Forensic psychiatrists reject hebephilia - yet again!

Will American Psychiatric Association heed professional consensus?

Twenty years ago, Humbert Humbert went to prison for a series of sexual assaults on his 12-year-old stepdaughter, whom he famously nicknamed "Lolita." Now, as his lengthy prison term draws to a close, Wisconsin is petitioning to have the 60-year-old literature professor indefinitely detained as a Sexually Violent Predator.

The venue for last week's trial of Vladimir Nabokov's fictional protagonist was the annual convention of the American Association of Psychiatry and Law (AAPL) in Montreal. The central question, decided by audience vote, was whether the controversial diagnosis "hebephilia" qualified as a legitimate mental disorder justifying Mr. Humbert's indefinite civil detention.

The rousing theatrical performance featured an all-star cast of attorneys and psychologists, presided over by Toronto Judge Maureen D. Forestell. New Jersey Assistant Attorney General Mark Singer served as prosecutor. His expert witness was prominent psychiatrist Richard Krueger, a member of the paraphilias subworkgroup that has proposed adding "hebephilia" to the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A hebephilic qualifier would extend pedophilia to men with sexual preferences for children who have entered puberty, such as the fictional Lolita.

Defending Mr. Humbert was preeminent Wisconsin attorney Robert LeBell. His expert was Washington psychologist Richard Wollert, who has published peer-reviewed articles on SVP-related topics and testifies for the defense in civil commitment proceedings. Appearing as the court's expert was prominent Canadian psychiatrist John Bradford, an advisor on paraphilia (or sexual deviance) to the DSM-IV, past president of the AAPL and clinical director of the Sexual Behaviors Clinic in Ottawa.

After a spirited and sometimes heated trial, the 131-member audience was given electronic clickers and voted overwhelmingly -- 82 percent -- against including hebephilia as a diagnosis in the DSM-5, due out in mid-2013. A majority also voted against even including the controversial diagnosis in a DSM-5 appendix as a condition meriting further study.

Third time's the charm?

This marks at least the third time in two years that respected professional bodies have voted against the idea of hebephilia as a new mental disorder. At a 2010 vote in Oslo, Norway, members of the International Association for the Treatment of Sexual Offenders (IATSO) were near-unanimously opposed to the newly proposed sexual paraphilia. U.S. forensic psychiatrists followed suit a month later at the 2010 AAPL conference, overwhelmingly voting against hebephilia as well as two other proposed paraphilias, "paraphilic coercive disorder" (aka rape) and hypersexuality, both since scrapped.

Earlier this year, more than 100 professionals, including prominent forensic psychologists and psychiatrists in the U.S. and internationally, sent an open letter to the DSM-5 revisers, urging them to nix hebephilia. Since then, at least two peer-reviewed articles have been published deconstructing its legitimacy, one in the respected Journal of Nervous and Mental Diseases ("Hebephilia and the Construction of a Fictitious Diagnosis" by forensic psychologists Paul Good and the late Jules Burstein) and the other a broad review ("Hebephilia as mental disorder?") by scholars Bruce Rind and Richard Yuill in the Archives of Sexual Behavior.

Rind and Yuill said they undertook their extensive review of the historical and cross-cultural evidence after hebephilia proponent Raymond Blanchard (a member of the DSM-5 paraphilias subworkgroup) and his colleagues at Toronto's Centre for Addiction and Mental Health brushed aside numerous published criticisms of the proposed disorder (see Table 1). Building on their earlier research, Rind and Yuill argue that hebephilia -- generally defined as sexual attraction to young pubescents in the age range of 11 to 14 -- is a biologically normal trait found to varying degrees in both human males and our closest mammalian relatives, such as higher apes. They blast hebephilia as a bold example of naked moral values masquerading as science:

"Blanchard et al. … did not invoke comparative evidence…. They did not invoke any evidence…. They declared it a disorder by fiat, bypassing scientific analysis in favor of a pre-given conclusion supportable only because it is, for the current time and place, culturally resonant. Had their pronouncement been the opposite (i.e., hebephilia is functional), their article would never have been accepted in a peer-reviewed journal without massive evidential backing. Strongly resonant opinion can facilely pass through without the kind of scrutiny demanded of non-resonant views."

Why hebephilia still clings to life, despite so much opposition and so little scientific support, is beyond me. It's like an unwanted house guest who just refuses to take the hint and pack his suitcase.

The evidence at trial 

In attacking the government's diagnosis of his client, defense attorney LeBell focused on the dearth of empirical studies on the condition, other than by researchers at a single Toronto clinic, and the likelihood of "false positive" diagnoses in legal cases.

The wording of the proposed new diagnosis has been changed again and again over the past couple of years. In its current iteration, pedophiles are defined as those who have "an equal or greater sexual arousal from prepubescent or early pubescent children than from physically mature persons, as manifested by fantasies, urges, or behaviors." (The requirements that the fantasies or urges be "recurrent" or "intense" have been removed, broadening the potential pool of sufferers.) Hebephiles are now defined as those with sexual attractions to "pubescent children" in Stages 2 to 3 of Tanner's pubertal stages (e.g., early development of pubic hair and breasts).

Defense expert Wollert testified that the problem of "false positives" -- people incorrectly identified as having a condition -- was extraordinarily high even in the controlled setting of the research laboratory. This problem would be much more acute in the forensic trenches where the hebephilia diagnosis is being deployed, he testified.

One insurmountable problem would be reliably identifying a sexual abuse victim's Tanner stage of pubertal development. Complicating this issue, testified the court's expert, John Bradford, Tanner Stages are highly variable. Because they reflect hormonal developments rather than specific ages, one could not assume a specific Tanner stage based on the age of a victim. About two years ago, alarming research indicated that girls are entering puberty far earlier than in previous generations; this month, a large study by the American Academy of Pediatrics identified a similar trend in boys.

Wisconsin psychiatrist Lynn Maskel, who organized and moderated the mock trial, labeled hebephilia a "weed diagnosis in the botanical garden of DSM."

"The question is not if sex with pubescent year old girls illegal, or if it is immoral," she told the audience of forensic psychiatrists. "The question to the psychiatric field is: Is it a disorder? And if it is, does this translate, for the expert witness, into a requisite mental disorder found in the specific SVP statute?"

Meanwhile, back in the real courtroom trenches …

In my seminal review, published in 2010 in Behavioral Sciences and the Law, I traced hebephilia's sudden emergence and rapid spread in legal discourse to the advent of Sexually Violent Predator laws, which require that the individual being considered for civil detention have a mental disorder that makes him qualitatively different from the garden-variety offender.

Since that article's publication, the introduction of hebephilia in U.S. courts has continued unabated, despite the lack of an official imprimatur by the American Psychiatric Association. In a string of SVP cases brought under the Adam Walsh Act, federal judges in North Carolina have ruled that the faux diagnosis is not a legitimate basis for civil detention.

