Journal of Forensic and Legal Medicine 31 (2015) 23e28

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Original communication

A forensic-psychiatric study of sexual offenders in Rio de Janeiro,

Brazil
Alexandre Martins Valença a, b, *, Leonardo Fernandez Meyer a, Rafael Freire a,
Mauro Vitor Mendlowicz a, b, Antonio Egidio Nardi a
a
Institute of Psychiatry-Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro), RJ, Brazil
b
Department of Psychiatry and Mental Health-Fluminense Federal University, Nitero
i (Universidade Federal Fluminense), RJ, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: Sexual violence is defined as any sexual act forced upon a person who did not give his or her consent. Our
Received 20 September 2014 objective is to investigate the socio-demographic features, clinical correlates, criminal behaviour char-
Received in revised form acteristics, and the level of penal responsibility of sexual offenders who were referred to forensic psy-
30 November 2014
chiatric assessment in the city of Rio de Janeiro, Brazil. This is a cross-sectional descriptive study. All
Accepted 9 January 2015
written reports made in the year of 2008 by court-appointed psychiatric experts on individuals charged
Available online 16 January 2015
with having committed sexual crimes and referred to the main forensic hospital in the State of Rio de
Janeiro, Brazil, for assessment were reviewed. Forty-four expert reports were identified. All alleged of-
Keywords:
Sex offender
fenders were male. Nineteen (43.2%) offenders did not receive any psychiatric diagnostic. Nine offenders
Sexual crime (20.4%) were diagnosed with mental retardation. In 16 cases (36.4%), some form of mental or neuro-
Penal responsibility logical disorder was diagnosed. Thirty-one (70.4%) offenders were considered fully responsible, eight
Mental disorder (18.2%) partially responsible, and five (11.4%) not responsible by reason of insanity. The sexual crimes
Intellectual disability allegedly perpetrated by the offenders were rape (n¼14, 32%), attempted rape (n¼4, 9%), indecent assault
Alcohol abuse (n¼26, 59%), and indecent exposure (n¼5, 11.4%). In 10 cases (22.7%), the offender was under alcohol
influence at the moment of the crime. The profile of Brazilian sex offenders subject to forensic psychiatric
assessment were male, caucasian, single, working part time, with no mental disorder, who perpetrated
indecent assault.
© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

1. Introduction coercion.2 Defining sexual crimes is not a straightforward task:

Sexual violence (SV) is a multidimensional concept that has a
number of definitions, depending on the context it is used. For
Bradford et al.,1 it is defined as any sexual act forced upon a person
who did not give his or her consent. Besides imposed sexual ac-
tivity, SV usually also includes extreme physical violence against
the victim.
SV victimizes men and women of all ages. It can present itself in
a number of ways. It is not limited to acts of non-consented sexual
intercourse (rape or attempted rape), but also includes penetration
of other parts of the body, using the penis, fingers or other objects,
inappropriate caresses and kisses, sexual harassment, and
* Corresponding author. R. Conde de Bonfim, 232, sala 511-Tijuca, Rio de Janeiro-
RJ, CEP 20520-054, Brazil. Tel.: þ55 21 2264 4394.
E-mail address: avalen@uol.com.br (A.M. Valença).
while motivation-based definitions emphasize the offender pur-
pose of obtaining sexual satisfaction, legal ones rely on the defini-
tions of sexual crimes found in penal statutes.3
Sexual violence has profound, pervasive, and enduring effects
on the physical and mental health and well-being of the victims.
