B1. What Causes People To Commit Sexual Offences?

There is no single cause of sex offending as there are no typical sex offenders. It may not even be accurate to think of factors which contribute to sexual offending as causal, in that a person has no choice and is driven by uncontrollable internal or external forces. Many ideas have been put forward over the past few decades but no singular theory or model adequately explains all forms of sexual aggression and abuse. As such it is necessary to draw on a variety of ideas when thinking about any individual offender.
Within the academic literature a number of ideas have been put forward over time, and theories have evolved as we continue to learn more about human behaviour and sexual offending in particular. No single theory offers a complete explanation, and there are useful ideas that can be drawn from the range of models and theories available. Ideas have stemmed from different scientific disciplines and the emphasis on particular aspects of sexual offending varies. Some authors focus specifically on the biological basis for understanding sexual aggression, other authors are more psychological or sociological and focus on social aspects of the offender and his environment, together with the personality characteristics (motivation, mood, thinking styles and behaviour). The main ideas are presented under the following headings below.
(See other NOTA sections on discriminating between sexual offenders)

Biological Explanations of Sexual Aggression 

Biological and evolutionary perspectives focus on sexual aggression as a form of deviant behaviour based in underlying biological dispositions or structures. At the purely biological level, sexual behaviour and dysfunction have been linked to hormonal and nervous system processes. Hormonally sex and aggression are linked to male androgens (e.g. testosterone), the chemicals involved in sexual development and arousal. Early medical explanations suggested that because testosterone was a main factor in sexual aggression, it could be dealt with by physical castration, later superseded by medication sometimes referred to as ‘chemical castration’.
Reoffending rates in men prescribed drugs such as cyproterone acetate (not available in the United States), triptorelin, goserelin, leuprorelin, and Depo-Provera (in North America) are low, but the significant side effects associated with these drugs means that they need to be used selectively – in cases where offenders report subjectively high and difficult to control sexual drive, or in some instances where there is a high risk of a serious offence. When prescribed, these drugs should be used in conjunction with appropriate psychological treatments. In the UK it is almost certainly the case that antilibidinal medication could be usefully considered more frequently than it is. Click here for ATSA’s position on castration and anti-libinal treatment.
http://www.atsa.com/ppantiandro.html
Studies have found that the monoamine neurotransmitters (specific chemicals in the brain that transmit information), such as dopamine, noradrenaline, and serotonin, serve a modulatory role in human and mammalian sexual motivation. Pharmacological agents that affect these neurotransmitters can have both significant facilitative and inhibitory effects on sexual behaviour. In other words brain chemistry affects arousal and motivation to have sex, or not.
With reference to behaviours associated with sexual offending it has been found that monoaminergic dysregulation bears some relationship to some forms of paraphilia (extreme deviant behaviours). This would suggest that sexual deviance or hypersexuality might, in part, be explained as a dysfunction of primary electro-chemical control mechanisms that result in maladaptive sexual behaviour.
In practice, selective serotonin reuptake inhibitors (often referred to as SSRIs and include drugs such as fluoxetine (Prozac) and sertraline (Lustral)) have been found to be effective in the treatment of some sex offenders, particularly those in whom there is are strong ruminative or compulsive components (Greenberg & Bradford, 1997). In these cases offenders frequently report a decrease in the intensity of their sexual fantasies, and find it easier to manage their sexual urges.

References 

Batamirov, I.I. (1999) Neuropsychological status of persons with sexual deviations Biological Psychiatry, Volume 42, Issue 1, Supplement 1, Pages 94-95.
Baumbach, J. (2002) Some implications of prenatal alcohol exposure for the treatment of adolescents with sexual offending behaviors. Sex Abuse. Volume 14, Issue 4, Pages 313-27. Review.
DelBello, M.P., Soutullo, C.A., Zimmerman, M.E., Sax, K.W., Williams, J.R., McElroy, S.L., & Strakowski, S.M. (1999) Traumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorder. Psychiatry Research, Volume 89, Issue 3, Pages 281-6.
Greenberg, D. M., and Bradford, J. M. W. (1997). Treatment of the paraphilic disorders: A review of the role of the selective serotonin reuptake inhibitors. Sexual Abuse: A Journal of Research and Treatment, 9:349-360.
Hucker, S. J. & Bain, J. (1990). Androgenic Hormones and Sexual Assault. In W. L. Marshall & H. E. Barbaree (Eds.), Handbook of Sexual Assault: Issues, Theories, and Treatment of the Offenders (pp.93-113). New York: Plenum.
Kafka, M.P. (1997) The monoamine hypothesis for the pathophysiology of paraphilic disorders: an update. Archives of Sexual Behaviour, Volume 26, Issue 4, Pages 343-58.

Evolutionary Explanations Of Sexual Aggression 

A dated and heavily criticized theoretical view point from some authors suggests that rape may serve as an evolutionary function as a form of procreation (Thornhill & Palmer 2000). It is argued that rape has evolved as a mating strategy analagous to the non-consensual sexual activity seen in our primate relatives. However there is strong contradictory evidence has been collated against such a position (Tang-Martinez & Mechanic 2000) indicating that ‘forced copulation’ is not successful at all with respect to reproduction.
Thornhill & Palmer further argue that rape is primarily driven by sexual desire, which is again contrary to the evidence that sexual offending is multiply-determined (see FAQ B2), motivated by sex, power, and a range of negative emotional states (Groth, Burgess 1977; Cohen et al 1980; Prentky & Knight 2000). Thornhill & Palmer is that because rapists offend against younger women (of child-bearing age) this supports the notion that rapists desire to reproduce through sex. This is a misunderstanding of the association between youth and offending. Men, whether rapists or not are more attracted to youth (Buss 1994) and this attraction is not the same as wanting to reproduce. A more fundamental flaw with this proposition is that it does not explain male offenders who commit sexual offences against male victims, or those female victims who are at too young an age to conceive children.
Some of the evolutionary confusion over rape has come from studies of non-humans including ducks in which animals are seen as forceful in their mating strategies. The term rape is often misapplied to animals and its presence in the animal world has led some authors to suggest that it has an evolutionary basis. But as Gould says:
“The situation can become truly insidious… when we impose a human institution upon nature by false metaphor- and then try and justify the social phenomenon as an inevitable reflection of nature’s dictates.Yet by falsely describing an inherited behaviour of birds with an old name for a deviant human action we subtly suggest that true rape- our own kind – might be a natural behaviour with Darwininan advantages to certain people as well” (Gould 1997, p433).

References 

Buss, D. M. (1994). The evolution of desire. New York: Basic Books.
Gould, S. J. (1997). Dinosaur in a Haystack. London: Penguin
Tang-Martinez, Z., & Mechanic, M.B. (2000). Response to Thornhill and Palmer on Rape. The Sciences: NY Academy of Sciences.
Thornhill, R., Palmer, C. T. (2000). A natural history of rape: Biological bases of sexual coercion. Cambridge, MA: MIT Press.
For a critique of this approach see http://www.thecurrentonline.com/news/2002/10/14/Opinions/Criminal.Evolution-296482.shtml
Social And Psychological Explanations Of Sexual Aggression
Four broad strands can be identified which contribute to the question of sex offence causality: Societal and cultural norms, early experiences and current psychological functioning.

Societal and Cultural norms 

Sociological research (e.g. Sanday, 1981; Mezey, 2000) has illustrated how societies in which rape is most prevalent are characterised by a predominance of male authority and power, and where violence is regarded as a legitimate form of problem solving. A culture of secrecy or collusion about sexual offending can be a barrier to identifying the prevalence of different types of sexual offending. These barriers are gradually being removed and increasingly more detailed information is becoming available on hitherto unrecorded offences.
An alternative perspective comes from Feminist theory that views rape as a form of social control and that ‘myths’ are perpetuated by social processes, including the media (Jozsa & Jozsa, 1980), thereby justifying male rape. These myths include: “Male Sex Drive” (driven by uncontrollable drives) and “Women Ask For It” (want to be raped) (Freedman 1989; Deckard, 1983). See also the work of Susan Brownmillar and Martha Burt.
Development and Early experiences 
It has been established that early problems in a child’s relationships with its parents can result in disrupted attachment experiences, which can, along with other experiences, contribute to the development of sexual offending behaviour (Marshall 1994;1996). Others studies similarly suggest that early attachment history is an important determinant of sexual aggression (Baker & Beech 2004). These early experiences, as well as leading to risk factors within the individual’s adult functioning, can also become treatment targets in therapy. Therapists tread a difficult line between helping offenders acknowledge, work through, and learn from childhood experiences, and not inadvertently reinforcing an abdication of responsibility for, or taking a ‘victim stance’ in relation to, their own behaviour.
In the case of sexual homicide for example Burgess et al (1986) described how an inadequate social environment in which a child is growing up (e.g. little parental support, or excessive demands on the child) combined with early traumatic experiences (e.g. abuse, or bullying) can set the conditions for the development of violent fantasies and distorted attitudes as a means of coping. In some individuals these violent fantasies and supporting attitudes can become sexualised as they reach puberty, reinforced by repeated pairing with masturbation. MacCulloch et al (1983) described how such violent sexual fantasies were present in the histories of a series of sadistic sexual offenders, who had developed elaborate sadistic fantasies which they eventually felt compelled to carry out.

