International Journal of Advanced Studies in Sexology https://www.sexology.ro/jurnal © Sexology Institute of Romania ISSN 2668-7194 (print), ISSN 2668-9987 (online) Vol. 2(2), 2020, pp. 101-108 DOI: 10.46388/ijass.2020.13.28

FORENSIC EVALUATIONS OF SEXUAL OFFENDERS

ADRIANA ROȘU SILAGHI1, ȘERBAN ROȘU2

1Stomatologist, MA 1st year Tibiscus University Timișoara, Str. Lascăr Catargiu 4-6, 300559, Timișoara, Romania 2Victor Babeș University of Medicine and Pharmacy Timișoara, Piata E. Murgu 2, 300041, Timișoara, Romania

Corresponding authors emails: [email protected], [email protected]

Abstract In this paper, my aim is to show the paraphilic disorders described in DSM-5 by highlighting their contribution to sex offences, the psychological profile of the sex offender, the most frequent sex offences, how the severity of is being assessed and the individual’s sexual interest.

Key words: , , , , masochism, sadism, fetishism, tranvestism, , sex, offender, offence, , abuse, anxiety, shame, , disorder, discomfort, paraphilic disorder, antisocial disorder, minors, children.

INTRODUCTION world. The consequences are the permanent emotional separation from her father, distrust The Romanian explanatory diction- in the friendship of men (“what does he really ary (DEX) (2010) describes the offence as a “violation of a predetermined rule which want from me?”) and inhibition reflected in the represents a social danger, consisting in the sexual life. If an offence is committed, does this culpable commission of a violation of the crim- mean that this father is an “offender”? inal law and it is sanctioned by law”. Synonym: The law established the severity of an “violation”. offence especially according to the severity of The offender is, also according to DEX the act, but what if some words have the same (2010), the person committing the offence. impact over the “victim” as an incest? Synonym: “wrongdoer”. In the following pages, I will talk about Of course, an offence has different degrees paraphilias and paraphilic disorders, their of severity. However, when a father tells his diagnosis and how they are assessed and 15-year-old daughter, “Stop wearing these tested, by following their criminal potential. shorts around the house, they’re too short and you’re already a young lady!”, could we Theoretical approach say the father is an offender? That sounds like According to DSM-5 (2016), the para- an exaggeration! However, although they are philia term defines “any intense and persis- just words, their impact on the daughter is tent sexual interest other than sexual interest enormous: “how is my father bothered if my in genital stimulation or preparatory fondling shorts are too short?”, “how did he notice that, with phenotypically normal, physiologically isn’t he my father?!”. From that moment on, mature, consenting human partners” (p. 685). “daddy’s girl” suddenly falls in a strange adult „A paraphilic disorder is a paraphilia that is

