Handbook of What Works With Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment, and Prevention 1st Edition Jean Proulx

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The Wiley Handbook of What Works with
Sexual Offenders
WILEY-BLACKWELL SERIES IN:
WHAT WORKS in OFFENDER REHABILITATION
Edited by
Leam A. Craig
Forensic Psychology Practice Ltd, The Willows Clinic, UK
Centre for Applied Psychology, University of Birmingham, UK
School of Social Sciences, Birmingham City University, UK
Louise Dixon
School of Psychology, Victoria University of Wellington, New Zealand
and
the late, J. Stephen Wormith

Centre for Forensic Behavioural Science and Justice Studies, University
of Saskatchewan, Canada
WHAT WORKS IN OFFENDER REHABILITATION: AN EVIDENCE-BASED

APPROACH TO ASSESSMENT AND TREATMENT
Leam A. Craig, Louise Dixon, and Theresa A. Gannon
THE WILEY HANDBOOK OF WHAT WORKS IN CHILD MALTREATMENT:

AN EVIDENCED-BASED APPROACH TO ASSESSMENT AND INTERVENTION
IN CHILD PROTECTION
Louise Dixon, Daniel Perkins, Catherine Hamilton-Giachritsis and Leam A. Craig
THE WILEY HANDBOOK ON WHAT WORKS FOR OFFENDERS WITH

INTELLECTUAL AND DEVELOPMENTAL DISABILITIES: AN EVIDENCE-BASED
APPROACH TO THEORY, ASSESSMENT, AND TREATMENT
William R. Lindsay, Leam A. Craig and Dorrothy Griffiths
THE WILEY HANDBOOK OF WHAT WORKS IN VIOLENCE RISK MANAGEMENT:

THEORY, RESEARCH AND PRACTICE
J. Stephen Wormith, Leam A. Craig and Todd Hogue
THE WILEY HANDBOOK OF WHAT WORKS WITH SEXUAL OFFENDERS:

CONTEMPORARY PERSPECTIVES IN THEORY, ASSESSMENT, TREATMENT,
AND PREVENTION
Jean Proulx, Franca Cortoni, Leam A. Craig and Elizabeth J. Letourneau
The Wiley Handbook of What Works
with Sexual Offenders
Contemporary Perspectives in Theory, Assessment,
Treatment, and Prevention
Edited by
Jean Proulx,
Franca Cortoni,
Leam A. Craig,
and
Elizabeth J. Letourneau
This edition first published 2020
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Library of Congress Cataloging‐in‐Publication Data
Names: Proulx, Jean, 1956– editor. | Cortoni, Franca, editor. | Craig, Leam A., editor. |
Letourneau, Elizabeth J., editor.
Title: The Wiley handbook of what works with sexual offenders: Contemporary Perspectives in Theory,
Assessment, Treatment, and Prevention / edited by Jean Proulx, Franca Cortoni,
Leam A. Craig, Elizabeth J. Letourneau.
Description: First Edition. | Hoboken : Wiley, 2020. | Includes index.
Identifiers: LCCN 2019056776 (print) | LCCN 2019056777 (ebook) |
ISBN 9781119439455 (cloth) | ISBN 9781119439370 (adobe pdf) |
ISBN 9781119439424 (epub)
Subjects: LCSH: Sex offenders. | Sex offenders–Psychology. | Sex offenders–Rehabilitation. |
Sex crimes–Prevention.
Classification: LCC HV6556 .H367 2020 (print) | LCC HV6556 (ebook) | DDC 365/.66–dc23
LC record available at https://lccn.loc.gov/2019056776
LC ebook record available at https://lccn.loc.gov/2019056777
Cover Design: Wiley
Cover Image: © krisanapong detraphiphat/Getty Images
Set in 10/12.5pt Galliard by SPi Global, Pondicherry, India
Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY
10 9 8 7 6 5 4 3 2 1
Contents
About the Editors ix

About the Contributors xi
Introduction xvii
Jean Proulx
Part I Theories of Sexual Offenders 1

Jean Proulx, Section Coordinator
1 Theories That Explain Sexual Aggression Against Women 3
Jonathan James and Jean Proulx
2 Theories That Explain the Sexual Abuse of Children 23
Beth Dangerfield, Gaye Ildeniz, and Caoilte Ó Ciardha
3 A Developmental Life‐Course View of Sexual Offending: Taking Stock of
Research on the Life‐Course Development of Antisocial and Criminal Behavior 39
Patrick Lussier and Evan McCuish
4 What Works to Prevent Sexual Violence from a Global Health Perspective 71
Greta Massetti, Laura Chiang, and Beverly Fortson
Part II Assessment of Sexual Offenders 87

Leam A. Craig and Franca Cortoni, Section Coordinators
5 Risk Assessment in Individuals Convicted of Sexual Offenses 89
Martin Rettenberger and Leam A. Craig
6 The Psychometric Assessment of Sexual Aggressors 103
Helen Wakeling
7 Indirect and Physiological Approaches to Assessing Deviant Sexual Interests 123
Kevin L. Nunes and Chloe I. Pedneault
8 Assessing Sadism in Sexual Offenders 139
Tamsin Higgs, Alex Lord, Ewa B. Stefanska, and Derek Perkins
vi Contents
9 Neurobiological Considerations on the Etiological Approach to Sexual

Offender Assessment: CAse Formulation Incorporating Risk
Assessment–Version 2 (CAFIRA–v2) 153
Leam A. Craig, Martin Rettenberger, and Anthony R. Beech
Part III Management of Sexual Offenders 175

Franca Cortoni and Leam A. Craig, Section Coordinators
10 The Utility of Treatment for Sexual Offenders 177
Liam E. Marshall
11 Contemporary Programs Designed for the Tertiary Prevention of Recidivism
by People Convicted of a Sexual Offense: A Review, and the U.K. Perspective 185
Laura Ramsay, Adam J. Carter, and Jamie S. Walton
12 Ensuring Responsive Treatment Options for Male Adults Who Have
Sexually Offended 201
Robin J. Wilson, Yolanda Fernandez, and David S. Prescott
13 Pharmacological Treatment of Sexual Offenders 217
Rajan Darjee and Alex Quinn
14 Community Dynamic Risk Management of Persons Who Have
Sexually Offended 247
Robin J. Wilson, Jeffrey C. Sandler, and Kieran McCartan
Part IV Special Populations 265

15 Evidence‐Based Assessment and Treatment Approaches for Adolescents
Who Have Engaged in Sexually Abusive Behavior 267
Alex R. Dopp, Cameron M. Perrine, Kathryn E. Parisi,
Morgan A. Hill, and Michael F. Caldwell
16 Female Sexual Offenders 279
Franca Cortoni and Georgi Stefanov
17 Sexual Murderers 295
Jean Proulx, Jonathan James, and Tamsin Higgs
18 Online Sexual Offenders: Typologies, Assessment, Treatment, and Prevention 311
Sarah Paquette, Francis Fortin, and Derek Perkins
19 An Evidence‐Based Model of Treatment for People with Cognitive
Disability Who Have Committed Sexually Abusive Behavior 327
Matthew C. Frize, Jessica Griffith, Robert Durham, and Catherine Ranson
20 The Role of Major Mental Illness in Problematic Sexual Behavior:
Current Perspectives and Controversies 353
Heather M. Moulden, Jeffrey Abracen, Jan Looman, and Drew A. Kingston
21 Noncontact Sexual Offenses 371
Jennifer DeFeo
Contents vii
22 Sadistic Sexual Aggressors 387

Nicholas Longpré, Jean‐Pierre Guay, and Raymond A. Knight
Part V Policy and Prevention 411

