Effective Tools Available To Treat Sexual Offenders

Though often difficult, it is possible to reduce the risk of sexual-offending behavior with psychiatric treatment, only through careful assessment, accurate diagnosis, and use of evidence-based treatments.

This was the message delivered by Fabian Saleh, M.D., at the annual meeting of the American Academy of Psychiatry and the Law in Chicago last October. Saleh is medical director of the Sexual Disorders Clinic at UMassMemorial Community Healthlink. He is also an assistant professor of psychiatry in the Law and Psychiatry Program and the Child and Adolescent Psychiatry Division at UMass Memorial Medical Center and director of research at the Baltimore-based National Institute for the Study, Prevention, and Treatment of Sexual Trauma.

The term “sexual offender” is a legal, not medical, construct, he noted, and psychiatrists should use their expertise to determine what may be motivating the sexually deviant behavior and then use evidence-based treatments to reduce the risk of recidivism.

A subcategory of people who have committed sexual crimes may have a type of paraphilia, such as pedophilia, exhibitionism, or voyeurism, he said, noting that paraphilias are underreported psychiatric disorders.

In addition, some people who sexually offend may do so partly due to symptoms of an underlying psychiatric illness such as bipolar disorder, antisocial personality disorder, or attention-deficit/hyperactivity disorder.

Deviant sexual behaviors may also be influenced by the presence of a neuropsychiatric or neurological disorder, such as a brain tumor or lesion, Saleh noted.

“According to the literature, about 10 percent to 20 percent of children have been molested by age 18,” he said. “Although one should not equate child molestation with pedophilia, one can certainly make the argument that a certain percentage of this cohort (that is, child molesters) may have offended because of an underlying paraphilic disorder (that is, pedophilia). Similarly, about 20 percent of adult females have been the targets of people with exhibitionism. These and similar data suggest that a certain percentage of sex offenders may indeed have an underlying paraphilic disorder.”

Aside from reducing the risk for future sexual-offending behavior, the goal of treatment for sexual offenders with comorbid psychiatric illness or paraphilia is to improve their quality of life by decreasing their distress, increasing their autonomy, and reintegrating them into society.

It is possible for people who offend sexually to have more than one type of paraphila, Saleh pointed out, or to have paraphilia and a comorbid psychiatric disorder, often including conduct disorder, attention-deficit/hyperactivity disorder, bipolar disorder, or schizophrenia. The sexual misconduct may be a symptom of an underlying psychiatric or neurological disorder, according to Saleh.

People who commit sexual offenses usually display “global patterns of behavior problems,” Saleh noted, which may manifest themselves through isolated or impulsive problem sexual behaviors such as exposing oneself or time-limited, reactive patterns of oversexualized behavior.