Military sexual assault scandal unearths "illegal" psychiatric diagnoses

If you haven't been following the sexual assault scandals in the U.S. military, tune in: It’s yet another arena where bogus psychiatric diagnoses are playing a sordid role.

Women soldiers who report sexual assault are diagnosed with psychiatric conditions such as borderline personality disorder or bipolar disorder that get them drummed out. Not only are their careers ruined, but they are denied benefits and sometimes must even repay any bonuses they got for enlisting.

Because the symptoms of these "preexisting" disorders overlap with the emotional sequelae of trauma -- anger, fear, depression, anxiety, avoidance -- it can be hard to tell the difference.

Women in every branch of the U.S. military are being disproportionately discharged with personality disorders, according to an investigative series, Twice Betrayed, in the San Antonio (Texas) Express-News. The Air Force has the widest disparity: Women make up 20 percent of the force, but 35 percent of personality discharges.

Sometimes, as in one case featured in the Express-News series, military psychologists and psychiatrists are being influenced by officers in the accused's or accuser's chain of command to view accusers as mentally unstable and/or sexually promiscuous.

In a report on "illegal" psychiatric diagnoses, the Vietnam Veterans of America say that in addition to rape victims, many combat soldiers with organic brain trauma or posttraumatic stress disorder continue to be drummed out of the military with bogus personality disorders and adjustment disorders that block their disability benefits, despite Congressional efforts to crack down on this abuse (for example, by requiring that the diagnoses be issued by psychiatrists or PhD-level psychologists).

It was a bit incongruous to find myself sitting in an Air Force courtroom, consulting on a sexual assault case, when the news broke that the chief of the Air Force's Sexual Assault Prevention and Response program had been arrested for sexually assaulting a female stranger in a parking lot.Talk about the fox guarding the hen coop.

That bizarre twist came on the heels of a headline-grabbing survey documenting skyrocketing rates of sexual assault in the military: An estimated 26,000 soldiers were sexually assaulted in 2012, up from 19,000 the year before. Women in the military face about twice the risk of sexual assault as civilian women (one in three versus about one in six). And only a tiny fraction of assaults -- 3,374 last year-- are reported.

That's likely due to the fact that women who do report rape are shunned, disbelieved, and retaliated against, and their assailants are rarely punished. The seven-month investigation by Karisa King of the San Antonio Express-News found that only about 10 percent (302 of 2,900) of the accused were court martialed, with only 177 sentenced to confinement. (The airman in my case was one of those rare few, but then again he was a low-level airman, not an officer. And it probably didn't help his case that all of these scandals were busting out that very week.)

It’s no coincidence that the San Antonio paper ran the series: Outside that city sits the sprawling Lackland base, the Air Force's basic training center for enlisted personnel. In an unfolding investigation there, at least 33 training instructors are suspected of sexually assaulting 63 or more trainees.

If this latest scandal isn't enough to convince people of the link between sexual violence and a climate of hostile masculinity (as researchers such as Neil Malamuth have been arguing for decades), I don't know what is. On the other hand, if psychologists in the sex offender treatment industry got their hands on these training officers, they'd probably label them with some fictional disorder like "paraphilia not otherwise specified (nonconsent)" that decontextualized their behaviors beyond recognition. 

Consulting in a military court martial one week and a sexually violent predator civil commitment hearing the next, I can't help but notice how mental illness strikes in clusters, afflicting sexual assault victims in one setting and offenders in the other. The clue that situational exigency is in play is that in neither case is the diagnosis about helping the supposed sufferer. It's all about punishment, with diagnosis as the weapon.

I highly recommend the series, Twice Betrayed. An in-depth report by the The Vietnam Veterans of America on the misuse of psychiatric diagnoses in the military, Casting Troops Aside, is HERE.

Miracle Village: A leper colony for bogeymen

Almost 750,000 Americans are now on sex offender registries, and the numbers just keep growing. Because the truly dangerous are mixed in with the far more numerous low-risk offenders, registries are useless from a public safety perspective. But they do have a pernicious effect on ex-offenders, who -- like the lepers of yore -- oftentimes find themselves with nowhere to go and no hope of ever reintegrating into society.

Enter "Miracle Village" in Florida. Built in 1964 for sugar cane workers (some of whom still live there), it was transformed into a haven by an evangelical pastor and his wife (both of whom, ironically, were sexually molested as children). It's now home to about 100 convicted sex offenders, a place they can be among others like themselves and feel a bit more human. Since the community was established in 2009, there has not been one reported sex crime, according to the local sheriff's office.

But it's only a drop in the bucket. The demand is extraordinary; more than 100 people per week apply for the limited housing.

The short video Sex Offender Village was put together by two people who come from what might be seen as opposite ends of the spectrum: Documentary filmmaker Lisa Jackson has spent years examining sex crimes from the victim’s point of view; David Feige is a former chief public defender from the Bronx turned TV writer. But they agree on one thing: U.S. sex offender laws are "doing more harm than good":

In the past 25 years, the laws governing sex offenses have gone from punitive to draconian to senseless. The term 'sex offender' simply covers too wide a range now, painting the few truly heinous crimes and the many relatively innocuous ones with the same broad brush. This overly broad approach wastes resources that could be better spent, for instance, on clearing the huge and unforgivable backlog of untested rape evidence kits. We see even deeper problems: the explosion of sex offender registries, stringent yet demonstrably ineffective residency restrictions, and the bizarre world of 'civil commitment,' where we punish what someone might do rather than what he or she has done. All of this suggests that our entire approach to dealing with sex offenders has gone tragically off the rails.

CLICK ON ABOVE IMAGE TO VIEW THE 5-MINUTE VIDEO AT THE NEW YORK TIMES OP-ED WEBSITE.

Risk screening worthless with juvenile sex offenders, study finds

Boys labeled as 'sexually violent predators' not more dangerous

Juveniles tagged for preventive detention due to their supposedly higher level of sexual violence risk are no more likely to sexually reoffend than adolescents who are not so branded, a new study has found.

Only about 12 percent of youths who were targeted for civil commitment as sexually violent predators (SVP's) but then freed went on to commit a new sex offense. That compares with about 17 percent of youths screened out as lower risk and tracked over the same five-year follow-up period.

Although the two groups had essentially similar rates of sexual and violent reoffending, overall criminal reoffending was almost twice as high among the youths who were NOT petitioned for civil commitment (66 percent versus 35 percent), further calling into question the judgment of the forensic evaluators.

Because of the youths' overall low rates of sexual recidivism, civil detention has no measurable impact on rates of sexual violence by youthful offenders, asserted study author Michael Caldwell, a psychology professor at the University of Wisconsin and an expert on juvenile sex offending.

