What Keeps Them Together? Insights into Sex Offender Couples Using Qualitative Content Analyses.

Research on sex offenders' relationships is scarce. The aim of this qualitative study was to investigate sex offenders' relationships as well as their female partners' adjustment strategies by means of interview analysis. Both partners profit from the relationship in terms of mutual support and acceptance. The sexual offense is a taboo subject, and the female partners were found to demonstrate cognitive distortions. The imbalance of power found in the sex offenders' relationships is discussed, as is the finding that those sexual offenders interviewed live out their need for dominance and sometimes their aggression. The women interviewed were found to cling to their partners as a result of their insecure attachment style. We discuss couples counseling and therapy as possibilities for addressing the imbalance of power and casting light upon the sexual aspect of the relationship.

[Criminal responsibility in sexual homicide perpetrators]. / Schuldfähigkeit bei sexuellen Tötungsdelikten.

OBJECTIVE: Evaluation of criteria for criminal responsibility, esp. in paraphilias and personality disorders. METHODS: We compared sexual murderers with diminished responsibility or not-guilty for reasons of insanity (n = 73) and those held fully responsible (n = 61) regarding psychiatric disorders, signs of severe paraphilias, level of personality structure (using Operationalized Psychodynamic Diagnostics) and offence related criteria. RESULTS: Sexual murderers found as diminished responsible or not-guilty, especially those detained in forensic psychiatric hospitals, showed more signs of a progressive sadistic development and lower levels of personality structure. Offence related criteria that are regarded as not supporting a diminished capacity plea (purposeful actions, long duration, complex, stepwise course of the offence) were found more frequent in those offenders that were detained in forensic hospitals. CONCLUSIONS: Signs for severity of paraphilias and personality disorders are useful in decisions about criminal responsibility. Criteria regarding purposeful course of action appear not to be adequate for the assessment of paraphilic sexual offenders.

[Comparison of sexual murderers in forensic psychiatric hospitals and in prison]. / Sexuelle Tötungsdelikte. Vergleich von Tätern im Straf- und im Massregelvollzug.

Empirical data are lacking that answer the question of how sexual murderers detained in forensic mental hospitals can be differentiated from those sentenced to prison. Psychiatric court reports and national criminal records on sexual murderers detained in a forensic mental hospital (n=45) were compared with those of prisoners (n=89) regarding diagnostic, criminologic, and prognostic characteristics and criminal recidivism rates after detention. Sexual murderers detained in forensic mental hospitals were characterized by higher psychiatric morbidity and slightly higher risk of future sexual and nonsexual violence. They were released from incarceration less often than the prison inmates but did not show higher sexual or nonsexual violence recidivism rates than those from the prison group.

[Selective serotonine reuptake inhibitors (SSRI) in the treatment of paraphilia]. / Selektive Serotoninwiederaufnahmehemmer (SSRI) in der Behandlung von Paraphilien.

For about 15 years selective serotonine reuptake inhibitors (SSRI) have been used in the treatment of paraphilias. In an open, uncontrolled, retrospective study, which was the first in the German speaking countries we investigated 16 male outpatients, who have been treated for different paraphilias with SSRI and psychotherapy. There was a marked reduction in paraphilic symptoms. Despite high rates of sexual side effects most patients reported a high overall treatment satisfaction. SSRI are an important addition in pharmacological treatment of paraphilic patients, especially with a risk of so called "hands-off" delinquency.

[Pornography and sexual abuse in the Internet]. / Pornographie und sexuelle Gewalt im Internet.

Internet pornography has been regarded as either stimulating sexual aggression and abuse or as serving as a safety valve. This controversy is an important issue in health, media and legal politics. According to empirical studies on pornography in general, soft-core pornography and nonviolent pornography can be regarded as harmless, whereas non-violent hard-core pornography and violent pornography may increase aggression. Individuals with a high risk for sexual aggression show more interest in violent pornography and are stimulated more strongly through such material. Two case histories illustrate the characteristics of internet pornography and "cybersex": easy access, anonymity, affordability, wide range and deviation of the material, unlimited market, blurring the borders between consumer and producer, interactive communication, space for experimenting between fantasy and in real-life behavior, virtual identities, easy contact between offender and victim or among offenders, and low risk of apprehension. The phenomenon of "sexual addiction" (or paraphilia- related disorder) is particularly relevant for the problematic use of internet pornography. Preventive measures to protect possible victims are presented as well as treatment strategies for offenders. Beside limiting access to the internet, these include therapy of comorbid psychiatric disorders and psychological problems (social isolation, bereavement, stress- and anger-management, guilt and shame, childhood traumata, cognitive distortion, victim empathy), psychopharmacotherapy and the enhancement of a more integrative and relationship-oriented sexuality.

Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics.

The aim of this study was to investigate which antihormonal treatment strategies are used in German forensic psychiatric institutions. Forensic clinics were asked about the number of treated patients. Four hundred seventy-four patients were committed for sex offences; 12% received either CPA (n = 29) or LHRH- agonists (n = 29). Differences in efficacy were small. Several side effects confirm the importance of a protocol for minimizing medical complications.

Treatment of paraphilia with luteinizing hormone-releasing hormone agonists.

Up to now there have been no published results of therapy of paraphilia (for example, pedophilia or sadism) and sexual aggressive impulsiveness with luteinizing hormone-releasing hormone (LHRH) agonists in the German-speaking countries. After a short introduction about physiologic features and the present state of investigations in treatment of paraphilia with LHRH agonists we describe 11 patients who were treated with the LHRH agonist Leuprolide Acetate over a period of 12 months. The patients showed no tendency toward sexually aggressive behavior and reported an evident reduction of penile erection, ejaculation, masturbation, sexually deviant impulsiveness, and fantasies. One patient died from suicide. In combination with other treatments, LHRH Agonists seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.

Discriminant validity of the child behaviour checklist CBCL-4/18 in German samples.

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys= 10.9 years, non-referred boys = 10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T > or = 60) 83.8% of children and adolescents could correctly be classified (sensitivity 83.6%, specificity 83.9%). Symptoms of the "Attention Problems Scale" show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents.

[Treatment of paraphilia and sexually aggressive impulsive behavior with the LHRH-agonist leuprolide acetate]. / Therapie mit dem LHRH-Agonisten Leuprorelinacetat bei Paraphilien und sexuell aggressiven Impulshandlungen.

Up to now there are no published results of therapy of paraphilia (Pedophilia, Sadism) and sexual aggressive impulsiveness with LHRH-(luteinizing hormone-releasing hormone) Agonists in the Germanspeaking countries. In this report we describe 11 patients which were treated with the LHRH-Agonist Leuprolide Acetate in a period of 12 months. The patients showed no tendency of sexual aggressive behaviour and reported an evident reduction of penile erection, ejaculation, masturbation, sexual deviant impulsiveness and fantasies. One patient died from suicide. In combination with other treatments LHRH-Agonists seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.

[The struggle against venereal disease in Lódz at the turn of the 19th century]. / Zwalczanie chorób wenerycznych w Lodzi na przelomie XIX I XX wieku.

At the turn of the 19th century in Lódz - with its poor sanitary conditions - venereal diseases (including the most dangerous, syphilis) were amongst the infectious and social diseases which were a great danger to the health and life of its inhabitants. Prostitution, which was a source of income for low-paid or unemployed women, contributed in great measure to the spread of infection. Bad housing conditions, abuse of alcohol, unawareness of danger and carelessness of treatment were also conducive to venereal diseases. The State authorities, who were obliged to struggle against venereal diseases, did so by repressive and humiliating police methods and by the introduction of controls in 1894 involving the registration and compulsory medical examination of prostitutes. Considering the lack of compulsion (except for prostitutes), venereal patients were hospitalized on a limited scale in only the general, specialist and constantly overcrowded Szpital Sw. Aleksandra (St. Alexander Hospital) - the prostitutes at their own expense and the poor at the expense of the municipality. The rich underwent treatment discreetly, in the surgeries and infirmaries of privately practising doctors. The lasting danger of venereal diseases prompted initiatives by doctors- philanthropists, members of Lódzkie Towarzystwo Lekarskie (the Medical Society of Lódz) and the local branch of Warszawskie Towarzystwo Higieniczne (the Hygienic Society of Warsaw). By their lectures, brochures and articles in medical periodicals they popularized their views on the causes; prevention and the struggle against venereal diseases. They were critical of the police and medical surveillance and the struggle against prostitution amongst juvenile girls and recommended the introduction of public, cost - free and obligatory treatment of the sick.

