Are Dangerous Offenders Different From Other Offenders? A Clinical Profile

Abstract

The Canadian dangerous offender (DO) statute requires the assistance of psychiatrists and psychologists in evaluating offenders’ potential danger and risk of future offenses, without substantive supporting empirical clinical research on the topic. The present study compared 62 men facing Canadian DO applications to 2,414 non-DO sexual and violent offenders (ACs) and 62 non-DO offenders matched on offense type (MCs). DOs differed significantly from ACs on 30 of 45 variables and from MCs only on 6. More DOs than MCs had an extensive criminal history, were psychopaths, and had more school truancy. Compared with ACs, DOs had less education and more school adjustment problems, more disturbed childhoods, and more often were diagnosed with sadism, psychopathy, and substance abuse problems. Total sexual and violent offense convictions provided the best but weak distinction of DOs from ACs. The “three strikes” law is noted and early intervention in DOs’ criminal careers is discussed.

Keywords

sadism substance abuse psychopathy diabetes brain dysfunction ADHD

“Dangerousness” is a controversial concept and the ability of mental health professionals and criminologists to define it and predict risk of future offending has been debated for decades (e.g., Beck, 2010; Monahan, 1978; Quinsey, Harris, Rice, & Cormier, 1998; Ullrich, Yang, & Coid, 2010). In spite of this, Canadian law has had a “dangerous offender” (hereafter DO) statute since 1969 that requires psychiatrists and psychologists to assist the courts in determining if an offender is a danger to the life, safety, or mental and physical well-being of others. Decisions have been made without substantial clinical research to determine what distinguished DOs from other non-DO offenders. In fact, only one empirical clinical study of Canadian DOs with a comparison group was found in PsychInfo and the Criminal Justice Abstracts (Bonta, Zinger, Harris, & Carriere, 1998). The present report offers the second study of the subject.

A recent change in Canadian law (Bill C27) may lead to many more DO applications, indicating the need for more empirical research on DOs. The 2009 law was proposed to reduce the requirements for DO applications and indicates that an offender convicted of a third sexual or violent offence, for which it would be appropriate to impose a sentence of 2 years or more, is presumed to be a DO, and the onus is on defense attorneys to prove that he or she is not. Crown attorneys, however, must state their intentions to initiate a DO application, but they are not required to do so, that is, it is not a three strikes law. The new law represents a change from previous practice of initiating DO application proceedings after an unspecified number of convictions and prior to sentencing for a current conviction. The assistance of psychiatrists and psychologists remains a requirement and a crown attorney may not proceed with the DO application without their clinical assessments concluding the offender is “dangerous.” A total of 410 criminals have been declared DOs between 1977 and 2006, but, under the revised legislation, that relatively small number could increase substantially from 2.5% to 47.6% of all sexual and violent offenders (Langevin, 2008). Offenders, not previously considered by mental health professionals or by the courts to be a threat to society, could be included to face indeterminate incarceration. Yessine and Bonta (2006) reported that once DO applications are initiated, 98% of offenders are convicted and very few are ever released from prison again. If this practice continues, psychiatrists and psychologists may be called upon to offer opinions on dangerousness for even more offenders without the benefit of substantive supporting research. The questions raised by the present study are as follows: Are DOs different from other offenders in general? Specifically, do they differ from sex offenders in general, the most frequent offenders among DOs? If so, are there distinctive clinical characteristics that psychologists and psychiatrists can rely on to assist them in defining the DO and predicting risk of future offending?

Comparing DOs to Sexual and Violent Offenders

Typically sexual offenders and, in lesser numbers, violent offenders have been the subject of DO applications. Yessine and Bonta (2006) reported that 82% of DOs were sex offenders and Trevethan, Crutcher, and Moore (2002) found that 83% of DOs had a history of sexual offences, the remainder of their groups being violent offenders. It therefore is appropriate that DOs be compared with sexual and violent offenders who have not been the subject of DO applications. Furthermore, DOs are few in number and researching them is limited at present, so information from sexual and violent offenders in general may be useful in understanding them.

The literature indicates that sex offenders exhibit a number of clinical features, which are prominent in their criminal behavior and may contribute to their risk of recidivism and potential dangerousness, namely, (a) deviant sexual history and paraphilic sexual preference, especially sadism; (b) substance abuse; (c) personality and mental illness (especially psychosis, antisocial personality disorders [ASPD], and ADHD); (d) criminal and violent history; (e) borderline cognitive functioning; and (f) biological factors, such as endocrine abnormalities (Langevin & Watson, 1996). Each of these factors is examined in turn to determine what contribution they may make to forensic clinicians’ determination of “dangerousness” and recidivism risk. Violent nonsex offenders are a relatively small subgroup of DOs, who have been found to share the foregoing features with sex offenders; with the exception of deviant sexual preferences and histories (Langevin, 1985; Langevin & Watson, 1996).

