual offenders.

Anti-hormonal treatment of sexual offenders with Cyproteronacetat is discussed. The authors report on their own findings, and review the literature. They believe that Cyproteronacetat in combination with supportive psychotherapy is a promising modality. They further comment on the Austrian legal situation.

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.

Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics.

The aim of this study was to investigate which antihormonal treatment strategies are used in German forensic psychiatric institutions. Forensic clinics were asked about the number of treated patients. Four hundred seventy-four patients were committed for sex offences; 12% received either CPA (n = 29) or LHRH- agonists (n = 29). Differences in efficacy were small. Several side effects confirm the importance of a protocol for minimizing medical complications.

[DSM III personality diagnosis in a group of chronic offenders]. / DSM-III-Persönlichkeitsdiagnostik bei einer Gruppe chronischer Straftäter.

A group of chronic offenders (n = 44) was investigated and their personality disorders coded according to two different methods, namely the ICD 9 (International Classification of Diseases 9) and the American DSM III (Diagnostic and Statistical Manual III). The total number of personality disorders diagnosed by DSM III was less than by ICD 9. This cannot be attributed only to the fact that according to DSM III cyclothymic disorders do not have a direct correlate in axis II-personality disorders, but are, instead, assigned to the group of affective disorders. The majority of persons in whom the diagnosis of cyclothymic personality disorders was made on ICD 9 were rated as having one of the "extroverted personality disorders" in DSM III. If the personality disorders are combined to form three groups - (a) eccentric (close to psychoses), (b) extroverted and (c) introverted - then the overall correlation between ICD 9 and DSM III is considerable. The DSM III system promises a higher reliability due to the existence of criteria for inclusion and exclusion. The diagnosis "borderline personality disorder" was compared with the DIB Gunderson interview (kappa 0.89). In the international classification DSM III borderline personality disorder was equivalent to a diagnosis of cyclothymic, irritable, hysteric or sociopathic personality disorder.

Outpatient treatment of mentally disordered offenders in Austria.

The mental health system is faced with a growing number of MDOs with treatment orders. For more than 90% of our sample of 157 discharged irresponsible MDOs a mandatory outpatient treatment was ordered. Considering the fact that half of these patients are transferred after discharge to institutions like psychiatric hospitals or nursing homes (Leygraf, 1988), institutional as well as outpatient treatment options are needed (Silver & Tellefsen, 1991). Within the Austrian mental health system here is an enormous lack of post-discharge treatment facilities for forensic patients (Meise, Rossler, & Hinterhuber, 1994). Furthermore, the existing structures obviously do not meet the special needs of forensic patients. Although this point of view is shared by the psychiatric hospitals and their contentment with the settings for forensic outpatient treatment was low, only one hospital intended conceptional change and modifications. Facing the reality that the same psychiatric hospital authorities complained that they could not release MDOs from an inpatient status because of inappropriate outpatient facilities, the responsibility for forensic patients seems to be projected from the medical to the legal system. This can be seen as a symptom of the tendency to a step wise and long-standing exile of forensic patients from the mental health system. Actually, forensic patients were for various reasons refused by mental health professionals and could not get psychotherapy, medication or adequate psychosocial care. A possible answer to these problems is to establish institutionalized outpatient facilities in the "hybrid" gap between the legal and mental health system (Lamb, Weinberger, & Gross, 1988). The new outpatient clinic in Vienna deals with rejected treatment-order patients, most of them with additional treatment problems such as impulsivity, substance abuse, and mental impairment (Cote & Hodgins, 1990). The special structure of the institution (i.e., a multiprofessional team that offers a wide and easily accessible spectrum of interventions, the realization of individual treatment programs with psychotherapeutic and psychosocial as well as biological aspects, and the long-term personal continuity of care by staff members with forensic psychiatric skills) promoted the experience that after some time half of the patients came on a voluntary basis (Fenell, 1992; Winick, 1994). Some pressure by the court was an efficient way to guarantee regular treatment for patients with personality disorders and perversions. The model of a special, structured, multiprofessional outpatient clinic is successful, but the role of such complementary pilot institutions is ambiguous. Simultaneously, the deficit of adequate outpatient care for MDOs has to be opposed by stopping the unacceptable withdrawal of general psychiatry from the forensic sector.

[Mental disturbances in children and adolescents in Germany. Results of a representative study:age,gender and rater effects]. / Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland--Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte.