However, other courts have been less circumspect. For example, just yesterday, in a narrow, 4-3 opinion, New York's high court upheld the civil commitment of a repeat sex offender named "Shannon S." based on the purported conditions of "paraphilia NOS" and "hebephilia." Mr. S. had engaged in a series of forcible rapes of adolescent girls, ages 13 through 16.

As the dissenters conceded, Shannon S. was a "very bad actor" and "the community may well be safer if he is kept behind bars."

"But, they added, "to put him there on the fiction that he has some sort of mental condition other than a tendency to commit the crimes for which he was convicted (and has served his time) is and should be constitutionally unacceptable."

Judge Robert Smith, writing for the minority, labeled as "absurd" the premise that attraction to adolescent girls is abnormal, as the government's two experts testified: "What is abnormal about appellant, and others who commit statutory rape by having sex with girls below the age of consent, is not that they find the girls attractive, but that they are willing to exploit them for their sexual pleasure -- in other words, they commit statutory rape."

Smith labeled hebephilia and the similarly disputed diagnosis of "paraphilia not otherwise specified" (rape) as "junk science devised for the purpose of locking up dangerous criminals." While such a practice might seem appealing from a public safety viewpoint, it creates "dangers of abuse," he eloquently warned:

"Many sex offenders are, or could reasonably be found to be, dangerous, and in common parlance they all have mental abnormalities: Mentally normal people do not commit sex crimes. Thus, unless 'mental abnormality' is defined with scientific rigor, such statutes could become a license to lock up indefinitely, without invoking the cumbersome procedures of the criminal law, every sex offender a judge or jury thinks likely to offend again.

"Some will intuitively respond: Not a bad idea. But it is a very bad idea, because not even a concern for public safety should be allowed to trump certain fundamental rules. Among them are that criminals can be confined only for crimes they have committed, after their guilt is proved beyond a reasonable doubt in a procedure in which they receive the many protections that our Constitution gives to those accused of crime, and that even when convicted they can be incarcerated for no more than the term of the maximum sentence provided by law. If the present sentences for sex offenders are too short, the Legislature should make them longer, but it should not, and constitutionally cannot, simply substitute civil for criminal proceedings as a means of keeping dangerous criminals off the streets."

As Judge Smith seems to recognize, it's a slippery slope. Bogus psychiatric diagnoses for sex offenders now, political dissidents (or others) tomorrow. That's the way they rolled in the former Soviet Union, after all.

Pretextual court rulings aside, the paraphilias subworkgroup has had more than two years to produce evidence for the reliability and validity of hebephilia, and it has not done so.

It is clear to most observers that hebephilia is not accepted by the relevant professional community. What remains unclear is whether the Board of Trustees of the American Psychiatric Association will get the message in time to prevent yet another in a veritable maelstrom of public-relations disasters and historical mistakes.

* * * * *

Additional resources: My resource page on hebephilia is HERE.

Of related interest: DSM-5  field trials discredit the American Psychiatric Association, by Allen Frances, Huffington Post, 10/31/2012

Happy Halloween!

Another one bites the dust: Hollow SVP prosecution no match for jurors' common sense

15 minutes.

After a five-week trial, that's how long it took a jury in a rural Northern California county to decide that an openly gay man who had served two years in prison for a forcible oral copulation of an acquaintance back in 2003 did not merit civil commitment as a sexually violent predator.

The prosecution's case featured a lone government psychologist whose opinion rested on a hollow combination of homophobia, bogus psychiatric diagnoses and trumped-up risk estimates. The psychologist cited archaic (and discredited) Freudian theory to claim that the ex-offender's crime at age 23 was evidence of an "oral incorporation" fixation caused by a domineering mother and an absent biological father. As a legal basis for civil commitment, he cited the bogus disorder of "paraphilia not otherwise specified-nonconsent,” and he used the Static-99R actuarial tool to present a highly inflated estimate of risk.

Testifying for the defense were four psychologists, including two retained by the defense, a government evaluator who had changed her mind (or "flipped," in the current parlance) and the man's treating psychologist at Coalinga State Hospital, who testified in no uncertain terms that "Mr. Smith," as I will call him, is neither mentally disordered nor likely to reoffend.

The defense team had barely left the courthouse when the court clerk summoned them back, saying the jury had reached a verdict. Their astonishingly fast decision hints that the jurors agreed that this case was an egregious example of overzealous prosecution and a waste of their valuable time.

Prior to being screened for possible civil commitment, Mr. Smith had been on parole in the community for 14 months without getting into any trouble whatsoever. Indeed, he was busy doing good works. His sexually violent predator screening stemmed from an entirely accidental parole violation connected with his charity work for a local gay rights organization. He had a special parole condition forbidding any contact with children. When a fellow member of the executive board brought his child to an awards ceremony, Mr. Smith was exposed to "incidental contact as one might have while shopping at a market," in the words of the parole hearing officer. Unfortunately for Mr. Smith, this was just one month after California voters enacted Jessica's Law, which allows for civil commitment of sex offenders who have only one qualifying victim rather than the previous minimum of two.

The prosecutor's strategy, as is typical in weak cases, was to hurl as many prejudicial, pseudoscientific labels as possible in Mr. Smith's direction, and hope a few might stick and scare jurors into voting for civil commitment: Psychopath, antisocial, homosexual, paraphilic, high risk, etc.

While licensed as a psychologist, the government's expert had not done what clinical psychologists are trained to do: Psychological testing, individualized case formulation, etc. Rather, as he boldly admitted on the witness stand, he relied on an assistant to cull through Mr. Smith's hospital records and pull out negative behavioral reports for him to review. Wow! Can you spell B-I-A-S?

In my testimony, which stretched over the course of three days, I stressed that Mr. Smith was neither sexually deviant nor likely to reoffend. His risk of sexual reoffense, I testified, was no greater than that of any other garden-variety sex offender. (The base rate of sexual recidivism among convicted sex offenders in California -- similar to the rest of the United States -- hovers around 6 percent or less.) I explained how growing up gay in a homophobic family and community causes sexual identity confusion that can lead to sexual acting out and other delinquent behavior in adolescence and early adulthood, and how Mr. Smith had changed as he matured and accepted his sexuality. I further debunked the accuracy of the Static-99R "actuarial" risk estimates assigned in this case, and the pretextually applied diagnoses of "paraphilia not otherwise specified-nonconsent" (which I've blogged about repeatedly) and antisocial personality disorder, a red herring that was invoked despite Mr. Smith's exceptionally good conduct in the community and while in prison.