Psychological Functioning 

Psychologists consider individuals as a complex system of related facets based in Cognition (thinking), Affect (feeling) and Behaviour operating in a Social context. Psychological explanations and interventions have developed around these core features of personality and functioning. As such the core features of sex offenders are often couched in psychological terms around affect, cognitions and behaviours. More specific emphasis on personality characteristics also indicates high levels of variation, although some types of personality are probably more likely than others to engage in such activities. Psychopaths for example.
The main factors considered important in understanding rapists and child molesters are also the main factors involved in treatment and risk assessment. Features that have been shown to contribute to sexual offending, and hence form the basis of treatment targets, include the following: Self-esteem, Social skills deficits, Intimacy deficits, Empathy deficits, Cognitive distortions, Deviant sexual arousal. At the individual level further factors may also contribute to sexual offending behaviour, such as anxiety or depression in response to situations or life events.
(Details on psychological treatment can be found in FAQ D1)
The literature on this area is vast although a few authors (listed below) have offered psychological models to help explain different forms of sexual aggression. Our understanding is also influenced by the psychiatric and psychological classifications suggested over the past few decades. (Further details are found in discriminating sexual offenders in B2). Readers are advised to investigate a number of models and classifications and draw their own conclusions.

Models

Finkelhor (1984) 
Precondition Theory
Marshall & Barbaree (1990) 
Integrated Theory
Hall & Hirschman (1992)
Quadripartite theory of child molestation
Ward, T. and Siegert, R. (2002) 
Theory Knitting pathways model
References 
Brownmiller, S. (1975). Against our Will: Men Women and Rape. New York: Simon and Schuster.
Burt, M. R. (1980). Cultural myths and supports of rape . Journal of Personality and Social Psychology, 38, 217-230.
Finkelhor, D. (1984) Child Sexual Abuse: New theory and research, New York: Free Press
Hall, G. C. N., & Hirschman, R. (1992). Sexual aggression against children: A conceptual perspective of etiology. Criminal Justice and Behavior, Volume 19, Pages 8-23
Marshall, W.L. & Barbaree, H.E. (1990) An integrated theory of the etiology of sexual offending. in WL Marshall, DR Laws, and HE Barbaree (eds) Handbook of sexual assault: Issues, Theories, and Treatment of the Offender. New York: Plenum.
Marshall, W.L., Barbaree, H.E., & Fernandez, Y.M. (1995) Some aspects of social competence in sexual offenders. Sexual Abuse: A Journal of Research and Treatment Volume 7, Pages 113-127.
Marshall, W.L., & Pithers, W.D. (1994) A reconsideration of treatment outcome with sex offenders. Criminal Justice Behaviour, Volume 21, Pages 10-27.
Perkins, D.E. (1991) Psychological treatment programme for sex offenders. in B McGurk, D Thornton, and M Williams (eds) Applying Psychology to Imprisonment. London: HMSO.
Perkins, D.E., Hammond, S., Coles, D., & Bishopp, D. (1998) Review of Sex Offender Treatment Programmes. Broadmoor Hospital: Report for HSPSCB. A summary is available at www.doh.gov.uk/hspscb/summary.htm.
Sanday, P.R. (1981) The socio-cultural context of rape: a cross-cultural study. The Journal of Social Issues, Volume 37, Pages 5-27.
Ward, T., Louden, K., Hudson, S., & Marshall, W.L. (1995) A descriptive model of the offence process. Journal of Interpersonal Violence, Volume 10, Pages 453-473.
Ward, T., Hudson, S.M., Johnston, L., & Marshall, W.L. (1996) Attachment style in sex offenders: a preliminary study. Journal of Sex Research, Volume 33, Pages 17-26.
Ward, T., Hudson, S.M., Johnston, L., & Marshall, W.L. (1997) Cognitive distortions in sex offenders: an integrative review. Clinical Psychology Review, Volume 17, Pages 479-507.
Ward, T., Hudson, S.M., & Keenan, T.R. (2000) The assessment and treatment of sexual offenders against children. in CR Hollin (ed) Handbook of Offender Assessment and Treatment. Chichester: Wiley.
Ward, T. & Siegert, R. (2002) ‘Toward a Comprehensive Theory of Child Sexual Abuse: A Theory Knitting Perspective’ , Psychology, Crime, & Law Volume 8, Issue 4, Pages 319-351
 

B2. How Can We Discriminate Between Sexual Offenders?

Sexual offenders are a heterogeneous group, although it is sometimes useful to group them according to victim age or sex, or by the nature of the act. As such offenders are often described as adult sexual offenders, or child molesters or they are described in terms of having committed rape, indecent assault or sexual homicide. These distinctions are practically useful but often mask a more complex picture in which offenders may offend against a range of victims in more than one way. A number of classification systems have emerged over the past 50 years that have attempted to discriminate between groups of child molesters, rapists and sexual murderers.
Early attempts to discriminate between sex offenders were based on rational taxonomies developed by professionals working with this group of offenders. These early typologies need to be considered in their context, reflecting early instinctivist ideas of innate sexual and aggressive drives, and Freudian theory, relating to pent-up sexual energy (Guttmacher and Weihofen 1952) or ego problems (Kopp 1962). Later, other typologies emerged, which were to identify more critical characteristics of rapists (Groth 1977, Prentky 1985), and child abusers (Groth and Birnbaum 1979, Prentky 1988). Unfortunately the discriminating characteristics used to classify sexual offenders are often ambiguous and not mutually exclusive. Motivations and behaviours transcend different offender categories; there are, for example, various types of aggression proposed, ranging from instrumental to sadistic, evident within most of the typologies. This ambiguity in the defining construct of aggression can lead to difficulties when assigning individuals to one or other aggressive type. Consequently we can only talk about such discriminations as typologies, rather than classifications because classification implies that the defining criteria are mutually exclusive.
Typologies have been offered for all major forms of sexual aggressor including rapist, child molesters, sexual murderers and even female sex offenders. Details of these are provided in subsequent FAQ sections.
 

B3. Characteristics Of Child Sexual Abusers

There are different approaches to studying the characteristics of child sex offenders. One approach is the classification of sex offenders into different types, while other studies focus on characteristics which are thought to apply to the whole group. Neither is definitive and both are useful.
One distinction which needs to be made is between those offenders who abuse within the home against their own or known children versus those who offend against strangers. It is difficult to establish the prevalence of these different types due to the under-reporting of intra-familial abuse (Arata 1998; Hanson 1999). As such the populations of child molesters examined by research may be biased. Other studies also suggest that girls are more likely to report the abuse than boys. As such the patterns and characteristics of offenders in the home may well be different to those who offend outside of the home as the relationship between abuser and victim is different and the strategies for abusing are also context related.
The Home Office (Fisher & Mair, 1998). carried out a review of the classification systems of sex offenders. The review describes the Knight and Prentky’s classification scheme for child molesters – the MTC: CM3. Prentky et al (1997) base their system on stable traits that have identifiable roots in childhood. The review highlights the limitations of this particular system, such as having a biased sample and excluding certain groups, such as incest offenders. A second classification system discussed in the Home Office review was the RAPID, Waterhouse et al, (1994) which represents four types of sexual abusers: Random Abusers, Paedophiles, Incest and Deniers. Again the review discusses the limitations of RAPID, such as using a small sample size and having rather vague categories, whereby offenders could fit into more than one category.
Erooga (2002) describes the characteristics of adults who commit sexual offences against children. He cites a study by Fisher (1994) which states that men who sexually abuse children do not differ significantly with non-offender populations on basic demographic variables. Despite this similarity, Erooga (2002) reports that male child sex offenders tend to have the following characteristics:
 “There tends to be high rates of convicted child abusers who have been themselves abused as children as compared with non offender populations (see, e.g., Abel et al. 1987). 
Men who sexually abuse children tend to experience relationship and other problems.
Cited findings from Beckett et al (1994) show that those child sex offenders in treatment tend to be “…typically emotionally isolated individuals, lack self confidence, underassertive, poor at appreciating the perspective of others, and ill equipped to deal with emotional distress…”
However, Erooga (2002) also states that the majority of cases of people who have been sexually abused during childhood do not go on to become abusers themselves. Furthermore, caution should be taken when interpreting these findings, as many people who are emotionally isolated, lack self confidence and have relationship difficulties for example, are not child sexual abusers.
Finkelhor (1984) proposes a model of child sexual abuse, which describes the process of child sexual offending as well as the characteristics of the offenders. It comprises of four preconditions leading to the sexual abuse of a child:
 
Sexual motivation 

 Overcoming internal inhibitions against acting on that motivation 
Overcoming external impediments to committing sexual abuse 
Undermining or overcoming the child’s resistance to the sexual abuse. 
There are several criticisms ofto Finkelhor’s model. For example, a critique by Ward (2001) states that the model suffers from vagueness and contains overlapping constructs.
A further approach to studying child sex offenders is the Pathways Model, as described by Tony Ward (in press). This describes multiple different pathways leading to the sexual abuse of a child, each involving different influences and mechanisms (such as intimacy deficits, deviant sex scripts, cognitive distortions, and emotional dysregulation). The major disadvantage of such an approach is that, in reality, child sex offending may involve a combination of more than one of the different pathways.
While it may be useful to try and consider sexual abusers within typologies, more often offenders have characteristics which go across types. In many ways “types” only helps to identify the many facets associated with the group. It is these characteristics which are important, rather than their formulation as types. The literature identifies characteristics associated with a broad group of sexual abusers of children. These characteristics help to define the group rather than the specific individuals.

