Sexual Offending: Predisposing Antecedents, Assessments, and Management is a three-part compendium that is optimally utilized as a reference for forensic evaluators who work with sex offenders. Psychiatrists in this line of work are tasked with understanding and forming evidence-based opinions related to a diverse and complex group of individuals labeled as sex offenders. This text reviews, in striking detail, the various structured and clinical assessment and treatment methodologies that are currently available to practitioners working with this population.
Forensic evaluators are commonly confronted with the following questions when conducting forensic evaluations of sex offenders. What factors are contributing to their behavior? What is their risk of re-offending? How do we effectively treat the offender? This book is presented in three parts, with each section addressing one of these questions.
Part One, “Disorders and Types of Sexual Offending,” provides an overview of the morphology and demographics of sex offenders and sex crimes. It exhaustively reviews the literature summarizing research findings, professional opinions, and legal holdings. This first part offers context to the work and provides a foundation for Parts Two and Three. A particularly thought-provoking chapter written by one of the book's co-editors, Harry Hoberman, is titled “Personality and Sexual Offending; Non-Sexual Motivators and Disinhibition in Context.” This chapter reads like a philosophic text and documents with nuance the nature of personality and character structure and the variety of traits that affect an individual's decision-making. It stands out in this book as a long-form essay that looks at this particular topic through a novel lens.
Part Two, “Assessment and Risk Appraisal of Sexual Offenders,” thoroughly reviews psychometric measures. For forensic psychiatrists with less experience administering psychological tests, this section may be difficult to metabolize. While there is an effort to describe the various tests, the chapters in this section are likely best utilized by forensic psychologists, particularly those who have greater experience with the administration of psychological tests and measures. That said, there are several sections in Part Two that provide guidance on evaluative strategies and the use of tools such as penile plethysmography and polygraph, which may be quite useful to forensic psychiatrists. These reviews are remarkably complete, often including the legal case history that influences the use of these evaluations in court. There are also several chapters on risk assessment and management that review the research supporting the use of several actuarial risk assessment instruments, such as the Static-99 and the Sex Offender Risk Appraisal Guide.
Part Three, “Management and Public Policy Issues Regarding Sexual Offenders,” is arguably the most relevant to forensic psychiatry. Part Three gives guidance to the forensic evaluator when answering the question about recommendations for treatment. The chapter “Pharmacotherapy for Sex Offenders,” written by a psychiatrist, Dr. Mohan Nair, reviews the evidence base for various pharmacologic interventions and provides guidance regarding the use of anti-androgen medications. There are also well-researched chapters on surgical castration and civil commitment that may be compelling to forensic psychiatrists. Two chapters written by attorneys on the differing legal perspectives on sexual offenders provide a glimpse into the thought process behind the opposing portrayals of sexual offenders. These chapters also offer practical guidance, from an attorney's perspective, on how to avoid pitfalls in forensic work with sexual offenders and how to adequately prepare for testimony. In addition, these two chapters offer a useful review of the landmark legal decisions that have shaped the practice of forensic assessments of sexual offenders.
On the whole, the organization of the text could be improved. The chapters did not always flow from one to the next in a logical manner, and there were some chapters in the middle of the various parts that would have been helpful as an introduction. Further, although comprehensive, the text could have been more succinct and clear at times. While reading, I had the feeling that inclusiveness was valued, sometimes at the expense of clarity and cohesion. Finally, the index at the end of the book is not particularly comprehensive, and it was difficult to use the index to quickly reference the chapters and sections of particular interest to me.
In conclusion, this book describes and quantifies the various facets of the evaluation, interpretation, and management of the sexual offender. It provides a comprehensive and balanced approach to the assessment of sexual offenders, with a particular emphasis on psychometric tools. Sexual offenders and sexual offending arise from a diverse group of influences, both biologic and environmental. This text effectively describes the heterogeneity of the taxonomy of sexual offending and positions itself as an essential resource for forensic evaluators.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2019 American Academy of Psychiatry and the Law