Stacking the deck

The prosecutor tried to stack the deck by striking from the jury all gay people or those who admitted having relatives or close friends who are gay; he also challenged those with advanced educational degrees. I guess he thought it would be easier to pull the wool over the eyes of an uneducated jury. It just goes to show that times have changed: Even in a rural county, antigay discrimination is no longer considered acceptable, and jurors don't need PhD's to recognize bias and pseudoscience when they hear it.  

The verdict was likely a bitter-sweet moment for Mr. Smith, who had spent more than four years incarcerated at Coalinga awaiting trial. Luckily, he has close friends to stay with while getting on his feet.

This is my third SVP case in a row that evaporated when finally exposed to the light of day. Like Mr. Smith's case, one of the other two also featured prominent antigay bias; the other targeted an immigrant. In neither case were the men either pedophiles or rapists.

I suppose I should feel pleased to see such gross miscarriages of justice thwarted. Instead, I find myself horrified by the unfettered power wielded by rogue psychologists, assigned to a case by luck of the draw. Whereas many government evaluators reserve "positive" findings for the rare sex offenders who are truly deviant and at high risk to reoffend, others are just hacks who are raking in obscene amounts of public funds while making little effort to truly understand these men, their motivations, their circumstances, or their pathways to desistance.

Especially frightening is the unconscious bias that creeps into SVP prosecutions. The constructs of "mental disorder" and "risk for reoffense" are malleable, lending themselves to use as pretextual weapons of prejudice wielded against gay men, racial minorities (especially African American men) and immigrants.

Clearly, people shouldn't get away with sexual misconduct. But none of these men had. All had pleaded guilty and served their time, only to be ambushed at the end of their prison terms with misguided efforts to indefinitely detain them based on purported future risk.

As it turned out, each case was about as solid as a house of cards. It didn't take gale-force winds like Hurricane Sandy's to flatten them.

Evaluators flipping like pancakes

The "flipping" of government evaluators illustrated this weak foundation. In two of the three cases, after reading the more thorough and individualized reports of the defense-retained experts, government psychologists abruptly changed their minds and decided that their previously proffered diagnoses of "paraphilia not otherwise-nonconsent" were invalid.

On the one hand, I applaud the openness and ethical backbone such a change of heart signals. But these "flips" also demonstrate the whimsical, nonscientific nature of the commitment process. The longer I work in these trenches, the more I realize that the random assignment of evaluators and attorneys (on both sides) exerts as much influence on the outcome as does the true level of future risk to the community that an ex-offender poses.

Indeed, the real reason Mr. Smith -- clearly not a sexual predator to anyone with a whit of commons sense -- was taken to trial, at a total cost to the citizenry of hundreds of thousands of dollars, was not because of his high risk, but because of a rigid prosecutor who was blind to the writing on the wall.

In contrast, the government dismissed the other two cases (one in the Midwest and one in the South) on the eve of trial. One case involved a gay man who had a brief sexual interlude with a teenage male relative; the other involved an immigrant who had gone on two dates with an underage teen girl he met on an online dating site (his misconduct never went beyond petting). Both had served substantial prison terms. But, again, garden-variety sex offenders, not the depraved, sex-crazed monsters likely envisioned by jurors when they are told they will be deciding a "sexually violent predator" case.

Bottom line: Should a random clinical psychologist, earning hundreds of thousands of dollars a year churning out boilerplate pseudoscientific garbage, be allowed to decide the fates of others?

At least in this one case, 12 discerning and conscientious jurors answered that question with a resounding "NO."


ON OTHER,TOTALLY UNRELATED NOTES: If you're looking for an intelligent movie in theaters now (always a challenging search), ARGO earns a qualified thumbs-up from me; my review is HERE. (If you find the review helpful, please click on "yes" at the bottom.) I've also just finished reading a thoroughly researched and well-written cultural biography of John Brown, Midnight Rising, that positions his raid on Harper's Ferry as a seminal moment in the lead-up to the Civil War. Tony Horwitz previously wrote Conservatives in the Attic, which -- as the descendant of Southerners -- I found spot-on.

Static-99R risk estimates wildly unstable, developers admit

The developers of the widely used Static-99R risk assessment tool for sex offenders have conceded that the instrument is not accurate in providing numerical estimates of risk for sexual recidivism for any specific offender.

The startling admission was published in the current issue of Criminal Justice and Behavior.

Examining the data from the 23 separate groups (totaling 8,106 offenders) that cumulatively make up the instrument’s aggregate norms, the researchers found alarmingly large variability in risk estimates depending on the underlying sample. The problem was especially acute for offenders with higher risk scores. A few examples:

• At a low Static-99R score of "2," an offender’s predicted sexual recidivism rate after 10 years ranged from a low of 3 percent to a high of 20 percent, depending on the sample.

• A score of "5" led to a recidivism estimate after five years of 10 percent in a large, representative sample of Swedish sex offenders, but a 250 percent higher risk, of 25 percent, in one U.S. sample. The absolute differences for more extreme scores were even larger.

• Conversely, the Static-99R score that would predict a 15 percent likelihood of recidivism after five years ranged from a low-risk score of "2" to a high-risk score of "8," an enormous difference (greater than two standard deviations).

The study’s authors -- Karl Hanson, Leslie Helmus, David Thornton, Andrew Harris and Kelly Babchishin -- concede that such large variability in risk estimates "could lead to meaningfully different conclusions concerning an offender’s likelihood of recidivism."

Overall risk lower than previously found

Despite the wide variations in rates of offending, the absolute recidivism rate for the typical sex offender in the combined samples was low overall. The rate of recidivism among typical sex offenders after five years was only 7 percent or less (with a range of 4 to 12 percent), lower than had been reported in a previous meta-analysis. The 10-year risk ranged from 6 to 22 percent for the typical offender.

The research team speculates that the risk inflation in earlier analyses may have been an artifact of characteristics of the underlying samples, with data from higher-risk offenders more likely to be preserved and available for study. We know that a sister instrument, the MnSOST-R, produced inflated estimates of risk due to oversampling of high-risk offenders.

Will risk inflation continue?

MC Escher, "Hand with Reflecting Sphere"

The Static-99R has a very modest ability to discriminate recidivists from non-recidivists. Its so-called "Area Under the Curve" statistic of around .70 means that, if you were to randomly select one known recidivist and one non-recidivist from a group of offenders, there is about a 70 percent probability that someone who will reoffend will have a higher score than someone who won’t.

Such information about a test’s relative accuracy may be helpful when one is choosing which method to employ in doing a risk assessment. But there are a number of problems with relying on it when reporting one's assessment of a specific individual.

First of all, even that level of reliability may be illusory. A study that is currently in progress is finding poor inter-rater agreement on scores in routine practice, especially at the higher risk levels.

Second, with base rates of recidivism hovering around 6 to 7 percent, even under optimal conditions it is very difficult to accurately predict who will reoffend. For every person correctly flagged as a recidivist based on a high Static-99R score, at least three non-recidivists will be falsely flagged, according to research by Jay Singh and others, as well as published error-rate calculations by forensic psychologists Gregory DeClue and Terence Campbell.

