Child molesters and other sex offenders
Stephen Hucker
Introduction
In most Western societies sexual offenders are more reviled than almost any other type of offender. On both sides of the Atlantic this is reflected in the sanctions that specifically address this group such as Sexually Violent Predator laws in the United States, Dangerous and Long-Term Offender legislation in Canada, and Sex Offender Orders in the UK. Related approaches include the introduction of sex offender registries and the widespread requirement that children at risk from sexual predators be reported by professionals and others.
The general psychiatrist and the sex offender
Though constituting a relatively small proportion of all reported offences, sex offending affects large numbers of people in the general population. Though there are methodological difficulties associated with much of the research in this area, the World Health Organization has reviewed estimates of childhood sexual abuse from 39 countries and found that the prevalence of non-contact, contact, and intercourse in female children was about 6, 11, and 4 per cent, respectively; the corresponding figure for males was about 2 per cent in all categories.(1) However, these must represent minimal figures as it is known that many victims do not report their experience and individual sex offenders, when guaranteed confidentiality, will admit to many more offences than they were charged with or convicted of.(2) Various forms of sexual offending against adults are also underreported but it has been estimated that about 13 per cent of women and 3 per cent of men have been raped at some time during their lifetime.(3)
The long-term effects of such victimization has been extensively studied and it is clear that people with a history of child sexual abuse, for example, experience a wide range of long-term psychological consequences.(4)
Although prone to find reasons to delegate the assessment and management of sex offenders to specialized forensic services, the general psychiatrist will find it impossible to avoid them entirely. Minor varieties, such as ‘flashers’ (exhibitionists) or ‘peeping Toms’ (voyeurs), may be viewed by the courts as less serious, and the opinion of the generalist will still be appreciated, especially when specialist resources are scarce and an appointment for a forensic assessment could be long-delayed. It is important, therefore, for the general psychiatrist to have some understanding of this area in order to make appropriate decisions and recommendations.
Definitions of sexual offending
Put simply, a sexual offender is an individual whose sexual behaviour contravenes the law in a particular jurisdiction. The types of activities that may be proscribed vary considerably. Western countries are generally more tolerant though most societies provide sanctions for sexual activity involving children below the age of consent, non-consensual sexual acts, sexual relations with close family, and sexual interference with animals or corpses. There are also typically legal and other interventions where a person fears sexual harassment or assault, and where there has been abuse, or likelihood of abuse, in certain professional relationships. Typically, also, there is regulation of pornography or obscene material.
Relationship between sexual deviancy and sexual offending
There is some overlap of sexual offences with a medical diagnosis of a paraphilia. However, this is not a complete concurrence. Thus, not all paedophiles have molested a child and not all child molesters are paedophiles; many, perhaps most, men who sexually assault adult women are not sexually deviant or paraphilic at all. The psychiatric categories of paraphilia and their characteristics are described elsewhere in this volume (Chapter 4.11.3 by Fedoroff).
Types of sexual offender
The vast majority of sexual offenders are male though it is recognized that women may also commit similar crimes.(5) Male sexual offenders can be broadly divided into: child molesters, rapists, and non-contact sex offenders.
Child molesters
Typologies of this subgroup in part refer to the degree of paraphilic attraction (sexual deviancy). Thus, there has been a common categorization into ‘fixated’ and ‘situational’ or ‘regressed’ types.(6) With the ‘fixated’ type there is a permanent attraction to children typically dating from adolescence thus conforming to definitions of paedophilia in DSM-IV and ICD-10. Those attracted to males are more likely to repeat their offences with recidivism at least
twice as high as with those attracted to girls. The former tend to victimize boys aged 11-15 years old, whereas the latter molest girls of 8 to 10.
twice as high as with those attracted to girls. The former tend to victimize boys aged 11-15 years old, whereas the latter molest girls of 8 to 10.
‘Fixated’ paedophiles tend to commit premeditated offences that often involve considerable planning. Manipulation and ‘grooming’ behaviour is used as a means of luring, even abducting, children into sexual activity, and they may gain the trust of the parents or other carers. They may appear to have an excellent rapport with the child victims and treat them kindly but their motive is primarily for the child to meet their own need for affection rather than the reverse. It is for this reason that ‘needy’ children are often selected as victims. Such offenders will typically profess their ‘love’ for children and convince themselves that their behaviour is not harmful. Other rationalizations, such as that were educating the child or introducing the child to sexual love in a caring way, are common.