Elizabeth J. Letourneau, Section Coordinator
23 Community‐Based Approaches to Sex Offender Management 413
Wayne A. Logan
24 Problem Sexual Behavior: A Review of Youth‐Focused Policies 427
Rebecca Fix, Maggie Ingram, and Elizabeth J. Letourneau
25 International Approaches to the Management of Perpetrators of
Sexual Harm Policy: Preventative, Practical, or Political? 441
Kieran McCartan and Katherine Gotch
26 Integrating Child Sexual Abuse Prevention Strategies into
Youth‐Serving Organizations 455
Keith Kaufman, Miranda Sitney, Judith Zatkin, Erin McConnell,
and Alyssa Glace
27 Youth‐Focused Child Sexual Abuse-Perpetration Prevention Strategies 473
Ryan T. Shields, Daniel B. Rothman, and Elizabeth J. Letourneau
28 Sexual Violence Prevention with Young Adult Males: Considering
Gender Inequality in an Ecological Context 489
Christopher T. Allen and Christine A. Gidycz
Index 509
About the Editors
Jean Proulx is a professor in, and the director of, the School of Criminology at the University
of Montreal, and Researcher at the International Centre for Comparative Criminology at that
university. Since 1987, he has also been active, both as researcher and forensic psychologist, in
treatment programs for sex offenders at the Philippe-Pinel Institute of Montreal, a maximum-
security psychiatric institution. His main research interests are the pathways in the offending
process, personality profiles, and sexual preferences and recidivism risk factors in sexual murderers,
rapists, pedophiles, and incest offenders. Over the past 30 years, he has published 10 books,
and more than 150 book chapters and peer-reviewed articles in French and in English.
Franca Cortoni is a registered clinical forensic psychologist and professor of criminological
psychology. Since 1989, she has worked with and conducted research on female and male
sexual offenders. She worked for many years with the Correctional Service of Canada
where she provided assessment and treatment services to incarcerated male and female
offenders, was director of an in-prison treatment program for high-risk sexual offenders,
and director of correctional research. In 2007, she moved to a full-time academic position
at the School of Criminology at the Université de Montréal. She is also a research fellow
at the International Centre of Comparative Criminology. Her research focuses on the
factors associated with the development of sexual offending behavior, risk assessment, and
treatment of both male and female sexual offenders. She has published extensively and
made numerous presentations at national and international conferences on both male and
female sexual offender issues. She is currently past-president of the Association for the
Treatment of Sexual Abusers (ATSA).
Leam A. Craig, Ph.D., C.Psychol, CSci, MAE, FBPsS, FAcSS, EuroPsy, is a consultant
forensic and clinical psychologist and partner at Forensic Psychology Practice Ltd. He is a
visiting professor of forensic clinical psychology at the School of Social Sciences, Birmingham
City University, and hon. professor of forensic psychology at the Centre of Applied Psychology,
University of Birmingham. He is a chartered and dual registered [forensic and clinical]
psychologist, a chartered scientist, holder of the European Certificate in Psychology, and a full
member of the Academy of Experts. He was awarded fellowship of the British Psychological
Society and the Academy of Social Sciences for distinguished contributions to psychology
x About the Editors
and the social sciences. He has previously worked in forensic psychiatric secure services,
learning disability hospitals, and consultancy to prison and probation services throughout
England, Wales, and Northern Ireland, specializing in high‐risk, complex cases. He was previ-
ously consultant lead to three community forensic psychiatric hospitals for people with person-
ality disorders, learning disabilities, and challenging behavior. He is currently a consultant to
the National Probation Service on working with offenders with personality disorders. He acts
as an expert witness to civil and criminal courts in the assessment of sexual and violent offenders
and in matters of child protection. He has previously been instructed by the Salvation Army,
Catholic and Church of England Dioceses, South African Police Service, and currently receives
instruction from the United States Air Force European Defence Counsel. He has over 100
publications including 12 books published/in press. In 2013 he received the Senior Academic
Award by the Division of Forensic Psychology for distinguished contributions to academic
knowledge in forensic psychology and in 2018 the Emerald Literati Award for a Highly
Commended paper. In 2015 he co-authored a Ministry of Justice research-funded report into
the use of expert witnesses in family law and in 2016 he was appointed as chair of the British
Psychological Society, Expert Witness Advisory Group. His research interests include sexual
and violent offenders, personality disorder, and forensic risk assessment, and the use of expert
witnesses in civil and criminal courts.
Elizabeth J. Letourneau is professor, Department of Mental Health and director, Moore Center
for the Prevention of Child Sexual Abuse, Johns Hopkins Bloomberg School of Public Health.
Since 1988 she has engaged in research on child sexual abuse prevention, policy, and practice.
Dr. Letourneau held previous academic and research positions at the Medical University of South
Carolina and with the United States Navy. She currently serves on the U.S. National Academies
of Science Forum on Global Violence Prevention and the Maryland State Council on Child
Abuse and Neglect. She previously served on the World Health Organization Guidelines
Development Group for Responding to Child and Adolescent Sexual Abuse. Dr. Letourneau’s
research – published in 100 articles and chapters – has been cited in state and federal sex crime
cases, by state legislatures, and by international bodies, including the Australian Royal
Commission into Institutional Responses to Child Sexual Abuse. She is a long-time member
of the Association for the Treatment of Sexual Abusers, where she served as president and
co-authored guidelines on adolescent practice.
About the Contributors
Jeffrey Abracen Atlanta, GA

Central District (Ontario) Parole U.S.A.
Department of Psychology
Correctional Service Canada Franca Cortoni
Toronto, ON School of Criminology
Canada University of Montreal
Montreal, QC
Christopher T. Allen Canada
Kennesaw State University Leam A. Craig
Kennesaw, GA Forensic Psychology Practice Ltd
U.S.A. The Willows Clinic
Sutton Coldfield
Anthony R. Beech
U.K.
Centre for Applied Psychology
University of Birmingham Beth Dangerfield
Birmingham South East Melbourne Primary Health Network
U.K. Heatherton, VIC
Australia
Michael F. Caldwell
Department of Psychology Rajan Darjee
University of Wisconsin – Madison Centre for Forensic Behavioural Science
Madison, WI Swinburne University of Technology
U.S.A. Alphington, VIC
Australia
Adam J. Carter
Her Majesty’s Prison and Probation Service, Jennifer DeFeo
England and Wales Private practice
London Aliso Viejo, CA
U.K. U.S.A.
Laura Chiang Alex R. Dopp
Division of Violence Prevention Department of Psychological Science
Centers for Disease Control and Prevention University of Arkansas
xii About the Contributors
Fayetteville, AR Alyssa Glace

U.S.A. Department of Psychology
Portland State University
Robert Durham
Portland, OR
Disability Forensic Assessment & Treatment
U.S.A.
Service
Department of Health & Human Services Katherine Gotch
Melbourne, VIC Integrated Clinical & Correctional Services
Australia Portland, OR
U.S.A.
Yolanda Fernandez
Department of National Defence Jessica Griffith
Sexual Misconduct Response Centre Disability Forensic Assessment & Treatment
Correctional Service of Canada Service
Ottawa, ON Department of Health & Human Services
Canada Melbourne, VIC
Australia
Rebecca Fix
Department of Mental Health Jean‐Pierre Guay
Johns Hopkins Bloomberg School of Public School of Criminology
Health University of Montreal
Baltimore, MD Montreal, QC
U.S.A. Canada
Francis Fortin Tamsin Higgs
School of Criminology Department of Psychology
Université de Montréal University of Montréal
Montreal, QC Montreal, QC
Canada Canada
Beverly Fortson Morgan A. Hill
Division of Violence Prevention Department of Psychological Science
Centers for Disease Control and Prevention University of Arkansas
Atlanta, GA Fayetteville, AR
U.S.A. U.S.A.
Matthew C. Frize Gaye Ildeniz
Disability Forensic Assessment & Treatment Centre of Research and Education in
Service Forensic Psychology
Department of Health & Human Services School of Psychology
Melbourne, VIC University of Kent
Australia Canterbury
U.K.
Christine A. Gidycz
Department of Psychology Maggie Ingram
Ohio University Department of Mental Health
Athens, OH Johns Hopkins Bloomberg School of Public
U.S.A. Health
About the Contributors xiii
Baltimore, MD Alex Lord

U.S.A. Sexual Behaviour Service
Broadmoor Hospital
Jonathan James
Crowthorne
School of Criminology
U.K.
University of Montreal
Montreal, QC Patrick Lussier
Canada School of Social Work and Criminology
Université Laval
Keith Kaufman
Quebec, QC
Canada
Portland State University
Portland, OR Liam E. Marshall
U.S.A. Waypoint Centre for Mental Health Care
Penetanguishine, ON
Drew A. Kingston
Canada
HOPE program
San Diego, CA Greta Massetti
U.S.A. Division of Violence Prevention
Centers for Disease Control and Prevention
Raymond A. Knight
Atlanta, GA
U.S.A.
Brandeis University
Waltham, MA Kieran McCartan
U.S.A. Health and Social Services
University of the West of England
Elizabeth J. Letourneau
Bristol
Moore Center for the Prevention of Child
U.K.
Sexual Abuse
Johns Hopkins Bloomberg School of Public Erin McConnell
Health Department of Psychology
Baltimore, MD Portland State University
U.S.A. Portland, OR
U.S.A.
Wayne A. Logan
Florida State University College of Law Evan McCuish
Tallahassee, FL School of Criminology
U.S.A. Simon Fraser University
Burnaby, BC
Nicholas Longpré
Canada
University of Roehampton Heather M. Moulden
London St. Joseph’s Healthcare Hamilton
U.K. Hamilton, ON
Canada
Jan Looman
Forensic Behaviour Services Kevin L. Nunes
Kingston, ON Department of Psychology
Canada Carleton University
xiv About the Contributors
Ottawa, ON Alex Quinn

Canada The Orchard Clinic
Royal Edinburgh Hospital
Caoilte Ó Ciardha
Edinburgh
Centre of Research and Education in Forensic
Scotland
Psychology
U.K.
School of Psychology
University of Kent Laura Ramsay
Canterbury Her Majesty’s Prison and Probation Service,
U.K. England and Wales
Sarah Paquette London
Internet Child Exploitation Unit U.K.
Sûreté du Québec
Catherine Ranson
Montreal, QC
Office of the Senior Practitioner
Canada
Compulsory Treatment Team
Kathryn E. Parisi Office of Professional Practice
Department of Psychological Science Department of Health & Human Services
University of Arkansas Melbourne, VIC
Fayetteville, AR Australia
U.S.A.
Martin Rettenberger
Chloe I. Pedneault Centre for Criminology (Kriminologische
Department of Psychology Zentrastelle – KrimZ)
Carleton University Wiesbaden
Ottawa, ON Germany
Canada
Daniel B. Rothman
Derek Perkins
Forensic Psychological Services – Ellerby,
Broadmoor Hospital
Kolton, Rothman & Associates
West London Mental Health NHS Trust
Winnipeg, MB
London
Canada
U.K.
Cameron M. Perrine Jeffrey C. Sandler
Department of Psychological Science Private practice
University of Arkansas New York, NY
Fayetteville, AR U.S.A.
U.S.A.
Ryan T. Shields
David S. Prescott School of Criminology and Justice Studies
Becket Family of Services University of Massachusetts Lowell
Portland, ME Lowell, MA
U.S.A. U.S.A.
Jean Proulx Miranda Sitney
School of Criminology Department of Psychology
University of Montreal Portland State University
Montreal, QC Portland, OR
Canada U.S.A.
About the Contributors xv
Georgi Stefanov Jamie S. Walton

School of Criminology Her Majesty’s Prison and Probation Service,
Université de Montréal England and Wales
Montreal, QC London
Canada U.K.
Robin J. Wilson
Ewa B. Stefanska
Department of Psychiatry and Behavioural
Neurosciences
University of Roehampton
McMaster University
London
Hamilton, ON
U.K.
Canada
Helen Wakeling Judith Zatkin
Directorate of Rehabilitation and Assurance Department of Psychology
Her Majesty’s Prison and Probation Service Portland State University
London Portland, OR
U.K. U.S.A.
Introduction
Jean Proulx
In a provocative paper entitled “What Works? Questions and Answers about Prison Reforms,”
Martinson (1974) favored a skeptical attitude to the possibility of rehabilitation of delinquents
and criminals. As a consequence of this attitude, there was a shift in the criminal justice system
of several countries toward strategies such as long‐term incarceration of offenders to increase
public safety (Petrunic, 1994). After more than four decades of research in the field of forensic
psychology, it is now well established that Martinson’s pessimism was misplaced. In fact, there
is now a wide body of evidence that a variety of treatment and prevention programs are effec-
tive in reducing recidivism and favoring rehabilitation, in both delinquents and criminals
(Weisburd, Farrington, & Gill, 2017). More particularly, this conclusion is true in the special-
ized case of sexual aggressors (Hanson, Bourgon, Helmus, & Hodgson, 2009; Marshall &
Marshall, 2012; Schmucker & Lösel, 2008).
In the 1970s and the early 1980s, a major theme of empirical research in the field of
sexual aggression was the study of the sexual preferences and interests of these offenders
(Proulx, 1989). At that time, the main causative factors of the crimes of sexual aggressors
were considered to be their sexual preferences for children as a sexual partner, and for
coercive sexual behaviors with nonconsenting adult partners. Consequently, treatments
were developed to reduce these deviant sexual preferences, and to increase sexual interest
in consensual adult partners. In the 1980s and the 1990s, models of sexual aggression and
treatment evolved, and began to take into consideration other factors such as social skill
deficits, cognitive distortions, and the use of sex to cope with negative emotions (Marshall,
Laws, & Barbaree, 1990). Another major contribution to the field of sexual aggression
was the development of the self‐regulation model of relapse prevention (Ward, Hudson,
& Keenan, 1998). This model integrates a diversity of factors, identified in previous
empirical studies, into a model that takes into account the heterogeneity in sexual
offenders, as well as the temporal sequence that culminates in an assault (Proulx,
Beauregard, Lussier, & Leclerc, 2014). As a consequence, the field has moved on from a
“one size fits all” approach to multifactorial conceptualization, assessment, and treatment
of sexual aggressors. With that in mind, we elaborate a handbook that provides an over-
view of the state of the art in the field of research into sexual aggression.
This handbook comprises five sections. The first one presents the major theories that have
been developed to explain sexual aggression against women and sexual aggression again
xviii Introduction
children. In addition, it includes a chapter on public health perspectives to understanding

sexual aggression. In the second section, assessment issues are addressed. Instruments designed
to evaluate the risk of recidivism, deviant sexual interests, and sexual sadism are presented, and
good practice in case formulation for treatment purposes is described. The third section of this
handbook is devoted to the treatment of sexual offenders. It includes chapters on components
of contemporary treatment programs, including one on pharmacological treatment and one
on responsivity to treatment. In line with the heterogeneity found in sexual offenders, the
fourth section of this handbook addresses the specificity of populations involved in sexual
offending, such as: female sexual offenders, sexual murderers, online sexual offenders, and
sexual offenders with intellectual development disorder or major mental disorders. These
chapters include details on the specific characteristics of these offenders and on their treatment
needs. Finally, in the fifth section, cutting‐edge prevention strategies designed to reduce the
incidence of sexual aggression against children and against women are presented.
This handbook on what works with sexual offenders is designed to provide an introduction
to a diversity of theories of sexual aggression, and to approaches to the assessment, treatment,
and prevention of sexual aggression. With the rapid advances in research and treatment during
the past four decades, it can be difficult for professionals new to the field to know where to
start. Who are the major researchers and clinicians in the field? Which assessment methods or
treatment programs have been demonstrated to be effective? Which prevention strategies
reduce the prevalence of sexual offending in specific contexts? We believe that this handbook
provides easily accessible answers to these questions; in addition, it suggests specialized refer-
ences for those interested in particular domains, be it the factors that favor sexual homicide or
best practices in sexual‐crime prevention on university campuses.
References
Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional
treatment also apply to sexual offenders: A meta‐analysis. Criminal Justice and Behavior, 36, 865–891.
Marshall, W. L., Laws, D. R., & Barbaree, H. E. (1990). Handbook of sexual assault. Issues, theories and
treatment of the offenders. New York, NY: Plenum Press.
Marshall, W. L., & Marshall, L. E. (2012). Treatment of sexual offenders: Effective elements and appropri-
ate outcome evaluations. In E. Bowen & S. Brown (Eds.), Perspectives on evaluating criminal justice
and corrections (pp. 71–94). London, England: Emerald Publishing.
Martinson, R. M. (1974). What works? Questions and answers about prison reform. The Public Interest,
35, 22–54.
Petrunic, M. (1994). Modèles de dangerosité: Les contrevenants sexuels et la loi [Models of dangerous-
ness: Sexual offenders and the law]. Criminologie, 27, 87–125.
Proulx, J. (1989). Sexual preference assessment of sexual aggressors. International Journal of Law and
Psychiatry, 12, 275–280.
Proulx, J., Beauregard, E., Lussier, P., & Leclerc, B. (2014). Pathways to sexual aggression. Abingdon,
England: Routledge.
Schmucker, M., & Lösel, F. (2008). Does sexual offender treatment work: A systematic review of outcome
evaluation. Psychotheme, 20, 10–19.
Ward, T., Hudson, S. M., & Keenan, T. (1998). A self‐regulation model of the sexual offense process.
Sexual Abuse: A Journal of Research and Treatment, 10, 141–157.
Weisburd, D., Farrington, D. P., & Gill, C. (2017). What works in crime prevention and rehabilitation:
An assessment of systematic review. Criminology and Public Policy, 16, 415–449.
Part I
Theories of Sexual Offenders
1
Theories That Explain Sexual
Aggression Against Women
Jonathan James and Jean Proulx
School of Criminology, University of Montreal, Montreal, Canada
Introduction
What leads some men to sexually assault a woman? Unfortunately, there is no consensus on the
developmental processes that underlie this behavior (Lussier, 2018a). This may be due in part to
the dominant approach to the analysis of sexual offending, that is, correctional psychology, which
focuses on the management of convicted sexual offenders’ risk of sexual recidivism. Consequently,
while effective tools do exist for the assessment of this risk, identification of the features of a sexual
offender’s life course that increased his likelihood of committing a sexual crime remains elusive.
Many studies of sexual offending have focused on the identification of characteristics that
are specific to sexual offenders, and have attempted to answer questions such as: Are these
individuals different from those who have never committed a crime? Are all perpetrators of
sexual crimes—particularly sexual aggressors against women—identical? And (the perennial)
are sexual offenders the same as other criminals?
This chapter presents the most noteworthy explanatory theories and models, and empirical
results, related to sexual aggression against women. For these purposes, “sexual aggression
against women” is defined as an extrafamilial sexual assault by an adult male against an adult
female (at least 16 years old) (for a discussion of theories related to marital rapists, see Proulx &
Beauregard, 2014a). In addition, while sexual offending against women is polymorphic, and
comprises sexual violence, sexual misconduct, and sexual exploitation, this chapter discusses
only rape and contact sexual aggression (see Figure 1.1). For a discussion of child sexual abuse,
sexual homicide, and noncontact sexual offenses, see Chapters 2, 17, and 21 of this book.
The Neuropsychology of Sexual Aggressors Against Women
In recent years, there has been a surge of interest in the identification of neuroanatomical and
neurophysiological deficits in antisocial individuals, and in the relationship of these deficits to the
psychological functioning of these individuals. Antisocial offenders, especially sexual offenders,
have received particular attention (e.g., Beech, Carter, Mann, & Rotshtein, 2018; Raine, 2013).
The Wiley Handbook of What Works with Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment,
and Prevention, First Edition. Edited by Jean Proulx, Franca Cortoni, Leam A. Craig, and Elizabeth J. Letourneau.
© 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd.
4 Jonathan James and Jean Proulx
Sexual homicide
Rape and sexual

Sexual violence
aggression
Child sexual
abuse
Sexual indecency
Sexual Sexual
Sex offending
misconduct harassment
Sexual misconduct
in a context of
authority
Intenet child
luring and
cyberpredation
Sexual Prostitution
exploitation (recruiting, pimping)
Child pornography
(making, producing,
distributing)
Figure 1.1 Sex offending: a multidimensional viewpoint. Lussier and Mathesius (2018).
Joyal, Beaulieu‐Plante, and de Chantérac (2014) conducted a meta‐analysis of studies of the

neuropsychological characteristics of sexual offenders, in order to determine the specificity of
the relationship between neuropsychological deficits and sexual offending. Their meta‐analysis
compared sexual offenders against women (N = 533) to sexual offenders against children
(N = 530), and compared all sexual offenders (N = 1,063) to nonsexual offenders (N = 378)
and to noncriminals (N = 378). In tests of cognitive functioning, such as visual attention,
speed processing, task switching, cognitive flexibility, and verbal fluency, both sexual offenders
as a whole, and sexual offenders against women, exhibited a wider variety of cognitive prob-
lems than noncriminals. In addition, while sexual offenders against women scored higher than
sexual offenders against children on tests of cognitive flexibility, perseveration, and reasoning,
they scored lower on tests of verbal fluency and cognitive inhibition. Finally, sexual offenders
against women and nonsexual offenders had similar neuropsychological profiles (e.g., low
scores on tests of verbal fluency and inhibition).
This meta‐analysis revealed some important points. First, it is possible that poor cognitive
performance is associated with sexual offending. Second, because the neuropsychological pro-
file of sexual offenders against women differs from that of sexual offenders against children,
these two groups should be investigated separately in both quantitative analyses and
Theories That Explain Sexual Aggression Against Women 5
theoretical models. Finally, the many similarities between the neuropsychological profiles of
sexual offenders against women and nonsexual offenders suggest that there is no causal rela-
tionship between neuropsychological deficits and sexual offending against women (Joyal et al.,
2014). However, it is important to note that these results do not mean that all sexual offenders
against women have neuropsychological characteristics similar to those nonsexual offenders.
In fact, drawing that conclusion requires analysis of the heterogeneity of sexual offenders
against women, and, especially, of the differences between sexual offenders with deviant and
nondeviant sexual preferences (see Knight, 2010; Proulx & Beauregard, 2014b).
The Psychology of Sexual Aggressors Against Women
Deviant sexual preferences

