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Not Just a Sex Offender: Paraphilias and Other Complicating Conditions
Donya L. Adkerson, MA, LCPC 2005
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Consider the individualSex offenders are not all the same B Consider
PParaphilia-specific issuesPConcurrent/Complicating Conditions
PComplicating Circumstances
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ParaphiliaWhat is it?
PRecurrent thoughts, feelings or behaviors indicating arousalPFor at least a 6 month durationPInvolving nonconsenting being, nonsexual object, or body part
PEarly adolescents= arousal patterns may not be fixed enough to diagnose
paraphilia
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Common paraphilias among sex offenders
PNot all sex offenders have a paraphiliaPPedophilia
PHebephilia/EphebephiliaPBestiality
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Common paraphilias among sex offenders
PVoyeurismPExhibitionism
PSadism PParaphilia NOS (Not Otherwise
Specified) e.g., rapePMANY other less common . . . arousal to
feet, diapers, urine, feces, underwear, shoes, fabrics, almost anything.
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Implications of a Paraphilia
PAssociated with increased risk for re-offense
PMay require arousal modification treatment techniques
<Compliance can be difficult<Can only suppress, not eliminate, the
paraphilic arousalPMay present issue in developing partner
relationshipsPMay cause feelings of shame, isolation
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Paraphilia-specific ConsiderationsVoyeurism
PHands-off offenses taken less seriously, but may not be the limit of the behaviorPVoyeurism is legal and sanctioned with
consent (the porn/strip industries)PLimited voyeurism in adolescence
culturally normal
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Paraphilia-specific ConsiderationsVoyeurism
PStalking & voyeurism can look similar; must differentiate
PThe underlying fantasy is critical<Is there fantasy of contact? Force?
<Voyeurism as a prelude to break & enter rape
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Paraphilia-specific ConsiderationsExhibitionism
PTo adults, often seen as joke; to kids, now taken seriously
PHigher correlation with hands-on when victim is child
PHigh correlation with narcissistic traits when target strangers
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Paraphilia-specific ConsiderationsExhibitionism
PHigh rates of relapse; ease of relapsePUnderlying fantasy goalB where does the
exposing lead?<Approval/sex/relationship<Sexual acknowledgment
<Negative response -fear/distress/anger/humiliation
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Paraphilia-specific ConsiderationsPedophilia and Hebephilia
PMay still have arousal to adults -- or may have little to none
PWhat age and gender span at risk?PPedophiles are very heterogenous
groupPParenting problems:
<Arousal to own children<Their children attract other children
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Paraphilia-specific ConsiderationsPedophilia and Hebephilia
PSafety planning areas<Work <Leisure <Family gatherings<Public places <Worship<Media stimuli <Holidays & Special events
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Paraphilia-specific ConsiderationsBestiality
PRarely exclusive in SO referralsPSome correlation of bestiality and
increased risk of child molestPScreen for signs of sadism
PSafety planning with family pets, farm animals, volunteering, work
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Paraphilia-specific ConsiderationsSadism
PArousal to infliction of pain, suffering, humiliation
PThe ULTIMATE DANGER, especially when combined with Antisocial Personality
DisorderPMost sadists offend at home, even if
also offending on strangers
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Paraphilia-specific ConsiderationsSadism
PVictims have EXTREME difficulty reporting and will be more fragile, more traumatized, than non-sadists= victims
<This means sadism may be more common than we realize
PIt is unclear if true sadists are treatable, at least through currently used treatment
approaches
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Recognizing SadismCommon offense elements
PDegradation tactics<Name calling, force begging, porn re-
enactments, use of animals/urine/fecesPBondage and/or Object usePInfliction of pain & injury
PDocumenting<Photos/videos<Souvenirs
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Childhood/Adolescent Histories of Sadistic Offenders
Elements often found
PAggression to peers (may include intentional pain infliction)
PCruelty to animals, animal killing/torturePCompulsive masturbation
PChronic lyingPEnuresis PFire setting
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Childhood/Adolescent history of Sadistic Offenders
Elements often found
PStealingPDestruction of property
PDaydreaming (onset of repetitive violent sexual fantasies and themes of
mastery/power over others)PPoor relationship with parents
PAchievement lower than potential
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Common Family History Factors For Sadists
PAlcohol abusePPsychiatric disordersPCriminal behavior
PInstability of residencePLow family-community involvement
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Paraphilia Specific ConsiderationsMasochism B the flip side of Sadism
PUncommon in offenders, but does turn up at times
PThe masochist feels arousal to experiencing pain/shame/humiliation
PDanger of eroticizing the entire S&M interaction
PDanger of projecting the masochistic arousal onto victims
PDesensitization of the pain & suffering of others
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Co-existing Complicating Conditions
Among sex offenders
PDevelopmentally Delayed/Mentally Retarded
POrganic syndromesPSubstance Abuse/Dependence
PADHD
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Co-existing Complicating Conditions
Among sex offenders
PObsessive-Compulsive disordersPPTSD
PPersonality Disorders
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DD/MR Disability is a continuum, terms may vary