101 SILAGHI and ROȘU currently causing distress or impairment to the 3. Frotteurism: touching or rubbing against individual or a paraphilia whose satisfaction a nonconsenting or unconscious individ- has entailed personal harm, or risk of harm, to ual to obtain intense sexual arousal. This others.” (p. 685). paraphilia is characterized by fantasies, DSM-5 presents eight types of paraphil- sexual impulses, or specific behaviours. ias, which are relatively common, in relation Frotteuristic disorder involves repeated to other paraphilic disorders, and some of behaviour and the presence of frotteurism them entail actions for their satisfaction that, for a period of at least 6 months and the because of their noxiousness or potential harm appearance of mental discomfort (feelings to others, are classed as criminal offenses. of shame, guilt) in the individual or of clini- 1. Voyeurism: spying on the intimate actions cally significant dysfunction in other impor- of nonconsenting individuals. The voyeur is tant areas of functioning. This disorder has hidden, does not want to be observed, and a significantly higher frequency in men than obtains pleasure and sexual arousal from in women. breaking the intimacy of the individual(s) 4. Sexual Masochism: acts through which observed. Generally, he/she desires to reach the individual is humiliated, beaten, tied, orgasm through masturbation while watch- or made to suffer in any other way for the ing or after when fantasizing about what purpose of obtaining intense sexual arousal. he/she saw. We can talk about a voyeuristic Masochism is characterised by fantasises, disorder when this behaviour is repeated sexual impulses or specific behaviours. This and persistent over a period of at least 6 turns into sexual masochism disorder when months, it causes mental discomfort or clin- the sexual masochism, with all its character- ically significant dysfunction in the social or istics, persists for at least 6 months and when personal area or in other important areas of the fantasies, sexual impulses or specific functioning, and the individual is of at least behaviours cause mental discomfort or clin- 18 years of age. ically significant dysfunction in the social 2. Exhibitionism: exposing the genitals by or professional area or in other important surprise to strangers with the purpose of areas of functioning. Other acts that cause intense sexual arousal. Much more frequent suffering can be: burning, skin perforation, in men, though there are cases in women too. flagellation, electric shocks, sexual acts with Rarely, exposing the genitals can be accom- immobilization, etc. Other acts which pose a panied by masturbation. It is considered an higher risk to the individual’s life are those exhibitionistic disorder when the specific that provide sexual arousal through oxygen behaviours or fantasies related to possible deprivation, a subtype called asphyxiophilia. reactions to this behaviour last for a period Asphyxiophilia (hypoxyphilia or auto-erotic of at least 6 months, causing mental discom- asphyxiation) consists of obtaining sexual fort (feelings of guilt, shame, intense sexual arousal through suffocation or controlled frustration, loneliness) or clinically signif- strangulation. This paraphilic disorder can icant dysfunction in the social or personal be harder to class as offence because the area or in other important areas of function- negative consequences are over the own ing. The subtypes for exhibitionistic disorder person, not over others. There is the risk of are based on the age or physical maturity of accidental death, especially through asphyx- the nonconsenting individuals to whom the iation. In the sexual masochism disorder, an individual prefers to expose his/her geni- associated feature sometimes appears repre- tals. The nonconsenting individuals can be sented by the use of pornographic material prepubescent children, adults, or both. The with individuals who are beaten, tied, or subtype is important to mention to be able made to suffer in different ways. The prev- to spot a coexistent consistent pedophilic alence of the disorder in the population is disorder. unknown, but according to existing data,

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no significant difference between men and of pornographic material showing prepu- women exists. bescent children. Pedophilia, it seems, is 5. Sexual sadism involves provoking the phys- a disorder that lasts for the entire life, but ical or mental suffering of a nonconsenting advancing in age has the effect of dimin- individual with the purpose of obtaining ishing this disorder, as is the case of other intense sexual arousal. It is characterized paraphilic or normal behaviours. The asso- by fantasies, sexual impulses, or specific ciation between pedophilic disorder and behaviours. Sexual sadism disorder involves antisocial disorder, alcohol consumption or repeated and persistent presence of specific even obsessive-compulsive disorder (rarely) behaviours, fantasies and sexual impulses increases the possibility for these individu- or mental discomfort or clinically signifi- als to exhibit a sexual behaviour that targets cant dysfunction in the social or professional children. When an individual’s history area, or in other important areas of func- suggests the possible existence of pedophilic tioning for at least 6 months. If the partner disorder but he/she denies having a strong consents (as a masochist) and sexual sadism or preferred attraction to children, psycho- is moderate, it can be considered a shared physiological methods of measuring sexual sexual practice and will not be considered a interest are used, such as visualisation time disorder. When sexual sadism is performed (also called visual reaction time), penile with nonconsenting individuals it is consid- plethysmography or vaginal photoplethys- ered an offence. Sexual sadism is especially mography. These methods will be described severe when associated with an antisocial later. personality disorder. This combination of 7. Fetishism, manifested through an array of disorders is extremely resistant to psychiatric fantasies, sexual impulses or specific behav- treatment and psychotherapy. Sex offenders iours, consists of using inert objects, either with a pronounced sexual sadism disorder in the very specific interest for a certain are capable of atrocious crimes. anatomical body part (excepting the geni- 6. Pedophilia is represented by obtaining tals) with the purpose of obtaining intense intense sexual arousal through sexual activ- sexual arousal. Repeated behaviour and ity with one or more prepubescent children presence for at least 6 months and mental (under 13 years old). Pedophilia disorder discomfort, associated with clinically signifi- involves the presence for at least 6 months cant dysfunction in the social or professional of sexually arousing fantasies, intense and areas or in other important areas of function- repeated sexual impulses or behaviours ing shape the fetishistic disorder diagnosis. leading to obtaining sexual arousal through The problems of an individual affected by sexual activity with one or more children. If fetishistic disorder are reflected especially in the individual has acted upon these sexual couples, because they cannot orgasm if the impulses or if these impulses or sexual fanta- fetishized object is unavailable. Therefore, sies cause significant mental discomfort even when in a romantic relationship, these (feelings of shame, guilt, anxiety, intense individuals prefer solitary sexual activity sexual frustration, isolation) or difficulties in where they can freely use their fetishized interpersonal relationships, this will be clas- objects. Fetishistic disorder is relatively rare sified as pedophilic disorder. For this, the in sex offenders. At most, their criminal acts individual must be at least 16 years old and are related to stealing fetishized objects. at least 5 years older than the victim child. 8. Transvestism is represented by donning and To abuse the child, the individual will use wearing clothes of the opposite sex (trans- force or mental manipulation, because later vestism) to obtain intense sexual arousal. It the child will be threatened not to reveal the manifests through fantasies, sexual impulses, abuse to someone else. Associated elements or specific behaviours. When these fanta- that support diagnosis are the extensive use sies, sexual impulses or behaviours cause