Prominent Features Associated With Violence and Risk of Recidivism

Sexual History and Paraphilic Preferences

Men who engage in persistent sexual crimes frequently have paraphilic preferences that preclude conventional sexual behavior or at least are more compelling than the latter (Langevin, 2004). Such preferences may endure into senior years, especially if children are victimized, and they present a continuing risk of recidivism (Hucker & Ben-Aron, 1985; Langevin, 2004). Studies on men who sexually assault adult females, the most frequent group among DOs, may “burn out” and some of the offenders may not be paraphilic (Langevin, 1983; Lalumiere & Quinsey, 1993). It is expected that the presence of enduring deviant sexual preferences pose a greater risk to act out in future and therefore are more likely to be found in DO applicants. In particular, sadism, in which sexual pleasure and violence are fused, is a paraphilia of greater concern to clinicians, as it may be associated with more frequent victim injury, more serious injuries, and even death (Kingston, Seto, Firestone, & Bradford, 2010; Nitschke, Blendi, Ottermann, Osterheider, & Mokros, 2009). It is expected that more sadism diagnoses would be reported for DOs than for non-DOs.

Approximately half of sex offenders in general and, perhaps even more DOs, engage in multiple sexually deviant behaviors (Abel et al., 1987; Langevin, 1983; Langevin & Paitich, 2002). Bonta et al. (1998) and Trevethan et al. (2002) found that DOs offended against adults and children, although the majority of victims were adult females, suggesting a mixture of sexually deviant behavior and paraphilic diagnoses. Therefore, in this study DOs are compared not only with sex offenders in general but also with a group matched on types of sexually deviant behavior, but lacking the DO status. DO may be considered paraphilic and have a deviant sexual history, but it remains an open question if they differ from other non-DO sex offenders in this respect.

Finally, Bonta et al. (1998) compared the DOs with a high risk violent offender group (hereafter, HRVOs), who share the criminal history of DOs but lack the DO status, and found that 87.8% of DOs reported a history of childhood sexual abuse, a rate much higher than the HRVOs at 42.9% or than child sexual abusers in general, who average 28.0% abused. The cycle of abuse hypothesis suggests that those men who were sexually abused as children, such as DOs, are more likely to be sex offenders themselves as adults and therefore are at greater risk to reoffend (Hanson & Slater, 1988).

Substance Abuse

Substance abuse and addiction are associated with greater violence in crimes and more victim injuries (Busch-Armendariz, DiNitto, Bell, & Bohman, 2010; Rada, 1975, 1976). Both alcohol and drugs may serve to disinhibit and cognitively impair the offender and may be associated with changes in personality, out-of-character behavior, and may even lead to psychosis (Langevin, 2003). The offenders typically with greatest levels of violence, sexual offenders against adult females, are overrepresented among DOs, and have among the highest rates of alcohol abuse and alcoholism of any sex offender group (Langevin & Lang, 1990).

Bonta et al. (1998) found both DOs and HRVOs frequently had substance abuse histories; 82.0% and 88.2% alcohol abuse, respectively, and 72.9% and 84.8% drug abuse; higher than reported for sexual and violent offenders generally: 52.1% alcohol abuse and only 2% to 3% drug abuse (Langevin & Lang, 1990). Bonta et al.’s results suggest that substance abuse, especially drug abuse, may be a more critical factor in DOs’ criminal behavior than typically seen among sexual or violent offenders in general, but they may not differ from a group of non-DO offenders matched on offense type.

Personality and Mental Illness: Psychosis, ASPD, and ADHD

Psychotic mental illnesses are infrequent among DOs and among offenders generally (Wormith & McKeague, 1996) and occur in less than 10% of the criminal population. Bonta et al. (1998) found that DOs were less often diagnosed with schizophrenia (8.5%) than HRVOs (26.9%), but they had more extensive treatment histories (89.8% vs. 64.5%) with “poorer treatment evaluation” (44.9% vs. 7.4%), although the nature of treatment and evaluation were not specified. Nevertheless, Smith (1999, 2000) studied 80 inpatient schizophrenics who committed sexual offenses against women while psychotic. They found 24% of the schizophrenics, who entertained aggressive and sadistic sexual fantasies, were more likely to have a history of sexual offending before the onset of schizophrenia. Smith’s results suggest that psychosis be examined as a factor in dangerousness and risk of recidivism.

More often, offenders are diagnosed with personality disorders. ASPD is the most common diagnosis. Bonta et al. (1998) found that 72.9% of DOs and 73.1% of HRVOs were diagnosed with ASPD, a nonsignificant difference. As the ASPD presents mainly criminal history variables, not surprisingly, the diagnosis is more common among criminals than the general population and ASPD is not peculiar to DOs (American Psychiatric Association [APA], 2000, p. 648).

