Assessing and Managing Problematic Sexual Interests

A Practitioner's Guide

Geraldine Akerman, Derek Perkins, Ross Bartels

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000096149
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Assessing and Managing Problematic Sexual Interests: A Practitioner's Guide provides a thorough review of atypical sexual interests and offers various ways through which they can be measured and controlled, including compassion-focused and psychoanalytic approaches.

This unique guide presents a detailed analysis of deviant sexual interest. Part I, 'Assessment, ' overviews the range of sexual interests and fantasies in men and women. Part II, 'Management, ' investigates the cutting-edge tools, approaches, interventions, and treatment advances used in a variety of settings to control deviant sexual interest. In Part III, 'Approaches to assessment and management', the authors consider how females with sexual convictions can be assessed and how offence paralelling behaviour can be used for assessment and treatment. Throughout, Assessing and Managing Problematic Sexual Interests offers necessary perspectives and emerging research from international experts at the forefront of this field.

With a thorough assessment of current research and a critical overview of treatment advances for problematic sexual interests, Assessing and Managing Problematic Sexual Interests is an essential resource for clinical and forensic psychologists, probation officers, academics, students working in the field, and members of allied professional fields.

Part I

Assessment

1

How do sexual interests cluster and relate to sexual offending behaviours against children?

Sarah Paquette and Sébastien Brouillette-Alarie

Introduction

Sexual interest, whether normophilic or paraphilic, is important for understanding human sexual behaviour as there are strong links between one’s sexual interest and behaviour (Kafka & Hennen, 1999, 2002; Långstrom & Hanson, 2006). According to the DSM-5, a normophilic sexual interest refers to an ‘interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners’; all other intense and persistent sexual interests are understood to be paraphilias (APA, 2013, p. 685). Paraphilias are not illegal per se but acting on some of them may constitute a criminal offence. An example of a legal sexual behaviour derived from a paraphilic interest would be to use an inanimate object, such as a shoe, to masturbate in a private room. Examples of illegal sexual behaviours are committing an act of bestiality driven by zoophilic interests, having sexual contact with a child driven by paedophilic interests, or displaying indecent behaviour in a public space. Individuals who commit sexual offences, including those who commit offences against children, may exhibit one or many paraphilias (Abel, Becker, Cunningham-Rathner, Mittelman, & Rouleau, 1988).

To contribute to knowledge on this topic, this chapter briefly reviews the scientific literature on the variety of sexual interests found among people who have committed sexual offences against children, followed by an analysis of the organizational patterns of these interests as well as their links to sexual offending behaviours. A discussion on the implications for assessment, treatment, and research concludes the chapter.

Sexual interests of men who have committed sexual offences

Paraphilic sexual interests are included in all contemporary multifactorial theories of sexual offending (e.g. Finkelhor, 1984; Hall & Hirschman, 1992; Ward & Beech, 2006, 2017; Ward & Siegert, 2002) and in a number of single factor theories (e.g. Kafka, 1997, 2003; Laws & Marshall, 1990; McGuire, Carlisle, & Young, 1965). McGuire et al. (1965) suggest that deviant sexual preferences are acquired through operant conditioning by masturbating to fantasies derived from early sexual experiences (i.e., the initial stimulus). Deviant sexual fantasies are reinforced by the pleasure procured from masturbation and non-deviant preferences are gradually extinguished when they are no longer used in masturbation scenarios. Sexual fantasies are also thought to play a role in the maintenance of sexual preferences. Laws and Marshall (1990) add that sexual preferences can disappear if negative reinforcement (e.g. punishment for acting on deviant sexual interests) occurs. These explanations for sexual preferences, drawn from conditioning and social learning theories, suggest that individuals with paedophilia who sexually offend against children develop and condition their sexual interests in children based on deviant early experiences that are later ‘relived’ as fantasies and used during masturbatory activities.

