Not Just a Sex Offender:
Paraphilias and Other
Complicating Conditions
Donya L. Adkerson, MA, LCPC
2005
Consider the individual
Sex offenders are not all the same B Consider
PParaphilia-specific issues
PConcurrent/Complicating Conditions
PComplicating Circumstances
Paraphilia
What is it?
PRecurrent thoughts, feelings or behaviors
indicating arousal
PFor at least a 6 month duration
PInvolving nonconsenting being,
nonsexual object, or body part
PEarly adolescents= arousal patterns may
not be fixed enough to diagnose paraphilia
Common paraphilias among sex
offenders
PNot all sex offenders have a paraphilia
PPedophilia
PHebephilia/Ephebephilia
PBestiality
Common paraphilias among sex
offenders
PVoyeurism
PExhibitionism
PSadism
PParaphilia NOS (Not Otherwise Specified)
e.g., rape
PMANY other less common . . . arousal to
feet, diapers, urine, feces, underwear,
shoes, fabrics, almost anything.
Implications of a Paraphilia
PAssociated with increased risk for reoffense
PMay require arousal modification
treatment techniques
< Compliance can be difficult
< Can only suppress, not eliminate, the paraphilic
arousal
PMay present issue in developing partner
relationships
PMay cause feelings of shame, isolation
Paraphilia-specific Considerations
Voyeurism
PHands-off offenses taken less seriously,
but may not be the limit of the behavior
PVoyeurism is legal and sanctioned with
consent (the porn/strip industries)
PLimited voyeurism in adolescence
culturally normal
Paraphilia-specific Considerations
Voyeurism
PStalking & voyeurism can look similar;
must differentiate
PThe underlying fantasy is critical
<Is there fantasy of contact? Force?
<Voyeurism as a prelude to break & enter rape
Paraphilia-specific Considerations
Exhibitionism
PTo adults, often seen as joke; to kids, now
taken seriously
PHigher correlation with hands-on when
victim is child
PHigh correlation with narcissistic traits
when target strangers
Paraphilia-specific Considerations
Exhibitionism
PHigh rates of relapse; ease of relapse
PUnderlying fantasy goalB where does the
exposing lead?
<Approval/sex/relationship
<Sexual acknowledgment
<Negative response fear/distress/anger/humiliation
Paraphilia-specific Considerations
Pedophilia and Hebephilia
PMay still have arousal to adults -- or may
have little to none
PWhat age and gender span at risk?
PPedophiles are very heterogenous group
PParenting problems:
< Arousal to own children
< Their children attract other children
Paraphilia-specific Considerations
Pedophilia and Hebephilia
PSafety planning areas
< Work
< Leisure
< Family gatherings
< Public places
< Worship
< Media stimuli
< Holidays & Special events
Paraphilia-specific Considerations
Bestiality
PRarely exclusive in SO referrals
PSome correlation of bestiality and
increased risk of child molest
PScreen for signs of sadism
PSafety planning with family pets, farm
animals, volunteering, work
Paraphilia-specific Considerations
Sadism
PArousal to infliction of pain, suffering,
humiliation
PThe ULTIMATE DANGER, especially when
combined with Antisocial Personality
Disorder
PMost sadists offend at home, even if also
offending on strangers
Paraphilia-specific Considerations
Sadism
PVictims have EXTREME difficulty
reporting and will be more fragile, more
traumatized, than non-sadists= victims
<This means sadism may be more common than
we realize
PIt is unclear if true sadists are treatable, at
least through currently used treatment
approaches
Recognizing Sadism
Common offense elements
PDegradation tactics
< Name calling, force begging, porn reenactments, use of animals/urine/feces
PBondage and/or Object use
PInfliction of pain & injury
PDocumenting
< Photos/videos
< Souvenirs
Childhood/Adolescent Histories of
Sadistic Offenders
Elements often found
PAggression to peers (may include
intentional pain infliction)
PCruelty to animals, animal killing/torture
PCompulsive masturbation
PChronic lying
PEnuresis
PFire setting
Childhood/Adolescent history of
Sadistic Offenders
Elements often found
PStealing
PDestruction of property
PDaydreaming (onset of repetitive violent
sexual fantasies and themes of
mastery/power over others)
PPoor relationship with parents
PAchievement lower than potential
Common Family History Factors
For Sadists
PAlcohol abuse
PPsychiatric disorders
PCriminal behavior
PInstability of residence
PLow family-community involvement
Paraphilia Specific Considerations
Masochism B the flip side of Sadism
PUncommon in offenders, but does turn up at
times
PThe masochist feels arousal to experiencing
pain/shame/humiliation
PDanger of eroticizing the entire S&M interaction
PDanger of projecting the masochistic arousal
onto victims
PDesensitization of the pain & suffering of others
Co-existing Complicating
Conditions
Among sex offenders
PDevelopmentally Delayed/Mentally
Retarded
POrganic syndromes
PSubstance Abuse/Dependence
PADHD
Co-existing Complicating
Conditions
Among sex offenders
PObsessive-Compulsive disorders
PPTSD
PPersonality Disorders
DD/MR
Disability is a continuum, terms may vary
PDSM-IV definitions:
< Mild MR: IQ level 50-55 to approximately 70
< Moderate MR: IQ level 35 - 40 to 50 - 55
< (IQ of 100 is average)