Psychopathy, as defined by Hare (2003) is increasingly common in psychiatrists’ and psychologists’ evaluations of DO applications because of the extensive research on psychopathy and recidivism (see Patrick, 2006). Hare’s Psychopathy Checklist - Revised (PCL-R) has even been incorporated into the most thoroughly researched actuarial measures of risk, the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG), constituting 26.6% and 22.7% of their total maximum scores (Quinsey et al., 1998). Bonta et al. (1998) examined Hare’s PCL-R scores among DOs and found they did not differ significantly from HRVOs on this measure (39.6% vs. 32.4%, respectively, were psychopaths). It is expected in the present study that DOs would more often be psychopaths than sexual and violent offenders in general, but would not differ from a group matched on offense type.

Few research studies have examined ADHD in adult sex and violent offenders, who may present with impulsive, illogical, and aggressive behavior. ADHD is associated with psychopathy in children (Frick & Marsee, 2007; Moffitt & Caspi, 2001) and Langevin and Curnoe (2010) found that ADHD was overrepresented among adult PCL-R psychopaths. Kafka and Prentky (1998) and Vaih-Koch, Ponsetti, and Bosinski (2001) found up to 42% of sex offenders were diagnosed with ADHD and their criminal behavior was associated with violence. Given the number of DOs considered psychopaths, it is expected in the present study they also might show more ADHD than offenders in general, but would not differ from a matched comparison group.

Criminal and Violent History

Offenders’ criminal and violent histories and family-of-origin violence are predictors of future violence and are often key elements in actuarial measures of risk (Hanson & Thornton, 1999; Quinsey et al., 1998). Bonta et al. (1998) found that DOs were comparable with HRVOs on criminal history variables, but they committed more sex offences, had more victims, more often were “brutal” (70.0% vs. 48.4%; no details provided by authors) and inflicted more physical injuries on their victims. As children, 81.8% of DOs versus 18.2% of HRVOs were neglected, 79.5% vs. 81.0% physically abused, 38.5% vs. 35.0% were runaways, 55.2% vs. 44.8% were Children’s Aid Society (CAS) wards, and 75.0% vs. 70.0% had juvenile records, although DOs were not significantly different from HRVOs on these variables, with the exception of the outstanding factor of neglect. At times, the criminal and violence history variables may be the only factors evaluated in determinations of dangerousness, for example, the Static99 (Hanson & Thornton, 1999) as the information is easy to code and usually readily available. It is expected that an extensive criminal history would be more common among DOs than in offenders generally, but they would not differ from a matched comparison group.

Cognitive Functioning

Impaired cognitive functioning may be associated with irrational and violent behavior and may play a role in DOs’ behavior. There appear to be no published studies of intelligence, learning disorders (LD), or neuropsychological impairment among DOs, but Trevethan et al. (2002) reported that 59% of incarcerated DOs had Grade 9 or less education, suggesting that they may score lower on intelligence tests than sexual and violent offenders generally. Langevin and Curnoe (2008a) found that sex offenders have more LD than seen in the general population and 38.7% were placed in special education classes in school (versus 2%-3% of Ontario children in general), and 57.1% did not complete high school; factors that Langevin and Curnoe (2007) suggested may lead to poor adjustment and a sense of social alienation.

A growing body of studies indicates that neurological disorders and head injuries are common among sexual and violent offenders, and may be associated with impaired neuropsychological functioning, personality change, as well as criminal and violent behavior (Blanchard et al., 2002; Blanchard et al., 2003; Kolarsky, Freund, Machek, & Polak, 1967; Langevin, 2006; Langevin & Curnoe, 2008b). Langevin (2006) found that 49.3% of sex offenders had been rendered unconscious in the past and 22.5% had known significant neurological insults, making neuropsychological assessment a significant factor in their clinical and risk evaluation. It is expected that neuropsychological abnormalities would be more common among DOs than ACs, but DOs and MCs would not differ significantly.

Endocrine Abnormalities

Endocrine functioning, which include sex hormones that drive sexual behavior, may be abnormal among sex and violent offenders and may be associated with mood change, impaired cognitive functioning, blatant mental illness, and aggressive behavior (Bain et al., 1989; Bain, Langevin, Dickey, Hucker, & Wright, 1988; Gaffney & Berlin, 1984; Lang, Langevin, Bain, Frenzel, & Wright, 1989; Rada, Laws, & Kellner, 1976; Rada, Laws, Kellner, Stivastava, & Peake, 1989). One of the more common endocrine disorders, diabetes, has been found to be more than twice as prevalent among sexual and violent offenders (13.9%) than reported for the general population (6.2%; Langevin, Langevin, Curnoe, & Bain, 2008). When uncontrolled, it may be associated with out-of-character behavior and aggression. There appear to be no studies of endocrine abnormalities among DOs, but it is expected that they would be more common among DOs than the general population, but DOs may not differ significantly from non-DO offenders.

Summary of Hypotheses

In the present report, DOs are compared with sexual and violent offenders to determine whether and how they differ on clinically significant variables. Because DO are represented only by some subgroups of sex offenders, mainly sexual offenders against adult females, they were also compared with a group matched proportionally on offender subgroup membership and subgroup scores on variables of interest in this study.

