Major Mental Illness in Those Who Sexually Abuse.

PURPOSE OF REVIEW: There is evidence showing an increasing prevalence of mental illness in those in conflict with the law. However, there are many factors affecting the detection, treatment, and management of criminals who are mentally ill. RECENT FINDINGS: Sex offenders with major mental illness present many challenges to those providing treatment and management services. For example, it is important to consider whether sexually offensive behavior is the cause of criminal behavior or whether it is reflective of an antisocial orientation. Recent evidence suggests it may help better understand and inform risk assessment and management. This paper will review the literature on mental illness among sexual offenders, present a typology to aid in the assessment, treatment, and management of sexual offender with mental illness, and highlight important considerations when providing treatment to sexual offenders with mental illness.

Psychological Treatment of the Paraphilias: a Review and an Appraisal of Effectiveness.

Initially, this paper notes that treatment for the paraphilias has been most thoroughly described and evaluated within the context of treating sex offenders (i.e., child molesters, rapists, and exhibitionists). We note that the literature does not always carefully distinguish "pedophiles" from other child molesters and that rapists are often identified as having a "Not Otherwise Specified" paraphilia. Both these practices appear problematic. We then outline current approaches to the treatment of sex offenders which have typically been seen as relevant to dealing with all types of paraphilias. The historical emergence of sex offender treatment is noted, leading to an outline of current approaches that address known problematic issues by employing established procedures and by delivering treatment in an empirically based manner. We conclude with a description of evaluations of the effectiveness of these treatment approaches which indicate overall positive outcomes.

Mindreading abilities in sexual offenders: an analysis of theory of mind processes.

The paper aims to assess the theory of mind (ToM) of sexual offenders. We administered to 21 sexual offenders and to 21 nonoffenders two classical first- and second-order ToM tasks, a selection of six Strange Stories, and a semi-structured interview, the Theory of Mind Assessment Scale (Th.o.m.a.s), which provides a multi-dimensional evaluation of ToM, investigating first- vs. third-person and egocentric vs. allocentric perspectives. Results show that sexual offenders performed worse than controls on second-order ToM tasks, on Strange Stories and on each of the Th.o.m.a.s dimensions, whereas they did as well as the control group on first-order ToM tasks. A detailed analysis of participants' performance on Th.o.m.a.s. showed that sex offenders performed worse on the third-person than on the first-person ToM scale, and worse on the allocentric than on the egocentric perspective; these findings did not apply to the controls. Implications for future research and treatment are discussed.

Assessment, diagnosis, and management of hypersexual disorders.

PURPOSE OF REVIEW: This review examines recent advances in conceptualizing and treating hypersexual disorders. RECENT FINDINGS: Studies on hypersexual disorders, inferred from research on their associated descriptors, suggest that these disorders have a strong relationship to a number of areas of functioning, in particular, self-regulation and sexually offensive behavior. SUMMARY: The proposed inclusion of hypersexual disorders in the upcoming Diagnostic and Statistical Manual of Mental Disorders-V may address many of the current issues related to the lack of empirical research on hypersexuality. Although there have been some gains made on understanding hypersexuality, there remains a lack of consensus and empirical research on hypersexual disorders. There are also an insufficient number of controlled studies on the efficacy of pharmacological and psychological treatments for hypersexual behavior problems.

Sexual offender treatment: a positive approach.

This article describes a treatment program for sexual offenders that is a modification of cognitive-behavioral therapy (CBT) and that emphasizes a positive approach. Several issues that characterize most CBT programs for sexual offenders are challenged and alternatives are offered. The overall features of the positive approach are then described. Finally outcome evaluations of the effects of CBT programs are described and compared with the long-term outcome of the current positive program. This comparison suggested that the positive program is more effective than the traditional CBT approach.

Working positively with sexual offenders: maximizing the effectiveness of treatment.

In this article, the authors draw on literatures outside sexual offending and make suggestions for working more positively and constructively with these offenders. Although the management of risk is a necessary feature of treatment, it needs to occur in conjunction with a strength-based approach. An exclusive focus on risk can lead to overly confrontational therapeutic encounters, a lack of rapport between offenders and clinicians, and fragmented and mechanistic treatment delivery. The authors suggest that the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. Examples are provided of how these targets may be met. When this is done within a therapeutic context where the treatment providers display empathy and warmth and are rewarding and directive, the authors suggest that treatment effects will be maximized.