Associations Between Self-Regulation, Experiences of Childhood Adversity, and Problematic Sexual and Aggressive Behaviors.

Problems with self-regulation are often theoretically and empirically linked to sexually abusive behavior, as is also true of experiences of early childhood abuse and maltreatment. Questions remain regarding how indicators of dysregulation and self-regulatory deficits interact and are associated with prior maltreatment. In the current study, a range of variables potentially indicative of emotional, cognitive, interpersonal, and behavioral dysregulation and adverse childhood experiences (ACEs) were examined using the frame of the multimodal self-regulation theory among 156 adult men residing in secure forensic care who were receiving treatment for prior sexual offenses. Data were subjected to principal components analysis, resulting in four components that described varying aspects of dysregulated behavior and experiences: Problematic Sexual Behavior (PSB)-Impulsivity, Serious Mental Illness (SMI)-Aggression, ACEs-Suicidality, and Paraphilic Interests-Behavioral Stability. One component comprised of variables associated with maltreatment was associated with impulsivity and PSBs, as well as SMI and violence via linear regression analysis. Theoretical and clinical implications are discussed.

Persons With Histories of Traumatic Brain Injury and Problematic Sexual Behavior: An Exploratory Analysis.

Persons with traumatic brain injuries (TBI) who have engaged in problematic or illegal sexual behavior present with complex assessment and intervention needs yet remain understudied within the empirical literature. In the current exploratory analysis, important differences in adaptive and clinical functioning, adverse childhood experiences, and criminal offense history are examined in 25 persons with previous brain injury, 118 persons with intellectual disability but no known TBI, and 103 persons with no history of brain injury or intellectual disability, all of whom have engaged in problematic sexual behavior and who were residing in secure forensic inpatient care. Group differences were examined using comparisons of means and chi-squares. Results highlight important differences in education and employment experiences, diagnostic presentation, exposure to childhood maltreatment, and justice system involvement and characteristics of their sexual offense victims. Associations with prior literature and future research directions are discussed.

Adverse Childhood Experiences and Suicidality and Self-Harm in Persons in Secure Forensic Care.

Prior research suggests a greater degree of suicidality and self-harm behavior in those involved with criminal justice and forensic mental health systems. Such individuals also evidence increased exposure to early childhood adversity, which is often associated with suicide risk. Other significant predictors of suicidality have been noted within forensic populations, however, including indicators of specific psychopathology and situational and demographic factors. These populations present with overlapping risk factors that remain underexamined. In the current study, 182 persons residing in secure forensic psychiatric care following incidents of illegal and aggressive behavior were evaluated. Adverse childhood experiences and other empirically derived potential predictors of suicide attempts and self-harm were examined via binomial logistic regression. Findings indicate frequent experiences of early adversity across participants, and that a combination of race, individual adverse childhood experiences, number of biological children, and diagnoses of either posttraumatic stress disorder or borderline personality disorder were significant predictors of suicide attempts, self-harm behavior, and first hospitalization resulting from a suicide attempt. Clinical and research implications are discussed.

"Built on Respect and Good Honest Communication:" A Study of Partnerships Between Mental Health Providers and Community Corrections.

The prevailing approach to managing persons with criminal histories involves community supervision professionals like probation and parole officers partnering with other mental health providers to address clients' needs. The relationships between individual professionals are seldom researched, though, and the current study aims to address this deficit in the empirical literature. This study utilized interviews about professionals' perceptions of their work experiences, analyzed open-endedly to identify major themes. Mental health providers' themes included appreciation and process of collaboration, individual characteristics and roles, characteristics of collaboration, elements of interprofessional relationships, and involvement of the courts. Community supervision professionals discussed issues pertaining to appreciation and process of collaboration, individual characteristics and roles, when conflict occurs, and the lack of basic knowledge about other professionals. Second, these partnerships were examined in light of interprofessional healthcare competencies. Themes identified here resembled healthcare values and ethics competencies and roles and responsibilities competencies; healthcare competencies regarding interprofessional communication and teamwork showed partial congruence with the current themes. Overall, interprofessional collaboration is valued. This research highlights the strengths of this type of interprofessional collaboration and offers suggestions for improving the efficacy of collaboration.