The study, just published in the journal Sexual Abuse, is one in a growing corpus pointing to flaws in clinical prediction of risk.

It tracked about 200 juvenile delinquents eligible for civil commitment as Sexually Violent Persons (SVP's). The state where the study was conducted was not specified; at least eight of the 20 U.S. states with SVP laws permit civil detention of juveniles, and all allow commitment of adults based on offenses committed as a juvenile.

As they approached the end of their confinement period, the incarcerated juveniles underwent a two-stage screening process. In the first phase, one of a pool of psychologists at the institution evaluated them to determine whether they had a mental disorder that made them "likely" to commit a future act of sexual violence. Just over one in every four boys was found to meet this criterion, thereby triggering a prosecutorial petition for civil commitment.

After the initial probable cause hearing but before the final civil commitment hearing, an evaluator from a different pool of psychologists conducted a second risk assessment. These  psychologists were also employed by the institution but were independent of the treatment team. Astonishingly, the second set of psychologists disagreed with the first in more than nine out of ten cases, screening out 50 of the remaining 54 youths. (Only four youths were civilly committed, and a judge overturned one of these commitments, so ultimately all but three boys from the initial group of 198 could be tracked in the community to see whether or not they actually reoffended.)

Evaluators typically did not rely on actuarial risk scales to reach their opinions, Caldwell noted, and their methods remained something of a mystery. Youths were more likely to be tagged for civil detention at the first stage if they were white, had multiple male victims, and had engaged in multiple instances of sexual misconduct in custody, Caldwell found.

However, no matter what method they used or which factors they considered, the psychologists likely would have had little success in predicting which youths would reoffend. Even "the most carefully developed and thoroughly studied" methods for predicting juvenile recidivism have shown very limited accuracy, Caldwell pointed out. This is mainly due to a combination of youths' rapid social maturation and their very low base rates of recidivism; it is quite hard to successfully predict a rare event.

Indeed, a recent meta-analysis revealed that none of the six most well-known and best-researched instruments for appraising risk among juvenile sex offenders showed consistently accurate results. Studies that did find significant predictive validity for an instrument were typically conducted by that instrument's authors rather than independent researchers, raising questions about their objectivity.

"Juveniles are still developing their personality, cognitions, and moral judgment, processes that reflect considerable plasticity," noted lead author Inge Hempel, a psychology graduate student in the Netherlands, and her colleagues. "There are still many possible developmental pathways, and no one knows what causes persistent sexual offending."

Caldwell agrees with Hempel and her colleagues that experts' inability to accurately predict which juveniles will commit future sex crimes calls into question the ethics of civil commitment.

"From the perspective of public policy, these results raise questions about whether SVP commitment laws, as written, should apply to juveniles adjudicated for sexual offenses," he wrote. "If SVP laws could be reliably applied to high risk juvenile offenders, the benefit of preventing a lifetime of potential victims makes for a compelling case. However, the task of identifying the small subgroup of juveniles adjudicated for sexual offenses who are likely to persist in sexual violence into adulthood is at least extremely difficult, and may be technically infeasible."

* * * * *

The articles are:

Michael Caldwell: Accuracy of Sexually Violent Person Assessments of Juveniles Adjudicated for Sexual Offenses, Sexual Abuse: A Journal of Research and Treatment. Request it from the author HERE.

Inge Hempel, Nicole Buck, Maaike Cima and Hjalmar van Marle: Review of Risk Assessment Instruments for Juvenile Sex Offenders: What is Next? International Journal of Offender Therapy and Comparative Criminology. Request it from the first author HERE.

Miracle of the day: 80-year-old man recaptures long-lost youth

(Or: How committing a new sex crime can paradoxically LOWER risk on the Static-99R)

"How old is the offender?"

 Age is an essential variable in many forensic contexts. Older people are at lower risk for criminal recidivism. Antisocial behaviors, and even psychopathic character traits, diminish as criminals reach their 30s and 40s. Men who have committed sex offenses become at considerably lower risk for further such misconduct, due to a combination of decreased testosterone levels and the changes in thinking, health, and lifestyle that happen naturally with age.

Calculating a person's age would seem very straightforward, and certainly not something requiring a PhD: Just look up his date of birth, subtract that from today's date, and -- voila! Numerous published tests provide fill-in-the-blank boxes to make this calculation easy enough for a fourth-grader.

One forensic instrument, however, bucks this common-sense practice. The developers of the Static-99R, the most widely used tool for estimating the risk of future sexual recidivism, have given contradictory instructions on how to score its very first item: Offender age.

In a new paper, forensic evaluator Dean Cauley and PsyD graduate student Michelle Brownfield report that divergent field practices in the scoring of this item are producing vastly different risk estimates in legal cases -- estimates that in some cases defy all logic and common sense.

Take Fred. Fred is 80 years old, and facing possible civil commitment for the rapes of two women when he was 18 years old. He served 12 years in prison for those rapes. Released from prison at age 30, he committed several strings of bank robberies that landed him back in prison on six separate occasions.

At age 80 (and especially with his only known sex offenses committed at age 18), his risk for committing a new sex offense if released from custody is extremely low -- something on the order of 3 percent. But evaluators now have the option of using any of three separate approaches with Fred, with each approach producing quite distinct opinions and recommendations.

Procedure 1: Age is age (the old-fashioned method)

The first, and simplest, approach, is to list Fred's actual chronological age on Item 1 of the Static-99R. Using this approach, Fred gets a three-point reduction in risk for a total of one point, making his actuarial risk of committing a new sex offense around 3.8 percent.

Evaluators adopting this approach argue that advancing age mitigates risk, independent of any technicalities about when an offender was released from various periods of incarceration. These evaluators point to the Static-99R's coding manuals and workbook, along with recent publications, online seminars, and sworn testimony by members of the Static-99 Advisory Committee. Additionally, they point to a wealth of age-related literature from the fields of criminology and psychology to support their scoring.

Procedure 2: Reject the Static-99R as inappropriate

A second approach is not to use the Static-99R at all, because Fred's release from prison for his "index offenses" (the rapes) was far more than two years ago, making Fred unlike the members of the samples from which the Static-99R's risk levels were calculated. Evaluators adopting this approach point to publications by members of the Static-99 Advisory Committee, generally accepted testing standards and actuarial science test standards to support their choice to not use the test at all.

