Understanding the Risk of Sexual Reoffending in Adult Men: A Network-Based Model.

The predominant approach to understand dynamic risk factors of sexual reoffending has been referred to as the Propensities Model (Thornton, 2016). According to this model, dynamic risk factors can be conceptualized as latent constructs whose change alters the risk of sexual reoffending. Despite its strengths and contributions to research, this model does not offer answers to the question of how dynamic risk factors contribute to the risk of sexual reoffending, or of how sustained change in risk might take place. In this paper we introduce the Network-Based Model of Risk of Sexual Reoffending (NBM-RSR), which addresses several limitations and constraints of the Propensities Model and offers empirically testable propositions regarding the nature and development of the risk of sexual reoffending. The NBM-RSR considers risk of sexual reoffending to involve a self-sustaining network of causally connected dynamic risk factors. Consistent with this, an increased risk of sexual reoffending is characterized through a network that contains more and stronger interconnected dynamic risk factors with a higher strength. Sustained change in risk of sexual reoffending occurs when activity in the network exceeds a critical point resulting in a new self-sustaining network. Propositions based on the NBM-RSR are introduced and translated into testable hypotheses. These propositions revolve around (a) risk of sexual reoffending resulting from the construction of a network of causally connected dynamic risk factors, (b) network stability, sudden changes, and critical transitions, and (c) dynamic risk factors' relative influence on risk of sexual reoffending.

Factor Analysis With Unusual Sexual Interests: A Replication Study in a Representative Population Sample.

A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.

Dynamic Individual Risk Networks: Personalized Network Modelling Based on Experience Sampling Data.

Following a network perspective, risk of sexual reoffending can be understood as a construct that emerges from the interactions between risk factors. If these interrelationships are validly mapped out, this leads to an increased understanding of the risk and thus may contribute to more effective and/or more efficient interventions. This paper reports on personalized network modeling mapping the interrelationships of dynamic risk factors for an individual convicted of sexual offenses, using experience sampling (ESM) based on Stable-2007 items. The longitudinal character of ESM enables both the assessment of interrelations between risk factors within a timeframe and the relationships between risk factors over time. Networks are calculated and compared to the clinical assessment of interrelationships between the risk factors.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample.

Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.

Do We Hold Males and Females to the Same Standard? A Measurement Invariance Study on the Psychopathy Checklist-Revised.

Psychopathy in females has been understudied. Extant data on gender comparisons using the predominant measure of assessment in clinical practice, the Psychopathy Checklist Revised (PCL-R), points to a potential lack of measurement invariance (MI). If indeed the instrument does not perform equally (well) in both genders, straightforward comparison of psychopathy scores in males and females is unwarranted. Using a sample of female and male forensic patients (N = 110 and N = 147 respectively), we formally tested for MI in a structural equation modeling framework. We found that the PCL-R in its current form does not attain full MI. Four items showed threshold-biases and particularly Factor 2 (the Social Deviance Factor) is gender biased. Based on our findings, it seems reasonable to expect that specific scoring adjustments might go a long way in bringing about more equivalent assessment of psychopathic features in men and women. Only then can we begin to meaningfully compare the genders on the prevalence, structure, and external correlates of psychopathy.

Exploratory Factor Analysis of Unusual Sexual Interests.

BACKGROUND: Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests. AIM: To identify underlying clusters of unusual sexual interests using exploratory factor analysis. METHODS: We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms. OUTCOMES: Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale). RESULTS: We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men. CLINICAL IMPLICATIONS: Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others. STRENGTHS & LIMITATIONS: Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding. CONCLUSION: Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.

Professionals' Understandings of and Attitudes to the Prevention of Sexual Abuse: An International Exploratory Study.