References 

Beckett, R., Beech, A, Fisher, D. & Scott-Fordham, A. (1998). Community based treatment for sex offenders: An evaluation of seven treatment programmes. London: Home Office Publications Unit.
Finkelhor, D. (1984) Child Sexual Abuse: New theory and research, New York: Free Press
Fisher, D. and Mair, G. (1998) A review of classification systems for sex offenders. Home Office Research and Statistics Directorate.
Prentky, R., Knight, R., Lee, A. (1997). Child Sexual Molestation: Research Issues. National Institute of Justice Research Report.
Ward, T., Siege, R. Towards a Comprehensive Theory of Child Sexual Abuse: A Theory Knitting Perspective. Psychology, crime and Law, (in press).
Ward T & Hudson (2001). A critique of Finkelhor’s precondition model of sexual abuse. Psychology, Crime and Law, 7, 333-350.
 
B4. Characteristics Of Rapists
A number of typologies have emerged over the past few decades that identify critical aspects of sex offender behaviour and motivation. Groth, Burgess and Holmstrom (1977) proposed one of the earliest of these. Groth and his colleagues suggested that rape was a pseudosexual way of demonstrating power and expressing anger, identifying four sub-types based on the functions of power and anger within rape. “Power dominance” and “power reassurance” are seen as the motivations for some groups of rapists, in contrast to more aggressive, “anger excitation” and “anger retaliation” sub-types who use sexual aggression as a means of expressing hostility towards women, or because it excites them. Although potentially useful, the complex nature of anger and power may be intertwined and vary qualitatively and quantitatively.
Rada (1978) attempted a classification based on diagnostic features, which show some overlap with Groth’s. He describes psychotic, sociopathic, situational stress, masculine identity conflict, and sadistic sub-types. Although there are similarities between Rada and Groth, Rada’s typology confuses motivational aspects, with characteristics of behaviour and mental disorder. In his favour, Rada did recognise that the categories are not mutually exclusive, which is a criteria for true classification.
Prentky, Knight et al. (1985; 1986; 1988; 1991; 2001) have offered a number of frameworks for distinguishing between rapist types, reflecting common themes in the literature. Knight and Prentky have proposed a classification system, which has constantly been revised in the Masssachussettes Treatment Centre (MTC -R1, R2 and R3). MTC-R1 proposed four rapist sub-types, ‘compensatory’ (Social Inadequacy), ‘Impulse’, (Impulsivity), ‘Displaced Aggression’ (angry), ‘Sex-Aggression Defusion’ (Aggressive and Sexual). MTC R2 was a revision due to difficulties defining a type, by impulsivity and the term sex-aggression defusion was re-labelled as sadistic.
This early work of Knight and Prentky attempted to define aggression with respect to specific motivations, creating ambiguous types. The types, expressive aggressive and instrumental aggressive are not necessarily exclusive to each other within the context of an offence and this makes any distinctions between types more difficult. The ‘sadistic’ type is defined as distinct from the aggressive and instrumental types, although sadism incorporates aspects of instrumental and expressed aggression in the execution of control and cruelty towards the victim. Types are further defined as high or low in impulsivity giving eight possible rapist types.
In Knight’s most recent work (2001) the MTC-R3 taxons have been explored in relation to Hare’s psychopathy checklist, demonstrating that the sadist sub-type is the most psychopathic. In this sense sadism may well represent a specifically sexual form of psychopathy, rather than a discrete type of individual. A difficulty arises when considering psychopathy as defined by Hare (1990), and the constructs of the MTC -R3. Psychopathy incorporates sexual, aggressive and impulsive traits, and sadism is defined by similar constructs. In addition Knight (2001) has proposed a theoretical formulation of the types , which is interestingly conceptually quite different to previous hierarchical organisations of the rape typology. The nine types are presented in a circumplex, with psychopathy as the principal bi-polar dimension, suggesting a hostile-friendly bi-polar construct.
Many of the typologies offer useful descriptors of meaningful sexual offender characteristics, but have yet to achieve reliable discrimination other than at a fairly crude level. There is no reason to think that rapists form ‘types’ as such and may vary on multiple dimensions of personality and behaviour that do not allow them to be easily classified. From a practitioners perspective each case needs to be considered uniquely drawing on any available information that might be useful in explaining and managing their behaviour.
In summary the search for clinical types has been an exhaustive one, but with relatively little success. Clinical typologies have attempted to use offending characteristics as diagnostic criteria, without exploring the scientific nature of the characteristics. The typology approach has also been based on small samples of incarcerated offenders, using motivational and behavioural features, which are assumed to be mutually exclusive. Of most concern, is the absence of a theoretical framework for understanding the variations between offenders and elements of personality. There are no stereotypical rapists. Perpetrators of sexual assault are as diverse as any other group defined by a particular behaviour. They are an heterogeneous cross-section of any society, who offend in a range of contexts, driven by differing motivations

References 

Brown, S.L., & Forth, A.E. (1997) Psychopathy and sexual assault: static risk factors, emotional precursors, and rapist subtypes. Journal of Consulting Clinical Psychology. Volume 65, Issue 5, Pages 848-57.
Connolly, M. (2004) Developmental trajectories and sexual offending: an analysis of the Pathways Model. Qualitative Social Work, Volume 3, Issue 1, Pages 39-59
Eccles, A., Marshall, W.L., & Barbaree, H.E. (1994) Differentiating rapists and non-offenders using the rape index. Behaviour Research Therapy.Volume 32, Issue 5, Pages 539-46. Kingston Sexual Behaviour Clinic, Queen’s University, Ontario, Canada.
Ellis, A. (1979).The sex offender. Psychology of crime and criminal justice, Toch-Hans (E), 1979, (1986), p. 405-426 (xiv 487 pages), US: Waveland Press, Inc, Prospect Heights, IL, ISBN: 0-88133-228-3 (paperback).
Groth, A.N., Burgess, W., & Holmstrom, LL. (1977) Rape: power, anger, and sexuality. The American journal of psychiatry Volume 134, Issue 11, Pages 1239-43.
Grubin, D.H., & Kennedy, H.G. (1991) The classification of sexual offenders. Criminal Behaviour & Mental Health, Volume 1, Issue 2, Pages 123-129.
Kalichman, S.C., Craig, M., Shealy, L., Taylor, J., Szymanowski, D., & McKee, G. (1989). An Empirically Derived Typology of Adult Sex Offenders Based on the MMPI: A Cross-Validation Study. Journal of Psychology and Human Sexuality, Volume 2, Pages 165-182.
Langton, C. M., & Marshall, W.L. (2001) Cognition in rapists Theoretical patterns by typological breakdown Aggression and Violent Behavior, Volume 6, Issue 5, Pages 499-518.
Levin, S.M., & Stava, L. (1987) Personality characteristics of sex offenders: A review. Archives of Sexual Behavior Volume 16, Issue 1, Pages 57-79
Overholser, J.C., & Beck, S.J. (1989) The classification of rapists and child molesters. Journal of Offender Counseling, Services & Rehabilitation, Volume 14, Issue 2, Pages 169-179.
Polaschek, D.L.L., Ward, T., & Hudson, S.M. (1997) Rape and rapists: Theory and treatment Clinical Psychology Review, Volume 17, Issue 2, Pages 117-144
Prentky, R., Cohen, M., & Seghorn, T. (1985) Development of a rational taxonomy for the classification of rapists: the Massachusetts Treatment Center system. Bulletin American Academy Psychiatry Law. Volume 13, Issue 1, Pages 39-70
Prentky, R.A., & Knight, R.A. (1991) Identifying critical dimensions for discriminating among rapists. Journal of Consulting Clinical Psychology. Volume 59, Issue 5, Pages 643-61 Massachusetts Treatment Center, Bridgewater 02324.
Prentky, R.A., Knight, R.A., & Rosenberg, R. (1988) Validation analyses on a taxonomic system for rapists: disconfirmation and reconceptualization. Ann N Y Academy of Science, Volume 528, Pages 21-40.
Rosenberg, R., & Knight, R.A. (1988) Determining male sexual offender subtypes using cluster analysis. Journal of Quantitative Criminology, Volume 4, Issue 4, Pages 383-410.
Rosenberg, R., Knight, R.A., Prentky, R.A., & Lee, A. (1988) Validating the components of a taxonomic system for rapists: a path analytic approach. Bull Am Acad Psychiatry Law. Volume 16, Issue 2, Pages 169-85. Massachusetts Treatment Center, Bridgewater 02324.
Sugarman, D.B. (1994). The conception of rape: A multidimensional scaling approach. Journal of Social Behavior & Personality, Volume 9, Issue 3, Pages 389-408,
Tirrell, F.J., & Aldridge, R.G. (1983) Diagnostic classification of rape. Corrective & Social Psychiatry & Journal of Behavior Technology, Methods & Therapy, Volume 29, Issue 2, Pages 56-61.
Warren, J.I., Reboussin, R., Hazelwood, R.R., & Wright, J.A. (1991) Prediction of rapist type and violence from verbal, physical, and sexual scales. Journal of Interpersonal Violence, Volume. 6, Issue 1, Pages 55-67.
 