Procedure 3: The amazing elixir of youth

But there is a third approach. One that magically transports Fred back to his youth, back to the days when a career in bank robbing seemed so promising. (Bank robbery is no longer alluring; it is quietly fading away like the career of a blacksmith.) The last five decades of Fred's life fade away, and he becomes 30 again -- his age when he was last released from custody on a sex offense conviction.

Now Fred not only loses his three-point age reduction, but he gains a point for being between the ages of 18 and 34.9. A four point difference! The argument for this approach is that it most closely conforms to the scoring methods used on the underlying samples of sex offenders, who were scored based on their date of release from their index sexual offense. These evaluators can correctly point to information imparted at training seminars, advice given by some members of the Static-99R Advisory Committee, and sworn testimony by developers of the test itself. They can also point to an undated FAQ #27 on the Static-99 website to support their opinion.

Fred could rape someone to reduce his risk!

Back-dating age to the time of the last release from a sex offense-related incarceration allows for a very bizarre twist:

Let's say that after Fred was released from prison on his most recent robbery stint, back when he was a vigorous young man of 61, he committed another rape. Being 60 or over, Fred would now get the four-point reduction in risk to which his age entitles him. This would cut his risk by two-thirds -- from 11.4 percent (at a score of 5) all the way down to a mere 3.8 percent (at a score of 1)!

While such a scenario might seem far-fetched, it is not at all unusual for an offender to be released from prison at, say, age 58 or 59, but to not undergo a civil commitment trial for a couple of years, until age 60 or 61. Such an offender's score will vary by two points (out of a total of 12 maximum points) depending upon how the age item is scored. And, as Cauley and Brownfield describe, the members of the Static-99R development team have, at different times, given contradictory advice on how to score the age item.

By completely negating the very substantial body of research on age and crime, this technocratic method creates other very concerning -- and paradoxical -- implications, Cauley and Brownfield argue: As the risk estimate for a more persistent offender is lowered, the offender who does not reoffend is stuck with a risk score that is forever jacked up.

Back-dating an offender's age is also at odds with the research that generated the test itself, they say, because the offenders in the samples used to construct the Static-99R had finished serving their sentences on their index sexual offenses within two years of being studied. In other words, none of the offenders had been released many years earlier, and there was none of this curious time-travel business in regard to their ages. As the instrument's developers noted in a publication just last year, the Static-99 "was developed on, and intended for, sexual offenders with a current or recent sexual offense."

So, if you are evaluating an old geezer in the local pen and he tells you that he is only 30 years old, don't assume that he has a delusional belief that he has discovered the elixir of youth -- or that he's pulling your leg. He just might be reciting the age that he was just assigned by a technocratic Static-99R evaluator.

The paper, "Static-99R: Item #1 -- What is the Offender's Age? A lack of consensus leads to a defective actuarial," is available for download both HERE and HERE.

Remarkable experiment proves pull of adversarial allegiance

 Psychologists' scoring of forensic tools depends on which side they believe has hired them

A brilliant experiment has proven that adversarial pressures skew forensic psychologists' scoring of supposedly objective risk assessment tests, and that this "adversarial allegiance" is not due to selection bias, or preexisting differences among evaluators.

The researchers duped about 100 experienced forensic psychologists into believing they were part of a large-scale forensic case consultation at the behest of either a public defender service or a specialized prosecution unit. After two days of formal training by recognized experts on two widely used forensic instruments -- the Psychopathy Checklist-R (PCL-R) and the Static-99R -- the psychologists were paid $400 to spend a third day reviewing cases and scoring subjects. The National Science Foundation picked up the $40,000 tab.

Unbeknownst to them, the psychologists were all looking at the same set of four cases. But they were "primed" to consider the case from either a defense or prosecution point of view by a research confederate, an actual attorney who pretended to work on a Sexually Violent Predator (SVP) unit. In his defense attorney guise, the confederate made mildly partisan but realistic statements such as "We try to help the court understand that ... not every sex offender really poses a high risk of reoffending." In his prosecutor role, he said, "We try to help the court understand that the offenders we bring to trial are a select group [who] are more likely than other sex offenders to reoffend." In both conditions, he hinted at future work opportunities if the consultation went well. 

The deception was so cunning that only four astute participants smelled a rat; their data were discarded.

As expected, the adversarial allegiance effect was stronger for the PCL-R, which is more subjectively scored. (Evaluators must decide, for example, whether a subject is "glib" or "superficially charming.") Scoring differences on the Static-99R only reached statistical significance in one out of the four cases.

The groundbreaking research, to be published in the journal Psychological Science, echoes previous findings by the same group regarding partisan bias in actual court cases. But by conducting a true experiment in which participants were randomly assigned to either a defense or prosecution condition, the researchers could rule out selection bias as a cause. In other words, the adversarial allegiance bias cannot be solely due to attorneys shopping around for simpatico experts, as the experimental participants were randomly assigned and had no group differences in their attitudes about civil commitment laws for sex offenders.

Sexually Violent Predator cases are an excellent arena for studying adversarial allegiance, because the typical case boils down to a "battle of the experts." Often, the only witnesses are psychologists, all of whom have reviewed essentially the same material but have differing interpretations about mental disorder and risk. In actual cases, the researchers note, the adversarial pressures are far higher than in this experiment:

"This evidence of allegiance was particularly striking because our experimental manipulation was less powerful than experts are likely to encounter in most real cases. For example, our participating experts spent only 15 minutes with the retaining attorney, whereas experts in the field may have extensive contact with retaining attorneys over weeks or months. Our experts formed opinions based on files only, which were identical across opposing experts. But experts in the field may elicit different information by seeking different collateral sources or interviewing offenders in different ways. Therefore, the pull toward allegiance in this study was relatively weak compared to the pull typical of most cases in the field. So the large group differences provide compelling evidence for adversarial allegiance."

This is just the latest in a series of stunning findings by this team of psychologists led by Daniel Murrie of the University of Virginia and Marcus Boccaccini of Sam Houston University on an allegiance bias among psychologists. The tendency of experts to skew data to fit the side who retains them should come as no big surprise. After all, it is consistent with 2009 findings by the National Academies of Science calling into question the reliability of all types of forensic science evidence, including supposedly more objective techniques such as DNA typing and fingerprint analysis.

Although the group's findings have heretofore been published only in academic journals and have found a limited audience outside of the profession, this might change. A Huffington Post blogger, Wray Herbert, has published a piece on the current findings, which he called "disturbing." And I predict more public interest if and when mainstream journalists and science writers learn of this extraordinary line of research.