Long-term physical consequences include gynecological and
pregnancy complications, chronic pelvic pain, premenstrual syn-
drome, gastrointestinal disorders, migraines and other frequent
headaches, and facial and back pain.2 Chronic psychological con-
sequences include major depression, post-traumatic stress disor-
der, engaging in high-risk or harmful behaviors and attempted or
completed suicide.4,5 Sexual violence also has social consequences,
such as strained relationships with family, friends, and intimate
partners and lower likelihood of marriage.6,7
It is believed that incidents of SV are underreported. This is due
to the “culture of secrecy” surrounding sexual assault cases. Victims

http://dx.doi.org/10.1016/j.jflm.2015.01.003
1752-928X/© 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
24 A.M. Valença et al. / Journal of Forensic and Legal Medicine 31 (2015) 23e28

Table 1
Comparison between the groups with no mental disorder, with mental retard and with other diagnostics.

With no mental disorder (n ¼ 19) Mental retardation (n ¼ 9) Mental or neurologic disorders (n ¼ 16)

Average/n SD/% Average/n SD/% Average/n SD/%

a
Age 41 12 47 16 47 11
Age at the time of the crimeb 40 13 49 15 44 11
Educationc Up to 5 yrs 9 56, 3% 9 100, 0% 9 75, 0%
More than 5 yrs 7 43, 8% 0 ,0% 3 25, 0%
d
Marital status Partnered/married 9 47, 4% 1 11, 1% 9 56, 3%
Single 10 52, 6% 8 88, 9% 7 43, 8%
Psychiatric recordse 5 26, 3% 5 55, 6% 10 62, 5%
Previous significant use of alcoholf 3 15, 8% 2 22, 2% 8 50, 0%
Previous use of cannabisg 4 21, 1% 0 ,0% 1 6, 3%
Previous of use of cocaineh 3 15, 8% 0 ,0% 4 25, 0%
Rape or attempted rapei 8 42, 1% 3 33, 3% 7 43, 8%
Indecent assaultj 12 63, 2% 4 44, 4% 10 62, 5%
Indecent exposure in publick 1 5, 3% 2 22, 2% 2 12, 5%
Victiml Female adult 3 16, 7% 1 11, 1% 6 37, 5%
Female minor 11 61, 1% 5 55, 6% 8 50, 0%
Male minor 3 16, 7% 1 11, 1% 1 6, 3%
No victim 1 5, 6% 2 22, 2% 1 6, 3%
Relationship of the Known 12 63, 2% 4 44, 4% 9 56, 3%
m
perpetrator with a victim Unknown 6 31, 6% 3 33, 3% 6 37, 5%
No victim 1 5, 3% 2 22, 2% 1 6, 3%
Placen Residence of 8 42, 1% 3 33, 3% 3 18, 8%
perpetrator
In the street 9 47, 4% 5 55, 6% 10 62, 5%
Others 2 10, 5% 1 11, 1% 3 18, 8%
Use of alcohol at the time of the crimeo 2 10, 5% 1 11, 1% 7 43, 8%
p
Imputability Imputable 19 100, 0% 2 22, 2% 10 62, 5%
Semi-imputable or 0 ,0% 7 77, 8% 6 37, 5%
unimputable

SD ¼ Standard deviation; DF ¼ degrees of freedom.

a
ANOVA e P ¼ 0.311.
b
ANOVA e P ¼ 0.212.
c
Chi-square ¼ 5627 e 2 DF e p ¼ 0.060.
d
Chi-square ¼ 5022 e 2 DF e p ¼ 0.081.
e
Chi-square ¼ 5052 e 2 DF e p ¼ 0.080.
f
Chi-square ¼ 5175 e 2 DF e p ¼ 0.075.
g
Chi-square ¼ 3340 e 2 DF e p ¼ 0.188.
h
Chi-square ¼ 2691 e 2 DF e p ¼ 0.260.
i
Chi-square ¼ 0.278 e 2 DF e p ¼ 0.870.
j
Chi-square ¼ 1006 e 2 DF e p ¼ 0.605.
k
Chi-square ¼ 1776 e 2 DF e p ¼ 0.411.
l
Chi-square ¼ 5330 e 6 DF e p ¼ 0.502.
m
Chi-square ¼ 2624 e 4 DF e p ¼ 0.623.
n
Chi-square ¼ 2348 e 4 DF e p ¼ 0.672.
o
Chi-square ¼ 6329 e 2 DF e p ¼ 0.042.
p
Chi-square ¼ 18,512 e 2 DF e p < 0.001.

