Not Just a Sex Offender: Paraphilias and Other Complicating Conditions

1. Not Just a Sex Offender: Paraphilias and Other Complicating Conditions Donya L. Adkerson, MA, LCPC 2005

2. Consider the individual Sex offenders are not all the same B Consider PParaphilia-specific issues PConcurrent/Complicating Conditions PComplicating Circumstances

3. Paraphilia What is it? • Recurrent thoughts, feelings or behaviors indicating arousal • For at least a 6 month duration • Involving nonconsenting being, nonsexual object, or body part • Early adolescents= arousal patterns may not be fixed enough to diagnose paraphilia

4. Common paraphilias among sex offenders PNot all sex offenders have a paraphilia PPedophilia PHebephilia/Ephebephilia PBestiality

5. Common paraphilias among sex offenders • Voyeurism • Exhibitionism • Sadism • Paraphilia NOS (Not Otherwise Specified) e.g., rape • MANY other less common . . . arousal to feet, diapers, urine, feces, underwear, shoes, fabrics, almost anything.

6. Implications of a Paraphilia • Associated with increased risk for re-offense • May require arousal modification treatment techniques • Compliance can be difficult • Can only suppress, not eliminate, the paraphilic arousal • May present issue in developing partner relationships • May cause feelings of shame, isolation

7. Paraphilia-specific Considerations Voyeurism PHands-off offenses taken less seriously, but may not be the limit of the behavior PVoyeurism is legal and sanctioned with consent (the porn/strip industries) PLimited voyeurism in adolescence culturally normal

8. Paraphilia-specific Considerations Voyeurism 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

9. Paraphilia-specific Considerations Exhibitionism • To adults, often seen as joke; to kids, now taken seriously • Higher correlation with hands-on when victim is child • High correlation with narcissistic traits when target strangers

10. Paraphilia-specific Considerations Exhibitionism PHigh rates of relapse; ease of relapse PUnderlying fantasy goalB where does the exposing lead? <Approval/sex/relationship <Sexual acknowledgment <Negative response -fear/distress/anger/humiliation

11. Paraphilia-specific Considerations Pedophilia and Hebephilia • May still have arousal to adults -- or may have little to none • What age and gender span at risk? • Pedophiles are very heterogenous group • Parenting problems: • Arousal to own children • Their children attract other children

12. Paraphilia-specific Considerations Pedophilia and Hebephilia • Safety planning areas • Work • Leisure • Family gatherings • Public places • Worship • Media stimuli • Holidays & Special events

13. Paraphilia-specific Considerations Bestiality • Rarely exclusive in SO referrals • Some correlation of bestiality and increased risk of child molest • Screen for signs of sadism • Safety planning with family pets, farm animals, volunteering, work

14. Paraphilia-specific Considerations Sadism • Arousal to infliction of pain, suffering, humiliation • The ULTIMATE DANGER, especially when combined with Antisocial Personality Disorder • Most sadists offend at home, even if also offending on strangers

15. Paraphilia-specific Considerations Sadism 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

16. Recognizing Sadism Common offense elements • Degradation tactics • Name calling, force begging, porn re-enactments, use of animals/urine/feces • Bondage and/or Object use • Infliction of pain & injury • Documenting • Photos/videos • Souvenirs

17. Childhood/Adolescent Histories of Sadistic Offenders Elements often found • Aggression to peers (may include intentional pain infliction) • Cruelty to animals, animal killing/torture • Compulsive masturbation • Chronic lying • Enuresis • Fire setting

18. Childhood/Adolescent history of Sadistic Offenders Elements often found PStealing PDestruction of property PDaydreaming (onset of repetitive violent sexual fantasies and themes of mastery/power over others) PPoor relationship with parents PAchievement lower than potential

19. Common Family History Factors For Sadists PAlcohol abuse PPsychiatric disorders PCriminal behavior PInstability of residence PLow family-community involvement

20. Paraphilia Specific Considerations Masochism B the flip side of Sadism • Uncommon in offenders, but does turn up at times • The masochist feels arousal to experiencing pain/shame/humiliation • Danger of eroticizing the entire S&M interaction • Danger of projecting the masochistic arousal onto victims • Desensitization of the pain & suffering of others