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emotional discomfort or clinically signifi- There is also the volumetric plethysmography cant dysfunction in the social or professional method, where a cylinder is placed over the area or other important areas of functioning penis to measure the air movement caused by or when they repeat and last for more than the penis erection. Some state that volumetric 6 months, we can talk about transvestism measurement is more precise than circumfer- disorder. However, in this situation, the ence measurement. The stimuli that can deter- individual’s social and cultural environment mine the penile volumetric or circumference matter, because the mental discomfort felt growth are represented by images and audio/ could be caused by not being accepted by video recordings (erotic slides) chosen accord- others. If the same individual would live in ing to the suspected disorder: nude children a society without negative reactions to trans- in the case of pedophiles, molested children in vestism, the mental discomfort would disap- the case of child molesters, sexual violence in pear, or it would be significantly lowered. the case of those with sexual sadism disorder, Suffering and dysfunction can manifest in etc. heterosexual couples when the man has Penile plethysmography allows to differ- difficulties in maintaining penile erection entiate between sex and non-sex offenders, and in obtaining sexual orgasm without and for sex offenders, between rapists and transvestism or without intimate fantasies non-rapists. Therefore, penile plethysmogra- about transvestism. phy and other measurements offer the most comprehensive and exact image of the sexual Causes and non-sexual interests of the individual, but One of the factors that appears to catalyse it also predicts the success of treatment, as well most paraphilias is childhood sexual abuse. as the probability of relapse. Thus, we can conclude that pedophilia can also Marshall (1996) and British Psychological be cause and effect of itself and at the base of Society (2008) do not recommend penile other paraphilias. In what regards pedophilia, plethysmography as: some proof shows that neurodevelopment - Sole criteria for determining deviant sexual disorders during in-utero life increase the interests; probability of pedophilia. - Sole criteria for recommending the release of offenders in community; Methods to evaluate the severity of - Consideration if the individual has finalized paraphilias treatment; a) Questionnaires: the fantasies, impulses - Conclusion if someone has or has not commit- or paraphilic sexual behaviours of the exam- ted a specific sexual offense; ined individual are evaluated in relation to his/ - Test for an individual before the remission of her normal sexual interests and behaviours: symptoms; lower, approximately equal, or stronger than - Determination of the risks and treatment the normal sexual interests and behaviours. The needs in the absence of other information; subjectivity of the answers given by a subject Also, the prudent use of penile plethys- represents a disadvantage in questionnaires. mography is recommended in people with b) Penile plethysmography is a psycho- developmental disabilities, major acute mental physiological procedure that can offer more disease (National Clearinghouse on Violence objective measurements, standardized to Family, 1998) or in those with difficulties in evaluate the individual’s sexual interest. The the exact perception of stimuli because of a subject’s sexual arousal is measured through limited capacity of discrimination between age a ring fixed around the penis which allows and sex in each examples of the evaluation and measuring the variation of the penile circum- who could have trouble with understating the ference. The ring is thin and elastic, and it procedure (Haaven and Schlank, 2001). stretches as the penis circumference grows.

