Axis I mental health disorders and sexual offending
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Popular culture touts mental illness as the primary explanation for the behaviors of identified sex offenders. Research with incarcerated sex offenders, forensic mental health patients, and sex offenders referred to treatment identify elevated rates of Axis I mental disorders; anxiety, depression, dissociative disorders, and psychotic illness (Dunseith et al. 2004). Epidemiology research with psychiatric patients has identified elevated rates of sex offending compared to community controls (Fazel, Sjostedt, Langstrom, & Grann, 2007). Importantly, the association between Axis I mental disorders and sex offending appears most evident in the presence of comorbid alcohol and substance related disorders (Alden, Brennan, Hodgins, & Mednick, 2007), and sex offenders with mental disorders do not necessarily have higher rates of recidivism compared to nonmentally ill counterparts (Hanson & Morton-Bourgon, 2005). Mentally disordered sex offenders may, however, prove more challenging to engage in therapeutic services, and have other adverse factors relevant to their risk of sex offending (Craissati & Beech, 2001). For a small proportion of mentally disordered sex offenders, there is some evidence to suggest their offending behavior appears related to mental health symptoms, including the content of delusions/hallucinations, obsessional thoughts, and deficits in coping skills (Hudson, Ward, & McCormack, 1999; Smith, 2000). This chapter draws on current research to identify the mental health disorders that are most commonly seen by mental health practitioners and their relationship to sex offending.
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