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Not Just a Sex Offender: Paraphilias and Other Complicating Conditions. Donya L. Adkerson, MA, LCPC 2005. Consider the individual. Sex offenders are not all the same B Consider. P Paraphilia-specific issues P Concurrent/Complicating Conditions P Complicating Circumstances. Paraphilia.

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not just a sex offender paraphilias and other complicating conditions

Not Just a Sex Offender: Paraphilias and Other Complicating Conditions

Donya L. Adkerson, MA, LCPC 2005

consider the individual

Consider the individual

Sex offenders are not all the same B Consider

PParaphilia-specific issues

PConcurrent/Complicating Conditions

PComplicating Circumstances



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
common paraphilias among sex offenders

Common paraphilias among sex offenders

PNot all sex offenders have a paraphilia




common paraphilias among sex offenders5

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.
implications of a paraphilia

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
paraphilia specific considerations

Paraphilia-specific Considerations


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

paraphilia specific considerations8

Paraphilia-specific Considerations


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 considerations9

Paraphilia-specific Considerations


  • 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
paraphilia specific considerations10

Paraphilia-specific Considerations


PHigh rates of relapse; ease of relapse

PUnderlying fantasy goalB where does the exposing lead?


<Sexual acknowledgment

<Negative response -fear/distress/anger/humiliation

paraphilia specific considerations11

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
paraphilia specific considerations12

Paraphilia-specific Considerations

Pedophilia and Hebephilia

  • Safety planning areas
    • Work
    • Leisure
    • Family gatherings
    • Public places
    • Worship
    • Media stimuli
    • Holidays & Special events
paraphilia specific considerations13

Paraphilia-specific Considerations


  • 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
paraphilia specific considerations14

Paraphilia-specific Considerations


  • 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
paraphilia specific considerations15

Paraphilia-specific Considerations


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 sadism

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
childhood adolescent histories of sadistic offenders

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
childhood adolescent history of sadistic offenders

Childhood/Adolescent history of Sadistic Offenders

Elements often found


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

common family history factors

Common Family History Factors

For Sadists

PAlcohol abuse

PPsychiatric disorders

PCriminal behavior

PInstability of residence

PLow family-community involvement

paraphilia specific considerations20

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
co existing complicating conditions

Co-existing Complicating Conditions

Among sex offenders

  • Developmentally Delayed/Mentally Retarded
  • Organic syndromes
  • Substance Abuse/Dependence
  • ADHD
co existing complicating conditions22

Co-existing Complicating Conditions

Among sex offenders

PObsessive-Compulsive disorders


PPersonality Disorders

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
organic syndromes

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
fetal alcohol syndrome

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
organic syndromes26

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

attention deficit hyperactivity disorder

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
obsessive compulsive disorder

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
post traumatic stress disorder

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
a word of caution regarding offenders reporting sexual victimization

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 disorders

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

common personality disorders

Common Personality Disorders

among sexual offenders

  • Borderline
  • Histrionic
  • Narcissistic
  • Antisocial
  • Other types exist, but less likely to turn up in SO treatment
borderline personality disorder

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
borderline personality disorder34

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

histrionic personality disorder

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

histrionic personality disorder36

Histrionic Personality Disorder

Implications for treatment & supervision

PHogging group time

PStruggle to pin down details

PLOTS of emotional displays

narcissistic personality disorder

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
narcissistic personality disorder38

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

antisocial personality disorder

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
antisocial personality disorder40

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
antisocial personality disorder41

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