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Ethical concerns related to the use of penile than penile plethysmography, as the subject plethysmography does not have to disrobe and have a device The ethical concerns are related to the fact attached to his/her genitals. that penile plethysmography evokes deviant The most known option of this method is sexual arousal and testing could be considered AASI (Abel Assessment for Sexual Interest). intrusive. The association for the treatment of The subject visualises 160 slides with masculine sexual abusers (2001), British Psychological and feminine characters, aged from 2 to adult Society (2008) and Marshall (1996) affirm that age. There are no nude images. The subject will the following ethical considerations should be indicate the degree of disgust or excitation on a kept in mind for penile plethysmography: scale of 1 to 7, where 1 reflects a very low inter- - The explicit exposure of the subjects to devi- est, even disgust, while 7 reflects the image is ant stimuli could be seen as tacit approval of sexually arousing. the material; d) Polygraph test - Exposing minors and impressionable adults The polygraph is a device that measures to materials with explicitly deviant stimuli and records certain physiological parameters could shape future patters for sexually devi- of a subject during a series of questions that ant interests; orient the examiner in establishing the verac- - The stimuli inherently degrade women and ity of the answers. However, three emotions children; which come up in the examined subjects are - Exposure to explicitly deviant stimuli can difficult to differentiate: induce anxiety, nervousness, depression and - The fear of detection by the guilty examinee; other emotional disorders; - The fear of possible errors in the procedure by - Laboratory procedures which impose the the innocent examinee; subject to auto-stimulation to reach maxi- - The anger towards the examination of the mum arousal lead to the subject’s innocent examinee. and could go against religious beliefs. When a question is perceived as threaten- ing, the sympathetic nervous system reacts in c) Visualisation time a discharge of epinephrine and norepineph- It is supposed that sexual arousal is not a rine which prepare the organism for “fight unitary construction, but it has three stages: or flight” mode. This hormonal secretion - When the response is aesthetic and the constricts small blood vessels which creates response to the sexual stimuli is hedonic (the nausea, skin pallor, cooling of the extremities subject is pleased with seeing the object of caused by decreased blood supply. The sali- attraction); vary glands change their secretion and saliva - The subject approaches the object of attraction becomes viscous causing the feeling of “dry with the desire of having body contact with it; mouth”. Conversely, the sweat glands acceler- - Genital response as reaction to the sexual ate secretion and sweat increases. The breath- impulses. ing rhythm changes, the pupils dilate, and Visualisation time is a method to evalu- the anal sphincter contracts. The polygraph ate sexual interest, it involves measuring the is composed of four basics components that visualisation reaction time and is based on a record physiological parameters: heightened visual response to seeing the objects - Pneumograph with sensors to record the of attraction (aesthetic or hedonic response). parameters of the respiratory system at the Compared to penile plethysmography, abdominal and thoracic level; which involves laboratory, equipment, hard- - Sensors to measure the electroconductive ware, software, and training costs, the visualis- quality of the skin, placed on the subject’s ation time method is a much more economical nondominant hand; alternative. What is more, it is less intrusive - Sleeve to determine blood pressure;