PSpecial programming will be needed
PKeep expectations reasonable
PIf group living is required, educating the
DD/MR home staff will be important
Organic Syndromes
Pervasive Developmental Disorders
PAsperger=s Syndrome - related to Autism,
but with better language development
PSevere social impairment - lacks
understanding and ability of normal social
interest, interaction
PStandard SO treatment unlikely to be
appropriate
Fetal Alcohol Syndrome
PAssociated features include facial
appearance, organ effects, vision and
hearing problems, poor coordination, slow
growth
PFeatures interacting with offending
problems include poor reasoning skills,
attention problems, trouble learning from
education or experience, attachment
problems, impaired impulse control
Organic Syndromes
Traumatic Brain Injury
PCommon symptoms:
<Impaired social judgement, emotional volatility
& violence
<Impaired ability to learn rules or grasp reasons
behind rules
<From thought to act without Ascreening@
PIf severe, treatment won=t help
Attention Deficit Hyperactivity
Disorder
PUp to 80% of JSOs in some studies;
Adults can have it too
PIncreased impulsivity B more likely to act
without reflection
PHarder to focus in therapy, inattention
decreases learning
PNegative social reactions to the
symptoms
PMedications helpful
Obsessive - Compulsive Disorder
PObsession = thought; compulsion =
behavior
PMay focus on sexual themes or
something else
PIncreased alcohol/drug risk with selfmedication attempts
PIndividual feels out of control to
him/herself
PMedication helpful
Post-Traumatic Stress Disorder
PAlternating intrusive/avoidance symptoms
PCan impair life functioning - sleep disturbance,
dissociation, emotional numbing, poor
concentration, hypervigilance, distrust, anger,
flashbacks
PSO treatment can trigger trauma symptoms for
abuse survivors
PTreating the PTSD can facilitate SO treatment
process
< Victim therapy
< Medication for symptom management
A word of caution regarding
offenders reporting sexual
victimization
PStudies using polygraph find that about
half of the sex offenders claiming a history
of sexual victimization are fabricated.
Such claims can help take the heat off the
offender and re-frame them as the victim.
Proceed with caution.
Personality Disorders
General criteria
PEnduring pattern of both internal
experiences and external behaviors
PMarkedly different from cultural
expectations
POnset in teens or early adult
PPervasive, inflexible, stable over time
PLeads to distress OR impairment
Common Personality Disorders
among sexual offenders
PBorderline
PHistrionic
PNarcissistic
PAntisocial
POther types exist, but less likely to turn
up in SO treatment
Borderline Personality Disorder
Key: Instability and impulsivity
PUnstable and intense extremes in interpersonal
relationships: AI hate you, don=t leave me!@
PUnstable identity - may vacillate on religion,
sense of self, even sexual orientation
PSuicidal gestures, self injury, other destructive
impulsive behaviors common
PEmotionally volatile, intense and rapid shifts of
mood
PWatch for Borderline PARTNERS of offenders
Borderline Personality Disorder
Implications for treatment & supervision
PThey will likely hate the therapist but fear
leaving treatment
PTheir support systems will likely be
frustrated and perplexed
PSuicide threats/gestures or other high
drama are par for the course
PExpects steps back along with steps
forward
Histrionic Personality Disorder
Key: Emotionality and Attention Seeking
PNot comfortable unless the center of
attention
PSexually seductive or provocative for
attention
PShallow, dramatic, shifting displays of
emotion
PSpeech is often overly vague, excessively
dramatic
Histrionic Personality Disorder
Implications for treatment & supervision
PHogging group time
PStruggle to pin down details
PLOTS of emotional displays
Narcissistic Personality Disorder
Key: Grandiosity, need for admiration, lack of empathy
PGrandiose view of self importance, talent,
superiority
PSees self as Aspecial,@ Aunique@
PSense of entitlement
PLacks empathy for others
PMay be exploitive, arrogant, and believes
others are envious of him
Narcissistic Personality Disorder
Implications for treatment & supervision
PYou probably don=t know as much as
they do
PRules don=t apply to them
PExpectations of special treatment,
attention, catering
PGroupmates may struggle with the huge
ego
Antisocial Personality Disorder
Key: Disregard for, and violation of, others
PPsychopathy and sociopathy are terms
sometimes used
PRepeated criminal behaviors
PDeceitfulness, conning, lying - for profit or
pleasure
PDisregard for the rights and safety of others
PIrritability/aggression
PIrresponsibility, fails to meet obligations
PLack of remorse, lack of concern for others
Antisocial Personality Disorder
Implications for treatment & supervision
PHIGHER RISK for recidivism
PRisk of other crimes in addition to
sex offending
PLikely to have antisocial peer group
Antisocial Personality Disorder
Implications for treatment & supervision
PWatch for using/manipulating
groupmates
PMay frighten groupmates
PExpect dishonesty, thinking errors,
and unpaid bills
PControversy on teaching empathy
with this population
