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Predicting escalation in sexually

violent recidivism: Use of
the SVR-20 and PCL: SV to
predict outcome with non-
contact recidivists and contact
recidivists
Gary JD Macpherson Consultant forensic clinical
a
psychologist AFBPsS, CPsychol
a
State Hospital , Carstairs, Lanark, ML11 8RP,
Scotland, UK
Published online: 17 May 2010.

To cite this article: Gary JD Macpherson Consultant forensic clinical psychologist

AFBPsS, CPsychol (2003) Predicting escalation in sexually violent recidivism: Use of
the SVR-20 and PCL: SV to predict outcome with non-contact recidivists and contact
recidivists , The Journal of Forensic Psychiatry & Psychology, 14:3, 615-627, DOI:
10.1080/14789940310001615470

To link to this article: http://dx.doi.org/10.1080/14789940310001615470

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 The Journal of Forensic Psychiatry & Psychology
Vol 14 No 3 December 2003 615627

Predicting escalation in
sexually violent recidivism:
Use of the SVR-20 and
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PCL: SV to predict outcome

with non-contact recidivists
and contact recidivists
GARY J.D. MACPHERSON,

ABSTRACT Forty convicted male sex offenders were classied as non-

contact or contact sex offence recidivists. Non-contact recidivists had a history
of non-contact sex offending on two or more occasions. Contact recidivists
had a history of non-contact sex offending and recidivated with a contact sex
offence. Groups were compared on the Sexual Violence Risk-20 (SVR-20) and
the Psychopathy Checklist: Screening Version (PCL: SV). Psychosexual
variables, criminal history and clinical risk factors were also coded using a
multi-variable assessment model. A retrospective-prospective comparison was
performed between non-contact and contact recidivist groups. Signicant
differences between non-contact recidivists and contact recidivists were
observed on a number of risk factors. Suggested revisions to the SVR-20 are
reported. The research demonstrates that a progressive pattern of sex offending
from non-contact sex offending to contact sex offending is reliably associated
with a combination of risk factors. This study offers the potential for early
detection of escalation in the severity of sex offending.

Keywords: risk assessment, sex offending, SVR-20, psychopathy

The Journal of Forensic Psychiatry & Psychology

ISSN 1478-9949 print/ISSN 1478-9957 online # 2003 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/14789940310001615470
 616 JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY Vol. 14 No. 3

INTRODUCTION
Research and clinical opinion has suggested that deviant sexual behaviour
may be classied by a simple hands-on and hands-off classication (Mair
and Stevens, 1994; Sugarman, Dumughn, Hinder and Bluglass, 1994). These
terms have been used interchangeably with the terms contact and non-
contact offending. The term non-contact refers to sex offenders whose
behaviour is characterized by offending without any physical contact with
the victim. The term contact refers to those individuals who have made
physical contact with the victim as part of the offending behaviour.
Few studies exist that examine recidivism rates of non-contact sex
offenders. Clinical tradition views these offenders as generally harmless
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(West, 1987). Snaiths (1983) early clinical case reports suggested that
progression from non-contact sex offending to more serious sexual violence
was the exception rather than the rule. Hanson and Harris (1998) excluded
non-contact offenders from their research on dynamic predictors of sex
offence recidivism. The few available research studies conclude that non-
contact sex offenders generally do not gravitate towards more serious sexual
crimes (Gebhard, Gagnon, Pomeroy and Christenson, 1965; West, 1987)
and non-contact offending is unlikely to lead to more intrusive types of sex
offending (Mair and Stevens, 1994).
However, non-contact sex offenders have high rates of recidivism (Mair
and Stevens, 1994), and Gebhard et al.s (1965) study found that
approximately one-fth of his sample of 135 non-contact offenders
gravitated towards sexual violence involving physical contact. Sugarman et
al. (1994) examined the psychiatric and medical case notes of 210 non-
contact offenders referred to a forensic psychiatric service, with a follow-up
period ranging between 8 and 25 years. They found that 26% of their sample
accrued at least one conviction for a contact sex offence. Non-contact
offenders who gravitated towards more intrusive types of offending were
more likely to have a history including childhood conduct disorder,
excessive libido, and convictions for acquisitive offending.
Quinsey, Harris, Rice and Cormier (1998) have argued that clinical
judgement is so inferior to actuarial methods that any consideration of
clinical risk factors simply dilutes predictive accuracy. However, wholly
actuarial approaches to risk assessment may neglect potentially relevant or
dynamic risk factors. Some authors have suggested adopting structured
clinical judgement to assess risk of recidivism, that is, risk assessment
conducted according to guidelines that are grounded in the scientic
literature (Boer, Hart, Kropp and Webster, 1997). Holland, Holt, Levi and
Beckett (1983) stated that empirically based clinical composites may be
superior to either actuarial or unstructured clinical judgement alone in
predicting recidivism with sex offenders. Hanson and Bussiere (1998) also
 PREDICTING SEXUAL VIOLENCE 617

