Sexual offences
Offences range from prostitution and
indecent exposure to rape. Other types of offences (e.g. homicide, assault,
robbery, theft, and burglary) may have a sexual component. Sex offending,
sexual deviation (b p. 480), and inappropriate sexual behaviour (a range
of sexual behaviours which cause offence and/or harm to others) are overlapping
but distinct concepts. A man who commits a sexual offence against a child may
or may not be a paedophile and a man who exposes himself may or may not be an
exhibitionist. A 17-yr-old male who has sexual intercourse with his 15-yrold
girlfriend is committing a sexual offence, but will probably not have a sexual
deviation. Here the focus will be on indecent exposure and contact sexual
offences against adults and children.
Types of sexual offences and offenders
The range of officially recognized
sexual offences is set out in Box 17.3. Legal classifications change and a legal
label says little about the nature of the actual incident. Various typologies
(based on the nature of the act, the motivation of the offender, the
characteristics of the offender, and the characteristics of the victim) lack
validity, reliability, and practical utility.
Indecent exposure The most common sexual offence. Classification:
- Exhibitionists Inhibited
men, often previous unremarkable character, with sudden powerful urge to
display genitals, who make little attempt to avoid capture and who make no
further erotic or obscene gestures/ attempt any contact with victim.
- Disinhibited—by
alcohol, stress, or psychiatric disorder.
- Aggressive,
impulsive, and antisocial—a small minority.
·
Most do not
reoffend. A small number may progress to more serious sexual offences. Rates of
further indecent exposure: first-time offenders—20%, previous sexual
offences—60%, previous sexual and non-sexual offences—70%.
Rape and other sexual assaults on adults
Usually perpetrated by men against
women and, less often, other men. Female perpetrators uncommon. Typologies lack
validity, but may be classified as: aggressive, sexual, or sadistic.
Most rapists are young males from poor social and educational backgrounds who
have a history of other offending. A small number of these offenders are sexual
sadists. Sadistic fantasy is common in men, but sadistic sexual offending is
rare—features which may be associated with acting out sadistic fantasies are
social isolation, coexisting other paraphilias, lack of empathy, disinhibition
(by alcohol, drugs, stress, or psychiatric disorder). 15% of rapists reoffend
sexually and 20% go on to commit non-sexual violent offences.
8
Rape and other sexual
assaults on children
Female children are victimized more than males.
·
Intra-familial
abuse (incest) is usually
perpetrated by fathers or stepfathers against daughters. Family pathology
(dysfunctional families with generational blurring) often mixed with pathology
in the perpetrator (alcohol misuse, personality disorder, paedophilia—but only
in a minority).
·
Extra-familial abuse is less common. Adolescent offending is
associated with poor social skills, physical unattractiveness, and isolation
from peers. Adult offenders are more likely to have paedophilic sexual
fantasies than adolescent offenders and intra-familial offenders. In some cases
offending against children reflects general antisocial tendencies or the
expression of repressed paedophilic impulses in susceptible men disinhibited
(by alcohol, stress, or psychiatric disorder). Many offenders become skilled at
targeting and grooming victims to gain their trust. A very rare minority have
sadistic paedophilic fantasies. Cases of sexually motivated killing of children
are extremely rare.
Rates of sexual offences
Rates of recorded sexual offences are
shown on b p. 685. Many sexual offences are not reported.
Rates of sexual reoffending
Extra-familial child offenders >
offenders against adults > incest offenders.
Internet offences
A growing concern over the last two
decades has been the role of the Internet in providing a method of distribution
of obscene and/or unlawful sexual material (particularly images of children).
The fast rate of technological developments and the global reach of the
Internet, crossing legal jurisdictions, has left the police and legal authorities
in many countries struggling to keep pace and the law in this area is still
developing. The recently adopted Section 63 of the Criminal Justice and
Immigration Act 2008 (in England and Wales) and Section 42 of the Criminal
Justice and Licensing (Scotland) Act 2010 (in Scotland) criminalize possession
of what it refers to as ‘extreme pornographic images’.
Characteristics of sex offenders
A heterogeneous group—possible
relevant factors: deviant sexual fantasy, sexual dysfunction, abnormal personality
(impulsivity, lack of empathy, inhibition, social anxiety), relationship
difficulties (poor social skills, social isolation), alcohol or drug misuse,
denial and minimization of offending, cognitive distortions (regarding sex,
women, or children), problems with assertiveness and control of anger, previous
histories of victimization.
