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OBJECTIVE: Evaluation of the relationship between antiandrogenic therapy of sexual offenders and home leave steps in a forensic psychiatric hospital. METHODS: Retrospective evaluation of all sexual offenders (n = 79) who were treated in the forensic psychiatric hospital Berlin between the 1.1.1998 and the 1.1.2005. RESULTS: There is an increase in the number of patients treated with antiandrogenic medication during the observed time period. Patients under this kind of pharmacotherapy receive higher grades of home leave steps. CONCLUSIONS: As possible reasons for the observed changes we discuss the contemporaneous implementation of a new pharmacotherapeutic treatment option (LHRH-agonists) and an aggravation of the German criminal law for sexual offenders. Language: de

Sexuelle Totungsdelikte durch Jugendliche sind kriminalstatistisch sehr selten und noch weitgehend unerforscht. Mittels einer retrospektiven Gutachtenanalyse und einer Auswertung aktueller Bundeszentralregisterauszuge wurde die Delinquenz einer Stichprobe 19 jugendlicher Sexualmorder von der Kindheit bis zum durchschnittlichen Alter von 45 Jahren erfasst. Mehr als die Halfte (58%) hatte schon vor dem sexuellen Totungsdelikt sexuelle Ubergriffe begangen oder versucht. Von 13 aus dem Gewahrsam entlassenen Tatern verubten sieben (54%) ein neues Sexual- oder Gewaltdelikt. Im Langzeitverlauf waren vergleichbar viele gunstige und ungunstige Delinquenzentwicklungen unterscheidbar. Die Ergebnisse weisen darauf hin, dass Personen, die als Jugendliche ein sexuelles Totungsdelikt begehen, haufig schon vorher sexuell Ubergriffe veruben und langfristig ein hohes einschlagiges Ruckfallrisiko haben.

In einer Untersuchung an 166 in der Zeit zwischen 1963 und 1991 verurteilten Straftatern, deren Sexualdelikt fur die Opfer todlich endete, ergaben sich zunachst beim Vergleich von Einfach- mit Mehrfachtatern ahnliche Verhaltnisse, wie aus Voruntersuchungen mit kleineren Stichproben bekannt war. Bei den Mehrfachtatern wurden haufiger sexueller Sadismus und andere Storungen der Sexualpraferenz sowie antisoziale, schizoide und sadistische Personlichkeitsstorungen gefunden. Katamnestische Daten aus dem Bundeszentralregister lagen von 139 Tatern vor. Wahrend die Entlassenen (n=90) durchschnittlich 12,2 Jahre in Gewahrsam verbrachten, waren die Nicht-Entlassenen (n=49) bis zur Erstellung der Bundeszentralregister-Auszuge im Durchschnitt seit 20,6 Jahren ununterbrochen in Haft oder im Masregelvollzug. Bei den Nicht-Entlassenen waren signifikant mehr Storungen der Sexualpraferenz und mehr antisoziale und sadistische Personlichkeitsstorungen zu verzeichnen. Storungen der Sexualpraferenz und Antisozialitat stellen ein empirisch gut belegtes besonderes Risiko fur einschlagige Ruckfalligkeit bei Sexualstraftatern dar. Auserdem zeigten samtliche angewandten Prognose-Instrumente (PCL-R, HCR-20, SVR-20, Static-99) bei den Nicht-Entlassenen hohere Werte. Vor diesem Hintergrund muss es gesehen werden, dass bei den entlassenen Tatern nur 1,1% (n=1) Ruckfalligkeit in vollendeten und 2,2% (n=2) Ruckfalligkeit in versuchten Totungsdelikten gefunden wurde. Die Ruckfalligkeit mit Sexual- und Gewaltdelikten war mit den Ergebnissen der Metaanalyse von Hanson und Morton-Bourgon (4) vergleichbar. Nachdem die bekannten Risikofaktoren offensichtlich schon bei der Entscheidung fur oder gegen eine Entlassung „verbraucht“ worden waren, blieben in der Katamnese nur mehr das Alter beim Delikt und das Alter bei der Entlassung als weitere Risikofaktoren zur Erklarung von Ruckfalligkeit mit Sexual- und anderen Gewaltdelikten uber. Das heist, je junger der Tater beim sexuellen Totungsdelikt und je junger bei der Entlassung, umso wahrscheinlicher ist ein Ruckfall im Katamnese-Zeitraum.