In the latest study, Murrie and Boccaccini conducted follow-up analyses to determine how often matched pairs of experts differed in the expected direction. On the three cases in which clear allegiance effects showed up in PCL-R scoring, more than one-fourth of score pairings had differences of more than six points in the expected direction. Six points equates to about two standard errors of measurement (SEM's), which should  happen by chance in only 2 percent of cases. A similar, albeit milder, effect was found with the Static-99R.

Adversarial allegiance effects might be even stronger in less structured assessment contexts, the researchers warn. For example, clinical diagnoses and assessments of emotional injuries involve even more subjective judgment than scoring of the Static-99 or PCL-R.

But ... WHICH psychologists?!

For me, this study raised a tantalizing question: Since only some of the psychologists succumbed to the allegiance effect, what distinguished those who were swayed by the partisan pressures from those who were not?

The short answer is, "Who knows?"

The researchers told me that they ran all kinds of post-hoc analyses in an effort to answer this question, and could not find a smoking gun. As in a previous research project that I blogged about, they did find evidence for individual differences in scoring of the PCL-R, with some evaluators assigning higher scores than others across all cases. However, they found nothing about individual evaluators that would explain susceptibility to adversarial allegiance. Likewise, the allegiance effect could not be attributed to a handful of grossly biased experts in the mix.

In fact, although score differences tended to go in the expected direction -- with prosecution experts giving higher scores than defense experts on both instruments -- there was a lot of variation even among the experts on the same side, and plenty of overlap between experts on opposing sides.

So, on average prosecution experts scored the PCL-R about three points higher than did the defense experts. But the scores given by experts on any given case ranged widely even within the same group. For example, in one case, prosecution experts gave PCL-R scores ranging from about 12 to 35 (out of a total of 40 possible points), with a similarly wide range among defense experts, from about 17 to 34 points. There was quite a bit of variability on scoring of the Static-99R, too; on one of the four cases, scores ranged all the way from a low of two to a high of ten (the maximum score being 12).

When the researchers debriefed the participants themselves, they didn't have a clue as to what caused the effect. That's likely because bias is mostly unconscious, and people tend to recognize it in others but not in themselves. So, when asked about factors that make psychologists vulnerable to allegiance effects, the participants endorsed things that applied to others and not to them: Those who worked at state facilities thought private practitioners were more vulnerable; experienced evaluators thought that inexperience was the culprit. (It wasn't.)

I tend to think that greater training in how to avoid falling prey to cognitive biases (see my previous post exploring this) could make a difference. But this may be wrong; the experiment to test my hypothesis has not been run. 

The study is: "Are forensic experts biased by the side that retained them?" by Daniel C. Murrie, Marcus T. Boccaccini, Lucy A. Guarnera and Katrina Rufino, forthcoming from Psychological Science. Contact the first author (HERE) if you would like to be put on the list to receive a copy of the article as soon as it becomes available.

Click on these links for lists of my numerous prior blog posts on the PCL-R, adversarial allegiance, and other creative research by Murrie, Boccaccini and their prolific team. Among my all-time favorite experiments from this research team is: "Psychopathy: A Rorschach test for pychologists?"

Texas SVP jurors ignoring actuarial risk scores

Expert witness for defense makes a (small) difference, study finds

The fiery debates surrounding the validity of actuarial tools to predict violence risk begs the question: How much influence do these instruments really have on legal decision-makers? The answer, at least when it comes to jurors in Sexually Violent Predator trials in Texas:

Not much.

"Despite great academic emphasis on risk measures - and ongoing debates about the value, accuracy, and utility of risk-measure scores reported in SVP hearings - our findings suggest these risk measure scores may have little impact on jurors in actual SVP hearings."

The researchers surveyed 299 jurors at the end of 26 sexually violent predator trials. Unfortunately, they could not directly measure the relationship between risk scores and civil commitment decisions because, this being Texas, juries slam-dunked 25 out of 26 sex offenders, hanging in only one case (which ultimately ended in commitment after a retrial).  

Instead of the ultimate legal outcome, the researchers had to rely on proxy outcome measures, including jurors' ratings of how dangerous an individual was (specifically, how likely he would be to commit a new sex offense within one year of release), and their assessment of how difficult it was to make a decision in their case.

There was no evidence that jurors' assessments of risk or decision difficulty varied based on respondents' scores on risk assessment tools, which in each case included the Static-99, MnSOST-R and the PCL-R. This finding, by the prolific team of Marcus Boccaccini, Daniel Murrie and colleagues, extends into the real world prior mock trial evidence that jurors in capital cases and other legal proceedings involving psychology experts are more heavily influenced by clinical than actuarial testimony.

What did make a difference to jurors was whether the defense called at least one witness, and in particular an expert witness. Overall, there was a huge imbalance in expert testimony, with almost all of the trials featuring two state experts, but only seven of 26 including even one expert called by the defense.

"Skepticism effect"

The introduction of a defense expert produced a "skepticism effect," the researchers found, in which jurors became more skeptical of experts' ability to predict future offending. However, jurors' lower risk ratings in these cases could also have been due to real differences in the cases. In SVP cases involving legitimately dangerous sex offenders, defense attorneys often have trouble finding experts willing to testify. In other words, the researchers note, "the reduced ratings of perceived risk associated with the presence of a defense expert may be due to nonrandom selection … as opposed to these defense experts' influencing jurors."

A back story here pertains to the jury pool in the Texas county in which civil commitment trials are held. All SVP trials take place in Montgomery County, a "very white community," an attorney there told me. A special e-juror selection process for SVP jurors whitens the jury pool even more, disproportionately eliminating Hispanics and African Americans. Meanwhile, many of those being referred for civil commitment are racial minorities. The potentially Unconstitutional race discrepancy is the basis for one of many current legal challenges to the SVP system in Texas.

Once a petition for civil commitment as a sexually violent predator is filed in Texas, the outcome is a fait accompli. Since the inception of the state's SVP law, only one jury has unanimously voted against civil commitment. Almost 300 men have been committed, and not a single one has been released.

Overall, the broad majority of jurors in the 26 SVP trials were of the opinion that respondents were likely to reoffend in the next year. Based on this heightened perception of risk, the researchers hypothesize that jurors may have found precise risk assessment ratings irrelevant because any risk was enough to justify civil commitment.

In a previous survey of Texas jurors, more than half reported that even a 1 percent chance of recidivism was enough to qualify a sex offender as dangerous. To be civilly committed in Texas, a sex offender must be found "likely" to reoffend, but the state's courts have not clarified what that term means.  

Risk scores could also be irrelevant to jurors motivated more by a desire for retribution than a genuine wish to protect the public, the researchers pointed out. "Although SVP laws are ostensibly designed to provide treatment and protect the public, experimental research suggests that many mock jurors make civil commitment decisions based more on retributive motives - that is, the desire to punish sexual offenses—than the utilitarian goal of protecting the public…. Jurors who adopt this mindset may spend little time thinking about risk-measure scores."