The hypotheses of this study in summary are as follows:

DOs compared with non-DO sexual and violent offenders in general would show more of the following:

Sexually deviant diagnoses and histories

Sadism diagnoses

Multiple sexually deviant behaviors

Sexual abuse as children

Substance abuse and addiction

Psychosis, ASPD, ADHD, and psychopathy

Extensive criminal histories

Impaired cognitive functioning

Endocrine abnormalities

When DOs are compared with a group matched on offense type (MC), there may be few or none of these differences evident.

Method

Research Participants

A total of 2,476 men referred to the forensic service of a psychiatric hospital and to a private forensic clinic for psychiatric and psychological assessment, risk assessment, and/or treatment by the court, police, probation and parole services, defense lawyers, or other mental health professionals between 1966 and 2009 was the subject of this study. A number of cases were seen multiple times, but all cases were seen prior to 2009 changes in Canadian law on DOs. Cases were classified into groups on the basis of their current and known lifetime criminal charges (see Table 1). Child victims were considered to be below 16 years of age and adult victims 16 and older in accordance with Canadian Law for the current age of consent.

Table 1.

Group Membership of the Total Sample, DO, and MC.

	Total sample	DO	MC
Homosexual/bisexual men, who engaged in consenting, sexual relations, but in public places	100
Men, who engaged in nonconsenting sex with men and/or both men and women	18	1	1
Extra-familial child sexual abusers of children under 16 years of age	666	15	15
Against boys	286	8	8
Against girls	307	5	5
Against both boys and girls	73	2	2
Exclusive genital exhibitionists	153
Incest offenders of children under 16 years of age	714	6	6
Against boys	96	2	2
Against girls	567	3	3
Against both boys and girls	51	1	1
Men who sexually assaulted both female adults and children	47	5	5
Men charged with possession of child pornography and who did not have any known sexual contact with children	63
Miscellaneous courtship disorders (combinations of voyeurism, exhibitionism, and/or toucheurism/frottage involving adult female victims)	41	2	2
Mixed gender dysphoric and transvestitic men: involved in assault, impersonation, and theft	80
Sexual offenders against adult females	328	29	29
Sexually polymorphous men, who offended against both males and females and against both adults and children and engaged in a wide range of sexually anomalous behavior	34
Miscellaneous sex offenders, who lacked sufficient information to classify them into the previous groups	83
VNS offenders	149	4	4
Grand total	2,476	62	62

Note: DO = dangerous offenders; MC = matched comparisons; VNS = violent nonsex.

Of the 2,476 cases, 62 (2.5%) had faced DO applications (Table 1). In our sample, DOs were not a random selection of offenders. Sexual offenders against adult females and against adults/children were significantly overrepresented and heterosexual incest offenders were underrepresented among DOs. Some groups such as exclusive genital exhibitionists were not represented at all. Because the DO were not randomly distributed in our sample, a third group (hereafter MC), matched to DO for number of cases per subgroup and mean scores of study variables for those subgroups, was used to construct a more representative comparison:

M_{mc} = \sum n_{i} M_{i} / n_{t}

where M_mc is the mean for the resulting MC group, n_i is the number of cases in each subgroup, M_i is the mean score for that subgroups, and n_t is the total number of cases. The variance of the total sample was used to provide an unbiased estimate in computations.

Two DO cases (3.2%) included in this study were unusual, as they had murdered their victims. All other homicide cases, sexual and nonsexual, were excluded, as they fell under other legal provisions and faced possible life sentences. Trevethan et al. (2002) similarly found 2% of DOs had previous convictions for murder and 3% for attempted murder. All females from our database also were excluded, as there were no female offenders facing DO applications in this sample. The sample size of DOs is comparable with that reported by Bonta et al. (1998) and represents approximately 15% of the total number of DOs in Canada at the time.

Procedure

The sample in this study had extensive clinical files that included criminal and correctional history; victim characteristics; psychiatric diagnosis; sexual history and phallometric test results; childhood development and family background factors; medical history and blood test results; demographic factors such as age, marital status, and education (including school adjustment); and history of substance abuse, among others, including a number of standard psychological tests.

To evaluate lifetime criminal history, Royal Canadian Mounted Police (RCMP) records were examined in 1994 and again in 2000. Hospital records also were examined that included provincial and federal criminal records, probation and parole reports, presentence reports, reports from other hospitals, as well as juvenile criminal records and the offenders’ and their families’ self-reports. Criminal history follow-up averaged 21.5 years and ranged from 5.1 to 41.1 years.

