Clinical Considerations of Paraphilic Sex Offenders with Comorbid Psychiatric Conditions

Guidry, Laurie L.; Saleh, Fabian M.

doi:10.1080/10720160490458201

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…11 Moreover, descriptions of treatment for sex offenders often do not attend to the potential role that antipsychotic medications might play in the treatment process, although a recent clinical review has pointed out the need for a change in this practice. 43 Thus, the few existing reports suggest that clinical practice is based on the presumption that treating the psychotic illness will prevent further sex offending. The findings of the present investigation indicate that this may be a faulty assumption.…”

Section: Discussionmentioning

confidence: 99%

Psychotic Disorders and Sex Offending in a Danish Birth Cohort

Alden

Brennan²,

Hodgins

et al. 2007

Arch Gen Psychiatry

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Context: Psychotic disorders are associated with an increased risk of aggressive behavior and violent crime. Whether there is also an association with sex offending is unknown.Objectives: To estimate the lifetime prevalence of arrests for sexual offenses (with and without physical aggression) among men and women with psychotic disorders, the moderating effects of comorbid personality disorders and substance use disorders, and the prevalence rates for 4 specific psychotic disorders. Design:We examined official records of arrests for sexual offenses with and without physical aggression to compare persons hospitalized with a psychotic disorder with those who had never been hospitalized. Results: Among the men, 2.2% were hospitalized with psychotic disorders. These men committed 8.4% of the physicallyaggressivesexualoffensesand9.0%ofthenon-physically aggressive sexual offenses of the men in the cohort. Compared with men who had never been hospitalized, men with psychotic disorders without a personality disorder or a substance use disorder were not at increased risk of arrest for physically aggressive sexual offenses but were 3 times more likely to have been arrested for non-physically aggressive sexual offenses. Psychotic disorders with comorbid personality disorders or substance use disorders were associated with a 6-fold increased risk of physically aggressive sex offending and a 3-to 5-fold increased risk of non-physically aggressive sex offending.Conclusions: Psychotic disorders comorbid with personality disorders and substance use disorders are associated withanincreasedriskofsexoffendingwithandwithoutphysical aggression. Mental health policy and practice need to take account of these findings to improve functional outcome among persons with psychotic disorders.

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Section: Discussionmentioning

confidence: 99%

Psychotic Disorders and Sex Offending in a Danish Birth Cohort

Alden

Brennan²,

Hodgins

et al. 2007

Arch Gen Psychiatry

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“…Most studies of comorbidity have been conducted among samples of sex offenders and have not distinguished between those with paraphilias and those without. High rates of comorbid mental illness and personality disorder have been reported (Guidry 2004). Mood and anxiety disorders are most prevalent and the presence of multiple paraphilias correlates with higher levels of psychiatric morbidity.…”

Section: Comorbid Psychiatric Conditionsmentioning

confidence: 99%

Paraphilias and paraphilic disorders: diagnosis, assessment and management

Yakeley¹,

Wood²

2014

Adv. psychiatr. treat

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SummaryWe outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.LEARNING OBJECTIVESBe able to diagnose a paraphilic disorder according to DSM-5 criteria.Understand the epidemiology, comorbidity and theories of aetiology of paraphilic disorders.Know how to assess the need for disclosure if the patient presents with illegal paraphilias.

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“…An underlying question is whether a person with more than one mutually exclusive paraphilia is more psychiatrically troubled than a person who experiences only one paraphilia, and is a person with multiple paraphilias more dangerous and/or more likely to re‐offend. Guidry and Saleh (57) described problems in clinical work with sex offenders who have no paraphilias and multiple paraphilias as well as comorbid psychiatric conditions. Brittain (58) believed that the sexual murderer habitually presents with more than one paraphilia.…”

mentioning

confidence: 99%

Evidence of Primary, Secondary, and Collateral Paraphilias Left at Serial Murder and Sex Offender Crime Scenes

White

2007

Journal of Forensic Sciences

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This paper is a descriptive review of the phenomenon of paraphilias, the relationship of possessing multiple paraphilias with the commission of sexual crimes and serial murder and the recognition of evidence related to sexual crimes committed by offenders with paraphilias. Several case studies are presented and the manifestations of multiple paraphilias, such as those experienced by Jeffrey Dahmer, Albert Fish, and others, are conceptualized and divided into three types: (i) replacement--no overlap; (ii) replacement with overlap; and (iii) cumulative. The categories are further divided into primary, secondary, and collateral paraphilias. Primary and secondary paraphilias are mutually exclusive and one does not build upon the other. Collateral paraphilias may serve to enhance the overall sexual experience of the primary and secondary paraphilias, including the sexualization of props or weapons. Implications for criminalists and criminal investigators are explained, particularly the value in discerning hidden as well as salient evidence of paraphilic behaviors left at crime scenes.

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Clinical Considerations of Paraphilic Sex Offenders with Comorbid Psychiatric Conditions

Cited by 12 publications

References 25 publications

Psychotic Disorders and Sex Offending in a Danish Birth Cohort

Psychotic Disorders and Sex Offending in a Danish Birth Cohort

Paraphilias and paraphilic disorders: diagnosis, assessment and management

Evidence of Primary, Secondary, and Collateral Paraphilias Left at Serial Murder and Sex Offender Crime Scenes

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