All this is not to say that actuarial scores are irrelevant. They are highly influential in the decisions that take place leading up to an SVP trial, including administrative referrals for full evaluations, the opinions of the evaluators themselves as to whether an offender meets civil commitment criteria, and decisions by prosecutors as to which cases to select for trial.

"But the influence of risk scores appears to end at the point when laypersons make decisions about civilly committing a select subgroup of sexual offenders," the researchers noted.

Bottom line: Once a petition for civil commitment as a sexually violent predator is filed in Texas, it's the end of the line. The juries are ultra-punitive, and the deck is stacked, with government experts outnumbering experts called by the defense in every case. It remains unclear to what extent these results might generalize to SVP proceedings in other states with less conservative jury pools and/or more balanced proceedings.

• The study, "Do Scores From Risk Measures Matter to Jurors?" by Marcus Boccaccini, Darrel Turner, Craig Henderson and Caroline Chevalier of Sam Houston State University and Daniel Murrie of the University of Virginia, is slated for publication in an upcoming issue of Psychology, Public Policy, and Law. To request a copy, email the lead researcher (HERE).

Showdown looming over predictive accuracy of actuarials

Large error rates thwart individual risk prediction

Brett Jordan David Macdonald (Creative Commons license)

If you are involved in risk assessments in any way (and what psychology-law professional is not, given the current cultural landscape?), now is the time to get up to speed on a major challenge that's fast gaining recognition.

At issue is whether the margins of error around scores are so wide as to prevent reliable prediction of an individual's risk, even as risk instruments show some (albeit weak) predictive accuracy on a group level. If the problem is unsolvable, as critics maintain, then actuarial tools such as the Static-99 and VRAG should be barred from court, where they can literally make the difference between life and death.

The debate has been gaining steam since 2007, with a series of back-and-forth articles in academic journals (see below). Now, the preeminent journal Behavioral Sciences and the Law has published findings by two leading forensic psychologists from Canada and Scotland that purport to demonstrate once and for all that the problem is "an accurate characterization of reality" rather than a statistical artifact as the actuarials' defenders had argued.

So-called actuarial tools have become increasingly popular over the last couple of decades in response to legal demand. Instruments such as the Static-99 (for sexual risk) and the VRAG (for general violence risk) provide quick-and-dirty ways to guess at an individual's risk of violent or sexual recidivism. Offenders are scored on a set of easy-to-collect variables, such as age and number of prior convictions. The assumption is that an offender who attains a certain score resembles the larger group of offenders in that score range, and therefore is likely to reoffend at the same rate as the collective.

Responding to criticisms of the statistical techniques they used in their previous critiques, Stephen Hart of Simon Fraser University and David Cooke of Glasgow Caledonian University developed an experimental actuarial tool that worked on par with existing actuarials to separate offenders into high- and low-risk groups.* The odds of sexual recidivism for subjects in the high-risk group averaged 4.5 times that of those in the low-risk group. But despite this large average difference, the researchers established through a traditional statistical procedure, logistic regression, that the margins of error around individual scores were so large as to make risk distinctions between individuals "virtually impossible." In only one out of 90 cases was it possible to say that a subject's predicted risk of failure was significantly higher than the overall baseline of 18 percent. (See figure.)

Vertical lines show confidence intervals for individual risk estimates;
these large ranges would be required in order to reach the traditional 95 percent level of certainty.

The brick wall limiting predictive accuracy at the individual level is not specific to violence risk. Researchers in more established fields, such as medical pathology, have also hit it. Many of you will know of someone diagnosed with a cancer and given six months to live who managed to soldier on for years (or, conversely, who bit the dust in a matter of weeks). Such cases are not flukes: They owe to the fact the six-month figure is just a group average, and cannot be accurately applied to any individual cancer patient.

Attempts to resolve this problem via new technical procedures are "a waste of time," according to Hart and Cooke, because the problem is due to the "fundamental uncertainty in individual-level violence risk assessment, one that cannot be overcome." In other words, trying to precisely predict the future using "a small number of risk factors selected primarily on pragmatic grounds" is futile; all the analyses in the world "will not change reality."

Legal admissibility questionable 

The current study has grave implications for the legal admissibility of actuarial instruments in court. Jurisdictions that rely upon the Daubert evidentiary standard should not be allowing procedures for which the margins of error are "large, unknown, or incalculable," Hart and Cooke warn.

By offering risk estimates in the form of precise odds of a new crime within a specific period of time, actuarial methods present an image of certitude. This is especially dangerous when that accuracy is illusory. Being told that an offender "belongs to a group with a 78 percent likelihood of committing another violent offense within seven years" is highly prejudicial and may poison the judgment of triers of fact. More covertly, it influences the judgment of the clinician as well, who -- through a process known as "anchoring bias" -- may tend to judge other information in a case in light of the individual's actuarial risk score.

Classic '56 Chevy in Cuba. Photo credit: Franciscovies

With professional awareness of this issue growing, it is not only irresponsible but ethically indefensible not to inform the courts or others who retain our services about the limitations of actuarial risk assessment. The Ethics Code of the American Psychological Association, for example, requires informing clients of "any significant limitations of [our] interpretations." Unfortunately, I rarely (if ever) see limitations adequately disclosed, either in written reports or court testimony, by evaluators who rely upon the Static-99, VRAG, Psychopathy Checklist-Revised (which Cooke and statistician Christine Michie of Glasgow University tackled in a 2010 study) and similar instruments in forming opinions about individual risk.

In fact, more often than not I see the opposite: Evaluators tout the actuarial du jour as being far more accurate than "unstructured clinical judgment." That's like an auto dealer telling you, in response to your query about a vehicle's gas mileage, that it gets far more miles per gallon than your old 1956 Chevy. Leaving aside Cuba (where a long-running U.S. embargo hampers imports), there are about as many gas-guzzling '56 Chevys on the roads in 2013 as there are forensic psychologists relying on unstructured clinical judgment to perform risk assessments. 

Time to give up the ghost? 

Hart and Cooke recommend that forensic evaluators stop the practice of using these statistical algorithms to make "mechanistic" and "formulaic" predictions. They are especially critical of the practice of providing specific probabilities of recidivism, which are highly prejudicial and likely to be inaccurate.

