Pergamon

Child Abuse & Neglect 26 (2002) 7392

Developmental risk factors for sexual offending

Joseph K.P. Lee*,a, Henry J. Jacksonb, Pip Pattisonb, Tony Wardc
a

Department of Psychology, University of Melbourne, and the Psychosexual Treatment Program, Victorian Institute of Forensic Mental Health, Melbourne, Victoria, Australia b Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia c Department of Criminology, University of Melbourne, Melbourne, Victoria, Australia Received 28 December 2000; received in revised form 17 July 2001; accepted 20 July 2001

Abstract Objective: The aim of the study was to identify the general, common, and specic developmental risk factors for pedophilia, exhibitionism, rape, and multiple paraphilia, and to address ve methodological issues observed in this area of research. Method: This study involved 64 sex offenders and 33 nonsex, nondrug-related, and nonviolent property offenders. The group of 64 sex offenders was further divided into eight subgroups, some of which overlapped in memberships because of multiple diagnoses. To overcome the methodological problem associated with overlapping group memberships, a special approach involving comparisons of sets of logistic regression analyses was adopted. Offenders were clinically assessed for evidence of paraphilias, and their adverse childhood experiences were measured by a battery of tests. Results: Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, and Childhood Sexual Abuse were found to be general developmental risk factors for paraphilias. Furthermore, Childhood Emotional Abuse and Family Dysfunction was found to be a common developmental risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. Additional analyses revealed that childhood emotional abuse contributed signicantly as a common developmental risk factor compared to family dysfunction. Besides, Childhood Sexual Abuse was found to be a specic developmental risk factor for pedophilia. Conclusions: The study has supported the value of conceptualizing certain childhood adversities as developmental risk factors for paraphilic behaviors. The role of childhood emotional abuse as animportant developmental risk contributor, and the relationship between childhood sexual abuse and

* Corresponding author address: Community Forensic Mental Health Service, Victorian Institute of Forensic Mental Health, 213219 Brunswick Road, Brunswick, Victoria, 3056, Australia.
0145-2134/02/$ see front matter 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 1 4 5 - 2 1 3 4 ( 0 1 ) 0 0 3 0 4 - 0

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pedophilia are of theoretical signicance. Furthermore, the results have signicant implications for the prevention of childhood abuse and treatment of sex offenders. 2002 Elsevier Science Ltd. All rights reserved.
Keywords: Sex offenders; Sexual abuse; Physical abuse; Emotional abuse; Paraphilia

Introduction Sexual offending is a signicant psychological and social problem that continues to confront our society. While remarkable progress has been made in treating sexual offenders, a greater understanding of childhood adversities associated with this type of deviant behavior is desirable. Such an understanding will have important implications for the treatment of sexual offenders and the prevention of sexual offending. It is noted that a number of theories and models have postulated that negative developmental events are signicant precursors to the occurrence of sexually offending behaviors. For example, in their integrated theory of sexual offending, Marshall and Barbaree (1990) propose that poor socialization experiences, such as violent parenting, are responsible for the development of strong feelings of resentment and hostility, which are essential elements in sexual offending. Additionally, Ward, Hudson, Marshall, and Siegert (1995) have further elaborated on the theoretical framework proposed by Marshall (1989) and develop a comprehensive attachment model of intimacy decits for sex offenders. This model suggests that various types of problematic parent-child relationships are associated with different types of insecure attachment styles found among sex offenders. Furthermore, Malamuth, Sockloskie, Koss, and Tanaka (1991) develop an empirically derived causal model of aggression against women, in which hostile childhood experiences in terms of parental violence and child abuse are associated with delinquency, which in turn leads to coerciveness against women. However, a review of the literature suggests that ve substantive and methodological issues have plagued the study of childhood adversities associated with sexual offending. The rst issue is a lack of a uniform research paradigm for studying this issue (i.e., a failure to apply a unied theoretical framework or a particular approach in understanding the relationships between childhood adversities and sexual offending). Although some researchers have investigated the relationships between childhood developmental events and sexual offending, usually they studied the empirical relationships between these two variables (e.g., comparing the percentages of those who experienced negative childhood experiences and those who did not) rather than the application of a theoretical approach (Dhawan & Marshall, 1996; Tingle, Barnard, Robbins, Newman, & Hutchinson, 1986). We argue that such a deciency can be addressed by adopting the risk factor research paradigm espoused in the perspective of developmental psychopathology (Kazdin, Kraemer, Kessler, Kupfer, & Offord, 1997). Developmental psychopathology can be dened as the study of the origins and course of individual patterns of behavioral maladaptation (Sroufe & Rutter, 1984), and in a research paradigm, childhood antecedents that are related to adult disorders can be conceptualized as risk factors. In this perspective, the notion of risk factors or developmental risk factors can be applied to different types of childhood adversities associated with sexual

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offending because they increase the risk of its occurrence in later years. For example, poor socialization, problematic parent-child relationships, parental violence and child abuse can be regarded as developmental risk factors for sexual offending. The second issue concerns the reliability of retrospective reports of childhood experiences. When a developmental risk factor research paradigm is adopted in the adult population, this method relies on the retrospective reports of childhood experiences. It is commonly observed that researchers tend to have a rather negative view about the reliability of retrospective reports. However, a comprehensive review of the literature by Brewin, Andrews, and Gotlib (1993) indicates that the unreliability of retrospective reports has been exaggerated. These authors note that when adults are asked to recall salient factual details of their own childhood, they are generally accurate, especially when these experiences are unique, consequential, and unexpected. A similar view is shared by Maughan and Rutter (1997). Two recent prospective controlled studies that examined the recollections of childhood physical and sexual abuse have indicated a reasonable degree of reliability (60% 63%) in retrospective reports of childhood maltreatment (Widow & Shepard, 1996; Widow & Morris, 1997). It can be concluded that retrospective reports of childhood adversities are reasonably reliable and, therefore, it is acceptable to employ retrospective reports as a method of investigation in the developmental risk factor research paradigm. The third issue relates to the possibility that sex offenders may over-report their histories of adverse childhood experiences. Hindmans (1988) study is often quoted as evidence of the tendency of sexual offenders to fake a history of childhood sexual abuse. In this study, two groups of sex offenders (pre-1982 and post-1982) were interviewed, but only one (the post-1982) group was warned that they would be subject to a lie detection examination (i.e., polygraph) to ascertain the truthfulness of their reports about childhood sexual abuse. In addition, these participants were told that they would be returned to prison should they fail the examination. The post-1982 sex offender group reported a lower percentage of childhood sexual abuse (29%) than the pre-1982 sex offender group (67%). This result was viewed as supporting the hypothesis that the post-1982 sex offender group was reporting less childhood sexual abuse for fear of being re-imprisoned for faking (Freund, Watson, & Dickey, 1990). However, this interpretation is open to challenge because the two sex offender groups were not properly matched on a number of relevant variables, such as the extent of childhood sexual abuse, offense nature, and demographic characteristics. Howitt (1995) further suggests that the result of the study can be subject to an alternative interpretation: the post-1982 sex offender group might have denied a history of childhood sexual abuse in order to avoid the prospect of re-imprisonment. Therefore, while there is a possibility that sex offenders may fake their histories of childhood sexual abuse, the evidence is equivocal. However, despite the research data we consider it prudent to control for social desirability when retrospective reports are used. The fourth issue relates to the denition of sexual offending and the methodological problem associated with the occurrence of multiple paraphilic diagnoses. There are two common methods of dening abnormal sexual behavior in the literature: one is the legal denition (i.e., according to the nature of the sexual offenses for which one is convicted) and the other is essentially clinical (i.e., according to the DSM-IV [American Psychiatric Association, 1994] diagnostic criteria for paraphilias). Because the diagnostic method is

