Renee Sorrentino

Trouble at teens' fingertips: Youth sexting and the law

The last decade has seen a rapid increase in the use of smartphones among young children and adolescents. One consequence of this phenomenon is sexting. Although researchers of sexting have yet to arrive at a single, cohesive definition for the behavior, it generally involves the transmission of text, pictures, or videos containing sexual material. Different definitions of the behavior have led to widely varying estimates of its prevalence, although some studies have documented relatively high rates of sexting among teenagers. As adolescence is the time period in peoples lives where the psychological tasks of identity consolidation and the development of intimate relationships become primary, it is not surprising that many teens utilize sexting as one way of practicing skills associated with successful completion of these tasks. The criminal prosecution of sexting cases, then, raises many legal and ethical questions. Offenders may be prosecuted under state or federal child pornography laws or state-specific sexting laws. Sexting laws, particularly in instances of consensual sext exchange, call into question who they are meant to protect and from what. In this article we review the research on teen sexting, its prevalence, and its association with mental health problems; summarize legal responses to the behavior in the United States; and identify considerations for prosecutors and legal decision-makers facing sexting cases.

Stalking and Violence

The three widely known stalker classifications assist in categorizing stalkers, which allows for better management of violence risk. Although 80% of stalking is done by men, women also engage in stalking, and their violence risk should not be underestimated. Juvenile stalkers do exist and juvenile stalking is also associated with violence. Clinicians can become a victim of stalking and may become victims of stalking by proxy, a special type of stalking behavior where the stalker involves other people or agencies to communicate with or track their victim. A careful stalking violence risk assessment is essential in the intervention and risk management process.

Gender Considerations in Violence

The role of gender in violence is poorly understood. Research has shown that gender has an important and, at times, distinct role in the prediction of violence. However, this gender disparity diminishes in the setting of mental illness. The risk assessment of violence in women is largely based on research in violent men. There are distinct characteristics in female violence compared with male violence. Attention to these characteristics may lead to the development of gender-dependent tools that can be used to evaluate violence risk.

Involuntary Treatment of Psychosis in Pregnancy

When a patient with acute psychosis refuses antipsychotic medication despite a clear need for treatment, involuntary medication is often considered. When the patient is both pregnant and acutely unwell, an additional layer of analysis enters the picture. This analysis then also includes the health of the mother and fetus, rights of the mother and fetus, and whose rights take precedence when choosing treatment options in event of a conflict. Antipsychotic agents are frequently the medications prescribed as involuntary treatment. Typical and atypical antipsychotic agents are often used in both emergent and nonemergent situations during pregnancy. Despite a lack of randomized, double-blind, controlled, prospective studies in pregnancy, available data regarding the safety of antipsychotic agents in pregnancy are relatively reassuring. At the same time, the risks of untreated psychosis, for both the mother and the fetus, are not negligible. Such cases merit ethics-related and legal analyses. Forensic psychiatrists involved in such cases need to consider the patients capacity to make medical decisions and be able to discuss the potential risks, benefits, and alternatives with patients and in court, as part of initiation of involuntary treatment.

Bestiality: An introduction for legal and mental health professionals

Bestiality, or human-animal intercourse, has been a concern of the legal and mental health communities for many years. Ancient legal codes delineated punishments for those who engaged in the behavior, denoting a moral and general societal concern surrounding bestiality dating to ancient times. Despite this longstanding interest in and legal efforts to punish humans for having sex with animals, there has been little research on the behavior. Current available research has largely been siloed based on the populations studied, making it difficult to render any firm conclusions about bestialitys prevalence, frequency, and the risk posed by those who have sex with animals. It is important for clinicians to know the legal status of the behavior in their jurisdictions, to understand possible medical and psychiatric complications and comorbidities, and to know how to evaluate and treat individuals who engage in bestiality or have the related diagnosis of zoophilic disorder. This article provides an overview of the terminology and research pertaining to bestiality, summarizes legal and ethical considerations, and describes clinically relevant information for the evaluation and management of individuals engaged in sex with animals.

Sex on the Silver Screen: Using Film to Teach About Paraphilias

Film has been successfully used to teach about a variety of psychiatric disorders. The ever-popular StarWars has recently been described in psychiatric teaching about disorders ranging from pathological gambling to pseudo-dementia to obsessivecompulsive personality disorder to malingering [1–3]. Forensic psychiatric topics abound in films [4, 5]. For example, teaching about female psychopathy has recently been described, using television clips [6]. Similarly, teaching about another difficult and less frequently discussed topic, the paraphilias, may best be done utilizing film. Using cinematography to teach specifically about paraphilias allows both a visual representation of the behaviors and a reflection of societal views on this highly charged topic. Even the aforementioned Star Wars has been used for teaching about pedophilia. Qui-Gon Jinn, a Jedi hero of the series, has also been described as being useful for demonstrating traits similar to the “tend and befriend” grooming behaviors of pedophiles [2]. Using films to teach ensures that trainees find learning memorable and engaging. They may feel uncomfortable with patients with these diagnoses, and thus film provides an initial experience which may ease discomfort and allow for more robust discussion. Most trainees will not have experience working with paraphilic disorders, since these are rarely found in residency outpatient clinics, and thus film may be their only entrée to these disorders. In cases of a difficult diagnosis, using films allows all trainees to see the same “patient.” With recent changes to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) regarding the paraphilias and paraphilic disorders, film viewing and discussion can be helpful to trainees. A paraphilia involves an anomalous sexual arousal pattern which is persistent and intense. The somewhat controversial DSM-5 changes include that paraphilias are not necessarily psychiatric disorders [7]. To be a paraphilic disorder, the paraphilia must lead to clinically significant distress or impairment. What is considered a normal (non-anomalous) sexual interest is “genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” [7]. Questions include whether the determination of what is anomalous belongs in the hands of psychiatry; rather this appears to be an historical and socio-cultural issue [8]. Gender issues abound within the diagnosis of paraphilias, as well [9]. Paraphilic disorders in particular are likely to be depicted in film because paraphilias are not uncommon and the general public shares an interest in exploring the line between unusual and disturbing sexual behavior. Professionally, this allows for a forum for diagnostic discussions. This article seeks to describe, therefore, how film can be used to teach trainees about paraphilias, paraphilic disorders, and recent DSM changes.