"This actually isn’t a radical idea; until quite recently, leading figures in the field of forensic mental health [such as Tom Grisso and Paul Appelbaum] argued that making probabilistic predictions was questionable or even ill advised," they point out. “Even in fields where the state of knowledge is arguably more advanced, such as medicine, it is not routine to make individual predictions.”

They propose instead a return to evidence-based approaches that more wholistically consider the individual and his or her circumstances:

From both clinical and legal perspectives, it is arbitrary and therefore inappropriate to rely solely on a statistical algorithm developed a priori - and therefore developed without any reference to the facts of the case at hand - to make decisions about an individual, especially when the decision may result in deprivation of liberties. Instead, good practice requires a flexible approach, one in which professionals are aware of and rely on knowledge of the scientific literature, but also recognize that their decisions ultimately require consideration of the totality of circumstances - not just the items of a particular test. 

In the short run, I am skeptical that this proposal will be accepted. The foundation underlying actuarial risk assessment may be hollow, but too much construction has occurred atop it. Civil commitment schemes rely upon actuarial tools to lend an imprimatur of science, and statutes in an increasing number of U.S. states mandate use of the Static-99 and related statistical algorithms in institutional decision-making.

The long-term picture is more difficult to predict. We may look back sheepishly on today's technocratic approaches, seeing them as emblematic of overzealous and ignorant pandering to public fear. Or -- more bleakly -- we may end up with a rigidly controlled society like that depicted in the sci-fi drama Gattaca, in which supposedly infallible scientific tests determine (and limit) the future of each citizen.

* * * * *

I recommend the article, "Another Look at the (Im-)Precision of IndividualRisk Estimates Made Using Actuarial RiskAssessment Instruments." It's part of an upcoming special issue on violence risk assessment, and it provides a detailed discussion of the history and parameters of the debate. (Click HERE to request it from Dr. Hart.) Other articles in the debate include the following (in rough chronological order): 

• Hart, S. D., Michie, C. and Cooke, D. J. (2007a). Precision of actuarial risk assessment instruments: Evaluating the "margins of error" of group v. individual predictions of violence.  British Journal of Psychiatry, 190, s60–s65. 

• Mossman, D. and Sellke, T. (2007). Avoiding errors about "margins of error" [Letter]. British Journal of Psychiatry, 191, 561. 

• Harris, G. T., Rice, M. E. and Quinsey, V. L. (2008). Shall evidence-based risk assessment be abandoned? [Letter]. British Journal of Psychiatry, 192, 154. 

• Cooke, D. J. and Michie, C. (2010). Limitations of diagnostic precision and predictive utility in the individual case: A challenge for forensic practice. Law and Human Behavior, 34, 259–274. 

• Hanson, R. K. and Howard, P. D. (2010). Individual confidence intervals do not inform decision makers about the accuracy of risk assessment evaluations. Law and Human Behavior, 34, 275–281. 

*The experimental instrument used for this study was derived from the SVR-20, a structured professional judgment tool. The average recidivism rate among the total sample was 18 percent, with 10 percent of offenders in the low-risk group and 33 percent of those in the high-risk group reoffending. The instrument's Area Under the Curve, a measure of predictive validity, was .72, which is in line with that of other actuarial instruments.

Pornography and contact sex offending

Guest essay by Jon Brandt, David S. Prescott and Robin J. Wilson*

Many people have grave concerns about the potential for a relationship between pornography and inappropriate sexual behavior. For obvious reasons, there are apprehensions about the sexual behaviors of those who have sexually abused. As a result, it is not uncommon for persons who have sexually abused to be restricted from certain activities that would have remained available to them had they not sexually offended. However, questions remain as to whether we are using our professional energy and resources wisely in trying to prevent persons convicted of sexual crimes from being sexually active. This point extends to whether persons who have sexually abused should have access to sexually explicit materials.

There are many reasons not to like pornography. Perhaps women, more than men, are objectified by pornography. Both women and men have raised questions about how pornography cheapens and depersonalizes sex. As men dedicated to sexual violence prevention, we are concerned about both the demeaning representation of women and the unflattering portrayal of men (e.g., piggish, self-absorbed, or uncaring) in much commercial pornography. There are also concerns about the effects of the depiction of unhealthy, violent, or potentially harmful sexual behaviors. There is an open question about the long-term effects of exposure to sexually explicit media. These are important considerations, but as offensive as pornography is to many people, extant research does not support a causal relationship between pornography and sexual offending.

Not just academic

Defining pornography remains a challenge. In our field, this is not simply an academic discussion. Sexual offenders are typically restricted from possessing any type of pornography, but there are no clear demarcation points between artistic expressions of the human form, sexually suggestive images, erotica, or hardcore pornography. When the legal consequences for possession of any sexual media are so severe, defining pornography has never been more important.

Jon Brandt

In the US, numerous court decisions, presidential task forces, and various think tanks have been unable to produce an agreement or useful definition of "pornography." With the need for greater precision within our profession than perhaps elsewhere in public discourse, our field would benefit from fine-tuning and distinguishing between various types of sexual media. Using "pornography" to describe all forms of sexual media is both imprecise and emotionally loaded. It can obscure treatment needs and interventions. Missed opportunities of therapeutically beneficial sexual imagery could inadvertently lead to more harm.

Good science or moral panic?

The historical perspective that sexually explicit images are offensive and therefore must be harmful is such a powerful narrative that it is difficult to close the gap between what we know about private sexual behavior and widespread public perceptions. We wonder whether some restrictions imposed on our clients are the considered application of good science or a default result of moral panic. If the latter is true, are therapists complicit in the unwarranted enforcement of social controls more than the healing arts of rehabilitation?

Gone are the days when pornography originated in adult bookstores or arrived discreetly in the mail. Most sexual media today is user-produced and shared through cell phones and the Internet. The use of sexual media by male teens and adults today is not just normative, it is pervasive. Science has yet to show any key differences between those who "sext" and those who do not, except for the behavior itself. Consumption of sexually explicit imagery has been explosive in the last decade. Sexual content in cyberspace may account for more than 30 percent of the data transfer of the entire Internet. Starting as teenagers, consumers are overwhelmingly male, but also include a significant percentage of women.

David Prescott

Though controversial and perhaps even counterintuitive, evidence of the adverse effects of sexual media has not been established. Other than child pornography, broad sexual media restrictions for most persons who have sexually abused do not appear to be supported by research. Frequently, restrictions on "pornography" for such clients include prohibition of every type of sexual media. Without knowing whether some level of exposure to some form of sexual media might have some adverse effects on human behavior, we use a shotgun approach to such restrictions. These squishy definitions and operatives also compromise research.