Hanson and Morton‐Bourgon (2005) conducted a meta‐analysis of studies involving postsen-
tencing follow‐up of 29,450 sexual aggressors (considered a homogeneous group), and con-
cluded that deviant sexual preferences were the strongest predictor of sexual recidivism. Results
such as this may reinforce the popular belief that sexual deviance is a causal factor of sexual
aggression and the hypothesis that all sexual aggressors against women prefer nonconsensual
sexual contact with women over consensual sexual contact (Barbaree, 1990). However, these
results must be balanced against the results of Lalumière and Quinsey’s (1994) meta‐analysis
of phallometry results from sexual aggressors against women (N = 415) and a control group
(N = 192; nonsexual offenders against women and noncriminals). Those authors found that
sexual aggressors responded more than nonrapists to rape cues and more to rape cues than to
consensual sex cues. This being said, it is important to note that not all sexual aggressors
against women are characterized by a sexual preference for rape (see also Michaud & Proulx,
2009), which means that a deviant sexual preference is at best a partial explanatory factor for
sexual aggression.
Lack of empathy, antisociality, and psychopathy

Hanson and Morton‐Bourgon (2005) found antisocial orientation (antisocial personality,
antisocial traits, history of rule violation) to be the second‐strongest predictor of sexual recid-
ivism. This finding is consistent with theories of sexual offending that posit that sexual aggres-
sors’ infliction of pain, fear, or suffering on their victims denotes a characteristic lack of
empathy (e.g., Marshall & Barbaree, 1990). Paradoxically, however, committing a sexual
assault is not synonymous with a lack of empathy for the victim—some aggressors are con-
vinced that their victim obtained pleasure from their sexual contact. In addition, even with
sexual aggressors who admit to a lack of empathy for their victim (e.g., were indifferent to,
or attracted by, their victim’s suffering), there is no basis for concluding that this lack of
empathy is structural and generalized, rather than specific and situational (e.g., due to nega-
tive emotions or intoxication at the time of the offense) (Hanson & Scott, 1995). Keeping
these nuances in mind, it is noteworthy that the results of studies that found no difference
between the empathy of sexual aggressors, nonsexual offenders, and noncriminals constitute
a challenge to theories that posit a generalized lack of empathy in sexual aggressors (see
Polaschek, 2003).
Marshall and colleagues (Fernandez & Marshall, 2003; Marshall & Moulden, 2001)
conducted several comparative studies to evaluate empathy deficits among sexual aggressors
against women. They reported that:
1. Sexual aggressors against women felt more empathy for women in general than nonsexual
offenders.
2. Sexual aggressors against women felt similar (Fernandez & Marshall, 2003) or less
(Marshall & Moulden, 2001) empathy for women who had suffered a sexual assault by
another man as did nonsexual offenders, and less empathy than noncriminals (Marshall &
Moulden, 2001).
3. Sexual aggressors against women felt less empathy for their victim than for other women.
4. Sexual aggressors against women felt less empathy for their victim than did nonsexual
offenders.
5. Sexual aggressors against women felt more hostility toward women than did nonsexual
offenders and noncriminals.
These results suggest that: (a) hostility toward women may be associated with sexual aggres-
sion (hostility toward women is also a risk factor for sexual recidivism; see Hanson, Harris,
Scott, & Helmus, 2007), and (b) the empathy deficit of sexual aggressors against women is
contextual and specific (e.g., triggered by anger against a woman), not structural and general-
ized. However, empathy deficits may be structural, and generalized, in sexual aggressors
against women who scored high for psychopathy (Knight & Guay, 2018; Yang, Raine, Narr,
Colletti, & Toga, 2009).
A consensus exists regarding the role of psychopathy in the sexual coercion of women
(Knight & Guay, 2018). For example, a meta‐analysis of the relationship between Psychopathy
Checklist—Revised (PCL‐R) scores and sexual recidivism revealed that a chronically unstable,
antisocial, and deviant lifestyle (PCL‐R Factor 2; Hare, 2003) is a good predictor of this type
of recidivism (Hawes, Boccaccini, & Murrie, 2013). While only a minority of sexual aggressors
against women are psychopaths (12.1–40.0%; e.g., Porter, Campbell, Woodworth, & Birt,
2001; Serin, Mailloux, & Malcolm, 2001), the prevalence in this group is higher than in the
general population (approximately 1.0%; Forth, Brown, Hart, & Hare, 1996; Hare, 1998)
and in sexual aggressors against children (5.4–6.3%; Brown & Forth, 1997; Porter et al.,
2001; Serin, Malcolm, Khanna, & Barbaree, 1994). It is also worth noting that the variation
of psychopathy among sexual aggressors against women may reflect differences in the security
level of the correctional institutions in which studies have been conducted or the predomi-
nance of certain types of aggressors in samples. For example, with regard to the latter point,
there is a consensus that psychopaths are overrepresented in samples of opportunistic sexual
aggressors against women (Brown & Forth, 1997; Knight, 2010; Proulx & Beauregard,
2014b). Finally, similar prevalences of psychopathy have been reported among sexual aggres-
sors against women and nonsexual offenders (35.9 and 34.0%, respectively; Porter et al.,
2001), suggesting that the sexual assault of women is an antisocial behavior reflecting a broader
antisocial tendency (Lussier, LeBlanc, & Proulx, 2005).
Although lack of empathy may favor sexual offending against women, it is not systematically
found in all sexual aggressors against women. Some sexual aggressors against women fail to
recognize the gravity of their behaviors and the negative consequences of these behaviors on
their victim’s psychological functioning, which raises the possibility that they have deficits
related to the processing of information about their social environment (Hanson & Scott,
1995; Marshall, Hudson, Jones, & Fernandez, 1995).
Cognitive distortions and implicit theories

Cognitive distortions are the third‐strongest predictor of sexual recidivism, according to
Hanson and Morton‐Bourgon (2005), and occupy a central place in theories of sexual offend-
ing (e.g., Ward & Siegert, 2002). Moreover, they are one of the main therapeutic targets in
the treatment of sexual aggressors (Ward, Polaschek, & Beech, 2006)—despite the absence of
supporting empirical evidence regarding their role in sexual aggression (Maruna & Mann,
2006; Ward, Gannon, & Keown, 2006).
The scientific community’s interest in the cognitions of sexual aggressors is based on the
hypothesis that cognitive distortions trigger or maintain coercive sexual behaviors. This hypo-
thesis was proposed in light of the statements of some sexual aggressors that suggested that
they interpreted their offense in an erroneous manner (e.g., they believed that the victim expe-
rienced pleasure during the sexual assault). To explain these cognitions, McFall (1990) sug-
gested that sexual aggressors against women suffer from deficits in the interpretation of cues
from women, and commit inappropriate sexual behaviors because they interpret negative cues
as positive. This hypothesis followed from the results of comparative studies indicating that
sexual aggressors against women decode cues from women less reliably than do nonsexual
offenders, and more strongly endorse beliefs supporting rape—for example, women are
responsible for their own rape, and men accused of rape are probably innocent (Lipton,
McDonel, & McFall, 1987; Marolla & Scully, 1986). These results should however be inter-
preted with caution, since other studies have failed to find any differences in the attitudes and
beliefs concerning women held by sexual aggressors against women, nonsexual offenders, and
noncriminals (Overholser & Beck, 1986; Segal & Stermac, 1984).
There is a consensus that sexual aggressors against women and sexual aggressors against
children have different cognitive distortions (Arkowitz & Vess, 2003; Bumby, 1996; Hayashino,
Wurtele, & Klebe, 1995). Ward and colleagues developed a schema‐based theory of sexual
offender cognition which posits that sexual aggressors’ cognitive distortions are the product
of underlying implicit theories—causal theories that help explain and predict our own and
others’ behavior (Ward, 2000). Further, they proposed that sexual aggressors against women
(Polaschek & Ward, 2002) and sexual aggressors against children (Ward & Keenan, 1999)
hold different implicit theories. Subsequently, Polaschek and Gannon (2004) confirmed the
existence of Polaschek and Ward’s (2002) implicit theories in a group of sexual aggressors
against women:
• Women as sex object (70% of the sample interviewed): Women are constantly sexually recep-
tive to men’s needs but are not always consciously aware that they are.
• Entitlement (68%): Men must satisfy their sexual needs and have the right to punish women
who refuse sexual contact.
• Women are unknowable (65%): Women are fundamentally different from men, with minds
so inherently alien that men cannot easily grasp how they work.
• Dangerous world (19%): The world is a hostile and threatening place.
• Male sex drive is uncontrollable (16%): Male libido is inherently uncontrollable, and women
must provide men with reasonable sexual access.
These results, together with those obtained from studies of sexual murderers (see Beech,
Fisher, & Ward, 2005; James, Beauregard, & Proulx, 2019), suggest that: (a) almost all sexual
aggressors against women hold at least one of Ward and colleague’s implicit theories described
above, and (b) some implicit theories are overrepresented among some types of sexual
aggressors against women (e.g., dangerous world and male sex drive is uncontrollable appear to
predominate among sadistic sexual aggressors).
To date, there have been few empirical studies of the cognitive distortions of sexual aggres-
sors against women. Nevertheless, the results suggest that the sexual assault of women is the
consequence of deficits in the perception or processing of information in social contexts. The
discrepancy between the cues generated in a social environment and the response of the sexual
aggressor are thought to be associated with difficulties establishing and maintaining healthy
and stable interpersonal relationships.
Intimacy deficits and attachment styles

