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.

Dynamic Individual Risk Networks: Personalized Network Modelling Based on Experience Sampling Data.

Following a network perspective, risk of sexual reoffending can be understood as a construct that emerges from the interactions between risk factors. If these interrelationships are validly mapped out, this leads to an increased understanding of the risk and thus may contribute to more effective and/or more efficient interventions. This paper reports on personalized network modeling mapping the interrelationships of dynamic risk factors for an individual convicted of sexual offenses, using experience sampling (ESM) based on Stable-2007 items. The longitudinal character of ESM enables both the assessment of interrelations between risk factors within a timeframe and the relationships between risk factors over time. Networks are calculated and compared to the clinical assessment of interrelationships between the risk factors.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample.

Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.

Exploratory Factor Analysis of Unusual Sexual Interests.

BACKGROUND: Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests. AIM: To identify underlying clusters of unusual sexual interests using exploratory factor analysis. METHODS: We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms. OUTCOMES: Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale). RESULTS: We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men. CLINICAL IMPLICATIONS: Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others. STRENGTHS & LIMITATIONS: Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding. CONCLUSION: Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.

Professionals' Understandings of and Attitudes to the Prevention of Sexual Abuse: An International Exploratory Study.

Sexual abuse is a global issue and, therefore, responding to and preventing sexual abuse are global challenges. Although we have examples of and evidence for sexual abuse prevention initiatives internationally, these tend to come from a small, select group of countries (i.e., United Kingdom, United States, Canada, Germany, Netherlands, New Zealand, and Australia) and not from a broader global pool. This article will present the qualitative data from an online study (n = 82), covering 17 countries, on professionals' (i.e., people working in the arena of sexual offending from a clinical, criminal justice, policy, research, and/or practice perspective) perceptions sexual abuse prevention in theory, practice, and policy. The article identifies three main themes: (a) professionals' understandings of the prevention of sexual abuse, (b) public understanding of sexual abuse prevention, and (c) governmental attitudes towards, and support of, sexual abuse prevention programs. The article highlights that, although there are similar understandings of sexual abuse prevention internationally, practice is characterised by national differences in the funding of, provision of, and public/policy perceptions of prevention as well as its impact on offending.

Exploring Hostility Toward Women in High-Risk Rapists: The Relevance of Ambivalence and Relational Experience.

Hostility toward women is an established risk factor for sexual violence and is often found to be present in men prone to sexual transgression. There are also clinical indications that high-risk rapists may have more ambivalent attitudes toward women, including the strong desire to be positively evaluated by women. We investigated attitudes toward women in high-risk male rapists (n = 42), nonsexual male offenders (n = 65), and matched male community controls (n = 42), by means of self-report (hostility toward women, benevolent sexism, hostile sexism) and implicit measures assessing associations (Implicit Association Test [IAT]) with "women are deceitful" and "women are prestige objects," and the approach tendency (Approach-Avoidance Task [AAT]) toward women. Results showed that high-risk rapists had a lesser implicit notion of women as deceitful and more explicit benevolent sexism than the community controls. These differences seemed most prevalent in the subgroup of high-risk rapists without any relationship history. It is hypothesized that unrealistically positive attitudes toward women may lead to rejection and frustration, which may influence sexual offending.

Mixed Emotions: An Incentive Motivational Model of Sexual Deviance.

Sexual offending behavior is a complex and multifaceted phenomenon. Most existing etiological models describe sexual offending behavior as a variant of offending behavior and mostly include factors referring to disinhibition and sexual deviance. In this article, we argue that there is additional value in describing sexual offending behavior as sexual behavior in terms of an incentive model of sexual motivation. The model describes sexual arousal as an emotion, triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. Consequently, we describe sexual offending behavior in terms of this new model with emphasis on the development of deviant sexual interests and preferences. Summarized, the model states that because sexual arousal itself is an emotion, there is a bidirectional relationship between sexual self-regulation and emotional self-regulation. Not only can sex be used to regulate emotional states (i.e., sexual coping), emotions can also be used, consciously or automatically, to regulate sexual arousal (i.e., sexual deviance). Preliminary support for the model is drawn from studies in the field of sex offender research as well as sexology and motivation research.

[Sexually offensive behaviour]. / Seksueel delictgedrag.

Sexually offensive behaviour, in all its forms, is very common. Most perpetrators of sexually offensive behaviour are not sexually deviant. Disinhibition as state, trait or 'choice' is a key factor in a large proportion of sexual offenses. Sexual deviance, i.e. a significant interest in, or preference for, sexually offensive behaviour, less often plays a significant role; it does, however, increase the risk of repeated sexually offensive behaviour. Little is yet known about the aetiology of deviant sexual interests.

A Quasi-Experimental Evaluation of High-Intensity Inpatient Sex Offender Treatment in the Netherlands.