suggested that guidelines informed by the empirical research can improve

the accuracy of violence prediction.
Boer et al. (1997) provide a set of guidelines for the structured clinical
assessment of risk of sexual violence. They refer to these guidelines as the
Sexual Violence Risk-20 (SVR-20). The SVR-20 is a practical manual that
considers clinical and empirical factors reported in the literature that are
known to be associated with recidivist sexual violence. The SVR-20 is
derived from a theoretical perspective and no data currently exist on the
effectiveness of the SVR-20 as a prediction instrument in clinical practice
although the method of examining multiple variables has support in the
meta-analytic research conducted on sex offending (Hanson and Bussiere,
1998).
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There continues to exist a demand by forensic mental health professionals

to establish factors that discriminate between sex offenders who do not
escalate in terms of sex offence severity from sex offenders who gravitate
towards more intrusive contact sex offending. The current study is unique
for two reasons. First, the research is the rst attempt to empirically validate
the SVR-20 with a clinical population of non-contact and contact sex
offenders. Second, the study aims to assess the potential of the SVR-20 for
early detection of non-contact sex offenders who may recidivate in a
sexually violent manner.

METHOD AND MATERIALS

The gold standard for evaluating any risk assessment scheme is to conduct a
long-term follow-up of convicted sex offenders at large in the community
post-evaluation and in the absence of any risk management strategies. Such
methodology may be informative for research purposes but clinically
undesirable in terms of withholding supervision from offenders. The
observed sex offence recidivism base rate is sufciently low that many years
are required before new studies yield meaningful results (Hanson and
Thornton, 1999). Furby et al. (1989) suggested that retrospective methods of
examining sex offence recidivism can be helpful to assist in the design of
prospective studies for two reasons. First, retrospective designs can provide
information about psychometric properties of measures and the magnitude
of change expected on various criteria. Second, results from retrospective
studies can be available within months, in contrast to the many years that it
takes to process subjects through all phases of a prospective evaluation.
A total of 40 patients were included in the present study. The patients
had been referred for assessment to a multi-disciplinary forensic
outpatient clinic in the centre of Glasgow over a period of 3 years. All
cases included in the study had to satisfy the minimum requirements of
 618 JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY Vol. 14 No. 3

sufcient case material, including a schedule of criminal convictions and

adequate collateral material. The patients were separated into two groups
based solely on offence history: One group of 20 sex offenders had a rst
conviction for a non-contact sex offence and recidivated with a further
non-contact sex offence. A second group of 20 contact offenders had a
rst conviction for a non-contact sex offence and recidivated with a
contact sex offence. All patients were assessed after recidivating using the
Sexual Violence Risk-20 (Boer et al., 1997) and the Psychopathy
Checklist: Screening Version (Hart, Cox and Hare, 1995) and additional
criminogenic and demographic information was recorded in a coding
booklet.
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THE SEXUAL VIOLENCE RISK-20

The SVR-20 consists of 20 risk factors divided into three major sections. The
sections and risk factors have been dened according to conventional
clinical opinion (Boer et al., 1997). As such they are not statistically
computed factors and the individual items are not equally weighted. The
items are intended to be elicited by semi-structured clinical interview and
le review.
The rst section of the SVR-20 relates to Psychosocial Adjustment, and
considers factors that are historical in nature, reecting either xed or
established characteristics, past and current functioning, and general social
and anti-social behaviour. The second section involves historical and
dynamic factors relating to sex offence specic behaviours. The third section
reects an individuals Future Plans. Ratings for each of the 20 items were
made on a three-point scale according to guidelines contained within the
manual (Boer et al., 1997).