Mental disorder and sex offending
The most common mental disorders found
in sex offenders: personality disorder, paraphilias, alcohol and substance
misuse; severe mental illness is rare. Sex offenders with psychosis share many
of the features of other sex offenders and offending is rarely due to specific
psychotic symptoms. Disinhibition due to mania or organic disorders may lead
to, usually minor, sexual offences. Most sex offences committed by people with
LD are associated with lack of sexual knowledge, poor social skills, and
inability to express a normal sex drive appropriately. A few more serious and
persistent LD offenders may share characteristics of other sex offenders.
Assessment of sex offenders
Full psychiatric history and MSE—
emphasis on the nature of the incident(s), psychosexual history, and previous
offences, utilizing sources of information other than the accused. It may be
difficult to build up a full picture of a person’s sexual fantasies and activities.
Some centres (mainly in North America) use penile plethysmography (measuring
the extent of penile erection in response to various stimuli).
Risk assessment
Consider the following factors: sexual
deviation; personality disorder; mental illness; substance misuse; relationship
problems; employment problems; previous offences (sexual and non-sexual);
previous supervision failure; frequency, types, and escalation in sexual
offending; physical harm to victims and use of weapons; denial/minimization and
cognitive distortions; future plans and attitudes towards intervention.
Management of sex offenders
Some mentally disordered offenders
require treatment in hospital (esp. those with mental illness or marked LD). In
psychotic sex offenders it is usually important to address factors common to
other sex offenders. Those with personality disorders, paraphilias, and
substance misuse are normally dealt with by the criminal justice system. Within
the criminal justice system, both in prison and the community, group CBT
programmes have been developed. A small number of sex offenders receive
psychodynamic treatment at specialist clinics. Medications such as
anti-androgens, anti-gonadotrophins, and SSRIs may be used in a few offenders.
Essence
A constellation of behaviours in which
an individual inflicts on another repeated, unwanted intrusions and
communications. Common stalking behaviours include: following, loitering
nearby, maintaining surveillance, and making approaches and communications in
any modality, most commonly phone calls. Stalking behaviour can arise as a
result of an attempt to establish, re-establish, or impose a relationship on
another who has either made clear their disinterest, or has not been consulted
on the matter, or to retaliate for some perceived injustice.
History
Stalking is not a new phenomenon, but
the naming of this course of conduct, coupled with legal, public, and scientific
interest in it is. The first state to specifically criminalize stalking was
California in 1990, following a series of high-profile stalking cases. It was
first made a specific criminal offence in the UK by the Protection from
Harassment Act 1997. This made it an offence to pursue a course of conduct
which amounts to harassment of another on two or more occasions.
·
Rejected
stalkers
Pursue
victims in order to reverse, correct, or avenge rejection (e.g. divorce,
separation, termination of relationship).
·
Resentful
stalkers
Pursue
a vendetta because of a sense of grievance against the victims. Motivated by
the desire to frighten and distress.
·
Incompetent
suitors
Despite
poor social or courting skills, have a fixation on, or in some cases a sense of
entitlement to, an intimate relationship with those who have attracted their
amorous interest.
·
Predatory
stalkers Initially spy on
victim as a precursor to a sexual assault. However, stalking can be sustained
in this group due to stalker taking pleasure in voyeurism and fantasy about the
coming attack.
·
Erotomaniac stalkers Have the delusional belief that another person, usually
of higher social status, is secretly in love with them. The sufferer may also
believe that the subject of their delusion secretly communicates their love
through seemingly innocuous acts, or if they are a public figure through clues
in the media. The object of the delusion usually has little or no contact with
the sufferer, who often believes the object initiated the fictional
relationship. Erotomaniac delusions are typically found as the primary symptom
of a delusional disorder, and in schizophrenia or mania.
·
Effects of
stalking on victims Stalking can have
devastating consequences for both the victim and stalker. Victims of stalking
can develop depression, PTSD-like symptoms, anxiety disorders/phobias, and
substance misuse problems.
·
Stalking of
health professionals Health
professionals (especially mental health professionals) are at increased risk of
being stalked compared to the general public. One study found that 53% of staff
in an inpatient psychiatric unit had experienced some form of stalkingharassment
during their careers. Another which looked at the frequency of various
diagnoses in patients who were stalking mental health staff found that 45% had
a psychotic disorder, 11% had a mood disorder, and 37% had a personality
disorder.
