Psychopathy, negative emotions of anger and ...

Psychopathy, Negative Emotions of Anger and Depression, and Causal Attributions: Relation to Sexual Aggression

A Thesis Submitted to the Faculty of Drexel University by Maria Di Francisco in partial fulfillment of the requirements for the degree of Doctor of Philosophy May 2006

ii Dedications In memory of my loving father, who was my role model and an example of dedication and passionate spirit.

iii Acknowledgments I can not commence this section without mentioning Christine Maguth Nezu, Ph.D., ABPP and Arthur Nezu, Ph.D., ABPP for their efforts in mentoring others in this fascinating world that we call “psychology”. Their interest, involvement, and contribution in this field, their passion for excellence and their pedagogy had a profound impact in me. Both supported me in difficult times throughout this career and my words can not capture my profound appreciation for that. I especially thank Dr. Christine M. Nezu, for being my mentor and dissertation chair, and for her availability and commitment in her role that contributed in the achievement of an important goal in my life. My thankfulness to all of the members of the committee, Jonathan Dudek, Ph.D., Pamela Geller, Ph.D, Cordella Malloy, Ph.D., and Drs. Christine and Arthur Nezu for their sharp comments and critical review that greatly contributed to the quality of this study. I thank Miguel, my dear husband, my two sons Miguel Jr. and Esteban and my beautiful daughter Nathalie for their on-going support when I decided to pursue my career. And above all I praise the Creator of the Universe for allowing me to accomplish one more goal in my life. The honor and glory to God who strengthened, taught, and guided me throughout all these years.

iv Table of Contents LIST OF TABLES……………………………………………………………………vi ABSTRACT………………………………………………………………………....vii CHAPTER 1: INTRODUCTION……………………………………………………..1 CHAPTER 2: LITERATURE REVIEW…………………………………………...…3 2.1 General Description of Construct Psychopathy…………………………...3 2.2 Psychopathy and Criminal Behavior……………………………………...7 2.3 Psychopathy and Sexual Aggression…………………………………….10 2.3.1 Psychopathy and Sexual Recidivism…………………………..11 2.3.2 Psychopathy and Deviant Sexual Arousal……………………..13 2.3.3 Incidence and Level of Psychopathy in Sexual Offenders…….14 2.3.4 Psychopathy and Nonsexual Offenses in Sexual Offenders…...17 2.3.5 Psychopathy and Victim Harm………………………………...18 2.4 Review of Other Factors Associated to Sexual Aggression……………..20 2.5 Anger……………………………………………………………………..23 2.6 Depression………………………………………………………………..29 2.7 Cognitive Attributional Factors………………………………………….31 2.7.1 Attributions of Hostile Intent…………………………………..33 2.7.2 Attributions of Provocative Intent……………………………..33 2.7.3 Internal and External Attributions……………………………..35 2.7.4 Causal Attributions…………………………………………….36 2.7.5 Personal Characteristics and Attributions……………………..37 2.8 The Present Study……………………………………………………….38

v CHAPTER 3: METHOD…………………………………………………………….44 3.1 Participants……………………………………………………………….44 3.2 Materials……………………………………………………………...….46 3.3 Procedure………………………………………………………………...53 CHAPTER 4: RESULTS…………………………………………………………….57 4.1 Descriptive Results………………………………………………………58 4.2 Correlational Analyses…………………………………………………...64 4.3 Regression Analyses: Rationale and Description………………………..67 4.4 Primary Analyses………………………………………………………...68 4.5 Secondary Analyses……………………………………………………...71 CHAPTER 5: DISCUSSION………………………………………………………..75 5.1 Overview of Study……………………………………………………….75 5.2 Summary of Results……………………………………………………...76 5.3 Limitations of the Present Study…………………………………………80 5.4 Directions for Future Research…………………………………………..83 CHAPTER 6: SUMMARY AND CONCLUSIONS………………………………..85 REFERENCES………………………………………………………………………88 VITA………………………………………………………………………………..114

vi List of Tables 1. Demographic Characteristics of the Sample……………………...........................99 2. Demographic Characteristics of the Sample, Molesters n = 14………………….100 3. Descriptive Values for Variables of Investigation……………………………….101 4. Correlation Corefficients for Variables of InvestigationRapists and Molesters groups……………………………………………………102 5. Regression for Psychopathy and Severity of Sexual Aggression- Rapists………103 6. Regression for Psychopathy and Severity of Sexual Aggression- Molesters……104 7. Hierarchical Regression for Psychopathy, Anger, Locus and Severity of Sexual Aggression- Rapists………………………………………….105 8. Hierarchical Regression for Psychopathy, Locus, Anger, Depression and Severity of Sexual Aggression- Molesters……………………………………….106 9. Regression for Relation to the Victim, Psychopathy F1 and Severity of Sexual Aggression- Rapists………………………………………….107 10. Regression for Psychopathy F1 and Severity of Sexual Aggression- Molesters………………………………………………………….108 11. Regression for Relation to the Victim, Psychopathy F2 and Severity of Sexual Aggression- Rapists………………………………………...109 12. Regression for Psychopathy F2 and Severity of Sexual Aggression- Molesters………………………………………………….110 13. Regression for Psychopathy Factors 1 and 2 and Severity of Sexual Aggression- Molesters, Partial Group…………………………………..111 14. Hierarchical Regression for Psychopathy, Locus, Anger, Depression and Severity of Sexual Aggression- Molesters, n = 14……………………………..112 15. Hierarchical Regression for Psychopathy, Locus, Anger, Depression and Severity of Sexual Aggression, n = 66…………………………………………117

vii Abstract Psychopathy, Negative Emotions of Anger and Depression, and Causal Attributions: A Model of Sexual Aggression Maria Di Francisco Christine Maguth Nezu, Ph.D., ABPP

Psychopathy has been extensively investigated in its relation to violent behavior. This construct appears to be an important variable in studying aggressive behavior given that it considers many of the problems manifested in the emotional, behavioral, and interpersonal domains among forensic populations. Emotion- and cognitive-oriented research have reported affective dyscontrol (negative emotions) and cognitive components such as causal attributions, as factors associated with criminal behavior. Integrating these findings, the current study examined the associations of psychopathy, anger and depression symptoms, and locus causal attributions to severity of sexual aggression in a retrospective study design. Eighty males with a history of conviction of adult (Rapists, n = 42) or child (Molesters, n = 38) sex offenses completed the Novaco Anger Scale and Provocation Inventory (NASPI; Novaco, 1994); Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996); and Offence Questionnaire (OQ; McKay, Chapman, & Long, 1996). The variables of psychopathy and severity of past sexual aggression were obtained from records review using the PCL-R (Hare, 1991) and SASI (Nezu, et al., 1997), respectively. Primary analysis indicated that psychopathy and locus causal attributions accounted for 50 % of the variance in severity of sexual aggression in Molesters, with

viii anger indicating a trend in the model. In the Rapists group, psychopathy accounted for 47 % of the variance in severity of sexual aggression, Anger and locus causal attributions were not significant. Results of secondary analysis indicated that one specific psychopathy factor (Factor 1) significantly contributed to severity of sexual aggression in both groups. Results of current study suggest that sexual offenders who display higher severities of sexual aggressive acts against their victims are also higher in psychopathic characteristics regardless whether they will be adult or child perpetrators. Findings impact treatment selection and treatment delivery drawn to specifically address features that are highly linked with treatment resistance, risk for recidivism, and difficulties in learning new non-deviant sexual patterns.

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Chapter 1: Introduction Sexual aggression is a behavior with profound implications for both the victim and the perpetrator. The uniqueness and complexity of sexual aggression hinders the development of a unified theoretical model that would account for the multiple factors in the etiology and heterogeneity of perpetrators (Hall & Hirschman, 1991). Several researchers have shown the construct psychopathy as highly involved in the presence of criminal nonsexual (Serin, 1991; Hart & Hare, 1989) and sexual aggressive behavior (Hare & Hart. 1981). Extensive research with individuals diagnosed as psychopaths has associated psychopathy with higher rates of sexual recidivism and sadistic acts inflicted on the victim. Individuals showing a pattern of deviant sexual arousal have been described as being more resistant in learning new adaptive patterns, in the presence of a diagnosis of psychopathy. In addition, lack of empathy for the victim and failing to accept responsibility for inappropriate sexual behavior are features of sexual offenders that are also linked to psychopathic characteristics. Investigators have underscored the role of other components involved in the production of sexual aggressive behavior, for instance, the role of cognitive attributional factors (Loza & Loza-Fanous, 1999; Segal & Stermac, 1993) and negative emotions (Hall & Hirschman, 1991). On the basis of bibliography review and empirical evidence, the purpose of the present research was to examine if the construct psychopathy is related to severity of past sexual aggression, and secondly, to determine if psychopathy, negative emotions (anger and/or depression), and locus causal attributions form a predictor

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model of severity of sexual aggression, based on their association with sexual aggression. The participants for this study were 80 male individuals with a history of a sexual offense(s) against adults or children, receiving treatment after having completed their sentences for a sexual offense(s). The sample was divided into two groups: rapists and child molesters. Consistent with past research, those individuals whose sexual offenses were committed on victims 14 years old or older were classified as Rapists, and those individuals whose sexual offenses were committed on victims 13 years old or younger were classified as Molesters. The contribution of variables of interest was analyzed separately in the two groups (Rapists and Molesters).

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Chapter 2: Literature Review General Description of the Construct Psychopathy Psychopathy is a factor of main interest in this study, thus, the following literature review begins with a general description of this construct. Well-known researchers in psychopathy, such as Hart & Hare (1998), have stated that psychopathy is a form of personality disorder with a clear pattern of symptoms in the interpersonal, affective, and behavioral domains. Furthermore, psychopathy is related, but not identical to antisocial personality disorder (APD) and the expression of the disorder is probably influenced by social and situational factors (Hare & Hart, 1981). In the interpersonal domain, psychopathy is characterized by selfishness, dominance, manipulation, superficial relationships, and lack of responsibility within relationships. The behavioral domain is portrayed by low frustration tolerance, impulsiveness, and sensation–seeking (Herpertz & Sass, 2000). The affective domain is characterized by fearlessness, shallowness, callousness, emotional detachment, and lack of empathy and remorse (Herpertz & Sass). There are two major theoretical approaches to the psychopathy construct (Hart & Hare, 1998). One approach is called the “Cleckley tradition” and focuses on both behavioral and interpersonal/affective characteristics of the construct. Kocsis and Irwin (1998) quoted from Cleckley, “Psychopathy entails persistent violation of the rights of others, a disregard for such rights, and a lack of remorse for any offense or injury to others, an inflated self-concept, and superficial charm” (p. 201). The second theoretical approach to psychopathy, called by Hart & Hare (1998), the “Washington University” tradition is circumscribed to assess the