Intimacy deficits (poor social skills, negative social influences, conflicts in intimate relation-
ships, loneliness) are the fourth‐strongest predictor of sexual recidivism, according to Hanson
and Morton‐Bourgon (2005), and occupy an important place in models and theories of sexual
aggression (e.g., Marshall, 1989; Ward & Siegert, 2002). In these theories, sexual aggression
is considered an inappropriate behavior resulting from the inability to establish and maintain
intimate and mutually gratifying interpersonal relationships (Christie, Marshall, & Lanthier,
1979; Clark & Lewis, 1977).
Marshall (1989) has suggested that sexual aggressors fail to establish and maintain intimate
relationships with others in adulthood because their childhood experiences precluded the
development of a secure attachment style. As a result, they suffer from loneliness and low self‐
esteem, which hinders the developments of intimate relationships and favors social isolation. It
is thought that sexual aggressors’ emotional distress drives them to take refuge in fantasy
worlds dominated by hostility toward women, and to exhibit sexually aggressive behaviors
(Proulx, McKibben, & Lusignan, 1996).
Marshall’s hypothesis has been partially validated by empirical studies that demonstrated
that loneliness is associated with hostility toward women and the tendency to resort to vio-
lence (Marshall & Hambley, 1996). However, this association is not specific to sexual aggres-
sors against women; in fact, similar results have been obtained with noncriminals (Check,
Perlman, & Malamuth, 1985). Moreover, it has been demonstrated that sexual aggressors
against women and noncriminals have similar social‐skill deficits (Segal & Marshall, 1985a,
1985b, 1986). On the other hand, sexual aggressors against women and noncriminals do dif-
fer in some respects. Sexual aggressors against women are characterized by deficits in
assertiveness (Stermac & Quinsey, 1986) and by an insecure attachment style—for example,
Ward, Gannon, and Keown (2006) observed an insecure attachment style in 69% of sexual
aggressors against women but only 55–65% of noncriminals.
Ward, Hudson, and Marshall (1996) reported that the insecure attachment style of sexual
aggressors against women differed from that of sexual aggressors of children: the former have
a dismissing style, the latter a preoccupied one. Individuals with a dismissing attachment style
are skeptical of the value of intimate relationships and place great importance on their
independence. They are more likely to exhibit hostility, and are consequently inclined to vio-
lently assault women. They score lower for loneliness than individuals with a preoccupied
attachment style but higher for fear of intimacy, anger expression, and anger suppression, and
tend to accept rape myths more than aggressors with other attachment styles (Hudson &
Ward, 1997). On the other hand, sexual aggressors with a preoccupied attachment style tend
to seek approval from others and sexualize intimate relationships, leading them to engage in
sexual contact with children. Not surprisingly, sexual aggressors against women tend to score
lower for loneliness, intimacy deficits, anxiety, and stress (Garlick, Marshall, & Thornton,
1996; Segal & Marshall, 1985a, 1985b, 1986), have a greater number of negative schemata
toward others, and have higher self‐esteem (Ward, McCormack, & Hudson, 1997), than
sexual aggressors against children.
The patterns described in the preceding sections suggest that sexual aggressors against
women, and nonsexual offenders, are more similar than different with regard to intimacy def-
icits and attachment styles. There appear to be no differences in their social skills, their percep-
tion and evaluation of their intimate relationships, and their investment in their intimate
relationships (Segal & Marshall, 1985a, 1985b, 1986; Ward et al., 1996, 1997). Moreover,
the prevalence of a dismissing attachment style is similar in the two groups, which suggests that
this insecure attachment style should be considered a risk factor for offending in general rather
than for a specific propensity for sexual aggression (Ward et al., 1996, 1997). It should be
noted that sexual aggressors against women tend to be lonelier than nonsexual offenders
(Garlick et al., 1996), which supports Marshall’s (1989) initial hypothesis.
In light of the preceding observations, future studies should attempt to clarify the role of
intimacy deficits in the process leading to the sexual assault of women, while taking into
consideration the heterogeneity of this category of sexual aggressors. The preceding sections
have demonstrated that the sexual assault of women is the product of multiple psychological
deficits located at the surface level of symptomology (Ward & Beech, 2006). The deficits of
intimacy, neuropsychology, empathy, or cognition described above are all incapable of explain-
ing on their own what leads some men to sexually assault a woman. Accordingly, to better
understand the phenomenon of sexual aggression, models that integrate all these factors,
rather than analyze them in isolation, have been developed. The rest of this chapter will pro-
vide an overview of the best‐known explanatory models and multifactorial theories of sexual
aggression, and typologies of sexual aggressors against women.
Models of Sexual Offending
Ward and Beech’s integrated theory of sexual offending (ITSO)

Ward and Beech’s (2006) ITSO is a theoretical framework that attempts to integrate every
aspect of sexual aggression and explain the onset, development, and maintenance of sexual
aggression (without however distinguishing between sexual aggression against women and
sexual aggression against children). The theory draws upon Pennington’s (2002) suggestion
that a neuroscientific account of human psychopathology requires consideration of four levels
of analysis: etiology, brain mechanisms, neuropsychology, and symptom levels. Etiology is concerned
with the elements responsible for psychopathology, that is, the interactions between genetic
and environmental factors. These interactions influence the structure and function of the
brain, and so influence brain mechanisms. Since the structure and function of the brain in turn
shape emotional, cognitive, and motor processes, they ultimately influence neuropsychological
responses, which, in a social context, generate a clinical symptom (Figure 1.2).
In the initial version of the ITSO, Ward and Beech (2006) suggested that a sexual assault
occurs as a result of a continuous flow of interactions between three distal and proximal causal
factors: biological factors (influenced by genetic inheritance and brain development), ecological
niche factors (i.e., acquired social, cultural, and personal factors), and neuropsychological factors.
The revised version of the ITSO (Ward & Beech, 2016) includes a fourth causal factor,
personal agency (i.e., intentional mental states), in order to take into account the fact that the
symptoms that can lead to sexual aggression (deviant sexual preferences, emotional problems,
cognitive distortions, social difficulties) are interrelated and play a functional role in a person’s
psychological life.
The ITSO has several strengths. First, it integrates several theories that have been validated
empirically. Second, by taking into consideration the diversity of potential interactions bet-
ween causal factors at different levels of functioning, it allows identification of multiple path-
ways to sexual aggression. Third, it reintroduces a biological perspective—frequently neglected
in attempts to explain criminal behavior—that situates sexual aggressors in cultural, social,
psychological, and biological terms. Fourth, it provides a systematic and multifaceted frame-
work for the evaluation and treatment of sexual aggressors. And finally, it offers a new and
promising perspective, by suggesting that sometimes problems have single causes, localized in
specific functional systems: “for example, an offender may articulate offense‐supportive state-
ments which appear to stem from offense‐supportive implicit theories (the perception and
motivation system), but which are actually the function of impression management strategies
instead (motivation/emotional and action selection and control systems)” (Ward & Beech,
2006, p. 61). Consequently, “it may make more sense to allocate individuals to groups based
of the type of functional systems compromised rather than upon the basis of their surface
symptoms” (Pennington, 2002, in Ward & Beech, 2006, p. 340). Although the ITSO pro-
vides a coherent framework for the understanding of the diversity of pathways leading to
sexual aggression, it has not been empirically validated.
Interlocking neuropsychological functions

Clinical symptoms:
State factors
Action
Motivational/ selection • Emotional problems
emotional and control • Social difficulties
• Cognitive distorsion
Perception • Deviant arousal
and
memory
functioning
Biological
Sexual
learning
Social
offending
ACTIONS
Brain development Ecological niche: proximal

and distal
Maintenance and
• Genetics • Social and cultural environment escalation
• Evolution • Personal circumstances
• Physical environment
Figure 1.2 Schematic illustration of the Integrated Theory of Sexual Offending (ITSO). Ward and
Beech, (2016).
Knight and Sims‐Knight’s etiological model

Knight and Sims‐Knight (2003) have proposed an etiological model of sexual aggression that
draws on the work of Malamuth, who identified two developmental pathways to sexual
aggression—one sexual (impersonal sex), the other hostile (hostile masculinity) (Malamuth,
1998; Malamuth, Linz, Heavey, Barnes, & Acker, 1995; Malamuth, Sockloskie, Koss, &
Tanaka, 1991). Their model has a robust empirical basis (structural equation modeling, testing
with a variety of samples, including a sample of sexual aggressors against women), and
comprises three pathways. While Knight and Sims‐Knight’s sexual pathway tends to validate
Malamuth’s impersonal sex pathway, their model replaces Malamuth’s hostile masculinity
pathway by two distinct pathways, callous/unemotional, characterized by insensitivity and a
lack of empathy, and antisocial behavior/aggression, characterized by antisociality (Figure 1.3).
According to Knight and Sims‐Knight, the sexual pathway is better defined in terms of hyper-
sexuality—defined as sexual preoccupation, urges, and compulsions—than sexual promiscuity
only (Malamuth’s hypothesis). This pathway is thought to be associated with sexual victimiza-
tion during childhood and with a wider range of sexual activities and psychosexual problems
(e.g., sexual compulsion) in adulthood. The sexual lifestyle of individuals following this pathway
is characterized by the pursuit of immediate sexual gratification, which facilitates disinhibition
of coercive and sadistic sexual fantasies, in turn directly associated with sexual coercion.
The callous/unemotional pathway is characterized by physical and verbal abuse in childhood,
which in turn favors insensitivity and lack of empathy in adolescence and adulthood. These
deficits in the consideration for others favor the development of hypersexuality, characterized
by the pursuit of immediate gratification, which in turn disinhibits coercive sexual fantasies.
The absence of consideration for others, in conjunction with hypersexuality and sexual devi-
ance, is hypothesized to directly favor recourse to sexual coercion.
The antisocial behavior/aggression pathway is characterized by physical and verbal abuse
during childhood, which directly and indirectly favors sexual and nonsexual antisocial
Antisocial
Behavior
Aggression
Physical/
Verbal Abuse Sexual
Coercion
Callous/
Unemotional
Aggressive
Sexual Sexual
Fantasy
Abuse
Sexual
Fantasy
Figure 1.3 Knight and Sims‐Knight’s (2003) three‐component theoretical structural model of sexual
coercion against women.
behaviors, as a result of insensitivity and lack of empathy. These antisocial behaviors favor the
emergence of coercive sexual behaviors, either directly, or indirectly through recourse to
deviant sexual fantasies.
Thus, Knight and Sim‐Knight’s etiological model considers sexual aggressors against women
antisocial individuals focused on the gratification of their immediate needs, and emphasizes
the role of psychopathic traits and hypersexuality. Although this model demonstrates that
sexual deviance and general deviance may lead, independently or jointly, to the sexual assault
of a woman, several studies have called into question the existence of its two distinct etiological
processes: (a) physical and/or verbal abuse leading to general deviance, and (b) sexual victim-
ization leading to sexual deviance.
Lussier, Proulx, and Le Blanc’s criminal‐pathways model

