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Paraphilic Sexual Interests and Sexually Coercive Behavior: a Population-Based Twin Study

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Paraphilic Sexual Interests and Sexually Coercive Behavior: a Population-Based Twin Study Arch Sex Behav DOI 10.1007/s10508-015-0674-2 ORIGINAL PAPER Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study 1,6 2,3 4 4,5 Elena Baur • Mats Forsman • Pekka Santtila • Ada Johansson • 4 2,3 Kenneth Sandnabba • Niklas La˚ngstro¨m Received: 8 July 2014 / Revised: 22 October 2015 / Accepted: 26 November 2015 Ó Springer Science+Business Media New York 2016 Abstract Prior research with selected clinical and forensic with a causal association. In conclusion, similar to previously samples suggests associations between paraphilic sexual interests reported predictive effects of paraphilias on sexual crime recidi- (e.g., exhibitionism and sexual sadism) and sexually coercive vism, paraphilic behavior among young adults in the general pop- behavior. However, no study to date used a large, representative ulation increases sexual offending risk. Further, early identifica- and genetically informative population sample to address the tionofparaphilicinterestandpreventiveinterventionswithat-risk potential causal nature of this association. We used self-report individuals might also reduce perpetration of first-time sexual data on paraphilic and sexually coercive behavior from 5990 18- violence. to 32-year-old male and female twins from a contemporary Fin- nish population cohort. Logistic regression and co-twin control Keywords Paraphilic behavior Á models were employed to examine if paraphilic behaviors were Sexually coercive behavior Á Twin study Á Genetics Á causally related to coercive behavior or if suggested links were Family environment Á DSM-5 confounded by familial (genetic or common family environ- ment) risk factors. Results indicated that associations between Introduction four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behav- Sexual violence is an important societal concern worldwide ior were moderate to strong. Transvestic fetishism was not inde- (e.g.,Krug,Mercy,Dahlberg,&Zwi,2002),andreviewssuggest pendently associated with sexual coercion. Comparisons of twins that one-quarter of women and one-tenth of men are victimized reporting paraphilic behavior with their paraphilic behavior-dis- sexually during childhood (Gilbert et al., 2009)oratanytimein cordant twin further suggested that associations were largely inde- life (Abrahams et al., 2014; Jewkes, Garcia-Moreno, & Sen, 2002). pendentof shared genetic and environmental confounds, consistent Some national surveys suggest both lower (UK; Macdowall et al., 2013) and higher prevalence figures (USA; Black et al., & Mats Forsman 2011), indicating that methodological issues including the def- [email protected] inition of sexual violence substantially influence self-reported base 1 Faculty of Psychology and Neuroscience, Maastricht rates (Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranen- University, Maastricht, The Netherlands burg, 2011). 2 Swedish Prison and Probation Service, R&D Unit, PO Box 12055, 102 22 Stockholm, Sweden Preventing Sexually Coercive Behavior 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Attempts to prevent sexual violence often focus on known per- 4 Department of Psychology and Logopedics, Abo Akademi petrators. However, recent systematic reviews have failed to find University, Turku, Finland clear support for the effectiveness of existing sex offender treat- 5 Department of Pharmacology, Institute of Neuroscience and ment programs (Dennis et al., 2012; Grønnerød, Grønnerød, & Physiology, Sahlgrenska Academy, University of Gothenburg, Grøndahl, 2015;La˚ngstro¨metal.,2013). One reason may be that Gothenburg, Sweden programs have insufficiently focused on risk factors with estab- 6 LWL-Maßregelvollzugsklinik, Herne, Germany lished causality for sexual violence (see, for example, Ward & 123 Arch Sex Behav Beech, 2006; Ward & Siegert, 2002). However, there are indica- proportions among those with the six remaining specified DSM tions, primarily from selected clinical samples, that paraphilias paraphilias (pedophilia, transvestic fetishism, frotteurism, fetish- might be causally related to sexually coercive behavior (see, for ism, exhibitionism, and voyeurism) that reported having raped an example, Abel, Becker, Cunningham-Rathner, Mittelman, adult woman were all in between the figures for masochism and &Rouleau,1988;Knight&Prentky,1990;Krueger,2010;Mann, sexual sadism. The suggested link between sadism and rape is also Hanson, & Thornton, 2010). reflected in sexual offender typologies. For example, the Mas- sachusetts Treatment Center: Rape classification system revi- Paraphilias sion 3 (MTC: R3, Knight,1999;Knight& Prentky, 1990) describes four primarily sexually motivated rapist subtypes, all character- A paraphilia can be defined as any‘‘intense and persistent sexual ized by extensive sexual or sadistic fantasies. interest other than sexual interest in genital stimulation or prepara- There is also considerable support for paraphilic interests pre- tory fondling with phenotypically normal, physically mature, con- dicting sexual recidivism among sex offenders (Mann et al., senting human partners’’(American Psychiatric Association, 2013). 