‘Regressed’ or ‘situational’ child molesters are, according to this typology, attracted primarily to adult females and may be in a maritaltype relationship at the time of their offence. They will often report feelings of personal inadequacy or low self-esteem and their offences are more typically spontaneous and occur in the context of a stressful life circumstance.
The ‘regressed’ child molester, in contrast to the ‘fixated’ type, is less inclined to ‘groom’ victims and their caregivers. Victims of this type may be older than those involved with the ‘fixated’ molester. Molestations however may begin before, and continue past, puberty.
Rapists
Once again, the typology expounded by Prentky, Knight, and colleagues can be useful.(6) In this scheme, offenders are differentiated through their apparent motivation by anger, power, or sadism. Most rapists act alone but individuals involved in ‘gang’ rape may represent several different types.
‘Anger-motivated’ rapists act out deviant fantasies of retaliation towards the victim, using violence as a means of expressing generalized anger, typically towards women though sometimes towards people in general. The intention of the attack is to humiliate and debase the victim who will typically have been selected randomly.
The ‘power-motivated’ rapist type has been further subdivided into the ‘power-reassurance’ and ‘power-assertive’ types. The former is plagued by doubts and insecurities about their own masculinity and sexual adequacy, often uses minimal force and may apologize to the victim or even seek a relationship afterwards. However, these victims may have been stalked and the attacks on them premeditated. The ‘power-assertive’ subtype is motivated by the desire to dominate women and has no doubts about his masculinity but, like the previous subtype, typically does not use gratuitous violence to subdue the victim.
‘Sadistic’ rapists, are the least common but perhaps most worrisome type, who derive sexual pleasure from inflicting hurt and suffering on their victim. Sometimes, however, this is difficult to differentiate from other types where pain, suffering and humiliation are the consequences, but not the primary motivation, for the attack.
Other types of sexual assault that do not involve penetration, and which represent related behaviours, include toucheurism and frotteurism. These involve, respectively, touching or grabbing strangers, typically females, in a way that provides him with sexual gratification. The former, in particular, may pass unnoticed by the victim, as attackers will typically touch or grab sexual areas such as breasts, buttocks, or crotch, in crowds and similar situations where the incident may be discounted as ‘accidental’.
Non-contact sexual offences
This group includes ‘peeping Toms’, ‘flashers’, and indecent phone callers with corresponding psychiatric diagnoses of the paraphilias voyeurism, exhibitionism, and telephone scatalogia, respectively.
Peepers have a penchant to observe an unsuspecting female stranger undressing, or couples in the act of copulation. They may masturbate at the scene or later in private while recalling what they saw. Most voyeurs, like most sex offenders who are paraphilic, are aware of their deviant impulses while still adolescent but the behaviour may become chronic.
Exhibitionists derive sexual excitement from exposing their genitals to unsuspecting female strangers. The desired reaction is one of ‘shock and awe’ and indifference is a useful response, if the victim has the presence of mind. The perpetrator may masturbate at the time or later in private. Though some cases are particularly intractable, it is unusual to see an exhibitionist still active much past the age of about 40 years old.
The unsuspecting victims of obscene telephone callers are greeted with a barrage of sexually explicit commentary over the telephone. When this is a habitual practice, accompanied by or followed by masturbation, it is distinguishable from an isolated incident committed as a prank.
In all three of the above non-contact sexual offences, there is typically no desire to have further contact with the victim and, indeed, such a prospect often fills the offender with anxiety. However, a small minority of these offenders may later commit a more serious sexual offence, even sexually motivated homicide.(7) Atypical features, such as a desire to have personal contact with the victim, or the repeated selection of child victims, may be an early warning sign of such potential and warrants further, expert assessment.
In recent years, paralleling the advance of technology, offenders have been apprehended for using the Internet as a means of obtaining or distributing pornography (especially child pornography) or as a means of contacting children for sexual purposes. Possession of child pornography is an indicator of sexual interest in children and it is associated with self-reported sexual interest in children and with laboratory measurements of changes in penile volume or circumference.(8)
Assessment of sex offenders
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