THE PSYCHOPATHY CHECKLIST: SCREENING VERSION

The Psychopathy Checklist: Screening Version (Hart, Cox and Hare,

1995) is a 12 item clinical construct rating scale based on clinical interview
and/or a review of available collateral information. Each item is rated on a
three-point scale according to how well it matches the description of
prototypical psychopathic traits contained within the PCL: SV manual. A
score of zero on any item indicates that the description does not apply. A
score of one indicates that there is a partial match between the subjects
characteristic and the information in the scoring manual. A score of two
indicates the presence of a good match on the essential features of that
item.
 PREDICTING SEXUAL VIOLENCE 619

The PCL: SV has 12 items and the maximum score is 24. Scoring criteria
contained within the manual indicate that a score of 18 or greater is
indicative for diagnostic purposes of psychopathy. Scores of 12 or below are
indicative of non-psychopaths. Scores of 13 to 18 are indicative of moderate
levels of psychopathy. Although it is possible that the underlying construct
is categorical, PCL: SV scores provide a useful indicator of the number of
psychopathic traits and behaviours presented by an individual.

RESULTS

Bryman and Cramer (1999) indicated that the Mann-Whitney test should be
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the statistical test of choice where data for two or more groups is non-
parametric, for determining the differences between means where the
assumptions underlying parametric tests cannot be met, and for a two
condition unrelated design when different subjects are used for each of the
conditions. A t test was used for variables that were parametric in nature and
a Mann-Whitney was used for non-parametric variables.
Both groups were relatively homogenous on a number of criminogenic
variables there were no signicant differences observed between non-
contact recidivists and contact recidivists for age or age at rst sex offence.
No signicant ndings were observed for variables relating to number of
non-sexual convictions, and both groups had similar histories of psycho-
sexual intervention. A signicant difference was found between the non-
contact recidivists and contact recidivists with regard to age at rst non-
sexual offence (t = 2.15, d.f. = 20, p = 0.044) with contact recidivists being
signicantly younger than non-contact recidivists at rst non-sexual
offence.
Quinsey, Rice and Harris (1995) stated that time at risk should be coded
as the time elapsed from date of rst conviction until time of second
conviction. Non-contact recidivists were at risk for an average of 11 years 8
months (S.D. = 10 years 3 months) between rst sex offence and follow-up
sex offence. Contact recidivists were at risk for an average of 8 years 2
months (S.D. = 9 years 6 months). Time at risk did not differ signicantly
between groups. No measure was available to determine the possible
confound of time spent in prison during time at risk although no signicant
difference was observed between non-contact recidivists and contact
recidivists on history of custodial sentences.
There were a number of signicant ndings between groups on risk
factors of the SVR-20. Sexual deviation was a signicant factor discriminat-
ing the non-contact recidivists from the contact recidivists (U = 68, n = 40,
p = 0.0002). A previous history of childhood victimization including
physical and/or sexual abuse was found to be a signicant factor
 620 JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY Vol. 14 No. 3

Table 1 Items of the Sexual Violence Risk-20 (Boer et al. 1997)

Part A: Psychosocial adjustment

1. Sexual deviation
2. Victim of child abuse
3. Psychopathy
4. Major mental illness
5. Substance abuse problems
6. Suicidal/homicidal ideation
7. Relationship problems
8. Employment problems
9. Past non-sexual violence
10. Past non-violent offending
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11. Past supervision failures

Part B: Sex offences

12. High density sexual offending
13. Multiple sex offence type
14. Physical harm to victim
15. Uses weapons or threats of death
16. Escalation in frequency or severity
17. Extreme minimization or denial
18. Attitudes that support sex offending