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based on explicit clinical criteria, it appears to be more useful and relevant to therapists. The potential complication with this method of denition lies with overlapping group memberships when a person has more than one paraphilic diagnosis (i.e., if a person has two paraphilic diagnoses, he can be counted twice because he belongs to two groups of paraphilias). This phenomenon can lead to the methodological problem of nonindependence between groups because it will articially inate the subject numbers in the various research groups (Marshall & Eccles, 1991). To overcome this methodological problem, it is necessary to devise appropriate research and data analytic strategies. The fth issue concerns the failure of previous studies to investigate a comprehensive range of adverse childhood experiences, indicating that the full impact of childhood adversities has not been not evaluated. For example, most researchers studied childhood sexual abuse or physical abuse among sex offenders, but rarely childhood emotional abuse (Roys & Timms, 1995; Worling, 1995). Furthermore, while some investigators examined the inuence of family dynamics or family relationships among sex offenders who had been sexually abused (Dhwan & Marshall, 1996; Langevin, Wright, & Handy, 1989), they failed to evaluate the effects of other types of childhood abuse. To understand the full impact of childhood adversities, we suggest that a wide range of adverse developmental events, including family dysfunction, should be investigated. In this article, we set out to study the childhood adversities associated with four common paraphilias (pedophilia, exhibitionism, rape, and multiple paraphilia) by (1) using the risk factor research paradigm espoused in the development psychopathology perspective; (2) addressing the various methodological issues; and (3) identifying the general (applicable to the targeted paraphilias collectively), common (applicable to each of the targeted paraphilias individually), and specic developmental risk factors (applicable to only one targeted paraphilia) for different paraphilias. Although rape is not considered as paraphilia, we have adopted Abel and Rouleaus (1990) perspective that there is utility in viewing this form of sexual deviancy as a paraphilia. This is because rape is similar to other paraphilias in that the persons affected have recurrent fantasies to commit rape, and experience a cycle of ongoing urges, attempts to control them, breakdown of such attempts, and a subsequent recurrence of the deviant behavior (Able & Rouleau, 1990). In terms of childhood adversities, a comprehensive range would include childhood sexual abuse, childhood physical abuse, childhood emotional abuse, childhood behavior problems, and family dysfunction. A review of the literature suggests that various types of childhood adversities (e.g., childhood sexual and physical abuse and neglect) are associated with arrests for sex crimes (Widom & Ames, 1994). It also appears that different types of childhood adversities may be associated with different types of sexual offending. For example, although childhood sexual abuse is found to be associated with sex offenders in general (Langevin et al., 1989), its prevalence rate is generally higher for child molesters than rapists (Seghorn, Prentky, & Boucher, 1987; Tingle et al., 1986). These ndings indicate that childhood sexual abuse may have a general relationship with sex offenders as a group, as well as a specic relationship with one particular type of sexual offending. Moreover, further evidence suggests that childhood sexual abuse is uniquely associated with pedophiles or child molesters (Freund & Kuban, 1994). A history of childhood physical abuse is commonly found among sex offenders (Seghorn

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et al., 1987; Tingle et al., 1986), but very few studies have examined the specic relationship between this kind of abuse and any particular type of sex offender. However, this relationship may be inferred from the relevant studies. Given that aggressive and violent behaviors are a common correlate of a history of childhood physical abuse (Malinosky-Rummell & Hansen, 1993) and of rapists (Groth, 1979), it seems reasonable to infer that childhood physical abuse is likely to bear a specic relationship with rapists. Such an inference is also supported by the nding that physically abused boys are more likely to be arrested for a violent sex crime (e.g., rape) later in life (Widom & Ames, 1994). There is a tendency to view childhood emotional abuse as the core issue in childhood adversities because this concept unies the dynamics that underlie the destructive power of all forms of child abuse and neglect (Hart & Brassard, 1987). Such a view suggests that childhood emotional abuse is likely to be a common predictor for various types of paraphilias. The supporting evidence lies with the observations that childhood emotional abuse tends to enhance the effects of childhood sexual abuse (Bagley, Wood, & Young, 1994) and childhood physical abuse (McGee, Wolfe, & Wilson, 1997) in predicting psychopathology. Furthermore, childhood emotional abuse is also found to be a robust predictor of maladjustment (McGee et al., 1997). Childhood behavior problems can be considered as a common correlate of childhood adversities or a form of developmental precursor to adult disorders. In either case, their presence suggests a wide range of childhood maladjustments, and is likely to be a general predictor of various types of paraphilias. For example, there is evidence that adolescent sex offenders display high levels of anxiety and neurotic symptoms compared to adolescent assaultive offenders (Blaske, Borduim, Henggeler, & Mann, 1989). In addition, because childhood behavior problems are such a broad-based indicator of maladjustment, they are likely to be a specic risk factor for the most disturbed type of paraphilia (i.e., multiple paraphilia). In terms of the severity of the four targeted paraphilias, exhibitionism is considered to be the least severe type, and hence no specic risk factor is postulated for this disorder. It is noted that family dysfunction often accompanies childhood adversities among sex offenders. There is evidence to suggest that sexually abused sex offenders have poorer family supports, more disturbed family background, and more negative relationships with their fathers (Dhawan & Marshall, 1996; Langevin et al., 1989). Unfortunately, the impact of family dysfunction in the presence of other types of childhood adversities is not often investigated. In this study, we investigate the relationships between four types of paraphilias and three types of developmental risk factors (general, common, and specicwhich are further explained in the Design and Analysis section). We hypothesized that childhood sexual abuse, childhood physical abuse, childhood emotional abuse, childhood behavior problems, and family dysfunction would be general developmental risk factors for paraphilias. It was further hypothesized that childhood emotional abuse would be a common developmental risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. Finally, we suggested that: (1) childhood sexual abuse would be a specic risk developmental factor for pedophilia; (2) no specic developmental risk factor would be identied for exhibitionism; (3) childhood