21. Co-existing Complicating Conditions Among sex offenders • Developmentally Delayed/Mentally Retarded • Organic syndromes • Substance Abuse/Dependence • ADHD

22. Co-existing Complicating Conditions Among sex offenders PObsessive-Compulsive disorders PPTSD PPersonality Disorders

23. DD/MR Disability is a continuum, terms may vary • DSM-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) • Special programming will be needed • Keep expectations reasonable • If group living is required, educating the DD/MR home staff will be important

24. Organic Syndromes Pervasive Developmental Disorders • Asperger=s Syndrome - related to Autism, but with better language development • Severe social impairment - lacks understanding and ability of normal social interest, interaction • Standard SO treatment unlikely to be appropriate

25. Fetal Alcohol Syndrome • Associated features include facial appearance, organ effects, vision and hearing problems, poor coordination, slow growth • Features interacting with offending problems include poor reasoning skills, attention problems, trouble learning from education or experience, attachment problems, impaired impulse control

26. Organic Syndromes Traumatic 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

27. Attention Deficit Hyperactivity Disorder • Up to 80% of JSOs in some studies; Adults can have it too • Increased impulsivity B more likely to act without reflection • Harder to focus in therapy, inattention decreases learning • Negative social reactions to the symptoms • Medications helpful

28. Obsessive - Compulsive Disorder • Obsession = thought; compulsion = behavior • May focus on sexual themes or something else • Increased alcohol/drug risk with self- medication attempts • Individual feels out of control to him/herself • Medication helpful

29. Post-Traumatic Stress Disorder • Alternating intrusive/avoidance symptoms • Can impair life functioning - sleep disturbance, dissociation, emotional numbing, poor concentration, hypervigilance, distrust, anger, flashbacks • SO treatment can trigger trauma symptoms for abuse survivors • Treating the PTSD can facilitate SO treatment process • Victim therapy • Medication for symptom management

30. 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.

31. Personality Disorders General criteria PEnduring pattern of both internal experiences and external behaviors PMarkedly different from cultural expectations POnset in teens or early adult PPervasive, inflexible, stable over time PLeads to distress OR impairment

32. Common Personality Disorders among sexual offenders • Borderline • Histrionic • Narcissistic • Antisocial • Other types exist, but less likely to turn up in SO treatment

33. Borderline Personality Disorder Key: Instability and impulsivity • Unstable and intense extremes in interpersonal relationships: AI hate you, don=t leave me!@ • Unstable identity - may vacillate on religion, sense of self, even sexual orientation • Suicidal gestures, self injury, other destructive impulsive behaviors common • Emotionally volatile, intense and rapid shifts of mood • Watch for Borderline PARTNERS of offenders

34. Borderline Personality Disorder Implications 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

35. Histrionic Personality Disorder Key: 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

36. Histrionic Personality Disorder Implications for treatment & supervision PHogging group time PStruggle to pin down details PLOTS of emotional displays

37. Narcissistic Personality Disorder Key: Grandiosity, need for admiration, lack of empathy • Grandiose view of self importance, talent, superiority • Sees self as Aspecial,@Aunique@ • Sense of entitlement • Lacks empathy for others • May be exploitive, arrogant, and believes others are envious of him

38. Narcissistic Personality Disorder Implications for treatment & supervision PYou probably don=t know as much as they do PRules don=t apply to them PExpectations of special treatment, attention, catering PGroupmates may struggle with the huge ego

39. Antisocial Personality Disorder Key: Disregard for, and violation of, others • Psychopathy and sociopathy are terms sometimes used • Repeated criminal behaviors • Deceitfulness, conning, lying - for profit or pleasure • Disregard for the rights and safety of others • Irritability/aggression • Irresponsibility, fails to meet obligations • Lack of remorse, lack of concern for others

40. Antisocial Personality Disorder Implications for treatment & supervision • HIGHER RISK for recidivism • Risk of other crimes in addition to sex offending • Likely to have antisocial peer group

41. Antisocial Personality Disorder Implications for treatment & supervision • Watch for using/manipulating groupmates • May frighten groupmates • Expect dishonesty, thinking errors, and unpaid bills • Controversy on teaching empathy with this population