often choose silence in an attempt to forget the assault altogether
and to escape the shame and embarrassment that accompanies
sexual violence.8 Because of this, the epidemiology, the causes and
the consequences of SV have been receiving growing attention
from researchers and health and human rights activists.
According to Prentky & Knight,9 the majority of sexual criminals
is not acutely ill from the psychiatric point of view and thus would
have to face criminal charges for their acts. However, some stud-
ies10e13 have shown that a substantial proportion of sexual ag-
gressors exhibit mental diseases, such as personality disorders,
substance abuse, mood disorders and compulsive sexual behavior.
Sexual aggressors seem to be a highly heterogeneous group,
since there are large variations in the type of offense and the way
they commit them.14 In spite of there being many non-scientific
publications concerning the profile of sexual criminals/aggressors,
including sensationalist media reports, we found that there is a lack
of scientific studies on these types of aggressors in the Brazilian
scientific literature.
The evaluation of criminal responsibility, according to the Bra-
zilian Penal Code, is based on a biopsychological concept.15 This
implies that full penal responsibility can only be excluded if the
offender was, at the time of the criminal deed, suffering from a
mental disorder (i.e., a biologic cause) and, as a consequence, was
completely incapable of understanding the unlawful nature of his ⁄
her acts or to restrain him⁄ herself from committing them (psy-
chological consequences). The existence of a causal link between
the mental disorder and the offense must be established beyond
doubt.16 The possibility of cases with limited responsibility,
resulting from partial impairment of cognitive or volitional func-
tions, is also acknowledged by the Brazilian penal law. Those who
are deemed not responsible for their unlawful acts are committed
to involuntary inpatient treatment in forensic mental hospitals.
Therefore, the diagnosis of a serious mental disorder is an essential
prerequisite to exclude the penal responsibility of any sexual
offender and to have him or her treated rather than punished. In
Brazil, the assessment of the mental state at the time of the offense
is made during the judicial proceedings phase by a court appointed
forensic psychiatrist and is called the penal imputability exam.15
The objective of this study was to investigate the socio-
demographic features, clinical correlates, criminal behavior
 A.M. Valença et al. / Journal of Forensic and Legal Medicine 31 (2015) 23e28
characteristics, and the level of penal responsibility of sexual of-
fenders who were referred to forensic psychiatric assessment in the
city of Rio de Janeiro, Brazil in 2008. We aim to check the main
types of sexual crimes committed and victims affected, in addition
to verify if these individuals presented mental disorders at the time
of the offense, or not.
2. Methods
This is a cross-sectional descriptive study. All written reports
made in the year of 2008 by court-appointed psychiatric experts on
individuals charged with having committed sexual crimes and
referred to the main forensic hospital in the State of Rio de Janeiro,
Brazil, for assessment were reviewed. The type of crime (rape,
attempted rape, indecent assault, or indecent exposure, as defined
in the Brazilian Criminal Code), socio-demographic profile of the
alleged offenders, psychiatric diagnosis according to ICD-10
(WHO),17 criminal behavior characteristics, and the level of crim-
inal responsibility were recorded. The study was approved by the
local Internal Review Board. The procedures were in accordance
with the Helsinki Declaration.
3. Statistical analysis
We performed the statistical analysis in two steps. In the first
step, we divided the reports in two groups: offender with psychi-
atric diagnosis and offender without psychiatric diagnosis. In the
second step we divided the sample in three groups: offender
without psychiatric diagnosis, offender with mental retardation
and offender with other psychiatric diagnosis. In both group com-
parisons the chi-square was used for categorical variables. The
authors made a visual inspection of the data and used the Kolmo-
goroveSmirnov test to evaluate if the continuous variables had a
normal distribution. For comparisons of means of these variables
the Student's t test was used in the first step and the Analysis of
Variance (ANOVA) was used in the second step, but these para-
metric tests were used only if the variables had normal distribu-
tions. All analyses were two-tailed and the level of statistical
significance was set at 5%.
