Psychiatric and legal features of 113 men convicted of sexual offenses.
BACKGROUND
To increase understanding of the relationships among sexual violence, paraphilias, and mental illness, the authors assessed the legal and psychiatric features of 113 men convicted of sexual offenses.


METHODS
113 consecutive male sex offenders referred from prison, jail, or probation to a residential treatment facility received structured clinical interviews for DSM-IV Axis I and II disorders, including sexual disorders. Participants' legal, sexual and physical abuse, and family psychiatric histories were also evaluated. We compared offenders with and without paraphilias.


RESULTS
Participants displayed high rates of lifetime Axis I and Axis II disorders: 96 (85%) had a substance use disorder; 84 (74%), a paraphilia; 66 (58%), a mood disorder (40 [35%], a bipolar disorder and 27 [24%], a depressive disorder); 43 (38%), an impulse control disorder; 26 (23%), an anxiety disorder; 10 (9%), an eating disorder; and 63 (56%), antisocial personality disorder. Presence of a paraphilia correlated positively with the presence of any mood disorder (p <.001), major depression (p =.007), bipolar I disorder (p =.034), any anxiety disorder (p=.034), any impulse control disorder (p =.006), and avoidant personality disorder (p =.013). Although offenders without paraphilias spent more time in prison than those with paraphilias (p =.019), paraphilic offenders reported more victims (p =.014), started offending at a younger age (p =.015), and were more likely to perpetrate incest (p =.005). Paraphilic offenders were also more likely to be convicted of (p =.001) or admit to (p <.001) gross sexual imposition of a minor. Nonparaphilic offenders were more likely to have adult victims exclusively (p =.002), a prior conviction for theft (p <.001), and a history of juvenile offenses (p =.058).


CONCLUSIONS
Sex offenders in the study population displayed high rates of mental illness, substance abuse, paraphilias, personality disorders, and comorbidity among these conditions. Sex offenders with paraphilias had significantly higher rates of certain types of mental illness and avoidant personality disorder. Moreover, paraphilic offenders spent less time in prison but started offending at a younger age and reported more victims and more non-rape sexual offenses against minors than offenders without paraphilias. On the basis of our findings, we assert that sex offenders should be carefully evaluated for the presence of mental illness and that sex offender management programs should have a capacity for psychiatric treatment.
Dunsieth
Neal W
NW
Center for the Study of Criminal Behavior, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.
Nelson
Erik B
EB
Brusman-Lovins
Lori A
LA
Holcomb
Jeff L
JL
Beckman
DeAnna
D
Welge
Jeffrey A
JA
Roby
David
D
Taylor
Purcell
P
Soutullo
Cesar A
CA
McElroy
Susan L
SL
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D000987:Antisocial Personality Disorder / Q000453:epidemiology; D015897:Comorbidity; D003415:Crime / Q000331:legislation & jurisprudence; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010262:Paraphilic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011570:Psychiatry / Q000331:legislation & jurisprudence*; D012742:Sex Offenses / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents