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PSYCHOPATHOLOGY OF INCARCERATED
SEX OFFENDERS
Sean Ahlmeyer, MA, Dennis Kleinsasser, PhD,
John Stoner, PhD, and Paul Retzlaff, PhD
From the Colorado Department of Corrections (S. A., D. K., J. S.) and the University of Northern
Colorado (P. R.)
Address correspondence to Paul Retzlaff, Psychology Department, University of Northern Colo-
rado, Greeley, CO 80634; E-mail: pretzlaff@aol.com.
306
SEX OFFENDER PSYCHOPATHOLOGY 307
METHOD
PARTICIPANTS
A sample of 7,921 adult male inmates with valid testing was abstracted from
recent admissions to the Colorado Department of Corrections (CDOC). Of
the total sample, 7,226 inmates were convicted of nonsexual offenses (e.g.,
murder, robbery, drug offenses, fraud). Grouping these diverse offenses
served to provide a broad representation of a corrections population against
whom to compare the sex offenders. Of the larger sample, 695 inmates had
current felony convictions for sexual offenses. Specifically, inmates con-
victed of sexual assault are referred to as rapists (N = 223). Inmates con-
victed of sexual assault on a child, sexual assault on a child by one in a
position of trust, and habitual sexual offense against a child are referred to
as child molesters (N = 472).
For the entire group, about 45% were White, 30% were Hispanic, and 20%
were African American. The mean age was 32. Differences were found across
the subgroups. About 46% of the nonsexual offenders were white as were
about 43% of the rapists. There were, however, more whites in the child mo-
lester group with about 60%. There were similar differences in terms of age.
Nonsexual offenders had an average age of 31, rapists an average age of 33,
and child molesters were the oldest at 36 (F = 72.22, p < .001). These differ-
ences represent the natural occurrence of those convicted in the state and
are not a function of sampling.
There is always a question as to the specificity of sex offender subgroups.
These sex offender groups are believed to be relatively clean because all
prior charges and convictions were abstracted and only offenders with one
type of offense are included in these groups. Further, offenders convicted of
incest, indecent exposure, enticement of a child, pimping a child, pandering
a child, prostituting a child, and misdemeanor sexual offenses were ex-
cluded from the study because the age of the victim was not known or the of-
fense did not constitute a sexual assault.
MEASURES
The Millon Clinical Multiaxial Inventory - III (MCMI-III; Millon, 1994, 1997)
is the most current version of a widely used test of psychopathology. It is of
310 AHLMEYER ET AL.
PROCEDURE
DATA ANALYSIS
The MCMI-III can be analyzed in two ways. First, group means and standard
deviations may be examined through ANOVA and Regression techniques.
This allows for a traditional analysis and relatively robust statistics. The
second approach follows the clinical use of the test where subjects viewed as
a function of their scores falling above the usual cutscores of 74 and 84. This
approach dichotomizes the data and allows for percentage types of analyses
such as Chi-Square and Odds Ratios. It allows for a better understanding of
the prevalence of the various traits.
For the purpose of the current article, both univariate ANOVAs and Odds
Ratios will be performed. In this way both group means and percentages of
pathology will be available to the reader. Finally, some sort of multivariate
statistic is required given the large number of univariate tests conducted
and, also, because of the covariance of the MCMI-III scales. Of the many ap-
proaches, logistic regression was chosen because the final solution allows
for the calculation of a multivariate Odds Ratio. This would allow for a
clearer appreciation of the shrinkage from the univariate tests to the
multivariate test. In order to limit the effects of chance but also simulta-
neously to compare possible predictors, only those scales that were signifi-
cant in both the ANOVA and Odds Ratio analyses were included in the
SEX OFFENDER PSYCHOPATHOLOGY 311
Personality Disorders
Schizoid 47(26) 49(25) 52(27) 8.866***c
Avoidant 39(31) 43(32) 50(34) 28.955***c,d
Depressive 42(32) 45(32) 54(32) 33.795***c,d
Dependent 40(26) 43(26) 52(26) 46.991***c,d
Histrionic 53(15) 51(17) 49(18) 17.663***c
Narcissistic 63(16) 58(14) 55(17) 67.227***a
Antisocial 59(21) 56(22) 54(23) 12.329***c
Sadistic 44(28) 40(26) 41(27) 3.048*e
Compulsive 54(12) 54(11) 53(12) 1.223
Negativistic 39(31) 40(31) 43(31) 3.075*e
Selfdefeating 37(30) 40(30) 45(31) 14.386***c
Schizotypal 36(29) 39(30) 44(29) 16.732***c,d
Borderline 39(25) 41(25) 41(26) 2.553
Paranoid 40(28) 39(29) 43(29) 1.948
Clinical Syndromes
Anxiety 44(35) 49(36) 54(36) 18.833***c
Somatoform 27(29) 31(29) 37(30) 27.194***c,d
Mania 49(21) 47(21) 48(22) 1.121
Dysthymia 34(31) 40(31) 46(33) 35.617***a
Alcohol Abuse 57(24) 58(26) 54(25) 2.816
Drug Abuse 59(19) 55(22) 52(21) 29.679***b,c
PTSD 32(28) 39(29) 41(30) 31.111***b,c
Thought Disorder 34(27) 33(27) 38(28) 6.678***c,d
Major Depression 26(28) 33(29) 38(30) 40.033***a
Delusional Disorder 37(28) 36(29) 35(29) 0.725
Note. *p < .05, **p < .01, ***p < .001. Scheffe tests: a = all groups significantly different from one another, b =
nonsexual and rapists significantly different, c = nonsexual and child molesters significantly different, d =
rapists and child molesters significantly different, e = no groups significantly different from one another.