Sexual abuse is a global issue and, therefore, responding to and preventing sexual abuse are global challenges. Although we have examples of and evidence for sexual abuse prevention initiatives internationally, these tend to come from a small, select group of countries (i.e., United Kingdom, United States, Canada, Germany, Netherlands, New Zealand, and Australia) and not from a broader global pool. This article will present the qualitative data from an online study (n = 82), covering 17 countries, on professionals' (i.e., people working in the arena of sexual offending from a clinical, criminal justice, policy, research, and/or practice perspective) perceptions sexual abuse prevention in theory, practice, and policy. The article identifies three main themes: (a) professionals' understandings of the prevention of sexual abuse, (b) public understanding of sexual abuse prevention, and (c) governmental attitudes towards, and support of, sexual abuse prevention programs. The article highlights that, although there are similar understandings of sexual abuse prevention internationally, practice is characterised by national differences in the funding of, provision of, and public/policy perceptions of prevention as well as its impact on offending.

Exploring Hostility Toward Women in High-Risk Rapists: The Relevance of Ambivalence and Relational Experience.

Hostility toward women is an established risk factor for sexual violence and is often found to be present in men prone to sexual transgression. There are also clinical indications that high-risk rapists may have more ambivalent attitudes toward women, including the strong desire to be positively evaluated by women. We investigated attitudes toward women in high-risk male rapists (n = 42), nonsexual male offenders (n = 65), and matched male community controls (n = 42), by means of self-report (hostility toward women, benevolent sexism, hostile sexism) and implicit measures assessing associations (Implicit Association Test [IAT]) with "women are deceitful" and "women are prestige objects," and the approach tendency (Approach-Avoidance Task [AAT]) toward women. Results showed that high-risk rapists had a lesser implicit notion of women as deceitful and more explicit benevolent sexism than the community controls. These differences seemed most prevalent in the subgroup of high-risk rapists without any relationship history. It is hypothesized that unrealistically positive attitudes toward women may lead to rejection and frustration, which may influence sexual offending.

Mixed Emotions: An Incentive Motivational Model of Sexual Deviance.

Sexual offending behavior is a complex and multifaceted phenomenon. Most existing etiological models describe sexual offending behavior as a variant of offending behavior and mostly include factors referring to disinhibition and sexual deviance. In this article, we argue that there is additional value in describing sexual offending behavior as sexual behavior in terms of an incentive model of sexual motivation. The model describes sexual arousal as an emotion, triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. Consequently, we describe sexual offending behavior in terms of this new model with emphasis on the development of deviant sexual interests and preferences. Summarized, the model states that because sexual arousal itself is an emotion, there is a bidirectional relationship between sexual self-regulation and emotional self-regulation. Not only can sex be used to regulate emotional states (i.e., sexual coping), emotions can also be used, consciously or automatically, to regulate sexual arousal (i.e., sexual deviance). Preliminary support for the model is drawn from studies in the field of sex offender research as well as sexology and motivation research.

Treatment responsiveness of replicated psychopathy profiles.

Theory and accumulating data suggest systematic heterogeneity among offenders with psychopathic traits. Several empirical investigations converge on the nature of subtypes, but little is known about differences in treatment responsivity. We have used the 4-facet model of the Psychopathy Checklist-Revised (PCL-R) to provide a framework for detecting subtypes. The present study used the full range of PCL-R scores in a sample of male violent offenders (N = 190) to replicate subtypes found in a partly overlapping sample by Neumann, Vitacco, and Mokros (2016), using Latent Profile Analysis (LPA), and subsequently to examine potential differences in treatment responsivity. Four subtypes emerged. Within the prototypical psychopathic group, the distinction between intent-to-treat and completers was crucial. Prototypical psychopathic offenders were significantly more likely to drop out, but completers appeared to proceed through the different phases of treatment in much the same way as the other groups. Clearly, more research is needed to elucidate treatment interfering mechanisms and their associated patient characteristics, particularly for the prototypical psychopathic group. Developing therapeutic strategies to improve treatment compliance is a necessary step in the development of specialized treatment programs for these difficult patients. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Sexually offensive behaviour]. / Seksueel delictgedrag.