B5 What Are The Characteristics Of Adult Female Sex Offenders?

Compared to other types of sexual offenders, particularly males, the literature on female sexual offenders is relatively limited. It has been suggested that this may be as a result of the proportionately low reporting of offences of this kind by this type of abuser. A range of factors has been suggested as to why this may be, including, a lack of disclosure due to unwillingness to report such an offence (for reasons such as humiliation or fear); the assumption that sex offences are perpetrated solely by males; women are more likely to have legitimate access in intimate situations; and/or the rarity of this particular type of offender.
Despite this limited knowledge base attempts have been made to identify characteristics that might help distinguish types of female sex offender, but it must be warned the findings may not be fully representative of this typology, and the reasons for this are discussed.

Personal Characteristics 

Predominantly female perpetrators of sexual abuse are found to be young woman falling somewhere in her 20s or 30s, although it needs to be noted a substantial age range has been identified with prepubescent females as young as ten years of age exhibiting coercive and forceful acts of sexual aggression toward other children (eg Johnston 1989).
Female sex offenders that have come to the attention of professionals have often come from a dysfunctional family of origin, and a considerably high proportion of those have experienced physical, emotional, and/or sexual abuse as a child, adolescent, or adult. Very often such experiences of abuse will have been extensive and severe, involving invasive sexual and physical activities, as well as multiple offenders.
With reference to social issues the literature suggests that the majority of female perpetrators are likely to be experiencing problems in many areas of their lives. They are likely to be in lower socioeconomic groups, although further work is required to establish a better picture of this group. Marital and peer relationships may be absent in their lives, and those which do exist may be dysfunctional or abusive. In many cases, the offender may be isolated from social supports. However there are a number of high profile cases in which female offenders have committed their offences with another perpetrator such as their partners.
When considering health issues it is suggested that a range of problems have presented themselves with female sex offenders. These have included difficulties with depression, suicidal ideation, chemical dependency (such as addictions), and/or low self-esteem, as well as more specific psychiatric diagnoses of personality disorders and mental health issues.

Offending Behaviour 

To date it has been suggested that no typical motivation can be attributed to adult female sex offending, the literature would suggest no consistent or typical pattern. A range of drives has been identified, such examples are deviant arousal and interest, sexual gratification from their abusive behavior, distorted perceptions regarding the inappropriateness of their acts, viewing abuse as a “normal” expression of affection for a child or a spouse, and denying or minimizing the seriousness of their sexually aggressive acts. Limited evidence exists concerning the recidivism rate of female sex offenders, one particular study places it at approximately 3% (Tewksbury 2004) although it is acknowledged this figure is not overly representative.
In terms of victimology female offenders are most likely to abuse a female child, although male children, and youngsters of both genders may also be commonly abused. While the offender may molest only a single child, in many cases, the abuse may be widespread, involving multiple victims. Typically, the woman will abuse children with whom she has an enduring or familiar relationship, and youngsters who fall within the pre-school and school-age range.

Prevalence of Female Sex Offenders

It has been suggested that adult female sexual abusers account for only a tiny proportion of recorded sexual offences. The Home Offices Criminal Statistics for England and Wales (2003) indicate that of the 2754 cases of sexual offending that were tried and received a guilty verdict female offenders made up 43 (1%) of the total. When breaking this down just over half were for Indecent Assault on adult victims (11 male, 13 female). A full breakdown of the offences is available at the link given below. 
http://www.homeoffice.gov.uk/rds/pdfs04/cs2003vol2pt1.xls
However despite the supposed infrequent occurrence of female sex offenders it has been strongly argued that rates for women who sexually abuse have been under-estimated in the past (Finkelhor 1986). Researchers of female sex offenders have attempted to offer valid explanations as to why this may occur. Examples include differing societal perceptions of maternal behaviour e.g., predominantly perceiving the mother as a care giver and not abuser; misperceptions of maternal innate goodness and asexuality as compared with the motivations and sexual interests of fathers; assumptions that boy victims are not really harmed by their abuse and/or may be too ashamed to disclose abuse; and overextension of feminist explanations that male dominance, differential socialisation and sexual explanation are the sole causes of child sexual abuse.
Concerning the characteristics of women who sexually abuse children, Freel (1992) comments:
“…there is general agreement on certain issues – that they are more likely to have been sexually abused as children; that they have had a traumatic childhood; that they are more likely to co-offend with men; (and) that they are likely to use alcohol or drugs… There is (also) evidence that female abusers are more likely to be the mothers or close relatives of the victim…”(pp.8-9)
Given that the bulk of existing data regarding abusive women is derived from uncontrolled studies and very small samples of perpetrators who have come to professional attention (Wakefield & Underwager, 1991), considerable caution must be used in interpreting these summary statements.
Additionally while studies of identified offenders may yield a range of in-depth information regarding women who sexually abuse, they are not likely to represent the full spectrum of female-perpetrated victimization, as very few offenders of either gender find their way to prison or treatment (Finkelhor & Russell, 1984). However as Adshead et. al (1994) suggest in their article this is a relatively unresearched area worthy of further study (see also Saradjian, 1996).

References 

Bell, K. (1999) Sexual assault: clinical issues. Female offenders of sexual assault. Journal of Emergency Nursing, Volume 25, Issue 3, Pages 241-3.
Chow, E.W.C., & Choy, A.L. (2002) Clinical characteristics and treatment response to SSRI in a female pedophile. Archives of Sexual Behavior Volume 31, Issue 2, Pages 211-215.
Christiansen, A.R., & Thyer, B.A. (2002) Female sexual offenders: a review of empirical research. Journal of Human Behavior in the Social Environment, Volume 6, Issue 3, Pages 1-16.
Cooper, A.J., Swaminath, S., Baxter, D., & Poulin, C. (1990) A female sex offender with multiple paraphilias: a psychologic, physiologic (laboratory sexual arousal) and endocrine case study. Canadian journal of psychiatry. Revue canadienne de psychiatrie, Volume 35, Issue 4, Pages 334-7.
Denov, M.S. (2003) To a safer place? Victims of sexual abuse by females and their disclosures to professionals. Child abuse & neglect, Volume 27, Issue 1, Pages 47-61.
Grayston, A.D., & De-Luca, R.V. (1999) Female perpetrators of child sexual abuse: A review of the clinical and empirical literature. Aggression & Violent Behavior, Volume 4, Issue 1, Pages 93-106.
Grier, P.E., Clark, M., & Stoner, S.B. (1993)Comparative study of personality traits of female sex offenders. Psychological reports, Volume 73, Issue 3, Page 1378
Higgs, D.C., Canavan, M.M., & Meyer, W.J. (1992) Moving from defense to offense: The development of an adolescent female sex offender. Journal of Sex Research, Volume 29, Issue 1, Pages 131-139.
Miccio, F.L.C. (2000) Adult and adolescent female sex offenders: Experiences compared to other female and male sex offenders. Journal of Psychology & Human Sexuality, Volume 11, Issue 3, Pages 75-88.
Nathan, P., & Ward, T. (2001) Females who sexually abuse children: Assessment and treatment issues. Psychiatry Psychology and Law, Volume 8, Issue 1, Pages 44-55.
Nathan, P., & Ward, T. (2002) Female sex offenders: Clinical and demographic features. Journal of Sexual Aggression, Volume 8, Issue 1, Pages 5-21.
O’Connor, A.A. (1987). Female sex offenders. British-Journal-of-Psychiatry, Volume 150, Pages 615-620.
Saradjian, J. (1996). Women who sexually abuse children: From research to clinical practice. England: John Wiley and sons.
Tewksbury, R. (2004) Experiences and Attitudes of Registered Female Sex Offenders. Federal Probation, Volume 68, Issue 3 , Pages 30-33.
Travin, S., Cullen, K., & Protter, B. (1990) Female sex offenders: Severe victims and victimizers. Journal of Forensic Sciences, Volume 35, Issue 1, Pages 140-150.
Vick, J., McRoy, R., & Matthews, B.M. (2002) Young female sex offenders: Assessment and treatment issues. Journal of Child Sexual Abuse Volume 11, Issue 2, Pages 1-23.
 

B6. What Are The Characteristics Of Juvenile Sex Offenders?

