As mentioned earlier, there is some controversy surrounding the diagnosis of a paraphilic disorder and what constitutes deviant sexual behavior. The definitions of these disorders can vary depending on time and culture, and the complication in diagnosing paraphilic disorders is compounded by the fact that several of the disorders could be associated with criminal behavior.^[1] In this section, we will take a closer look at the criminal forms of sexual violence and abuse (that may or may not stem from a paraphilic disorder).

Sexual assault is an act in which a person intentionally sexually touches another person without that person’s consent or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which includes child sexual abuse, groping, rape (forced vaginal, anal, or oral penetration or a drug-facilitated sexual assault), or the torture of the person in a sexual manner.

Figure 1. Reported rates of sexual assault in the United States (BJS)

Victims of Sexual Assault

Age

• 15% are under the age of 12
• 29% are age 12–17
• 44% are under age 18
• 80% are under age 30
• 12–34 are the highest risk years
• Girls ages 16–19 are four times more likely than the general population to be victims of rape, attempted rape, or sexual assault.

By Gender

A study from 1998 found that

• 88.7% of rape victims are women, the other 11.3% are men.
• 17.6% of women have been victims of attempted (2.8%) or completed (14.8%) rape during their lifetime.
• 3% of men have been victims of attempted or completed rape during their lifetime.
• 17.7 million women have been victims of attempted or completed rape during their lifetime.
• 2.78 million men have been victims of attempted or completed rape during their lifetime.

Largely because of child and prison rape, approximately 10% of reported rape victims are male.

The National Crime Victimization Survey conducted by the U.S. Justice Department (Bureau of Justice Statistics) found that from 1995 to 2013, men represented 17% of victims of sexual assault and rape on college campuses, and 4% of non-campus sexual assaults and rapes.

Child Sexual Abuse

Approximately 15–25% of women and five to 15% of men were sexually abused when they were children. The median age for sexual abuse is eight or nine years for both boys and girls (Finkelhor et. al. 1990). Most boys and girls are sexually abused by a male. Childhood sexual abuse is defined as any sexual contact between a child and an adult or a much older child. Incest refers to sexual contact between a child and family members. In each of these cases, the child is exploited by an older person without regard for the child’s developmental immaturity and inability to understand the sexual behavior (Steele, 1986).

Sexual abuse can create feelings of self-blame, betrayal, and feelings of shame and guilt (Valente, 2005). The effects of child sexual abuse include depression, post-traumatic stress disorder, anxiety, propensity to re-victimization in adulthood, physical injury to the child, and increased risk for future interpersonal violence perpetration among males, among other problems. Additionally, victims of sexual abuse may suffer from problems with intimacy and suicide (Valente, 2005). Studies suggest that children who have been sexually abused have an increased risk of eating disorders and sleep disturbances.

Sexual abuse is particularly damaging when the perpetrator is someone the child trusts. As stated above, sexual abuse by a family member is a form of incest. It is more common than other forms of sexual assault on a child and can result in more serious and long-term psychological trauma, especially in the case of parental incest. Most sexual abuse offenders are acquainted with their victims. Approximately 30% of the perpetrators are relatives of the child—most often brothers, fathers, mothers, sisters, and uncles or cousins. Around 60% are other acquaintances such as friends of the family, babysitters, or neighbors. Strangers are the offenders in approximately 10% of child sexual abuse cases. Many states have criminalized sexual contact between teachers or school administrators and students, even if the student is over the age of consent.

Often, sexual assault on a child is not reported by the child for several of the following reasons:

• children are too young to recognize their victimization or put it into words
• they were threatened or bribed by the abuser
• they feel confused by fearing the abuser
• they are afraid no one will believe them
• they blame themselves or believe the abuse is a punishment
• they feel guilty for consequences to the perpetrator

Although rates of sexual abuse are higher for girls than for boys, boys may be less likely to report abuse because of the cultural expectation that boys should be able to take care of themselves and because of the stigma attached to homosexual encounters (Finkelhor et. al. 1990). Girls are more likely to be victims of incest and boys are more likely to be abused by someone outside the family.

Figure 2. Abuse can lead to low self-esteem in girls.

Being sexually abused as a child can have a powerful impact on self-concept. The concept of false self-training (Davis, 1999) refers to holding a child to adult standards while denying the child’s developmental needs. Sexual abuse is just one example of false self-training. Children are held to adult standards of desirableness and sexuality while their level of cognitive, psychological, and emotional immaturity is ignored. Consider how confusing it might be for a nine-year-old girl who has physically matured early to be thought of as a potential sex partner. Her cognitive, psychological, and emotional state do not equip her to make decisions about sexuality or, perhaps, to know that she can say no to sexual advances. She may feel like a nine-year-old in all ways and be embarrassed and ashamed of her physical development. Girls who mature early have problems with low self-esteem because of the failure of others (family members, teachers, ministers, peers, advertisers, and others) to recognize and respect their developmental needs. Overall, youth are more likely to be victimized because they do not have control over their contact with offenders (parents, babysitters, etc.) and have no means of escape (Finkelhor and Dzuiba-Leatherman, in Davis, 1999).

