1. By:
Dr. Hani Hamed Dessoki, M.D. Psychiatry
Associate Prof. Psychiatry
Acting Head, Psychiatry Department
Beni Suef University
Supervisor of Psychiatry Department
El- Fayuom University
2013

2. Introduction
 “…there is no know
psychological test, profile,
evaluation procedure, of
combination of such tools that
prove or disprove whether an
individual has committed a
specific sexual act.”

3. Defence of mental disorder (Section 16)Defence of mental disorder (Section 16)
No person is criminally responsible for an actNo person is criminally responsible for an act
committed or an omission made while sufferingcommitted or an omission made while suffering
from a mental disorder that rendered the personfrom a mental disorder that rendered the person
incapable of appreciating the nature and qualityincapable of appreciating the nature and quality
of the act or omission or of knowing that it wasof the act or omission or of knowing that it was
wrong.wrong.
Every person is presumed not to suffer from aEvery person is presumed not to suffer from a
mental disorder so as to be exempt frommental disorder so as to be exempt from
criminal responsibilitycriminal responsibility by virtue of subsection.by virtue of subsection.

4. Agenda
 Introduction
 Prevalence
 Who are sex offenders
 Types
 General Rules
 Preparing your self for the evaluation
 Assessment

5. ‫مقدمه‬
‫المركز‬ ‫مصر‬ ‫احتلل‬ ‫إلى‬ ‫تشير‬ ‫دراسة‬ ‫نشر‬ ‫مع‬ ‫بالتزامن‬
،‫الجنسية‬ ‫الجريمة‬ ‫معدلت‬ ‫في‬ ‫العربي‬ ‫الدول‬ ‫بين‬ ‫الول‬
‫إدارة‬ ‫أن‬ ‫المصرية‬ ‫الداخلية‬ ‫وزارة‬ ‫في‬ ‫مصدر‬ ‫كشف‬
‫من‬ ‫أكثر‬ ‫ضبطت‬ ‫الداب‬ ‫جرائم‬ ‫مكافحة‬45‫جريمة‬ ‫ألف‬
‫عام‬ ‫بداية‬ ‫منذ‬ ‫آداب‬2006‫مارس‬ ‫وحتى‬2007‫بينما‬ ،
‫العام‬ ‫شهد‬2006‫من‬ ‫أكثر‬52‫جنسي‬ ‫تحرش‬ ‫جريمة‬ ‫ألف‬
‫واغتصاب‬.
‫الجتماعية‬ ‫للبحوث‬ ‫القومي‬ ‫للمركز‬ ‫حديثة‬ ‫بإحصائية‬
‫إن‬ ‫تقول‬ ‫مصر‬ ‫في‬ ‫والجنائية‬20‫اغتصاب‬ ‫حالة‬ ‫ألف‬
‫يا‬ّ ‫سنو‬ ‫مصر‬ ‫في‬ ‫ترتكب‬ ‫جنسي‬ ‫وتحرش‬.

6. ‫مقدمه‬
‫الطبيب‬ ‫عن‬ ‫الشرعي‬ ‫النفسي‬ ‫الطبيب‬ ‫مهام‬ ‫تختلف‬
‫ومحقق‬ ‫طبيب‬ ‫هو‬ ‫الشرعي‬ ‫فالطبيب‬ ‫العادي‬ ‫النفسي‬
‫مريض‬ ‫مع‬ ‫يتعامل‬ ‫لنه‬ ‫الوقت‬ ‫نفس‬ ‫في‬ ‫وشاهد‬ ‫وفاحص‬
‫من‬ ‫يهرب‬ ‫حتي‬ ‫والجنون‬ ‫المرض‬ ‫يدعي‬ ‫يكون‬ ‫ان‬ ‫وارد‬
‫الجنائية‬ ‫المسئولية‬
‫الـ‬ ‫تتعدي‬ ‫الجنون‬ ‫يدعون‬ ‫الذين‬ ‫المتهمين‬ ‫نسبة‬70‫من‬ %
‫الشرعي‬ ‫النفسي‬ ‫الطب‬ ‫وحدة‬ ‫إلي‬ ‫تحول‬ ‫التي‬ ‫الحالت‬
‫ول‬ ‫المتهم‬ ‫عن‬ ‫الدفاع‬ ‫عن‬ ‫المتهم‬ ‫محامي‬ ‫يعجز‬ ‫وعندما‬
‫أن‬ ‫تفيد‬ ‫روشتة‬ ‫أو‬ ‫شهادة‬ ‫باستخراج‬ ‫يقوم‬ ‫مخرج‬ ‫أي‬ ‫يجد‬
‫طبيب‬ ‫لدي‬ ‫يعالج‬ ‫كان‬ ‫المتهم‬