The characteristics of the abuse committed by young abusers is similar to that perpetrated by adult sex offenders, e.g., they engage in both contact (including penetrative acts) and non-contact behaviours. Likewise some ‘groom’ their victims while others are more opportunistic and may use verbal or physical coercion. They abuse a variety of victims including much younger children as well as peers or adults. It is even possible to identify sub-groups of young sexual abusers that resemble the ‘child molester’ & ‘rapist’ sub-types among adult offenders e.g., those who only abuse children at least 4 years younger than them or those who only abuse peers or adults (Veneziano & Veneziano, 2002). Differences between these sub-types suggest that young sexual abusers are not an homogenous group.
Comparisons with adolescent delinquents who do not sexually abuse reveal many similarities between the groups (e.g., dysfunctionl family backgrounds, childhood abuse and neglect, low academic achievement) though some differences are also apparent (e.g., young sexual abusers appear to exhibit more problematic peer relationships, are less likely to engage in delinquent activities such as gang behaviour or drug/alcohol misuse, and some exhibit serious mental health problems such as depression and anxiety).
Consistent findings indicate that the majority of young sexual abusers do not go on to commit sexual offences as adults (Sipe et al, 1998; Worling & Curwen, 2000; Gretton et al, 2001). Sexual recidivism rates range from 0% to 30% with the variability being a result of the length of follow-up used, the type of abuser observed, and the definitions of recidivism. Rates of non-sexual offending however are much higher, and indicate that young sexual abusers are at greater risk of committing non-sexual offences in adulthood and that interventions during adolescence should address general criminogenic risk factors and not just address treatment for sexually abusive behaviour.
In trying to discriminate between sub-groups of juvenile sex offenders it may be useful to draw on other typologies concerned with the nature of the act, rather than the age of the perpetrator.

References 

Aylwin, A.S., Reddon, J.R., & Burke, A.R. (2005) Sexual fantasies of adolescent male sex offenders in residential treatment: a descriptive study. Archives of sexual behavior, Volume 34, Issue 2, Pages 231-9.
Barbaree, H.E. (1993) The Juvenile Sex Offender. Guilford Press Hardcover
Barbaree, H.E., Hudson, S.M., & Seto, M.C. (1993). Sexual assault in society: The role of the juvenile offender. In H.E. Barbaree, W.L. Marshall & S.M. Hudson (Eds.), The Juvenile Sex Offender. New York: Guilford.
Butler, S.M., Seto, M.C. (2002) Distinguishing Two Types of Adolescent Sex Offenders. Journal of the American Academy of Child and Adolescent Psychiatry, Volume 41, Issue 1, Pages83-90.
Curwen, T.(2003) The importance of offense characteristics, victimization history, hostility, and social desirability in assessing empathy of male adolescent sex offenders. Sexual abuse, Volume 15, Issue 4, Pages 347-64.
Dadds, M.R., Smallbone, S., Nisbet, I., & Dombrowski, J.(2003) Willingness, confidence, and knowledge to work with adolescent sex offenders: An evaluation of training workshops. Behaviour Change, Volume 20, Issue 2, Pages 117-123.
Dalton, J.E., Ruddy, J.L., & Simon, R.Liza.(2003) Adolescent sex offenders’ mean profile on the BASC Self-report of Personality. Psychological reports, Volume 92, Issue 3 Part 1, Pages 883-8.
Eastman, B.J. (2004) Assessing the efficacy of treatment for adolescent sex offenders: A cross-over longitudinal study. Prison Journal, Volume 84, Issue 4, Pages 472-485.
Epps, K.J. (1994) Treating adolescent sex offenders in secure conditions : the experience at Glenthorne centre. Journal of Adolescence, Volume 17, Pages 105-122.
Farr, C., Brown, J., Beckett, R.(2004) Ability to empathize and masculinity levels: Comparing male adolescent sex offenders with a normative sample of non-offending adolescents. Psychology, Crime & Law, Volume 10, Issue 2, Part 155-167.
Gretton, H.M., McBride, M., Hare, R.D., O’Shaughnessy, R., & Kumka, G. (2001). Psychopathy and recidivism in adolescent sex offenders. Criminal Justice and Behaviour, Volume 28, Pages 427 – 449.
Home Office. (2001). Criminal Statistics: England and Wales 2001. HMSO:London.
Hunter, J.A., Figuerdo, A.J., Malamuth, N.M., & Becker, J.V. (2003). Juvenile se offenders: Towards the development of a typology. Sexual Abuse: A Journal of Research and Treatment, Volume 15, Issue 1, Pages 27 – 48.
Lee, J.K., Jackson, H.J., Pattison, P., & Ward, T. (2002). Developmental risk factors for sexual offending. Child Abuse and Neglect, Volume 26, Pages 73 – 92.
Matthews, R., Hunter, J.A. & Vuz, J. (1997). Juvenile female sexual offenders: Clinical characteristics and treatment issues. Sexual Abuse: A Journal of Research and Treatment, Volume 9, Pages 187 – 199.
Richardson, G., Graham, F., Bhate, S.R., & Kelly, T.P. (1995). A British sample of sexually abusive adolescents: Abuser and abuse characteristics. Criminal Behaviour and Mental Health, Volume 5, Pages 187 – 208.
Ryan, G. (1999). Treatment of sexually abusive youth. Journal of Interpersonal Violence, Volume 14, Issue 4, Pages 422 – 436.
Seto, M.C., Lalumière, M.L., & Blanchard, R.(2000) The discriminative validity of a phallometric test for pedophilic interests among adolescent sex offenders against children. Psychological Assessment, Volume 12, Issue 3, Pages 319-27.
Sipe, R., Jensen, E.L., & Everett, R.S. (1998). Adolescent sexual offenders grown up: Recidivism in young adulthood. Criminal Justice and Behaviour, 25, 109 – 124.
Smets, A.C., & Cebula, C.M. (1987) A Group treatment program for adolescent sex offenders : five steps towards resolution. Child Abuse and Neglect, Volume 11, Issue 2, Pages 247-254.
Veneziano, C. & Veneziano, L. 2002. Adolescent sex offenders: A review of the literature. Trauma, Violence and Abuse, 3(4), 247 – 260.
Wahlberg-L, Kennedy-J, Simpson-J.(2003) Impaired sensory-emotional integration in a violent adolescent sex offender. Journal of Child Sexual Abuse, Volume 12, Issue 1, Pages1-15.
Wilson, P.H., Smallbone, S.W. (2004) A prospective longitudinal study of sexual recidivism among adolescent sex offenders. Sexual abuse, Volume 16, Issue 3, Pages 223-34.
Worling, J.R., & Curwen, T. (2000). Adolescent sexual offender recidivism: Success of specialised treatment and implications for risk prediction. Child Abuse and Neglect, 24, 965 – 982.
Worling, J.R., & Langstrom, N. (2003). Assessment of criminal recidivism risk with adolescents who have offended sexually. Trauma, Violence and Abuse, 4(4), 341 – 362.
Worling-J-R(1995) Sexual abuse histories of adolescent male sex offenders: Differences on the basis of the age and gender of their victims. Journal of Abnormal Psychology Volume 104, Issue 4, Pages 610-613.
Web Resources Children and young people who display sexually harmful behaviour Elizabeth Lovell (NSPCC Public Policy Group) January2002 http://www.nspcc.org.uk/Inform/Research/Findings/IThinkIMight_asp_ifega26196.html
 
B7. What Is Meant By Sexual Deviance?
Sexual deviance in the context of sexual offending can be interpreted in more than one way. The act of rape or child abuse can itself be viewed as deviant, however the sexual activities that occur in the context of offending also vary in the degree to which they might be interpreted as deviant. The term ‘sexual deviance’ is sometimes used in a very general way (at the sociological level) to refer to behaviour which falls outside social or statistical norms, but is not necessarily illegal. Homosexuality for example is by definition a deviation from ‘normal’ sexual practices and at different points in history has been considered acceptable or illegal (see Gore Vidal). In the psychological and psychiatric literature the term ‘sexual deviance’ refers to sexual preferences for deviant and illegal sexual acts, such as child sexual abuse. The severity of deviance is difficult to quantify and often the level of deviance is determined by the frequency of offending, the gender of the victim (male being doubly deviant), and the age of the victim (younger, or older victims indicating another facet of deviance).
Sexual deviations are defined (medically) in terms of the person or object (using Greek or Latin roots) and suffixed with sexual interest (philia), (e.g. child -paedo philia; adolescent – hebe philia; older adult – geronto philia). Deviations may also apply to particular behaviours such as sado-masochism, or sex with dead bodies (necrophilia). Rape itself can be a deviant sexual interest (Groth & Burgess 1977) and has been proposed as a distinct courtship disorder, or type, the preferential rapist (Freund, Scher & Hucker 1983) or paraphilic coercive disorder (Abel 1989), or biastophilia (Money 1990). There are an almost infinite variety of sexual interests, or paraphilias that have been labelled in this way, suggesting that almost anything can become sexualised. Although psychiatry has offered a valuable labelling system for sexual deviations, it has offered very little in the way of explanation and understanding (see Foucault 1977). Others argue that the causes of sexual deviation often stem from individualised interests that develop over a number of years or are acquired through experience, either positive or negative (learned from others).
A number of other deviations, which are worth considering, occur in the context of rape and sexual homicide, and are concerned with pain, power and death. In some cases necrophilia is the motive for murder, and can involve elaborate fantasies with regard to the method of killing, and subsequent sexual activity (MacCulloch, Snowden, Wood & Mills 1983; Ressler, Burgess & Homstrom 1986; Prentky, Cohen & Seghorn 1985). In some extreme cases of rape and sexual homicide, the intent is clearly associated with sadistic or power interests. Necrophilia is another rare interest, which can take any number of forms defined by Wulffen (1910); generally it refers to sex with corpses but can include necrosadism (in which murder precedes the act), and necrophagy (in which the corpse is eaten). What these terms might suggest is that paraphilias represent continua of activity, rather than distinct diagnosable disorders.
Many offenders are characterised by conventional (pseudo-normal) sexual interests and only a minority are deviant or paraphilic (Freund and Blanchard 1986). Penile Plesthysmography (PPG), an assessment of penile response to sexual stimuli, has been utilised in many studies examining sexual arousal. The PPG technique has demonstrated that deviant arousal characterises the most violent and habitual rapists, (Abel, Barlow, Blanchard & Guild 1977; Becker et al 1978), and the general consensus is that the level of deviancy is indicated by the variety, or range of sexual interests.
Understanding the origins of sexually deviant interests has yet to be fully established an receives little research attention. A number of perspectives have been offered including a simple biological explanation that men are simply more deviant than women. Men are therefore more prone to deviation because of a Y chromosome (Flor-Henry 1989). The higher sexual libido in men has also been suggested as causal in sexual offending (Wilson, 1980), an idea extended through the work of Thornhill & Palmer (see causes section) in their evolutionary description of rape. These authors go so far as to suggest that rape is an adaptive evolutionary, mating strategy, although this would seem to apply more readily to non-human species.