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physical abuse would be a specic developmental risk factor for rape; and (4) childhood behavior problems would be a specic developmental risk factor for multiple paraphilia.

Methods Participants The current study involved a total of 97 offenders who formed two independent groupsa paraphilia group of 64 sex offenders and a comparison group of 33 nonsex, nonviolent, nondrug-related property offenders. The paraphilia group of 64 consisted of 26 sex offenders recruited from a number of Community Corrections Centers in the Melbourne metropolitan region, Victoria, Australia. Another 38 sex offenders were recruited from the Community Forensic Mental Health Service, Victorian Institute of Forensic Mental Health, Victoria, Australia. Paraphilia group. On the basis of three inclusion criteria, the paraphilia group recruited offenders (1) who were convicted for sex offenses; (2) who were placed on one of the two Orders (Community-Based Orders for which offenders served their sentences by participating in the appropriate community corrections programs or meeting other requirements as specied by courts, or Parole); and (3) who showed evidence of any one of the four targeted paraphilias: pedophilia, exhibitionism, rape, or multiple paraphilia. The exclusion criteria consisted of (1) conviction for any offenses against persons (such as assault) other than sex offenses, robbery, or drug offenses; and (2) history of psychotic illness or intellectual disability. When offenders were assessed for evidence of paraphilias, the diagnostic criteria as given in the DSM-IV (American Psychiatric Association, 1994) were applied. The deviant activities for two of the targeted paraphilias (i.e., pedophilia and exhibitionism) are dened in DSM-IV, but those of the other two (i.e., rape and multiple paraphilia) are not. For the current study, the deviant activities of rape were considered to involve coercing or forcing a nonconsenting person to engage in sexual activity (Abel & Osborn, 1992), whereas multiple paraphilia was dened by the authors as a disorder which consisted of three or more paraphilias, one of which was pedophilia, exhibitionism, or rape. Paraphilia subgroups. To study the four targeted paraphilias of interest, eight subgroups were derived from the original group of 64 paraphiliacs. The four subgroups of the targeted paraphilias comprised 29 pedophiles, 28 exhibitionists, 12 rapists, and 13 multiple paraphiliacs; however, these subgroups overlapped in membership because of the occurrence of multiple paraphilic diagnoses (e.g., one person could belong to two subgroups). Apart from these four paraphilia subgroups, another four paraphilia subgroups were derived, and each additional subgroup was formed as the complement of one targeted paraphilia subgroup with respect to the total group of 64 paraphiliacs (e.g., 35 nonpedophile paraphiliacs 64 paraphiliacs29 pedophiles). These four additional subgroups consisted of 35 nonpedophile (64 paraphiliacs29 pedophiles), 36 nonexhibitionist (64 paraphiliacs28 exhibitionists), 52

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nonrapist (64 paraphiliacs12 rapists), and 51 nonmultiple (64 paraphiliacs13 multiple paraphiliacs) paraphiliacs. Comparison group. Based on two inclusion criteria, the comparison group consisted of offenders (1) who were convicted for property offenses, and (2) who were placed on one of the two Orders (Community-Based Corrections Order or Parole). The exclusion criteria were (1) evidence of any paraphilias; (2) conviction for sexual offenses, offenses against persons (such as assault), robbery, or drug offenses; and (3) history of psychotic illness or intellectual disability. The purpose of having these exclusion criteria was to rule out alternative explanations because of these conditions for the observed differences in childhood adversities. This comparison group of 33 nonsex, nonviolent, nondrug-related property offenders was recruited from 100 potentially suitable participants who were selected randomly from 1121 property offenders from the community corrections database. This list of 1121 property offenders was obtained from the database after specifying the inclusion and exclusion criteria as specied above, except for the evidence of paraphilias which were only assessed in a semistructured interview. Of the 100 randomly drawn property offenders, 33 were recruited after they had fullled all criteria and consented to participate in the research project. Thirty were unavailable for interviews because they lost contact with the Community Corrections Centers, six were unsuitable because of their histories of psychotic illness and intellectual disability, and 31 refused to participate in the research. Comparison of group characteristics When the paraphilia and the comparison groups were compared, they were found to be comparable in terms of their educational levels, 2 (1, N 96) .14, ns, occupation, 2 (1, N 95) 2.63, ns, and employment status, 2 (1, N 94) 1.12, ns. The majority of the offenders in these two groups received high or technical school education, and did technical and laboring work. About half of the offenders in both groups were employed. However, the paraphilia and comparison groups differed in age, t (95) 4.07, p .001, marital status, 2 (1, N 96) 7.08, p .01, and legal status, 2 (1, N 97) 8.61, p .01. The paraphilia group (M 38.91, SD 9.85) was signicantly older than the comparison group (M 29.61, SD 12.09). There were also more offenders who were never married in the comparison group (66.7%) than in the paraphilia group (38.1%). The paraphilia group had signicantly fewer offenders (67.2%) on community disposition orders than the comparison group (93.9%). Furthermore, the paraphilia group (M 14.30, SD 5.61) scored signicantly lower on social desirability, t (95) 2.29, p .05, than the comparison group (M 17.03, SD 5.47). Measures Eight instruments were administered to all the participants in the paraphilia and comparison groups to determine their paraphilic diagnoses; to measure their extent of social desirability; and to assess their childhood experiences retrospectively in terms of nine variables, namely, childhood emotional abuse, parental care, parental control, family adapt-