The current study quasi-experimentally assessed the outcome of high-intensity inpatient sex offender treatment in the Netherlands in terms of sexual and violent (including sexual) recidivism. It was hypothesized that treated sex offenders would show lower recidivism rates than untreated sex offenders of the same risk level. In line with the risk principle of the Risk, Need, Responsivity (RNR) model, we predicted that this would especially hold true for offenders of higher risk levels. The study sample consisted of 25% of all convicted Dutch sex offenders not referred to any form of treatment and discharged from prison between 1996 and 2002, and all convicted Dutch sex offenders referred to inpatient treatment who were discharged between 1996 and 2002. Static-99R risk levels of these 266 offenders were retrospectively assessed and survival curves regarding sexual and violent (including sexual) recidivism were compared between treated and untreated offenders, controlling for level of risk. Mean follow-up was 148.0 months (SD = 29.6) and the base rate of sexual recidivism was 15.0% and 38.4% for violent (including sexual) recidivism. Cox regression survival analyses showed marginally significant lower failure rates regarding sexual recidivism for treated high-risk offenders only, and significantly lower failure rates regarding violent (including sexual recidivism) for treated sex offenders of moderate-high and high-risk levels. No treatment effects for low and low-moderate risk offenders were found. Results underscore the risk principle of the RNR model: Treatment is more effective when its dosage is attuned to risk level.

Risk levels, treatment duration, and drop out in a clinically composed outpatient sex offender treatment group.

Previous research in the Netherlands documented that clinical judgment may yield a substantial amount of treatment referrals for sexual offenders that are inconsistent with actuarial risk assessment and the Risk Need Responsivity (RNR) principles. The present study tested the risk level distribution of a high-intensity, open-format outpatient treatment group. Eighty patients were enrolled during a 620-week period, and their STATIC-99R risk levels were retrospectively determined. The distribution of risk levels in this treatment group did not differ from the distribution of a representative sample of sex offenders referred to outpatient treatment in the Netherlands between 1996 and 2002 (n = 145), nor from the combined Canadian samples (n = 2011) used to assess STATIC-99R normative percentile. These findings suggest that no selection in terms of actuarial risk level occurred between conviction and treatment, leading to over-inclusion of low risk offenders in this high-intensity outpatient treatment group. It is concluded that the standard use of structured risk assessment for the compilation of treatment groups may improve both the effectiveness and efficiency of sex offender treatment in the Netherlands.

A comparison of the predictive properties of nine sex offender risk assessment instruments.

Sex offender treatment is most effective when tailored to risk-need-responsivity principles, which dictate that treatment levels should match risk levels as assessed by structured risk assessment instruments. The predictive properties, missing values, and interrater agreement of the scores of 9 structured risk assessment instruments were compared in a national sample of 397 Dutch convicted sex offenders. The instruments included the Rapid Risk Assessment for Sexual Offense Recidivism, Static-99, Static-99R, a slightly modified version of Static-2002 and Static-2002R, Structured Anchored Clinical Judgments Minimum, Risk Matrix 2000, Sexual Violence Risk 20, and a modified version of the Sex Offender Risk Appraisal Guide; sexual and violent (including sexual) recidivism was assessed over 5- and 10-year fixed and variable follow-up periods. In general, the instrument scores showed moderate to large predictive accuracy for the occurrence of reoffending and the number of reoffenses in this sample. Predictive accuracy regarding latency showed more variability across instrument scores. Static-2002R and Static-99R scores showed a slight but consistent advantage in predictive properties over the other instrument scores across outcome measures and follow-up periods in this sample. The results of Sexual Violence Risk 20 and Rapid Risk Assessment for Sexual Offense Recidivism scores were the least positive. A positive association between predictive accuracy and interrater agreement at the item level was found for both sexual recidivism (r = .28, p = .01) and violent (including sexual) recidivism (r = .45, p < .001); no significant association was found between predictive accuracy and missing values at the item level. Results underscore the feasibility and utility of these instruments for informing treatment selection according to the risk-need-responsivity principles.

Treatment referral for sex offenders based on clinical judgment versus actuarial risk assessment: match and analysis of mismatch.

The Risk Need Responsivity (RNR) principles (Andrews & Bonta, 2010) dictate that higher risk sex offenders should receive more intensive treatment. The present study investigates how clinically based treatment assignment relates to risk level in a sex offender sample from The Netherlands. Correlational analyses served to identify sources of mismatches: that is, variables differing significantly in their relation between treatment selection and risk level. Our study sample consisted of 194 convicted rapists and 214 convicted child molesters. All participants' criminal files were retrospectively coded in terms of the items of the STATIC-99R, PCL: SV, and SVR-20. A low to moderate correlation was observed between clinical treatment selection and actuarial risk levels. A substantial part of the sex offenders, especially child molesters, received overly intensive treatment and another substantial part, especially rapists, received treatment of lesser intensity than indicated by their risk levels. General violent and antisocial risk factors seemed to be underemphasized in the clinical evaluation of sex offenders, especially rapists. A negative attitude toward intervention was negatively associated with clinical treatment selection. It is concluded that clinical treatment selection leads to an insufficient match between risk level and treatment level and systematic use of validated structured risk assessment instruments is necessary to ensure optimal adherence to the risk principle.