4. Results
Forty-four expert reports were identified. All alleged offenders
were male. Twenty-one individuals were Caucasians and 18 non-
Caucasian. Information about race was missing in five cases.
Twenty five offenders were single, nine were married, eight were
separated or divorced, and one widowed. Information about
marital status was missing in one case. Only four individuals were
working full time. Twenty six were working part time, seven were
unemployed, six were on sick leave and one was retired. Mean age
at the time of the offense was 44.3 (SD ¼ 12.5) years, ranging from
29 to 63 years. Regarding education, 73% of the sample had five
years of study or less.
Nineteen (43.2%) offenders did not receive any psychiatric
diagnosis. Nine offenders (20.4%) were diagnosed with mental
retardation. In 16 cases (36.4%), some form of mental or neuro-
logical disorder was diagnosed: epilepsy (n ¼ 2), alcohol depen-
dence (n ¼ 3), alcohol abuse (n ¼ 2), cocaine abuse (n ¼ 2),
schizophrenia (n ¼ 2), non-specified psychotic disorder (n ¼ 1),
hypomanic episode (n ¼ 1), anti-social personality disorder (n ¼ 1),
and sexual preference disorder (n ¼ 2) (see Table 1).
Thirty-one (70.4%) offenders were considered fully responsible,
eight (18.2%) partially responsible, and five (11.4%) not responsible
by reason of insanity. Among those found partially responsible, the
main diagnoses were mental retardation (n ¼ 5), hypomanic
25
episode (n ¼ 1) alcohol dependency syndrome (n ¼ 1) and sexual
preference disorder (n ¼ 1). Among those found not criminally
responsible by reason of insanity the main diagnoses were
schizophrenia (n ¼ 2), mental retardation (n ¼ 2) and non-specified
psychotic disorder (n ¼ 1).
The sexual crimes allegedly perpetrated by the offenders were
rape (n ¼ 14, 32%), attempted rape (n ¼ 4, 9%), indecent assault
(n ¼ 26, 59%), and indecent exposure (n ¼ 5, 11.4%). In a five cases
(11%) the individuals were accused of more than one type of sexual
crime. As regarding the relationship between perpetrator and vic-
tims, we found family victims (n ¼ 13), victims known to the
perpetrator (n ¼ 12), unknown victims (n ¼ 15). Among the victims
there was daughters (n ¼ 8), niece (n ¼ 3), sister-in-law (n ¼ 1) and
ex-wife (n ¼ 1). In two cases there was no specification of the
relationship between victim and perpetrator. In four other cases
there was no direct victims (crimes related to exposure of genitals
or masturbating in public spaces). The victims were mostly girls
(n ¼ 24, under 18 years old), but there were also adult women
(n ¼ 10, over 18 years old) and boys (n ¼ 5, under 18 years old).
In the majority of cases (n ¼ 43, 97.7%), there was one sole
perpetrator. Most crimes were committed in the streets (n ¼ 24,
54.5%; usually indecent exposure), but some cases took place in the
offenders' or the victims' house (n ¼ 14, 31.8% and n ¼ 3, 6.8%,
respectively). Firearms were employed in three cases, and one
offender pretended to be carrying one in more three.
In 10 cases (22.7%), the offender was under alcohol influence at
the moment of the crime. Eight of these individuals had mental
disorders: alcohol dependence (n ¼ 3), alcohol abuse (n ¼ 1),
cocaine abuse (n ¼ 1), schizophrenia (n ¼ 1), mental retardation
(n ¼ 1), and sexual preference disorder (n ¼ 1). When the offenders
with mental or neurological disorders (including mental retarda-
tion) were compared with those without any disorder, the former
were more likely to be under alcohol influence at the moment of
the crime (82 ¼ 6,329, p < 0.05) (Table 1).