Links between paraphilic sexual interests and engaging and maintaining sexual offending behaviours have been well established (e.g. Baur, Forsman, Santtila, Johansson, Sandnabba, & Långström, 2017; Hanson & Morton-Bourgon, 2005; Mann, Hanson, & Thornton, 2010; Stephens, Cantor, Goodwill, & Seto, 2017). However, it appears that some specific types of sexual interests are better predictors of specific types of sexual offending; for example, paedophilia is a better predictor than sexual sadism of sexual offending against children (e.g. Mann et al., 2010).

Paedophilia

Paedophilia is defined as sexual interest in prepubescent children. This interest can be directed towards boys, girls, or both, and occur inside (incest) or outside (extrafamilial) the family, or both. It can be exclusive or not to children (APA, 2013). Although its precise prevalence is unknown in the general population, it is estimated to be between 1% and 3% among males and much lower among females (APA, 2013; Seto, 2013). Paedophilia appears to be the most documented sexual interest among individuals who commit sexual offences against children. While strongly associated with such offending behaviours (Hanson & Morton-Bourgon, 2005; Mann et al., 2010), it is not the only explanation, as only approximately half the men known to have committed contact sexual offences against children meet the diagnostic criteria for paedophilia (Seto, 2008). Paedophilia appears to be more common among men who consume child sexual exploitation material (CSEM) over the internet than among those who have committed contact sexual offences against children and even less common among those who use the internet to solicit children (Babchishin, Hanson, & Hermann, 2011; Babchishin, Hanson, & VanZuylen, 2015; Seto, Wood, Babchishin, & Flynn, 2012). Men who sexually solicit children over the internet are more frequently diagnosed with hebephilia; that is, a sexual interest in pubescent children (Brouillette-Alarie & Proulx, 2014; Seto et al., 2012).

In terms of offending behaviours, men with paedophilia tend to vary in the severity of their crimes, the number of victims, and recidivism risk level. Men who are sexually attracted to boys tend to have more contact victims than those who are sexually attracted to girls, while those who commit sexual offences against extrafamilial victims tend to have more victims than incestuous men (Abel, Becker, Mittelman, Cunningham-Rathner, Rouleau, & Murphy, 1987). Offences of incestuous men more frequently involve sexual intercourse – as opposed to fondling and genital contact – than those of extrafamilial offending men (Abel et al., 1987). In terms of risk of reoffending, sexual interests in boys, evidenced either by sexual contact with male children or consuming CSEM depicting boys, is associated with a higher risk of sexual recidivism and targeting extrafamilial victims (Hanson & Morton-Bourgon, 2005; Seto & Eke, 2015). These results show that paedophilia can manifest itself in different ways, leading to variation in sexual offending behaviours. The presence of other types of sexual interests in addition to paedophilia tends to increase the risk of reoffending among sexual offenders (Mann et al., 2010).

Other interests

A diversity of deviant sexual interests other than paedophilia are often observed among men who sexually offend. For example, among a sample of 221 men convicted of sexual offences against children, Smallbone and Wortley (2004) found that almost one-third reported sexual interests in voyeurism (32%), with lower prevalences found for exhibitionism (9%), public masturbation (7%), frotteurism (6%), telephone scatalogia (5%), fetishism (4%), masochism (4%), transvestic fetishim (3%), sadism (3%), and zoophilia (1%). Interestingly, while none of these sexual interests were associated with sexual offending behaviours, some of them – voyeurism, frotteurism, telephone scatalogia, masochism, and sadism – were significantly associated with nonsexual offending. In a sample of 30 men who had sexually offended against children and 28 who had sexually offended against adolescents, Sea and Beauregard (2018) found evidence of sexual interest in sadism, voyeurism, and exhibitionism, but not of fetishism, public masturbation, frotteurism, masochism, telephone scatologia, necrophilia, or zoophilia. In a study comparing the sexual interests of men who had committed contact sexual offences against children, CSEM users, and mixed offenders (i.e., those who had committed both online and contact sexual offences), Sheldon and Howitt (2008) found that the fantasies most frequently reported by participants were normophilic. Paraphilias involving humiliation, violence, coercion, and death were all extremely rare and sometimes never reported. They also found that men who had consumed CSEM reported greater numbers of sexual fantasies involving female children but did not find any differences in sexual fantasies involving male children, humiliation, force, homo/heterosexual adults, non-contact sexual behaviours, and bestiality.

