Crossover sexual offenses. Heil P1, Ahlmeyer S, Simons D. Abstract Crossover sexual offenses are defined as those in which victims are from multiple age, gender, and relationship categories. This study investigates admissions of crossover sexual offending from sex offenders participating in treatment who received polygraph testing. For 223 incarcerated and 266 paroled sexual offenders, sexual offenses were recorded from criminal history records and admissions during treatment coupled with polygraph testing. The majority of incarcerated offenders admitted to sexually assaulting both children and adults from multiple relationship types. In addition, there was a substantial increase in offenders admitting to sexually assaulting victims from both genders. In a group of incarcerated offenders who sexually assaulted children, the majority of offenders admitted to sexually assaulting both relatives and nonrelatives, and there was a substantial increase in the offenders admitting to assaulting both male and female children. Although similar trends were observed for the sample of parolees, the rates were far less dramatic. Parolees appeared to have greater levels of denial, had participated in fewer treatment sessions, and perceived greater supervision restrictions as a result of admitting additional offenses. These findings support previous research indicating that many sexual offenders do not exclusively offend against a preferred victim type. Multiple Paraphilic Diagnoses among Sex Offenders Gene G. Abel, MD; Judith V. Becker, PhD; Jerry Cunningham-Rathner, BA; Mary Mittelman, DrPH; and Joanne-L. Rouleau, PhD The psychiatric literature suggests that paraphiliacs can be expected to partic- ipate in only one type of deviant sexual behavior. Using self-reports gathered with assured confidentiality from 561 nonincarcerated paraphiliacs, we discovered that most paraphiliacs have had significant experience with as many as ten different types of deviant sexual behavior without regard, in many cases, to gender, age, and familial relationship of the victim. The relevance of these findings to our un- derstanding of paraphiliacs and their treatment is discussed. Sex crimes are a major social problem. portant research. If the accelerating in- Despite changing cultural trends toward cidence of reported sex crimes and the open discussion of sexual behavior, in- attendant victimizations are to be re- formation about sex crimes and the in- duced, however, the psychopathology dividuals who commit them remains of the perpetrators must be examined. sketchy and inconclusive. Psychiatry, The best source of accurate infor- psychology, and sociology have tended mation about participation in deviant to avoid the study of sex offenders, per- sexual behaviors is the paraphiliacs haps because they are viewed with dis- themselves. However, a major factor dain by all levels of society. Instead, the inhibiting the collection of accurate in- focus has been on the victims of sex formation from paraphiliacs is the fear crimes-certainly worthwhile and im- of negative social and legal repercus- sions because of the lack of assured confidentiality. The paraphiliac be- Dr. Abel is Professor of Psychiatry and Dr. Rouleau lieves that valid reporting of his deviant is Assistant Professor of Psychology, Department of Psychiatry, Emory University, Atlanta, GA. Dr. behavior is likely to increase the prob- Becker is Associate Professor of Psychology, Ms. Cun- ningham-Rathner is Assistant Instructor of Psychol- ability of arrest for crimes unknown to ogy, and Dr. Mittelman is Associate Research Scien- others, to prolong his incarceration, or tist, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. to jeopardize his probation status. Fur- Address reprint requests to Dr. Abel, Behavioral Med- thermore, most states have laws that re- icine Institute, 3193 Howell Mill Rd., Suite 202, At- lanta, GA 30327. quire the reporting of some sex crimes This research was supported by the National Institute (e.g., child molestation) to law enforce- of Mental Health, Grant ROlMH33678, "The Evalu- ation of Child Molesters," awarded to Dr. Gene G. ment authorities. Therefore, paraphi- Abel. The authors gratefully acknowledge the editorial assistance of Larry Brown in the preparation of this liacs are reluctant to discuss the true manuscript. scope of their deviant behavior with Bull Am Acad Psychiatry Law, Vol. 16, No. 2, 1988 153 Abel et a/. others. The key issue, then, to obtain- tained from incarcerated paraphiliacs, ing valid and reliable information from these studies reported that each had paraphiliacs in order to facilitate as- participated, on the average, in fewer sessment and treatment is an assurance than two different types of paraphilia. of confidentiality. Information gathered under a Certifi- Information currently available con- cate of C~nfidentiality,',~.