Dunsieth Neal W, Nelson Erik B, Brusman-Lovins Lori A, Holcomb Jeff L, Beckman DeAnna, Welge Jeffrey A, Roby David, Taylor Purcell, Soutullo Cesar A, McElroy Susan L
Center for the Study of Criminal Behavior, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0559, USA.
J Clin Psychiatry. 2004 Mar;65(3):293-300. doi: 10.4088/jcp.v65n0302.
To increase understanding of the relationships among sexual violence, paraphilias, and mental illness, the authors assessed the legal and psychiatric features of 113 men convicted of sexual offenses.
113 consecutive male sex offenders referred from prison, jail, or probation to a residential treatment facility received structured clinical interviews for DSM-IV Axis I and II disorders, including sexual disorders. Participants' legal, sexual and physical abuse, and family psychiatric histories were also evaluated. We compared offenders with and without paraphilias.
Participants displayed high rates of lifetime Axis I and Axis II disorders: 96 (85%) had a substance use disorder; 84 (74%), a paraphilia; 66 (58%), a mood disorder (40 [35%], a bipolar disorder and 27 [24%], a depressive disorder); 43 (38%), an impulse control disorder; 26 (23%), an anxiety disorder; 10 (9%), an eating disorder; and 63 (56%), antisocial personality disorder. Presence of a paraphilia correlated positively with the presence of any mood disorder (p <.001), major depression (p =.007), bipolar I disorder (p =.034), any anxiety disorder (p=.034), any impulse control disorder (p =.006), and avoidant personality disorder (p =.013). Although offenders without paraphilias spent more time in prison than those with paraphilias (p =.019), paraphilic offenders reported more victims (p =.014), started offending at a younger age (p =.015), and were more likely to perpetrate incest (p =.005). Paraphilic offenders were also more likely to be convicted of (p =.001) or admit to (p <.001) gross sexual imposition of a minor. Nonparaphilic offenders were more likely to have adult victims exclusively (p =.002), a prior conviction for theft (p <.001), and a history of juvenile offenses (p =.058).
Sex offenders in the study population displayed high rates of mental illness, substance abuse, paraphilias, personality disorders, and comorbidity among these conditions. Sex offenders with paraphilias had significantly higher rates of certain types of mental illness and avoidant personality disorder. Moreover, paraphilic offenders spent less time in prison but started offending at a younger age and reported more victims and more non-rape sexual offenses against minors than offenders without paraphilias. On the basis of our findings, we assert that sex offenders should be carefully evaluated for the presence of mental illness and that sex offender management programs should have a capacity for psychiatric treatment.
为了增进对性暴力、性偏好障碍和精神疾病之间关系的理解，作者评估了113名被判性犯罪男性的法律和精神科特征。
113名从监狱、看守所或缓刑机构转至住院治疗机构的连续男性性犯罪者接受了针对《精神疾病诊断与统计手册》第四版轴I和轴II障碍（包括性障碍）的结构化临床访谈。还评估了参与者的法律、性和身体虐待情况以及家族精神病史。我们比较了患有和未患有性偏好障碍的犯罪者。
参与者一生中轴I和轴II障碍的发生率很高：96人（85%）患有物质使用障碍；84人（74%）患有性偏好障碍；66人（58%）患有情绪障碍（40人[35%]患有双相情感障碍，27人[24%]患有抑郁症）；43人（38%）患有冲动控制障碍；26人（23%）患有焦虑障碍；10人（9%）患有进食障碍；63人（56%）患有反社会人格障碍。性偏好障碍的存在与任何情绪障碍（p<.001）、重度抑郁症（p=.007）、双相I型障碍（p=.034）、任何焦虑障碍（p=.034）、任何冲动控制障碍（p=.006）和回避型人格障碍（p=.013）的存在呈正相关。虽然没有性偏好障碍的犯罪者在监狱中度过的时间比有性偏好障碍的犯罪者更长（p=.019），但有性偏好障碍的犯罪者报告的受害者更多（p=.014），开始犯罪的年龄更小（p=.015），并且更有可能实施乱伦（p=.005）。有性偏好障碍的犯罪者也更有可能被判（p=.001）或承认（p<.001）对未成年人进行严重的性侵犯。没有性偏好障碍的犯罪者更有可能仅有成年受害者（p=.002）、曾有盗窃前科（p<.001）和青少年犯罪史（p=.058）。
研究人群中的性犯罪者精神疾病、物质滥用、性偏好障碍、人格障碍以及这些情况之间的共病发生率很高。患有性偏好障碍的性犯罪者某些类型精神疾病和回避型人格障碍的发生率明显更高。此外，与没有性偏好障碍的犯罪者相比，有性偏好障碍的犯罪者在监狱中度过的时间更少，但开始犯罪的年龄更小，报告的受害者更多，对未成年人实施的非强奸性犯罪也更多。基于我们的研究结果，我们断言应对性犯罪者是否存在精神疾病进行仔细评估，并且性犯罪者管理项目应具备精神科治疗能力。