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observable antisocial behavior of the individual, based on the rationale that clinicians cannot assess interpersonal and affective characteristics in a valid and reliable manner. This approach is reflected in the Diagnostic and Statistical Manual of Mental Disorders, Third and Fourth Editions (DSM-III, DSM-III-R, DSM-IV, American Psychiatric Association 1980, 1987, 1994) respectively under the APD. The Cleckley and Washington schools differ in their rates of diagnosis. For instance, Lilienfeld (1994) reported that the Cleckley tradition might lead to the overdiagnosis of psychopathy in criminal populations and to underdiagnosis in noncriminal populations. The Washington University approach diagnoses APD in 50% - 80% of incarcerated offenders, whereas the Cleckley approach diagnoses psychopathy in about 25% of the same population (Hare 1983, 1985; Hare, Hart, & Harpur 1991). In synthesis, most individuals diagnosed with psychopathy are also diagnosed with APD; however, the reverse is not necessarily true (Hart, Hare, & Harpur, 1992). Thus, psychopathy with its symptoms manifested in a triple domain (interpersonal, affective, and behavioral) is a more specific diagnosis and only 20 % -30% of those diagnosed with APD meet the criteria for psychopathy (Hart & Hare, 1989; Serin 1996). As an assessment tool of psychopathy, the Hare Psychopathy ChecklistRevised (PCL-R; Hare 1990, 1991, 2003) and its screening version, the Hare Psychopathy Checklist-Screening Version (PCL: SV; Hart, Cox, & Hare, 1995), is able to reflect both the behavioral and the interpersonal/affective domains of this construct. In addition, the PCL-R is an empirically validated method of measuring the

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construct psychopathy and is widely used in the clinical and research field (Rice & Harris, 1997). Items of the PCL-R have shown content, criterion, and predictive validity (Hare, 1991, 2003). The Hare PCL-R factor structure is composed of two correlated factors. Factor 1 assesses symptoms related to the interpersonal/affective domain (i.e., grandiosity, superficiality, pathological lying, manipulation, lack of remorse, callousness, shallow affect, failure to accept responsibility for own actions) and Factor 2 assesses social deviant behavior (i.e., parasitic lifestyle, poor behavioral controls, need for stimulation, early behavioral problems, lack of realistic long-term goals, impulsivity, irresponsibility, juvenile delinquency, revocation of conditional release) (Hare & Hart, 1981). Both factors are positively correlated (r = .50) and factors are also correlated with violence, substance use, and personality variables (Hart & Hare, 1998). Recently, this two Factor model has been revised. In accordance with the interpersonal, affective, and behavioral domains of psychopathy expression, data supports a three Factor model: arrogant and deceitful interpersonal style, deficient affective experience, and impulsive and irresponsible behavioral style. (Cooke & Michie, 2001). Characteristics of some major psychiatric Axis II diagnoses, such as antisocial, borderline, histrionic, and narcissistic personality disorders, overlap to a certain degree with psychopathy (Hart & Hare, 1989). In addition, substance abuse is commonly found among those who are given a diagnosis of psychopathy (Hart & Hare). However, the major significant association with psychopathy is APD (Hart & Hare; Hart, Forth, & Hare, 1991). For instance, Hart, Forth, and Hare (1991) found a positive correlation with the PCL-R and APD (r = .45). PCL-R total scores were

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likely to be negatively correlated with the Axis I principal diagnoses of schizophrenia, bipolar, and anxiety disorders (Hart & Hare; Hare & Hart, 1981). With regard to PCL-R factors, Factor 2 has a high positive correlation with a diagnosis of APD, substance abuse, and general criminality, and a negative correlation with demographic variables, such as age, socioeconomic level, education, and intelligence. Scores on Factor 1 are positively correlated with narcissistic and histrionic personality disorder, criminal behaviors, recidivism, and violence. Factor 1 is negatively correlated with avoidant and dependent personality disorders (Hart & Hare; Hare & Hart). From the above studies it can be summarized that psychopathy is a term that encompasses a comprehensive clinical presentation of symptoms across multiple domains involving a style of interpersonal relations, a pattern of affective characteristics, and a style of social deviant behaviors. In forensic settings, the most widely seen features of psychopathy are antisocial behavior and narcissistic personality, thus these two components are highly relevant in analyzing criminal behavior (McNiel & Meyer, 1990). Considering the features expressed above, the construct psychopathy appears to be a reliable variable to include in the study of violent behavior because it considers the problems encountered in the emotional, behavioral, and relational areas in forensic populations (Hart, Kropp, & Hare, 1988). To continue, the following is a review of psychopathy in relation to general criminal behavior.

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Psychopathy and Criminal Behavior Forensic research has demonstrated that psychopathy is positively correlated with criminal career, early onset of delinquency, high rate of offenses, use of threats, use of weapons, and instrumental violence. Thus, this construct has a strong association with criminal behavior (Forth, Hart, & Hare, 1990; Hare, Forth, & Strachan, 1992; Hart, Hare, & Forth, 1994; Serin, 1991; Porter et al., 2000). Research indicates that individuals diagnosed with psychopathy are at higher risk to reoffend, recidivate sooner, and are at a high probability that the reoffense will be violent when compared to individuals diagnosed as nonpsychopaths (Harris, Rice, & Cormier, 1991; Hart, Kropp, & Hare, 1988). Overall, studies confirm a strong relationship between violent behavior and psychopathy among forensic populations (Serin 1991; Hare & McPherson, 1984; Williamson, Hare & Wong, 1987) and that psychopathy is a good predictor of recidivism in criminal and psychiatric samples (Serin, 1996). Serin (1996) assessed 81 offenders from the Correctional Service of Canada and followed the sample for an average period of 30 months. Those subjects who had a score of 29 on the PCL-R received a diagnosis of psychopathy and those who had a score of less than or equal to 16 were diagnosed as nonpsychopaths. The author found that those who received a diagnosis of psychopathy reoffended sooner, at a higher rate, and committed both general and violent recidivism (violent offense included robbery, assault, manslaughter, sexual assault, and murder; possession of a weapon was not considered a violent offense). The violent recidivism rate was 10 % and was only committed by individuals diagnosed as psychopaths. Further statistical analysis

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demonstrated that Factor 1 was significantly associated with violent recidivism and Factor 2 with general recidivism. Consistent with Serin (1996), similar findings were previously reported by Serin, Peters, and Barbaree, (1990). In a study with 169 offenders with mental disorders released from a security psychiatric hospital, Harris, Rice, and Cormier (1991) reported that psychopathy predicted violent reoffense with 78 % accuracy. In another study of 121 inmates, Hart, Kropp, and Hare (1988) found that those whose score of psychopathy was in the top third of the distribution generally performed very poorly following conditional release from prison, violated the conditions of release more frequently, and exhibited greater problems in developing a stable lifestyle when compared with other inmates. In three separate retrospective studies on a sample of 500 incarcerated males, ages less than 35 years old, Hare and McPherson (1984) found that individuals diagnosed with psychopathy engaged in more violent crimes and other forms of aggressive behavior (i.e., murder/ manslaughter, armed robbery, robbery, assault, forcible seizure, rape, aggressive homosexuality, vandalism, fighting, kidnapping, and possession of a weapon) when compared to other criminals (Hare & McPherson). The authors found that those who were diagnosed with psychopathy were more prone to be convicted for armed robbery, assault, and forcible possession when compared to those diagnosed as nonpsychopaths. Overall, empirical research is consistent in finding a strong link between the construct psychopathy and criminal behavior. With regard to the use of violence among those who commit a criminal act, there is some evidence that there exists a

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difference in the use of violence among those diagnosed with psychopathy and other violent offenders. Specifically, there is evidence that offenders diagnosed with psychopathy commit crimes for material gain or for revenge/retribution (Williamson, Hare, & Wong, 1987; Serin 1991), and the aggressive acts are mostly motivated by emotions such as tension or frustration rather than stronger emotions such as fear or anger (Cleckley, 1976; Williamson, Hare, & Wong, 1987). Furthermore, they have a greater likelihood of using threats and weapons and selecting victims who are unknown to them. Several authors such as Serin (1991); Williamson, Hare, and Wong (1987); and Serin, Malcolm, Khanna, and Barbaree (1994) have pointed out that the violence of individuals diagnosed with psychopathy has a tendency to be instrumental and goal-oriented (i.e., robbery) in contrast to violent offenders diagnosed as nonpsychopaths who are apparently motivated by strong emotional arousal or expressive aggression (aggression in response to provocation or perceived threat); however, “the distinction between instrumental and reactive violence is not absolute” (Cornell et al. ,1996, p. 788). For instance, Cornell et al. investigated 106 male inmates who committed crimes of instrumental aggression such as robbery and those who committed crimes of reactive aggression in response to provocation. A pilot work revealed that violent offenders with a history of instrumental violence also had a history of reactive aggression. In order to solve this problem, the authors distinguished between offenders who committed at least one instrumental violent crime (group of instrumental violent offenders) and offenders with a history of reactive violent offenses (group of violent offenders). Among those offenders who

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committed at least one instrumental violent crime, findings revealed higher PCL-R scores, when compared to offenders who engaged solely in reactive violence. Cornell et al. emphasized that there is a “critical problem in distinguishing instrumental from reactive violence” (p. 784) because a crime that is instrumental (i.e. robbery) may have become a reactive aggression when the individual became angry with the victim and engaged in reactive aggression. Therefore, there were instrumental offenders who acted impulsively under a stage of anger and there were reactive offenders who carefully planned and carried out their offense (Cornell et al.). From the aforementioned, criminal activity and criminal recidivism are associated with a diagnosis of psychopathy. A particular manifestation of criminal behavior is sexual aggression and, for the purpose of this study, the following review is focused on sexual aggressive behavior as a component of criminal behavior. In the case of sexual aggressive behavior, Hare and Hart (1981) reported that sex offenders displayed a particular combination that consisted of a high score on the PCL-R and evidence that the individual was sexually “turned on” by violence. For the purpose of this study, only psychopathy will be the factor of interest.

Psychopathy and Sexual Aggression The construct psychopathy is identified as an important variable in understanding sexual aggressive behavior (Boer, Wilson, Gauthier, & Hart, 1997; Marshall & Barbaree, 1984). For instance, among a college sample psychopathic personality traits were associated with self-reports of sexually aggressive behavior and degree of sexual aggression (Hersh & Gray-Little, 1998; Kosson, Kelly, & White,

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1997). Empirical research associates the construct psychopathy with different aspects of sexually aggressive behavior such as sexual recidivism, deviant sexual arousal, and victim harm. The following literature review addresses these findings.