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ability, family cohesion, childhood competence, childhood behavior problems, childhood sexual abuse, and childhood physical abuse. These instruments are described as follows: 1. A semistructured clinical interview schedule was developed to facilitate the establishment of any evidence of a paraphilia, according to the diagnostic criteria as specied in DSM-IV (American Psychiatric Association, 1994). In the current study, no one in the comparison group was found to have any evidence of paraphilia. For the paraphilia group, an interjudge reliability with a kappa value of .87 was obtained for the paraphilic diagnoses using a random sample of 20 interview schedules, and this value suggested an excellent reliability (Cicchetti & Sparrow, 1981). In these cases, an independent judge (an experienced clinical psychologist) was asked to diagnose the participants without having any prior knowledge of their original diagnoses based on the interview schedule data. 2. The Marlowe-Crowne Social Desirability Scale is a 33-item measure used to assess the extent of the participants defensiveness (Crowne & Marlowe, 1960). The total score of the Scale was used for the present study. A high score indicates a higher level of social desirability. Crowne and Marlowe (1960) reported a mean score of 13.72 and a standard deviation of 5.78 in a sample of 120 subjects. The internal consistency coefcient was .88 and the test-retest correlation was .89. 3. The Parental Acceptance-Rejection Questionnaire, Adult version, is a 60-item measure used to assess childhood emotional abuse received from the mother (Rohner, 1976). Rohner (1991) reported that the total score of this questionnaire ranged from 60 to 240 with 150 as a midpoint, and the internal consistency ranged from .86 to 95. To measure both parents attitude towards their children, scores for the fathers attitude were added to the Questionnaire, and the average of the total scores for both parents on childhood emotional abuse was used for the present study. 4. The Parental Bonding Instrument is a 25-item measure used to assess parental care and parental control (Parker, Tupling, & Brown, 1979). Parker et al. (1979) reported a mean score of 26.9 for maternal care, 23.1 for paternal care, 13.9 for maternal control, and 11.7 for paternal control in a group of 131 male patients who attended three general practitioners. The split-half reliability was .88 for the care scale and .74 for the control scale. The test-retest reliability agreement was .76 for the care scale and .63 for the control scale over a 30-week interval. In the current study, the average scores of the total ratings for both parents caregiving styles that the participants received in their rst 16 years represented the measure of parental care and the measure of parental control, respectively. 5. The Family Adaptability and Cohesion Scale II is a 30-item measure used to assess two dimensions of family functioning: family adaptability and family cohesion (Olson, Portner, & Bell, 1982). Although satisfactory psychometric properties were reported for this instrument, the data would not be applicable to this adapted version. In the present study, this scale was adapted to measure the functioning of the participants families of origin in their rst 16 years instead of that of their own families (D.H. Olson, personal communication, September 30, 1993). This adaptation was achieved by changing the items of the scale from the present to the past tense and changing the

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test instruction given to the participants. The scores on family adaptability and on family cohesion for the participants families of origin were used for the present study. 6. The Youth Self-Report is a 119-item questionnaire used to measure childhood competence and seven areas of childhood problems before the age of 16 (Achenbach, 1991). Although good psychometric properties were reported for this instrument, the data would not be applicable to the current adapted version. To measure the retrospective reports of childhood behavior, this questionnaire was adapted by changing the present tense to the past tense and the test instruction given to the participants (T.M. Achenbach, personal communication, October 5, 1993). For the current study, the two composite scores of the childhood competence and of childhood problems were used for analyses. 7. The Sexual Abuse Scale is a measure used to assess childhood sexual abuse as recalled by adults, but no psychometric data were reported (Briere, 1992). This scale was modied in two ways. First, the age of the victim was changed from 17 to 14 so that any sexual contacts as an adolescent could be eliminated. Second, although both the identity of the abuser and the nature of the abuse were included in the scale, only the latter was utilized for the present study. Participants were asked if they experienced any of the seven types of contact sexual abuse (i.e., touching the body sexually, touching the sexual parts of the body, kissing in a sexual manner, vaginal sex, oral sex, anal sex, and penetration by objects) from an abuser 5 or more years older. The total score of these seven responses was analyzed. 8. The Physical Abuse Scale is a 5-item scale used to measure the extent of childhood physical punishment received from both parents in terms of slapping, hitting, beating, punching, and kicking (Briere & Runtz, 1988). Participants were asked to rate the extent of their physical maltreatment by both parents at the worst time before the age of 16 or younger. Briere and Runtz (1988) reported alpha values of 7.5 to 7.8 for this scale in a sample of 251 university women. To maintain a consistency with other measures, the age limit in the original scale was altered from 14 to 16. The average of the total scores for both parents was used in the analyses. Design and analysis The nine variables that measured childhood experiences were subjected to principal component analysis with varimax rotation to derive their underlying factors. Appropriate constructs of childhood adversities were identied by this analysis. Because the dependent variable (paraphilic diagnosis) was a dichotomous variable, logistic regression was the analysis of choice. This type of analysis provided two main statistics (odds ratio and logistic regression coefcient) for interpretation of an independent variable, and the results were interpreted in terms of odds ratios rather than logistic regression coefcients because it was easier to conceptualize the former than the latter. A primary aim of the current study was to identify the general, common, and specic developmental risk factors for the different types of paraphilias. In this regard, the general developmental risk factors were adverse childhood events that would increase the overall likelihood of having paraphilias later in life, and the common developmental risk factors