METHOD: A study on behavioral and emotional problems and competence in children and adolescents in Germany (PAK-KID study) is described. It is the first nationwide representative survey of this kind of children and adolescents aged 4 to 18 years in Germany. For children aged 4 to 10 years the parents completed the German version of Achenbach's Child Behavior Checklist (CBCL 4-18) developed by the Arbeitsgruppe Deutsche Child Behavior Checklist. Children and adolescents aged 11 years and older filled out the German version of the Youth Self-Report that is part of Achenbach's CBCL in addition to the parents completing the German version of the CBCL. A total of 2856 parent questionnaires and 1798 self-report questionnaires completed by children and adolescents were analyzed. RESULTS: The sample was representative with respect to the main sociodemographic variables. On all problem scales children and adolescents aged 11 to 18 years reported significantly more problems than their parents did. The frequency of internalizing problems (social withdrawal, somatic complaints, anxiety/depression) and delinquent behavior of children and adolescents reported by parents increased with the children's age, whereas aggressive behavior and attention problems decreased with age. Girls reported significantly more problems than boys on all internalizing scales of the Youth Self-Report. The effect was not totally replicated in the parent reports. In the parent reports, boys had more attention problems and more aggressive and delinquent behavior than girls.

[Incidence of psychiatric symptoms and somatic complaints in 4- to 10-year-old children in Germany as judged by parents--a comparison of norm-oriented and criteria-oriented models]. / Häufigkeit psychischer Auffälligkeiten und somatischer Beschwerden bei vier- bis zehnjährigen Kindern in Deutschland im Urteil der Eltern--ein Vergleich normorientierter und kriterienorientierter Modelle.

OBJECTIVES: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents. METHOD: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist. RESULTS: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

[Epidemiologic situation and the fight against acute infectious diseases in Lodz at the turn of the XIX and XX century (to 1918)]. / Sytuacja epidemiologiczna i zwalczanie ostrych chorób zakaznych w Lodzi na przelomie XIX i XX W. (do 1918 r.).

At the turn of the 19th century, in the times of partition of Poland and national servitude, acute infectious diseases raged in Lódz with a high intensity, in consequence of sanitary-hygienic negligance and bad living conditions of working class. Smallpox, cholera, typhoid fever, dysentery, scarlet fever, diphtheria, measles and hooping cough were among the most services diseases. The Russian sanitary administration was obliged to fight against them, but its prophylactic and therapeutic activity was not systematic and only complementary. The epidemic threat released initiatives of the medical circle. The intensification of them took place at the beginning of 20th century. The effectiveness of the activity intensified in the years of World Wars, after the occupation of Lódz by German invaders. The responsibility for municipal affairs was taken over at that time by inhabitants, among others by doctors, who had influence on the creation of conditions for more effective fight against infectious diseases.

[Psychopathological evaluation of children and adolescents in 4 child and adolescent psychiatry referral groups--a multicenter study]. / Die psychopathologische Beurteilung von Kindern und Jugendlichen in vier kinder- und jugendpsychiatrischen Inanspruchnahmestichproben--eine multizentrische Studie.

Goal of the multicenter study with the Clinical Assessment Scale of Child and Adolescent Psychopathology (CASCAP) in a sample of N = 5027 patients from the inpatient and outpatient clinics of psychiatry and psychotherapy of childhood and adolescence of the universities of Berlin (Virchow Clinic), Frankfurt, Cologne and Zurich is the comparison of the clinical populations of these institutions with respect to single symptoms, to symptom scales and to the supreme level of aggregation, the clinical diagnoses according to ICD 10. On the level of diagnoses similar distributions can be found in the centers, but there are also significant differences between the centers. This differences can be found again also on the level of symptom scales and single symptoms, though the deviations are comparatively low.

[The value of different sources of information in evaluating psychiatric disorders in adolescence--a comparison of parental judgment and self-assessment by adolescents]. / Die Bedeutung unterschiedlicher Informationsquellen bei der Beurteilung psychischer Störungen im Jugendalter--ein Vergleich von Elternurteil und Selbsteinschätzung der Jugendlichen.