In 13 cases, there were records of past abusive alcohol con-
sumption. Use of cocaine (n ¼ 7) and of cannabis (n ¼ 5) was also
documented, although there is no evidence that the offense was
committed under the influence of any of these two drugs. Twenty
individuals (45.5%) had a history of previous psychiatric treatment.
Eleven offenders (25%) reported involvement in criminal activities
other than the sexual crime they were being charged of. The re-
cords assessed did not specify about sexual preference disorders or
psychiatric comorbidities.
5. Discussion
Our study evaluated clinical, criminological, and socio-
demographic characteristics and the level of criminal re-
sponsibility of individuals who have allegedly committed sexual
crimes in the State of Rio de Janeiro, Brazil, in the year 2008, as
described in official forensic reports. Our findings highlighted the
fact that the majority of sexual aggressors did not suffer from a
mental disorder and that, even among those who were diagnosed
with a psychiatric illness, the sexual crimes were carried out with
full understanding and deliberation, thus warranting a conclusion
that the individuals were fully responsible for their acts.
Although most studies describe a high incidence of criminality
among younger individuals (between 16 and 25 years old),18 mean
age at the time of the offense was relatively high (44.3 ± 12.5). One
cannot exclude, however, the possibility that some of the accused
may have committed sexual crimes at a younger age without being
caught.
It is noteworthy that in 22.7% of the cases, offenders were under
the influence of alcohol at the time of the sexual crime. Four sexual
offenders were diagnosed with alcohol abuse or dependence. Other
26 A.M. Valença et al. / Journal of Forensic and Legal Medicine 31 (2015) 23e28
studies have emphasized the role played by the influence alcohol at
the time of commission of the sexual offense.19,20 Research has
shown an increased risk of physical violence when the offender is
intoxicated with alcohol.19 In a population-based study with 16,480
adults in New Zealand,20 1% of women and 0.4% of men reported a
sexual assault in the past 12 months. Forty-five percent of re-
spondents reporting sexual assault described more than one inci-
dent. Victims of sexual assault reported drinking by the perpetrator
in 57% of the incidents.
In our study the individuals accused of sexual crimes were
evaluated by psychiatric experts due to suspect of mental disorder,
which was not the case in the majority of the individuals examined,
as has already been mentioned. A significant point is that there was
description in the expert examination reports that the group of
individuals who presented mental or neurological disorder used
more alcohol at the time of the sexual crime (43.8%), compared to
the groups with no mental disorder (10.5%) and mental retardation
(11.1%) (p ¼ 0.042) (Table 1). Due to the small size of the total
sample (n ¼ 44), it was not possible to characterize a significant
number of individuals with a specific mental disorder. This group of
individuals with mental or neurological disorder received several
psychiatric diagnosis and in two cases there was a diagnosis of
epilepsy.
Studying this theme, Dunsieth et al.21 evaluated 113 men con-
demned for sexual offenses, who were referred to treatment pro-
grammes, in Ohio, in the United States. 84 men (74%) were found to
fulfill the diagnostic criteria for at least for one type of mental
disorder. The psychiatric diagnosis most encountered were: disor-
ders related to the use of drugs (n ¼ 84, 74%); paraphilias (n ¼ 84,
74%); mood disorders (n ¼ 66, 58%), with n ¼ 40 (35%) for bipolar
disorder; control of impulse disorder (n ¼ 43, 38%); anxiety dis-
orders (n ¼ 26, 23%) and eating disorder (n ¼ 10, 9%).