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were adverse childhood events that would increase the likelihood of having any one of the four targeted paraphilias later in life. The general and common developmental risk factors were complementary to each other in that the former applied to the four targeted paraphilias collectively, while the latter applied to each of the four targeted paraphilias individually. In contrast, the specic developmental risk factors were adverse childhood events that would increase the likelihood of having only one targeted paraphilia later in life. The general developmental risk factors were derived by applying a logistic regression analysis and identifying the predictors of the paraphilia group when it was contrasted with the comparison group. However, to identify the common and specic developmental risk factors, a specic approach involving comparisons of subgroups and groups was necessary. This was because memberships for some paraphilia subgroups overlapped (e.g., a person could belong to the exhibitionism and rape paraphilia subgroups), and therefore direct comparison of one subgroup to another (e.g., exhibitionism vs. rape) was not possible. Therefore, in this approach: (1) the common developmental risk factors were derived by identifying the common predictors for pedophilia, exhibitionism, rape, and multiple paraphilia subgroups when each of them was contrasted with the comparison group separately; and (2) the specic developmental risk factors were derived by identifying the common predictors when each targeted paraphilia subgroup was contrasted with the comparison group and with a group of all other paraphilias, respectively. Procedure All potentially suitable participants were informed by phone or in writing to participate in a research project and to attend for an interview at either the local Community Corrections Center or the Community Forensic Mental Health Service. At the interview, the purpose of the study was explained to them. These participants were informed of the condentiality of the disclosed information, and the fact that they could withdraw from participation at any time if they should change their mind. They were also told that if they found some of the questions (e.g., those on abusive events) upsetting for them, they should let the researcher (J.L.) know about it so that some assistance could be arranged for them. The offenders were then presented with a written consent form for signature if they agreed to participate, after which they attended a semistructured interview and completed the various tests. Three offenders convicted for rape failed to complete the initial interview or the questionnaires presented to them.

Results Constructs of childhood adversities Principal component analysis using varimax rotation was performed on nine childhood experience variables with a view to deriving the underlying constructs of childhood adversities. These variables measured the retrospective perceptions of the participants parental caregiving attitudes, functioning of families of origin, childhood behaviors, and childhood

J.K.P. Lee et al. / Child Abuse & Neglect 26 (2002) 7392 Table 1 Constructs of childhood adversitiesprincipal component analysis (with varimax rotation) of the childhood experience variables Childhood experience variable Parental care Family adaptability Family cohesion Childhood emotional abuse Parental control Childhood competence Childhood behavior Problems Childhood sexual abuse Childhood physical abuse Factor 1 .90 .87 .81 .63 .37 .43 2 .28 .87 .38 .42 .87 .67 .43

83

.95 .53

Note. Only factor loadings equal to or greater than .25 are given in the above table. The three Factors are named as follows. Factor 1: Childhood Emotional Abuse and Family Dysfunction. Factor 2: Childhood Behavior Problems. Factor 3: Childhood Sexual and Physical Abuse, which was split up into two factors for further analyses.

sexual and physical abuse. Using the scree plot method, this analysis produced three orthogonal factors that accounted for 76% of the total variance. The rst factor, Childhood Emotional Abuse and Family Functioning, accounted for 41.3% of the variance, while the second and third factors, Childhood Behavior Problems and Childhood Sexual and Physical Abuse, accounted for 20% and 14.7%, respectively. As seen in Table 1, many of the factor loadings for these three factors were in the moderately high to high range. However, to study the independent effects of the two variables that made up the third factor, this factor was split up into Childhood Sexual Abuse and Childhood Physical Abuse. Therefore, the current study would employ four, instead of three, constructs of childhood adversities, namely, Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, Childhood Sexual Abuse, and Childhood Physical Abuse. These four constructs were subject to further regression analyses to identify the different types of developmental risk factors for paraphilias. An examination of the inter-relationships among these four constructs, age, social desirability, and paraphilic diagnosis for the total sample showed that: (1) paraphilic diagnosis was signicantly correlated with Childhood Emotional Abuse and Family Dysfunction (r .40), Childhood Behavior Problems (r .33), Childhood Sexual Abuse (r .38), Childhood Physical Abuse (r .46), and age (r .38); (2) Childhood Physical Abuse was signicantly associated with Childhood Emotional Abuse and Family Dysfunction (r .43), Childhood Behavior Problems (r .45), and Childhood Sexual Abuse (r .38); and (3) social desirability was signicantly negatively correlated with Childhood Emotional Abuse and Family Dysfunction (r .44).

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Table 2 Prediction of paraphilic diagnosis by the constructs of childhood adversities (paraphilia group versus the comparison group, with age as a covariate) Variable Age Childhood Emotional Abuse and Family Dysfunction Childhood Behavior Problems Childhood Sexual Abuse Childhood Physical Abuse Constant OR 2.34 3.30 3.32 3.88 1.20 B .85* 1.19** 1.20** 1.36* .18 1.42 SE .34 .38 .47 .56 .44 .40

Note. OR: Odds ratio; B: Logistic regression coefcient (standardized); and SE: standard error. * p .05; ** p .01; *** p .001. N 97 1 96 (one participant was removed from analysis because of incomplete data set).

General developmental risk factors To render the estimates more comparable, all the independent variables were examined for normality with a view to data transformation and were converted to z scores for analyses. It was noted that a square root transformation was necessary for Childhood Emotional Abuse and Family Dysfunction, and Childhood Physical Abuse, while a logarithmic transformation was applied to Childhood Sexual Abuse. Because there were signicant between-group differences in age (the paraphilia group was older than the comparison group), and, to a lesser extent, in social desirability (the paraphilia group scored lower than the comparison group), it was desirable to include age and, probably, social desirability as covariates. To examine if addition of one or two covariates might differ, logistic regression analyses for all group comparisons with age as a covariate, and with age and social desirability as covariates, were compared. The results of these two sets of analyses showed little difference in their abilities to predict paraphilic diagnosis. However, in one analysis with the addition of both covariates a perfect t or complete separation resulted (Menard, 1995) (i.e., the paraphilic diagnosis was perfectly predicted, and this led to an inability to interpret the parameter estimates). Therefore, it was decided to use logistic regression analyses with only age as a covariate for all group comparisons. Logistic regression analysis showed that the set of four constructs of childhood adversities with age as a covariate was predictive of paraphilic diagnosis, Model 2 (5, N 96) 55.91, p .001. As seen in Table 2, the same analysis further indicated that for every standard deviation increase in Childhood Emotional Abuse and Family Dysfunction, in Childhood Behavior Problems, and in Childhood Sexual Abuse, the odds of receiving a paraphilic diagnosis increased signicantly by a factor of 3.30, 3.32, and 3.88, respectively. In other words, Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, and Childhood Sexual Abuse were identied as general developmental risk factors for paraphilias as a group. It was also apparent that the contributions of these developmental risk factors to the occurrence of paraphilic diagnosis were largely comparable, given that the 95% condence intervals of estimation as indicated by the odds ratios (3.32 to 3.88) and the standard errors (.38 to .56) were fairly similar to each other. Furthermore, because social desirability was negatively correlated with Childhood Emotional Abuse and Family Dys-