Data from the national representative epidemiologic survey (PAK-KID-study) assessed by the German versions of Achenbach'S Child Behavior Checklist and Youth Self-Report of N = 1757 parents and their children aged 11 to 18 years are compared by using the corresponding Cross-Informant-Scales. On all problem scales adolescents report more problems than parents. For some scales the differences between girls and their parents are higher than between boys and their parents (social withdrawal, somatic complaints, anxious/depressed, attention problems, internalizing and total score). Averaged Pearson correlations of the eight subscales are in a moderate rage (r < 0.50). For all problem scales an agreement of 30% in the area of high problems (> PR95) is found. If one informant scores above PR95 the Relative Risk of the other one scoring in this range too is significantly higher than one for nearly all scales.

[The struggle against venereal disease in Lódz at the turn of the 19th century]. / Zwalczanie chorób wenerycznych w Lodzi na przelomie XIX I XX wieku.

At the turn of the 19th century in Lódz - with its poor sanitary conditions - venereal diseases (including the most dangerous, syphilis) were amongst the infectious and social diseases which were a great danger to the health and life of its inhabitants. Prostitution, which was a source of income for low-paid or unemployed women, contributed in great measure to the spread of infection. Bad housing conditions, abuse of alcohol, unawareness of danger and carelessness of treatment were also conducive to venereal diseases. The State authorities, who were obliged to struggle against venereal diseases, did so by repressive and humiliating police methods and by the introduction of controls in 1894 involving the registration and compulsory medical examination of prostitutes. Considering the lack of compulsion (except for prostitutes), venereal patients were hospitalized on a limited scale in only the general, specialist and constantly overcrowded Szpital Sw. Aleksandra (St. Alexander Hospital) - the prostitutes at their own expense and the poor at the expense of the municipality. The rich underwent treatment discreetly, in the surgeries and infirmaries of privately practising doctors. The lasting danger of venereal diseases prompted initiatives by doctors- philanthropists, members of Lódzkie Towarzystwo Lekarskie (the Medical Society of Lódz) and the local branch of Warszawskie Towarzystwo Higieniczne (the Hygienic Society of Warsaw). By their lectures, brochures and articles in medical periodicals they popularized their views on the causes; prevention and the struggle against venereal diseases. They were critical of the police and medical surveillance and the struggle against prostitution amongst juvenile girls and recommended the introduction of public, cost - free and obligatory treatment of the sick.

[Sanitary and antiepidemic regulations of medical services of the state administration in Lodz at the turn of the XIXth and XXth c. (till 1914)]. / Zarzadzenia sanitarno-przeciwepidemiczne sluzb medycznych administracji panstwowej w Lodzi na przelomie XIX I XX w. (do 1914).

At the turn of XIX and XX c., because of the spreading of acute infectious diseases in Lodz, the medical services of the state administration, responsible for the public health care, were obliged to publish and to enforce different sanitary and anti-epidemic regulations. They contained basic instructions e.g. the care of sanitary state of dwellings, hospitalization of infectious patients and isolation of persons suspected of contact with diseased, disinfection and anti-smallpox vaccination. Such prophylactic and therapeutic activity was neither systematic nor complementary due to the bureaucratic and incompetent administration of Lodz affairs by municipal authorities and had no essential influence on the melioration of the sanitary situation of the city and of the health of its inhabitants.

[Comparison of sexual murderers in forensic psychiatric hospitals and in prison]. / Sexuelle Tötungsdelikte. Vergleich von Tätern im Straf- und im Massregelvollzug.

Empirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.

[Criminal responsibility in sexual homicide perpetrators]. / Schuldfähigkeit bei sexuellen Tötungsdelikten.

OBJECTIVE: Evaluation of criteria for criminal responsibility, esp. in paraphilias and personality disorders. METHODS: We compared sexual murderers with diminished responsibility or not-guilty for reasons of insanity (n = 73) and those held fully responsible (n = 61) regarding psychiatric disorders, signs of severe paraphilias, level of personality structure (using Operationalized Psychodynamic Diagnostics) and offence related criteria. RESULTS: Sexual murderers found as diminished responsible or not-guilty, especially those detained in forensic psychiatric hospitals, showed more signs of a progressive sadistic development and lower levels of personality structure. Offence related criteria that are regarded as not supporting a diminished capacity plea (purposeful actions, long duration, complex, stepwise course of the offence) were found more frequent in those offenders that were detained in forensic hospitals. CONCLUSIONS: Signs for severity of paraphilias and personality disorders are useful in decisions about criminal responsibility. Criteria regarding purposeful course of action appear not to be adequate for the assessment of paraphilic sexual offenders.