Howard E. Barbaree

An Integrated Theory of the Etiology of Sexual Offending

This chapter represents an attempt to integrate a widely disparate literature concerning factors which play a role in the etiology of sex offending and lead to its persistence. In particular we are concerned that most researchers seem to take a rather narrow perspective of this behavior, stressing their own preferred processes (i.e., psychological, biological, or sociological) to the virtual exclusion of others. We have previously emphasized the role of learning experiences (Marshall and Barbaree, 1984a), sociocultural factors (Marshall, 1984a), and biological processes (Marshall 1984b) in the etiology of rape, but this represents our first attempt at integration and the first time we have extended our theorizing to account for other sex offenses. We believe that a proper understanding of sex offending can only be attained when these diverse processes are seen as functionally interdependent.

Treatment outcome with sex offenders

Abstract Previous reviews have taken either a severe methodological stance and concluded that treatments have not been demonstrated to be effective with sex offenders, or they have ignored methodological considerations and expounded about the value, of particular treatment approaches. We have attempted to adopt a position somewhere between these, two and have concluded that some treatment programs have been effective with child molesters and exhibitionists but not, apparently, with rapists. In examining the value of the different approaches, we concluded that comprehensive cognitive/behavioral programs (at least for child molesters, incest offenders, and exhibitionists) are most likely to be effective, although there is a clear value for the adjunctive use of antiandrogens with those offenders who engage in excessively high rates of sexual activities.

The long-term evaluation of a behavioral treatment program for child molesters

Abstract Recidivism data derived from various sources over a follow-up period of 1–11 yr, provided the basis for appraising the effectiveness of a comprehensive cognitive-behavioral treatment program for familial and nonfamilial child molesters. Unofficial records held by police and Childrens Aid Societies proved to be the best data for estimating recidivism. These data revealed increases in recidivism with longer follow-up periods, but there were consistent advantages for the treated over the untreated patients. Men who had sexually abused the daughters of other people demonstrated the clearest treatment benefits. The younger offenders and those who had engaged in genital-genital contact with their victims were more likely to reoffend even if they were treated. Contrary to the expectations of behavior therapists, indices of deviant sexual preferences did not predict outcome.

Early Onset and Deviant Sexuality in Child Molesters

One hundred twenty-nine outpatient child molesters (91 nonfamilial and 38 father/daughter offenders) were assessed and interviewed regarding various aspects of their deviant sexuality. Of our total sample, 29% reported having deviant fantasies prior to age 20, and this was most pronounced (41.1%) among those who molested the sons of other people. Fourteen percent of the nonfamilial offenders against boys, 11.8% of the nonfamilial offenders against girls, and 7.9% of the incest offenders had one or more paraphilia additional to their index offense; only three of the total sample reported more than two additional paraphilias. These data differ from those reported earlier by Abel and his colleagues (1985) and by Freund (1990). The results are discussed in terms of these discrepancies.

Psychopathy and Deviant Sexual Arousal in Incarcerated Sexual Offenders

This study investigates the relationship between psychopathy and deviant sexual arousal in a sample of 65 sexual offenders, with approximately equal numbers of rapists and child molesters. Psychopathy, measured by the Psychopathy Checklist-Revised and phallometric indexes of deviant sexual arousal were significantly correlated, r(63) =.28, p <. 02. Differentiating between rapists, extrafamilial pedophiles, and incest offenders revealed that this relationship, however, was most apparent for extrafamilial child molesters, somewhat less for rapists, and not at all for incest offenders. The incidence of psychopathy was substantially lower than previous rates in incarcerated samples and a psychiatric sample of sexual offenders. Rapists had higher psychopathy ratings than child molesters, approaching statistical significance t(60) = -1.88, p < .07.

Outcome of Comprehensive Cognitive-Behavioral Treatment Programs

A great variety of treatment programs for sex offenders are now available (Brecher, 1978; Hults, 1981; Knopp, 1984). Evaluations of the outcome from nonbehavioral psychotherapy programs (Barbaree & Marshall, in press-a) reveal that methodological problems present difficulties in determining effectiveness. While those programs appear to consistently result in recidivism rates around or below 10% (Furby, Weinrott, and Blackshaw, 1989), this apparent effectiveness is seriously confounded by selection procedures which exclude the most dangerous offenders from treatment (Barbaree & Marshall, in press-a) and by the failure to provide an adequate comparison group of untreated offenders (Furby et al., 1989; Tracy, Donnelly, Morgenbesser, & Macdonald, 1983). The effectiveness of physical treatment procedures has been evaluated by Bradford (1985; and Chapter 17, this volume), who comes to optimistic conclusions contrary to the views expressed by us in our reviews of this literature (Barbaree & Marshall, in press-a; Quinsey & Marshall, 1983).

Alcohol intoxication and deviant sexual arousal in male social drinkers.

Abstract Using a balanced-placebo drink administration procedure, 32 male social drinkers were presented with verbal descriptions of mutually-consenting sexual intercourse and rape. Penile tumescence was recorded continuously during verbal descriptions. Neither alcohol intoxication nor alcohol expectancy had any effect on overall sexual arousal. Furthermore, alcohol expectancy had no effect on the difference between arousal to mutually-consenting sex and rape cues. However, subjects who drank the placebo drink increased the difference between their arousal to mutually-consenting and rape cues as the session progressed, while subjects who drank a beverage containing 0.63 ml of absolute ethanol/kg of body wt showed no increase in differential sexual arousal. Results were discussed in terms of the relation between alcohol intoxication and inhibition of socially-inappropriate sexual arousal.

Comparisons Between Sexual and Nonsexual Rapist Subtypes Sexual Arousal to Rape, Offense Precursors, and Offense Characteristics

Sixty incarcerated rapists were subtyped according to the Massachusetts Treatment Center Rapist Typology as either “nonsexual” (i.e., the opportunistic and vindictive subtypes) or “sexual” (i.e., the nonsadistic and sadistic subtypes). Subjects were then tested using the circumferential penile plethysmograph, assessing their erectile responses to verbal descriptions of consenting sex and rape. Additionally, the Psychopathy Checklist-Revised was scored for each subject, and institutional files were summarized and coded. The index offenses committed by the nonsexual subtypes were more violent and resulted in greater victim damage; the offenses of the men in the nonsexual subtypes were more likely to be impulsive; the men in the sexual subtypes were more socially isolated at the time of the offense. Relative sexual arousal to rape descriptions was greater among the sexual subtypes than among the nonsexual subtypes. These results are discussed in terms of two separate cognitive-behavioral processes leading to rape.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features.

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

Identification of cues and control of sexual arousal by rapists

Abstract The experiments in this article pertain to factors relevant to rape. The first experiment examined the ability of four groups to discriminate between appropriate and inappropriate sexual cues. Rapists detected such cues as well as did either Normals or Non-rapist Inmates, in all but the most assaultive rape tape. Normal subjects who had consumed alcohol prior to testing, detected inappropriate cues earlier in the tapes than did all other subjects. The second experiment addressed the ability of subjects to inhibit sexual arousal when instructed to do so. Rapists and Non-rapists were shown to be equally capable of inhibiting arousal in response to both mutually-consenting and rape cues. These findings negate theories suggesting that rapists differ from other men in that they are unable to exert control over their arousal, and that they have difficulty in identifying inappropriate cues to arousal.