Sexually offensive behaviour, in all its forms, is very common. Most perpetrators of sexually offensive behaviour are not sexually deviant. Disinhibition as state, trait or 'choice' is a key factor in a large proportion of sexual offenses. Sexual deviance, i.e. a significant interest in, or preference for, sexually offensive behaviour, less often plays a significant role; it does, however, increase the risk of repeated sexually offensive behaviour. Little is yet known about the aetiology of deviant sexual interests.

The predictive properties of dynamic sex offender risk assessment instruments: A meta-analysis.

This meta-analysis is the first to our knowledge to evaluate the predictive properties of dynamic sex offender risk assessment instruments, which are designed to assess factors associated with recidivism that are amenable to change. Based on 52 studies (N = 13,446), we found that dynamic risk assessment instruments have small-to-moderate predictive properties, with Cohen's d ranging between 0.71 for sexual recidivism (41 studies, 22 unique samples, N = 5,699) and 0.43 for violent (including sexual) recidivism (27 studies, 14 unique samples, N = 10,368). Incremental predictive validity of dynamic over static risk assessment instruments was significant but modest; Cox hazard ratios varied between 1.08 for sexual recidivism (19 studies, 13 unique samples, N = 3,747) and 1.05 for any recidivism (11 studies, 8 unique samples, N = 2,511). Cox hazard ratios for the predictive validity of change scores on dynamic risk assessment instruments, controlling for static and initial dynamic scores, varied between 0.91 for sexual recidivism (6 studies, 6 unique samples, n = 1,980) and 0.95 for any recidivism (3 studies, 3 unique samples, n = 1,172). These findings indicate that dynamic risk assessment instruments can, in terms of Andrews and Bonta's (2010) risk and need principles, be a useful tool for improving sex offender treatment. They have the potential to contribute to the selection of appropriate, more individually tailored treatment approaches (focusing on individually relevant criminogenic need factors) and can assist in the evaluation of treatment effects. Considering this, further development of dynamic risk assessment instruments is warranted. (PsycINFO Database Record

Using MMPI-2-RF Correlates to Elucidate the PCL-R and Its Four Facets in a Sample of Male Forensic Psychiatric Patients.

This study documents the associations between the MMPI-2-RF (Ben-Porath & Tellegen, 2008 ) scale scores and the Psychopathy Checklist Revised (PCL-R; Hare, 2003 ) facet scores in a forensic psychiatric sample. Objectives were to determine how the MMPI-2-RF scales might enhance substantive understanding of the nature of the 4 PCL-R facets and to discern possible implications for the treatment of psychopathic patients. A sample of 127 male forensic psychiatric offenders admitted to a Dutch forensic psychiatric hospital completed the PCL-R and the MMPI-2. Exploratory stepwise regression analyses assessed the prediction of the PCL-R total and its facet scores from MMPI-2-RF scales at its 3 hierarchical levels. Conceptually meaningful results emerged at each level of the MMPI-2-RF hierarchy, including several consistent differences between predictor sets across the facets. Interestingly, ideas of persecution (RC6) was a specific predictor of PCL-R Facet 2, a facet noted for its association with treatment failure. Results are compared and contrasted to the extant body of empirical work to date, and some tentative clinical implications are offered.

A Quasi-Experimental Evaluation of High-Intensity Inpatient Sex Offender Treatment in the Netherlands.

The current study quasi-experimentally assessed the outcome of high-intensity inpatient sex offender treatment in the Netherlands in terms of sexual and violent (including sexual) recidivism. It was hypothesized that treated sex offenders would show lower recidivism rates than untreated sex offenders of the same risk level. In line with the risk principle of the Risk, Need, Responsivity (RNR) model, we predicted that this would especially hold true for offenders of higher risk levels. The study sample consisted of 25% of all convicted Dutch sex offenders not referred to any form of treatment and discharged from prison between 1996 and 2002, and all convicted Dutch sex offenders referred to inpatient treatment who were discharged between 1996 and 2002. Static-99R risk levels of these 266 offenders were retrospectively assessed and survival curves regarding sexual and violent (including sexual) recidivism were compared between treated and untreated offenders, controlling for level of risk. Mean follow-up was 148.0 months (SD = 29.6) and the base rate of sexual recidivism was 15.0% and 38.4% for violent (including sexual) recidivism. Cox regression survival analyses showed marginally significant lower failure rates regarding sexual recidivism for treated high-risk offenders only, and significantly lower failure rates regarding violent (including sexual recidivism) for treated sex offenders of moderate-high and high-risk levels. No treatment effects for low and low-moderate risk offenders were found. Results underscore the risk principle of the RNR model: Treatment is more effective when its dosage is attuned to risk level.