We each entered the field of treating sexual aggression at a time when professionals assumed that all persons who had sexually abused were at high risk to persist. Not only has this turned out to be untrue, but the rates of sexual aggression and re-offense have declined at the very same time as access to sexually explicit imagery has never been easier. Although we know of no interactive relationship between these co-occurring trends, they should each cause us to reconsider our attitudes and beliefs about what is important in the treatment and supervision of persons who have sexually abused.

There has been limited research involving pornography's influence on sexual aggression. The strongest concerns in studies published in refereed journals include a potentially aggravating influence of routine pornography use by men already at high risk for re-offending (and/or higher in entrenched antisociality, sometimes referred to as psychopathy). Certain types of pornography with high-risk offenders may also increase risk. Researchers such as Drew Kingston and Neil Malamuth appear to support the cautious position that without more conclusive research we should evaluate higher risk situations on a case by case basis. To our knowledge, no studies have as yet produced a credible indictment of pornography usage among persons who have sexually abused.

No definitive link found

Two additional facts are worthy of consideration. First, both biased and impartial groups have been funding research for more than 50 years to find a connection between pornography and sexual offending, and none have been able to find any definitive link. Second, despite the explosion of sexual media since the advent of the Internet and rapid transfer of visual imagery, there has been no increase in rates of sexual offending—everywhere it has been studied, around the world. Arguably, the same information superhighway that provides access to pornography has also brought attention to the numerous media outlets that remind us that true sexual violence is intolerable.

Robin Wilson

Several researchers have suggested that the correlation between pornography and sexual offending is either absent or inverse. A noteworthy advocate for this theory is sexologist Milton Diamond of the University of Hawaii. His published research on pornography and sexual offending in the US, Japan, and Europe persuasively argues that the relationship between pornography and sexual offending is negatively correlated. Diamond's research appears to also hold true for the relationship between child pornography and engagement in contact offenses. If validated, consider the implications of such findings in mitigating contact offenses against children, as offensive as it may seem. Perhaps adult pornography really is more offensive than actually harmful in the treatment and supervision of people who have sexually abused.

What might account for a negative correlation between pornography and contact offenses? Diamond and others have theorized that sexual media may provide a vicarious satisfaction of sexual curiosity and/or a cathartic venting effect for libido. If this theory turns out to be correct, restricting most sexual offenders from having sexual media might not just be overly cautious, it might, in individual circumstances, be counterproductive.

Individual differences proposed

Kingston and Malamuth have challenged some of Diamond's research, but only to the extent that Diamond's aggregate data, while compelling, might not apply to certain individuals. Theirs is an important point for consideration. Michael Seto has raised similar concerns with respect to certain risk factors and child pornography. We can also see how this is an important aspect to consider. However, a ban on all sexual media for all persons who have sexually abused appears neither science-based nor justified.

At what point does research become conclusive? It may be that pornography currently remains too controversial and emotionally charged for effective public policy to emanate from good science. Nonetheless, our concern is that broad bans on sexual media may be squandering resources, at the expense of truly science-based treatment and supervision elsewhere. 

These are not simply academic points. Revoking a person's parole or violating their probation because of behaviors that are socially undesirable, rather than an established characteristic of risk or harm, can be costly to society as well as the individual. All too often, we implement public policies and impose restrictions on offenders because we feel better to believe we are doing something to help stop victimization. However, we should also consider that when we overreach with risk management, limited resources are stretched thin.

Recommendations

We are not suggesting that pornography use by clients should be ignored. Following the model of Risk-Needs-Responsivity, the risk and need principles may guide the formation of effective therapeutic and correctional interventions. To that end, clinicians would be wise to thoroughly assess the effects of sexual media on individual clients (see appendix). Professionals should avoid restricting clients' access to sexual media based only on personal values, unsupported professional beliefs, or undocumented theories. Therapeutic efforts should be focused on managing abuse-related sexual interests (as opposed to all sexual interests). Therapists can provide clients with education about healthy sexuality, with the end goal of a safe, fulfilling, and non-exploitive sex life.

Given that science continues to better inform us about the psychological and social dynamics of sexual behavior, we should periodically review status quo. When scientific trending suggests current policies or practices might be unfounded, outdated, or perhaps even counterproductive, we should gather the professional courage to explore better pathways that might more effectively prevent or mitigate sexual offending.

Appendix

In assessing the effects of sexual media with individual clients, clinicians might explore:

1) The client's history, current use, and experience with different types of sexual media.
2) The client's use of sexual media compared to normative data.
3) Possible connections between certain sexual media and problematic sexual behavior.
4) Escalating or compulsive patterns of the use of sexual media.
5) The possible relationships of sexual media to the index offense(s).
6) The use of sexual media as socially or psychologically protective measures.
7) How sexual media could be interfering with relationships.
8) The use of sexual media to explore or satisfy sexuality curiosity.
9) How sexual media is an element of libido management.
10) Whether clients might benefit from a modified use of sexual media.
11) The possible therapeutic or conditioning benefits of proscriptive sexual media.
12) Sexual media that might be contraindicated therapeutically or socially.
13) The legal hazards or consequences for accessing certain types of sexual media.
14) Limitations on certain sexual media for specific higher-risk offenders.
15) The various risk factors involved in client’s access to sexual media via the Internet, cell phones, digital cameras, Wi-Fi communication devices, and social networking websites.
16) The degree to which clients can exercise internal controls in managing sexual media or to what level external controls might be beneficial to aid in risk management.
17) How clients can move from external controls to internal controls prior to discharge from treatment or supervision in anticipation of independent management.

References

Andrews, D.A. and Bonta, J. (2010). The psychology of criminal conduct. 5th Ed. Cincinnati, OH: Anderson.

Bensimon, P. (2007). The role of pornography in sexual offending. Sexual Addiction and Compulsivity, 14.

Burton, D. (2010). Comparison by crime type of juvenile delinquents on pornography exposure: The absence of relationships between exposure to pornography and sexual offense characteristics. Journal of Forensic Nursing, 6.

D’Amato, A. (2006). Porn up, rape down. Northwestern Public Law Research Paper No. 913013.

Diamond, M. (1999). The effects of pornography: An international perspective. International Journal of Law and Psychiatry.

Diamond, M. (2009). Pornography, public acceptance and sex related crime: A review. International Journal of Law and Psychiatry.

Diamond, M., et al. (2010). Pornography and sex crimes in the Czech Republic. Archives of Sexual Behavior, 40, 1037-1043.

Diamond, M., et al. (2011) Rejoinder to Kingston and Malamuth. Archives of Sexual Behavior, 40, 1049-50.

