Susan Curry

Pornography use and sexual aggression: the impact of frequency and type of pornography use on recidivism among sexual offenders

In this study, we examined the unique contribution of pornography consumption to the longitudinal prediction of criminal recidivism in a sample of 341 child molesters. We specifically tested the hypothesis, based on predictions informed by the confluence model of sexual aggression that pornography will be a risk factor for recidivism only for those individuals classified as relatively high risk for re-offending. Pornography use (frequency and type) was assessed through self-report and recidivism was measured using data from a national database from the Royal Canadian Mounted Police. Indices of recidivism, which were assessed up to 15 years after release, included an overall criminal recidivism index, as well as subcategories focusing on violent (including sexual) recidivism and sexual recidivism alone. Results for both frequency and type of pornography use were generally consistent with our predictions. Most importantly, after controlling for general and specific risk factors for sexual aggression, pornography added significantly to the prediction of recidivism. Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups. The importance of conceptualizing particular risk factors (e.g., pornography), within the context of other individual characteristics is discussed.

Recidivism of child molesters: A study of victim relationship with the perpetrator

OBJECTIVE To compare the rates among of recidivism or re-offense among convicted child molesters who offend against biological children, stepchildren, and relationships where the child is an extended family member, acquaintance or stranger to the victim. METHOD Four hundred male subjects 18 years of age or older and at least 5 years older than the victim at the time of the index offense, were convicted of a hands on sexual offense against one or more children under the age of 16. Subjects were grouped into five categories according to the type of relationship the perpetrator had with the victim. The subjects records of criminal arrests and convictions was obtained from the national Royal Canadian Mounted Police data. Subjects were then followed-up for a period of up to 15 years after conviction when they were at risk to re-offend in the community. Survival outcome data after the index sexual offense was collected for all new sexual, violent, and any criminal offenses. RESULTS A larger proportion of men ( 16.2%) who sexually offended against children who were acquaintances, were charged with a new sexual offense than men who sexually offended against biological (4.8%) or their stepchildren (5.1%). The percentage of men who were subsequently charged with any type of criminal offense and who offended against their biological children (19%) was smaller than men who offended against children where the relationship is an extended family member (40%), acquaintances (35.9%) or strangers (45.2%). CONCLUSIONS When comparing the different categories of relationship the victim had with the perpetrator, the category of stranger has been highlighted as a group with a higher risk for re-offense. Our results have shown that comparatively, the risk of acquaintance group is a significantly higher risk category than was previously thought. Although professionals are principally concerned with sexual recidivism, general criminality appears to present in relatively large proportions of all child molesters with the stranger group at the highest risk level. While no single factor will predict recidivism in itself, the importance of defining the relationship between the perpetrator and victim is evident from this study.

Changes in Sexual Arousal as Measured by Penile Plethysmography in Men with Pedophilic Sexual Interest

INTRODUCTION Although pedophilia is defined by a recurrent sexual interest in prepubescent children, little attention has been paid to the stability or fluidity of this sexual interest over time. AIM The aim of the current study was to investigate if patterns of penile tumescence (as a proxy for sexual interest) measured by penile plethysmography testing (PPT) can change. METHODS In this retrospective chart review study, PPT results of 43 men diagnosed with pedophilia were collected and analyzed. All participants displayed a pedophilic sexual arousal pattern at the time of their first PPT. To test for change, we compared initial PPT results with subsequent PPT results measured at least 6 months later. MAIN OUTCOME MEASURE Sexual arousal was assessed using PPT by measuring change in penile circumference induced by the presentation of standardized sexual audio stimuli. RESULTS Approximately half of the sample (n = 21) displayed a change in PPT results. This change was characterized by a significant decrease of sexual arousal in response to pedophilic (child) stimuli and a significant increase of sexual arousal in response to nonpedophilic (adult) stimuli. No differences between sexual interest changers (ICs) and nonchangers (NC) were found for demographic data or for length of time between assessments. However, between-group comparisons revealed that ICs had significantly lower pedophilic indices at the initial assessment than NCs. CONCLUSIONS Results from the current study indicate that relative pedophilic interest, as defined by increase in penile circumference in response to nonpedophilic stimuli as measured by PPT, changed in about 50% of men diagnosed with pedophilia who also had initial pedophilic PPT sexual responses. This represents a significant challenge to the hypothesis that sexual interest in men with pedophilia is unchangeable and should be the focus of future studies.