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- Plethysmograph with photoelectrical sensor • The nature and evolution of the disorders on the finger to measure cardiac rhythm. preceding or accompanying the act can be In practice, the polygraph is used for the established; following types of examinations, according to • Some appreciations can be made on the PCSOT (T. Tipton, 2007): degree of danger over the individual’s a) Examination of sexual history; personality traits or over the existent b) Examination of the reveal; behaviour disorders. c) Maintenance examination (at 3-6 months); d) Monitoring examination; Sex offenders can manifest personality e) Examination of the incident itself. disorders that are oftentimes associated with paraphilic disorders. A sex offender with the Sex offenders antisocial personality disorder is capable of atro- Taking into account the complex charac- cious crimes because he/she is unable to feel ter of personality, approaching the offender in , , guilt, or shame. the context of legal psychology must target the The sexual psychopath, where psychopa- following channels, according to T.Butoi (2004): thy is associated with one or more paraphilic • Clinical research, to establish the individ- disorders: voyeurism, exhibitionism, frotteur- ual’s personal and possible pathological ism, masochism, sadism, paedophilia. About antecedents; sexual psychopaths, Szondi says that instinc- • Paraclinical examinations, to test the clin- tively they are dominated by the principle of ical diagnosis or to establish other possi- pleasure, meaning they are stuck at a prim- ble clauses (for example, establishing brain itive-infantile stage of sexuality; from there tumours, etc.); comes their tendency to polymorphic perver- • Biogenetic investigations, to identify hered- sions and sexual offences. ity factors; A common element in many offenders is • Neurophysiopathological interpretation, frustration, which results from being hindered to explore the causality of aggressive mani- from or deprived of obtaining satisfaction or festations with an antisocial echo related to reaching a desired goal and is felt on the cogni- biopsychological conditions which heighten tive plan as a tension affecting the individual’s or trigger them; activity. Depending on the degree of tolerance • Sociologic research that follows, on one to frustration, the individual can surpass the hand, the reconstruction of the delinquent’s frustration state (in the case of a high tolerance personality, and on the other hand, the possi- to frustration) or he/she can react aggressively bilities of social reinsertion; and chaotically (in the case of a low tolerance • The result of forensic and psychiatric exper- to frustration). tise, that through psychiatric and psycho- logic examination established the presence, Sex offences absence, or reduction of judgement in the Often, men commit more sex offences than subject. women. As a group, sex offenders rank higher Approaching the offender’s personality in than other offenders, though they usually this way is needed for the following reasons: have a history of non-sex offences. The most • It allows the correct appreciation of the common sex offences are: rape, sex offences individual’s mental state by establishing against children, exhibitionism. Some sex the diagnosis and excluding simulation offences do not imply violence (exhibitionism, (through biodetection); voyeurism, etc.), while others considerably • The essential characteristics of the individ- imply violence (rape). ual’s personality can be established;

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Rape • offenders who had committed sex offences Most rapists are young, sexually frustrated, and other offences as well; inexperienced in sexual relationships and most • offenders who had committed violent sex have criminal records. The main behavioural offences. types are: Alex Thio created a psycho-behavioural • Antisocial aggressive men with a history profile of those who commit sexual abuse of general criminal behaviour, but with- against children as compared to rapists: out any mental disorders (most frequent); • the age average is over 35, rapists being • Sadistic, aggressive men, who want to under 20; humiliate and harm women; • they are sexually inhibited or less sexually • Explosive rapists, often shy and inhib- aggressive; they start with masturbation ited, who premeditate the act to release and have sexual contact later in life; their frustration; • generally they are calm, gentle, and passive, • Mentally ill rapists, who are often manic. rapists being much more aggressive; • unable to maintain relationships with the Sex offences against children opposite sex as they are anxious and lack These offences vary in severity from mild the ability of communication, as opposed indecency to severely aggressive behaviour, to rapists; but most do not imply violence: • most commit offences against the same - Indecent allusions; child, while rapists attack more victims; - Severe indecency; • most admit guilt when accused, while - Insistent indecent behaviour; rapists don’t; - Rape or rape attempt; • homosexuals who molest boys admit guilt - Indecent exposure; much easier than heterosexuals who molest - Incest; girls. - Pornography; - Illegal sexual relationship (ages lower CONCLUSIONS than 16). A recent study performed in 2001 by M. As shown, in most cases of sex offences Tardif and H.V. Gijseghem in Canada, using the the offender’s behaviour is based on the mani- Minnesota Multiphase Personality Inventory, festation of one or more paraphilic disorders Rorschach test, Ego Identity Scale, has made often triggered by childhood sexual abuse. the following conclusions: paedophiles who This could be the psychological factor, though abuse female victims and who abuse masculine not the only one: recent researches have victims have more fragile limits of their image shown that paraphilic disorders can also be of self and score higher on the social introver- determined by biological, neurobiological, sion scale than offenders who do not commit and hormonal causes. Should we know more sex offences. What is more, paedophiles who about these processes, we could intervene with abuse masculine victims have a weaker ego prevention, a much more efficient method than than paedophiles who abuse female victims or treating these affections. Numerous studies than offenders who do not commit sex offences. Delcea C, Enache A, Stanciu C, 2017; Delcea In a 2000 study on 462 men accused of sex C, Enache A, 2017; Gherman C, Enache A, offences against minors in England, of which Delcea C, 2018; Delcea C, Fabian A. M, Radu 374 were condemned, C. Pritchard and C. Bagley C. C, Dumbravă D. P, 2019; Rus M, Delcea C, made an interesting typology of those. Based Siserman C, 2019; Siserman C, Delcea C, Matei on the substantial law parameters, the authors H. V, Vică M. L., 2019; Gherman C, Enache A, of the study split the men in three categories: Delcea C, Siserman C, ; Delcea C, Siserman • offenders who had only committed sex C., 2020 confirm our results. Paying attention offences; to children and their social circles, plays a key

