Challenges in the Treatment of Sex Offenders

Sexual offences are committed by a very heterogeneous population, within which we can distinguish paraphilic and non-paraphilic sex offenders (SOs). In addition, paraphiliacs vary in multiple factors, such as the target, origin, recurrence and intensity of their sexual fantasies, arousal or behaviours. Compared to other types of offenders, convicted SOs usually stay longer in forensic care, have more severe legal sanctions (e.g. community registration, residential restriction, extended supervision) and are perceived by the community as more dangerous. As a result, this affects their length of stay in care facilities. That is why accurately predicting recidivism is extremely important when it comes to SO. Actuarial instruments and professional guidelines help assessing the likelihood of a SO to reoffend in order to carefully make decisions that might seriously affect them and/or the community, such as their length of stay. Treatments should be chosen based on multiple factors, including demographic variables, information about the type of paraphilia, comorbidity with mental disorders, medical examination, past experiences, recidivism risk and risk of violence, personal and interpersonal factors and many others (even more so in adolescents). Combinations of pharmacological (i.e. SSRIs, antiandrogen treatment) and psychological (i.e. BT, CBT) interventions have proven their efficacy in reducing recidivism risk among SOs. Despite the profound social cost of paraphilic behaviour, paraphilic disorder is still under-researched.