References 

Becker, J.V. (1992) Sexual deviance. Current Opinion in Psychiatry, Volume 5, Issue 6 Pages 788-791.
Burk, L.R., & Burkhart, B.R. (2003) Disorganized attachment as a diathesis for sexual deviance – Developmental experience and the motivation for sexual offending. Aggression and Violent Behavior Volume 8, Issue 5, Pages 487-511.
Earls, C.M. (1983) Some issues in the assessment of sexual deviance. International journal of law and psychiatry, Volume 6, Issue 3-4, Pages 431-41.
French, L. (1991) A practitioner’s notes on treating sexual deviance. Psychological reports, Volume 68, Issue 3, Part 2, Pages 1195-8
Grubin, D. (1991) Sexual deviance. Current Opinion in Psychiatry Volume 4, Issue 6, Pages 846-849.
Hildebrand, M., de-Ruiter, C., & de Vogel, V. (2004). Psychopathy and sexual deviance in treated rapists: association with sexual and nonsexual recidivism. Sexual abuse, Volume 16, Issue 1, Pages 1-24.
Hunter, J.A., & Mathews, R. (1997). Sexual deviance in females. In D.R. Laws W. ODonohue (Eds.), Sexual Deviance. Theory, Assessment, and Treatment (pp. 465-480). New York: The Guilford Press.
Lalumière, M.L., & Quinsey, V.L. (1996). Sexual deviance, antisociality, mating effort, and the use of sexually coercive behaviors. Personality & Individual Differences, Volume 21, Issue 1, Pages 33-48.
Lalumière, M.L., Harris, G.T., Quinsey, V.L., & Rice, M.E. (1998) Sexual deviance and number of older brothers among sexual offenders. Sexual Abuse: Journal of Research & Treatment, Volume 10, Issue 1, Pages 5-15.
Laws, D.R., & O-Donohue, W. (1997) Sexual deviance: theory, assessment, and treatment. Guilford Press.
Maletzky, B.M. (1991). Treating the Sexual Offender. Newbury Park, CA: Sage.
Marshall, W.L., Eccles, A., & Barbaree, H.E. (1991) The treatment of exhibitionists: A focus on sexual deviance versus cognitive and relationship features. Behaviour Research and Therapy Volume 29 Issue 2 Pages 129-135.
Marshall, W.L., Hudson, S.M., & Ward, T. (1992) Sexual deviance. Principles and practice of relapse prevention, Wilson-Peter-H (E), 1992, p. 235-254 (xi 383 pages), US: Guilford Press, New York, NY..
Seghorn, T.K., & Ball, C.J. (2000) Assessment of sexual deviance in adults with developmental disabilities. Mental Health Aspects of Developmental Disabilities, Volume 3, Issue 2, Pages 47-53.
Simon, W.T., & Schouten, P.G. (1991) Plethysmography in the assessment and treatment of sexual deviance: an overview. Archives of sexual behavior, Volume 20, Issue 1, Pages 75-91.
Veneziano L., & Riggen, K. (2004). Sexual deviance among male college students: prior deviance as an explanation. Journal of Interpersonal Violence, Volume 19, Issue 1, Pages 72-89.
Withers, J., Warren, S. (2005) Sexual Deviance: Issues and Controversies. Journal of Sexual Aggression, Volume 11, Issue 1, Pages 115-117, Editor(s): Beech-Tony.
The Kinsey Institute for Research in Sex, Gender, and Reproduction http://www.indiana.edu/~kinsey/
National Centre for Social Research Sexual Attitudes & Behaviour http://www.natcen.ac.uk/natcen/pages/report_sexatt.htm
University of Plymouth: Neurobiology of Sexual Behaviour http://salmon.psy.plym.ac.uk/year2/Sexbehav.htm

D1. How Do We Treat Sex Offenders?

Medical treatment

From a medical perspective sexual offending is often viewed as pathological in nature, with a biological basis. Some studies suggest that there is a biological component including disturbed sex steroids (Bradford 1990; Hucker & Bain 1990).
See section on biological explanations FAQ B1 (i)
Historically medical intervention were both invasive and ineffective. Drug treatments including anti-libidinals have been tried and are occasionally useful (Laschett 1972; Morey 1980). Emory, Cole & Meyer (1992) evaluated the use of Depo-Provera and concluded that the treatment radically lowered sexual interest, enabling better therapeutic engagement. Surgical techniques have also been used including castration and brain surgery (stereotaxic hypothalamotomy), but while these have had a direct impact on underlying sex drive, they are permanently damaging. The long-term effects of such treatment often contributes to the offender committing suicide or committing violent crime.
Medical treatments are generally only efficacious for a minority of sex offenders (Bradford 1990) and as such do not meet the needs of most sex offenders. Many sex offenders’ motives are non-sexual so simply reducing the libido may have little or no effect on offending behaviour. Findings that support this view come from a study that reviewed treatment outcome and concluded that comprehensive cognitive/behavioral programs (at least for child molesters, incest offenders, and exhibitionists in this particular study) are most likely to be effective when compared to medical intervention, although there is a clear value for the adjunctive use of antiandrogens with those offenders who engage in excessively high rates of sexual activities. Additionally it has been acknowledged that the combination of reducing anxiety and arousal, via medical methods, may be useful in making the patient more susceptible to psychological treatments (Coleman et al 1992; Emory et al 1992).

Treatment Programmes

Sexual offenders present with unique difficulties although often share many of the same underlying difficulties. Although some difficulties may be more prevalent in child molesters or rapists, the core issues underlying offending are present to varying degrees across types of sex offenders. Sex offending is not attributable to a single cause or motive. As such the range of treatments reflects the range of difficulties. In the UK sex offenders are ‘treated’ in a number of different ways, although the same issues are addressed. The largest ‘treater’ is the Prison Service which incorporates a Sex Offender Treatment Programme (SOTP) and evaluation (Beech, Becket, Fisher, 1998)
The range of difficulties identified in the literature includes the psychological treatment factors listed below. Many of these features are assessed psychometrically providing a means to identify the problem and assess any change.

Self-esteem 

Sex offenders typically have low self-esteem (related to childhood relationship difficulties) which a) makes engagement in therapy difficult, and b) is also a risk factor for sexual re-offending (Marshall et al (1996). This can be manifested in the offender being either cynical of others or self-denigrating.
Social skills deficits 
Child molesters typically have problems with social confidence and competence (Ward et al (1996). Rapists have been found to misinterpret a rebuff from a woman as a sign of positive interest in them (Lipton et al (1987), and to judge aggressive behaviour as more socially acceptable than either appropriate assertion or under-assertiveness (Marshall et al 1995).

Intimacy deficits 

Sexual offenders typically display deficiencies in their capacity for intimacy, resulting from poor childhood relationships with their parents, leading to emotional loneliness, lack of intimacy skills, and relationship difficulties. Often linked as they are to other problems such as distorted perceptions of other people and sexuality, and recourse to deviant sexual fantasies, intimacy deficits increase the risks of sexual re-offending (Marshall, 1989).
Empathy deficits 
Hudson et al (1993) identified four components of empathy: emotional recognition, perspective taking, compassionate emotional response, and taking action to comfort or help. In some studies rapists typically display difficulty recognising emotions in others, for example confusing anger, disgust, and fear, emotions likely to be present in sex offence victims (Marshall et al, 1995), and this confusion has been shown to be especially so for offenders who used most violence in their offences and who were not drunk at the time of the offence (Hanson & Scott,1995). Other research has suggested that child molesters’ and rapists’ empathy deficits can be limited to their own victims (Ward et al, 1997).

Cognitive distortions 

Ward et al (1997) describe how sexually aggressive behaviour is often facilitated and justified by distorted thinking. Cognitive distortions have been found in both sexual aggressors against adults (Bumby, 1996)) and children (Ward et al, 1995). Cognitive distortions can be a risk factor for offending and can also be reinforced by the offender’s need to justify his offending behaviour and reduce stress, shame, or guilt after the event.