Because a variety of procedures were used to determine diagnoses over the years, all diagnoses were standardized to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000) criteria. A number of psychological tests were also available to assist in diagnosing mental illness and personality, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and its earlier version, MMPI (Dahlstrom & Tellegen, 1992) and Millon Clinical Multiaxial Inventory (MCMI-II and MCMI-III; Millon, Davis, & Millon, 1997). Ratings of psychopathy were derived from Hare’s (2003) 20-item PCL-R. ADHD diagnoses were supplemented in more recent cases by the Connors Adult ADHD Rating Scale (CAARS; Connors, Erhardt, & Sparrow, 1998), as available. Supplementary information on suicide attempts was derived from psychiatric and hospital reports.

Diagnoses of sexual disorders, including sadism, were derived from interview material, criminal history, victim statements, and the Clarke Sex History Questionnaire (SHQ; versions of the older and current SHQ-R; Langevin & Paitich, 2002). In formulating diagnoses of sexual disorders and sadism, phallometric testing, as available, was used to compute the pedophilia index, a measure of relative attraction to children versus adults, and the rape index, a measure of relative attraction to violent sexual outlet and rape versus consenting sexual relations. Histories of sexual and/or physical abuse were based on offenders’ and their parents’ self-reports as well as psychological, social work, and CAS reports, and the Parent Child Relations Questionnaire (Older and current version; Paitich & Langevin, 1976).

Alcoholism and drug addiction diagnoses relied on the World Health Organization (WHO) criteria, as used in the Michigan Alcoholism Screening Test (MAST; Selzer, 1971) and Drug Abuse Screening Test (DAST; Skinner, 1982) with supporting clinical interviews. When these tests were not available, they were reconstructed from clinical files as much as possible, but some information was lost in older files.

Cognitive functioning was examined with the Halstead–Reitan Neuropsychological Test Battery using 1993 norms (Reitan & Wolfson, 1993), and Wechsler Adult Intelligence Scale (WAIS-R and WAIS-III; Wechsler, 1981; Tulsky, Zhu, & Ledbetter, 1997). Endocrine functioning and medical history were evaluated by endocrinologists, blood test results, psychiatrists, and an unpublished Medical History Questionnaire.

Results were analyzed with SPSS-17.0. For categorical variables, likelihood ratios (LR) were used and for continuous variables, t tests. Because of the large number of statistical tests (90), probability levels were adjusted accordingly using the Bonferroni correction and only results beyond p < .001 were considered statistically significant.

Results

Age and Education

Table 2 shows that the DO did not differ significantly in age from ACs, but were significantly less educated and more often did not complete high school. They were similar in this respect to Trevethan et al.’s (2002) sample. More DOs than ACs were in special education classes, but results were not statistically significant. The DOs more often were suspended and almost all DOs had truancy problems. Differences between DO and MCs were smaller and DOs only differed significantly from MCs in having more problems with truancy.

Table 2.

Age and Education of DO and Comparison Groups.

	DO	AC	MC
Mean age	36.1	35.0	33.7
Mean years of education	9.6	11.5***	11.4
High school dropout (%)	80.0	53.4***	63.7
Special education (%)	56.1	35.0	42.4
School suspensions (%)	52.5	25.9***	38.1
School truancy (%)	92.9	47.6***	55.2***

Note: DO = dangerous offenders, AC = all offenders; MC = match comparison group. Asterisks beside AC represent a significant difference from DO and those beside MC indicate significant differences between them and the DO group.

***

p < .001.

Criminal and Violent History

DOs had a more extensive criminal history than ACs (Table 3). They started their criminal careers earlier in life, had more sexual and violent crime and total convictions, and more repeat offenses in more cities throughout their lives. They had more criminal associates both before and after age 16 and significantly more often were considered to be bullies as children; the latter correlated with an adult history of antisocial behavior (Vaughn et al., 2010). When DOs are compared with MCs, the same statistically significant, but smaller, differences emerged, but the two groups did not differ on age at first offense, criminal associates, or bullying. All three groups were similar in the span of their criminal histories.

Table 3.

Criminal History of DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Mean age first offence	18.6	27.8***	24.8
Juvenile offender (%)	56.5	12.7***	22.6***
Span criminal history in years	20.0	15.9	16.4
Number of sex and violent convictions	10.9	3.3***	4.4***
Total number convictions	21.0	6.8***	9.5***
Number of court appearances	11.6	4.6***	6.3***
Number of cities where offended	3.9	2.0***	2.1***
Criminal associates
Before age 16	45.7	19.0***	26.5
After age 16	37.1	10.0***	18.7
Offender was bully before age 15	48.3	17.7***	33.7

Note: DO = dangerous offenders; AC = all offenders; MC = match comparison group.

***

p < .001.

Table 4 shows that more DOs’ parents than ACs’ were separated and were substance abusers, who were aggressive to each other and to the children and neglected the children’s basic needs, even for food. DOs more often than ACs ran away from home and the CAS was more likely to be involved with the family during their childhoods. Results were not statistically significant in comparing DOs with MCs.

Table 4.