Part C: Future plans

19. Lacks realistic plans
20. Negative attitude towards intervention

discriminating between non-contact sex offenders and contact sex offenders

(U = 98.5, n = 40, p = 0.0051) offenders with a previous history of
victimisation were at elevated risk of contact recidivism. A signicant
nding was the difference in levels of non-violent offending between non-
contact recidivists and contact recidivists as assessed using the SVR-20 item
criteria. The same result was not observed using a mean total of offences and
convictions between non-contact offenders and contact offenders and may
be a feature of the less strict criteria used to dene non-violent offending on
the SVR-20 as mean total of offending behaviours is not calculated on
convictions alone.
A number of signicant differences were observed between non-contact
recidivists and contact recidivists on items of the SVR-20 relating to Part
B: Sexual Offences. These results primarily reect the difference between
groups with regard to contact and non-contact offending and may not be
open to interpretation due to the risk of circularity. Of note was the non-
 PREDICTING SEXUAL VIOLENCE 621

Table 2 Items of the Psychopathy Checklist: Screening Version (Hart et al. 1995).

PCL: SV items
Part 1 Part 2

1. Supercial 7. Impulsive
2. Grandiose 8. Poor behavioural controls
3. Deceitful 9. Lacks goals
4. Lacks remorse 10. Irresponsible
5. Lacks empathy 11. Adolescent antisocial behaviour
6. Doesnt accept responsibility 12. Adult antisocial behaviour
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signicant nding between the groups on Item 12 of the SVR-20: High

Density Sexual Offences. A tentative conclusion was that non-contact
recidivists and contact recidivists committed a similar frequency of
offences taking into account time at risk the offences varied only with
respect to offence severity and escalation from non-contact to contact
offending. This result runs contrary to the sample of offenders studied by
Mair and Stevens (1994). They found that exhibitionists have a relatively
high rate of sex offence recidivism and higher prevalence of sexual
convictions both before the index offence and over the ten-year follow-up
period. The current nding is consistent with the meta-analysis of Hanson
and Bussiere (1998) who failed to nd a difference between non-contact
and contact offenders and recidivism rates in a North American
population of sex offenders.
None of the non-contact recidivists met the diagnostic cut-off for
psychopathy on the PCL : SV and two contact sex offenders met cut-off
criteria for psychopathy. It is of interest to note that only 5% of the sample
of recidivist sex offenders in the current research were classied as
psychopaths. This result is not consistent with North American research
on prevalence of psychopathy in sex offender populations although the
nding has support in the research on cultural differences in the prevalence
of psychopathy between UK and North American samples (Doyle, Dolan
and McGovern, 2002) and may also reect the observation that le ratings
result in a more conservative score on the Psychopathy Checklist (Wong,
1988).
A signicant difference was observed between non-contact recidivists and
contact recidivists on factors of the SVR-20 relating to Extreme Minimisa-
tion or Denial (U = 126.0, n = 40, p = 0.0460) and Attitudes that Support or
Condone Offending (U = 108.5, n = 40, p = 0.0122). Contact offenders were
signicantly more likely to minimise or deny their offending behaviour or
to hold attitudes that are supportive of sex offending.
 Table 3 Comparison of Sexual Violence Risk-20 (SVR-20) items between 20 non-contact recidivists and 20 non-contact to contact

622
recidivists referred to a multidisciplinary forensic outpatient clinic using a Mann-Whitney Analysis

JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY

Non-contact Contact recidivist
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SVR-20 Items Mann-Whitney Analysis recidivist means means

A. Psychosocial Adjustment
1. Sexual Deviation U = 68, n = 40, p = 0.0002** 0.85 1.85
2. Victim of Child Abuse U = 98.5, n = 40, p = 0.0051** 0.25 1.10
3. Psychopathy U = 98.5, n = 40, p = 0.0051** 0.05 0.70
4. Major Mental Illness U = 174.0, n = 40, p = n.s. 0.45 0.20
5. Substance Abuse Problems U = 180.5, n = 40, p = n.s. 0.65 0.45
6. Suicidal/Homicidal Ideation U = 171, n = 40, p = n.s. 0.10 0.30
7. Relationship Problems U = 194.5, n = 40, p = n.s. 1.30 1.25
8. Employment Problems U = 146.0, n = 40, p = n.s. 0.70 1.10
9. Past Non-sexual Violent Offences U = 190.0, n = 40, p = n.s. 1.25 1.30
10. Past Non-violent Offences U = 120.0, n = 40, p = 0.0304* 0.40 1.20
11. Past Supervision Failures U = 163.5, n = 40, p = n.s. 0.70 1.05