Evidence That Arousal to Pedophilic Stimuli Can Change: Response to Bailey, Cantor, and Lalumière

We thank Drs. Bailey, Cantor, and Lalumiere for their careful reviews of Muller et al. (2014), hereafter referred to as ‘‘our study’’or‘‘our article.’’Our study reported on the results of a retrospective analysis of a group of men assessed at the Sexual Behaviours Clinic at the Royal Ottawa Mental Health Centre between 1983 and 2011, who fulfilled the following inclusion criteria: DSM-III, IV or IV-TR (American Psychiatric Association, 1980, 1994, 2000) diagnosis of pedophilia, an initial penileplethysmographytest (PPT) indicativeofsexual interest in children, and a second PPT test at least 6 months later. Because we were interested in testing the hypothesis that arousal topedophilic stimulicanchange,weselectedmenwhose PPT at Time 1 showed a greater increase in penile circumference in response to children compared to adults. Of this group, about halfshowedagreaterincreaseinpenilecircumferenceinresponse to adults (as compared to children) at Time 2. In the article, we noted that the men who changed PPT response profiles demonstrated both a decrease of penile circumference change in responsetoaudiotapesdescribingsexual interactionwithchildren and an increase in penile circumference change in response to audiotapes describing sexual interactions between adults. In our article, we suggested that the demonstration of a statistically significant decrease in sexual response toward children (p\.001), combined with a statistically significant increase in sexual response to adults (p\.001), presents a challenge to the claim that pedophilic sexual interest is unchangeable. We note that there was an error that has been formally communicated to the Editor of the Journal of Sexual Medicine, due to the misclassification of three of the men in the study. The removal of these cases and complete re-analysis of the data did not change the results or our conclusions. Bailey, Cantor, and Lalumiere each claimed that the notion of the immutability of pedophilic interest is not challenged by the findings of our study and attempted to offer some non-evidencebased support for their opinions. We are grateful for the opportunity to respond and do so below by reviewing each commentary in alphabetized author order. Bailey began his commentary by equating sexual orientation with sexual arousal,‘‘Because a man’s sexual orientation/ erotic interest is identical to his characteristic sexual response pattern...’’We disagree because sexual orientation is different from sexual arousal. Men who have sex with men are not necessarily gay, and a gay man is still gay even if he loses his sex drive or is unable to get an erection. In our article, we speculated that the reluctance of researchers to accept there is evidence that pedophilic sexual interest can change is due to confusion between sexual orientation and sexual interest. It should be noted that our study was never designed to investigate change insexualorientationandweexplicitlystated in thearticle thatour study does not support any recommendations aimed at changing sexual orientation. Equating orientation with interest confuses interpretation of the issue and may be clinically harmful. Bailey wrote that‘‘...sometimes men do not get sufficient erection during a PPT to be accurately classified.’’ We agree. This is why we selected men who initially produced more changein penile circumference in response tochild stimuli than to adults, as well as only those who demonstrated a change in J. P. Fedoroff (&) S. Curry R. Ranger J. Bradford Forensic Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Health Care Group, 1145 Carling Ave., Ottawa, ON K1Z 7K4, Canada e-mail: paul.fedoroff@theroyal.ca

A Time Series Modeling Approach in Risk Appraisal of Violent and Sexual Recidivism

For over half a century, various clinical and actuarial methods have been employed to assess the likelihood of violent recidivism. Yet there is a need for new methods that can improve the accuracy of recidivism predictions. This study proposes a new time series modeling approach that generates high levels of predictive accuracy over short and long periods of time. The proposed approach outperformed two widely used actuarial instruments (i.e., the Violence Risk Appraisal Guide and the Sex Offender Risk Appraisal Guide). Furthermore, analysis of temporal risk variations based on specific time series models can add valuable information into risk assessment and management of violent offenders.