Finally, and perhaps most importantly, telling a judge or jury how an offender compares with other offenders does not provide meaningful information about the offender’s actual risk. Indeed, such testimony can be highly misleading. For example, told that "Mr. Smith scored in the 97th percentile," judges and jurors may understandably believe this to be an estimate of actual risk, when the less frightening reality is that the person's odds of reoffending are far, far lower (probably no greater than 16 percent), even if he scores in the high-risk range. Seeing such statements in reports always flashes me back to a slim little treatise that was required reading in journalism school, How to Lie With Statistics.

Rather, what the trier of fact needs is a well calibrated test, such that predicted probabilities of recidivism match up with actual observed risk. The newly developed MnSOST-3 is promising in that regard, at least for offenders in Minnesota, where it was developed. In contrast, the popular Static-99 tools have always overestimated risk.

When the Static-99 premiered, it featured a single table of misleadingly precise risk figures. High scorers were predicted to reoffend at a rate of 52 percent after 15 years, which made it easy for government evaluators to testify that an offender with a high score met the legal criteria required for civil commitment of being "likely" to reoffend.

The instrument’s developers now admit that this original risk table "turned out to be a gross simplification."

Indeed, with each of a series of new iterations over the past few years, the Static-99's absolute risk estimates have progressively declined, such that it would be difficult for the instrument to show high enough risk to support civil detention in most cases. However, in 2009 the developers introduced a new method that can artificially inflate risk levels by comparing an offender not to the instrument's aggregate norms, but to a specially created "high risk" subsample (or "reference group") with unusually high recidivism rates.

Some evaluators are using this method on any offender who is referred for possible civil commitment. For example, I was just reviewing the transcript of a government expert's testimony that he uses these special high-risk norms on offenders who are referred for "an administrative or judicial process." In some cases, this amounts to heaping prejudice upon prejudice. Let's suppose that an offender is referred in a biased manner, due to his race or sexual orientation (something that happens far more often than you might think, and will be the topic of a future blog post). Next, based solely on this referral, this individual's risk level is calculated using recidivism rates that are guaranteed to elevate his risk as compared with other, run-of-the-mill offenders. This method has not been peer reviewed or published, and there is no evidence to support its reliability or validity. Thus, it essentially amounts to the claim that the offender in question is at an especially high risk as compared with other offenders, just "because I (or we) say so." 

The admission of poor stability across samples should make it more difficult to claim that this untested procedure -- which assumes some level of commonality between the selected reference group and the individual being assessed -- is sufficiently accurate for use in legal proceedings. Given some of the sketchy practices being employed in court, however, I am skeptical that this practice will be abandoned in the immediate future.

The article is: "Absolute recidivism rates predicted by Static-99R and Static-2002R sex offender risk assessment tools vary across samples: A meta-analysis" by Leslie Helmus, R. Karl Hanson, David Thornton, Kelly M. Babchishin and Andrew J. R. Harris. Click HERE to request a copy from Dr. Hanson. 

Mysterious mental illness epidemics hit sexual predators in Arizona, Illinois

European sex offenders largely spared pejorative conditions

First responders racing to scene of a pedophilia outbreak

A survey of Sexually Violent Predator cases in eight U.S. states has revealed striking disparities in psychiatric disorders.

Almost two-thirds of the worst-of-the-worst sex offenders in Arizona suffer from pedophilia, and more than half have bad cases of a strange-sounding new disease called "paraphilia not otherwise specified." That is almost double the rate of pedophilia cases in Minnesota (with 35 percent) and, similarly, much higher than the rate of paraphilia not otherwise specified in Wisconsin (37 percent).

Meanwhile, a whopping 94 percent of sex offenders in Illinois suffer from personality disorders, most commonly antisocial personality disorder and an oddball affliction called "personality disorder not otherwise specified." That’s more than double the rate of personality disorders in Wisconsin, where only 41 percent of sex offenders have any personality disorder, mostly antisocial personality disorder.

The cause of the strange outbreaks remains shrouded in mystery. Could the dry climate in the U.S. Southwest produce more pedophiles? Perhaps the Chicago winds lend themselves to an infiltration of antisocial characters? Or, there is always the possibility of circumscribed contagions within the containment facilities for sex offenders in these two geographically discreet states (as in Legionella pneumophila).

Quarantining suspected antisocial virus carriers returning from court

The researchers who discovered the pattern attribute some of the variation to sampling differences. The Florida and Texas samples may have lower rates of mental illness, they write, because those samples included men who were referred for civil commitment but found not to meet criteria. In contrast, the samples from the other states consisted of men who were either civilly committed or on their way to being committed, having lost probable cause hearings in court.

The researchers are Shan Jumper, clinical director of a detention facility in the personality disorder-ridden state of Illinois and a leader of a national consortium of SVP facility administrators, and colleagues Mark Babula of Ohio and Todd Casbon of Indiana.

The three surveyed the SVP population in Illinois and compared their results with previously collected data from Arizona, California, Florida, Minnesota, Texas, Washington and Wisconsin. The study appears in the current issue of the International Journal of Offender Therapy and Comparative Criminology.

On average, pedophilia was the most common diagnosis among SVPs, assigned in 49% of cases nationwide. This was followed by paraphilia not otherwise specified (47%), antisocial personality disorder (43%), and personality disorder not otherwise specified (36%). Other sexual paraphilias, or abnormal sexual predilections, such as voyeurism, exhibitionism and sexual sadism, were assigned far less frequently.

Illusory differences?

All kidding aside, I would be willing to bet that there’s not a whole lot of genuine difference among the detained sex offenders in one state as compared with another. If that is so, then the dramatically different rates of diagnosis among the eight states is further evidence that these diagnoses – invoked as a legal basis for involuntary detention – are being applied arbitrarily, even whimsically, and lack sufficient reliability or validity.

Further support for evaluator differences as accounting for the large discrepancies is the fact that rates of these mental disorders are far lower in European countries that do not require mental illness as a basis for preventive detention of dangerous sex offenders. In one German survey, for example, about one-third of men who were civilly detained had molested children yet only 7 percent were diagnosed with pedophilia, suggesting the diagnosis is reserved for those with a demonstrable sexual orientation toward children.

The intriguing question of why forensic evaluators in certain of the 20 U.S. states with Sexually Violent Predator statutes are more likely to assign a given diagnosis than are their counterparts in other states remains a mystery.

The irony of the "NOS" label

With the advent of SVP laws, "NOS" categories of paraphilia (sexual deviance) and personality disorder have steadily gained popularity among sex offender evaluators in the United States.