Childhood and Family Background of DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Parents separated	59.6	35.6***	39.5
Parental substance abuse	85.3	58.2***	61.0
Mother	42.3	22.1	30.3
Father	78.8	54.0	57.9
Violence in the home	71.7	41.8***	50.6
Offender physically abused	57.8	30.2***	34.5
Neglected	70.3	32.7***	38.9
Lack of food	46.9	14.3***	17.1
Runaway	54.5	23.4***	30.8
Children’s aid involved	60.0	20.2***	29.7

Note: DO = dangerous offenders; AC = all offenders; MC = match comparison group.

***

p < .001.

Sexual History and Paraphilic Preferences

Table 5 shows that the DOs, ACs, and MCs did not differ in the numbers diagnosed with paraphilias and the majority of all groups were considered sexually deviant. They did not differ in terms of the type of diagnosis, with the exception that significantly more DOs than ACs were diagnosed with sadism, but DOs and MCs did not differ on this diagnosis. More DOs had multiple paraphilic diagnoses than ACs or MCs, but differences did not reach statistical significance. Although more DOs than MCs or ACs reported being sexually abused as children, results also were not statistically significant.

Table 5.

Sexual History and Preference of DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Any paraphilic diagnosis	88.7	88.3	87.1
Type of paraphilia:
Pedophilia	40.3	54.9	32.6
Sadism	40.3	7.2***	15.2
Courtship disorder	50.0	49.8	58.1
Miscellaneous	3.2	6.0	2.4
Multiple paraphilias	45.2	30.5	29.7
None	11.3	13.4	7.5
Sexually abused as a child	59.0	37.4	33.4

Note: DO = dangerous offenders; AC = all offenders; MC = match comparison group.

***

p < .001.

Substance Abuse

Table 6 shows that more DOs than ACs abused alcohol and/or drugs, but DOs and MCs did not differ significantly. Noteworthy the DOs more often abused alcohol and drugs. At the time of the offenses leading to DO applications, significantly more DOs than ACs were consuming alcohol and/or drugs, more often both. DOs and MCs did not differ significantly in this respect.

Table 6.

Substance Abuse Among DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Substance abuse diagnosis:	77.4	48.3***	56.8
Alcohol only	19.4	22.1	34.8
Drugs only	6.5	3.6	4.7
Both alcohol and drugs	48.4	21.3	20.2
Not specified	3.1	1.3	2.9
At time of the offence any substance use	85.7	47.9***	59.7
Drinking	39.3	31.4	34.8
Using drugs	5.4	4.1	4.7
Using both alcohol and drugs	41.1	12.4***	20.2

Note: DO = dangerous offenders; AC = all offenders; MC = match comparison group.

***

p < .001.

Psychosis, ASPD, and ADHD

DOs, ACs, and MCs did not differ significantly in the prevalence of psychosis (Table 7). The DOs, however, more often than ACs made attempts on their lives, but they did not differ from MCs in this respect. The three groups did not differ significantly in desire for treatment or ADHD diagnoses.

Table 7.

Psychosis, ADHD, Personality Disorders, and Psychopathy Among DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Diagnoses:
Psychotic	16.1	9.4	11.5
ADHD	10.7	12.6	15.7
Personality disorder	42.0	18.5***	26.1
ASPD	35.5	10.6***	18.5
PCL-R > 30	46.4	7.3***	22.6***
Clinical features:
Suicide tries	51.9	24.7***	30.2
Wants treatment	66.7	47.3	47.9

Note: DO = dangerous offenders; AC = all offenders; MC = match comparison group; ASPD = Antisocial Personality Disorders; PCL-R = Psychopathy Checklist.

***

p < .001.

The largest significant differences between DOs and ACs were in personality disorders. The difference was mainly attributable to ASPD diagnoses. Differences between DOs and MCs were not statistically significant.

There were more DOs than ACs, who met criterion for psychopathy, based on the PCL-R. Again differences are weaker when DOs are compared with MCs and the majority of men in all groups were not PCL-R psychopaths, similar to Bonta et al.’s (1998) study.

Cognitive Functioning and Endocrine Factors

Table 8 shows that DOs scored significantly lower on IQ tests than ACs, but not than MCs. Mean IQs were in the average range (90-110). The DOs had a higher prevalence of LD than the other groups, but differences did not reach statistical significance. Other neuropsychological features were common in all three groups, but differences were not statistically significant.

Table 8.

Cognitive and Endocrine Factors Among DO and Comparison Groups.

	Percent
Variable	DO	AC	MC
Neuropsychological
Mean full IQ	93.4	101.8***	99.2
Mentally retarded	4.8	2.6	3.7
LD	53.1	30.5	38.7
Past rendered unconscious	64.7	44.4	48.5
Neurological disorders	23.1	18.9	21.9
Failed HR battery	34.1	26.8	27.4
Endocrine abnormality	34.4	21.5	20.0
Diabetes	28.1	13.9	13.7
Other	6.3	7.6	6.3

Note: DO = dangerous offenders, AC = all offenders; MC = match comparison group; LD = Learning disorder; HR = ‘Halstead Reitan’ battery. For diabetes only 32 dangerous offenders were examined. In the general population, 6.2% are diabetic.