Psychopathy and Sexual Recidivism Quinsey, Rice, and Harris (1995) investigated factors associated with sexual recidivism among rapists and child molesters. Findings demonstrated that psychopathy scores on the PCL-R predicted sexual recidivism. The mechanism of this outcome is uncertain; however, psychopathy is associated with less treatment progress and treatment completion. In turn, these two events have been found associated with recidivism, thus linking psychopathy to sexual recidivism. Various studies have confirmed that the construct psychopathy has been demonstrated to be a significant factor in sexual and nonsexual recidivism. For example, Seto and Barbaree (1999) found that male individuals who scored higher on the PCL-R were more likely to commit a new offense of some kind and at a higher degree to commit a new serious offense. Prentky, Lee, Knight, and Cerse (1997), who analyzed a sample of 251 rapists and child molester sex offenders discharged over a 25-year period on variables accounting for recidivism, concluded that “antisociality, psychopathy, lifestyle impulsivity, and number of prior sexual offenses are factors known to be correlated with reoffense risk for sexual offenders” (p. 654). Firestone et al. (1999) studied a sample of 251 incest offenders. The authors reported that scores on the PCL-R (general score, Factor 1, and Factor 2) and scores on the Buss-Durkee Hostility Inventory (BDHI; Buss 1961) were linked to sexual

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recidivism (any charge or conviction for a sexual offense), violent recidivism (any charge or conviction for either violent nonsexual or sexual offenses), criminal recidivism (any charge or conviction), and a history of criminal behavior. In addition Firestone et al. found that general PCL-R scores discriminated sexual recidivist from nonrecidivists. In predicting sexual recidivism, some researchers have specifically analyzed the role of history of antisocial behaviors and general criminal activity. Overall, research is consistent in reporting that high-impulsivity predicted reoffense among rapists and child molester sex offenders. Furthermore, in a study with a sample of 68 incarcerated sexual offenders (child molesters and rapists). Serin, Mailloux, and Malcolm (2001) reported that recidivists had scored significantly higher on the PCLR Factor 2 scores than nonrecidivists. This finding is consistent with a study of Prentky, Knight, and Lee (1997) who analyzed 111 extrafamilial child molesters in variables of recidivism confirming that variables that reflected impulsive, antisocial behaviors predicted violent reoffenses (sexual and nonsexual) as well as nonsexual offenses. Prentky, Knight, Lee, and Cerce (1995) examined the relationship of lifestyle impulsivity as a valid discriminator of recidivism in a sample composed of rapists discharged from a maximum security treatment institution. The authors also found that variables revealing impulsive and antisocial behavior predicted violent (sexual and nonsexual) and nonsexual offenses in general.

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Psychopathy and Deviant Sexual Arousal The construct psychopathy is of singular significance in predicting risk factors for reoffense when studied in conjunction with deviant sexual arousal. Rice, Harris, and Quinsey (1990) studied a sample of 54 rapists released from a maximumsecurity psychiatric institution. These authors reported that degree of psychopathy and sexual arousal to nonsexual violent stimuli, independently or together, produced an increase of prediction of recidivism when compared to the sole variable of history of sexual aggression and general criminal behavior. In a sample of child molesters, rapists, and mixed offenders analyzed by Rice and Harris (1997), the joint presence of psychopathy and deviant sexual arousal (preference for deviant stimuli, such as children, rape cues, or nonsexual violence cues) was strongly predictive of sexual offenses. The results are consistent with a subsequent study by Serin, Mailloux, and Malcolm (2001). Specifically, in the Serin et al. research, adding PCL-R scores to deviant arousal data resulted in an incremental value in predictive validity of the PCL-R for reoffense. Several authors have investigated the psychopathy-deviant sexual arousal relationship. Quinsey, Rice, and Harris (1995) reexamined two samples of sexual offenders by combining data from the two previous investigations conducted by Rice, Harris, and Quinsey in 1990, and Rice, Quinsey, and Harris in 1991. The authors found that higher psychopathy ratings were related to greater deviance on the penile plethysmograph response. Serin, Malcolm, Khanna, and Barbaree (1994) studied child molesters and rapist plethysmograph response and its relation to psychopathy. Findings reported a significant relationship between scores on psychopathy and

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deviant sexual arousal in extrafamilial child molesters and approaching significance in the rapist group. Consistent with these findings, Firestone, Bradford, Greenberg, and Serran (2000) reported a significant relationship between psychopathy and deviant arousal in child molesters when relationships between PCL-R and plethysmograph response were examined. Hare and Hart (1981) refer to psychopathy-deviant sexual arousal relationship as the “deadly combination” (p.11). Rice and Harris (1997), referring to the same topic, explained that in a nonpsychopathic individual concern for the victim and lack of general propensity to use people for his own end would help the individual with deviant preferences to restrain his deviant sexual behavior. However, this would not be the case of a psychopathic individual with deviant sexual preferences who might act on them (Rice & Harris).

Incidence and Level of Psychopathy in Sexual Offenders The rate and incidence of psychopathy among sexual offenders varies given that this population is heterogeneous in its risk for reoffense, criminal diversity, and personality profiles (Boer, Wilson, Gauthier & Hart, 1997; Prentky & Knight, 1991; Rosenberg & Knight, 1988). Some studies have consistently reported higher scores of psychopathy (Hare & Hart, 1981) and higher incidence of psychopathy in individuals who committed a sexual offense against adults (rapists) or those who committed an offense against adults and children (mixed), than in individuals who committed a sexual offense against children (child molesters) (Hare, Clark, Grann, & Thornton, 2000).

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Serin, Malcolm, Khanna, and Barbaree (1994) found a 12.2 % incidence of psychopathy among a sample of individuals who committed offenses against adults, and 7.5 % among individuals who committed offenses against children. In another study Porter et al. (2000) investigated 329 incarcerated sexual offenders and nonsexual offenders with regards to rate of psychopathy. The authors divided the sample according to the type of offense. The mixed group (offenders who victimized both children and adults) had the highest rate of psychopathy (64.0 %), rapists and nonsexual offenders had moderately high rates (35.9 % and 34 % respectively), whereas the child molesters had the lower rates (6.3 % for extrafamilial child molesters and 10.8 % for intrafamilial child molesters). From the sample of offenders diagnosed with psychopathy, 38.9% had committed rape to only adult victims, 16.8% offended against both children and adults, 4.2 % committed only incest, 3.2 % were extrafamilial child molesters, and 1.1 % were familial and extrafamilial child molesters. The percentages reported above are higher than the percentages reported about sexual offenses in the group diagnosed as nonpsychopathic, although the authors did not report if such a difference was statistically significant. Seto and Barbaree (1999) found a significant difference between rapists and child molesters in level of psychopathy. When PCL scores of 272 male sex offenders were analyzed, findings revealed that the group composed of rapist offenders scored higher than the group composed of child molesters (extrafamilial and incest). The rate of psychopathy was also higher for rapist offenders than for child molesters (Seto & Barbaree).

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Quinsey, Rice, and Harris (1995) reexamined two samples of sexual offenders combining data from the two previous investigations conducted by Rice, Harris, and Quinsey in 1990, and Rice, Quinsey, and Harris in 1991. The authors found a significant difference between child molesters and rapists. When child molesters were compared to the other two groups, composed of rapists and mixed offenders (sexual offenses against children and adults), the child molesters had lower PCL-R scores and the scores for the mixed group were located halfway between child molesters and rapists. Findings with regards to offenders against children and psychopathy are mixed. For instance, Dorr (1998) stated that there is a high rate of comorbidity between psychopathy and pedophilia. This author reported several studies where child molesters scored significantly high on the Psychopathic Deviate Scale of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1967). Dorr observed that several of the PCL-R characteristics have been noted in descriptions of the pedophile. For instance: callous, lack of empathy, failure to accept responsibility for one’s decisions, lack of remorse or guilt, cunning and manipulation, pathological lying, shallow affect, poor behavioral controls, promiscuous sexual behavior, impulsivity, irresponsibility, and numerous short-term marital relationships. Few studies further analyzed the characteristics associated with Factor1 (interpersonal and affective dimension of psychopathy) and Factor 2 (social dimension of psychopathy) and the relation to sexual aggressive behavior. Firestone et al. (1998) compared 17 homicidal child molesters with 35 convicted child molesters. Although the group of homicidal child molesters was particularly higher in

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the general score of psychopathy and Factor 1, overall, there was a high degree of psychopathy found for all child molesters with higher scores on Factor 1 than Factor 2. Porter et al. (2000) studied four offender groups (child molesters, rapists, mixed group: offenders against children and adults, and nonsexual offenders). Porter reported higher PCL-R general score and Factor 1 and 2 scores in the mixed group, followed by the rapist and the nonsexual offender groups. Further statistical analysis revealed that in general, the group of all sex offenders combined (child molesters, rapists, and mixed) scored higher in Factor 1 and that the groups composed of rapists, mixed offenders, and nonsexual offenders scored significantly higher than child molesters on the factor that reveals antisocial behaviors (Factor 2) (Porter). Although the general score and Factor 2 of PCL-R measure of psychopathy shows significant differences among child molesters and rapists; both share an association between Factor 1 on the PCL-R and sexual aggression.

Psychopathy and Nonsexual Offenses in Sexual Offenders The construct psychopathy is related to more extensive nonsexual criminal history among samples of sexual offenders. For instance, studies conducted by Hare and McPherson (1984) and Brown and Forth (1997) found the construct psychopathy positively associated with more extensive criminal history (nonsexual offenses) in its early onset in a sample of sexual offenders against adults. Several other studies have also reported relationships between the domain impulsivity/antisocial behavior and the likelihood of aggressive sexual behavior among normal, noncriminal samples (Prentky & Knight, 1991; Rapaport & Burkhart, 1984; Lisak & Roth, 1988).

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In summary, psychopathy is a term used to define various clinical aspects of an individual and is generally linked to criminal behavior and particularly relevant when explaining sexual aggressive acts, although not all sexual offenders are diagnosed with psychopathy. In general, child molesters score lower in measures of psychopathy and present a lower incidence of the disorder, although some studies have reported mixed findings. The construct is also germane when considered in conjunction with deviant sexual arousal and the risk of sexual reoffenses making this construct a core component in clinical decision-making. Few studies further analyzed the separate Factors 1 and 2 contributions to sexual aggression, finding in general an association between Factor 1 across sexual offenders groups and Factor 2 in rapists and mixed groups.

Psychopathy and Victim Harm Psychopathy is a construct of intrinsic interest in studying sexual aggression, considering the lack of empathy for the victim and failure to accept responsibility for their behavior that is encountered among sexual offenders. One purpose of this present study is to determine if psychopathy is related to the severity of sexual aggressive behavior displayed by the perpetrator. The problem encountered in reviewing the literature is that the presence of psychopathy and degree of victim injury has been sparsely studied, and results of empirical research have reported mixed findings. For instance, Hare, Clark, Grann, and Thronton (2000) summarized that the offenses of sexual offenders diagnosed with psychopathy tend to be more violent or sadistic in comparison to nonpsychopathic sexual offenders, associating

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psychopathy with sexual sadism. Similar findings have been reported by Hare and Hart (1981) and Stone (1998). Berger, Berner, Bolterauer, Gutierrez, and Berger (1999) in a study of 70 offenders (27 child molesters, 33 rapists, and 10 murderers), found a high comorbidity of sadistic personality disorder among sexual offenders against adults (rapists) and those who committed homicide. The authors also reported a frequent comorbidity of the diagnosis of sadistic personality with the DSM-II-R- cluster B personality disorder (antisocial, borderline, histrionic, narcissistic), although the overlap diagnoses were highest with APD. In contrast with the above authors mentioned, reported studies of Williamson, Hare, and Won (1987); Quinsey, Rice, and Harris (1995); and Brown and Forth (1997) found that psychopathy was not associated with degree of harm inflicted on their victims. The studies on victim harm have all used the Offense Severity Rating, OSR (Quinsey & Chaplin, 1982). The OSR is a seven-point scale where: 1= no damage; 2 = slight damage with no weapon; 3 = slight damage with weapon; 4 = victim treated in clinic and released; 5 = victim treated in hospital and stayed at least one night; 6 = victim death; and 7 = victim death with postmortem mutilation (as shown by autopsy reports). It is thought that the failure in finding a link between psychopathy and degree of victim injury could be associated with the item characteristics of the OSR, which may not be sensitive enough to appropriately capture the nuances involved in the expression of sexual aggression. Therefore the use of a more behavioral-sensitive measure would be more helpful in detecting relationships if any exist.