7. Prevalence of Legal Sexual Compulsive
Behavior
 According to the Internet Filter Review site, 40 million
Americans visit Internet porn sites at least once a
month (Maltz, 2008).
 Currently, over 60 percent of all visits on the Internet
involve a sexual purpose (Schneider and Weiss,
2010).

8. Prevalence of Legal Sexual Compulsive
Behavior
 A record breaking 25% of employees in the
United States are accessing porn at work,
(Maltz, 2008).

9. Prevalence of Legal Sexual Compulsive
Behavior
 There are 100,000 Web sites dedicated to
selling sex in some way-not including chat
rooms, emails, or other forms of sexual
contact on the web (Cybersex Unhooked,
2007).

10. Prevalence of Legal Sexual Compulsive
Behavior
 In the United States, twenty million “adult” magazines
are sold each month.

11. Prevalence of Legal Sexual
Compulsive Behavior
 Pornography has become a substantial part of the
United States’ economy .
 No matter it’s means of access,
pornography produced annual
revenues in excess of $13 billion
dollars in the United States.
 Worldwide it produced $100 billion.

12. 2006 World Wide Pornography
Revenue

13. Pornography’s Effects
 Evidence shows that as many as one in three
rapists and child molesters use pornography
to become sexually aroused immediately
proceeding and during the commission of
their crimes (Marshall, 1989).
 And other studies report that 56% of rapists
and 42% of child molesters reported that
pornography was somehow implicated in their
offense (Able, 1985).

14. Pornography’s Effects
 Persons reporting exposure to pornography are 28%
more likely to engage in sexually deviant behavior
(such as exhibitionism or voyeurism) than the general
population.
 Risk of engaging in sexual perpetration - that is,
sexually hostile or violent behavior - was found to
increase by between 21 and 30% for persons exposed
to pornography.

15. A word on calling it “Sexual
Addiction”

16. Who are sex
offenders?
What comes
to mind
when you
think about
sex
offenders?

17. In Fact. . . .
Sex Offenders:
Juveniles
Adults
Juveniles
comprise
25.8% of all
sexual
offenses

18. What is a
Juvenile Sex Offender?
An adolescent male or female who has been
adjudicated (charged and found
responsible) for engaging in sexually
aggressive behaviors, who sexually
abuse or offend, or who engage in
inappropriate sexual behaviors that
victimize others.

19. Common Characteristics of
JSO’s ?
•11-17 years of age
•Prior sex offense unlikely
•47% have been physically abused
•58% have witnessed domestic
violence
•35% have been sexually abused
•Most have problems with impulse
control
•60% have learning disabilities and
academic problems
•Most have social deficits
•Likely have other behavior and
mental health problems

20. Age and Sex of Juveniles Who
Offend
0
5
10
15
20
25
30
35
40
45
50
Age
Age
The rate of sexual offense
behavior rises sharply at
the age of 12, and plateaus
after age 14.
The vast majority of
juveniles who sexually
offend are male (93%).
 Females who offend tend to
be younger, have more
victims, offend alongside
peers more, have more male
victims, and have more
victims that are family
members.

21. Differences
 Juveniles are more likely to offend in groups
than adults (24% as opposed to 14%).
 They are more likely to have a male victim
(25% versus 13%).
 They are less likely to offend at home (69%
versus 80%) and more likely to offend at
school (12% versus 2%).