Regression to the Mean or the Semmelweis Reflex

We are delighted to have the opportunity to respond to a fourth critiqueofouroriginalstudy(Mülleretal.,2014). In thecurrent critique by Mokros and Harbermeyer (2015), they offer an essentially statistical argument based on a quasi-statistical reanalysis of the raw data on which our study was based. They begin their article by referencing a study concerning flight cadets in which regression to the mean was used to explain the observation that cadets who performed poorly on the first training session were more likely to perform better on a second session than cadets who performed better on the first session (Kahneman,2012).This,ofcourse, isbecause theperformance of cadets on training sessions naturally changes. Since change is so common in the life sciences, we are surprised that the idea that sexual interest can change causes so much angst. One explanation may be the Semmelweis reflex, based on the apocryphal tale of how the medical establishment refused to accept Semmelweis’ observation that hand-washing was associated with decreased infant mortality on obstetrics wards (Sinclair, 1909).The Semmelweis reflex states there is tendency to reject new evidence if it appears to contradict the current paradigm. MokrosandHarbermeyer(2015)claimedthat‘‘regression to the mean in combination with low reliability does indeed provide an exhaustive explanation for the results [of our study].’’ We respectfully respond that invoking two phenomena (regressionto themean andreliability) to explainanobservation is not the same as refuting the alternative explanation, which is that sexual arousal patterns as measured by phallometry can change in the same way that the performance of cadets can change. Further, as we stated in our response to previous critics (Fedoroff et al., 2015), regression to the mean might explain a flattening out or averaging of phallometric test results but does not explain an increased response to adult stimuli by men who previously responded most to children. As we stated in the limitations section of our original article, phallometric testing has important limitationsandwecontinuetorecommendactual prospective replications of our study (we are currently conducting one ourselves that we hope will directly address the well-founded concerns of our critics). We agree that reliability isan important issuethathasbeen inadequatelyaddressed in the literature on phallometry. Ideally, this would involve establishing equivalent stimulus sets that could be presented in a test–retest study in which the time interval is short enough to exclude the possibility that the participant’s interests have changed. Our group is hoping to accomplish both tasks in future work. We would like to emphasize some lessons to be learned from the Semmelweis story. In the case of Semmelweis, he simply observed an association and recommended a change in practice that followedfromanunprovenhypothesis: thathandwashing decreased infant deaths. Sadly, his recommendation was ignored, in part, because it preceded development of germ theory and contradicted the paradigms prevalent at the time that Semmelweis was practicing. In a similar vein, our group has presented data that can be explained in multiple ways, including the possibility that pedophilic sexual interest can decrease at the same time that adult interest increases. If true, it opens up new ways to research and treat people with pedophilia. If wrong, little harm can result from telling people with pedophilia there is evidence that pedophilia gets better, though some disagree. Conversely, the harm that may result from telling people with pedophilia there is no evidence they can recover is analogous to telling doctors there is no point in washing their hands. & J. Paul Fedoroff Paul.Fedoroff@theroyal.ca

The predictive validity of common risk assessment tools in men with intellectual disabilities and problematic sexual behaviors

This CIHR-funded study examined whether certain current risk assessment tools were effective in appraising risk of recidivism in a sample of sex offenders with intellectual disabilities (ID). Fifty men with ID who had engaged in problematic sexual behavior (PSB) were followed for an average of 2.5 years. Recidivism was defined and measured as any illegal or problematic behavior, as well as any problematic but not necessarily illegal behavior. At the beginning of the study, each participant was rated on two risk assessment tools: the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG). During each month of follow-up, participants were also rated on the Short-Dynamic Risk Scale (SDRS), an assessment tool intended to measure the risk of future problematic behaviors. Data was analyzed using t-tests, Cohens d and area under the curve (AUC) to test predictive validity of the assessment tools. Using the AUC, results showed that the VRAG was predictive of sexual (AUC=0.74), sexual and/or violent (AUC=0.71) and of any criminally chargeable event (AUC=0.69). The SORAG was only significantly predictive of sexual events (AUC=0.70) and the SDRS was predictive of violent events (AUC=0.71). The t-test and Cohens d analyses, which are less robust to deviations from the assumptions of normal and continuous distribution than AUC, did not yield significant results in each category, and therefore, while the results of this study suggest that the VRAG and the SORAG may be effective tools in measuring the short term risk of sexual recidivism; and the VRAG and SDRS may be effective tools in appraising long term risk of sexual and/or violent recidivism in this population, it should be used with caution. Regardless of the assessment tool used, risk assessments should take into account the differences between sex offenders with and without ID to ensure effective measurement.

The Limits of Ecological Psychology

Gillett and Huang (2013) argue for two claims: first, that an ecological perspective on psychopathy adds to our understanding of the disorder, and, second, that this perspective supports a moral claim regarding the obligations of society to pychopaths. We are in general agreement with the authors. The biomedical model of mental disorders that currently dominates psychiatry, especially in North America, has undoubtedly obscured the contribution of environmental factors in the development of psychopathology, and an ecological perspective could make an important theoretical contribution. In addition, an obligation of concern for the marginalized, including those with psychopathy, is morally uncontroversial. Our disagreement lies in specifics: We believe that the relevance of the ecological approach to psychopathy has not been adequately defended, and that an ecological approach does not support the moral claim defended by the authors, even if the moral claim is true. We consider both of these issues in turn. Gillett and Huang’s claim about the importance of the environment to the development of psychopathy does not distinguish between psychopathy, which is not a Diagnostic and Statistical Manual of Mental Disroders (DSM) diagnostic category, and antisocial personality disorder (ASPD), which is. Psychopathy is a construct that includes emotional unresponsiveness and antisocial behavior as central features. People with psychopathy are often diagnosed with ASPD, but only one-third of those who are diagnosed with ASPD meet the criteria necessary for psychopathy (Hart and Hare 1996). ASPD thus represents a psychologically heterogeneous population, and the relative contribution of genes and environment to that condition is likely to differ depending on a variety of factors. In contrast to ASPD, the extent to which the environment contributes to psychopathy is more controversial. Currently there are no known environmental factors that explain the pathophysiology of psychopathy (Blair 2007), although there is a link between a history of child abuse and some features of the disorder (Poythress et al. 2006). Furthermore, even though some psychopathic traits have been correlated with environmental factors, current research has found that environmental stressors,