Lussier, Proulx, and Le Blanc (2005) analyzed the associations between victimization (both
sexual and nonsexual) and exposure to criminogenic models in childhood, on the one hand,
and sexual and nonsexual offending in adulthood, on the other. Using structural equation
modeling, they analyzed the criminal pathways of 209 sexual aggressors against women, and
identified the developmental pathways that best explain sexual offending in adulthood. Like
the previously described models (e.g., Knight & Sims‐Knight, 2003), their model identified
multiple pathways to sexual aggression: a general pathway (related to general deviance), a
specific pathway (related to sexual deviance), and a general‐specific pathway (related to both
general and sexual deviance) (Figure 1.4).
Individuals following the general pathway had behavioral problems in childhood that per-
sisted through adolescence and adulthood. These individuals committed a variety of sexual
and nonsexual crimes, and were characterized by hostility. Individuals following the specific
pathway had a lifestyle characterized by the consumption of pornography, sexual promiscuity,
high sex drive, sexual compulsion, sexual preoccupation, and sexual deviance. The general‐
specific pathway was followed by both sexual and nonsexual offenders. These individuals were
characterized by general deviance (antisociality), sexualization (consumption of pornography,
impersonal sexuality, sexual compulsion), and sexual deviance (deviant sexual arousal).
The results of Lussier, Proulx, and Le Blanc (2005) indicate that the general and general‐
specific models better explain the commission of sexual crimes against women than does the
specific model. The authors suggest that sexual aggression against women is favored by exposure
to criminogenic models in childhood, as well as by a trajectory characterized by general devi-
ance. Diversified antisocial behavior that begins in childhood and persists into adolescence is
associated with earlier onset and more frequent sexual crimes in adulthood, suggesting that the
factors influencing the propensity to sexually assault a woman are similar to those influencing
the propensity to chronically offend. Thus, sexual aggression against women is better explained
by general deviance than by sexual deviance, and the sexual assault of a woman should therefore
be considered one of many manifestations of a chronically antisocial lifestyle characterized by
impersonal sexuality, poor tolerance of frustration, and low self‐control (Lussier, 2018b).
By demonstrating the importance of general deviance in the pathways of sexual aggressors
against women, the results obtained by Knight and Lussier are consistent with the results of
comparative studies suggesting that sexual offenders and nonsexual offenders are more similar
than different. Nevertheless, no model has established any association between the character-
istics and the motivations of individuals following each of the pathways to sexual aggression
against women.
Exposure Exposure
Deviant
Victimisation Criminogenic Victimisation
sexual
models
models
Authority-
Pornography
conflict
Impersonal
Reckless
sex General
Sexualisation
deviance
Compulsivity Overt
Covert
Nonsexual
violence
Rape Deviant sexual
humiliation interests
Rape
Adult age of Adult age of

onset Nonsexual onset
Sexual criminal criminal
activity activity
Frequency Frequency
Figure 1.4 General‐specific model of the criminal activity of sexual aggressors against women. Lussier,
Proulx, and Le Blanc (2005).
The Massachusetts Treatment Center’s rapists typology (MTC:R)

The MTC:R typology (Knight, 1999; Knight & Prentky, 1990; Knight, Rosenberg, &
Schneider, 1985; Prentky, Knight, & Rosenberg, 1988) is the culmination of a research
program extending over more than 20 years. Its most recent revision (MTC:R4; Knight, 2010)
is a circumplex model whose core defining dimensions are psychopathic, callous‐manipulative,
and impulsive‐antisocial traits, as well as hypersexuality (Figure 1.5). The MTC:R4 typology is
based on eight scales (expressive aggression, juvenile unsocialized behaviors, adult unsocialized
behaviors, social competence, sexualization, pervasive anger, sadism, offense planning), and has
allowed the identification of nine types of sexual aggressors against women, defined primarily
by five principal motivations to commit a sexual assault (sadistic, pervasively angry, opportu-
nistic, sexual nonsadistic, and vindictive), and secondarily by aggressors’ degree of social com-
petence. In order to emphasize the central elements of this typology, only the types defined by
the five primary motivations are presented.
U Hig
ce/C hS
len
h Vio exu
aliz
Hig atio
n
Sadistic
y
ivit
uls
Pervasively Mod S.C.

mp
Angry
hI
Vindictive
Hig
Low S.C.
Low S.C.
Low S.C. Sexual

Non-Sadistic
y
ivit
uls
Opportunistic
mp
High S.C.
wI
Lo
High S.C.
Lo
wS
exu
aliz U
atio ce/C
n len
Vio
Low
Figure 1.5 Revised rapist typology indicating speculative placement for three major components of the
typology (impulsivity, sexualization, and violence/callous‐unemotional). Knight (2010).
The primary motivation of sadistic sexual aggressors was to act out their fantasy world in
which they rape, torture, and kill women. They carefully planned their assaults, which were
characterized by a level of coercion that was not only more than necessary to overcome their
victim’s resistance, but also ritualistic. In fact, their violent behaviors were the expression of
their deviant sexual fantasies (i.e., torture, bondage, humiliation, mutilation) and their anger
against women. Their victims were seriously injured, and a high proportion of them died or
were killed. Sadistic sexual aggressors had social skills deficits and led an antisocial lifestyle that
began in adolescence. Knight (2010) concludes that some sadistic aggressors are psychopathic,
while some others are avoidant and schizoid (see also Longpré, Guay, & Knight, 2018; Proulx
& Beauregard, 2014b).
The primary motivation of the pervasively angry sexual aggressors against women was
intense anger. However, these aggressors also vented their anger in nonsexual contexts, against
both men and women. Their antisocial lifestyle began in adolescence, and was dominated by
violent crime. Their sexual crimes were not planned and involved a high level of verbal and
physical coercion, even when the victim did not resist. Their victims were seriously injured and
a significant proportion of them died or were killed. According to Knight (2010), pervasively
angry sexual aggressors have a personality profile characterized by psychopathic and border-
line (emotional dysregulation) traits. They have no deviant sexual preferences.
The primary motivation of opportunistic sexual aggressors against women was unfettered
sexual gratification regardless of the consequences for the victims. Their sexual crimes reflected
not only their lack of empathy but also an antisocial lifestyle. Their sexual assaults were impul-
sive, unplanned, and largely conditioned by situational factors. Opportunistic sexual aggressors
used instrumental violence, that is, the minimal amount of force necessary to subdue their
victim. According to Knight (2010), opportunistic sexual aggressors of women have an antiso-
cial‐narcissistic personality profile, and become angry when they lose control of the assault due
to strong victim resistance. In addition, these aggressors have neither deviant sexual fantasies
nor deviant sexual preferences (Knight, 1999, 2010).
The sexual nonsadistic aggressors had rape fantasies in which they dominated and controlled
women. There were no sadistic or retaliatory components in their fantasies. However, they
had cognitive distortions that supported domination of males over females. These aggressors
carefully planned their crimes. They usually used instrumental violence, and some desisted if
their victim strongly resisted. The lifestyle of these aggressors was marked by a variety of both
deviant and nondeviant sexual activities. Apart from their sexual crimes, they manifested few
antisocial behaviors. Sexual nonsadistic aggressors are not psychopathic, but no other person-
ality traits have been reported to describe them. Knight and Prentky (1990), however, men-
tioned that these aggressors have “a feeling of inadequacy about their masculinity and masculine
self‐image” (p. 46).
Vindictive sexual aggressors against women had an intense misogynistic anger, and women
were in fact the exclusive targets of their anger. Their assaults were unplanned, and involved a
high level of verbal and physical coercion. Their lifestyle included few antisocial behaviors, and
no deviant sexual interests. Vindictive aggressors are not psychopathic. However, Knight
(2010) concluded that they had an avoidant‐schizoid personality profile, and that they shared
some characteristics with sadistic sexual aggressors against women.
Knight and Sims‐Knight’s (2003) classification of sexual aggressors against women is based
on a solid empirical basis (factorial analysis, hierarchical cluster analysis) and has been validated
by several studies. Overall, these validation studies have confirmed the concurrent validity of
the classification. Knight and Sims‐Knight’s classification has allowed the demonstration of the
heterogeneity of sexual aggressors against women on multiple scales. Moreover, the MTC:R4
clarifies the role of various psychopathic traits in sexual aggression against women and is con-
gruent with empirically validated etiological models (see Knight & Sims‐Knight, 2003, 2011).
In fact, both the typological and etiological models converge on the same three core traits
central to their structures: sexualization, callous‐manipulativeness, and impulsive‐antisocial.
However, while Knight and Sims‐Knight’s classification takes into consideration the heteroge-
neity, personality profiles, and motivations of sexual aggressors against women, it does not take
into consideration the life‐course characteristics that may trigger sexual aggression.
Proulx and Beauregard’s pathways to sexual aggression against women