Harsch et al.22 compared the prevalence of mental disorders
among 40 sexual offenders in forensic psychiatric hospitals, 30
sexual offenders in prison, and 26 violent offenders in prison. It
was found that substance use and alcohol disorders were the most
frequent diagnosis in all three groups. In the forensic sexual
offender group, the prevalence of Axis I disorders, excluding
substance use disorders, was still at almost 63% and significantly
higher than among the imprisoned sexual offenders and the vi-
olent offenders groups. The percentage of personality disorders
(especially antisocial personality disorder) was significantly
higher in the group of forensic sexual offenders (85%), compared
to the imprisoned sexual offenders (27%) and the violent offenders
(39%) groups.
A study of Koch et al.23 compared the prevalence of psychiatric
and personality disorders in 166 homicidal and 56 nonhomicidal
sexual offenders. They found that homicidal sexual offenders were
significantly more likely to have consumed alcohol at the time of
their offense. This group also presented significantly more para-
philias, especially sexual sadism and fetishism. Pedophilia was
diagnosed more often in nonhomicidal sexual offenders. They were
also more likely to be diagnosed with an Axis II disorder, especially
schizoid personality disorder. No significant difference was found
in any cluster B personality disorders, such as antisocial personality
disorder, although this personality disorder has been the most
common in both groups. In our sample only one case received the
diagnosis of antisocial personality disorder. Maybe the experts of
our study were more concerned with the diagnosis of axis I disor-
ders. Some of the 19 offenders of the group without mental dis-
orders might have undiagnosed personality disorders.
Alcohol is used in some societies as an excuse for sexual
harassment and even rape. It is also sometimes used to justify both
the unlawful behavior of the offender and the presumed acquies-
cence of the victim. Indeed, Grubin24 found a high prevalence of the
use of alcohol among british rapists: 58% of the men convicted of
rape had been drinking before committing the offense and 37%
were considered to be alcoholics. A review of literature25 con-
cerning the prevalence of the use of alcohol among sexual offenders
have found great variability in the figures, which range from 13% to
63% among rapists and from 3% to 72% among young sexual of-
fenders. This large variability probably reflects differences in the
research methodology and in the composition of samples, such as
the use of different criteria for assessing the use of alcohol, the
thoroughness of the investigation of the use of alcohol before the
commitment of the crimes and local variation in the availability of
alcoholic beverages.25
Baltieri and Andrade26 evaluated the role of alcohol and drug
consumption in 100 men sentenced for sexual crimes against
children, in a penitentiary of Sorocaba, Sa ~o Paulo, Brazil, who
divided in sexual offenders against boys (n ¼ 48) and against girls
(n ¼ 52). Their research showed that sexual offenders against boys
were significantly more likely to have problems with alcohol than
sexual aggressors against girls. The authors point out that alcohol
problems management at correctional institutions might decrease
sexual offense recidivism.
Twelve individuals whose reports were examined for the pre-
sent study had a history of using illicit drugs, such as cannabis
(n ¼ 5) and cocaine (n ¼ 7). Recent research has focused on the
relationship between criminality and substance abuse. The preva-
lence of the use of illicit of drugs was 10%e48% among male in-
mates and 30%e60% among female prisoners.27 These estimates
vary widely, but they are much higher than in the general popu-
lation. Although there are few studies relating the type of drug
abuse to sexual aggression, Tzeng et al.28 found that 5.3% of the
child molesters had a record of misuse of cocaine and 14% had a
record of use of any illicit drug.
The close relationship between the use of alcohol and drugs and
sexual aggressions may have significant implications for penal and
health policies. Langevin and Lang29 emphasized the importance of
including substances abuse in the evaluation and treatment of
sexual offenders considering that the scientific literature found a
higher prevalence of alcoholics among sexual offenders than in the
general population. The abuse of alcohol and of illicit drugs should
be an important concern for health professionals who work with
sexual offenders and proper training on this issue should be pro-
vided to them.
Nine individuals of our sample (20.4%) received a diagnosis of
mental retardation. Several pieces of research have studied the
relationship between mental retardation and sexual crimes. Barron
et al.30 undertook a two-year prospective, study of offenses in 61
individuals with mental disability (IQ below 80), in London, UK.