B. Sexual Offences
12. High Density Sexual Offences U = 176.0, n = 40, p = n.s. 1.00 1.20
13. Multiple Sex Offence Type U = 12.0, n = 40, p = 0.0000** 0.15 1.60
14. Physical Harm to Victim U = 90.0, n = 40, p = 0.0024** 0.00 1.00
15. Uses Weapons or Threats of Death U = 130.0, n = 40, p = 0.0596* 0.00 0.55
16. Escalation in Frequency or Severity U = 1.5, n = 40, p = 0.0000** 0.05 1.85
17. Extreme Minimisation or Denial U = 126.0, n = 40, p = 0.0460* 1.15 1.65
18. Attitudes that Support Sex Offences U = 108.5, n = 40, p = 0.0122* 0.25 0.85

Vol. 14 No. 3
C. Future Plans
19. Lacks Realistic Plans U = 148.5, n = 40, p = n.s. 0.75 0.75
20. Negative Attitude Towards Intervention U = 152.5, n = 40, p = n.s. 0.25 0.85

*at p 5 0.05 level. **at p 5 0.01 level. Bonferroni correction applied.

 PREDICTING SEXUAL VIOLENCE 623

DISCUSSION

There is considerable responsibility on the clinician to identify non-contact

sex offenders who may potentially commit sexually violent behaviours
(Hall, 1990) and an increased demand for evidence-based risk assessments
(Macpherson, 1997; Thomas-Peter and Warren, 1998). This research was
aimed at providing an evidence base to clinical decision making by
proposing a systematic method for differentiating sex offenders who do
not escalate in terms of offence severity from offenders who gravitate
towards more serious sexual crimes.
Predicting the sex offenders who escalate in terms of offence severity is
important for several reasons. First, non-contact offending has been found
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to be the most common type of sexual offence in the UK (Mair and Stevens,
1994; Snaith, 1983). Rooth (1973) found that non-contact sex offending was
the most commonly prosecuted sexual offence. Second, both clinical
opinion and the few predictive research studies on male sex offenders
conclude that a signicant minority of non-contact offenders gravitate
towards sexual violence involving physical contact (Gebhard et al., 1965;
Mair and Stevens, 1994; West 1987).
Boer et al. (1997) also suggest that the presence or absence of a certain
number or combination of SVR-20 factors might be clinically useful in
attempts to predict risk for different groups of sex offenders. The results of
the present study show that a progressive pattern of sex offending from non-
contact sexual offending to contact sexual offending is associated with a
combination of several factors from the SVR-20.
The presence of a sexual deviation is one of the most signicant factors
associated with sexually violent recidivism in a range of research studies,
reviews of the clinical literature, and meta-analyses (Greer, 1991; Hanson
and Bussiere, 1998; McGovern and Peters, 1988; Murphy, Haynes and Page,
1992). Sexual deviation is also a signicant risk factor for recidivism in
studies of young sex offenders in North America and Northern Europe
(Langstrom, 1999; Ross and Loss, 1991). The signicant difference between
non-contact sex offence recidivists and contact recidivists with regard to
sexual deviation in the current study is unlikely to simply reect a confound
of an escalation towards contact sex offending. It has long been emphasized
that the motives of power and anger predominately characterise rape, rather
than sexual assault motivated primarily by sexual deviation (Cohen, Seghorn
and Calmas, 1969; Knight and Prentky, 1990; Prentky, Knight, Lee and
Cerce, 1995). The presence of a sexual deviation predicts sex offence
recidivism in general (Hanson and Bussiere, 1998) and appears to be a
powerful factor discriminating between sex offenders who escalate in terms
of offence severity and sex offenders who recidivate with non-contact sex
offending in the current study.
 624 JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY Vol. 14 No. 3