107 SILAGHI and ROȘU role in avoiding their exposure to any kind of Int J MentHealthPsychiatry 4:1. 2018. DOI: abuse, especially sexual abuse. 10.4172/2471-4372.1000160. 9. Gherman C, Enache A, Delcea C. The multifactorial determinism of forensic expertise BIBLIOGRAPHY regarding sentince interruption on medical 1. Phenix, A., Hoberman, H., Maram, W., Sexual grounds and decision. Journal of Forensic and Offending- Predisposing Antecedents, Assessments Legal Medicine. Elsevier. 2019. Vol. 61, pp 45. and Management, Ed. Springer Science+Business DOI 10.1016/j.jflm.2018.10.005. Media, New York, 2016, p. 1-56, p. 331-349. 10. Delcea C., Fabian, A. M., Radu, C. C, Dumbravă 2. Perrotta, G., Paraphilic Disorder: Definition, D. P. within the forensic Contexts and Clinical Strategies, Neuro Research context. Rom J Leg Med27(4)366-372(2019). 1(1):4, 2019. DOI:10.4323/rjlm.2019.366. 3. American Psychiatric Association, DSM-5 11. Rus, M., Delcea C., Siserman C. The relationship Manual de Diagnostic și Clasificare Statistică a between emotional distress and neuroticism Tulburărilor Mintale, Editura Medicală Callisto, at the operational personnel of ambulance București, 2016, p. 685-705. services. Rom J Leg Med27(3)279-284(2019). 4. Butoi, T., Butoi I., Psihologie judiciară, Editura DOI:10.4323/rjlm.2019.279 Fundației România de Mâine, București, 2004, p. 12. Siserman, C., Delcea C., Matei, H. V., Vică M. 385-389. L. Major affective distress in testing forensic 5. Zamoșteanu, A., Delincvența, între etiologie și paternity. Rom J Leg Med27(3)292-296(2019). abordare trapeutică, Editura Eurobit, Timișara, DOI:10.4323/rjlm.2019.292. 2008. 13. Gherman, C., Enache, A., Delcea C., Siserman 6. Delcea C, Enache A. Individual Differences C., An observational study on the parameters in Personality and Reasoning Traits between influencing the duration of forensic medicine Individuals Accused of Murder and those expert reports in assessment of inmates’ health who have not Committed Murder. Int status in view of sentence interruption on J MentHealthPsychiatry 3:1. 2017. DOI: medical grounds - conducted at the ClujNapoca 10.4172/2471-4372.1000140. Legal Medicine Institute between 2014 and 7. Delcea C, Enache A, Stanciu C, Assessing 2018. Rom J Leg Med 27(2)156-162(2019). Maladaptive Cognitive Schemas as Predictors DOI:10.4323/rjlm.2019.156. of Murder. Int J MentHealthPsychiatry 3:1. 14. Delcea C., Siserman C. Validation and 2017. DOI: 10.4172/2471-4372.1000142. Standardization of the Questionnaire for 8. Delcea C, Enache A, Siserman C. The Reasoning Evaluation of Paraphilic Disorders. Rom J Involved in the Decision Making Process of Leg Med 28 (1)14-20(2020). DOI: 10.4323/ Individuals Who have Committed Murder. rjlm.2020.14.

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