Measurement of DSM-5 section II personality disorder constructs using the MMPI-2-RF in clinical and forensic samples.

In the current study, we evaluated the associations between the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) scale scores and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) Section II personality disorder (PD) criterion counts in inpatient and forensic psychiatric samples from The Netherlands using structured clinical interviews to operationalize PDs. The inpatient psychiatric sample included 190 male and female patients and the forensic sample included 162 male psychiatric patients. We conducted correlation and count regression analyses to evaluate the utility of relevant MMPI-2-RF scales in predicting PD criterion count scores. Generally, results from these analyses emerged as conceptually expected and provided evidence that MMPI-2-RF scales can be useful in assessing PDs. At the zero-order level, most hypothesized associations between Section II disorders and MMPI-2-RF scales were supported. Similarly, in the regression analyses, a unique set of predictors emerged for each PD that was generally in line with conceptual expectations. Additionally, the results provided general evidence that PDs can be captured by dimensional psychopathology constructs, which has implications for both DSM-5 Section III specifically and the personality psychopathology literature more broadly.

Prioritizing Child Pornography Notifications: Predicting Direct Victimization.

The growing number of notifications for child pornography (CP) possession constitutes a capacity problem for police forces entrusted with the investigation of these offenses. Notifications of CP offenses in which the investigation reveals concurrent direct victimization, in the form of contact offenses, grooming, online offending, or the production of CP material, form a potential target group for prioritization. The first of the twofold aims of this study was to validate the occurring distinction between mixed suspects (i.e., CP possession suspects who were also ever associated with direct victimization) and CP-only suspects (i.e., CP possession suspects who were never associated with direct victimization) to predict an outcome of the investigation including direct victimization. The second aim was to explore variables related to direct victimization among CP-only suspects. A total of 150 files of police investigations into notifications for CP offenses were studied. Findings confirmed significantly greater prevalence of direct victimization as an outcome of the investigation among mixed suspects than CP-only suspects (90% vs. 10%). Among CP-only suspects, direct victimization was predicted by (a) prior police contacts, charges, or convictions concerning noncontact sexual offending, (b) the confiscation of more than two computers during the house search, and (c) a more serious nature of the CP material that formed the basis for the notification in terms of younger victims and more extreme content. These variables may point to a small subgroup of heavily invested CP offenders who are at a higher risk to cross the line to direct victimization. Cross-validation of these preliminary findings is indicated.

Risk levels, treatment duration, and drop out in a clinically composed outpatient sex offender treatment group.

Previous research in the Netherlands documented that clinical judgment may yield a substantial amount of treatment referrals for sexual offenders that are inconsistent with actuarial risk assessment and the Risk Need Responsivity (RNR) principles. The present study tested the risk level distribution of a high-intensity, open-format outpatient treatment group. Eighty patients were enrolled during a 620-week period, and their STATIC-99R risk levels were retrospectively determined. The distribution of risk levels in this treatment group did not differ from the distribution of a representative sample of sex offenders referred to outpatient treatment in the Netherlands between 1996 and 2002 (n = 145), nor from the combined Canadian samples (n = 2011) used to assess STATIC-99R normative percentile. These findings suggest that no selection in terms of actuarial risk level occurred between conviction and treatment, leading to over-inclusion of low risk offenders in this high-intensity outpatient treatment group. It is concluded that the standard use of structured risk assessment for the compilation of treatment groups may improve both the effectiveness and efficiency of sex offender treatment in the Netherlands.