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85

Table 3 Logistic regression analyses for the four targeted paraphilia subgroups contrasted with the comparison group respectively Independent variable Logistic regression analyses for different group comparisons Pedophilia vs. comparison (n 62) OR B Exhibitionism vs. comparison (n 60) SE OR B Rape vs. comparison (n 45) B Mult paraphilia vs. comparison (n 46) SE OR B 1.33 2.43** 3.38* 1.78* 1.24 SE .75 .93 1.41 .80 1.12

SE OR

Age Childhood. Emotional Abuse 6.40 1.86* & Family Dysfunction Childhood Behavior Problems 5.05 1.62* Childhood Sexual Abuse 13.43 2.60** Childhood Physical Abuse 1.67 .52

2.17 .77* .37 1.84 .61 .48 3.76 .74 3.67 1.30* .46 3.58 1.27* .57 11.27 .84 4.16 1.43* .58 2.48 .88 1.67 .51 .70 1.67 .70 1.16 .15 .49 1.28 .91 .51 .25 .64 29.35 .80 5.91 .62 .29

Note: OR: Odds ratio; B: Logistic regression coefcient (standardized); and SE: standard error. *p .05; ** p .01; *** p .001.

function (r .44, p .001), this suggested that the paraphilia and comparison groups might tend to report a lesser degree of this risk factor, owing to a greater psychological defensiveness. It was also interesting to note that Childhood Physical Abuse was the only construct which did not independently predict paraphilic diagnosis. One possible reason was that this construct had a shared variance with other developmental risk factors. Common developmental risk factors Similar to the above analysis, the same independent variables and covariate were employed for each of the four targeted paraphilia. The four constructs of childhood adversities were found to be predictive of pedophilia, Model 2 (5, n 62) 70.85, p .001; exhibitionism, Model 2 (5, n 60) 29.71, p .001; rape, Model 2 (5, n 45) 19.47, p .01; and multiple paraphilia, Model 2 (5, n 46) 32.28, p .001. A further examination of the results showed that as contrasted with the comparison group: (1) Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, and Childhood Sexual Abuse, were each predictive of pedophilia (OR 5.05 to 13.43); (2) Childhood Emotional Abuse and Family Dysfunction, and Childhood Behavior Problems, were each predictive of exhibitionism (OR 3.67 to 4.16); (3) Childhood Emotional Abuse and Family Dysfunction was predictive of rape (OR 3.58); and (4) Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, and Childhood Sexual Abuse, were each predictive of multiple paraphilia (OR 5.91 to 29.35) (see Table 3). In the analysis involving the pedophilia and comparison groups, age as a covariate was removed from the equation because its presence produced a perfect t situation (Menard, 1995) and rendered the parameter estimates uninterpretable. In the analysis involving the multiple paraphilia and the comparison groups, the results were accepted despite the high standard errors because they were largely consistent with the zero-order correlations. In brief, as seen from the results of the four analyses in Table 3, Childhood Emotional Abuse and Family

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Dysfunction was the only common predictor, and was hence identied as a common developmental risk factor, for each of the four targeted paraphilias. Table 3 also indicates that for every standard deviation increase in this risk factor, the odds of receiving a diagnosis of pedophilia, exhibitionism, rape, and multiple paraphilia increased by a factor of 6.40, 3.67, 3.58, and 11.27, respectively. To determine whether childhood emotional abuse or family dysfunction was more predictive of paraphilias, simultaneous and stepwise logistic regression analyses were performed on the ve variables (childhood emotional abuse, parental care, parental control, family cohesion, family adaptability) that constituted the construct of Childhood Emotional Abuse and Family Dysfunction for the total sample. The results of the simultaneous regression analysis showed that childhood emotional abuse was the only predictor for paraphilic diagnosis (OR 1.04, B .04, SE .02, p .05). The importance of childhood emotional abuse among the different variables was also conrmed by the forward and backward stepwise regression analyses, both of which showed that it was the only signicant predictor for paraphilic diagnosis. Specic developmental risk factors As explained in the design and analysis section, the specic developmental risk factors for each targeted paraphilia were obtained by identifying the common predictors from logistic regression analyses conducted for eight pairs of group comparisons. Because four of these regression analyses involving the comparison group are presented in Table 3, the results pertaining to the group comparisons of one targeted paraphilia to all the other paraphilias are described as follows: (1) Childhood Sexual Abuse (OR 2.65) was predictive of pedophilia compared to nonpedophilia paraphilia; (2) Childhood Sexual Abuse (OR .39) was negatively predictive of exhibitionism compared to nonexhibitionism paraphilia; (3) no developmental risk factor was predictive of rape compared to nonrape paraphilia; and (4) no developmental risk factor was predictive of multiple paraphilia compared to nonmultiple paraphilia (see Table 4). When the predictors for the pedophilia versus comparison groups (see Table 3) and those for the pedophilia versus nonpedophilia paraphilia groups (see Table 4) were compared, only Childhood Sexual Abuse was identied as a specic developmental risk factor for pedophilia. Tables 3 and 4 indicate that for every standard deviation increase in Childhood Sexual Abuse, the odds of being in the pedophilia group rather than the comparison group increased by a factor of 13.43, and of being in the pedophilia group rather than the nonpedophilia paraphilia group increased by a factor of 2.65. When similar comparisons were made for exhibitionism, rape, and multiple paraphilia (Tables 3 and 4), no specic risk factor was identied.