The irony of assigning the label of "not otherwise specified" as if it is a bona fide mental disorder meriting involuntary detention largely escapes notice. But what an evaluator is actually conceding in assigning that descriptor is that the individual does NOT meet the minimal criteria for any established mental disorder, as catalogued in the American Psychiatric Association’s diagnostic manual, the DSM-IV-TR.

If you flip through the personality disorders section of the DSM, you will notice all manner of symptoms. Stop any random stranger on the street, and he or she is likely to manifest at least a few. For example, consider these:

• Angry reactions to perceived attacks on character or reputation (paranoid personality)
• Use of physical appearance to draw attention to oneself (histrionic personality)
• Envy of others (narcissistic personality)
• Feelings of inadequacy (avoidant personality)
• Difficulty disagreeing with others for fear of losing their support (dependent personality)
• Reluctance to delegate unless others conform to one's standards (obsessive compulsive personality)

The label of "personality disorder not otherwise specified" is given to individuals who are thought to have some smattering of symptoms of one or more personality disorders, but do not meet the full criteria for any. Most often, this label carries the specifier, "antisocial traits." What this actually means is that the individual does not meet even the minimal criteria for a diagnosis shared by a large proportion -- anywhere from 40 to 60 percent -- of garden-variety criminals in prison. (Of course, to qualify for a personality disorder, the person must suffer distress or impairment in functioning as a result of his symptoms. But, in a tautology, evaluators often say that this condition is met by the mere fact of arrest and incarceration.)

Harkening back to the original justification for SVP laws, the US Supreme Court stressed, in the landmark cases of Hendricks (1996) and Crane (2002), that the goal of civil commitment was to isolate a handful of mentally disordered predators who were qualitatively different from the run-of-the-mill criminal. How a diagnosis that essentially admits that the individual does not even qualify for an established disorder can meet that threshold is beyond me.

Click HERE to request the article, “Diagnostic Profiles of Civilly Committed Sexual Offenders in Illinois and Other Reporting Jurisdictions: What We Know So Far,” from the first author.

Assessing “volitional control” in sex offenders

When I review government reports in sexually violent predator cases, I find that most focus on two things: (1) the person's risk of future sexual violence, and (2) whether that risk is related to a psychiatric disorder.

But this misses a critical piece of the puzzle. In order for a civil commitment based on future danger to be Constitutional under Kansas v. Crane, the former sex offender must also demonstrate a serious difficulty controlling his behavior.

It's understandable that some evaluators shy away from addressing this issue of so-called "volitional control." After all, it is not easy to measure. Far easier to assume a circular tautology, in which a failure to control one's behavior is advanced as evidence of inability to exert self control. But, as the American Psychiatric Association famously noted in a 1983 statement opposing conclusory opinions on volitional control in insanity cases:

"The line between an irresistible impulse and an impulse not resisted is probably no sharper than that between twilight and dusk."

Into this breach jumps psychologist Frederick Winsmann of Boston. In an article in the current issue of Sex Offender Treatment, he proposes a model for how to assess volitional control in sexually violent predator evaluations.

Credit: The Bad Chemicals

Winsmann theorizes that poor self control emanates from two related processes: (1) behavioral impulsivity, and (2) impaired decision-making. He recommends that evaluators incorporate screening measures that tap into these two processes, such as the Barratt Impulsiveness Scale and tests of executive (frontal lobe) functioning like the Wisconsin Card Sorting Test or the Iowa Gambling Task.

While this approach is a welcome step in the right direction, it must be recognized that tests of impulsivity and frontal lobe functioning are just indirect measures of the volitional impairment that is theorized to underlie some sexual offending.

Indeed, Winsmann stresses that these tests should be approached as part of a larger idiographic framework of understanding the person as a unique individual, and that poor test performance does not in and of itself establish volitional impairment. For example, scores may be lowered by poor cognitive abilities. (I have also seen cognitively normal people with fine self control do poorly on the Wisconsin Card Sorting Test due to high anxiety.)

The full article is available for free online (HERE).

Open letter opposing DSM-5 paraphilias expansion

Photo credit: Dr. Joanne Cacciatore

As readers of this blog are aware, proposals to expand the sexual disorders in the American Psychiatric Association's upcoming DSM-5 have generated significant controversy among forensic psychologists and psychiatrists. Now, forensic psychologists are banding together to urge APA President John Oldham to reject the proposed diagnoses of pedohebephilia, paraphilic coercive disorder and hypersexual disorder. The text of an open letter drafted by Richard Wollert, an Oregon psychologist with extensive experience in sex offender treatment and evaluation, follows. If, after reading it, you would like to become a signator, just click on the indicated link, and provide Dr. Wollert with your name and professional credentials. Don't delay, as I understand that this important letter is being submitted very soon. 

CLICK HERE TO ADD YOUR NAME TO THE LETTER

 

Dear Dr. Oldham:

As a mental health professional and/or sex educator I am writing to you to encourage the American Psychiatric Association to leave invalid sexual disorders out of DSM-5. 

In 1999, the Dangerous Sex Offender Task Force of the American Psychiatric Association issued a strongly worded statement about psychiatry's failed efforts to meaningfully define and classify sexual deviance. In contrast to the cautious approach advised by the Task Force, a Paraphilias Subworkgroup of the DSM-5 is vigorously lobbying for the adoption of three highly controversial expansions of sexual disorders (Hebephilia, Paraphilic Coercive Disorder, and Hypersexual Disorder). The expansions would be a major mistake, due to poor reliability, unproven validity and -- most of all -- the potential for vast and harmful unintended consequences. 

The Subworkgroup is now proposing to add a "Hebephilic" type to Pedophilia, extending the diagnosis of Pedophilia from covering those with sexual attractions to prepubescent children to those with sexual attractions to pubescent children under age 15. It also proposes to add new diagnoses of "Paraphilic Coercive Disorder" and "Hypersexual Disorder" to the Appendix as "Criteria Sets for Further Study." I am dismayed by each of these recommendations for the following reasons. 

Hebephilia lacks conceptual coherence. Most men are attracted to sexually maturing 14-year-olds, as reflected in the large number of industrialized countries where the age of sexual consent is 14 (Green, 2010). Normative attractions may be criminal when acted upon, but they should not be labeled as mental disorders. "Hebephilia" is an archaic term that languished in psychiatric obscurity until the passage of modern civil commitment laws in the United States (Franklin, 2010). Since then, some evaluators who confuse statutory rape with mental disorder have invoked Hebephilia as a condition that justifies civil commitment (Ewing, 2011). Such usages do not provide a cogent explanation for behavior that is illegal in the United States but legal in other countries being classified as a mental disorder. Finally, Hebephilia lacks adequate diagnostic reliability (Wollert and Cramer, 2011). Most of the research has been conducted by a single Canadian research team that is overly represented on the Paraphilias Subworkgroup. Although the DSM-5 Task Force has indicated that final decisions about proposed revisions will be made on the basis of field trial data, a November 2011 change in the proposed criteria for the diagnosis rules out the application of even this meager safeguard. 