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When taking these controversial findings together and according to the substantial body of literature on predictors of variables of sexual aggressive behavior, there is a strong suggestion that psychopathy might not be used as a sole indicator in the assessment and prediction of future victim harm (Brown & Forth, 1997). Furthermore, other factors might be present in relation to the severity of aggression perpetrated by a sexual offender.

Review of Other Factors Associated with Sexual Aggression In considering different components that might be present in facilitating sexual behavior that is aggressive, some studies have aimed to explain the various elements involved in sexual aggression. For instance, Malamuth (1986) emphasized that in understanding the causes of sexual aggression, it is crucial to consider the function of multiple factors, such as “those creating the motivation to commit the act, those reducing internal and external inhibitions that might prevent it from being carried out, and those providing the opportunity for the act to occur” (p. 953). Malamuth (1986) and Malamuth, Heavey, and Linz (1993) proposed a model of sexual aggression against women consisting of a confluence/interaction of high levels of motivation, disinhibition, and opportunity predictor variables. Authors suggest that motivation and disinhibition factors are organized in two paths, “hostile masculinity” and “sexual promiscuity.” These paths enable the individual to overcome inhibitions and engage in gratifying sexual behavior. Hall and Hirschman (1991) and Hall (1996) proposed a theory-driven model of sexual aggression called the “quadripartite” model of sexual aggression, which

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seems to be functional in understanding factors associated with sexual aggressive behavior. Based on four major models of sexual aggression ( physiological, cognitive, affective, and developmental) and integrating the understanding that each model brings to the concept of interest, the authors drew four motivational precursor factors of sexual aggression: physiological sexual arousal (modulated by deviant and nondeviant sexual fantasies), cognitive (appraisals-distortions), affective (affective dyscontrol: states of anger and hostility in adult offenders), and depressive states among child offenders, and developmentally related personality problems (intellectual impairment, family conflicts, history of victimization, juvenile delinquency, poor social skills, emotional difficulties, and poor adult adjustment). The presence of one or more motivational component is not necessarily related to sexual aggression and depends on the individual threshold gradients for sexual aggressive behavior (Hall & Hirschman, 1993). Both models of sexual aggression, Interactive Model (Malamuth, 1986; Malamuth, Heavey, & Linz, 1993) and the Quartipartite Model (Hall & Hirschman, 1991; Hall, 1996) considered that precursors of sexual aggression may interact with situational determinants to establish the likelihood of sexually aggressive behavior (Hall, 1996). In summary, multiple and complex factors might be involved in a sexual aggressive act; however, the conceptualization of a model of sexual aggression would be more useful when the relationships of the constructs of interest are explained in a parsimonious manner (Kazdin, 1992). Following this scientific-oriented principle, it is thought that Hall (1996), Hall and Hirschman (1991) model of sexual aggression

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would be more useful for theoretical guidance in this study in identifying other factors involved in sexual aggressive behavior. As such, cognitive-affective components would shed light on understanding this behavior and may be implicated in the degree of displayed sexual aggression, along with psychopathic characteristics. Cognitive-oriented theorists emphasize perceptions of the environment in evoking aggression, whereas emotion-oriented theorists propose emotional states as the primary determinants of aggressive behavior (Chermack, Berman, & Taylor, 1997). Berkowitz (1989) suggests that “any kind of negative affect, sadness as well as depression and agitated irritability will produce aggressive inclinations” (p. 7). Integration of emotional-cognitive factors in sexual aggression is found in the literature in the “relapse prevention” model. It considers that negative emotional and cognitive states are a key component in the cascade of emotional-cognitive events that ultimately lead to a sexual offense (Pithers, Kashima, Cumming, Beal, & Buell, 1988). For instance, Pithers, et al., found that 89 % of a sample of both pedophiles and rapists reported experiencing strong emotional states prior to relapse and that the affect-thought component was the first stage involved in sexual aggression. Studies aimed to identify emotional precursors of sexual offending behavior have identified different negative mood or dysphoria (i.e., anxiety, anger, depression, loneliness, feelings of distress, and rejection) (Brown & Forth, 1997), thus emotions of anger and depression might be considered as emotional antecedents of sexual aggression and should be discussed in addition to the cognitive components.

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Anger Among situational determinants of sexual assault, some authors considered anger as a robust influence on aggressive behavior. For instance, Hanson and Harris (2000) found increase of anger and dysphoric mood as significant predictors of recidivism in a sample of sexual offenders. Barbaree (1990) reported that among other factors, victim blame and anger are disinhibitors to rape. Marshall, Earls, Segal, and Darke (1983) reported that “anger interfered with the usual inhibition initiated in normal men by the presence of force or violence in sexual acts” (p. 152). Moreover, Barbaree, Seto, Serin, Amos, and Preston (1994) stated that “it has been suggested that anger and aggression interact with or modulate sexual arousal during rape” (p. 98). Lisak and Roth (1988) reported that anger, among other variables, distinguished sexually aggressive from nonaggressive men, concluding that this finding is similar to those among incarcerated rapists. Research in laboratory with normal populations had demonstrated that techniques used in provocation of affect in males had facilitated aggression toward an adult female. For instance, Yates, Barbaree, and Marshall (1984) examined the effect of anger arousal on the sexual responses of normal men to rape cues, using provocation in producing a state of anger. Specifically, the sample was composed of 21 male university students, ages 21-33. During the experimental condition, eight subjects exercised (pedaled on a bicycle) and were insulted (a female confederate said in a derogatory style, “Is that all?” and “Is that the best you can do?”), eight subjects exercised but were not insulted, and the third group of subjects neither exercised nor

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were they insulted. Immediately after the exercise and/or insult condition, subjects were presented with descriptions of both mutually consenting sex and rape while their sexual arousal was measured by penile plethysmography. In subjects who were in the nonprovocative condition, rape cues evoked significantly less sexual arousal than descriptions of mutually consenting sex. In the provocation condition, rape cues and mutually consenting sex evoked similar levels of sexual arousal in the subjects. The authors reasoned that anger toward a female made the pattern of sexual arousal of normal males similar to those of rapists, concluding that the negative emotion of anger worked attenuating arousal to consenting sex and enhancing arousal to forced sex (Yates et al.). Similarly, previous studies conducted by Donnerstein, Donnerstein and Evans (1974); Donnerstein and Barret (1978); and Donnerstein and Hallam (1978) reported interactions between the negative emotion of anger and sexual arousal. However, both adult-victim and child-victim offenders may have anger problems at some level (Maiuro & Hall, 1986). In a review of research findings, Maiuro and Hall found evidence indicating that anger and hostility scores are higher in individuals who committed rape to adult victims, although some studies indicated that individuals who committed rape to adults or children had significantly higher anger and hostility scores than individuals who committed non-violent sexual offenses against children. In addition, Hall (1989) reported significantly higher scores on the Buss-Duke Hostility Inventory (BDHI) among sexual offenders who had used excessive physical force against their victims (physical force beyond what was necessary to gain victim compliance, the threat of force, or use or display of a

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weapon), regardless if they were child molesters or rapists, albeit, the child molesters scored significantly lower on the BDHI in comparison to offenders against adolescents and adults. Some studies assessing anger in sexual offenders through self-report measures showed no significant findings. For instance, Loza and Loza-Fanous (1999), administered four self-report anger inventories to four groups of inmates composed of violent vs. nonviolent and rapists vs. nonrapists. Violent offenses included murder, manslaughter, assault, kidnapping, forcible confinement, robbery with violence, and sexual offenses. The results of this study indicated that there were no differences between violent offenders and nonviolent offenders and between rapists and nonrapists on measures of anger. Smallbone and Milne (2000) studied trait anger on a sample of 110 incarcerated offenders against adults (rapists) and offenders against children (child molesters). Their findings revealed that trait anger, as measured by self-report measures, was significant for verbal aggression but it was not the case for physical aggression and the groups did not differ in trait anger. Dalton, Blain, and Bezier (1998) assessed a heterogeneous group of sex offenders with the State-Trait Anger Expression Inventory (STAXI; Spielberger, 1988). The authors reported that sex offenders displayed slightly higher states of anger at the time of testing in comparison to the norms although they did not have any significantly higher scores. The findings of Loza and Loza-Fanous (1999) and Dalton, Blain, and Bezier (1998) are consistent with those of Serin (1991), which failed to find anger as significant among a forensic population, when assessed with self-report measures;

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however, it was significant when assessed with vignettes of anger-provoking situations. Serin analyzed a sample of 87 male inmates incarcerated at a mediumsecurity prison. The group was divided according to their offense (violent or nonviolent and level of psychopathy, resulting in three groups: nonviolent nonpsychopaths, violent nonpsychopaths, and violent psychopaths). Although there were no differences in scores of the Novaco Anger Inventory (Novaco, 1975) across groups, the group of individuals diagnosed with psychopathy scored significantly higher in reporting anger to provocative situations in vignettes of anger-provoking situations. In synthesis, Serin’ study showed that testing anger through hypothetical situations was more accurate in the forensic population. When anger is assessed with self-report measures, the failure to find a link to aggressive behavior (sexual or non sexual) may be a function of a weakness of self-report measures, which are highly sensitive to social desirability. According to Knight and Prentky (1990), the sexual aggression resulting from affective dyscontrol is opportunistic and unplanned, rather than deliberate and controlled, although several acts of sexual aggression might have both components. Given this hypothesis, it is pertinent to investigate the role of this emotion in individuals diagnosed with psychopathy. Loza and Loza-Fanous (1999) considered that anger itself is not related to aggressive and assaultive behavior. Moreover, these authors stressed that anger might be an excuse that violent offenders and offenders against adults use for their violent acts, and that in addition, anger and violent behavior does not concur with the

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findings that those diagnosed as psychopaths have less anger and less frustration prior to violent acts when compared to nonpsychopathic criminals. In contrast with Loza and Loza Fanous (1999), Dorr (1998) posited that the “psychopath grandiose self-image” and the “psychopath self-knowledge” of this positive self-concept is not genuine. Furthermore, these individuals experience the labeled “zero state.” In the “zero state”, the individual experiences a decline of the self-esteem as evidenced by emotions of worthlessness, hopelessness, and futility (Dorr). However, this inner emptiness, which appears to be depressive, is experienced in a state of rage. This rage is associated with thoughts of injustice in the world. As a compensatory behavior of this state, the individual might seek to own and/or devaluate the other, ending in a behavioral pattern of predation (Dorr). The presence of negative emotional states, similar to those named “zero state” preceding sexual aggression, was documented by Long, Wuesthoff, and Pithers (1989) and Marlatt (1989). These authors found emotions such as loneliness, worthlessness, depression, rejection, anger, or resentment preceding the offense among both sexual offenders and violent offenders in general. In addition, Pithers, Kashima, Cumming, Beal, and Buell (1988) stated that the first change in the relapse of sexual aggression is affective whereby the subjects referred to themselves as feeling moody or brooding. Dorr (1998) stated that dysphoric emotions such as those reported above, are similar to those descriptions of the sequence and progression of cognitions and emotions typically observed by individuals with a diagnosis of psychopathy,