Discussion This study has achieved its aim of identifying the general, common, and specic developmental risk factors for various types of paraphilias. The hypothesis that childhood sexual abuse, childhood physical abuse, childhood emotional abuse, childhood behavior problems, and family dysfunction are general developmental risk factors was largely conrmed. Of the

J.K.P. Lee et al. / Child Abuse & Neglect 26 (2002) 7392 Table 4 Logistic regression analyses for the four targeted paraphilia subgroups compared to their respective nontargeted paraphilia subgroups Independent variable Logistic regression analyses for different group comparisons Pedophilia vs. nonpedophilia (n 63) OR Age 2.38 Childhood Emotional Abuse .91 & Family Dysfunction Childhood Behavior Problems 1.62 Childhood Sexual Abuse 2.65 Childhood Physical Abuse .92 B SE Exhibitionism vs. nonexhibitionism (n 63) OR B .71* .02 SE Rape vs. nonrape (n 63) OR B SE

87

Mult vs. nonmult paraphilia (n 63) OR B SE .51 .45 .33 .42 .45 .37 .31 .33 .60 .44

.87* .38 .49 .09 .39 .98 .48 .35 .97 .98** .33 .39 .08 .42 .92

.37 .67 .37 1.47

.40 .43 .60 .38 .43 1.40 .05 .39 1.57 .45 .39 1.36 .09 .43 .55

.03 .34 .96 .95** .35 .64 .09 .39 1.09

Note: OR: Odds ratio; B: Logistic regression coefcient (standardized); and SE: standard error. *p .05; ** p .01; *** p .001.

four constructs of childhood adversities, three were found to be independently predictive of paraphilic diagnosis. The odds of receiving a paraphilic diagnosis increased by approximately three to four times for every standard deviation increase in Childhood Emotional Abuse and Family Dysfunction, Childhood Behavior Problems, or Childhood Sexual Abuse. There is no evidence to suggest that sex offenders exaggerated their self-reports of childhood abuse because of the inuence of social desirability. If this had been the case, it was expected that the paraphilia group would have scored higher on the social desirability measure than the comparison group. On the contrary, they actually scored lower on this measure than the latter group, and this result contradicts the suggestion that sex offenders might act defensively and show a tendency to overstate their histories of childhood abuse. Furthermore, although it is possible to attribute the effects of developmental risk factors to the occurrence of violent and drug-related offenses, this alternative explanation can also be ruled out because offenders with these criminal records were excluded from both the paraphilia and the comparison groups in the current study. In addition, the only construct that was not predictive of paraphilic diagnosis was Childhood Physical Abuse. It is possible that this could be accounted for by the correlations (and thus a shared variance) between this construct and other developmental risk factors. The current results partly conrmed the hypothesis that childhood emotional abuse is a common developmental risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. Childhood Emotional Abuse and Family Dysfunction was identied from various analyses as a common developmental risk factor for pedophilia, exhibitionism, rape, or multiple paraphilia. However, further simultaneous and stepwise regression analyses indicated that childhood emotional abuse was a signicant contributor as a common developmental risk factor. This important nding on the role of childhood emotional abuse is consistent with those reported in other studies. For example, Bagley et al. (1994) found that only those men who were both sexually and emotionally abused, but not those who were sexually abused alone, displayed sexual interests involving children. McGee et al. (1997) also found that

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childhood emotional abuse predicted maladjustment consistently, and that it contributed uniquely to the prediction of maladjustment. In short, all this evidence has provided support for the notion that childhood emotional abuse should be regarded as the core element of various types of childhood adversities as proposed by Hart and Brassard (1987). As regards the specic effects of childhood abuse, the present study conrmed two hypotheses by identifying (1) Childhood Sexual Abuse as a specic predictor for pedophilia, and (2) no specic predictor for exhibitionism. However, the data disconrmed the other two hypotheses by failing to identify (3) Childhood Physical Abuse as a specic predictor for rape, and (4) Childhood Behavior Problems as a specic predictor for multiple paraphilia. Specically, the results showed that the odds of being in the pedophilia group rather than the comparison group increased by approximately thirteen and a half times, and of being in the pedophilia group rather than the nonpedophilia paraphilia group increased by approximately three times, for every standard deviation increase in Childhood Sexual Abuse. This nding is consistent with the results of other recent studies concerning the association between childhood sexual abuse and sexual offending. For example, Haywood, Kravitz, Wasyliw, Goldberg, and Cavanaugh (1996) found that the odds of becoming a child molester was 5.42 times as likely for adult male victims of childhood sexual abuse as for adult male nonvictims. The nding that no specic predictor was found for exhibitionism was expected. It may be because exhibitionism differs from other types of paraphilias in degree rather than in kind, and which is characterized only by a common developmental risk factor. It is also interesting to note that the odds of being in the exhibitionism group rather than the nonexhibitionism paraphilia group decreased by a factor of .39 for every standard deviation increase in Childhood Sexual Abuse. In other words, Childhood Sexual Abuse was negatively predictive of exhibitionism. The failure to identify Childhood Physical Abuse as a specic developmental risk factor for rape was unexpected. The regression analyses did not identify Childhood Physical Abuse as a risk factor for rape when contrasted with both the comparison group and the nonrape paraphilia group. There are two possible reasons for this nding. First, there is an association (a shared variance) between Childhood Physical Abuse and other developmental risk factors. Second, it could be because of the characteristics of the rapists for this study. We suspect that an insufcient number of hostile, aggressive rapists (Groth, 1979) were included in the current sample, partly because of the community setting in which they were recruited, and partly because aggressive offenders are arguably more likely to refuse to become research participants. The failure to identify a specic developmental risk factor for multiple paraphilia was contradictory to our initial prediction. Although Childhood Behavior Problems was found to be one of the predictors for multiple paraphilia group when contrasted with the comparison group, the same result was not obtained when it was contrasted with the nonmultiple paraphilia group. This nding indicates that although Childhood Behavior Problems was not a specic developmental risk factor for multiple paraphilia, the fact that this factor was predictive of pedophilia, exhibitionism, or multiple paraphilia (see Table 3) suggests that it is an important factor overall. The nding that Childhood Sexual Abuse was a specic developmental risk factor for pedophilia is consistent with the theory that male children and adolescents who have been sexually abused are at a greater risk in later years of becoming sexual abusers of children or adolescents. This view is described as the victim-to-abuser cycle (Bagley et al., 1994), the abused/abuser hypothesis (Garland & Dougler, 1990), or the molestation theory of pedo-