~however, re- cerning paraphiliacs has come generally vealed that paraphiliacs have often been from incarcerated offenders who are involved in many more paraphilias than also unlikely to report accurately their previously suspected. To gain a better various deviant sexual interests and be- understanding of the number of differ- haviors. It is well known among incar- ent paraphilias in which the paraphiliac cerated paraphiliacs that if the nature of may participate and how the various their crimes becomes known to fellow paraphilic diagnoses interrelate, the fol- inmates, the risk of violent reprisal will lowing study was undertaken. be substantially increased. Conse- Methods quently, what we know about sex of- fenders as a population has been lim- Subjects The study population in- ited. cluded 561 men seeking voluntary eval- Recent studies,'-3 relying on a Cer- uation andlor treatment for possible tificate of Confidentiality from the fed- paraphilia at the University of Tennes- eral government4 that protects the iden- see Center for the Health Sciences, tity and confidentiality of research Memphis, Tennessee, or at the New subjects (in this case, self-reports ob- York State Psychiatric Institute, New tained from paraphiliacs), have re- York City. At the former site, all cate- vealed a marked discrepancy between gories of paraphilia were evaluated; at information in the literature regarding the latter, subjects with a diagnosis of paraphiliacs and information gathered rape and/or child molestation, because from paraphiliacs with the above assur- of preselection, constituted the largest ance of confidentiality. The literature segment of the subject population. Ap- suggests that the average sex offender proximately one third of the subjects commits fewer than two crimes5-'; were referred through mental health more recent studies' indicate that a rap- routes, one third from legal or forensic ist may commit as many as seven rapes, sources, and one third from other that a pedophile molesting young boys sources.' may commit an average of 240 such Diagnostic Criteria Interviews were crimes, and that exhibitionists, frot- conducted over an eight-year period teurs, and voyeurs commit an average (1977 to 1985), during which time the of over 500 paraphilic acts each. Diagnostic and Statistical Manual of Previous studies5**have also under- Mental Disorders of the American Psy- estimated the number of different types chiatric Association was revised from of paraphilia in which sex offenders DSM-I1 to DSM-111. Both DSM-I1 and may participate. With information ob- DSM-I11 describe nearly all of the char- 154 Bull Am Acad Psychiatry Law, Vol. 16, No. 2, 1988 Multiple Paraphilic Diagnoses acteristics of paraphilias appearing in paraphilia by relying upon the DSM-I1 this study, i.e., unusual or bizarre im- or DSM-I11 criteria, therefore, would agery or acts that tend to be insistently undermine any investigation into the and involuntarily repetitive, generally coexistence of multiple paraphilic di- involving the preference for the use of agnoses in a single subject. Regardless a nonhuman object for sexual arousal, of what proportion of sexual arousal re- repetitive activities with humans in- sulted from paraphilic interests or fan- volving real or simulated suffering or tasies, the victimization and the attend- humiliation, or repetitive sexual activi- ant consequences still occurred. This ties with nonconsenting partners. All study describes individuals who, at subjects reported recurrent, repetitive times, participated in nonparaphilic be- urges to carry out these deviant sexual haviors without relying on paraphilic behaviors; subjects were not included thoughts, and, at other times, used par- simply because they had committed the aphilic thoughts to develop fantasy, behavior. erection, and/or behaviors. Thus, our Diagnostic problems arose, however, diagnostic criteria in this one respect when the criteria for diagnosis using varied with the diagnostic criteria out- DSM-I1 and DSM-I11 indicated that the lined in DSM-I1 and DSM-111. subject's predominating sexual activity Based upon the subjects' reported life must involve paraphilic behavior history, we categorized each paraphilic (DSM-11), or that sexual excitement is diagnosis by gender and age of target possible only when the individual fan- (less than 14, 14 to 17, and more than tasizes or uses paraphilic images or be- 17 years of age) except in paraphilias haviors to become sexually excited where such divisions were irrelevant (DSM-111). We discovered that these (e.g., bestiality, coprophilia, some fe- latter criteria were inconsistent