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concluding that “the act of sexual offense is an act of predation with the intent to defend” (p. 310) against those negative emotions. Continuing with studies of psychopathy and negative emotions, Brown and Forth (1997) compared a sample of 60 sexual offenders against adults. The authors divided the sample into two groups, those who had received a diagnosis of psychopathy and those who did not have a diagnosis of psychopathy. Statistical analysis did not reveal a significant difference between the groups (psychopathic and nonpsychopathic) in relation to negative emotions preceding the offense. Fifty-seven percent of their sample (including both those diagnosed as psychopaths and those diagnosed as nonpsychopaths) reported experiencing at least one negative emotion. When analyzing the nature of emotions reported by both groups, the group diagnosed as nonpsychopaths reported significantly increased feelings of hopelessness, loneliness, inadequacy, guilt, and rejection. The group diagnosed as psychopaths reported significantly more positive emotions (happiness, joy, and excitement) and anxiety and stress. When compared to reported emotions of depression (depression and moodiness) and anger, there were no significant differences between both groups. With regard to the intensity of emotion, Brown and Forth found a negative relationship between negative emotional intensity scores and PCL-R scores (r = -.39) and Factor 1 scores (r = -.41), indicating that although both groups (psychopaths and nonpsychopaths) reported experiencing similar types of negative emotions, it may be the intensity of the negative emotions that differentiates between the two groups (Brown & Forth). These authors concluded that their finding is consistent with the

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hypothesis that individuals diagnosed as psychopaths are capable of experiencing emotions, although the emotions are short lived and void of depth (Brown & Forth). In summary, the negative emotion of anger has been empirically validated as a variable that contributes to aggression toward a female in samples of normal males in experimental settings. Findings of its contribution to sexual aggressive behavior are consistent across rapists of adults and, at some level, rapists of children. In recidivists, the emotion of anger has been frequently reported prior to the offense. Studies on identifying anger in individuals diagnosed with psychopathy and their relation to their sexual offenses are also mixed. Given the discrepancy of the role of anger in sexual aggression among studies, Maiuro and Hall (1986) stressed that “although anger and hostility are existing problem in sexual aggression, more work is needed to identify the source(s) of such affects and attitudes” (p. 123).

Depression Congruent with the heterogeneity of the sexual offender population, some research studies indicate that anger and hostility are the most reported emotions prior to relapse in rapists of adults while depression symptoms are prevalent among child molesters. For instance, Pithers, Kashima, Cumming, Beal, and Buel (1988) found that 38 % of individuals with a diagnosis of pedophilia reported feeling depressed and 46 % reported feeling anxious preceding the sexual offense while most aggressors against adults recalled emotions of intense anger as the affective precedent of their sexual aggression. Consistent with this, other authors such as Hall (1996); Hall and

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Hirschman (1992); and Hall, Shondrick and Hirschman (1993) reported that depression is a frequent affective emotional antecedent of child molestation. Maiuro, Cahn, Vitalino, Wagner, and Zegree (1988) examined anger, hostility, and depression across generally assaultive men, domestically violent men, and nonviolent control group. The domestically violent men were more likely to be significantly depressed as well as significantly angry and hostile, supporting their hypothesis that this population is simultaneously angry and depressed. The authors present an interesting connection between these two apparent paradoxical emotions by relating low-self esteem, loss, and helplessness to depression and linking the experience of anger to the experience of loss. This analysis is consistent with Dorr (1988) who stated that during stages of anger, frustration, loneliness, and impaired self-esteem; the individual experiences a strong sense of deprivation that may precipitate sexual aggression. The above studies identify depression as linked to sexual offending behavior specifically in the group of molesters who reported experiencing these symptoms previous to the offense. However, studies analyzing a clinical diagnosis of depression as an emotional component of sexual aggression are not existent. Depression was investigated in its predictive value to general violent behavior in the MacArthur Study of Mental Disorder and Violence (Monahan et al., 2001). Results indicated that a diagnosis of depression was unrelated to future violence. In summary, a few studies considered the variable of depression, and results show evidence that sexual aggressors against children report more emotions of depression prior to the offense in comparison to sexual aggressors against adults.

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However, these symptoms might be related to a mild or moderate level of depression rather than to a major level of depression. Given that across the literature anger and depression are the most prevalent negative moods identified as precursors of sexual offenses, in the present study both would be considered relevant variables for studying their link to sexual aggression. When pondering the negative emotions of anger and depression, it is essential to address the fact that they are quite different emotional phenomena, corresponding to two distinct theoretical paradigms. Thus, it seems difficult to link both experiences to the same event: sexual aggressive behavior. Moreover, anger is associated with behavior activation while depression is associated with behavior withdrawal. Review of literature shows that anger has been studied in its relation to general aggression and sexual aggressive behavior. Studies on depressive symptoms indicate that symptoms of depression have been found prior to the event of a sexual aggressive act thus being depressive symptoms associated with aggressive acting out. There are indications that angry and depressive states covary and that pervasive negative states influence perceived threats in the behaviors of others (Hall, 1996).

Cognitive Attributional Factors Prediction of violence could be enhanced if both history of violence and attributional factors are considered. Moreover, Serin (1991) hypothesized the existence of an interactive relationship between attributional bias and aggressive behavior.

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Berkowitz (1989) proposed an alternative to the traditional view of anger as controlled by the stimulus situation. Berkowitz stated that aggressive behavior is directly linked to negative affect. However, cognitions can go into operation and causal attributions about unpleasant experiences may enrich, differentiate, intensify, or suppress the feelings and further actions. For instance, Berkowitz stated that “people are more strongly instigated to attack their frustrater when they think they have been deliberately and wrongly kept from reaching their goal than when they believe the interference has only been accidental” (p. 70). Betancourt and Blair (1992) proposed a mediating role of attribution processes as an antecedent of aggression, where anger, in part, is “…a function of the cognitive processes that take place when an instigating action occurs in a conflict situation. It is possible that situational factors do directly influence anger and this effect is at least in part cognition (attribution) mediated” (p. 344). The appraisal of a situation as a threat and attributions of malevolence “are more likely when individuals have a hostile ‘working model’ of their social world” (Blackburn, 1998 p. 51). In a revision of cognitive and behavioral theories of anger, Kennedy (1992) focused attention on Bandura’s social learning theory of aggression where “any emotional arousal would increase the probability of aggression when the context was predisposed to aggression” (p.147), and on Beck’s hypothesis in which aggressive behavior is conceptualized in terms of provocation and the appraisal of threat, and the strength of the angry response is determined by attributional styles, self-esteem, value judgments, and expectations (Kennedy).

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Attributions of Hostile Intent Dodge (1980), Dodge and Newman (1981), and Dodge and Frame (1982) consider that attributional factors and aggressive behavior are associated in the formation of the social-information processing model. Moreover, Dodge and Frame assessed social cognitive biases and deficits among a sample of aggressive boys. The authors followed Berkowitz’s hypothesis stating that a frustrating social stimulus is a cue for an aggressive response if the child attributes hostile intent to the stimulus person (Dodge and Frame p. 620). The authors found that following an ambiguous provocation by a peer, aggressive boys were more likely than nonaggressive boys to attribute the provocation to the hostile, rather than accidental, behavior of the peer. Consistent with Dodge (1980), Dodge and Frame found that differences in retaliatory aggression among aggressive and nonaggressive boys were a function of differences in attributions of hostile intent between both groups. In consequence, aggressive behavior among the sample of aggressive boys was directly linked to systematic biases in the attributions that these boys made about their peer’s intentions.

Attributions of Provocative Intent Laboratory studies conducted by different authors such as Betancourt and Blair (1992), Epstein and Taylor (1967), and others reported that the belief that another person’s actions are intended to be provocative could result in both anger and aggression. Based on these previous findings, Chermack, Berman, and Taylor (1997) studied the effects of provocation on emotions and aggression during an aggressive

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encounter in a college sample. The aggressive encounter was a competitive reaction time (RT) paradigm. According to the authors, the competitive RT task provided a context “in which the aggressive intent of both the participant and the opponent is clearly communicated by delivery of various levels of electric shock” (p. 2). The RT task was a measure of physical aggression and “aggression was defined as the magnitude of shock participants were willing to administer to their adversary” (p. 2). Research condition had two groups: low constant provocation (LP) and increasing provocation (IP). Participants were informed that they were competing in an RT task with another person that was in a nearby room. At the beginning of each trial, they were told that “they would select the intensity of shock they wished their opponent to receive” (p. 2) and that they would see the shock intensity that the opponent had set for them. Positive and negative emotions were assessed at four times during the experiment as well as at a baseline. Chermack, Berman, and Taylor (1997) results were consistent with Yates, Barbaree, and Marshall’s (1984) findings, explained previously in the section on anger (p. 23). Particularly, provocation had a significant impact on the participant’s aggressive behavior and emotions. Increases in provocation were associated with increases of aggression and negative emotions. The participants in the IP condition set significantly higher shocks as provocation increased, and were more aggressive than participants competing with an opponent exhibiting low levels of shock. With regard to negative emotions, participants in the IP condition had higher ratings of harm emotions (anger, sadness, disappointment, guilt, and disgust) after receiving substantial increases in provocation. None of the positive or negative emotions

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directly influenced aggressive responses or intervened in the relationship between provocation and aggression. From these results, Chermack, Berman, and Taylor (1997) suggested that factors other than emotions might be taken into account as one of the primary determinants of aggression: “…a perceived intentionality and controllability of incitive acts, norms of reciprocity or motivational states (intention to harm), may play a more central role in accounting for the relationship between provocation and aggression” (p. 8).

Internal and External Attributions Heider (1958), who is cited in most attribution bibliography for being the first who produced a systematic analysis of attributions, differentiated between external and internal causes. He stated “…the result of an action is felt to depend on two sets of conditions, namely factors within the person and factors within the environment” (p. 82). Furthermore, there is a likelihood of attributing one’s own undesirable behavior to external factors such as sociological problems or victim’s provocation (West, Gunn, and Chernicky, 1975) than to internal factors. Loza and Clements (1991) clarify that external attribution occurs when the explanation of the behavior is focused on outside social and environmental factors, whereas an internal attribution involves the allocation of blame to the actor’s personality traits.

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Causal Attributions Using Heider’s (1958) theory as a guideline, attribution research identified the causal attributions of the subjects and translated them into causal dimensions (Russell, 1982). For instance, Weiner (1986) classified three causal dimensions: Locus (causes are perceived on an internal-external continuum), Stability (causal factors are perceived as stable-unstable), and Controllability (causal factors perceived as controllable or uncontrollable). Causal attributions have been studied in relation to general criminal blame (Gejdenson, 1984; Gudjonsson & Singh, 1988; Gudjonsson & Peterson, 1991). Causal attributions have also been studied among sexual offenders. Blumenthal, Gudjonsson, and Burns (1999) reported that sexual offenders against adults were more like violent offenders in their attributional style, endorsing more external attributions than sex offenders against children who endorsed more guilt feelings (internal attributions). Similar findings were reported by Loza and Clements (1991) where sexual offenders against adults attributed blame on the victim and those sex offenders who used alcohol blamed their sexual offending behavior on alcohol. Garlick, Marshall, and Thornton (1996) analyzed intimacy deficits and attribution of blame in a sample composed of sexual offenders against adults and children. The authors reported significant differences in attribution style between both groups. Sex offenders against adults endorsed external attributions and sex offenders against children endorsed internal attributions for their intimacy problems. Inconsistent with these findings, Gudjonsson (1990) reported significant correlation between cognitive distortions of sexual offenders against children regarding their

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sexual behavior and external attributions of blame, indicating that this group blamed their aggressive sexual behavior on the victim or social circumstances. McKay, Chapman, and Long (1996) analyzed causal attributions of males convicted of child sex offenses. These attributions were compared with attributions obtained on adult sex offenders, property offenders, and violent offenders. Findings suggested that sex offenders against children attributed their criminal offending behavior to internal, stable, and uncontrollable causes, and those who offended against adults attributed their offending behavior to external, stable, and uncontrollable causes.