Men who consumed CSEM also displayed some paraphilic interests in the pornographic material used. Although pornographic material may be considered only a proxy for sexual interests, Eke and Seto (2017) found correlates between the preferences of men who use CSEM in terms of age/gender and the characteristics of victims depicted into their material, suggesting an association between sexual interests and the pornographic content viewed. A variety of pornographic content was found in CSEM users’ collections. In a sample of 231 men arrested for CSEM-related offences, Endrass and colleagues (2009) found that 47% had pornography involving brutality, 45% involving excrement, and 44% involving animals. In a comparison of men who had committed online, contact, and mixed sexual offences against children, Paquette and Cortoni (2017) found that CSEM users reported significantly more consumption of pornography involving bondage, homosexual males, heterosexual adults, sex in groups, bestiality, and rape than those with contact offences. They did not find differences in terms of consumption of pornography depicting homosexual females but found that consumption of bestial pornography was positively associated with online sexual offending behaviours. No other type of pornographic content was associated with sexual offending behaviours against children.

Multiple paraphilias

Initial conceptualizations of paraphilia considered it to be a unidimensional construct: one was either sexually deviant or not (see Heil & Simons, 2008). Such conceptualizations failed to acknowledge various types of sexual interests or the coexistence of both normophilic and paraphilic interests. An early study by Abel and colleagues (1988), conducted among a community sample of 561 men diagnosed with paraphilias, refutes this conceptualization, showing that very few (10%) of these men exhibited only one paraphilic interest. They also found that some paraphilias were less likely to be co-morbid than others. For example, 52% of the men diagnosed with transsexualism had no other paraphilia, while all men diagnosed with either bestiality, fetishism, sadism, masochism, or coprophilia had at least one other deviant sexual interest. Among those sexually interested in children, 72% to 96% had multiple paraphilias – up to 10 different kinds.

Having multiple paraphilias has been established as a risk factor for sexual recidivism (e.g. Brouillette-Alarie, Proulx, & Hanson, 2018; Mann et al., 2010), but studies generally remain vague about the nature of this relationship, neglecting to examine, for example, whether certain combinations of paraphilias are more frequent than others, which are most risk-relevant, or how many are necessary for risk to increase. Preliminary investigations suggest that some combinations of sexual paraphilias are more common than others. For example, a Finnish population-based study examined the co-occurrence of paraphilias among 5990 male and female participants and found that sadism was more strongly associated with masochism but less strongly associated with exhibitionism (Baur et al., 2017). Exhibitionism appeared to be more strongly related to voyeurism, and some paraphilias were more strongly associated with sexually coercive behaviour (e.g. sadism vs transvestic fetishism). The co-occurrence of paraphilias was a better predictor of sexual offending than any paraphilia taken individually.

The current study

The scientific literature not only shows that paraphilic sexual interests are associated with sexual offending behaviour, but also that: (1) certain types of interest are better predictors of offending behaviour than others, and (2) the presence of multiple paraphilias are associated with a greater risk of reoffending than having only one. However, although it has been shown that some sexual paraphilias are more frequently found together, it remains unclear whether certain combinations are associated with particular types of sexual offending behaviour. The purpose of the current study was therefore to examine whether there are links between clusters of sexual interests and sexual offending behaviours in a sample of men who had committed either online and contact sexual offences against children or both.

While normophilic and paraphilic interests have been found to be characteristic of men who sexually offend against children, other research has found evidence of atypical sexual interests among non-offending samples. A recent survey conducted among the general population in Canada revealed that both men...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Dedication
• Series foreword by
• Foreword by
• PART I: Assessment
• PART II: Management
• PART III: Approaches to assessment and management
• Index