·
Stalking risk
assessment Usually performed
by a forensic psychiatrist or psychologist, a risk assessment tool such as the
Stalking Assessment and Management (SAM) tool, can be used to stratify stalkers
into groups depending on the level of risk of harm they pose. Various factors
have been found to increase the risk of harm arising, e.g. substance misuse
problems, previous criminality, persistence. The aim is to formulate a
management plan to target risk factors to reduce risk.
What to do if
you are being stalked
·
Inform others
(family, friends, neighbours, work, police) what is happening, as stalkers will
use embarrassed secrecy on the part of the victim to further their stalking
aims.
·
Protect personal
information (e.g. social networking sites, household rubbish).
·
Use an answering
machine (enables recording of stalker’s calls).
·
Retain all
evidence of stalking.
·
Contact the
police early, and keep contacting them whenever further incidents occur, and
provide them with any evidence of the stalking.
·
Obtain a
restraining order which, if breached, will result in the incarceration of the
stalker.
Other
offences
·
Arson Arson (fire-setting in Scotland) is considered to be a
serious offence due to its potential to threaten life and cause massive
destruction. Only a small proportion (less than 20%) of arson offences lead to
prosecution. As with sex offenders and
other offenders, typologies are fraught with problems. The following groups
have been described (but they are not mutually exclusive): insurance fraud,
covering evidence of crime, politically motivated, gang activity, revenge/anger,
cry for help, desire for power, desire to be hero, fascination with fire, sexual
excitement, suicide, psychiatric disorder.
Psychiatric disorder Alcohol/substance misuse and personality disorder are
the most frequent; less common are psychosis, organic disorders, and learning
disability (a previously highlighted association due to studies of patients in
secure hospitals). Pure ‘pyromania’ is rare—features are usually seen in
individuals with personality disorders.
Assessment Full psychiatric assessment with detailed examination
of current and previous offences.
Management Treatment of mental disorder if present; specific psychological
interventions have been proposed but little evidence; important to take steps
to prevent access to matches and lighters if ongoing risk in hospital setting.
Outcome Rates of further arson 2–20%, rates of any reoffending
10–30%. No specific indicators of risk.
Other damage to
property
Acts of vandalism
are common, especially in adolescence. There is little psychiatric literature
on criminal damage excluding arson.
·
Crimes of
dishonesty
Burglary, theft, and fraud are
common offences which are rarely asso ciated with psychiatric
disorder. Shoplifting has attracted some clinical attention.
About 5% of shoplifters suffer from significant mental disor-der (personality
disorder, substance misuse, depression, schizophrenia, dementia). Pure
kleptomania is extremely rare (see b p. 408).
·
Drug offences
Mental disorder
rarely an issue (with the obvious exception of substance misuse/dependence and
associated conditions).
·
Car crime
Impaired ability
to drive may be caused by a number of disorders (see b p. 902).
Occasional rare cases of people disinhibited by mania or impaired by dementia
who cause serious injury or death. However, mental disorder is rarely an issue
in car crime.
What is the relationship between
mental disorder and offending?
Mental disorder is common and
offending is common, so it would not be surprising to find an individual with
both. But is the relationship more than coincidental? When looking at studies
of this relationship one needs to consider:
·
The nature of the
sample studied (community vs. institutional; clinical vs. epidemiological;
pre-treatment vs. post-treatment; offenders vs. non-offenders).
·
The criteria used
to define mental disorder (legal vs. clinical vs. operationalized) and the
method used to determine its existence (case notes vs. interviews; clinically
trained vs. lay interviewers).
·
The criteria used
to define offending (types of officially recorded offences included; inclusion of
unreported or unprosecuted ‘offences’) and the method used to detect offences
(official records vs. self-report vs. third-party report).
Most of the
research has focused on violence. The following are the main conclusions to be
drawn from current evidence.
·
People with
mental disorder as a broad group are no more or less likely to offend than the
general population.
·
Some specific
mental disorders do increase the risk of a person acting violently,
particularly alcoholand drug-related disorders and personality disorders
(especially those with predominant cluster B characteristics).
·
Schizophrenia has
a modest association with violence, but the overwhelming majority of people
with schizophrenia are never violent, being more likely to be victims than
perpetrators of violence.
