Sexual Deviance: Theory, Assessment, and Treatment

This book is an essential starting point for any forensic practitioner involved in the assessment and treatment of sexual deviance. I suspect that many forensic practitioners who work in the area of sexual deviance will have a copy of the first edition of the book on their shelves.

The editors have once again crafted a book that makes clinical sense. Those familiar with the first edition of the book will be glad to see that the new edition has followed the same format. I particularly liked the perspective of the editors, which is conveyed through their introductory chapter. The editors are frank in their assessment of the current state of the field of sexual deviance and clear in their opinions regarding continuing problems. I sensed the influence of this sober and realistic editorial tone filtering down into the individual chapters, which have a pragmatic orientation. The individual authors appear agnostic regarding particular theories and treatment modalities and provide a balanced and evidence-based summary of the research literature.

Each one of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defined paraphilias is addressed over two chapters. The first chapter deals with psychopathology and theory. The second chapter addresses assessment and treatment. All the paraphilias are dealt with including: exhibitionism, fetishism, frotteurism, pedophilia, sexual sadism, sexual masochism, transvestic fetishism, voyeurism, and paraphilia not otherwise specified.

This edition of the book covers new ground as well. There are chapters on the etiology of sexual deviance, legal concerns with sex offenders, and a public health approach to sexual violence. One strength of this book is the inclusion of other chapters devoted to areas of growing interest in the field of sexual deviance. For example, there are chapters devoted to neurobiological processes and comorbidity, online sexual offending, and sexual deviance in females.

The chapters on sexual deviance in females summarize data that are difficult to find elsewhere. There are surprising findings. For example, prevalence data suggest that women are responsible for between four and five percent of all sexual abuse. Although quite high in absolute numbers, other data suggest that rates of sexual recidivism in females are quite low. The chapter authors make a point of challenging societal beliefs, assumptions, and biases regarding female nature as being incompatible with sex offending. There is a useful framework for assessment of female sexual offenders that will help forensic practitioners organize data for comprehensive examinations.

There is an excellent chapter on sexual deviance over the lifespan that proposes a new category of risk factor for assessing sexual recidivism: maturation. Based on review of present evidence, the chapter authors note a pattern of gradual, linear decrease in average recidivism rates from ages 25 to 70, at which point the estimated recidivism rate is close to zero. The chapter also provides a concise review of the effects of aging on male sexual physiology, which complements the information in another chapter dealing with medical models and interventions in sexual deviance.

This is not a book that is likely to be read straight through. Instead, I suspect that the forensic practitioner will more productively use the book by first reading the chapters that are broadly relevant and afterward choosing chapters which are relevant to clinical cases at hand. Used in this manner, the chapters dealing with the assessment and treatment aspects of each paraphilia are particularly useful. For the less common paraphilias, this book alone will be more than sufficient. For the more common clinical syndromes, such as pedophilia, and rape, this book will serve as a useful starting point or a source to turn to for a quick review of up-to-date information.

Even for those who have the first edition on the bookshelf, this second edition is recommended. The additional areas covered in this new edition of the book alone make it worth the purchase price. For those considering this book for the first time, it is highly recommended. The book is a definitive starting point for any review of sexual deviance and paraphilias. I expect that it will replace the first edition as one of the key references in the field of sexual deviance.

• American Academy of Psychiatry and the Law