Dennis M. Doren

Dimensions associated with assessments of sex offender recidivism risk.

This research explored empirical dimensions of sex offender recidivism risk. Study 1 portrayed descriptive statistics and factor structure information concerning actuarial risk instruments and diagnoses derived from a sample of sex offenders being evaluated for civil commitment in Wisconsin. Study 2 used a sample from England and Wales to analyze the relationships between individual risk factors commonly found as items within actuarial scales. Factor structure results from Study 2 conceptually overlapped those found in the first sample, and variables developed from this factor structure predicted sexual reconviction as well. Results from these two studies are discussed in terms of separable components of risk for sexual recidivism and the roles those components may play in processes underlying sexual reoffense.

Recidivism base rates, predictions of sex offender recidivism, and the “sexual predator” commitment laws

Predictions of future sexual offending have been mandated by various “Sexual Predator” commitment laws, despite historical arguments that clinicians are frequently inaccurate and over-predict violence. The basis for those arguments has been the perspective that sexual recidivism is a relatively rare event. Research is reviewed, however, with the finding that sexual recidivism for certain offenders is a rather common occurrence when the definition of recidivism is in keeping with the sex offender commitment laws. This finding is used to demonstrate that under-, rather than over-prediction of the designated violence is necessarily todays practice. Practical and ethical implications are discussed.

Effectiveness of Sex Offender Treatment for Psychopathic Sexual Offenders

Meta-analyses have suggested that sexual offender treatment (SOT) completion is associated with lowered sexual recidivism rates for convicted sexual offenders. The paucity of properly designed studies allows for the alternative explanation of less recidivism among treated samples as reflecting that lower risk offenders disproportionately self-select into treatment. A test of the “self-selection explanation” can occur by investigating treatment effect on known high-risk offenders. Psychopathy correlates with increased sexual recidivism risk, such that an exploration of the SOT effect on psychopathic offenders could clarify the accuracy of the self-selection hypothesis. Additionally, the debated degree to which psychopaths are treatable might obtain clarification by a research review. This article examines empirical findings concerning the effectiveness of SOT for psychopathic sexual offenders. Ten studies were found to meet the minimal quality standards used, stemming from only four data sources. Shortcomings of existing research precluded clear conclusions, though trends in the data are delineated.

Diagnostic and Risk Profiles of Men Detained Under Wisconsin’s Sexually Violent Person Law:

Previous studies described the characteristics of individuals committed under sexual offender civil commitment laws in Arizona, Florida, and Washington. This study describes the diagnostic and risk profiles of 331 sexual offenders held under Wisconsin’s sexual offender statute and compares them to the people held in those other states. Persons detained under Wisconsin’s law substantially differ from those in the other states. This variability is attributed to differences in both diagnostic procedures and statutory risk thresholds. The authors believe this is the first study to directly compare diagnoses and risk measures of sex offenders referred for commitment in different states, thereby offering a more national view of who is detained under these laws.

The Diagnostic Reliability of Sexual Sadism

Previous studies have reported low diagnostic agreement on the paraphilias, especially sexual sadism. In the present study, 34 evaluators throughout the United States reviewed summaries of 12 committed sex offenders. The evaluators agreed more than 90% of the time on whether offenders met criteria for any paraphilia in general and sexual sadism in particular. The authors attribute the low reliability reported in previous studies to different agreement indices, the amount and quality of information available to evaluators, and the prevalence of the respective paraphilic diagnoses in their samples.

Litigiousness as a Resistance to Therapy

With the criminalization of the mentally ill, increasing numbers of patients with experience in the criminal justice system are entering psychiatric facilities, and “jailhouse lawyers” are becoming more familiar to clinicians. While the use of grievances and lawsuits as methods of asserting control and harassing staffs is well known, there has been less discussion of patients’ litigiousness serving as resistance to dealing with other issues in therapy. The authors discuss this subject, and present methods for minimizing the problems, including dealing with the reinforcement of such resistance by adversarial advocates.

The Munchausen patient in a forensic facility

The many reports in the literature of chronic factitious illness (Munchausens Syndrome) have emphasized the difficulty of treating these patients because of their propensity to leave medical facilities as soon as the factitious nature of their symptoms is discovered, and because of their disinclination to accept psychiatric help. The authors report on their treatment of such a patient who was incarcerated for over ten years under a criminal commitment, and discuss methods for overcoming resistances to treatment in Munchausens patients.