RESULTS
Table 1 presents the means and standard deviations for the three groups. As
well, there are ANOVA and paired comparison tests. The means and stan-
dard deviations appear well behaved. Most means are in the 40 and 50
range. The highest means are in the areas of traditional criminal personality
including the Narcissistic and Antisocial scales. Eleven of the 14 Personality
Disorder scales had significant ANOVAs. Scheffe post-hoc tests revealed
that the most commonly different groups were the nonsexual inmates and
the child molesters. The nonsexual inmates were higher on the Histrionic,
Narcissistic, and Antisocial scales.
312 AHLMEYER ET AL.
TABLE 2. Percent of Inmates with Scores >74 and Associated Odds Ratios
Looking at the Clinical Syndrome scales, seven of the ten scales had signif-
icant ANOVAs. Only the Drug Abuse scale had a higher mean for the
nonsexual inmates than the sex offending groups. Most often, the child mo-
lesters had the highest means on the scales. A picture develops across this
table of many differences among the groups, of the nonsexual inmates being
higher on the traditional criminal types of personality, and of the sex of-
fenders having varied, broad pathology.
Table 2 presents the prevalence of the disorders for the nonsexual offend-
ers compared to the two sex offender groups collapsed into a general sex of-
fender group. For the general population inmates, a number of scales had
20% or more with scores over 74. They include Avoidant, Narcissistic, Anti-
social, Negativistic, Anxiety, and Alcohol Abuse. The sex offenders are simi-
larly high with the exception of Narcissistic and a number of others over
20%. These ad di tional scales in clude De pres sive, De pend ent, and
Dysthymia. There appears to be a wide range of pathology using the usual
MCMI-III cutscore of 74, especially for the sex offenders.
Table 2 also provides an Odds Ratio for each scale comparing the two prev-
alence rates. The Odds Ratio is the relative risk of an offender being a sex of-
fender given that his score was elevated on that particular scale. For
SEX OFFENDER PSYCHOPATHOLOGY 313
Beta Wald p
Personality Disorders
Schizoid 0.002 0.630 .428
Avoidant .003 2.097 .148
Depressive 0.004 3.116 .078
Dependent 0.007 11.715 .001**
Narcissistic .024 56.242 .001**
Antisocial .014 27.690 .001**
Sadistic .002 0.427 .514
Selfdefeating 0.002 0.717 .397
Schizotypal 0.005 4.247 .039*
Constant .756
cohol Dependence. Here, it is apparent that the two types of sex offenders
are quite different on a number of scales using the clinical cutscore
approach.
There are many approaches to the multivariate analysis of this data. There
are so many scales that it is important to guard against chance by not in-
cluding all scales in an analysis. There is also a need to compare and con-
trast scales significant at the univariate level within a multivariate analysis.
It is also reasonable to stay with an analysis consistent with either of the
univariate approaches. As such, two logistic regressions were accom-
plished. The first attempts to differentiate sex offenders in general from the
nonsexual inmates. The second attempts to model the differences between
child molesters and rapists. These regressions follow from the Odds Ratio
analyses and allow for a multivariate Odds Ratio. Rather than forcing all
variables into the equation or using a stepwise approach, only those scales
that were significant in both the ANOVA analysis and the respective Odds
Ratio analysis were included in the logistic regressions. Also, as a primary
focus of this work is personality disorders, only those scales were included.
This further serves to guard against chance result. The variables were all
entered but only those that are significant in the final summary are
interpreted.
Table 4 provides the summary information for the prediction of sex of-
fenders from the nonsexual inmates. Dependent, Narcissistic, Antisocial,
and Schizotypal are significant. The positive beta weights for Dependent and
Schizotypal indicate that high scores here are associated with being a sex of-
fender. The negative beta weights for Narcissistic and Antisocial indicate as-
sociation with nonsexual status. The Odds Ratio associated with the final
predictive matrix is 2.12.
Table 5 presents the logistic regression summary table for the differentia-
tion of child molesters from rapists. While five scales were significant in both
of the univariate analyses, only one scale, Dependent, was significant in the
final regression. Here the positive beta indicates that higher Dependent
SEX OFFENDER PSYCHOPATHOLOGY 315
Beta Wald p
Personality Disorders
Schizoid 0.209 0.587 .444
Avoidant 0.199 0.744 .388
Depressive 0.102 0.176 .675
Dependent 0.490 4.034 .045*
Selfdefeating 0.140 0.247 .619
Constant 0.496
scores are associated with child molester status. The Odds Ratio for the final
prediction matrix was 2.09.