Personal Characteristics and Attributions Studies of Gudjonsson (1984) and Dolan (1995) reported a link between attribution of blame and personality characteristics associated with criminal behavior. Moreover, Gudjonsson found a significant relationship between personality and attribution processes among offenders for their criminal activities. In Gudjonsson’s study, external attributions significantly correlated with the psychotism factor of the Eynsenck Personality Questionnnaire (EPQ). Serin (1991) found attributional differences among individuals diagnosed with psychopathy and those diagnosed as nonpsychopaths in a general forensic population. Specifically, the group diagnosed with psychopathy attributed more hostile intent to neutral situations presented than the second group. Consistent with Serin (1991), Loza and Loza-Fanous (1999) found that the offender’s attributions of blame and cognitive style interact with the situation in

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facilitating the aggressive behavior. The authors stated that antisocial feelings, antisocial beliefs, and antisocial attitudes might be counted as significant factors to be considered in the treatment of rape and violence instead of centering on the anger emotion itself. In summary, studies associate the attributional style of an individual to aggressive behavior. Findings report that attributions of blame and attributions of hostile intent are linked to aggressive behavior in forensic populations. Furthermore, external attributions in the form of blame and hostile intent have been found to be used as explanations for criminal (nonsexual and sexual) behavior. In addition, the belief that another person’s actions are intentionally provocative can result in anger and aggression in laboratory settings using groups of college students. Research in perceived causality for criminal acts provides some understanding of motivational causes for criminal behavior. Consistent findings of external attributions for aggressive behavior might explain a motivational factor for future aggressive behavior.

The Present Study Rationale A review of described studies show evidence that psychopathy is highly associated with criminal behavior and violence among forensic populations (Hare & Hart, 1981; Hare & McPherson, 1984). Specifically, individuals who were diagnosed as having psychopathy are at higher risk to engage in more violent crimes and other

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forms of aggressive behavior than those who do not have a diagnosis of psychopathy (Forth et al., 1990; Hare et al., 1992; Harris, Rice, & Cormier, 1991). The PCL-R scores are the single best predictor of violence and aggression (Hare & Hart, 1981; Serin, 1996; 1991), and according to Serin (1996), psychopathy makes a unique contribution in predicting aggressive/violent behavior in forensic populations. For instance, among sexual offenders, the construct psychopathy is a clinically significant component in understanding and predicting sexual violence (Boer et al. 1997; Marshall & Barbaree, 1984). Consequently, psychopathy seems to be a reliable construct for studying sexual aggressive behavior because it accounts for the emotional, relational, and behavioral problems encountered among individuals who display sexually aggressive behavior. There is empirical evidence that sexual offenders are high in psychopathic characteristics when measured with the PCL-R (Hare & Hart, 1981), although the prevalence of psychopathy differs among various types of sexual offenders (Hare, Clark, Grann, & Thornton, 2000). In general, child molesters present lower scores and lower incidence in psychopathy, when compared to rapists or mixed groups (offenders against children and adults) (Hare, Clark, Grann, & Thornton, 2000; Porter et al., 2000; Soto & Barbaree, 1999; Rice, Harris, & Quinsey, 1990), albeit, some studies report higher degree of psychopathy among child molesters (Dorr, 1998). However, in general, most research evidence is presented for rapists when compared to child molesters (Porter et al.; Prentky, Knight, Lee, & Cerce, 1995). It was also found that higher scores of psychopathy are related to other extensive criminal behavior across all sexual offenders (both against children and adults).

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Several studies reported that the offenses of sexual offenders who received diagnosis of psychopathy tend to be more violent or sadistic than are offenses of nonpsychopathic sexual offenders (Hare, Clark, Grann, & Thronton, 2000; Hare & Hart, 1981; Stone, 1998) although other studies have failed to show a relationship between psychopathy and degree of harm inflicted on their victims (Brown & Forth, 1997; Williamson, Hare, & Won, 1982). Various authors suggested that different factors such as emotions and cognitions might interact to determine the likelihood of sexual aggressive behavior (Hall & Hirschman, 1991; Serin 1991). There is evidence that affective dyscontrol such as anger and depression might contribute to sexual offenses (Mauro & Hall, 1986; Long, Wuesthoff & Pithers, 1989; Marlatt, 1989; Hall, 1996). There is also evidence that violent behavior might be associated with external attributions in the form of provocation attributions (Betancour & Blair, 1992) and attributions of hostile intent (Dodge & Frame, 1982; Loza & Loza-Fanous, 1999; Serin, 1991). Accordingly, the study of affective states and cognitive attributions could contribute to the understanding of sexual aggressive behavior, in addition to the psychopathy construct. Studies aimed to specifically assess causal attributions for their sexual aggressive behavior in sexual offenders is extremely scarce and report mixed findings. For instance, studies of Blumental, Gudjonsson, and Burns (1999); Loza and Clements (1991); and McKay, Chapman, and Long (1996), revealed that offenders against children reported internal causes as explanations of their sexual offenses, whereas external causes were explanations of sexual offenses in offenders against

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adults. However, Gudjonsson (1990) found external causes as explanations of their sexual offenses in child molesters. Studies aimed to investigate causal attributions, psychopathy, and negative emotions of anger and/or depression as components in severity of sexual aggression toward the victim are nonexistent. Based on the literature review, it is proposed that psychopathy, anger and/or depression, and style of causal attributions may be related to displayed severity of sexual aggression. In this study, three questions will be investigated: 1) Is the variable psychopathy related to severity of past sexual aggression? If it is to a significant degree, then questions 2 and 3 are relevant and should be addressed. 2) In the group of offenders against adults, could psychopathy, anger, and locus causal attributions predict severity of sexual aggression? 3) In the group of offenders against children, could psychopathy, anger or depression, and locus causal attributions predict severity of sexual aggression? Given the aforementioned research questions, the purpose of this study is to (A) determine if psychopathy is related to severity of past sexual aggression and (B) determine if psychopathy, negative emotions (anger and/or depression), and locus causal attributions contribute to severity of sexual aggression, therefore forming a predictor model of severity of sexual aggression.

Working Hypotheses 1) There is a relationship between severity of sexual aggression and psychopathic features in both groups: sexual offenders against children and sexual

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offenders against adults, therefore, psychopathy will predict severity of past sexual aggression. 2) In the group of sexual offenders against adults, anger and locus causal attributions would be predictors of severity of sexual aggression after accounting for psychopathy. 3) In the group of sexual offenders against children, anger and/or depression, and locus causal attributions would be predictors of severity of sexual aggression after accounting for psychopathy. Psychopathy in this study is measured as the general score in the PCL-R (Hare, 1991). Anger is defined as scores in the NASPI (Novaco, 1994). Depression, as scores of the BDI-II (Beck, Steer, & Brown, 1996), Locus Causal Attributions are defined as scores in the OQ (McKay, Chapman, & Long, 1996), and Severity of Aggression is defined as scores in SASI (Nezu, et al., 1997). The group composed of sexual offenders against adults in this study, consists of offenders who had at least a sexual charge against a 14-year old person or older. The offending behavior includes offenses such as: rape, sodomy, and sexual battery (Campbell, 1996; Chantry & Craig, 1994). The group composed of sexual offenders against children in this study, consists of offenders who had at least a sexual charge against a 13-year old person or younger. The offending behavior includes offenses such as: sexual exploitation and sexual acts with or without physical contact (Campbell).

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This is a retrospective assessment design and the variables for the hypotheses are: Predictor Variables (IV): psychopathy; anger and/or depression, locus causal attributions. Criterion Variable (DV): severity of sexual aggression.

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Chapter 3: Method Participants The sample for the present study consisted of 80 male individuals with a history of conviction of adult (victim 14 years or older) sexual offenses or child (victim 13 years or younger) sexual offenses. All participants were at least 20 years old and capable of providing informed consent. Subjects were court mandated and enrolled at two partial treatment units of sexual offender programs in the North Eastern United States, after having completed their sentences for a sexual offense(s). The sample was divided into two groups: rapists and child molesters. Those individuals whose sexual offenses were committed against victims 14 years old or older were classified as “Rapists” and those individuals whose sexual offenses were committed against victims 13 years old or younger were classified as Molesters. The cutoff for the victim’s age in order to classify subjects as Rapists or Molesters was decided following other studies as a guideline, such as Rice, Quinsey, and Harris (1991); Marshall, Barbaree, and Eccles (1991); Rice, Harris, and Quinsey (1990); Quinsey, Rice, and Harris (1995); and the DSM IV criteria of Pedophilia which refers to sexual activities with children generally age 13 years or younger (DSM IV). Nevertheless, literature review does not show a consistency on a specific cutoff for the victim’s age across the studies. For instance, Prentky, Lee, Knight, and Cerce (1997) defined rapist those individuals who have offended a person 16 years or older; while Berger, Berner, Bolterauer, Gutierrez, and Berger (1999) classified molesters as those individuals whose sexual offenses were on victims up to 14 years old. Still, most studies follow the victim’s age cutoff as defined in this study.

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Forty-two males were perpetrators against adults (Rapists) and 38 males were perpetrators against children (Molesters). The number of participants who completed the study is less than the 120 participants originally proposed. Attempts were made to complete the original proposed sample size, however, the moderate-to-low response rate of sexual offender individuals to participate in the study was the reason for the diminished sample size. Participants were informed that the participation in this study was voluntary and they could withdraw at any time. Moreover, prospective participants were informed that their participation or refusal to participate would not have an impact on their legal or treatment status. All participants were native English speakers or fluent in the English language. Those who met the following criteria were asked to participate.

Inclusion Criteria Eligibility for participation in this study included: A) Participant had to be a male who had been charged with one or more sexual offenses during the last 15 years. B) Participant had to be between the ages of 20 and 50 years old. C) Participant had to have a history of one or more sexual offense(s) against a child (13 years or older) or against an adult (14 years or older), defined as having been incarcerated or adjudicated for sex-offending behavior that resulted in imprisonment. D) Participant had to have committed the above offense(s) at least at the age of 18.

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Exclusion Criteria Exclusion criteria for participation in this study included: A) Presence of a current or previous history of psychotic symptoms B) The participant’s estimated intellectual functioning is below an IQ score of 70.