Child grooming is befriending and establishing an emotional connection with a child, and sometimes the family, to lower the child’s inhibitions with the objective of sexual abuse. To establish a good relationship with a child and the child’s family, child groomers might do several things: They might try to gain the child’s or parents’ trust by befriending them, with the goal of easy access to the child. Sexual grooming of children also occurs on the internet. Some abusers will pose as children online and make arrangements to meet with them in person. Online grooming of children is most prevalent within the 13–17 age group (99% of cases), and particularly 13–14 (48%). The majority of targeted children are girls, and most victimization occurs with mobile-phone support. Children and teenagers with behavioral issues such as “high attention seeking” have a much higher risk than others. Contact-driven pedophiles and predators use online grooming to carry out cybersex trafficking crimes. The internet provides adults and children with a medium for professional and personal communication throughout the world. As widespread communication in cyberspace grows exponentially, the potential for internet-related crimes, such as cyberstalking, has accelerated. Children are particularly vulnerable to sexual predators, such as pedophiles, on the internet.

In Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention, Cimbolic & Cartor (2006) noted that because of the large share of post-pubescent male minors among cleric victims, there is need to further study the differential variables related to ephebophilia (sexual interest in mid-to-late adolescents, generally ages 15 to 19) versus pedophilia (sexual interest in prepubescent children, generally those 13 years of age or younger) offenders. Cartor, Cimbolic & Tallon (2008) found that 6% of the cleric offenders in the John Jay Report are pedophiles, 32% ephebophiles, 15% attracted to 11- and 12-year-olds only (both male and female), 20% indiscriminate, and 27% mildly indiscriminate.

In the United States, following Kansas v. Hendricks, sex offenders who have certain mental disorders, including pedophilia, can be subject to indefinite civil commitment under various state laws (generically called SVP laws or Sexually Violent Predator laws) and the federal Adam Walsh Child Protection and Safety Act of 2006. Similar legislation exists in Canada. Generally speaking, SVP laws have three elements: (1) that the person has been convicted of a sexually violent offense; (2) that the person suffers from a mental abnormality and/or personality disorder, which causes them serious difficulty controlling their sexually violent behavior; and (3) that this mental abnormality and/or personality disorder makes the person likely to engage in predatory acts of sexual violence if not confined in a secure facility.

The Adam Walsh Child Protection and Safety Act is a federal statute that was signed into law by U.S. President George W. Bush on July 27, 2006. The Walsh Act organizes sex offenders into three tiers according to the crime committed, and mandates that Tier 3 offenders (the most serious tier) update their whereabouts every three months with lifetime registration requirements. Tier 2 offenders must update their whereabouts every six months with 25 years of registration, and Tier 1 offenders must update their whereabouts every year with 15 years of registration. Failure to register and update information is a felony under the law. States are required to publicly disclose information of Tier 2 and Tier 3 offenders, at minimum. As stated above, it also contains civil commitment provisions for sexually dangerous people.

The Act also creates a national sex offender registry and instructs each state and territory to apply identical criteria for posting offender data on the internet (i.e., offender’s name, address, date of birth, place of employment, photograph, etc.). The Act was named after Adam Walsh, an American boy who was abducted from a Florida shopping mall and later found murdered.

In Kansas v. Hendricks, the U.S. Supreme Court upheld as constitutional a Kansas law, the Sexually Violent Predator Act, under which Hendricks, a pedophile, was found to have a “mental abnormality” defined as a “congenital or acquired condition affecting the emotional or volitional capacity that predisposes the person to commit sexually violent offenses to the degree that such person is a menace to the health and safety of others,” which allowed the State to confine Hendricks indefinitely irrespective of whether the State provided any treatment to him. In United States v. Comstock, this type of indefinite confinement was upheld for someone previously convicted on child pornography charges; this time a federal law was involved—the Adam Walsh Child Protection and Safety Act. The Walsh Act does not require a conviction on a sex offense charge, but only that the person be a federal prisoner, and one who “has engaged or attempted to engage in sexually violent conduct or child molestation and who is sexually dangerous to others,” and who “would have serious difficulty in refraining from sexually violent conduct or child molestation if released.”

In the United States, offenders with pedophilia are more likely to be recommended for civil commitment than non-pedophilic offenders. About half of committed offenders have a diagnosis of pedophilia. Psychiatrist Michael First (2008), in “Use of DSM Paraphilia Diagnoses in Sexually Violent Predator Commitment Cases” writes that, since not all people with a paraphilia have difficulty controlling their behavior, the evaluating clinician must present additional evidence of volitional impairment instead of recommending commitment based on pedophilia alone.