22. Hands On Hands Off
 Sexual assault
 Rape
 Molestation
 Forcible sodomy
 Sexual touching
 Exhibitionism
 Possessing illicit
pornography
 Obscene telephone
calls
 Voyeurism
 Sexual harassment
Types of Sexual Crimes

23. Overview of field: Old Paradigm
 Those—especially males--who have been
sexually abused are going to become
offenders.
 “Once an offender, always an offender.”
 Offenders—including children and
adolescents-- do not respond positively to
treatment.

24. Old Paradigm
 Must come from highly dysfunctional
families.
 There is no specific family profile. No unique
family pattern has been identified The
characteristics of are diverse and may or
may not be considered dysfunctional.

25. Who are the Abusers?Who are the Abusers?
 86% of ALL (adult and child) sexual assault cases
reported to law enforcement were committed by
someone known to the victim – a family member or
acquaintance (Bureau of Justice Statistics, 2000).
 93% of victims under the age of 17 & 73% of victims
age 18 and older, were assaulted by someone they
knew.
 Where the victim was a child, 34% of offenders were
family members and 59% were acquaintances
(Bureau of Justice Statistics, 2000).

26. New York StatisticsNew York Statistics
** 85% of registered NYS sex offenders have V < 18 y.o. **
Source: NYS SOR as of 3/30/2010 Produced by: DCJS OJRP - Crimestat Unit

27. What reactions do all of victims elicit?What reactions do all of victims elicit?

28. OUTRAGE
OUTRAGE
PANIC!!PANIC!!
FEARFEAR
LOATHING
LOATHING
ANGERANGER
SadnessSadness
SympathySympathy

29. General Rules

30. Some history of the insanity defense
 M’Naghten Rule: England, 1843
– Insanity is not knowing the difference between right and
wrong (cognitive test)
– Still used as the definition of insanity in half of all U.S.
states
 In some jurisdictions, rule broadened by including
the irresistable impulse test
– A “sane” person must know right from wrong, AND
– Be able to resist the impulse to do a wrong deed
(volitional aspect)

31. Substantial Capacity
Attempted to remove problems of both
M’Naghten and Irresistible Impulse while
maintaining the legal nature of both
Emphasizes reason and will
Substantial capacity is not complete mental
capacity
Individuals with some, but limited capacity may still be
found insane

32. Diminished Capacity
 Distinguish between diminished responsibility
– Diminished responsibility
What I did was wrong, but under the circumstances I am less
responsible.
Seeks to be punished for lesser offense
– Diminished capacity
Focuses on defendant’s capacity to commit a specific intent
crime
 Most states reject both diminished capacity and
diminished responsibility defenses…or allow the court
to consider it for sentencing purposes

33. Legal competence
 Psychological issue most frequently
addressed in the court system =
competence
 Competence involves the defendant’s ability
to
– Understand the charges against him/her
– Participate in proceedings in a meaningful way

34. Children and competence
 Children generally presumed incompetent
until age 7 (sometimes even 10 or 14)
 Factors bearing on a child’s competence:
– Understanding difference between truth and
falsehood
– Capacity to understand and describe events
– Memory ability
– Suggestibility (biasing influences from parents,
attorneys, etc.)

35. Age
The defense of age focuses on whether
defendant was too young to have the
capacity to commit a crime (not whether he
or she will be tried in juvenile court…whether
he or she could be tried at all)

36. European Age
 Republic of Ireland - 12
 France, Holland, Poland - 13
 Germany and Italy - 14
 Spain - 16
 Luxembourg - 18

37. Voluntary act is the first principle of criminal
liability
In order to have criminal liability there must
be criminal conduct
Criminal conduct is conduct that is without
justification or excuse
Voluntary act is the “conduct” part of
criminal conduct
Many crimes don’t include a criminal intent
or bad result.