Pathways to delinquent and sex offending behavior: The role of childhood adversity and environmental context in a treatment sample of male adolescents.

BACKGROUND: Exposure to greater Adverse Childhood Experiences (ACEs) has been associated with increased likelihood of general and sex offending behaviors. However, few studies consider both the impact of varied ACE exposures and other early experiences on pathways to offending behaviors in adolescents who have engaged in sexually abusive behaviors. OBJECTIVE: The purpose of this study was to examine the impact of ACEs and sexual boundary problems within the home on the development of delinquent and sexually abusive behavior. PARTICIPANTS & SETTING: Data were collected from archival records of male adolescents (N = 285) who had received treatment for sexually abusive behavior at a youth facility. METHODS: This study investigated the effects of individual adverse experiences on delinquent nonsexual and sexually abusive behaviors through structural equation modeling. RESULTS: Structural equation modeling revealed a three-factor model for ACEs. Direction and significance of paths between ACEs and the onset, persistence, and nature of maladaptive behaviors differed. Household dysfunction was related to an earlier onset (ß = 1.19, p = 0.013) and more persistent nonsexual delinquent offending (ß = 1.05, p = 0.048) and contact sexual offending (ß = 1.19, p = 0.010). Conversely, sexual abuse and exposure to sexual boundary problems were associated with an earlier onset of sexually abusive behavior (ß = -1.08, p = 0.038) as well as indicators of adolescent-onset (ß = -1.30, p = 0.002), less persistent (ß = -1.53, p = 0.001), and nonviolent (ß = -1.89, p = 0.001) delinquency. CONCLUSIONS: Findings suggest variations in ACE exposures differentially influence the onset, severity, and persistence of delinquent and sexually abusive behaviors among these youths.

Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior.

Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice-involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-of-home placements. Implications and future directions are discussed.

Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment: A Case of Individual Needs in an Era of Manualized Treatment.

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

Treatment Progress and Behavior Following 2 Years of Inpatient Sex Offender Treatment.

Emerging research highlights the role of self-regulation in the treatment of sexual offenders. Safe Offender Strategies (SOS) is a manualized sex offender treatment program that emphasizes the role of self-regulation and self-regulatory skills development in sex offender treatment, particularly for offenders with serious mental illness and intellectual/developmental disabilities. The current study involves 156 adult male sexual offenders in an inpatient psychiatric setting who received SOS treatment for a period ranging from 6 months to 1 year. Participants' baseline and treatment data were obtained from archival medical records describing 1 year pre-treatment and up to 2 years of treatment participation. Dependent variables included monthly count rates of verbal and physical aggression and contact and noncontact sexual offending, as well as sexual deviancy attitudes, self-regulatory ability, and cooperation with treatment and supervision, as measured by the Sex Offender Treatment Intervention and Progress Scale (SOTIPS). Data were examined via paired-samples t tests, regression, and multilevel modeling, examining the impact of overall percentage of SOS groups attended over time, comparing participants' baseline measures to data from 2 years of treatment. The impact of predicted risk was also evaluated. Significant treatment dose effects were identified for improvements in aggression, sexual offending, and indicators of treatment compliance and change. These findings suggest that the skills-based, self-regulation approach utilized in SOS may be effective in improving clients' aggressive and sexual behaviors, attitudes toward their offenses and treatment, and self-regulatory ability over time. Implications for further research and treatment generalizability are discussed.

Adults with Pedophilic Interests in the United States: Current Practices and Suggestions for Future Policy and Research.

Adults with pedophilic interests are often viewed by the public as a homogenous subgroup based on what we know from those who sexually offend against children. The stigma associated with child sexual abuse may serve to deter such behaviors but may also interfere with the person's stability and willingness to seek assistance in managing pedophilic interests. This article contrasts the sex offender response and prevention efforts typically employed in the U.S. (i.e., containment, registration, and notification policies and public education programs) with treatment programs aimed at preventing child sexual abuse in Germany, Belgium, and Canada. Five major areas are identified that should be further examined with regard to implementing preventative outreach and treatment programs in the U.S.: barriers to outreach and treatment programs, how to expand or reframe current preventative educational programs, implementation of such programs in light of current mandating reporting policies, promising treatment approaches for pedophilic interests among non-offenders, and ethical concerns relevant to preventative psychological interventions.

