[Institution Title]
Introduction
In an investigation conducted by the FBI, Joe, a 64-year-old Caucasian male was arrested for possession of child pornography after his name and credit card information was traced to a website that featured hardcore child pornography. During the search of his house, the FBI agents found several pictures and video clippings involving children engaging in different kinds of sexual activities. Since he was positively identified and evidences were also found in his house he was brought to court and was trialed for sexual offense. During the deliberation of his case, Joe was recommended to undergo a Sex Offender Evaluation to help determine the gravity of his offense and the risk he pose to society. During the course of the interview Joe revealed that he was once a high school art teacher at a local community college who had access to children. The purpose of further evaluation was also to determine whether there was any instance during those 20 years of teaching if he had abused any of his students.
For the purpose of evaluation, several tests may be administered to determine the gravity of the offense and the level by which the offender is hooked to the crime committed. In most cases, the Sexual Adjustment Inventory (SAI) is used to identify the specific deviancy that is associated the offender. The SAI contains 13 scales classified into two categories: (a) sex-related scale and (b) non-sex-related scales. The two categories determine whether the sexual behavior is associated with other psychiatric condition that can either be sexual in nature or otherwise.
In an article that reviews the risk of sexual offenders the author mentioned that the classification of risk varies according to offenders . According to the article it is important that in assessing sex offenders the evaluators should be in the lookout of detecting risk factors projecting of sexual offence recidivism. In which case, the evaluator should employ the use of actuarial risk assessments that would help identify the high risk sexual offense recidivism and the low risk.
Patient Diagnosis
Considering the information provided by Joe during the initial interview, it revealed that he was suffering from what is classified according to DSM-IV-TR as 302.2 Pedophilia. DSM-IV defines pedophilia as a kind of mental disorder associated with sexual deviancy.
“characterized by sexual activity with a child, usually age 13 or younger, or in the case of an adolescent, a child 5 years younger than the pedophile”
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While Joe refute that he was a threat to society or poses a risk because of his unusual fetish for children being the subject of sexual activity, Joe’s sexual deviancy is considered alarming by the very fact that he spends his retirement saving and pension package in paying to have access to this websites. In addition, Joe also has approximately 300 pictures stored in his computer of children between ages 10 to 14 years old engaging in various sexual activities.
The client also verbalized that following the offense he lost interest in sex suggesting that “it was not worth it”. This was a change to his previous perception of child pornography before the arrest and the conviction. This response of the client can be classified as 302.71 Hypoactive Sexual Desire Disorder according to DSM-IV-TR. Hypoactive Sexual Desire Disorder is defined as a mental disorder under the category of sexual dysfunction. Similarly, Hypoactive Sexual Desire Disorder is also a kind of disorder that is classified under sexual desires. Sadock, Kaplan and Sadock defined Hypoactive Sexual Desire Disorder as,
“disorder experience absent or markedly diminished sexual appetite separate from any other mental disorder”
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Initially however, this diagnosis has only been made following the arrest but there are reasons to believe that before the client was caught, the diagnosis would have been Hypersexual Disorder and Preoccupation with Internet Pornography as discussed in a Clinical Case Conference published in the American Journal of Psychiatry in 2001. According to clinicians Stein, Black, Shapira and Spitzer this diagnosis is often triggered by a number of factor including depression, use of certain drugs and medication and other non-sexual factors identified in the Handbook of Sex Offender Treatment . However, ruling out the other diagnosis, Joe’s case was more associated with the clinical classification as specified according to DSM-IV-TR as 302.2 Pedophilia. The diagnosis of Pedophilia comes with a criteria. The criteria has to be met to assume the classification of a particular type of sexual deviancy. For the purpose of better evaluating the client as per the diagnosis, the provision on the diagnostic criteria DSM-5: Diagnostic Criteria 302.2 (F65.4) - Pedophilic Disorder are as indicated:
(Source: American Psychiatric Association, 2013)
In support of the diagnosis, there is also the extensive use of pornography that features prepubescent children which is a useful indicator of the said disorder. It is the result of several study that individuals chooses the kind of pornography to which they are interested in or is the subject of the sexual desires or fantasy. In the case of the Joe, while there were no report of prior abuse relating to his offense, the fact that he was online and accessing paid subscription to a child pornographic website. In addition, to affirm the diagnosis the client revealed in the interview that his interest for child pornography has been going on for a few years. However, it was not specified exactly how long, the criteria in section (1) has been satisfied as it only specifies an ongoing period of 6 months. While Joe has not actually participated in the actual deed involving a prepubescent child, the fact that the subject of his arousing fantasies met the category of a prepubescent child Joe’s diagnosis of Pedophilic Disorder has been affirmed.
Treatment for Sexual Deviancy
In a study featured in the International Journal of Offender Therapy and Comparative Criminology, the authors proposed that sexual offenders should attend a probation sexual offender treatment program (Craig, Browne, & Stringer, 2004, p.23). The said program aims to rectify the disorder through counselling and aggressive behavioral management through reduction of recidivism. Reduction of recidivism requires the offender to gradually let go of the negative behavior . However, the said treatment is resolved in the idea that such treatment cannot be done overnight. Neither is the said treatment feasible in abrupt and total reformation. The treatment allows the sex offender to divert his attention to a normal outlet or find a more normal and socially acceptable object for his sexual interest.
Personal Reflection
Going through the case of the client it revealed that his diagnosis was probably a result of his lifestyle and the living conditions that he has been in for quite some time. In retrospect, the client’s inability to keep a normal relationship may be the reason why his interest was diverted to prepubescent children who are comparatively easier to persuade than adults. This perception of the patient may be drawn from his 20 years of experience as a high school art teacher at a local community college. From this point of view, the treatment of choice is in fact appropriate because it would allow the patient to gradually overcome the unhealthy sexual urge for prepubescent children by shaping the mind of patient that his previous experience should not constitute to his diverting of interest to a lesser, more submissive subject.
Also, it is highly noticeable how immediate the patient’s realization of the negative implication of his sexual deviancy. In fact, his verbal conviction suggesting that his sexual interest for prepubescent children is “not worth it” may come a little too early. Seemingly, the evaluator and therapist should be vigilant that the patient is simply masking this behavior to gain a favorable commendation that will be carried through with the judge who is hearing his case. Personally, the insights generated from the interview assumes that the client is fully capable of recovery through gradual processing. However, it also proves that the client may be a little manipulative and as a therapist this should be something to be vigilant about.
References
American Psychiatric Association. (2013, April 11). Phallic Disorder. Retrieved from American Psychiatric Association Website: http://www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf
Craig, L., Browne, K., & Stringer, I. (2004). Comparing Sex Offender Risk Assessment Measures on a UK Sample. International Journal of Offender Therapy and Comparative Criminology, 7-27.
Lindeman, H. (2011). Sex Offender Assessment: Sexual Adjustment Inventory. In B. Schwartz, Handbook of Sex Offender Treatment (pp. 1-26). Kingston, NJ: Civic Research Institute.
National Reentry Resource Center. (2011, December 26). News Article: Principles of Recidivism Reduction. Retrieved from Correction Website: http://www.corrections.com/news/article/29737-principles-of-recidivism-reduction
Sadock, B., Kaplan, H., & Sadock, V. (2007). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia: Lippincott Williams & Wilkins.