Es gab bislang keine Untersuchungen daruber, wie sich im Strafvollzug inhaftierte und im psychiatrischen Masregelvollzug untergebrachte Tater sexueller Totungsdelikte (sog. Sexualmorder) unterscheiden. Anhand psychiatrischer Gutachten sowie Auszugen aus dem Bundeszentralregister wurden in einer psychiatrischen Klinik untergebrachte (n=45) und im Strafvollzug inhaftierte (n=89) Sexualmorder bez. diagnostischer, kriminologischer und prognostischer Merkmale sowie der Legalbewahrung miteinander verglichen. Im Masregelvollzug Untergebrachte waren durch eine hohere psychiatrische Morbiditat und ein leicht erhohtes Risiko hinsichtlich zukunftiger sexueller wie nichtsexueller Gewaltdelinquenz gekennzeichnet. Sie wurden seltener entlassen als inhaftierte Tater, aber nicht haufiger mit Sexual- oder anderen Gewaltdelikten ruckfallig.

For about 15 years selective serotonine reuptake inhibitors (SSRI) have been used in the treatment of paraphilias. In an open, uncontrolled, retrospective study, which was the first in the German speaking countries we investigated 16 male outpatients, who have been treated for different paraphilias with SSRI and psychotherapy. There was a marked reduction in paraphilic symptoms. Despite high rates of sexual side effects most patients reported a high overall treatment satisfaction. SSRI are an important addition in pharmacological treatment of paraphilic patients, especially with a risk of so called "hands-off" delinquency.

Controversies exist about the diagnostic concept of “sexual addiction.” The aim of this study was to investigate if German specialized sex therapists are confronted with patients who possess sexual addiction symptoms and to obtain information about diagnoses, comorbidity and treatment. A 12-item questionnaire was sent to all members of the German Society of Sex Research asking them about diagnoses, comorbidity and treatment of patients who experienced sexual addiction problems. Forty-three out of 149 members (28.9%) responded to the survey and reported about 97 patients with sexual addiction symptoms. Most common were pornography dependence, compulsive masturbation, and protracted promiscuity. Using ICD-10 definition “excessive sexual drive” was diagnosed more often in women while “disorder of sexual preference” was mainly diagnosed in men. In women neurotic (e.g., anxiety disorders) and eating disorders were most commonly diagnosed as comorbid disorders, while in men substance disorders were most commonl...

Background: Sexual homicides – and particularly offenders with multiple victims – receive much attention in the general public as well as among forensic experts. The aim of this study was to assess psychiatric disorders in a large sample of sexual murderers and to identify disorders related to multiple sexual homicides. Sampling and Methods: Psychiatric court reports from 20 German forensic psychiatrists on 166 men who had committed a sexual homicide were evaluated for psychiatric disorders according to DSM-IV, including standardized instruments for personality disorders (criteria from the Structured Clinical Interview) and psychopathy (Psychopathy Checklist-Revised). Offenders with a single sexual homicide victim (n = 130) were compared to those with multiple victims (n = 36). Results: High lifetime prevalence rates were found for substance abuse or dependence, paraphilias (especially sexual sadism), sexual dysfunctions and personality disorders (especially antisocial, borderline, sadistic and schizoid). In the multiple sexual murderer group sexual sadism, voyeurism, sadistic, antisocial and schizoid personality disorders were more frequent than in the single-victim group; none of the multiple offenders was diagnosed with a mood disorder. Conclusions and Limitations: Multiple sexual murderers are characterized by disorders in three major psychopathological domains: sexual as well as ‘character’ sadism, antisociality and schizoid personality. A thorough diagnostic evaluation of Axis I as well as Axis II disorders should be part of risk assessments in sexual homicide perpetrators. Although the study was a retrospective investigation on psychiatric court reports, the size of the sample and consistency with results from previous studies give confidence that the identified group differences are unlikely to be due to methodological limitations.

Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors-so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.

The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.

In a retrospective investigation of the court reports about sexual homicide perpetrators chromosome analysis had been carried out in 13 of 166 (7.8%) men. Three men (1.8%) with XYY chromosome abnormality were found. This rate is much higher than that found in unselected samples of prisoners (0.7-0.9%) or in the general population (0.01%). The three men had shown prepubescent abnormalities, school problems, and had suffered from physical abuse. The chromosome analysis in all cases had been carried out in connection with the forensic psychiatric court report due to the sexual homicide. However, two men had earlier psychiatric referrals. All were diagnosed as sexual sadistic, showed a psychopathic syndrome or psychopathy according to the Psychopathy Checklist-Revised [Hare RD, 1991, The Hare Psychopathy Checklist-Revised, Toronto, Ontario, Canada: Multi-Health Systems]. Two were multiple murderers. Especially forensic psychiatrists should be vigilant of the possibility of XYY chromosome abnormalities in sexual offenders.