Based on the personality characteristics, general and sexual lifestyle, life context 1 year prior to
the crime, immediate precursors to the crime (48 hr prior to the crime), and modus operandi of
a sample of 180 sexual aggressors of women (59 were sexual murderers), Proulx and Beauregard
(2009, 2014b) identified three offending pathways: sadistic, angry, and opportunistic.
Sexual aggressors following the sadistic pathway are characterized by an anxious personality
profile (avoidant, dependent, schizoid), a problematic lifestyle (e.g., social isolation), deviant
sexuality (e.g., sadistic fantasies), and hypersexuality (e.g., compulsive masturbation). Aggressors
with such a personality profile have low physical and psychological self‐esteem and believe that
people they meet, especially women, reject and humiliate them. Such cognitive distortions
trigger negative emotions (i.e., anger, humiliation, anxiety, suffering) that dominate their inner
worlds. In reaction, they isolate themselves and withdraw into a world of sadistic fantasies that
are used during their compulsive masturbatory activities. Moreover, they consume pornog-
raphy and frequent strip clubs and prostitutes. Nevertheless, they are sexually unsatisfied. This
may be due to the fact that their sadistic fantasies lose much of their gratifying power over time;
this habituation precipitates a quest for ever more violent, intense, deviant sexual fantasies and
behaviors. In sadistic sexual aggressors, deviant sexual fantasies were strong internal constraints
that not only constituted a motivation to offend, but also shaped the modus operandi. Moreover,
anger and alcohol/drug intoxication may have been disinhibiting factors that increased the
intensity of both deviant and nondeviant sexual arousal of these aggressors. To ensure that their
crimes match their sadistic fantasies, these aggressors carefully planned their offenses. Their
strategy for overcoming their victims involved a variety of physical restraints (handcuffs, rope,
tape), and removal of the victim to a preselected location (kidnapping). Furthermore, since the
victim was under their control and there was a low probability of intervention by a guardian,
sadistic aggressors took their time during the commission of the crime. Finally, their modus
operandi was characterized by a high level of coercion (humiliation, mutilation, physical injury)
and they often killed their victim (60%).
Sexual aggressors following the angry pathway were characterized by a dramatic personality
profile (narcissistic, dependent). In keeping with this profile, they had an unstable self‐perception
that was sometimes positive and sometimes negative. Because they considered themselves special,
they expected their partner to always fulfill their sexual and emotional needs. When their partner
did not satisfy their unrealistic expectations—or, even worse, abandoned them—they felt as if the
world had come to an end, and became depressed, anxious, and angry. Angry sexual aggressors
had a general antisocial lifestyle that was as unstable as their self‐image. Their lives were chaotic,
and characterized by substance abuse, temper tantrums, rebelliousness, and chronic lying. As a
result of their unstable mood and lifestyle, in the year prior to their crime, the angry sexual aggres-
sors were lonely and lost their sense of self‐worth; in many cases, this was the result of the end of
an intimate relationship. Some attempted to avoid this emotional distress by working compul-
sively. However, they typically dealt with their failures by abusing drugs and alcohol, and by nur-
turing revenge fantasies against those they considered the cause of their misfortunes. Their modus
operandi was shaped by their desire for vengeance against individuals they believed to be respon-
sible for their unhappiness, and by intense anger. Moreover, alcohol and drug intoxication may
have been disinhibiting factors that intensified their anger. Their aggression stemmed from their
need for revenge, and their sexual assaults of women were coping mechanisms for their anger. No
deviant sexual fantasies shaped their modus operandi. Their attack was impulsive, the level of
violence was extreme, and in almost half of the cases they killed their victim (40%).
Sexual aggressors following the opportunistic pathway were characterized by a dramatic per-
sonality profile (narcissistic, antisocial). This profile is very similar to the psychopath profile
described by Hare (2003). They were convinced that they are superior to other people, whom
they expect to fulfill their needs and admire them. If this did not occur, they adopted a victim
stance. In addition, they believed that laws and societal rules are unfounded, and consequently
felt no obligation to respect them or the people who apply them. For this type of sexual
aggressor, any obstacles to the immediate satisfaction of their needs are unfair and unaccept-
able. They therefore felt entitled to use any means necessary to achieve their goals. Manipulation,
threats, and physical coercion were all acceptable strategies (instrumental violence) for these
egocentric aggressors who had no empathy for others. Some opportunistic sexual aggressors
reported sexual dissatisfaction. However, since they expected to have a willing partner every
time they wanted to have sex, they were at risk of being unsatisfied sexually—although they
did in fact have an active sexual life. The modus operandi of opportunistic sexual aggressors was
not shaped by internal constraints (deviant sexual fantasies, anger). In fact, any planning they
did engage in was oriented toward having sex with a willing partner. Consequently, they did
not use weapons or physical restraints to overpower their victims. They used threats and a
minimal amount of force to obtain victim compliance; victims typically did not physically resist
and were rarely killed. Furthermore, since the opportunistic aggressors’ goal is sexual gratifica-
tion, they did not humiliate or mutilate their victims.
There is a high degree of concordance between the three offending pathways identified by
Proulx and Beauregard—sadistic, angry, and opportunistic—and the three types of sexual
aggressors against women—sadistic, pervasively angry, and opportunistic—identified by Knight
and Sims‐Knight. However, there are differences in the personality profiles of the sadistic
types. While Proulx and Beauregard’s sadistics are avoidant, dependent, and schizoid, Knight’s
are antisocial and psychopathic. Finally, Proulx and Beauregard did not define sexual nonsadis-
tic and vindictive types; they note that this may be the result of sample bias—the absence of
aggressors serving sentences shorter than 2 years in their sample. Moreover, the absence of a
vindictive type in the three‐pathway model may reflect the fact that this type is simply a variant
of the sadistic type, rather than a distinct type in itself. This hypothesis is supported by research
following the initial development of the MTC:R indicating that Knight and Prentky’s vindic-
tive and sadistic types in fact share several characteristics (Knight, 2010).
Conclusions
Over the past 40 years, theories and empirical studies have suggested and demonstrated that a
variety of problematic characteristics should be taken into account in order to explain what
drives some men to sexually assault a woman. The most important of these characteristics are
neuropsychological deficits, deviant sexual preferences, lack of empathy, cognitive distortions,
and relationship problems. Furthermore, it has been suggested that these problematic charac-
teristics are the products of interactions between distal factors (genetic and social–environment
characteristics), and favor sexual aggression when associated with contextual (stressful life event)
or situational (consumption of alcohol, deviant pornography) proximal factors. Thus, sexual
aggression against women is an inappropriate behavior with a multifactorial origin and prob-
lematic characteristics that are in most cases not specific to sexual aggressors against women.
Many comparative studies have been carried out to identify the distinctive characteristics of
sexual aggressors against women. Overall, the results indicate that sexual aggressors against
women differ to some extent from noncriminals, particularly with regard to neuropsychological
performance, antisociality, assertiveness, and attachment style. They also differ from sexual
aggressors against children, particularly with regard to neuropsychological performance,
empathy, antisociality, attachment style, cognitive distortions, loneliness, intimacy deficits, anx-
iety and stress, and self‐image. But the results also indicate that sexual aggressors against women
and nonsexual offenders are more similar than different, particularly with regard to neuropsy-
chological performance, empathy, antisociality, attachment style, social skills, perception and
evaluation of, and investment in, intimate relationships (Table 1.1). Consequently, sexual aggres-
sion against women appears to be more related to general deviance than to sexual deviance.
Table 1.1 Summary of the results of comparative studies
Sexual aggressors Nonsexual

Noncriminals against children offenders
Sexual Aggressors Neuropsychological X X —

Against Women performance
Empathy X —
Antisociality X X —
Attachment style X X —
Assertiveness X
Cognitive distortions X
Loneliness X
Intimacy deficits X
Anxiety, stress X
Poor self‐image X
Social skills X
Intimacy deficits X
— = Similar.
X = Different.
Blank cells indicate that no results are available.
The importance of sexual deviance in the pathway to sexual aggression against women is
controversial. First, deviant sexual preferences appear to be one of the main differences bet-
ween sexual and nonsexual aggressors against women; more specifically, the former respond
more strongly than the latter to rape stimuli. However, as discussed above, not all sexual
aggressors against women have deviant sexual preferences. This finding appears to be validated
by etiological models of sexual aggression against women, which demonstrate that sexual devi-
ance is not part of every pathway to this phenomenon, and that pathways characterized by
general deviance better explain it. These results have clarified a debate based on a dichotomous
vision of sexual aggressors against women: are they generalists or specialists? The results of
typological and developmental studies of sexual aggressors of women indicate that conceptu-
alizing the problem in these terms is a sterile exercise. As Knight (2010, p. 18) points out,
“sexual coercion against women is a serious crime that is committed for a variety of reasons by
a heterogenous group of offenders.” It turns out, not surprisingly, that once the heterogeneity
of sexual aggressors against women is taken into account, general deviance tends to charac-
terize the life course of some aggressors (pervasively angry, opportunistic, vindictive) and sexual
deviance the life course of others (sadistic, sexual nonsadistic).
Our comprehension of the phenomenon of sexual aggression against women has improved in
recent decades, thanks in large part to comparative studies and the development of typologies
and pathways. This research has revealed that sexual aggression is a complex, polymorphic
phenomenon, that sexual aggressors do not appear to be fundamentally different from other
members of their community, and that not all sexual aggressors are the same. Future studies
should take into account the heterogeneity of sexual aggressors, and propose more accurate
longitudinal models. More longitudinal studies are required to clarify what drives an individual
to follow a pathway leading to the sexual assault of a woman. Finally, consideration of biological
factors should allow clarification of developmental pathways and the types of sexual aggressors.
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2
Theories That Explain the Sexual
Abuse of Children
Beth Dangerfield*, Gaye Ildeniz*, and Caoilte Ó Ciardha
Centre of Research and Education in Forensic Psychology, School
of Psychology, University of Kent, Canterbury, U.K.
Introduction
In this chapter, we summarize single‐factor and multifactorial theories that seek to explain the
sexual abuse of children, and outline, where available, empirical evidence that tests these the-
ories. Specifically, we examine theories that may explain contact sexual offending against chil-
dren. Other chapters in this book deal with noncontact offenses or online offending (see
Chapters 21 and 18, this volume). Space does not permit us to comprehensively evaluate each
theory. Instead, we summarize theories and the empirical findings relevant to their evaluation,
and signpost useful sources. For readers requiring a more in‐depth examination of single‐ and
multifactorial theories of sexual offending, we recommend Ward, Polaschek, and Beech (2006)
and Beech and Ward (2017). Additionally, much of the literature we review focuses most
directly on male perpetration. For readers interested in theories of female sexual offending
against children we suggest Gannon and Cortoni (2010).
Ward and Hudson (1998) outlined a meta‐theoretical framework for the classification of
different levels of theory in the domain of sexual offending. According to their classification,
level I (multifactorial) theories include comprehensive explanations of sexual offending; level
II (single‐factor) theories examine a specific factor that is thought to have a role in explaining
sexual offending; and, finally, level III (micro‐level) theories are descriptive models of the
offense chain. In this chapter, we focus on the first two levels of theory—multifactorial and
single‐factor. For a review of level III theories, see Proulx, Beauregard, Lussier, and Leclerc
(2014). Within the literature on sexual offending, single factors have undergone considerably
more empirical testing than multifactorial theories. Indeed, there have been very few studies
that pit the assertions of one multifactorial model or theory against another (Nunes &
Hermann, 2016). Instead, the evidence base for multifactorial theories is mostly the same as
single factors. In other words, we can be more confident of the individual constructs that
* Denotes shared first‐authorship. The order of the first two authors is alphabetical.
The Wiley Handbook of What Works with Sexual Offenders: Contemporary Perspectives in Theory, Assessment, Treatment,
and Prevention, First Edition. Edited by Jean Proulx, Franca Cortoni, Leam A. Craig, and Elizabeth J. Letourneau.
© 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd.
24 Beth Dangerfield, Gaye Ildeniz, and Caoilte Ó Ciardha
appear to be causally related to sexual offending against children than the exact relationships
of these factors to one another, or what the typical etiological pathways through these are.
Single‐Factor Theories
Theories of deviant1 sexual interest