A comparison of the predictive properties of nine sex offender risk assessment instruments.

Sex offender treatment is most effective when tailored to risk-need-responsivity principles, which dictate that treatment levels should match risk levels as assessed by structured risk assessment instruments. The predictive properties, missing values, and interrater agreement of the scores of 9 structured risk assessment instruments were compared in a national sample of 397 Dutch convicted sex offenders. The instruments included the Rapid Risk Assessment for Sexual Offense Recidivism, Static-99, Static-99R, a slightly modified version of Static-2002 and Static-2002R, Structured Anchored Clinical Judgments Minimum, Risk Matrix 2000, Sexual Violence Risk 20, and a modified version of the Sex Offender Risk Appraisal Guide; sexual and violent (including sexual) recidivism was assessed over 5- and 10-year fixed and variable follow-up periods. In general, the instrument scores showed moderate to large predictive accuracy for the occurrence of reoffending and the number of reoffenses in this sample. Predictive accuracy regarding latency showed more variability across instrument scores. Static-2002R and Static-99R scores showed a slight but consistent advantage in predictive properties over the other instrument scores across outcome measures and follow-up periods in this sample. The results of Sexual Violence Risk 20 and Rapid Risk Assessment for Sexual Offense Recidivism scores were the least positive. A positive association between predictive accuracy and interrater agreement at the item level was found for both sexual recidivism (r = .28, p = .01) and violent (including sexual) recidivism (r = .45, p < .001); no significant association was found between predictive accuracy and missing values at the item level. Results underscore the feasibility and utility of these instruments for informing treatment selection according to the risk-need-responsivity principles.

Mapping the Personality Psychopathology Five domains onto DSM-IV personality disorders in Dutch clinical and forensic samples: implications for DSM-5.

The Personality Psychopathology Five (PSY-5) model represents 5 broadband dimensional personality domains that align with the originally proposed DSM-5 personality trait system, which was eventually placed in Section III for further study. The main objective of this study was to examine the associations between the PSY-5 model and personality disorder criteria. More specifically, we aimed to determine if the PSY-5 domain scales converged with the alternative DSM-5 Section III model for personality disorders, with a particular emphasis on the personality trait profiles proposed for each of the specific personality disorder types. Two samples from The Netherlands consisting of clinical patients from a personality disorder treatment program (n = 190) and forensic psychiatric hospital (n = 162) were used. All patients had been administered the MMPI-2 (from which MMPI-2-RF PSY-5 scales were scored) and structured clinical interviews to assess personality disorder criteria. Results based on Poisson or negative binomial regression models showed statistically significant and meaningful associations for the hypothesized PSY-5 domains for each of the 6 personality disorders, with a few minor exceptions that are discussed in detail. Implications for these findings are also discussed.

Treatment referral for sex offenders based on clinical judgment versus actuarial risk assessment: match and analysis of mismatch.

The Risk Need Responsivity (RNR) principles (Andrews & Bonta, 2010) dictate that higher risk sex offenders should receive more intensive treatment. The present study investigates how clinically based treatment assignment relates to risk level in a sex offender sample from The Netherlands. Correlational analyses served to identify sources of mismatches: that is, variables differing significantly in their relation between treatment selection and risk level. Our study sample consisted of 194 convicted rapists and 214 convicted child molesters. All participants' criminal files were retrospectively coded in terms of the items of the STATIC-99R, PCL: SV, and SVR-20. A low to moderate correlation was observed between clinical treatment selection and actuarial risk levels. A substantial part of the sex offenders, especially child molesters, received overly intensive treatment and another substantial part, especially rapists, received treatment of lesser intensity than indicated by their risk levels. General violent and antisocial risk factors seemed to be underemphasized in the clinical evaluation of sex offenders, especially rapists. A negative attitude toward intervention was negatively associated with clinical treatment selection. It is concluded that clinical treatment selection leads to an insufficient match between risk level and treatment level and systematic use of validated structured risk assessment instruments is necessary to ensure optimal adherence to the risk principle.