To examine the predictive accuracy of four well established risk assessment instruments (PCL-R, HCR-20, SVR-20, and Static-99) in an important subgroup of sexual offenders, these instruments were assessed retrospectively based on information from forensic psychiatric court reports in a sample of 90 released male sexual homicide offenders (out of an original sample of 166) in Germany. Follow-up information about criminal reconvictions after release were obtained from the federal criminal records. Total scores as well as subscales and single items of these risk assessment instruments did not predict sexual recidivism, and only some of them had moderate predictive power regarding nonsexual violent recidivism. Possible explanations for these unexpected results are the retrospective study design with missing information about influences during the long duration of detention and time after release, the small sample size as well as the possibility that the risk assessment instruments investigated were valid for general sex offender samples, but not for the particular subgroup of offenders with sexually motivated homicides.

This study investigates characteristics differentiating sexually motivated murderers targeting child victims (CV; n = 35) from those with only adult victims (AV; n = 100). In the initial phase, psychiatric court reports were evaluated using standardized instruments (SCID-II, PCL-R, HCR-20, SVR-20, Static-99). In the second phase, data on duration of detention and reconviction rates were obtained from German federal criminal records. The CV group showed more often diagnostic criteria of pedophilia (43% vs. 4%) and less often alcohol abuse and drug dependency (31% vs. 55%), sexual dysfunctions (9% vs. 29%) and narcissistic personality disorder (0% vs. 13%). No significant differences were found regarding PCL-R and total risk assessment scores. Child victim perpetrators were more likely to have committed acts of sexual child abuse before the sexual homicide (46% vs. 16%) but were less likely to have committed rape or sexual assault (17% vs. 42%) or caused bodily injury (26% vs. 50%). The CV group was detained more frequently in forensic psychiatric hospitals (59% vs. 26%), but the two groups showed the same rates of release and reconviction for sexual (22% for both groups), nonsexual violent (CV 25% vs. AV 15%) and nonviolent offenses (CV 63% vs. AV 59%). Although well-known differences between nonhomicidal sexual child abusers and rapists were replicated in this study on sexual homicide perpetrators, the groups showed more similarities than differences. The high prevalence of violence and antisocial personality disorder in both groups seem to be important risk factors for committing a (sexual) homicide and might have outweighed other differences.

Evaluation of the relationship between antiandrogenic therapy of sexual offenders and home leave steps in a forensic psychiatric hospital.Retrospective evaluation of all sexual offenders (n = 79) who were treated in the forensic psychiatric hospital Berlin between the 1.1.1998 and the 1.1.2005.There is an increase in the number of patients treated with antiandrogenic medication during the observed time period. Patients under this kind of pharmacotherapy receive higher grades of home leave steps.As possible reasons for the observed changes we discuss the contemporaneous implementation of a new pharmacotherapeutic treatment option (LHRH-agonists) and an aggravation of the German criminal law for sexual offenders.

Forensic psychiatric reports on 166 sexual homicide perpetrators in Germany were retrospectively analyzed for criminal risk factors. Follow-up information about release and reconvictions from federal criminal records was available for 139 offenders; 90 (64.7%) had been released. The estimated recidivism rate (Kaplan—Meier analyses) for 20 years at risk was 23.1% for sexual and 18.3% for nonsexual violent reoffences. Three men (3.3%) were reconvicted for attempted or completed homicide. Only young age at the time of sexual homicide resulted in higher sexual recidivism, whereas increased nonsexual violent recidivism was related to previous sexual and nonsexual delinquency, psychopathic symptoms, and higher scores in risk assessment instruments. Increased recidivism with any violent reoffence was associated with age-related factors: young age at first sexual offence, at homicide, and at release and duration of detention. The impacts of the results for risk assessment, relapse prevention, and supervision are discussed.

Controversies exist about the diagnostic validity of sexual sadism and its relation to sadistic personality disorder in sex offenders. The aim of this study was to investigate which diagnostic, developmental, and criminal characteristics differentiate sexual sadistic from non-sadistic sexual homicide perpetrators. Psychiatric court reports on 166 men who had committed a sexual homicide were evaluated regarding psychiatric, sexual and criminal history. Sixty-one offenders (36.7%) with sexual sadism (SeSd) were compared with 105 (63.3%) offenders without this diagnosis (NSeSd). Besides the sexual sadistic symptoms, there were seven factors that discriminated best between the two groups (sexual masochism, sadistic personality disorder, isolation in childhood, multiple sexual homicide, previous rape, previous tendencies for similar behavior, and long duration of the homicidal act). Sexual sadism is connected with circumscribed other characteristics and has to be considered in risk assessment and treatment of sex offenders.