The theory that holding a sexual interest in children is causally linked to sexual abuse of chil-
dren is both the most intuitive single‐factor theory and the most empirically supported. The
prevalence of pedophilia among individuals who have abused children has been estimated at
approximately half, based on accumulated empirical evidence (Seto, 2008). Additionally,
meta‐analyses show that “deviant” sexual interest is a key predictor of sexual recidivism (e.g.,
Hanson & Morton‐Bourgon, 2005). The existence of nonoffending pedophilic individuals
(Cantor & McPhail, 2016) suggests that pedophilic sexual interest alone is not sufficient to
cause sexual abuse, and the observation that not all abusers hold problematic sexual interests
(Seto, 2008) indicates that it is not a necessary causal factor. Despite this, it is safe to regard
problematic sexual interest as a proximal/intermediate causal factor underpinning a large
proportion of abuse. There are a number of theories, however, that seek to explain the causes
of these sexual interests, and thus, more distal causes of child sexual abuse.
Early theorizing on sexual interest in children drew on social learning theory, which sug-
gests that individuals develop behaviors through modeling others, or on conditioning, a pro-
cess of reinforcement through reward or punishment. McGuire, Carlisle, and Young (1964)
hypothesized that early traumatic experiences shaped fantasy and masturbatory behavior,
strengthening the conditioned relationship between the experience and sexual arousal. Laws
and Marshall (1990) proposed that among individuals who commit sexual offenses against
children, a process of conditioning throughout childhood cultivates a preference for children
or dilutes sexual desire for adults. They further suggested that social learning dictates how the
fundamental conditioned components of sexual behavior are expressed by the individual.
The growing recognition of the heterogeneity of human sexual experience, and of the con-
tribution of biological and developmental factors to that heterogeneity, encouraged researchers
to challenge a purely learned or conditioned causal model of sexual interest in children.
Certainly, the evidence of conditioning as a causal explanation of sexual interest in children, in
the absence of other etiological factors, is scant (Seto, 2008).
Over the past 20 years in particular, evidence has been accumulating for biological bases for
the development of pedophilia (see Tenbergen et al., 2015)—or at least for the vulnerability
to pedophilia. There is evidence for the heritability of sexual interest in children (Alanko, Salo,
Mokros, & Santtila, 2013), and evidence that links pedophilia with early neurodevelopmental
perturbations, including lower IQ, non‐right‐handedness, and lower physical height (Blanchard
et al., 2007; McPhail & Cantor, 2015). In addition, some developmental factors, such as psy-
chosocial deficits and early sexualization, are associated with the presence of a sexual interest
in children (Lussier, Beauregard, Proulx, & Nicole, 2005).
Based on genetic and neurodevelopmental research, and on factors such as age of onset and
stability of sexual interest over time, Seto (2017b) concludes that sexual interest in children
reflects an extreme end of an age‐preference dimension within a multidimensional model of
sexual orientation. The current state of knowledge suggests that the types of sexual interests
that place people at risk of sexual offending are likely to follow different etiological pathways
Theories That Explain the Sexual Abuse of Children 25
that may include genetic predisposition, pre/perinatal conditions, trauma impacting sexual
development, and the neurodevelopmental consequences of any or all of these factors.
Theories of distorted cognition

The idea that individuals who sexually abuse children hold a distorted view of their own social
world has been a fertile source of theoretical and empirical research examining the etiology of
sexual offending. Research on so‐called cognitive distortions within the domain of sexual
offending stems in large part from work by Abel and colleagues (e.g., Abel, Becker, &
Cunningham‐Rathner, 1984) and by Bumby (1996). As is the case with the concept of
“deviant” sexual interest, there is an inherent intuitiveness to the theory that individuals who
sexually offend are qualitatively different from the rest of the population when it comes to
their social‐cognitive makeup. Indeed, the statements made by individuals who offend tend to
evidence such a divide. Unfortunately, much of the early work on the topic did not offer a
sufficiently consistent definition of cognitive distortions or a coherent theory of the etiological
role of those potential distortions (see Ó Ciardha & Ward, 2013). A paper by Maruna and
Mann (2006) was highly influential in challenging the position that cognitive distortions, as
conceptualized by many authors, represent criminogenic factors.
Ward (2000) was the first author to provide a coherent theory of cognitive distortions and
their role in offending. Ward suggested that, during childhood, individuals develop schematic
frameworks of information about the world and how they should behave in it. These schemata,
or implicit theories, shape how individuals interpret social information. Ward suggested that, for
some, these implicit theories become distorted and facilitate maladaptive behavior. Ward and
Keenan (1999) hypothesized multiple implicit theories that contribute to sexual behavior in
individuals who have sexually offended against children. These hypothesized implicit theories
were characterized by core beliefs that an individual may hold about the world (that it is a hos-
tile place, that only children may be trusted), about their potential victims (that children have
adult‐like sexual interests and knowledge, and/or that sexual abuse is not harmful), and about
themselves (that their needs supersede others’, and/or that their actions are not controllable).
Despite the greater coherence of Ward’s theory relative to the theories of cognitive distor-
tion that preceded it, empirical support remains equivocal (Ó Ciardha & Ward, 2013). On the
one hand, qualitative research has typically shown evidence of the existence of coherent implicit
theories among individuals who have sexually offended (e.g., Marziano, Ward, Beech, &
Pattison, 2006). Similarly, questionnaires often provide evidence of greater endorsement of
cognitive distortions—such as the attributions of sexual motives to children’s behaviors—
among offending individuals compared to controls (e.g., Keown, Gannon, & Ward, 2010),
albeit without emphatic endorsement of distorted views (see Gannon, Keown, & Polaschek,
2007). On the other hand, determining whether there is evidence of schematic beliefs map-
ping onto the proposed problematic implicit theories is particularly important for testing the
implicit theories theory of cognitive distortions. While indirect methods of assessment appear
to show simple associations between children and constructs related to sex, entitlement, and
uncontrollability among offending samples (e.g., Mihailides, Devilly, & Ward, 2004),
researchers using indirect measures to find evidence of richer social‐cognitive representations
of implicit theories have failed to demonstrate sufficient support for the hypothesis that dis-
torted constructs shape social information processing (e.g., Keown et al., 2010).
In an attempt to address the implications of the mixed evidence for the implicit‐theories
theory, at least two newer theories of cognitive distortions have been proposed: the judgment
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Handbook of What Works with Sexual

Offenders : Contemporary Perspectives

the late, J. Stephen Wormith

WHAT WORKS IN OFFENDER REHABILITATION: AN EVIDENCE-BASED

THE WILEY HANDBOOK OF WHAT WORKS IN CHILD MALTREATMENT:

THE WILEY HANDBOOK ON WHAT WORKS FOR OFFENDERS WITH

THE WILEY HANDBOOK OF WHAT WORKS IN VIOLENCE RISK MANAGEMENT:

THE WILEY HANDBOOK OF WHAT WORKS WITH SEXUAL OFFENDERS:

About the Editors ix

Part I Theories of Sexual Offenders 1

Part II Assessment of Sexual Offenders 87

9 Neurobiological Considerations on the Etiological Approach to Sexual

Part III Management of Sexual Offenders 175

Part IV Special Populations 265

22 Sadistic Sexual Aggressors 387

Part V Policy and Prevention 411

Jeffrey Abracen Atlanta, GA

Fayetteville, AR Alyssa Glace

Baltimore, MD Alex Lord

Ottawa, ON Alex Quinn

Georgi Stefanov Jamie S. Walton

children. In addition, it includes a chapter on public health perspectives to understanding

The Neuropsychology of Sexual Aggressors Against Women

Rape and sexual

Joyal, Beaulieu‐Plante, and de Chantérac (2014) conducted a meta‐analysis of studies of the

The Psychology of Sexual Aggressors Against Women

Deviant sexual preferences

Lack of empathy, antisociality, and psychopathy

Cognitive distortions and implicit theories

Intimacy deficits and attachment styles

Models of Sexual Offending

Ward and Beech’s integrated theory of sexual offending (ITSO)

Interlocking neuropsychological functions

Brain development Ecological niche: proximal

Knight and Sims‐Knight’s etiological model

Lussier, Proulx, and Le Blanc’s criminal‐pathways model

Adult age of Adult age of

The Massachusetts Treatment Center’s rapists typology (MTC:R)

Pervasively Mod S.C.

Low S.C. Sexual

Proulx and Beauregard’s pathways to sexual aggression against women

Table 1.1 Summary of the results of comparative studies

Sexual aggressors Nonsexual

Sexual Aggressors Neuropsychological X X —

Theories of deviant1 sexual interest

Theories of distorted cognition

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About the Editors ix