Deviant Sexual Preferences

Research focusing on the deviant sexual preferences propensity model suggests that people who perpetrate acts of sexual violence are sexually aroused by non-consensual sexual interactions more than consensual sexual interactions. The research that seeks to support this model (penile plethysmography) has not been able to reliably find differences in the two different groups of males (those who have committed acts of sexual aggression and those who have not). Instead, the studies are providing more evidence for the cognitive, attitudinal, neuropsychological, and lifestyle differences that impact sexual arousal in certain situations, rather than a deviant sexual preference leading to a higher propensity for sexual violence.

The antisocial personality lens stems from a study done by Hall and Hirschman (1991) and emphasizes the subsequent consequences of experiencing adversities/abuses in childhood, which can lead to the development of antisocial personality traits in adulthood. The antisocial personality traits combine with contextual, emotional (rage/anger), cognitive (irrational thoughts that influence emotions), and physiological (deviant sexual arousal) factors that increase the probability of committing sexual violence.

Domestic Violence

Domestic violence is violence or other abuse by one person against another in a domestic setting, such as in marriage or cohabitation. It is strongly correlated with sexual assault. Not only can domestic abuse be emotional, physical, psychological, and financial, it can also be sexual. Some of the signs of sexual abuse are similar to those of domestic violence. Domestic sexual violence includes all forms of unwanted sexual activity. It is considered abuse even if the victim may have previously engaged in consensual sexual activities with the perpetrator. Men and women can both fall victim to this type of abuse. A 2006 WHO study on physical and sexual domestic violence against women conducted across ten countries, found that the prevalence of sexual domestic violence ranges on average between 10 and 50%. Domestic sexual violence is also considerably less common than other forms of domestic violence.

Rape

Outside of law, the term rape (sexual intercourse or other forms of sexual penetration carried out against a person without that person’s consent) is often used interchangeably with sexual assault. Although closely related, the two terms are technically distinct in most jurisdictions. Sexual assault typically includes rape and other forms of non-consensual sexual activity.

Abbey et al. state that female victims are much more likely to be assaulted by an acquaintance, such as a friend or co-worker, a dating partner, an ex-boyfriend, or a husband or other intimate partner than by a complete stranger. In a study of hospital emergency room treatments for rape, Kaufman et al. stated that the male victims as a group sustained more physical trauma and were more likely to have been a victim of multiple assaults from multiple assailants. It was also stated that male victims were more likely to have been held captive longer.

In the U.S., rape is a crime committed primarily against youth. A national telephone survey on violence against women conducted by the National Institute of Justice and the Centers for Disease Control and Prevention found that 18% of women surveyed had experienced a completed or attempted rape at some time in their lives. Of these, 22% were younger than 12 years and 32% were between 12 and 17 years old when they were first raped.

In the United States, several studies since 1987 have indicated that one in four college women have experienced rape or attempted rape at some point in their lifetime. These studies are based on anonymous surveys of college women, not reports to the police, and the results are disputed.

The removal of a condom during intercourse without the consent of the sex partner, known as stealthing, may be treated as a sexual assault or rape.

Figure 3. For many victims, emotional trauma lasts for years after the assault takes place.

Emotional Effects 

Aside from physical traumas, rape and other sexual assault often result in long-term emotional effects, particularly in child victims. These can include, but are not limited to denial, learned helplessness, genophobia, anger, self-blame, anxiety, shame, nightmares, fear, depression, flashbacks, guilt, rationalization, mood swings, numbness, promiscuity, loneliness, social anxiety, difficulty trusting oneself or others, and difficulty concentrating. Being the victim of sexual assault may lead to the development of post-traumatic stress disorder, addiction, major depressive disorder, or other psychopathologies. Family and friends experience emotional scarring including a strong desire for revenge, a desire to “fix” the problem and/or move on, and a rationalization that “it wasn’t that bad.”

Physical Effects

While sexual assault, including rape, can result in physical trauma, many people who experience sexual assault will not suffer any physical injury. Rape myths suggest that the stereotypical victim of sexual violence is a bruised and battered young woman. The central issue in many cases of rape or other sexual assault is whether or not both parties consented to the sexual activity or whether or not both parties had the capacity to do so. Thus, the physical force resulting in visible physical injury is not always seen. This stereotype can be damaging because people who have experienced sexual assault but have no physical trauma may be less inclined to report to the authorities or to seek health care. However, women who experienced rape or physical violence by a partner were more likely than people who had not experienced this violence to report frequent headaches, chronic pain, difficulty sleeping, activity limitation, poor physical health, and poor mental health.