2010). In an influential systematic review of recidivism studies, It is necessary to stress that having, or acting on, a paraphilic broadlydefinedassexualdeviancy,includingparaphilias,sexual interest is not necessarily pathological. Most people with preoccupation or hypersexuality, and gender dysphoria, was one atypical sexual interests do not have a mental disorder. There- of the strongest individual predictors of sexual reoffending among fore, the Diagnostic and Statistical Manual of Mental Disorders sex offenders (d =.30; Hanson & Morton-Bourgon, 2005). How- (American Psychiatric Association, 2013) makes a clear distinc- ever, specific interest in using violence in relation to sex, or sex- tion between paraphilias, that is, atypical sexual interests, and ual sadism, did not significantly predict repeat sexual violence paraphilic disorders that additionally cause‘‘distress or impair- whereas it did so in Knight and Thornton’s (2007) large-scale menttotheindividual’’orcause‘‘personal harm, or risk of harm, recidivism prediction study. Additionally, when data from both to others’’(American Psychiatric Association, 2013, p. 685). studies were combined, interest in sexual sadism significantly The DSM-5 specifies eight paraphilias and their correspond- predicted sexual reoffending among sexual offenders (Mann ing paraphilic disorders. These are exhibitionism (with a specific et al., 2010).Finally,thepresenceoftwoormoreparaphiliaswas focus onsexualarousal from… exposingone’s genitalsto non- significantly associated with sexual reoffending in Knight and consenting others), fetishism (…using non-living objects or hav- Thornton’s (2007)study. ing a highly specific focus on non-genital body parts), frotteur- ism (…touching or rubbing against a non-consenting individ- The Present Study ual), pedophilia (…prepubertal children), sexual masochism (…undergoinghumiliation,bondage,orsuffering),sexualsadism Prior studies with primarily forensic or correctional samples (…inflicting humiliation, bondage, or suffering), transves- suggestanon-trivialassociationbetween paraphiliasandsexually tic fetishism (…engaging in cross-dressing), and voyeurism coercive behavior. However, the size and possible causal nature (…spying on others in intimate sexual activities). of this association is much less clear. We addressed three main research questions in a large, contemporary, population-based Paraphilias and Sexually Coercive Behavior twin cohort: 1. What are the risks of sexually coercive behavior as a func- Intuitively, associations between at least some paraphilias and tion of specific paraphilic behaviors? sexually abusive or coercive behavior seem likely. Acting on cer- 2. Are specific paraphilic behaviors related to sexually coer- tain paraphilias, such as pedophilia or frotteurism, is per definition cive behavior independently of age, gender, and other co- sexually coercive behavior. Sexually sadistic or pedophilic inter- occurring paraphilic behavior? ests, although rarely sufficient since additional offending risk fac- 3. Areparaphilicbehaviorsrelatedtosexuallycoercivebehav- torsareneededinacumulativefashion, would increase the risk ior independently of confounding familial (genetic or com- that an individual acts out according to these paraphilic interests mon family environment) risk factors, consistent with a compared to someone without such sexual interests. Consistent causal effect? with this, prevalence rates, although sparse and incomplete, do sug- gest an overrepresentation of essentially all studied paraphilias in sex offenders compared to the general population (see Abel et al., 1988;Krueger,2010;Seto,2008). More specifically, prior research Method indicates an association between sexual sadism and rape. Abel et al.’s (1988) report on 561 men undergoing evaluation or treat- Participants ment for deviant sexual interests in the U.S. suggested that 18 % of men with masochism to a high 46 % among those with sadism Participants were part of the project The Genetics of Sexu- anonymouslyreportedalsohavingrapedanadultwoman.The ality and Aggression (GSA), established in 2005 at the Abo 123 Arch Sex Behav Akademi University in Turku, Finland. The major research know,’’and‘‘don’twanttoanswer.’’Additionalquestionsaddressing goal was to conduct investigations with genetically sensitive recurrence,
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