Not Just a Sex Offender: Paraphilias and Other Complicating Conditions

Donya L. Adkerson, MA, LCPC 2005

Consider the individualSex offenders are not all the same B Consider

PParaphilia-specific issuesPConcurrent/Complicating Conditions

PComplicating Circumstances

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

Common paraphilias among sex offenders

PNot all sex offenders have a paraphiliaPPedophilia

PHebephilia/EphebephiliaPBestiality

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.

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

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

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

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

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

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

Paraphilia-specific ConsiderationsPedophilia and Hebephilia

PSafety planning areas<Work <Leisure <Family gatherings<Public places <Worship<Media stimuli <Holidays & Special events

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

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

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

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

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

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

Common Family History Factors For Sadists

PAlcohol abusePPsychiatric disordersPCriminal behavior

PInstability of residencePLow family-community involvement

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

Co-existing Complicating Conditions

Among sex offenders

PDevelopmentally Delayed/Mentally Retarded

POrganic syndromesPSubstance Abuse/Dependence

PADHD

Co-existing Complicating Conditions

Among sex offenders

PObsessive-Compulsive disordersPPTSD

PPersonality Disorders

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

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

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

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

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

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

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

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.

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

Common Personality Disorders among sexual offenders

PBorderlinePHistrionicPNarcissisticPAntisocial

POther types exist, but less likely to turn up in SO treatment

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

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

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

Histrionic Personality DisorderImplications for treatment & supervision

PHogging group timePStruggle to pin down detailsPLOTS of emotional displays

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

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

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

Antisocial Personality DisorderImplications for treatment & supervision

PHIGHER RISK for recidivismPRisk of other crimes in addition to

sex offendingPLikely to have antisocial peer group

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