2006 Revision of Sexual Sadist Criterion (co-author Steven Hucker)
lostc...@gmail.com
contributions.
Basically this 2006 article says there's little agreement between
professionals as to what constitutes a true sexual sadist, that it
needs to be clarified and a more universally accepted definition
arrived at because it affects the public's safety, and offender
sentencing (gee, ya think?). Note: co-author Steven Hucker!! The
authors provide a short list at the end of this article,
representative of their definition of sadistic behavior. While some
of it applies to Paul Bernardo (ex. record and trophy-keeping,
exercises power/control/domination over victim), most of what does
apply to him applies to all but the power-reassurance (or "gentleman")
rapist. Things that would seem to be needed for a true sexual sadist
diagnosis(ex. gratuitous use of violence and mutilation, torture,
etc.) are missing; again, it comes down to whether you think power,
contol and domination are paramount for Paul, or whether sexual
stimulation from seeing his victims experiencing the pain he inflicts
on them is most important. I still go with power control and
domination. Hence, this guy shouldn't have been diagnosed like he
was, and should be getting treatment (oh yeah, I've said that
before).
I figure "justiceforbernardo" is going to have at least 3 fronts:
1)The crimes: Karla's version vs. Paul's version (punching holes in
Karla's story, "proving" Paul's), 2)The law enforcement and legal end:
highlighting the flawed and prejudiced investigation, the political
"necessity" of the Crown's use of Karla after it ceased to need her,
and 3)Paul's solitary isolation and the use of the "dangerous
offender" status in this case is a human rights violation; (I
understand they can't move him for his own protection, but that might
not be the case if it weren't for numbers one and two).
Issues in the diagnosis of sexual sadism
William L. Marshall1,** Steven .J. Hucker2**
1 Rockwood Psychological Services, Canada
2 University of Toronto
[Sexual Offender Treatment, Volume 1 (2006), Issue 2]
Abstract
This paper summarizes our research to date on sexual sadism. Our
initial review of the literature revealed confusion over diagnostic
criteria. Our first empirical study showed that experienced forensic
psychiatrists did not accurately employ many of the important
diagnostic criteria while our second study demonstrated that
internationally-renowned forensic psychiatrists could not reliably
apply the diagnosis. On the basis of these observations we developed
a Sexual Sadism Scale that we are now in the process of evaluating.
Key Words: Sexual sadism, diagnosis, reliability
Sexual sadists represent a real threat to the community in terms of
their risk to reoffend but also in terms of the harm they will cause
should they reoffend. Researchers and clinicians working with sexual
offenders have yet to produce a combined index of risk that includes
both the likelihood of reoffending and the likelihood of harm to a
potential victim. In addition to this problem, the issue of whether
or not a sexual offender meets criteria for sexual sadism has serious
implications for decision makers (e.g., the courts, prison
authorities, parole boards). Failure by clinicians to identify a true
sadist might result in the offender's release from custody when he is
in fact a real threat to the community. On the other hand,
diagnosizing a sexual offender as a sadist when he is not might result
in continued or extended incarceration thereby jeopardizing the
offender's rights. It is clear from these considerations that the
diagnosis of sexual sadist (or the finding that an offender is not a
sadist) has serious implications for both the proper protection of the
community and for the rights of identified offenders.
As a result of our concerns about these matters, we took the first
step of reviewing the extent literature (Marshall & Kennedy, 2003).
Unfortunately this review raised more concerns than it solved. We
found that while most authors indicated they used the criteria
specified by either the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorder (DSM), or the World Health
Organization's International Classification of Diseases (ICD), to
diagnose their subjects, in fact the criteria they actually specified
did not comply with either of these systems. Each researcher chose an
idiosyncratic list of criteria which typically included some features
from both DSM and ICD, but also included other features not mentioned
in either of these texts.
>From our review we identified at least 35 features that had been
employed in one or another study as criteria for sexual sadism. The
most common features related to the use of violence (including murder
or mutilation), attempts to humiliate or degrade the victim, the
exercise of power, control, dominance, or enslavement, ritualistic
features associated with careful pre-planning of an attack, cruelty or
torture, abduction of the victim and transport to a pre-selected
location, bondage, prior history of cruelty to others or to animals,
anal sex, and post-mortem sex or mutilation. Other features that were
mentioned by some authors included keeping trophies from, or records
of, the attack, crossdressing in the history of the offender,
cannibalism, use of sadistic pornography, use of weapons in the attack
and strangulation of the victim. The only common feature to all the
reports was that sexual arousal to the identified criteria was seen as
essential.