Paraphilic Coercive Disorder (PCD) was initially proposed for inclusion in DSM-5 as a diagnosis that would be limited to men who preferred rape over consensual sex. Because only a very small percentage of rapists prefer rape over consensual intercourse (American Psychiatric Association, 1999), clinicians are unable to reliably apply this label (Wollert, 2011). This is one reason for the American Psychiatric Association's consistent rejection of rape-based paraphilias in three previous editions of the DSM (Zander, 2008). In the face of overwhelming opposition, the Subworkgroup has taken the fallback position of recommending PCD only for inclusion in the Appendix as a condition meriting "further study." However, this would confer an undeserved back-door legitimacy to the invalid construct. Rather than a mental disorder, rape is a crime for which the proper placement is prison. 

The proposed criteria for Hypersexual Disorder (HD) are the product of a recent ad hoc literature review by Martin Kafka, a member of the Subworkgroup. His review indicated their validity has not been empirically confirmed. Given the inherent difficulty in determining at what point a normal human drive becomes abnormal, it is not surprising that the proposed diagnosis is marred by conceptual confusion and vague verbal anchors (Moser, 2011). Its poor reliability and validity will translate to a high rate of false positives in both civil commitment trials and outpatient clinics that serve the community in general. With the proposal becoming a magnet for ridicule both by academic scholars and the popular press, it too has been relegated to the Appendix. However, the Appendix was not intended as a storage site for criteria sets that, like Hypersexuality Disorder, have never been tested. 

These three proposals all lack adequate empirical support. They will increase false positive diagnoses by labeling behaviors that are normative, developmental, or criminal as mental disorders. Promoting the misclassification of juveniles and other vulnerable populations as dangerous sex offenders, they will undermine the reputation of forensic practitioners and those who study sexual behavior. Collectively, professions that endorse the use of unreliable diagnoses run the risk of losing their credibility. 

The British Psychological Society, the American Counseling Association, and the Society for Humanistic Psychology and many other divisions of the American Psychological Association have all submitted petitions or letters of concern to the American Psychiatric Association regarding revisions proposed for the DSM-5. These documents express concerns about the lack of empirical support for many DSM-5 proposals, the likelihood of “false-positive epidemics” flowing from decreased diagnostic thresholds, and the negative effects of "over-medicalizing" human behavior. They also point out that the prevention of false-positive epidemics should take precedence over "nomenclatural exploration" and that the temptation to adopt new diagnoses should be tempered by the recognition that diagnostic labels tend to be confounded with normative social expectations. 

I share these concerns as they apply to sexual disorders. I further support the adoption of sexual disorder criteria sets only after they have been established to have high true positive rates and acceptable false positive rates. Therefore, I urge the DSM Task Force to remove the Hebephilia qualifier from the proposed diagnosis of Pedophilia, and to eliminate Paraphilic Coercive Disorder and Hypersexual Disorder from any inclusion in the DSM-5. 

Sincerely, 

CLICK HERE TO ADD YOUR NAME TO THE LETTER

(email your name and professional credentials to Dr. Wollert)

References 

American Psychiatric Association (1999). Dangerous sex offenders: A task forcereport of the American Psychiatric Association. Washington D. C.: American Psychiatric Association.

Ewing, C. P. (2011). Justice perverted: Sex offense law, psychology, and public policy. New York: Oxford University Press. 

Franklin, K. (2010). Hebephilia: Quintessence of diagnostic pretextuality. BehavioralSciences and the Law, 28, 751-768. 

Green, R. (2010). Sexual preference for 14-year-olds as a mental disorder: You can’t be serious!! [letter to the editor]. Archives of Sexual Behavior, 39, 585-586. 

Moser, C. (2011). Hypersexual Disorder: Just more muddled thinking [letter to theeditor]. Archives of Sexual Behavior, 40, 227-229. 

Wollert, R. (2011). Paraphilic Coercive Disorder does not belong in DSM-5 forstatistical, historical, conceptual, and practical reasons [letter to the editor]. Archives of Sexual Behavior, 40, 1097-1098. 

Wollert, R. & Cramer, E. (2011). Sampling extreme groups invalidates research on the Paraphilias. Behavioral Sciences and the Law, 29, 554-565. 

Zander, T. (2008). Commentary: Inventing diagnosis for civil commitment of rapists. The Journal of the American Academy of Psychiatry and the Law, 36, 459-469.

Hebephilia bites the dust -- again

  Federal judge rules that faux diagnosis cannot be basis for civil detention 

In yet another blow to those seeking to expand mental illness in order to civilly detain U.S. citizens for possible future crimes, a judge has again held that the faux diagnosis of  "hebephilia" is not valid for this purpose.The Good Friday ruling was one in a string of defeats for the federal government in its efforts to civilly detain ex-convicts under the Adam Walsh Act.

Judge Terrence Boyle rejected the testimony of two government psychologists who had diagnosed George Hamelin with hebephilia based on his sexual misconduct with one 13-year-old boy and another boy under the age of 13 (whose precise age was not specified).

Calvin Klein billboard: Fashion industry banking on hebephilia

As opposed to pedophilia, hebephilia involves sexual attraction to youths who have reached puberty. The controversial diagnosis was first proposed by a team of psychologists at a sex clinic up in Toronto. Two members of the Canadian team also belong to the sexual disorders work group for the DSM-5, the upcoming revision of the American Psychiatric Association’s influential diagnostic manual. With sexually violent predator statutes enacted by the federal government and 20 U.S. states requiring a mental disorder as a prerequisite for civil commitment, government evaluators have taken to invoking the label against sex offenders who are neither pedophiles nor rapists.

Wrote the judge in rejecting the label as a basis for civil commitment:

Hebephilia is not listed as an accepted mental disorder in the DSM-IV-TR. Although hebephilia has been proposed to be included as a mental disorder in the revision of the DSM, it has been rejected as a proper mental disorder by numerous psychologists…. [N]oted mental health professionals have opined that sexual arousal to pubescent and post-pubescent minors is not an inherently deviant sexual interest, albeit one that, in this country, if acted on might violate the law.

The Court finds persuasive the testimony of Dr. [Joseph] Plaud on this issue, who states in his report that "a possible diagnosis of a deviant sexual interest in pubescent/post-pubescent males, termed by some psychologists as 'paraphilia NOS hebephilia/ephebophilia,' ... is an invalid diagnosis."

Given that the characterization of hebephilia is a contested issue in the mental health community, the Court finds that it would be inappropriate to predicate civil commitment on a diagnosis that a large number of clinical psychologists believe is not a diagnosis at all, at least for forensic purposes.