The impact of trauma on the onset of mental health symptoms, aggression, and criminal behavior in an inpatient psychiatric sample.

Experiences of trauma and maltreatment are frequent predictors of poor physical and mental health outcomes in adulthood. Existing literature also suggests an impact of developmental adversity on criminality and aggressive behavior, though little research exists describing the effects of cumulative adversity in forensic mental health samples. In the current study of 381 forensic mental health inpatients, rates of trauma, neglect, and parental substance abuse are reported in comparison with community norms. Cumulative adversity and the occurrence of foster care placement are examined via linear and logistic regression analyses in relation to age at first arrest, first psychiatric hospitalization, and onset of aggression, as well as history of suicide attempts and non-suicidal self-injury. Results revealed that experiences of developmental adversity were more common among participants than have been reported in community samples using the ACE survey, and that there were differential effects of gender on the prevalence of traumas experienced. Cumulative adversity scores were significantly associated with all outcomes, though the addition of foster care placement to the model significantly contributed to understanding outcomes, and in some cases, removed the effect of cumulative adversity. Implications and direction for future study are discussed.

Posthospitalization Outcomes for Psychiatric Sex Offenders: Comparing Two Treatment Protocols.

This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n= 58) and RP (n= 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings.

Suicide attempts and self-harm behaviors in psychiatric sex offenders.

Suicidality and self-harm behaviors among sex offenders remain underreported in the clinical literature and are often misunderstood in this complex population. The present study aims to identify rates of suicide attempts and self-injurious behaviors in a sample of 1,184 psychiatric inpatients, 462 of whom are sexual offenders. Between-group comparisons revealed significant differences in history of suicide attempts and self-harm behaviors, with sexual offenders evidencing greater rates of both. Significant psychiatric correlates of suicide attempts and self-harm behaviors among sex offenders varied by group and included a variety of psychiatric symptom presentations. These are compared with the general literature on suicide risk and the sex offender population. Implications for treatment of these behaviors in a sex offender population are discussed.

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns.

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.

Assessing sexual deviance: a comparison of physiological, historical, and self-report measures.

A variety of instruments and techniques are available for assessing sexually deviant interests and arousal among those who have committed sexual offenses. These measures include those that rely on objective or physiological data, self-reported information from the offender, and historical behavior. In this study, several assessment methods from each category were examined and compared with one another to determine their similarity and their usefulness in identifying sexual interest and arousal patterns in known sexual offenders. Comparisons between these instruments and their relation to known behavior are described, as well as effective combinations of assessment tools that may be helpful in better categorizing interest and arousal patterns across different types of sex offenses.

Self-regulation and the etiology of sexual deviance: evaluating causal theory.

Recently introduced theories of sex offending, including the self-regulation model and the multimodal self-regulation theory, have implicated self-regulatory deficits as a key variable in the development of sexually inappropriate interests and behaviors. While dysregulation has been considered an important component of a variety of behavioral, emotional, and interpersonal disorders, sexual behaviors have rarely been conceptualized within this context. In this study, we have examined a number of variables linked to self-regulation and dysfunctional outcomes in a sample of 95 sex-offending men. Results of a path analysis demonstrated that self-regulatory deficits were significantly predictive of paraphilic and antisocial behaviors in this group. Implications for our understanding of the etiology of sexual deviance and future research in this area are discussed.

A preliminary study on findings of psychopathy and affective disorders in adult sex offenders.

The construct of psychopathy has often been considered mutually exclusive to the presence of genuine depressive or anxiety symptomotology. This article addresses the hypothesized reasons for this dichotomous relationship. In this study, 68 civilly committed adult male sex offenders were evaluated using a variety of psychological measures to determine if psychopathic individuals in this group would demonstrate clinically significant affective symptoms. Results indicate that the men in this sample endorsed high rates of psychopathy on the PCL-R, with 42% of these expressing concurrent symptoms of depression and 26% manifesting symptoms of an anxiety disorder. Relationships between affective symptoms and PCL-R factor scores and qualitative differences between these constructs in child molesters and rapists are also discussed.