Deviant sexual arousal 

The acquisition of deviant sexual interests and urges has been linked to early sexual and social experiences followed by the pairing of abusive and violent fantasies with repeated masturbation (MacCulloch et al, 1983; Burgess et al, 1986). Deviant sexual arousal has been shown to contribute to maintenance and escalation of some kinds of sexual offending, including paedophilic and sadistic offending, a) through escalation in the dangerousness of sexual fantasies and urges, and b) through its effect on limiting alternative, legal behaviours (Marshall & Barbaree, 1990; MacCulloch et al, 1983). Deviant sexual interest and preoccupation has been shown to be a key risk factor for sexual recidivism in long-term follow-up studies (Hanson & Bussiere, 1998).

Follow-Up Treatment in the Community -Relapse Prevention 

Most sex offender treatment programs, having targeted the above-mentioned ‘current functioning’ factors, include some form of relapse prevention. This typically focuses on a) the high-risk situations that the offender will be likely to encounter on returning to the community after imprisonment or hospitalisation, and b) his/her skills in recognising and handling these high-risk situations (see Laws) .

Most treatment programs for sex offenders that have been formally evaluated have been characterised by:
 
1. The targeting within treatment sessions of empirically-based risk factors for sexual recidivism (eg Hanson & Bussiere, 1998). 
2.Inclusion of individualised assessments of offenders’ risk factors and needs based upon history, current functioning, analysis of offending behaviour and therapeutic engagement (Perkins, 1991; Marshall & Eccles, 1995). 
3. Treatments carried out in a group format within a cognitive-behavioural model, usually with individual therapy kept to a necessary minimum (Ward et al, 2000).

The literature on the assessment and treatment of mentally disordered sex offenders identifies the importance of attending to similar issues following stabilisation of psychosis (Craissati and Hodes, 1992).

Features of the more successful treatment programmes for sex offenders include:

1. Identification of deviant sexual arousal and preoccupation, which is then addressed by behavioural modification techniques and/or appropriate medication. 
2. The use of cognitive-behavioural techniques to increase motivation and to develop offence-reduction skills in the three key modalities of thinking, feeling and behaviour. 
3. The development of personally-relevant relapse prevention plans which are monitored and supported after return to the community (Marshall and Pithers, 1994); Marshall et al, 1999; Perkins et al, 1998).

References 

Bumby, K.M. (1996) Assessing the cognitive distortions of child molesters and rapists: developments and validation of the molest and rape scales. Sexual Abuse: A Journal of Research and Treatment, Volume 8, Pages 37-54.
Baker, E., & Beech, A.R. (2004). Dissociation and variability of adult attachment dimensions and early maladaptive schemas in sexual and violent offenders Journal of Interpersonal Violence, Volume 19, Pages 1119-1136.
Bickley, J.A., & Beech, A.R. (2002). An evaluation of Ward and Hudson’s self- regulation theory of the relapse process. Journal of Interpersonal Violence.Volume 17, Pages 372-393.
Hanson, K., & Scott, H. (1995) Assessing perspective taking among sexual offenders, non-sexual criminals and non-offenders. Sexual Abuse: A Journal of Research and Treatment, Volume 7, Pages 259-277.
Hudson, S.M., Marshall, W.L., Wales, D., McDonald, E., Bakker, L.W., & McLean, A. (1993) Emotional recognition skills of sex offenders. Annals of Sex Research, Volume 6, Pages 199-211.
Laws, R., Hudson, S., & Ward, T. (2000). Remaking Relapse Prevention with Sex Offenders. Sage: London.
Lipton, D.N., McDonel, E.C., & McFall, R.M. (1987) Heterosexual perception in rapists. Journal of Consulting and Clinical Psychology, Volume 55, Pages 17-21.
Marshall, W.L. (1989) Intimacy, loneliness and sexual offenders. Behaviour Research and Therapy, Volume 27,Pages 491-503
Marshall, W.L. (1994) Poverty of bonding and deficiency in intimate relationships in the sexually aggressive. Criminologie, Volume 27, Issue 2, Pages 55-69.
Marshall, W.L. (1996) Assessment, treatment and theorising about sex offenders: developments during the past twenty years and future directions. Criminal Justice and Behaviour, Volume 23, Pages 162-199.
Marshall, W.L., Anderson, D., & Champayne, F. (1996) The importance of self-esteem in sexual offenders. Psychology, Crime, Law, Volume 3, Pages 81-106.
Marshall, W.L., Anderson, D., & Fernandez, Y. (1999) Cognitive Behavioural Treatment of Sexual Offenders. Chichester: Wiley.
Marshall, W.L., & Eccles, A. (1995) Cognitive-behavioural treatment of sex offenders. in VMB Hasselt and M Hersen (eds) Sourcebook of Psychological Treatment Manuals for Adult Disorders. New York: Plenum.
 

D2. What Is The Sex Offender Treatment Program (SOTP)

SOTP refers to the treatment programs offered in prisons to try and reduce recidivism. These programmes aim to help participants develop the skills and appropriate attitudes to lead a personally satisfying life that does not involve re-offending. This includes enhanced victim empathy, more trusting attitudes towards others, better skills in coping with personal problems and a clearer idea of how to achieve healthy intimacy including sexual intimacy (see Beech & Fisher ????; Beckett & Scott-Fordham, 1998)
The British Sex Offender Treatment Programme
The largest ‘treater’ is the Prison Service which incorporates a Sex Offender Treatment Programme (SOTP) and evaluation (Beech, Becket, Fisher, 1999). The British Prison Service has, over the last ten years, led the way in developing group-based treatment programmes for sex offenders aimed at reducing recidivism (Thornton and Hogue, 1993), and this has led to the development of a national Sex Offender Treatment Programme (SOTP), which is now the largest of its kind in the world. The latest figures indicate that the programme includes approximately 600 offenders a year. The Prison Offending Behaviour Programmes Unit (OBPU), which manages the SOTP, has approached these issues by establishing 10 criteria for treatment programme accreditation which it applies to its own Sex Offender Treatment Programme (SOTP). These comprise the following: 
1. An explicit, empirically-based model of change, drawing from the relevant literature. 
2. Interventions which target criminogenic need. 
3. Treatment methods to which offenders in the programme will be responsive, e.g. which engage their active participation. 
4. Treatment methods which have been shown to be effective with the types of offenders in the programme. 
5. Treatment methods which provide offenders with skills needed to avoid future offending. 
6. A range of treatment targets that are relevant to avoiding future offending. 
7. An amount, intensity and sequencing of treatment (“dose”) appropriate to the seriousness and persistence of offending behaviour. 
8. Appropriate arrangements for future through care including reports of treatment impact and future risk 
9. Ongoing monitoring of staff selection, training and support, treatment integrity and delivery. 
10. Ongoing evaluation of treatment impact on offenders and staff, and long term effects on recidivism. 
These requirements are managed by a series of audits and insepctions which are overseen by a specially constituted international panel of experts.

References 

Beech, A., Fisher, D. & Beckett, R.(1999). STEP 3: An evaluation of the prison sex offender treatment programme. London: HMSO.
For a summary of recent findings
http://www.homeoffice.gov.uk/rds/pdfs2/r205.pdf

 
D3. Does Sex Offender Treatment Work ?

The Home Office have evaluated the Prison Sex Offender Treatment Programme (SOTP). Specifically it looked at the effect of this programme on offenders readiness to admit to offensive behaviour, pro-offending attitudes, social competence and their knowledge of relapse avoidance techniques. These findings are confined to men who abused children.

Key Findings 

• Programmes were successful in increasing the level of child abusers admittance of offending behaviour. 
• Pro-offending attitudes, such as thoughts about having sexual contact with children, were reduced as were levels of denial of the impact that sexual abuse has had upon victims. 
• Overall the programmes were successful at increasing levels of social competence.
• Of the sample, 67% (53 out of 77 men) were judged to have shown a treatment effect – e.g.,there were significant changes in all or some of the main areas targeted.
• Longer-term treatment (about 160 hours) produced results which held up better after release than short term therapy (about 80 hours), particularly for highly deviant offenders. 
• It must be remembered that as sex offenders are a heterogeneous group treatment efficacy is going to vary this was outlined by in Beech et al’s study (1998) indicating that low deviancy offenders required the lesser treatment time of 80 hours whereas the high deviancy offenders responded better to the 160 hours of treatment.