This notion that it is sexual arousal to various features of the
attacks that is crucial to the diagnosis has a long history. Krafft-
Ebing (1886) defined sadism as "the experience of sexual, pleasurable
sensations ... produced by acts of cruelty" (p. 109). Both DSM-IV-TR
(American Psychiatric Association, 2000) and ICS-IV (World Health
Organization, 1992) see sexual arousal to certain features as
essential to the diagnosis. While this may seem reasonable in order
to define any form of sexual deviance, it does present problems for
diagnosticians since it is not clear how sexual arousal to the
features is determined. In the absence of an admission by the
offender, which in our experience is unlikely, the diagnostician must
either infer sexual arousal from the information he/she has available
or employ phallometry to detect such arousal. The degree to which
inferences must be made, reduces the likely reliability of a diagnosis
a fact that the authors of DSM-III (American Psychiatric Association,
1980) noted as their justification for moving away from a theory-based
approach to the specification of more observable features to serve as
diagnostic criteria. As yet no one has developed satisfactory
specific stimuli for phallometric testing designed to detect sexual
arousal to sadistic acts, although some have inferred sadistic
tendencies from arousal to scenes of forced sex (Barbaree, Seto,
Serin, Amos & Preston, 1994; Langevin et al., 1985; Seto & Kuban,
1996).
As a result of the confusion we noted in our literature review
regarding the criteria used to diagnose sexual sadists, we decided
that further research was required. Our first step was to determine
how effectively the diagnosis was applied in federal prisons in
Canada. We (Marshall, Kennedy & Yates, 2002) examined the records in
three prisons of all sexual offenders for whom a psychiatric appraisal
was made over the period 1989-1998. From these records we identified
evaluations of 59 sexual offenders with 41 being diagnosed as sexual
sadists while the remaining 18 were given other diagnoses. It is
important to note that the clinicians, whose diagnoses we examined in
this study, were all respected and experienced forensic
psychiatrists. We then compared those diagnosed as sadists with those
who were identified as nonsadists, on the features we derived from our
literature review. We found that it was the nonsadists who displayed
the so-called sadistic features. For example, 61.6% of those thought
not to be sadists but only 24.4% of the sadists, violently beat their
victims; similarly, 38.9% of the nonsadists and 9.8% of the sadists
tortured their victims. On two composite indices of sadism it was
again the nonsadists who appeared most problematic. On composite
index derived from offense details, 100% of the nonsadists and 80.5%
of the sadists scored in the deviant range; on a composite index based
on phallometric responses only 17.1% of the sadists appeared deviant
and yet 44.4% of the so-called nonsadists displayed deviant responses.
The results from this first study revealed that the diagnosis of
sexual sadism was not being applied in the Canadian prison service in
a way that matched any of the criteria identified in the literature.
When we examined each diagnostician's application of the criteria, it
was evident that there was not only disagreement across diagnosticians
in the criteria they considered relevant, there was no evident
consistency within diagnosticians in the criteria they used. As a
result we decide to see if a range of international experts might show
greater consistency.
Our next study involved extracting, at random, twelve of the cases
from our first study, and then producing documents that detailed every
aspect of the offenses, the offenders' life histories, their self-
reported sexual fantasies and sexual interests (where available),
psychometric test data, and phallometric assessment results. Six of
these offenders had been identified as sadists in our first study and
six had been given other diagnoses. We (Marshall, Kennedy, Yates &
Serran, 2002) then sent these extensive documents to 24
internationally-renowned forensic psychiatrists and asked them to
diagnose each case as a sadist or not a sadist. Fifteen psychiatrists
returned the complete data. Diagnostic agreement across the
psychiatrists proved to be unacceptably low. We employed the kappa
coefficient to examine reliability across diagnosticians. This
statistic corrects for chance agreement. Our analyses revealed a
kappa of 0.14. For relatively important decisions, it is usually
accepted that reliability across diagnosticians must reach a kappa of
at least 0.9, whereas for unimportant decisions a kappa of at least
0.6 is required (Murphy & Davidshofer, 1998). Clearly the kappa we
found was unacceptably low.
In this study we also asked the diagnosticians to rate all the
criteria we identified in our literature review, in terms of their
relevance for the diagnosis of sexual sadism. On the basis of the
ratings provided by these experts, we developed a Sexual Sadism
Scale. This scale has 17 items clustered in 4 groups. The first
group of 5 items was judged by our experts to be essential to the
diagnosis of sexual sadism, so in our scale these items are given the
highest weightings. The items in each successive group are given
progressively less weight, until the final grouping, which has only 2
items, is given the lowest weightings. We hoped to make the scale
minimally dependent upon the diagnostician's inference or on the
offender's self-report, and for the most part we were successful.
Note that except for one item, the scale is indifferent regarding the
issue of whether the offender is sexually aroused by the acts
described in each item. Most of the items in the scale describe
features that can be identified objectively from crime scene details
or from detailed police and/or victim reports. One item ("offender is
sexually aroused by sadistic acts") depends on either the offender's
self-report or phallometric assessment results, although it could be
inferred from the details of official reports of the offense.