Violence (57.4%) was the most common offense type when full
offense history was analyzed, with property offenses (52.5%) and
sex offenses also being common (47.5%). Day31 carried out a
retrospective study of individuals with mental disability hospital-
ized for the treatment of antisocial sexual behavior in England.
Forty-seven patients committed 191 incidents of sexual abuse with
a total of 202 victims. More than half of the incidents (55.5%) were
of heterosexual nature. There were also incidents of indecent
exposure (24.6%) and homosexual offenses (12%), with only 3.6% of
the cases involving physical aggression. The majority of the in-
cidents were relatively trivial, with 60% of them consisting of in-
decent exposure of minor seriousness.
Langevin and Curnoe32 studied a forensic database of 2.286
male sex offenders and paraphilics (SOPS) comparing with 241
nonsex offenders controls, in Canada. They found that there were
no differences among sex offenders and controls in overall IQ. Sex
offenders were generally of average intelligence and the mentally
retarded were not overrepresented among them, but the learning
 A.M. Valença et al. / Journal of Forensic and Legal Medicine 31 (2015) 23e28
disorders were. Unfortunately there was no information about
learning disabilities or sexual preference disorders in the records
we studied, which is a limitation of our study.
Another study33 compared two samples of offenders with in-
tellectual impairment. Those who perpetrated sexual offenses and
were involved in incidents of sexual abuse were compared to other
offenders whose offense had no sexual content. The sample con-
sisted of 106 sexual aggressors and 78 non-sexual offenders. All
were admitted to community treatment service in Scotland. It was
found that a significantly higher proportion of sexual aggressors
had a chaotic life style (32 %  16 %) and had problems of rela-
tionship (52% and 24%), compared to non-sexual offenders.
Regarding the types of sexual offenses, 33% committed lascivious
and libidinous (offenses without penetration in minors); 26% sex-
ual aggression; 21% indecent exposure; 11% illegal sexual inter-
course (2% for each).
In our study, individuals with a diagnosis of mental retardation
committed the following offenses: rape (n ¼ 3), indecent assault
(n ¼ 4) and indecent exposure in public (n ¼ 2). Their victims
consisted of adult women (n ¼ 2, with a single offender carrying
out both crimes), young girls (n ¼ 5), and a young boy (n ¼ 1). In
two cases of indecent exposure in public, there were no direct
victims. It is noteworthy that most victims of individuals with
mental retardation were minors (n ¼ 6). Some authors have tried to
explain the association between mental disability and sexual of-
fenses. Hayes34 suggested that these individuals have a confused
self-concept, poor social relationships, lack of social knowledge and
negative early experiences (including physical and sexual abuse). In
the reports we have examined, there was no information regarding
suffered physical and sexual abuse, a limitation we acknowledge in
the study.
The find that 20.4% of the sexual offenders received a diag-
nosis of mental retardation represents a level well above the
literature. According to some authors,35,36 it can be argued that
mentally retarded individuals may be overrepresented among
incarcerated sex offenders because they are more likely to be
apprehended by police as a result of their cognitive impairment
and carelessness in avoiding detection. In other words, these
individuals tend to be referred more often than expected by
chance for a psychiatric assessment when facing criminal
charges. The experts who examined the sex offenders made a
clinical interview using the ICD-1017 diagnostic criteria for the
establishment of psychiatric diagnosis. There was no application
of IQ tests. Some of the offenders of this group might have un-
diagnosed learning disabilities.