References

Becker, J.V., & Murphy, W.D. (1998) What We Know and Do Not Know About Assessing and Treating Sex Offenders. Psychology, Public Policy, and Law, Volume 4, Issues 1-2, Pages 116-137
Beech, A., Fisher, D. & Beckett, R.(1999). STEP 3: An evaluation of the prison sex offender treatment programme. London: HMSO.
Beech, A., Fisher, D., Beckett, R. & Scott-Fordham A. (1998). An evaluation of the prison sex offender treatment programme. Home Office Research Findings No.79. 1998.) 
http://www.homeoffice.gov.uk/rds/pdfs/r79.pdf
Chaffin, M. (1992) Factors associated with treatment completion and progress among intrafamilial sexual abusers. Child Abuse & Neglect, Volume 16, Issue 2,Pages 251-264
Covell, C.N., & Scalora, M.J. (2002) Empathic deficits in sexual offenders: An integration of affective, social, and cognitive constructs. Aggression and Violent Behavior, Volume 7, Issue 3, Pages 251-270.
Craissati, J. & McClurg, G. (1997) The Challenge Project: A treatment program evaluation for perpetrators of child sexual abuse Child Abuse & Neglect, Volume 21, Issue 7, Pages 637-648
Epps, K.J. (1994) Treating adolescent sex offenders in secure conditions: the experience at Glenthorne Centre. Journal of Adolescence, Volume 17, Issue 2,Pages 105-122
Gerber, J. (1994) The use of art therapy in juvenile sex offender specific treatment The Arts in Psychotherapy, Volume 21, Issue 5,Pages 367-374
Grubin, D. (1996) Sexual offenders: treatment, punishment or both? European Psychiatry, Volume 11, Supplement 4, Page 213s.
Hanson, K., Broom, I., & Stephenson, M. (2004) Evaluating Community Sex Offender Treatment Programs: A 12-Year Follow-Up of 724 Offenders. Canadian Journal of Behavioural Science, Volume 36, Issue 2, Pages 87-96
Marshall, W. L., Jones, R., Ward, T., Johnston, P., & Barbaree H. E. (1991) Treatment outcome with sex offenders Clinical Psychology Review Volume 11, Issue 4 , Pages 465-485.
Marshall, W. L. (1994) Treatment effects on denial and minimization in incarcerated sex offenders. Behaviour Research and Therapy, Volume 32, Issue 5,Pages 559-564.
O’Donohue, W., & Letourneau, E. (1993) A brief group treatment for the modification of denial in child sexual abusers: Outcome and follow-up Child Abuse & Neglect, Volume 17, Issue 2, Pages 299-304.
Perkins, D., Hammond, S. Coles, D & Bishopp, D. (1998). Review of Sex Offender Treatment Programmes. Report prepared for High Security Psychiatric Services Commissioning Board. 
http://www.ramas.co.uk/report4.pdf
Polaschek, D.L.L. (2003) Relapse Prevention, Offense Process Models, and the Treatment of Sexual Offenders. Professional Psychology: Research and Practice, Volume 34, Issue 4, Pages 361-367.
Tierney, D.W., & McCabe, M.P. (2002) Motivation for behavior change among sex offenders: A review of the literature. Clinical Psychology Review, Volume 22, Issue 1, Pages 113-129
Ward, T. (2002) Good lives and the rehabilitation of offenders: Promises and problems Aggression and Violent Behavior, Volume 7, Issue 5, Pages 513-528
Ward, A., & Stewart, C.A. (2003) The Treatment of Sex Offenders: Risk Management and Good Lives. Professional Psychology: Research and Practice, Volume 34, Issue 4, Pages 353-360
 
 
D4. How Can We Assess And Treat Sexual Deviance?

Self-reports of sexual interest and preference have been shown to be unreliable in sex offender populations. Abel et al (1985) for example found a 70% discrepancy between reported sexual interest and sexual preferences as determined by penile plethysmography (PPG) assessments. Early work on the treatment of sex offenders focused on assessing and, where it was present, attempting to modify the offender’s deviant sexual interests on the rationale that this would reduce the probability of sexual offending. Methods for this purpose were directed towards a) suppressing deviant/illegal sexual interests through, for example, aversion therapy, covert sensitisation and satiation, and/or b) enhancing non-deviant/legal sexual interests, through, for example, orgasmic reconditioning, shaping, and systematic desensitisation of anxieties about adult sexuality. Maletzky (1991) provides a compendium of such behavioural techniques.
Sexual preference modification techniques on their own proved to be unsuccessful in sustaining reductions in offending behaviour. Therapeutic approaches over the last thirty years have expanded to include techniques aimed at developing acceptance of responsibility for offending, increasing self-esteem, improving social skills and sexual knowledge, reducing cognitive distortions and minimisations of offending, enhancing awareness of and empathy for victims, as well as dealing with unresolved issues from childhood/ adolescence which contributed to the development of sexual offending behaviour (Marshall et al, 1999).
Sex offender follow-up studies have highlighted the importance of sexual deviance as a predictor of sexual recidivism. Marshall et al (1999) draw attention to the ways in which the different risk factors that contribute to sexual offending can interact with each other, for example, low victim empathy can contribute to cognitive distortions about offending, and cognitive distortions can facilitate the development of violent sexual fantasies. It follows that treatment of one risk factor might influence others, for example Marshall et al (1999) suggest that enhancing sex offenders self-esteem can lead to decreases in deviant sexual fantasies and interest, even though the latter has not been directly targeted by treatment. A review of the effectiveness of sex offender treatment programmes (Perkins et al, 1998) indicated that the two approaches that showed most promise in the reduction of sexual deviance, where this was a risk factor relevant in the maintenance of sexual offending, were either behaviour modification techniques or anti-libidinal medication. In summary, deviant sexual interests, where present, should be directly targeted in treatment, along with other relevant risk factors, and monitored by a combination of self-report, psychometric, PPG, and behavioural observation data.

References and Resources 

Abel, G.G., Mittelman, M.S., & Becker, J.V. (1985) Sexual offenders: results of assessment and recommendations for treatment. in MH Ben-Aron and CD Webster (eds) Clinical Criminology: The Assessment and Treatment of Criminal Behaviour. Toronto: M&M Graphic, 191-205.
Araji, S., and Finkelhor, D. (1986) Abusers: a Review of the Research. in D Finkelhor (ed) A
Becker, J.V. (1992) Sexual deviance. Current Opinion in Psychiatry, Volume 5, Issue 6 Pages 788-791.
Burk, L.R., & Burkhart, B.R. (2003) Disorganized attachment as a diathesis for sexual deviance – Developmental experience and the motivation for sexual offending. Aggression and Violent Behavior Volume 8, Issue 5, Pages 487-511.
Earls, C.M. (1983) Some issues in the assessment of sexual deviance. International journal of law and psychiatry, Volume 6, Issue 3-4, Pages 431-41.
French, L. (1991) A practitioner’s notes on treating sexual deviance. Psychological reports, Volume 68, Issue 3, Part 2, Pages 1195-8
Grubin, D. (1991) Sexual deviance. Current Opinion in Psychiatry Volume 4, Issue 6, Pages 846-849.
Hildebrand-Martin, de-Ruiter-Corine, de-Vogel-Vivienne (2004). Psychopathy and sexual deviance in treated rapists: association with sexual and nonsexual recidivism. Sexual abuse, Volume 16, Issue 1, Pages 1-24,
Hunter, J.A., & Mathews, R. (1997) Sexual deviance in females. Sexual deviance: Theory, assessment, and treatment, Laws-D-Richard (E) , O’Donohue-William-T (), 1997, p. 465-480 (xii 514 pages), US: Guilford Press, New York, NY.
Jackson A., Veneziano L., & Riggen K. (2004).Sexual deviance among male college students: prior deviance as an explanation. Journal of Interpersonal Violence, Volume 19, Issue 1, Pages 72-89.
Lalumière, M.L., & Quinsey, V.L. (1996) Sexual deviance, antisociality, mating effort, and the use of sexually coercive behaviors. Personality & Individual Differences, Volume 21, Issue 1, Pages 33-48.
Laws, D.R., & O-Donohue, W. (1997) Sexual deviance: theory, assessment, and treatment. Guilford Press.
Maletzky, B.M. (1991) Treating the Sexual Offender. Newbury Park, CA: Sage. Marshall, W.L., Eccles, A., & Barbaree, H.E. (1991) The treatment of exhibitionists: A focus on sexual deviance versus cognitive and relationship features. Behaviour Research and Therapy Volume 29 Issue 2 Pages 129-135.
Marshall, W.L., Hudson, S.M., & Ward, T. (1992) Sexual deviance. Principles and practice of relapse prevention, Wilson-Peter-H (E), 1992, p. 235-254 (xi 383 pages), US: Guilford Press, New York, NY..
Marshall, W.L., Anderson, D., & Fernandez, Y. (1999) Cognitive Behavioural Treatment of Sex Offenders. Chichester: Wiley. i) chs 4, 5, 6, and 7; ii) 84-86 and 64-68; iii) 124-126.
Seghorn, T.K., & Ball, C.J. (2000) Assessment of sexual deviance in adults with developmental disabilities. Mental Health Aspects of Developmental Disabilities, Volume 3, Issue 2, Pages 47-53.
Simon, W.T., & Schouten, P.G. (1991) Plethysmography in the assessment and treatment of sexual deviance: an overview. Archives of sexual behavior, Volume 20, Issue 1, Pages 75-91.
Withers, J., Warren, S. (2005) Sexual Deviance: Issues and Controversies. Journal of Sexual Aggression, Volume 11, Issue 1, Pages 115-117, Editor(s): Beech-Tony.
The Kinsey Institute for Research in Sex, Gender, and Reproduction http://www.indiana.edu/~kinsey/
National Centre for Social Research Sexual Attitudes & Behaviour http://www.natcen.ac.uk/natcen/pages/report_sexatt.htm
University of Plymouth: Neurobiology of Sexual Behaviour http://salmon.psy.plym.ac.uk/year2/Sexbehav.htm