38. Elements of Criminal Liability
Actus Reus— the criminal act
Mens rea— the criminal intent
Concurrence—the requirement that the
criminal intent trigger the criminal act
Attendant circumstances (when a crime does
not require the criminal intent, it generally
requires some attendant circumstance)
Bad result causing a criminal harm

39. Elements of Criminal Liability (cont.)
Corpus delicti = “body of crime” but it doesn’t
necessarily mean a physical body. It refers,
instead to the elements of a crime
Criminal conduct = criminal act triggered by
the criminal intent
Criminal act = voluntary bodily movement.

41. Preparing yourself for the
evaluation
The right preparation makes all the
difference

42. UNANTICIPATED HAZARDS

43. What an Evaluation can do:
 Clarify recidivism risk level
 Determine guilt or innocence regarding a
specific crime
 Identify problem areas and complications to
the offending problem
 Identify treatment needs
 Lay groundwork for treatment

44. Components of the Evaluation
 Review of History
 Collateral interviews
 Client interview
 Client testing
 Actuarial assessment
 Writing report

45. Structuring the Evaluation
 Safe and comfortable setting
 Full days vs. multiple short sessions
 Collateral before client interviews
 Start with low defense areas, move to
difficulty subjects later

46. As the Evaluator, you should:
 Know your subject – sexual offenders –
before doing any evaluation
 Get education, training, supervision and
experience

47. As the Evaluator, you should:
 Do your homework. There is no substitute
for thorough background research before
your client interview
 Think Kojak/Columbo.
 Understand your client’s agenda; it will not
be the same as yours
 Respect the client as a person

48. Evaluation Interview skills
 Take thorough notes. Get the name, age,
gender of every person the client mentions
 Don’t give away what you know.
 Rephrase and re-ask questions at different
points in the interview.
 Bring your poker face. Smile pleasantly at
appropriate opportunities to help put the
client at ease.

49. Watch the NONVERBAL language
Words are not the only way people
communicate, and nonverbal
communication becomes very important
when working with people who may be
motivated to be dishonest.
No matter how good you are at reading
nonverbals, you still can't catch every lie.

50. Watch the NONVERBAL language
 Eye contact/changes noted
 Voice tone/changes noted
 Tearfulness
 Power/control behaviors (i.e., walks around
office during interview, handles objects from
desk, tries to direct interview, silence)

51. Watch the NONVERBAL language
 Nervous behaviors (i.e., leg shaking,
tapping)
 Defensive/evasive posturing (arms tightly
closed, refuses to remove coat, gaze fixed to
side or ceiling)
 Destructive (to body, clothing, furniture,
office objects, other)

52. Creating Comfort with the Client
 Assure the client of your knowledge,
experience, comfort with the issues to help
decrease embarrassment.
 Choose language appropriate for the client’s
developmental age and functioning.
 Be sure terms are understood.
 Use the client’s terms whenever possible.

53. Using Discomfort in the Interview
 Use silence to your advantage when you
want the client to tell more.
 Don’t rush to speak.
 Use hints of your information without details
to elicit information in areas the client first
omits.

54. Helpful Interview Techniques
 Mind-reading
 Prediction
 Leading

55. Assessment of Legal Compulsive Sexual
Behavior
 Extensive Questionnaire
 Detailed Clinical Interview
 Assessment instruments
 Collateral information from the spouses

56. Ask open ended
questions
Use presumptive
questioning
Build rapport
Start with more neutral
questions (non
judgmental)
Ask questions in unique
ways, and at different
times, helps get away
from “rehearsed”
answers
Don’t help them be a
better liar by pointing
out inconsistencies
Ask good follow up.
Assessment

57. ________________________________________________________________________________________________________________________Su
ccessfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement“
Developed by the National Center for Women & Policing, with support provided by the
Violence Against Women Office, Office of Justice Programs (Grant #97-WE-VX-K004)
Interview Techniques
 The interviewing investigator must be very comfortable with
abhorrent sexual behaviors
 Use a soothing and reassuring voice throughout the interview
 Keep an open mind at all times