I hope the American Psychiatric Association is listening. If they let the proposed diagnosis of pedohebephilia sneak into the DSM-5, it will only contribute to the already massive outpouring of criticism being leveled against them for expanding the range of mental illnesses. A grassroots petition protesting the diagnostic expansions has garnered almost 13,000 signatures to date.

My report on Judge Boyle's January ruling rejecting hebephilia in the case of Jeffrey Neuhauser (Federal judge tosses hebephilia as basis for civil detention) is HERE. My online resource page on hebephilia is HERE. Wikipedia has further background and links on the controversial diagnosis. A USA Today probe of the beleaguered federal SVP program is HERE.

USA Today probe: Federal SVP program crumbling

Constitutionality of lengthy sex offender detentions questioned

In the six years since the U.S. government authorized civil detention for dangerous sex offenders, it has sought to commit 136 men. Out of those, it has won civil commitments of only 15, or 11 percent.

In contrast, it has either lost, or been forced to dismiss, 61 cases, or 45 percent. (Actually, make that 62.*)

The remaining 59 men (43 percent) are languishing in prison, locked in legal limbo while their cases await resolution. (A 136th man has died.)

An investigative report by USA Today paints a picture of federal prosecutors and their prison "experts" as flailing in their efforts to establish that they qualify as "sexually dangerous persons." The legal criteria for this designation include a history of sexually violent conduct or child molestation and a mental illness that would cause the person difficulty in refraining from such behavior if released.

I put the word "expert" in quotes because many of the prison psychologists drafted to conduct these evaluations and testify in court had no prior experience and little or no training when the law went into effect. As the former psychologist in charge told USA Today, "It was rushed, and initially, I believe, quality probably suffered."

The government's cases "have crumbled because of weak evidence, faulty psychological evaluations and an inability to convince judges the detainees have mental conditions so serious they will find it difficult to not re-offend," the USA Today reports. Due to the low levels of recidivism among convicted sex offenders, "even when the government can prove someone committed sex crimes, it has struggled to show he remains dangerous."

Brad Heath and Amanda Muscavage reviewed thousands of pages of legal filings and interviewed dozens of attorneys, psychologists and former detainees for their report. Their interactive website includes links to 290 documents that they have made available online.

USA Today reporter Brad Heath

In one amazing quote, the psychologist who formerly ran the civil commitment program at Butner, the prison in North Carolina where the detainees are being held, all but admits that clinicians certified men as sexually dangerous even knowing that they did not meet the legal criteria.

"If we thought someone was really dangerous but there wasn't a strong legal case, we might very well still push it for the public interest," Anthony Jimenez said. "Hopefully justice is served in the end."

This is the "consequentialist" approach advocated by some in the sex offender industry, who claim that sexually violent predator cases represent an exception to general forensic practice, in which the end (protecting the public) justifies the means. If anything, however, the high stakes involved when people are threatened with a loss of liberty for something that they might do in the future would seem to demand the opposite approach, of even greater caution and transparency in diagnosis and risk assessment.

As Fred Berlin, the director of the Sexual Behaviors Consultation Unit at the Johns Hopkins Hospital, told the reporters: "We need to be very, very careful in a free society about a system in which a group of people can make statements that result in someone being deprived of their liberty for a future crime. If it's going to be done, it has to be done in a just and fair manner."

One reason for the government’s quagmire is that the federal cases are decided by a judge, rather than a jury. The seasoned judges hearing these cases are less likely to let their emotional reactions to past crimes, some of them pretty upsetting, distract them from the government's legal burden of proof.

For example, in the recent trial of Markis Revland (which I blogged about HERE), the offender had admitted to 149 child molestations. However, the judge found that the government had failed to prove that any of these incidents actually happened, or that Revland had a genuine mental illness.

Similarly, at the trial of Jeffrey Neuhauser (which I blogged about HERE), the judge rejected the controversial label of "hebephilia" as a legitimate mental illness qualifying someone for involuntary detention.

Unfortunately, because they only had access to records that have been made public, the USA Today team didn't have the 411 on some of the most egregious attempts to civilly detain low-risk prisoners. In one case I am familiar with, the government spent four years pursuing civil commitment against a man who was quite clearly not mentally ill, not a rapist, not a pedophile, and not dangerous, only to dismiss the case on the eve of trial.

This case points to an aspect that I wished the USA Today team had delved into: The unusual nature of the federal sex offender population. Although those eligible for civil commitment are supposed to be the worst of the worst, in reality Butner's population is heavily weighted toward an unlikely admixture of:

• Men convicted of possessing or distributing online child pornography, criminalized in 2003, and

• Native Americans.

The second group was the surprise to me. Unlike routine sex offenses that are prosecuted in state courts, crimes committed on Indian reservations are federal offenses.

Up until now, neither the U.S. Justice Department nor any watchdog agency has expressed public concern with whether the the federal civil commitment scheme, with its haphazard and capricious implementation, passes Constitutional muster.

Hopefully, this USA Today report will bring some much-needed attention to just what is going on down there in North Carolina.

Prior blog posts about the federal civil commitment prosecutions:

• Civil commitment petition against Butner, NC prisoner dismissed (Jan. 5, 2012)
• Federal judge tosses hebephilia as basis for civil detention (Jan. 20, 2012)

*The situation remains fluid. Right after the publication of the USA Today report five days ago, I have learned that the government lost yet another trial. This despite a 200-page report from a government expert assigning Steven Wiseman a panoply of mental disorders, including pedophilia, hebephilia and antisocial personality disorder.

Blogger urges new paradigm for sex offenders

Clarence Opheim, sentenced to 4 years
in prison back in 1988

Among sex offenders in Minnesota, Clarence Opheim is a very important man. After 20 years of treatment, the 64-year-old pedophile will be the second person ever released from civil detention in the North Star State, which holds the dubious distinction of having the highest per capita civil commitment rate.

The other 639 detainees are pinning all their hopes on next month's provisional release. If Opheim can make it, maybe they can too. The only other guy who came out except in a body bag violated his release conditions and in 2003 was returned to detention, where he died at age 45 of a heart attack. [See comments section for more on him.]

The program has been under pressure to release someone; otherwise, it might be found Unconstitutional: The legal premise behind civilly detaining people for crimes that are only remote future possibilities is not that they will be locked up forever, but that they will be treated and then released.

Although some are cheering this as a major turning point in the civil commitment industry, one prominent Minnesota clinician says the celebration is premature: What we really need is a bold paradigm shift in which industry leaders reject civil commitment altogether.

Comparing the civil commitment of sex offenders to the interment of Japanese during World War II, Jon Brandt asks, “If hindsight is 20/20, when we look back at sex offender civil commitment many years in the future, will we be proud of the roles that we had today?"