***

p < .001.

DOs had more endocrine abnormalities than ACs or MCs, but results were not statistically significant. In particular, DOs had more than twice the numbers with diabetes and more than four times that of the general population (Langevin et al., 2008), although it was only possible to obtain blood test results on 32 DOs. Differences for other endocrine disorders were not significant.

Best Predictors of Dangerousness

All variables in Tables 1 through 8 were poor predictors of DO versus AC membership, none explaining even 10% of the common variance. The largest correlation was 0.27 (7.3% of variance) for sex/violent offense convictions.

Discussion

The question raised by this study was whether specific clinical characteristics differentiated DOs from other offenders. The answer is “yes” but differences are not definitive of DOs versus ACs, and the answer is “no” when DOs and MCs are compared. There were 30 of 45 significant differences between DOs and ACs, but only 6 when DOs were compared with MCs. An examination of Tables 2 through 8 indicates that the DOs are more extreme on most variables, but results do not reach statistical significance. Moreover, variables reported do not capture their intensity or duration, but only the presence or absence of a feature, for example, lack of food was noted, but it is was beyond the scope of this study to determine how long the offender lacked food as a child, whether he suffered from malnutrition, at what ages it occurred, and so on. The latter may be more revealing in differentiating DOs from other offenders. The combination of variables was also not examined and their interaction may be more important than each alone. This is illustrated by substance abuse where the use of alcohol and drugs was significant. The types of drugs used, their quantity, duration of use, and so on, may also be more revealing in differentiating DOs from other offenders. The significant features of the DOs were their extensive criminal histories, which started earlier in life and involved more sexual and violent crimes, but criminal history was a weak discriminator of DO versus AC group membership. As in Bonta et al.’s (1998) study, DOs appear to be a random selection of violent sex offenders. The clinical profile of DOs was not unique among sexual and violent offenders, just more extreme in some of their features. This is seen in each set of the six clinical factors used in the present study to compare DOs with sexual/violent offenders in general.

Sexual History and Paraphilic Diagnosis

DOs were no more likely than AC or MC to have a sexual disorder diagnosis, but almost six times more DOs than ACs were considered to be sadists. Nevertheless, only 40.3% of DOs were diagnosed as sadists, a noteworthy but far from discriminative factor for DO applications. The men who abused alcohol and drugs were more likely to be labeled with sadism, raising the issue whether a combination of intoxicants and/or the extent of offenders’ addiction are reflected in this finding and are critical in the violence noted. It is an open question whether the aggressive sexual behavior reported in their crimes represents more a paraphilic preference or the aggression-inducing effects of alcohol and/or drugs at the time, or an interaction of the two factors.

There were no significant differences among the three groups in multiple paraphilias or childhood sexual abuse, although more DOs than the other two groups showed both. The relative strength and persistence of the multiple paraphilias was not examined and perhaps there would be greater differences if these were considered. Similarly, the extent and frequency of childhood sexual abuse was not examined and it too may be discriminating.

Substance Abuse

Like their parents, the DOs were more likely than ACs to become substance abusers (Langevin, Langevin, Curnoe, & Bain, 2006). The abuse of both alcohol and drugs was more pronounced among DOs suggesting a greater degree of disinhibition in this group compared with either MC or AC. The Correctional Service of Canada has long had programs to help offenders with substance abuse, but early intervention may be even more effective in deterring substance abuse and its associated violence in crime.

Personality and Mental Illness

DOs were not more often psychotic, but there was an underlying emotional disturbance reflected in more DOs having attempted suicide. Bonta et al. (1998) reported that DOs more often had a history of treatment failures or treatment with poor outcome. Present results indicate that DO treatment may involve a complex of factors with substance abuse, sexual deviance, emotional problems, and suicidal ideation, and possibly brain dysfunction and diabetes, which need addressing in a multimodal treatment approach, including relapse prevention therapy and medication.

DOs were more likely than AC to be diagnosed with ASPD and to be labeled psychopaths. However, the majority of DOs were neither diagnosed with ASPD nor considered PCL-R psychopaths. A considerable body of literature suggests that the PCL-R has a disputed number of factors, is a poor predictor of recidivism among sex offenders, and may be primarily a measure of criminal history and not of a personality disorder (see Douglas, Vincent, & Edens, 2006; Langevin & Curnoe, 2011). Although previous research has found an association of psychopathy and ADHD, the latter did not significantly discriminate the DOs either from AC or MC groups. The prevalence of ADHD in this study generally was lower than reported in other studies, that is, Kafka and Prentky (1998) and Vaih-Koch et al. (2001), which in part may be due to missing information, especially in our older cases.