PDSM-IV definitions:<Mild MR: IQ level 50-55 to approximately 70<Moderate MR: IQ level 35 - 40 to 50 - 55 <(IQ of 100 is average)PSpecial programming will be needed
PKeep expectations reasonablePIf group living is required, educating the
DD/MR home staff will be important
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Organic SyndromesPervasive Developmental Disorders
PAsperger=s Syndrome - related to Autism, but with better language
developmentPSevere social impairment - lacks
understanding and ability of normal social interest, interaction
PStandard SO treatment unlikely to be appropriate
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Fetal Alcohol Syndrome
PAssociated features include facial appearance, organ effects, vision and
hearing problems, poor coordination, slow growth
PFeatures interacting with offending problems include poor reasoning skills,
attention problems, trouble learning from education or experience, attachment problems, impaired impulse control
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Organic SyndromesTraumatic Brain Injury
PCommon symptoms:<Impaired social judgement, emotional volatility
& violence<Impaired ability to learn rules or grasp reasons
behind rules<From thought to act without Ascreening@
PIf severe, treatment won=t help
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Attention Deficit Hyperactivity Disorder
PUp to 80% of JSOs in some studies; Adults can have it too
PIncreased impulsivity B more likely to act without reflection
PHarder to focus in therapy, inattention decreases learning
PNegative social reactions to the symptoms
PMedications helpful
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Obsessive - Compulsive Disorder
PObsession = thought; compulsion = behavior
PMay focus on sexual themes or something else
PIncreased alcohol/drug risk with self- medication attempts
PIndividual feels out of control to him/herself
PMedication helpful
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Post-Traumatic Stress Disorder
PAlternating intrusive/avoidance symptomsPCan impair life functioning - sleep disturbance,
dissociation, emotional numbing, poor concentration, hypervigilance, distrust, anger,
flashbacksPSO treatment can trigger trauma symptoms for
abuse survivorsPTreating the PTSD can facilitate SO treatment
process<Victim therapy<Medication for symptom management
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A word of caution regarding offenders reporting sexual
victimization
PStudies using polygraph find that about half of the sex offenders claiming a history
of sexual victimization are fabricated. Such claims can help take the heat off the offender and re-frame them as the victim.
Proceed with caution.
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Personality DisordersGeneral criteria
PEnduring pattern of both internal experiences and external behaviorsPMarkedly different from cultural
expectationsPOnset in teens or early adult
PPervasive, inflexible, stable over timePLeads to distress OR impairment
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Common Personality Disorders among sexual offenders
PBorderlinePHistrionicPNarcissisticPAntisocial
POther types exist, but less likely to turn up in SO treatment
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Borderline Personality DisorderKey: Instability and impulsivity
PUnstable and intense extremes in interpersonal relationships: AI hate you, don=t
leave me!@PUnstable identity - may vacillate on religion,
sense of self, even sexual orientationPSuicidal gestures, self injury, other destructive
impulsive behaviors commonPEmotionally volatile, intense and rapid shifts
of moodPWatch for Borderline PARTNERS of offenders
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Borderline Personality DisorderImplications for treatment & supervision
PThey will likely hate the therapist but fear leaving treatment
PTheir support systems will likely be frustrated and perplexed
PSuicide threats/gestures or other high drama are par for the course
PExpects steps back along with steps forward
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Histrionic Personality DisorderKey: Emotionality and Attention Seeking
PNot comfortable unless the center of attention
PSexually seductive or provocative for attention
PShallow, dramatic, shifting displays of emotion
PSpeech is often overly vague, excessively dramatic
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Histrionic Personality DisorderImplications for treatment & supervision
PHogging group timePStruggle to pin down detailsPLOTS of emotional displays
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Narcissistic Personality DisorderKey: Grandiosity, need for admiration, lack of empathy
PGrandiose view of self importance, talent, superiority
PSees self as Aspecial,@ Aunique@ PSense of entitlement
PLacks empathy for othersPMay be exploitive, arrogant, and believes
others are envious of him
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Narcissistic Personality DisorderImplications for treatment & supervision
PYou probably don=t know as much as they do
PRules don=t apply to themPExpectations of special treatment,
attention, cateringPGroupmates may struggle with the huge
ego
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Antisocial Personality DisorderKey: Disregard for, and violation of, others
PPsychopathy and sociopathy are terms sometimes used
PRepeated criminal behaviorsPDeceitfulness, conning, lying - for profit or
pleasure PDisregard for the rights and safety of others
PIrritability/aggressionPIrresponsibility, fails to meet obligations
PLack of remorse, lack of concern for others
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Antisocial Personality DisorderImplications for treatment & supervision
PHIGHER RISK for recidivismPRisk of other crimes in addition to
sex offendingPLikely to have antisocial peer group
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Antisocial Personality DisorderImplications for treatment & supervision
PWatch for using/manipulating groupmates
PMay frighten groupmatesPExpect dishonesty, thinking errors,
and unpaid billsPControversy on teaching empathy
with this population