Ferguson, C.J. and Hartley, R.D. (2009). The pleasure is momentary… the expense damnable?: The influence of pornography on rape and sexual assault. Aggression and Violent Behavior, 14, 323-329.

Kingston, D. and Fedoroff, P. (2008). Pornography use and sexual aggression: The impact of frequency and type of pornography use on recidivism among sexual offenders. Aggressive Behavior, 34, 1-11.

Kingston, D. and Malamuth, N. (2009). The importance of individual differences in pornography use: Theoretical perspectives and implications for treating sexual offenders. Journal of Sex Research, 46, 216-232.

Kingston, D.A. and Malamuth, N.M. (2011). Problems with aggregate data and the importance of individual differences in the study of pornography and sexual aggression: Comment on Diamond, Jozikova, and Weiss (2010). Archives of Sexual Behavior, 40.

Seto, M.C., et al. (2010). Contact sexual offending by men with online sexual offenses. Sexual Abuse: A Journal of Research and Treatment, Vol. 23.

Williams, K.M., et al. (2009). Inferring sexually deviant behavior from corresponding fantasies: The role of personality and pornography consumption. Criminal Justice and Behavior, Vol. 36, 198-222.

Winick, C. and Evans, J.T. (1996). The relationship between non-enforcement of state pornography laws and rates of sex crime arrests. Archives of Sexual Behavior, 25.

*Originally published at the Sexual Abuse: A Journal of Research and Treatment (SAJRT) blog. Republished by permission of the authors.

Of related interest: Salon - Did porn warp me forever? Like other boys my age, I grew up with unlimited access to smut. At 23, I wonder if it's totally screwed me up, by Isaac Abel.

Special offer on groundbreaking group rape text

The Handbook on the Study of Multiple Perpetrator Rape: A multidisciplinary response to an international problem

Photo credit: Sajjad Hussain

Two current events, on opposite sides of the globe, signal encouraging changes -- dare I say even a tipping point -- in public attitudes toward sexual violence:

1. The giant waves of protest sweeping India in response to the vicious gang rape of a young woman (who died from her injuries) on a public bus in New Delhi. Protesters, spurred on by social media, are demanding that authorities address gender violence in a country in which police and prosecutors have often turned a blind eye to rampant violence against women, including rape, sexual harassment, dowry murders and honor attacks. As Shalini Nataraj of the Global Fund for Women notes in an op-ed in the San Francisco Chronicle,  what is remarkable is that "people of all backgrounds are coming out into the streets, they are bringing their young children, they are demanding accountability from their government for this culture of violence that goes unpunished. People in India today are talking about rape."

2. The uproar over a sexual assault by members of the high school football team in Steubenville, Ohio against an unconscious girl, and alleged attempts by local authorities to cover it up. After a tenacious crime blogger posted deleted tweets and was (unsuccessfully) sued by a young athlete, the New York Times published an excellent, in-depth piece. Now, in an unprecedented development, the underground hacker group Anonymous has entered the fray, digging up and publishing incriminating tweets and videos (including the disturbing one below, featuring an athlete who has not been arrested) and demanding more aggressive prosecution.

These are precisely the types of cases that I analyzed for an upcoming chapter in the first-ever book on multiple-perpetrator rape, due out next month. My analysis focuses on the subtexts pertaining to masculinity, social status and race that are embedded in media coverage of high-profile cases. But although some of the two dozen cases that I analyzed generated widespread public outrage, it typically focused narrowly on the perpetrators and, at times, their immediate communities. The current international uproar is qualitatively different, in that people are connecting the dots between patriarchal power and sexual victimization.

Given this current level of public interest, next month's publication date for The Handbook on the Study of Multiple Perpetrator Rape is timely. I just finished reviewing the galley proofs and found the book to be a highly informative compilation, written from an international and multi-disciplinary perspective.

From the publisher's promotional blurb:

"The contributions to this collection are written by leading academics and practitioners from a variety of disciplines who bring together research and practice on multiple perpetrator rape by presenting new data from a strong theoretical and contextual base. This book will be a key text for students and academics studying multiple perpetrator rape and an essential reference tool for professionals working in the field, including police officers, educationalists, forensic psychologists, youth workers, probation staff, lawyers, judges and policy makers."

Ad glorifying group rape; my web page with more examples is HERE.

Co-editors Miranda A. H. Horvath and Jessica Woodhams are phenomenal researchers who head an international consortium (of which I am proud to be a part) that focuses on the understudied problem of group rape. Horvath, who has published extensively on sexual violence and violence against women, is the David Jenkins Chair in Forensic and Legal Medicine at Middlesex University, where she is also deputy director of Forensic Psychological Services. Woodhams is a forensic psychologist who teaches forensic psychology at the University of Birmingham, UK and has also published extensively on sex offending.

Chapters include:

• Multiple perpetrator rape as an international phenomenon by Teresa Da Silva, Leigh Harkins and Jessica Woodhams
• Masculinity, status, and power: implicit messages in Western media discourse on high-profile multiple perpetrator rape cases by Karen Franklin
• Variations in multiple perpetrator rape characteristics relative to group size: Comparing duo and larger group MPR offences by Mackenzie Lambine
• Group sexual offending: comparing adolescent female with adolescent male offenders by Jan Hendriks, Miriam Wijkman and Catrien Bijleveld
• Busting the ‘gang-rape’ myth: girls’ victimisation and agency in gang-associated rape and peer-on-peer exploitation by Carlene Firmin
• Streamlining: understanding gang rape in South Africa by Rachel Jewkes and Yandisa Sikweyiya
• Multiple perpetrator rape during war by Elisabeth J. Wood
• Leadership and role-taking in multiple perpetrator rape by Louise Porter
• Offender aggression and violence in multiple perpetrator rape by Jessica Woodhams
• Multiple perpetrator rape victimization: how it differs and why it matters by Sarah Ullman
• Multiple perpetrator rape in the courtroom by Miranda A. H. Horvath and Jacqueline M. Gray
• Issues concerning treatment of adolescent multiple perpetrator rape offenders by Talia Etgar
• Girls and gangs: preventing multiple perpetrator rape by James Densley, Allen Davis and Nick Mason

This is the fourth volume in the book series Issues in Forensic Psychology, edited by Richard Shuker of the therapeutic prison community HMP Grendon in the UK. The series aims to provide analysis and debate on current issues of relevance to forensic psychology and associated fields. Routledge anticipates issuing the paperback in 2014.

To take advantage of a 20 percent pre-publication discount (until February 28), visit the book's web page and use the discount code CRIMHPR12 when placing your order. The same url can also be used to recommend the book to your institution's librarian.