[Epidemiologic situation and the fight against acute infectious diseases in Lodz at the turn of the XIX and XX century (to 1918)]. / Sytuacja epidemiologiczna i zwalczanie ostrych chorób zakaznych w Lodzi na przelomie XIX i XX W. (do 1918 r.).

At the turn of the 19th century, in the times of partition of Poland and national servitude, acute infectious diseases raged in Lódz with a high intensity, in consequence of sanitary-hygienic negligance and bad living conditions of working class. Smallpox, cholera, typhoid fever, dysentery, scarlet fever, diphtheria, measles and hooping cough were among the most services diseases. The Russian sanitary administration was obliged to fight against them, but its prophylactic and therapeutic activity was not systematic and only complementary. The epidemic threat released initiatives of the medical circle. The intensification of them took place at the beginning of 20th century. The effectiveness of the activity intensified in the years of World Wars, after the occupation of Lódz by German invaders. The responsibility for municipal affairs was taken over at that time by inhabitants, among others by doctors, who had influence on the creation of conditions for more effective fight against infectious diseases.

Clinical behavioral problems in day- and night-wetting children.

In this prospective, clinical study of 167 consecutive wetting children, the associations between specific forms of day and night wetting and clinical behavioral symptoms according to a parental questionnaire (Child Behavior Checklist; CBCL), as well as ICD-10 child psychiatric diagnoses are analyzed. For the entire group, the proportion of children with at least one ICD-10 diagnosis was 40.1% and for the CBCL total problems scale 28.2% - three times higher than in the general population. Expansive disorders (21%) were twice as common as emotional disorders (12%). A significantly higher (P<0. 05) proportion of day-wetting children had at least one diagnosis (52.6%) and emotional disorders (19.5%) compared with nocturnal enuretics (33.6% and 8.2%, respectively). Secondary nocturnal enuretics had significantly higher CBCL total problem scores (39.3% vs. 20.0%, P<0.05) as well as psychiatric ICD-10 diagnoses (75% vs. 19.5%, P<0.001) than primary enuretics. Children with primary monosymptomatic enuresis had the lowest rate of CBCL total behavioral symptoms (14.5%) and diagnoses (10%). Of the day-wetting children, those with voiding postponement had more expansive disorders (39.3% vs. 13.6%, P<0.05) and externalizing symptoms (37% vs. 19.%, NS) than those with urge incontinence. In summary, a third of wetting children showed clinically relevant behavioral problems with specific psychiatric comorbidity for the subtypes. A more-detailed differentiation into syndromes rather than into day/night and primary/secondary forms is needed.

[Sexual homicide--a data collection from psychiatric records]. / Sexualdelikte mit Todesfolge. Eine Erhebung aus Gutachten.

After an analysis of the concerning literature we conceptualized a questionnaire with 124 items, which describes the most common characteristics of sexual murderers. The relevance of these characteristics was examined on the basis of psychiatric records. The hypothesis was, that persons who murdered more than once show these characteristics more evidently than single murderers. We compared 20 psychiatric records about single sexual murderers with those about 10 repetitive sexual murderers. Planned offenses, chronic isolation, narcism and tendency to perversity were found more often in persons that murdered more than once. Especially the psychosocial factors were found less often than in the angloamerican literature. More pronounced were the differences between a group of sadistic murderers compared with nonsadistic murderers, using criteria for sadism extracted from Kafft-Ebings first description (1892), Schorsch and Becker (1977), MacCulloch et al. (1983) and Ressler et al. (1988). A case example illustrates the importance of an elaborated concept of sadism and its relation to personality disorder.

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.

[Incidence of psychiatric symptoms and somatic complaints in 4- to 10-year-old children in Germany as judged by parents--a comparison of norm-oriented and criteria-oriented models]. / Häufigkeit psychischer Auffälligkeiten und somatischer Beschwerden bei vier- bis zehnjährigen Kindern in Deutschland im Urteil der Eltern--ein Vergleich normorientierter und kriterienorientierter Modelle.