We found that in a large number of cases, the victims were
relatives or acquaintances of the offenders. Other study also has
found a high frequency of intra-family sexual aggressions.37 In
spite of the popular belief that sexual offenses are mostly
perpetrated by strangers, this type of crime is practised most
often by people known to the victim. In Brazil, a study indicated
that most sexual violence is carried out by parents or by people
close to the victim, which makes reporting of the crime more
unlikely.38 Factors such as the failure to report the offense due to
fear of retaliation or social stigma, make the knowledge of the
outcome of these cases difficult, as much for the victim as for the
perpetrator. In our study, another finding that highlights the
closeness between the offender and the victim was the fact that
31.8% of the sexual crimes were committed in the perpetrator's
own residence.
Another noteworthy finding was the large proportion of un-
derage victims, particularly of the female sex (n ¼ 24). This is a
particularly worrying aspect, since sexual abuse in childhood is
considered a risk factor for sexual victimization in adulthood39 and
for the future development of mental disorders.40 According to
27
Steel et al.,41 these effects may vary with the type of sexual abuse
sustained, the number of offenders, the duration of the abuse, the
relationship with the aggressor, use of force, age in which the abuse
began and the number of incidents.
Although there is strong evidence from different countries
indicating that psychotic disorders increase the risk of violent
behavior,42 mental disorder was not listed among the risk factors
for committing rape43 or sexual abuse in a review study.44 Only
three (1.3%) of the offenders in our forensic reports review featured
psychotic disorders, a fact that illustrates the lack of an association.
On the other hand, a study of Stinson and Becker45 evaluated data
from a sample of 245 inpatient psychiatric sexual offenders in a
forensic mental health setting, finding a high prevalence of mood
disorders, psychotic disorders, and multiple forms of psychopa-
thology, including substance abuse disorders and personality
disorders.
In an epidemiological survey, Hoertel et al.46 found significant
associations between sexual assault and lifetime of antisocial per-
sonality disorder, conduct disorder, cocaine use disorder and psy-
chotic disorder. The literature10,47e49 highlights that psychotic
disorders have greater prevalence among sexual offenders than we
found in our study. We believe that in many cases, psychotic sex
offenders were not reported to police investigation and were sent
to psychiatric care services without going through psychiatric
expert assessment.
One offender with a diagnosis of schizophrenia had a signifi-
cant record of alcohol use. Smith49 suggests that among the fac-
tors which lead to criminal sexual behaviour in psychotic patients
are personality characteristics compounded by the use of alcohol
and psychoactive substances. However, there is no unequivocal
conclusion concerning which clinical parameters lead to deviant
sexual behavior, whether the illness itself, the personality traits,
or the sexual drives that predispose the patient to commit the
offense.
It is important to point out the methodological limitations our
study: the relatively small number of reports reviewed, the use of
retrospective data, and the lack of direct examination of sexual
offenders or their victims. We believe that the retrospective study
of clinical and expertise diagnosis through data records, although
being used in research, have some problems: physicians involved
in these records often were not involved in research activities, at
the time of the evaluation, hence have not used standardized
diagnostic instruments. Another limitation is that this study
included only forensic reports that were part of criminal cases. A
significant number of sexual crimes are never reported and thus
many sexual offenders are not assessed. In consequence, our
sample may not be representative of all the sexual aggressors in
the population at large, a problem that occurs in the majority of
similar studies.37 Nevertheless, we believe that our study may
contribute to a better characterization of sexual offenders and
their victims and for an improved definition of penal re-
sponsibility in these cases.
In summary, the profile of Brazilian sex offenders subject to
forensic psychiatric assessment were male, caucasian, single,
working part time, with no mental disorder, who perpetrated in-
decent assault. Most of them were considered fully responsible for
the sexual offense and their victims were girls, related to the
offender by marriage or family ties or were acquaintances of the
perpetrator. According to our results, in most cases of sexual crimes,
mental disorders were not present.
Conflict of interest
We declare that there is no conflict of interest in the article “A
forensic-psychiatric study of sexual offenders in Rio de Janeiro,
Brazil”.
28 A.M. Valença et al. / Journal of Forensic and Legal Medicine 31 (2015) 23e28
Funding
None.
Ethical approval
None.
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