For diagnosticians, our scale can serve to justify the diagnosis of
sexual sadism or reveal features that warrant concern. Thus the scale
serves both the needs of a categorical classification system, such as
DSM or ICD, while at the same time employing the benefits of a
dimensional system that has been touted by some as a better approach
to diagnosis (Livesley, 2001; Widiger & Coker, 2003). Along with
colleagues in several centres, we are in the process of subjecting our
scale to empirical analyses with the first step being to establish the
inter-rater reliability of the scale.
We hope that other researchers will either employ our scale or develop
their own to pursue a more objective dimensional approach to
identifying the problems presented by sexual sadists. We also
encourage clinicians to use our scale and to provide us with feedback
(table 1).
1.
Offender is sexually aroused by sadistic acts
2.
Offender exercises power/control/domination over victim
3.
Offender humiliates or degrades the victim
4.
Offender tortures victim or engages in acts of cruelty on victim
5.
Offender mutilates sexual parts of victim's body
6.
Offender has history of choking consensual partners during sex
7.
Offender engages in gratuitous violence toward victim
8.
Offender has history of cruelty to other persons or animals
9.
Offender gratuitously wounds victim
10.
Offender attempts to, or succeeds in, strangling, choking, or
otherwise asphyxiating victim
11.
Offender keeps trophies (e.g., hair, underwear, ID) of victim
12.
Offender keeps records (other than trophies) of offense
13.
Offender carefully pre-plans offense
14.
Offender mutilates nonsexual parts of victim's body
15.
Offender engages in bondage with consensual partners during sex
16.
Victim is abducted or confined
17.
Evidence of ritualism in offense
Table 1: Items of the "Sadism Scale"
References
1. American Psychiatric Association (2000). Diagnostic and
statistical manual of mental disorders (4th ed. Text rev.).
Washington, DC: Author.
2. Barbaree, H.E., Seto, M.C., Serin, R.C., Amos, N.L., & Preston,
D.L. (1994). Comparisons between sexual and non-sexual rapist
subtypes: Sexual arousal to rape, offense precursors and offense
characteristics. Criminal Justice and Behavior, 21, 95-114.
3. Krafft-Ebing, R. von (1996). Psychopathia sexualis.
Philadelphia: F.A. Davis.
4. Langevin, R., Bain, J., Ben-Aron, M.H., Coulthard, R., Day, D.,
Handy, L., Heasman, G., Hucker, S.J., Purins, J.E., Roper, V., Russon,
A.E., Webster, C.D., & Wortzman, G. (1985). Sexual aggression:
Constructing a predictive equation. A controlled pilot study. In R.
Langevin (Ed.), Erotic preference, gender identify, and aggression in
men: New research studies (pp. 39-76). Hillsdale, NJ: Lawrence
Erlbaum.
5. Livesley, W.J. (2001). Commentary on reconceptualizing
personality disorder categories using trait dimensions. Journal of
Personality, 69, 277-286.
6. Marshall, W.L., & Kennedy. P. (2003). Sexual sadism in sexual
offenders: An elusive diagnosis. Aggression and Violent Behavior: A
Review Journal, 8, 1-22.
7. Marshall, W.L., Kennedy, P., & Yates, P. (2002). Issues
concerning the reliability and validity of the diagnosis of sexual
sadism applied in prison settings. Sexual Abuse: A Journal of Research
and Treatment, 14, 310-311.
8. Marshall, W.L., Kennedy, P., Yates, P., & Serran, G.A. (2002).
Diagnosing sexual sadism in sexual offenders; Reliability across
diagnosticians. International Journal of Offender Therapy and
Comparative Criminology, 46, 668-676.
9. Murphy, K.R., & Davidshofer, C.O. (1998). Psychological testing:
Principles and applications (4th ed.). Hillsdale, NJ: Prentice Hall.
10. Seto, M.C., & Kuban, M. (1996). Criterion-related validity of a
phallometric test for paraphilic rape and sadism. Behaviour Research
and Therapy, 34, 175-183.
11. Widiger, T.A., & Coker, L.A. (2003). Mental disorder as discrete
clinical conditions: Dimensional versus categorical classification. In
M. Hersen & S.M. Turner (Eds.), Adult psychopathology and diagnosis
(4th ed., pp. 3-35). New York: John Wiley & Sons.
12. World Health Organization (1992). The ICD-10 classification of
mental and behavioral disorders. Geneva; WHO.
Author address
William L. Marshall
Rockwood Psychological Services
Suite 403, 303 Bagot Street, Kingston
Ontario, K7K 5W7 Canada
E-mail: bi...@rockwoodpsyc.com