Reviews of the literature conclude that a history of child abuse is linked

to sex offending possibly because of the inuence of sexual abuse on deviant
sexual practices (Marshall, Laws and Barbaree, 1990). Hanson and Harris
(1998) found that sex offence recidivists were more likely to have histories
of sexual and emotional abuse. Lewin, Beary, Toman and Sproul-Bolton
(1994) found a denite history of physical and sexual abuse in 48 per cent of
offenders referred to a community based treatment programme, and a
review of the literature by Jehu (1991) found an association between sex
offending in adulthood and a history of sexual abuse in childhood. It may be
that the majority of non-contact recidivists do not gravitate towards contact
sexual offending due to the absence of exposure to an abusive orientation in
childhood. Bentovim (1996) considered that abuse in childhood is an
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important factor in triggering abusive action as an adult, as an early

experience of abuse is the key factor leading to abusive behaviour towards
children in adulthood. The current research found that a progressive pattern
of sex offending from non-contact sexual offending to contact sexual
offending is associated with a history of childhood victimisation. At present
the SVR-20 guidelines for coding childhood victimisation combine both
physical non-sexual abuse and sexual abuse as a single factor. Further
exploration on type of victimisation may be appropriate as sexual abuse in
childhood may produce behaviours in adulthood that differ from those
associated with non-sexual physical abuse or serious neglect in childhood.
Several points can be concluded from the signicant difference observed
between non-contact recidivists and contact recidivists with regard to items of
the PCL: SV. First, when the PCL: SV is used as a dimensional measure, the
presence in particular of affective and interpersonal characteristics of
psychopathy appears to discriminate between non-contact and contact sex
offenders. Second, the research is consistent with the view expressed in the
PCL: SV manual (Hart et al., 1995) that psychopathic traits may prove useful
for research in predicting behaviour where no one fulls the diagnostic criteria
for psychopathy. It is notable that few of the recent assessment guidelines with
the exception of the SVR-20 incorporate a measure of psychopathy as a
variable in the assessment of risk of sexual violence (Greer, 1991; Grubin,
1998; Hanson, 1997; Hanson and Thornton, 1999; Quinsey et al., 1998; Ross
and Loss; 1991) despite unanimous agreement on the importance of
psychopathy in the structured assessment of violence in general (Webster,
Douglas, Eaves and Hart, 1997). The present research conrms the validity of
psychopathic traits as important factors to consider when assessing the
potential for escalation towards sexually violent recidivism.
The signicant difference observed in level of cognitive distortions
between non-contact recidivists and contact recidivists on factors relating to
denial and attitudes supportive of offending suggests that contact offenders
are signicantly more likely to minimize or deny their offending behaviour
 PREDICTING SEXUAL VIOLENCE 625

or hold offence justifying beliefs than non-contact recidivists. There appears

to exist a relationship between degree of intrusiveness of sex offending and
subsequent level of cognitive distortions. This nding may require
interpretation as Marshall et al. (1999) comment on the absence of evidence
that changing a deniers status to one of admission has any effect on
subsequent recidivism.

CONCLUSION

There is sufcient evidence to indicate that empirically based risk

assessments can meaningfully predict the risk for sexual offence recidivism
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(Hanson and Thornton, 1999). It is suggested that the simple dichotomous

categorization of sex offenders should receive support in future research.
This study is an attempt to provide the clinician with a structured clinical
assessment procedure that offers the potential for early detection of non-
contact sex offenders whose offending behaviour may escalate towards
sexual violence. The factors that discriminated between non-contact and
contact sex offenders were primarily historical in nature, reecting xed or
relatively stable characteristics. This may allow for the early detection of a
potentially more serious escalation in sexual offending, and the possibility of
supervision and clinical risk management to reduce recidivism risk.

ACKNOWLEDGEMENTS

The author would like to thank Dr Ursula Cawthorne at the Northern

Forensic Mental Health Service for Young People, St Nicholas Hospital,
Newcastle-upon-Tyne and Dr Tom White at the State Hospital, Carstairs,
for their helpful comments.

Gary Macpherson, AFBPsS, CPsychol, consultant forensic clinical psychologist,

State Hospital, Carstairs, Lanark, ML11 8RP, Scotland, UK

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