OBJECTIVES: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents. METHOD: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist. RESULTS: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

[Sanitary and antiepidemic regulations of medical services of the state administration in Lodz at the turn of the XIXth and XXth c. (till 1914)]. / Zarzadzenia sanitarno-przeciwepidemiczne sluzb medycznych administracji panstwowej w Lodzi na przelomie XIX I XX w. (do 1914).

At the turn of XIX and XX c., because of the spreading of acute infectious diseases in Lodz, the medical services of the state administration, responsible for the public health care, were obliged to publish and to enforce different sanitary and anti-epidemic regulations. They contained basic instructions e.g. the care of sanitary state of dwellings, hospitalization of infectious patients and isolation of persons suspected of contact with diseased, disinfection and anti-smallpox vaccination. Such prophylactic and therapeutic activity was neither systematic nor complementary due to the bureaucratic and incompetent administration of Lodz affairs by municipal authorities and had no essential influence on the melioration of the sanitary situation of the city and of the health of its inhabitants.

[Mental disturbances in children and adolescents in Germany. Results of a representative study:age,gender and rater effects]. / Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland--Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte.

METHOD: A study on behavioral and emotional problems and competence in children and adolescents in Germany (PAK-KID study) is described. It is the first nationwide representative survey of this kind of children and adolescents aged 4 to 18 years in Germany. For children aged 4 to 10 years the parents completed the German version of Achenbach's Child Behavior Checklist (CBCL 4-18) developed by the Arbeitsgruppe Deutsche Child Behavior Checklist. Children and adolescents aged 11 years and older filled out the German version of the Youth Self-Report that is part of Achenbach's CBCL in addition to the parents completing the German version of the CBCL. A total of 2856 parent questionnaires and 1798 self-report questionnaires completed by children and adolescents were analyzed. RESULTS: The sample was representative with respect to the main sociodemographic variables. On all problem scales children and adolescents aged 11 to 18 years reported significantly more problems than their parents did. The frequency of internalizing problems (social withdrawal, somatic complaints, anxiety/depression) and delinquent behavior of children and adolescents reported by parents increased with the children's age, whereas aggressive behavior and attention problems decreased with age. Girls reported significantly more problems than boys on all internalizing scales of the Youth Self-Report. The effect was not totally replicated in the parent reports. In the parent reports, boys had more attention problems and more aggressive and delinquent behavior than girls.

[Psychopathological evaluation of children and adolescents in 4 child and adolescent psychiatry referral groups--a multicenter study]. / Die psychopathologische Beurteilung von Kindern und Jugendlichen in vier kinder- und jugendpsychiatrischen Inanspruchnahmestichproben--eine multizentrische Studie.

Goal of the multicenter study with the Clinical Assessment Scale of Child and Adolescent Psychopathology (CASCAP) in a sample of N = 5027 patients from the inpatient and outpatient clinics of psychiatry and psychotherapy of childhood and adolescence of the universities of Berlin (Virchow Clinic), Frankfurt, Cologne and Zurich is the comparison of the clinical populations of these institutions with respect to single symptoms, to symptom scales and to the supreme level of aggregation, the clinical diagnoses according to ICD 10. On the level of diagnoses similar distributions can be found in the centers, but there are also significant differences between the centers. This differences can be found again also on the level of symptom scales and single symptoms, though the deviations are comparatively low.

[The value of different sources of information in evaluating psychiatric disorders in adolescence--a comparison of parental judgment and self-assessment by adolescents]. / Die Bedeutung unterschiedlicher Informationsquellen bei der Beurteilung psychischer Störungen im Jugendalter--ein Vergleich von Elternurteil und Selbsteinschätzung der Jugendlichen.

Data from the national representative epidemiologic survey (PAK-KID-study) assessed by the German versions of Achenbach'S Child Behavior Checklist and Youth Self-Report of N = 1757 parents and their children aged 11 to 18 years are compared by using the corresponding Cross-Informant-Scales. On all problem scales adolescents report more problems than parents. For some scales the differences between girls and their parents are higher than between boys and their parents (social withdrawal, somatic complaints, anxious/depressed, attention problems, internalizing and total score). Averaged Pearson correlations of the eight subscales are in a moderate rage (r < 0.50). For all problem scales an agreement of 30% in the area of high problems (> PR95) is found. If one informant scores above PR95 the Relative Risk of the other one scoring in this range too is significantly higher than one for nearly all scales.