Criminal and Violent History

Number of sexual and violent offense convictions was the best predictors of DO group membership, but the difference was small, accounting for only 7.3% of the variance between the two factors. In spite of this, recidivism among DOs (11.6 mean court appearances) was almost double that of MCs (6.3) and three times that of ACs (4.6). Such data have become the focus of actuarial studies over the past two decades and instruments such as the Static99 (Hanson & Thornton, 1999) and General Statistical Information on Recidivism (SIR) Scale (Nuffield, 1989) focus only on criminal behavior and some demographics, whereas the VRAG and SORAG (Quinsey et al., 1998) have attempted to capture a wide range of clinical variables, many of which have been reported in this study. Results have generally been weak for all instruments, for example, Bonta, Harman, Hann, and Cormier (1996), but Hart, Michie, and Cooke (2007) considered the predictions from the VRAG and Static99 to be so broad that they were “meaningless”: interesting as the former scale incorporate Hare’s PCL-R scores in the computation. In a study of sex killers, Langevin (2003) found that the killers were as likely to be considered a low risk as a high risk on the VRAG and SORAG, when information prior to the homicides is used in the computations of risk. Spehr, Hill, Habermann, Briken, and Berner (2010) also found sex killers showed many similarities to nonhomicidal rapists and no differences in psychopathy, as measured by the PCL-R. Results of this study suggest that a number of variables, which have not been considered previously, may be useful in evaluating risk and in treatment, namely the following.

Cognitive Functioning

DOs were less educated than AC and had more school difficulties in terms of suspensions and truancy. The DOs’ homes were more violent than ACs’ and they were more often physically abused and neglected. CAS involvement occurred in three of five DOs’ childhood homes compared with one in five ACs’. Being in such dysfunctional families with prominent neglect, they may have been least likely of any offender group to receive the professional intervention to help them with their LD and ADHD, which often have associated emotional problems (Moffitt & Caspi, 2001; Ward, Wender, & Reimherr, 1993).

There are very few reports on neuropsychological functioning and abnormalities in sex offenders, although the literature has been growing in the past decade. If neuropsychological abnormalities are detected, treatment programs for such impaired offenders are not available in Canadian prisons, and in a search of PsychInfo and the Criminal Justice Abstracts, we were unable to identify community-based clinics focusing on criminals as clients.

Noteworthy, DOs more often want treatment, but they may be less likely to benefit due to their cognitive impairment, which can be a source of embarrassment as well as presenting more difficulties processing therapy information than in offenders without the cognitive impairment (Langevin, Marentette, & Rosatti, 1996). Individuals with neurological disorders and brain dysfunction/damage may show even more extreme problems in this regard and need further study, especially in reference to violent sex crimes.

Biological Factors/Endocrine Functioning

There is also a reluctance to acknowledge and assess offenders for endocrine functioning, in spite of there being 34.1% abnormalities among DOs; the prevalence of diabetes being more than twice that of sex offenders in general (28.1% vs. 13.9%) and four times that for the general population (6.2%). PsychInfo and the Criminal Justice Abstracts indicate only one study of diabetes in a forensic population (Langevin et al., 2008). Our study was limited, as we were only able to obtain blood results on 32 DOs and, in some cases, defense attorneys had to obtain court orders to have testing done. Endocrine abnormalities present treatable conditions and, with medical attention, the afflicted may show improvement in mental symptoms, impulse control, and cognitive functioning and reduced risk of further offense (Langevin et al., 2008). Cognitive and endocrine factors merit further scrutiny in reference to violent and sexually inappropriate behavior, in spite of the small number of cases in this study. Treatments are available and they present possibilities for change in violent behavior that historical variables, such as school truancy, may not.

The lack of unique features among DOs compared with MCs and the significance of criminal history in the results could argue for a “three strikes” law. However, Bonta et al.’s (1998) study and the present one represent small samples of available DOs and further work with larger samples may provide more discriminating results. In addition, DOs are predominantly sex offenders and much can be learned from the study of the latter group, especially of variables that have not been considered sufficiently to date, namely, ADHD, brain dysfunction/cognitive impairment, and biological/endocrine abnormalities.

This study found results that may have a significant bearing on DOs’ behavior, possible rehabilitation, and especially on early intervention and prevention. Bullying was also pronounced in DOs and it too could be targeted in childhood as a preventive and treatment measure (Vaughn et al., 2010). The more frequent abuse of alcohol and drugs, LD, and neuropsychological and endocrine abnormalities in DOs offer new paths of intervention. DOs scored lower on IQ tests than ACs and more often had LD and they were more often rendered unconscious in the past, although the latter two differences did not reach statistical significance. In spite of this, the higher prevalence of learning and neurological disorders in all groups requires further research and clinical attention. The combination of compromised cognitive functioning (lower IQ, LD, compromised neuropsychological functioning) with substance abuse, especially both alcohol and drugs, and diabetes, and a childhood in which violence was modeled in an atmosphere of neglect, presents a potential formula for acting out in aggressive and antisocial ways.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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