Materials In the original proposal eight measures were to be utilized in this study. Screening measures (WAIS-R, Block design and Vocabulary Scales, Structured Clinical Interview for DSM-IV, Axis I Disorder, Module B; and Demographic Information Form); measures of predictor variables (Hare Psychopathy Checklist: PCL, Novaco Anger Scale and Provocation Inventory: NASPI, Beck Depression Inventory: BDI-II-, Offence Questionnaire: OQ); dependent variable measure (Sexual Aggression Severity Inventory: SASI). In this study the predictor and criterion variables were treated as in a continuum given that any degree of sexual aggression reveals a deviant behavior that acts against the well being of a victim. Any degree of manifestation of the predictor variables is also relevant in order to understand the outcome. Therefore, for the purpose of this study, the entire set of all predictor variable scores were used to investigate the relationship between these scores and severity of sexual aggression.

Screening Measures: Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) Vocabulary and Block Design subtests. The WAIS-R subtests were originally

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proposed to ensure that participants were functioning at a cognitive level that they would understand the administered measures, thus, to exclude from the study volunteers with estimated scores below 70. The cutoff of 70 was chosen based on the DSM-IV criteria of Mental Retardation (IQ of 50-55 to approximately 70). The Vocabulary and Block Design subtests are a short form of the WAIS-R and correlate .90 with the Full Scale IQ score (Sattler, 1992) and overestimates Full Scale IQ by only 3 points. The WAIS-R Block Design and Vocabulary Scales were administered if the individuals have not been previously screened through their programs. Otherwise, scores were gathered through record review. Scores were relevant for demographic purposes. Structured Clinical Interview for DSM-IV Axis I Disorders, Module B: Psychotic and Associated Symptoms (SCID-I; First, Spitzer, Gibbon, & Williams, 1997). Given that participants for this study were recruited from a program rather than from the parole office, the mechanism for recruitment of participants precluded excluding any participant based on the screening measures. Therapists who were in charge of presenting the study and recruiting the participants, closely followed the exclusion criteria based on their knowledge of the background of each participant. Therefore, the Structured Clinical Interview for DSM-IV Axis I Disorders, Module B was not administered since it was unnecessary for exclusion criteria reasons. The SCID, Module B is a semistructured interview and was originally proposed for rating the lifetime occurrence of psychotic symptoms (i.e., delusions, hallucinations, disorganized speech and behavior, and negative symptoms). Since research links these symptoms with violent behavior, these symptoms may covariate

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with the variables of interest. The present study was designed to exclude individuals with a history of psychotic symptoms.

Demographic Information Form. The demographic information form provided relevant participants data regarding variables that may serve as potential covariates in addition to gathering information about the demographic characteristics of the sample. The following items are the variables used: age, race, marital status, current psychiatric diagnosis, highest level of education completed, age at the time of sexual index offense(s), age and gender of the victim(s), relationship to the victim(s), number of accused sexual assault victims (victims reported in court), number of victims reported in treatment, number of years sentenced to serve for current offense (index offense), history of victimization, history of drug/alcohol abuse/use, number of nonsexual offenses, juvenile delinquency, and treatment history. The demographic form was developed following the study of Hanson and Bussiere (1998) study on predictor variables of sexual aggression. The information was gathered through a review of records.

Measures of Predictor Variables: The Hare Psychopathy Check List Revised (PCL-R; Hare 1991).The PCL-R is a 20-item rating scale designed to assess psychopathic personality disorder in forensic populations. Individuals are assigned ratings from 0 (absent), 1 (some indication), or 2 (present) on each of the 20 items. Scale scores are obtained by adding the items. The total score ranges from 0 to 40 and the conventional cutoff for psychopathy as a

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diagnosis is 30; however, there is not a sharp dividing line (Hare, 2003). The PCL-R generates a total score and two factors scores that are consistent and stable across a variety of samples (Hare, 1991). Factor 1 is a measure of self-centered and exploitive use of others (interpersonal/affective domain) and Factor 2 measures an irresponsible and antisocial lifestyle (social deviance). The PCL-R has demonstrated reliability, and concurrent, predictive, and construct validity. This measure was used in this study to determine if psychopathic features are associated with severity of sexual aggression. The PLC-R score was taken directly from the records when it was available; otherwise, the PCL-R score was generated through a review of records, using previous studies as a guideline (Harris, Rice, & Quinsey, 1994). It was originally proposed to administer the PCL-R 2nd Edition to each subject; however, per IRB request, the PCL score should be taken directly from the file every time when it was there or being generated through a review of records. Given these restrictions, it was not possible to use the PCL-R 2nd Edition form (latest PCL version) due that the records contained the PCL-R score. The PCL-R 2nd Edition retains the two-factor model although each factor is divided into two facets (Factor 1 is divided into the interpersonal facet and affective facet. Factor 2 contains the lifestyle facet and antisocial facet). These four facets would allow a narrow investigation of the psychopathic components that may have an effect on sexual aggression. The researcher was trained in the use of the PCL-R following Hare (1991) guidelines and was experienced in using this measure. In general, research aimed to study the construct of psychopathy selects a cutoff score to divide the groups of study

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as psychopaths and nonpsychopaths. The purpose of this study is not to divide groups based on a diagnosis of psychopathy but to use the entire set of scores to investigate the relationship between these scores and severity of sexual aggression. In this manner, this study treats the construct psychopathy as a continuum variable (Rutherford, Cacciola, Altermann & McKay, 1996), rather than a categorical/dichotomous variable (Hare, 2003).

Novaco Anger Scale and Provocation Inventory (NASPI; Novaco, 1994). The NASPI is a self-report questionnaire composed of the Anger Scale (NAS), a 60-item rating scale, and the Provocation Inventory (PI), a 25-item rating scale. The NAS comprises a total score of anger disposition and contains four anger subscales: cognitive, behavior, arousal, and anger regulation. The anger regulation subscale does not contribute to the total anger score and gives information about individual’s mechanisms to regulate the experience of anger. The PI is also a measure of anger disposition, assessing self-reported anger intensity in response to a range of provoking situations and covers five kinds of provocations: disrespectful treatment, unfairness, frustration, annoying traits of others, and irritations. The NASPI total T scores range from 70 = very high. The NASPI has demonstrated internal and test-retest reliability of .95 and .84 respectively (Novaco, 1994).The NASPI has been validated with incarcerated and paroled sex offenders.

Beck Depression Inventory-Second Edition (BDI-II; Beck, Steer, & Brown, 1996). The BDI-II is a 21-item self-report for measuring the severity of depression.

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The BDI-II has demonstrated content and construct validity. Total scores of 0-13 are in the range of minimal depression, scores of 14-19 indicate mild depression, scores of 20-28 indicate moderate depression, and scores of 29-63 indicate severe depression. The BDI-II is one of the most used self-report measures of depressive symptoms and therefore, it was used in this study to assess these symptoms.

The Offence Questionnaire (OQ; Mc Kay, Chapman, & Long, 1996). The OQ was developed to be used with sexual offender population, based on Weiner’s (1986) attribution theory and the Causal Dimension Scale (CDS; Russell, 1982). The CDS assesses the respondent’s perceptions of causes in a particular situation (Russell). The factor analyses of the CDS confirmed the three-factor structure of the scale (locus, control, stability). The three subscales demonstrated internal consistency and construct validity. The CDS measures each dimension on a nine-point Likert scale with a total score from a possible 3 (external, unstable, uncontrollable) to a possible 27 (internal, stable, controllable). The CDS was validated in assessing causal dimensions in achievement settings. Based on the CDS, the OQ retains the three attributional dimensions (locus, control, stability) and the total number of items. The OQ is a 9-item report questionnaire with three attributional dimensions: locus, stability, and controllability. There are three items for each dimension. Each dimension is measured on a five-point Likert scale and ranges from a possible 3 (external, unstable, uncontrollable) to a possible 15 (internal, stable, controllable) (McKay, Chapman, & Long, 1996). The OQ is designed to specifically assess how the sexual aggressor perceives the causal

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attributions of his sexual offense. The first part is an open-ended question and asks for the participant’s cause/causes of his sexual offense. This question is not used in scoring but serves as a guide for completing the second part of the OQ. In the second part, participants rate the primary cause they had indicated in the open-ended section for their offending behavior on each of the attributional dimensions (McKay, et al.). Prior to using the OQ for research purposes with sexual offenders, the authors conducted a pilot study with sexual offender inmates. They modified the word style to an extent in order to ensure that the offender population understands the items (McKay, et al.). The final product is a user-friendly measure that is easily understood by individuals functioning in a low average range of intelligence. In this study, per IRB restrictions, the participants were asked to think about the response to the first open-ended question rather than writing it, and with the response still in their minds, they had to answer the items.

Dependent Variable Measure: The Sexual Aggression Severity Inventory (SASI; Nezu, et al., 1997). The SASI is a 7-item self-report scale, assessing the level of sexual aggression exhibited by a subject. Scores range from 1 to 7. One indicates sexual acts involving non-physical contact with the victim, 2 = sexual acts in which there is non-physical contact with the victim that involves threat of harm and /or contact, 3 = acts of a sexual nature involving non-penetrative physical contact and/or verbal coercion, 4= forcing/coercing a victim to perform or receive oral sex, 5 = physical sexual acts involving penetration with the victim, 6 = physical sexual acts involving penetration

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and force, 7 = sexually sadistic acts involving serious physical pain and injury to the victim while forcibly engaged in a sexual activity. This measure was completed with information obtained from the records, such as offense history, frequency, and severity. The SASI was chosen as an alternative to the Offense Severity Rating (Quinsey & Chaplin, 1982) which is used in studies about the severity of the victim’s harm because the items in the SASI reveal a wider spectrum of sexually offending behaviors.

Procedure The study required two individual sessions with the volunteer and review of records. Recruitment of participants occurred directly from two sexual offender programs where participants assisted after completing their sentences, instead of being recruited through the parole office, as originally proposed. This change was due to restrictions in recruiting participants from the office of parole. The following announcement mechanisms were used: (1) Flyers announcing the study and requesting volunteers was available in the public area. (2) Therapists of the programs announced the study and recruited volunteers, following the inclusion/exclusion criteria. After the list of volunteers was generated, the sessions for the study were scheduled. No coaxing or coercion was employed regarding an individual’s choice to participate.

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First Session: Informed Consent: Before participation in the study, individuals who elected to participate signed an informed consent prior to starting the study and after all questions were answered. The study was described in detail by the researcher, including the anticipated risks and benefits, length of participation, and confidentiality issues. Subjects were informed that the decision to participate in this study was entirely voluntary. As such, participation in the study could be withdrawn at any time, with no consequences to the individual regarding any ongoing treatment, court disposition, or any future decision about his status. Participants were informed that the questionnaires used in this study did not include specific questions about reported/nonreported or prosecuted/nonprosecuted offense(s). As such, they were requested to limit themselves to respond to only the questionnaires given. They were informed that they were not requested to provide information that could place them at risk or jeopardize their legal status. They were informed that their honest answers to the questionnaires did not at all affect their current or future legal status, or any future decision about any treatment that they were undergoing, or decisions (legal or not legal) about their case. Participants were informed that the consent form covered participation in the research and review of records. Participants were informed that their answers to the questionnaires were confidential (only researchers have access to this information), kept in a locked cabinet, and used exclusively for the purposes of this study. Their names or any other identification such as their State Bureau Identification Number, location of the program, etc., was going to be kept confidential. Participants were

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informed that if during the course of their participation in this study they spontaneously disclosed any nonprosecuted offense to the researcher, they agreed to have this information disclosed and that it may result in possible new legal charges. Individuals, who volunteered and agreed to participate in the study, signed the consent form. Following participant consent, each participant was administered the WAIS-R- Vocabulary and Block Design if this score was not in the subject’s chart. Otherwise, it was directly taken from the chart. Originally it was proposed that the results of this first (screening) session would determine if the participant was eligible to further participate in this study; however, given that therapists presented the study to those who already met the inclusion criteria, this step was unnecessary. The results were used only for demographic purposes.