Brandt, a social worker, directs a residential treatment program for adolescent boys. He is also an expert witness in juvenile proceedings and a frequent professional trainer and media commentator who has addressed the Minnesota legislature on child welfare issues.

In his guest post on the blog of the influential Association for the Treatment of Sexual Abusers (ATSA), Brandt says the industry may have painted itself into a corner through its timidity about releasing sex offenders back into the community:

The Moose Lake detention site

It is not just in everyone's interest that Mr. Opheim succeeds; it is imperative. Consider the alternative: If the second of only two discharges in MSOP [the Minnesota Sex Offender Program] history fails, for any reason, both failures will be seen as a malfunction of both MSOP and SOCC [sex offender civil commitment]. A second unsuccessful discharge is not only likely to have far-reaching consequences for sexual offender management in Minnesota; a seismic "thud" may well be heard at ATSA listening posts across the country. In addition, it would be hard for the courts to ignore.

SOCC in Minnesota may now be painted into a corner. In the interest of public safety we may have compromised Constitutional protections beyond integrity. Perhaps Ben Franklin's quote is apt, that "those who would give up essential liberty to purchase a little safety deserve neither liberty nor safety."

Brandt urges ATSA to take the lead in challenging civil commitment, based on the low rates of sex offender recidivism established through empirical research including a new survey in Connecticut that found that only 3.6 percent of parolees who had served a prison term for a sex crime were arrested and charged with a new sex crime:

We have very solid empirical evidence to challenge current misguided public policies. We need to get good research to the right folks. We need to infuse policy makers with the necessary information for bureaucracies to champion productive recommendations into meaningful change…. If we use our knowledge and expertise to educate the public, inform our colleagues, and persuade policymakers that best practices should emanate from good science, we might not have to settle for incremental changes. We can help create new paradigms….

If professionals who work with sexual offenders do not challenge the politics, misinformation, and misguided management of sex offender civil commitment, where is a more credible voice going to come from? In an area of public policy where reason is often eclipsed by emotion, ATSA members may be in the best position to know the research, understand competing principles, and advocate for sound rationales. If forensic psychology with sexual offenders is being dominated more by forensics than psychology, I would suggest that the tail might be wagging the dog.

I recommend reading the entire post, available HERE.

Treatment and risk among the most dangerous sex offenders

 Study questions need for lengthy treatment of detainees 

McNeil Island with prison ferry in foreground

McNeil Island is a lonesome place these days. In a cost-saving moving, the state of Washington has shuttered the prison. The McNeil Island Correctional Center was the last of its kind, the twin sister of the more infamous Alcatraz Penitentiary in the San Francisco Bay.

Back when I briefly worked there in the late 1990s, it was a rustic place, its forests and overgrown orchards teeming with deer and other wildlife. Now, it is dominated by a modern civil detention site housing about 284 sex offenders. Built at a cost of $60 million, the Special Commitment Center costs another $133 million* per year to run, at a time of massive cuts to essential public services.

Special Commitment Center (photo credit: Seattle Times)

Although Washington holds the distinction of housing civil detainees on a remote island that can only be reached by air or water, the state's larger quandary is not unique. Swept along by public panics and political posturing, 20 U.S. states have approved civil detention programs that are becoming costly albatrosses.

The 30 other U.S. states, as well as other countries around the world, are in a position to ridicule the obscenely high costs of indefinitely quarantining such small handfuls of offenders.

Our neighbors to the north are far more sensible, as it turns out. At the Regional Treatment Centre (RTC) in Kingston, Ontario, Canada, civil commitment is nonexistent, and the highest-risk sex offenders may be released after an average of just seven months of treatment.

And how many of those bad actors go on to sexually reoffend after their brief but intensive treatment?

Fewer than 6 percent, according to a new study. Although the study's 2.5-year follow-up period is relatively short, the findings echo those of a previous study by co-author Jeffrey Abracen and colleagues, finding that even after nine years, only about 10 percent of offenders released from the RTC had reoffended.

Comparing high-risk Canadian sex offenders with similarly dangerous offenders civilly committed in the U.S. state of Florida, the researchers found the two populations to be virtually identical. Of the 31 sex offenders released in Florida, only one (or 3 percent) sexually reoffended. Because so few sex offenders are being released from civil detention sites in the United States, it is difficult to accurately estimate how many of them might reoffend in the community; this study could help to fill this gap, by providing a proxy group.

The low recidivism rates in Canada after only brief treatment suggests that the interminable treatment regimens at U.S. civil commitment sites, which typically last for years and years, are "more cultural than practical," reflecting the U.S. propensity for severe punishment, according to the study's authors, Robin Wilson and Donald Pake Jr. of Florida and Jan Looman and Jeffrey Abracen of Canada. One downside of such interminable treatment is that offenders may become institutionalized, with negative affects on their personalities, the authors suggest.

The researchers highlighted the fact that despite being among the highest-risk sex offenders from their respective prison systems, both the Canadian and U.S. offenders reoffended at rates far below those predicted by the Static-99 and Static-99R, the most widely used actuarial instruments for predicting recidivism.

These researchers are not the only ones coming to the conclusion that the actuarial instruments drastically overpredict recidivism. In the state of Virginia, lawmakers are questioning the use of the Static-99 after noting that civil commitment recommendations shot up when the state began mandating use of the Static-99 in 2006, jumping from about 7 percent to 25 percent of all sex offenders being released from prison.

"When the test was designated in law in 2006, it was believed that a score of 5 meant that the offender was 32 percent likely to commit another sex crime," according to a news report. "Updates have brought that risk down to about 11 percent. Researchers say that even may be too high."

Echoing what many of us have been saying for several years now, a study by Virginia's Joint Legislative Audit and Review Commission, the investigative arm of that state's General Assembly, concluded that the Static-99 is not all that accurate for assessing the risk of specific individuals, as opposed to groups.

Rather than scrapping the civil commitment program altogether, and saving themselves a cool $23 million per year, the first state to mandate the Static-99 almost did a 180 to become the first state to scrap its use altogether. Proposed legislation would have entirely "eliminate[d] the use of the Static-99 assessment instrument" for civil commitment purposes. For some reason, though, that language was removed from the most current version of House Bill 1271.

Stay tuned. As more solid research begins to overtake the hype, these and other political skirmishes are likely to become more common in financially desperate states. Eventually, I predict the entire civil commitment enterprise will hit the scrap pile as did the old sexual psychopath laws of the 1950s, but not before 20 U.S. states and the federal government squander many, many more millions of public dollars.

The study is: Comparing Sexual Offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center by Robin Wilson, Jan Looman, Jeffrey Abracen and Donald Pake Jr., forthcoming from the International Journal of Offender Therapy and Comparative Criminology. To request a copy of this article, you may email co-author Jan Looman (CLICK HERE). Thank you, Dr. Looman.

*See comment by Becky, below, who found the exact cost in the current state budget.