58. Factors To Be Considered In Assessing
Criminal Responsibility
 Evidence of mental disorder currently, in the past
and at time of offense presence of delusions, mood
disorder
 Motive for offense
- if no apparent motive other than psychotic,
suggests valid mental disorder
- if rational motive also present, such as profit,
suspect malingering or coincidental mental disorder
 Consider planning and preparation for crime
 Evidence of impaired functioning within a few days
of the crime

59. Gather information about
 History of aggression or violence,
 History of sexually abusive behavior, including
details about victims, tactics used in the
commission of the offense, and the circumstances
in which the sexual abuse occurred,
 Level of cognitive functioning,
 Medical and mental health histories,
 Official and unreported history of sexual and
nonsexual crimes,

60. Gather information about
 Peer and romantic relationship histories,
 Substance use/abuse
 Relevant personality traits such as, but not limited
to suspiciousness, hostility, risk-taking, impulsivity,
and psychopathy,

61. Gather information about
 Sexual history, including sexual fantasies, urges,
and behavior, early sexual experiences; number and
duration of sexual relationships; gender identity
and sexual orientation; masturbation and
intercourse frequency; sexual functioning; unusual
sexual interests or behavior that are not sexually
deviant.
 Use of sexually arousing materials (e.g., magazines,
videos, computer porn, internet sites, phone sex)

62. Use multiple sources of information
 Sexual preference measures
 Relevant psychometric testing
 Risk assessment
 Client interview

63. Areas to Assess
– Specifics of sexual crimes
– Sexual deviance patterns
– Sexual dysfunction
– Sexual preferences
– Sexual practices
– Attitudes and cognitions (thoughts) about
sexuality & offending

64. Areas to Assess
 Level of denial and deception
 Level of violence and coercion
 Evaluation of risk

65. Do not base conclusions on Client
self report alone
 Describe the sources of information
 Identify any significant missing information in
the report and note the impact this information
could have on results/recommendations

66. What is a Risk Assessment?
 A comprehensive evaluation to determine a
particular sex offender’s likelihood to commit
a subsequent sex crime, and a determination
of their likelihood to benefit from treatment

67. Risk Assessment
 Actuarial Risk
Assessment
 Clinical Risk
Assessment
– Psychiatric
Assessment

68. Actuarial Risk Assessment
 Objective and Reliable
 Questionable generalization to other populations
 Static historical data generating Static risk
 Not amenable to change
 Ignore individual factors
 Make statements about groups not individuals

69. Actuarial Assessment
 Assessment based on research statistical analysis
of factors strongly correlated with recidivism risk.
 This type of assessment is currently only available
for adult male sexual offenders.
 Continuing research is needed before such tools
will be available for minors and for females.

70. Clinical Risk Assessment
 Thorough psychiatric assessment with reasoned
opinion
 Understanding phenomenology of sexual
behaviours for the purpose of treatment/risk
management
– Paraphilias
 Patient focused and treatment orientated
 Should take into consideration actuarial risk
assessment tools
 Both static and dynamic risks

71. The Content
 A risk assessment should be comprehensive,
and include at least some information on all of
the following areas:

72. The Content
Reason for Referral
Family History
Educational History
Vocational History
Military History
Legal History
Drug and Alcohol Use
History
 Treatment History
 Sexual History
 Previous Psychological
Evaluations
 Previous Sexual Crimes
 Previous Risk Assessments
 Current Sexual Crime
 Diagnoses
 Summary and Recommendations

73. Offender ObligationsOffender Obligations
 Register as a sex offender upon release to the community,
whether released from incarceration or to probation or
discharged upon payment of fine, given conditional or
unconditional discharge
 Annually verify address
 Notify of change of address
 Notify if attending, enrolled in, residing, or employed by an
institution of higher education
 Provide internet information
 Provide updated photograph
 Notify of employment address
 Personally verify address every 90 days

74. Written report
 The product from the evaluation process.
 The report serves to document, educate and
guide decisions regarding the client’s
containment and treatment.
 It should be detailed and specific.

75. Thoughts…Comments