As is typical with most multiscale tests, there is quite a bit of shrinkage
from univariate to multivariate analyses. Final regression analyses are the
most conservative and appropriately interpreted. Individual univariate
analyses are viewed as inconclusive. On the other hand, the multivariate
analyses can overlook important clinical information in the vacuum of
multicolinearity.
DISCUSSION
The present study establishes that sex offenders in general are different
from nonsexual offenders with regard to psychopathology. While several
scales indicate high levels of pathology in both groups, a number of scales
suggest differences between the two types of offenders. Nonsexual offenders
seem to have more classic criminal personality styles such as Antisocial,
Narcissistic, and Sadistic patterns. There is also evidence of nonsexual of-
fenders having higher rates of substance abuse. The sex offenders in general
were more broadly pathological with elevations typically associated with
more traditional mental health types of problems. These include the social
inadequacies of Schizoid, Avoidant, Dependent, and Schizotypal; the affec-
tive characteristics of Depressive, Anxiety, Dysthymia, and PTSD; as well as
the relatively severe psychopathology of Thought Disorder, Major Depres-
sion, and Delusional Disorder. Multivariately, Dependent, Narcissistic,
Antisocial, and Schizotypal are the most important.
The present data also show that child molesters are different from rapists
in terms of personality and clinical syndromes. The neurotic trend from
nonsexual offenders to sex offenders generally continues when the sex of-
fenders are differentiated into the two groups. The child molesters differ
from the rapists along the same social and affective lines. Indeed, child mo-
lesters have some very high levels of psychopathology. Forty-one percent are
high on Avoidant, 30% on each of Depressive and Dependent, 49% on Anxi-
ety, and 30% on Dysthymia. This suggests that child molesters are quite dis-
turbed from a psychopathology perspective, and Dependent is the most
important statistically. The disturbance is not classically criminal. It is also
probably as characterlogical as Axis I in nature.
316 AHLMEYER ET AL.
These findings support the empirical literature that sexual offenders man-
ifest severe comorbid psychopathology, especially affective disorders and
psychosis (e.g., McElroy et al., 1999; Armentrout & Hauer, 1978). Mar-
shalls (1993) theoretical understanding of the concept of developmental
vulnerability in sexual offenders is more recently gaining recognition as a
comprehensive model for pinpointing the etiology of sexual deviancy. While
this model leans toward sexual victimization as a critical component, lack of
attachment is the central factor in the development of psychopathology in
general (Werner, 1989). Research in fleshing out these pathways is
currently being undertaken (e.g., Simons, Wurtele, & Heil, 2002).
From a test perspective, it is interesting that not only were many of the
findings involving the MCMI-I replicated here but also that the new scales all
differentiated among the groups. The Depressive and Self-defeating scales
are significant in both comparisons. The Sadistic and PTSD scales separate
sex offenders in general from nonsex offenders.
These data also suggest that treatment might focus on the underlying so-
cial and affective disturbances of the offender in addition to the offense be-
haviors. The depth of the characterlogical disturbance shown here suggests
more than simple behavior. Treatment should address both the personality
disturbance as well as the Axis I disturbance. These profiles also suggest
that individualized treatment plans are probably warranted. While there are
many logistical and financial reasons to have fixed treatment programming,
the highly varied nature of the psychopathology found here indicates that
the best treatment success will probably be found through relatively narrow
treatment protocols.
It is important to note several of the limitations of this study. First, these
inmates represent only those in Colorado. A good cross-replication in an-
other large state would certainly be of interest. This should be increasingly
easy because a number of additional states including Illinois have adopted
the MCMI-III as an initial screening instrument. Second, the numbers of
subjects in the two sex offender groups are a bit small. Confidence would be
higher if the two groups were closer to 1,000 each. Additionally, we used as
our control group all offenders who did not commit a sex offense. An alterna-
tive is to use only those convicted of a violent crime as the control group such
as Chantry and Craig (1994) have done. The difficulty with this is that there
is some belief in corrections that offenders of any type tend to commit many
different types of crimes and as such the current conviction is inappropri-
ately narrow. Finally, we excluded about 10% of profiles as being invalid.
This is a higher exclusion rate than that suggested by the manual. Other
locations using the current findings should take that into account.
This study found that sexual offenders manifest severe psychopathology
in comparison to controls. The comorbid Axis I clinical syndromes and Axis
II personality disorders suggest adjunct therapies to traditional sex offender
treatment will be necessary for obtaining efficacious outcomes. The
MCMI-III appears to be a useful instrument for differentiating these critical
areas related to sexual offense behaviors.
SEX OFFENDER PSYCHOPATHOLOGY 317
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