Second Session: During this session, the following three questionnaires were administered: (1) NASPI, (2) BDI-II, and (3) OQ. These three measures were completed twice during this session. Firstly, participants were asked to fill out the three self-report questionnaires to the best of their ability, with regard to how they were currently feeling and thinking [Now variable].

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Secondly, participants were asked to complete the same three questionnaires as to how they were feeling and thinking at the time of the offense (or the last offense for which they were in the program) [Then variable: used for analyses of hypothesis]. Given that this study includes retrospective assessment which is subject to inaccuracy for drawing valid inferences (Kadzin, 1980), we collected two sets of scores (Now and Then) for each self-report measure, with the purpose of having control against factors that might be contemporary (that may have appeared after the outcome of interest). For the purpose of the main analyses, only Then scores were used.

Debriefing: Upon completion of all the measures, and after finishing the second session, the participants were given the opportunity to discuss any concern. Participants were asked if they had experienced any untoward effects to the questionnaires. Although reports of such experiences did not occur, it was originally planned that in the case of any extreme distress, the researcher would discuss with the participant the alternative of contacting his therapist to obtain further help.

Remuneration: Participants received $40.00 that was deposited in their program’s account, according to a prior stipulated agreement.

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Chapter 4: Results Data Screening Prior to conducting the statistical analyses, the data set was reviewed for accuracy of data entry. Relevant data was screened for the presence of outliers, influential data points, and compliance with the assumptions of multivariate analyses. Examination of the data revealed that the means, standard deviations, and ranges for each of the variables were plausible. Basic assumptions for multivariate analyses were tested (1: multivariate normality, 2: homoscedasticity, 3: linearity, 4: and multicollinearity). The presence of univariate outliers was explored by examination of histograms. Skewness and Kurtosis were calculated to examine the normality of each variable to the analyses. Examination variables indicated that all study variables approximate a normal distribution. All data was analyzed in SPSS 11.0 software package. Missing data was minimal and pertained to demographic information. Demographic information was completed through review of available records and it was not surprising that some items were missing in charts or the information provided in the chart was not clear enough to allow appropriate codification. With regard to intra-measure missing data, no participant missed questions. Arrangements were made and the examiner did observe all data being completed independently.

Sample Characteristics Eighty male participants were selected for this study. Those individuals whose sexual offenses were on victims 14 years or older were classified as Rapists

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(n = 42; 52.5 %), and those individuals whose sexual offenses were on victims 13 years or younger were classified as Molesters (n = 38; 47.5 %).

Descriptive Results Preliminary Analyses Demographic characteristics of the two groups are summarized in Table 1. Various relevant demographic characteristics (age at time of data collected, age at index offense(s), race, years of education, estimated IQ, average number of sex offenses) were compared in both groups. The samples from both programs were not significantly different based on the demographic information examined. The next set of analyses compared samples of Rapist and Molesters on the variables of interest: severity of sexual aggression (SASI), psychopathy (PCL-R), anger (NASPI, Now and Then), depression (BDI, Now and Then), and causal attributions dimensions (Locus, Control, Stability at Then). Descriptive values for the measures utilized in the present study are displayed in Table 3.

Severity of sexual aggression: The Sexual Severity Index (SASI) was employed to assess the level of severity of sexual aggression in Rapists and Molesters. The possible range for scores is 1 (least severity of sexual aggression) to 7 (maximum severity of sexual aggression). An independent samples t-test was conducted to determine if Rapists and Molesters differ on severity of sexual aggression. Levene’s test for equality of variances was not significant for severity of sexual aggression, suggesting equal variances for both groups. The test suggests there

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was not a significant difference on severity of sexual aggression for the two groups, t (78) = .61, ns.

Psychopathy: The Hare Psychopathy Checklist-Revised (PCL-R) was used to measure psychopathic characteristics in Rapists and Molesters. The total score ranges from 0 (least psychopathic characteristics) to 40 (highest psychopathic characteristics) with a conventional cutoff of 30 for a diagnosis of psychopathy. An independent samples t-test was conducted to determine if Rapists and Molesters differed on psychopathy. Levene’s test for equality of variances was not significant for psychopathy, suggesting equal variances for both groups. The test revealed a significant difference for the two groups, t (78) = 2.58, p < .05. The Molesters scored significantly higher on psychopathy than the Rapists. This finding seems to be incongruent with most studies reporting higher scores in psychopathy in Rapists (Hare and Hart, 1981; Seto and Barbaree, 1999), although other studies found high scores on the psychopathic Deviate Scale of the Minnesota Multiphasic Personality Inventory (MMPI), (Dorr, 1998). In addition, Firestone et al. (1998) and Dorr (1998) observed several psychopathic characteristics listed in the PCL-R, Factor 1 among pedophiles. It was thought that findings revealing higher scores in the Molesters group in this current study would be related to the internal characteristics of the sample. Furthermore, a close review of scores revealed that a subgroup of subjects in the Molester group (n = 14; descriptive characteristics are summarized in Table 2) had a diagnosis of pedophilia (several of them) and were identified for special treatment because of their past resistance to treatment and lack of treatment

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improvement. Consistent with the literature, higher psychopathic characteristics correlate with resistance to treatment. When mean scores of both groups (Rapists and Molesters) were compared after removing the subset of scores of those subjects who were in the “more resistant to treatment” group (n = 14), the mean scores did not reach significant differences, t (64) = .36, p .85. The test suggests there was not a significant difference on psychopathy for the two groups, once the subset of scores was removed. Further analysis on Factors 1 and 2 revealed that Molesters scored significantly higher on Factor 2 than Rapists, t (78) = 4.93, p. < .01. This is surprising given that research findings are consistent in reporting higher Factor 2 scores on Rapists when compared with Molesters. When mean scores of both groups (Rapists and Molesters) were compared without the subset of scores from subjects who were in the more resistant to treatment subgroup (n=14), the mean scores did not reach significant differences, t (64) = .37, p .71, indicating that in this study sample, Molesters did not significantly differ in their Factor 2 score when both groups were compared without the Molesters subgroup. In summary, results revealed specific internal characteristics of this sample. When the subgroup of Molesters is removed from the analysis, the individuals in the Rapists and Molesters did not differ in their antisocial activities. Nevertheless, the present findings suggest that in this sample there is a subgroup of Molesters who expressed behaviors that are antisocial, indicating that committing sexual offenses against 13-year old children or younger children does not preclude the possibility of

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having a background of antisocial behaviors as this unique sample of Molesters has demonstrated.

Anger: Anger was measured with the Novaco Anger Inventory and Provocation Inventory (NASPI). The possible range for NASPI t scores is ≤ 29 (very low) to ≥ 70 (very high) anger. A 2-way repeated measure ANOVA was conducted to determine if there were differences on anger by Group (Molesters vs. Rapists) and Time (Now vs. Then). Anger was the dependent variable, Group was the between-subjects variable, and Time was the within-subjects variable. Levene’s test for equality of variances was not significant for Depression, suggesting equal error variances. The ANOVA for anger revealed a within-subjects difference, F (1, 78) = 61.45 p < .01. Participants scored significantly higher on the Then anger variable than on the Now anger variable. The main effect for the between-subjects Group variable was not significant, F (1, 78) = 2.06 p >. 05. This suggests that there were no significant differences on anger scores by Group. The interaction term Time x Group also failed to reach significance, F (1, 78) = .19, p > .05. In general, NASPI Then scores in this sample are in the range of high average to very high which is lower than scores obtained among paroled sex offenders in the standardization sample.

Depression: Depression was assessed with the Beck Depression Inventory (BDI-II). The total scores range from 0 (minimal depression) to 63 (severe depression). A 2-way repeated measures ANOVA was conducted to determine if there were differences on depression by Group (Molesters vs. Rapists) and Time

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(Now vs. Then). Depression was the dependent variable, Group was the betweensubjects variable, and Time was the within-subjects variable. Levene’s test for equality of variances was not significant for depression, suggesting equal error variances. The ANOVA for depression revealed a within-subjects difference on Time F (1, 78) = 24.2, p < .01. Participants scored significantly higher on the Then depression variable than on the Now depression variable. The main effect for the between subjects variable was not significant, F (1, 78) = .81, p > .05. This suggests that there were no significant differences on depression scores by Group. The interaction term Time x Group failed to reach significance, F (1, 78) = .56, p > .05. Summarizing, Rapists and Molesters reported significantly higher levels of negative emotions (anger and depression) at the time of committing their index offense(s), in the self-report retrospective measures. Results indicated that Then scores on the variables of interest were significantly higher than Now scores, suggesting that the subjects would be able to recall their emotions back in time, although this practice does not preclude bias, which can not be controlled by the design of the present study.

Causal Attributions: The Offender Questionnaire was used to assess the attributional dimensions: locus, control, and stability. Scores on each dimension scale range from 3 (external, unstable, uncontrollable) to a possible 15 (internal, stable, controllable). Higher scores would indicate a more effective causal attribution. The independent samples t-test on Control Then attributions revealed a significant difference for the two groups, t (78) = 2.85, p < .01. Rapists scored significantly

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higher on past control attributions than Molesters, indicating that they attributed their sexual offense to more controllable causes than Molesters. The independent samples t-tests on Locus Then [t (78) = .97, p > .05] and Stability Then [t (78) = .97, p > .05] were not significant. Both group means suggest that they attributed their sexual offending behavior to a combination of internal-external and stable-unstable causes. In the study of Mc Kay, Chapman, and Long (1996), using the same OQ measure, rapists attributed their sex offending behavior to more external, unstable, and controllable causes, and molesters to internal, stable, and uncontrollable causes.

Comparisons of Molester subgroup (n = 14) with the overall rest of the sample: Molesters and Rapists (n = 66) The subgroup of molesters (n = 14) who were the most resistant to treatment improvement was more closely examined to determine if this group was a special distinguish group from the entire rest of the sample (n = 66). Both groups were compared on various relevant demographic characteristics (age at index offense(s), race, years of education, estimated IQ, average number of sex offenses). Demographic characteristics of the subgroup n = 14 is summarized in Table 2. Both groups were not significantly different on the demographic information examined. The next set of analyses compared both groups (n = 14, and n = 66) on the variables of interest: severity of sexual aggression (SASI), psychopathy (PCL-R), anger (NASPI, Then), depression (BDI, Then), and causal attributions dimensions (OQ Locus, Then). Descriptive values for the measures in the subgroup n = 14 is displayed in Table 3 [values in brakes]. Independent t-tests were conducted to

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determine if both groups were different on the variables of the interest. The n = 14 subgroup scored significantly higher on psychopathy, t (78) = 5.30, p