·
In people with
mental disorders the factors most strongly associated with offending are the
same as for non-mentally disordered offenders: male gender, young age,
substance misuse, disturbed childhood, socioeconomic deprivation.
·
When considering
an offence perpetrated by a person with mental disorder, one should bear in
mind that, as with any offence, there is interplay between the perpetrator, the
victim, and the situational circumstances. Although mental disorder may play a
part it is rarely the only factor that leads to an offence.
The lifetime risk of violence in
people with schizophrenia is about 5 times that in the general population.
People with schizophrenia account for less than 10% of all violent crime in
Britain. The factors most commonly associated with violence in people with
schizophrenia are those associated with violence in people without psychosis.
Alcohol and drug misuse are particularly important. Specific symptoms may be
important but clearly are not enough in themselves, otherwise virtually every
person with schizophrenia would be violent. Threat control-override symptoms
(delusions regarding being threatened or being controlled) have been found to
be associated with violence, but again, most patients with these symptoms are
never violent. The role of command auditory hallucinations is unclear. When
people with psychosis are violent the victim is more likely to be known to them
(particularly relatives) than when violence is committed by nonpsychotic
individuals.
Delusional disorders are probably
over-represented among patients detained in secure psychiatric hospitals;
however, the research on the association between delusional disorders and
violence is difficult to interpret as the samples are usually selective and
uncontrolled, and in many studies patients with delusional disorders are lumped
in with patients with other psychoses, especially schizophrenia. Increased risk
of violence has been reported to be associated with persecutory delusions,
misidentification delusions, delusions of jealousy, delusions of love, and
querulous delusions. Jealousy may be dangerous whether it is delusionally based
or not. In some cases it is difficult to differentiate between premorbid personality
disorder (perhaps with paranoid and/or narcissistic features) and delusional
disorder. The relevant beliefs are probably no less risky if they are
over-valued ideas than if they are delusional.
Affective disorders have a far less
strong relationship with offending and violence than schizophrenia. Mania
commonly leads to minor offending due to grandiosity and disinhibition, but
rarely leads to serious violence or sexual assaults. Depression is very rarely
associated with violence or offending. Extended suicide (also known as
altruistic homicide), in which a depressed parent (usually the father) kills
members of their family before attempting and perhaps succeeding in killing
themselves, is extremely rare and impossible to predict. In some cases it
occurs in depressive psychosis associated with nihilistic delusions, but more
commonly there is a history of marital breakdown in people who are depressed
and suicidal but not psychotic. A historical association between shoplifting
and depression has been highlighted, but is probably insignificant.
Alcoholand drug-related problems are
more strongly linked to offending and violence than any other mental disorders.
A number of aspects of alcohol and substance misuse may be relevant: direct
effects of intoxication or withdrawal; funding the habit; the personal and
social consequences of dependence; the neuropsychiatric sequel of prolonged
misuse; the social context (peer group, socio-economic deprivation, childhood
mistreatment), and personal characteristics (impulsivity and sensation
seeking), which may lead to substance misuse, may also be associated with
offending.
Personality disorder is more strongly
related to offending and violence than mental illness. Personality disordered
offenders are heterogeneous: only a small number are psychopathic (see b p.
496). Various aspects of personality disorder may be related to offending:
impulsivity, lack of empathy, poor affect regulation, paranoid thinking, poor
relationships with others, problems with anger and assertiveness.
Offending occurs more often in people
with milder forms of learning disability than in those with severe learning
disability. Offences are broadly similar to those in non-learning disabled
offenders and are associated with family and social disadvantage. Evidence for
increased rates of sex offending and fire-raising is based on highly selected
patient samples in secure hospitals and is therefore questionable. In some
learning disabled offenders poor social development, poor educational
achievement, gullibility, and impaired ability to communicate may be important
factors. Profound and severe learning disability may be associated with
disturbed behaviour, including aggression, but would rarely come to the
attention of the criminal justice system.
Aggression is well recognized in
dementia, but rarely leads to serious violence. Delirium and brain injury may
lead to aggression. In head injury cases it may be difficult to differentiate
the effects of the head injury from premorbid personality. Epilepsy is twice as
common in offenders as in the general population, but this is probably due to
shared environmental and biological disadvantages that predispose individuals
to both. Violence resulting from epileptic activity is extremely rare.
Last Updated: 11 Dec 2024