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philia (Howitt, 1995). Our results are inconsistent with the claim that the effects of childhood sexual abuse are nonspecic rather than specic (Hanson & Slater, 1988). This is because Childhood Sexual Abuse was not identied as a specic risk factor for exhibitionism, rape, or multiple paraphilia. In short, our result supports the theoretical position that there is a specic relationship between childhood sexual abuse and pedophilia. Finally, the current results have also conrmed the utility of the risk factor research paradigm. It is useful to conceptualize certain childhood adversities as developmental risk factors for the occurrence of sexual offending later in life. One important nding that stems from the present study is the conrmation of childhood emotional abuse as a signicant developmental risk contributor leading to the occurrence of various types of paraphilias. In addition, the presence of a specic developmental risk factor for pedophilia is also of theoretical signicance. The nding that Childhood Emotional Abuse and Family Dysfunction, Childhood Sexual Abuse, and Childhood Behavior Problems were independent developmental risk factors for paraphilias lends support to Marshall and Barbarees (1990) integrated theory of sexual offending, Ward et al.s (1995) comprehensive attachment model of intimacy decits for sex offenders, and Malamuth et al.s (1991) causal model of aggression against women. In these models, adverse childhood experiences such as poor socialization, problematic parent-child relationships, and parental violence and child abuse can be regarded as developmental risk factors for the subsequent onset of paraphilias and sexually abusive behaviors. One limitation of the current study concerns the failure to consider the role of protective factors against the development of sexual offending. Although we have identied the developmental risk factors for various types of paraphilias, such outcomes are not invariable. It is apparent that not all individuals who have been subjected to childhood adversities will be adversely affected and progress to becoming offenders themselves. The inuence of protective factors may explain why some individuals do not succumb to childhood abuse, while others develop disorders later in life. One implication of the current study relates to the use of the special approach in analysis to overcome the methodological problem associated with overlapping group memberships. The usefulness of this approach suggests that it may be applied to other areas of investigations where it is difcult to conduct between-group comparisons because of this limitation. Another significant implication concerns the management of offenders victimization experiences. Our results imply that treating sex offenders childhood abuse is an important task that demands a higher priority than is currently the case. Additionally, the prevention of childhood abuse and early intervention for those at risk are effective primary measures for reducing the development of sexual offending. In this respect, the community may benet signicantly by promoting educational programs on parenting skills to the general public, and by providing early intervention programs to those who are put at risk as a result of childhood adversities. In conclusion, this study has supported the value of conceptualizing certain childhood adversities as developmental risk factors for the occurrence of paraphilic behaviors. The strength of this study lies with its attempt to overcome a number of methodological problems identied in this area of research, and the results have important implications for the prevention of childhood abuse and treatment of sex offenders. Having established systematically the associations between developmental risk factors and paraphilic behaviors, we suggest that the next step would be to

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identify the mediating variables between these two events. Because some possible underlying mechanisms are proposed between adverse developmental experiences and sexually offending, it would be useful to build on the current knowledge and to test the linkages between developmental risk factors, mediating processes, and sexually offending behaviors.

References
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Resume
Objectifs: Le but de cette etude consistait a identier les facteurs de risque speciques pour le ` developpement de la pedophilie, de lexhibitionisme, du viol et des paraphilies multiples et de noter cinq aspects methodologiques observes dans ce champ de recherche. Methode: Cette etude a concerne 64 agresseurs sexuels et 33 agresseurs sur un mode autre que sexuel,

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lie a la drogue, ou sans violence. Le groupe de 64 agresseurs sexuels a ete divise en huit sous-groupes, ` certains se recouvrant a cause de diagnostics multiples. Pour tenir compte du probleme method` ` ologique provenant de ce fait on a adopte une approche speciale utilisant des comparaisons densembles danalyze logistique de regression. les agresseurs ont ete evalues cliniquement sur le plan des paraphilies et leurs experiences infantiles defavorables ont ete mesurees par unebatterie de tests. Resultats: On a trouve que les facteurs: Sevices psychologiques pendant lenfance et Dysfonctionnement familial, Comportement infantile perturbe et Sevices sexuels durant lenfance pouvaient presenter des risques en general pour le developpement des paraphilies. De plus, Sevices psychologiques durant lenfance et Famille dysfonctionnelle sont des facteurs qui presentent un risque de developpement vers la pedophilie, lexhibitionisme, le viol ou les pedophilies multiples. Des analyses supplementaires ont revele que les sevices psychologiques ont contribue signicativement en tant que facteur general de risque dans le developpement comparativement au dysfonctionnement familial. De plus, Sevices sexuels subis dans lenfance sest avere constituer un facteur de risque specique pour la pedophilie. Conclusions: Letude engage a conceptualiser certaines experiences infantiles defavorables comme ` des facteurs de risque pour levolution vers des comportements de pedophilie. Le role des sevices psychologiques subis dans lenfance en tant que contribuant de facon importante au risque dans le developpement ainsi que la relation entre les sevices sexuels subis dans lenfance et la pedophilie ont une importance theorique. Les resultats ont encore des implications de grande portee pour la prevention des sevices sexuels aux enfants et le traitement des agresseurs.

Resumen
Objetivo: El objetivo de este estudio fue identicar los factores de riesgo en el desarrollo: generales, comunes y especcos para la pedolia, el exhibicionismo, la violacion y la paralia multiple, y tratar cinco aspectos metodologicos observados en este campo de la investigacion. Metodo: Este estudio incluyo 64 ofensores sexuales y 33 no sexuales, no-relacionado con la droga, y ofensores de propiedad no violentos. El grupo de los 64 ofensores sexuales se dividio a su vez en ocho subgrupos, algunos de ellos se superponan como miembros en varios grupos por diagnosticos multiples. Para superar el problema metodologico asociado con la superposicion de la membresa en varios grupos, se adoptaron conjuntos de analisis de regresion logstica. Los ofensores fueron clnicamente evaluados para medir presencia de las paralias, y se midieron sus experiencias adversas en la ninez con una batera de pruebas. Resultados: Se encontro que el Abuso Emocional en la Ninez y la Disfuncion Familiar, los Problemas de Conducta y el Abuso Sexual en la Ninez, eran factores de riesgo generales en el desarrollo para las paralias. Ademas, el Abuso Emocional en la Ninez y la Disfuncion Familiar se encontraron como factores de riesgo en el desarrollo, comunes a las paralias. Analisis adicionales revelaron que el abuso emocional en la ninez contribua signicativamente como un factor de riesgo comun en el desarrollo, en comparacion con la disfuncion familiar. Tambien, el Abuso Sexual en la Ninez se encontro que era un factor de riesgo especco en el desarrollo para la pedolia. Conclusiones: El estudio apoya el valor de conceptualizar ciertas adversidades en la ninez como factores de riesgo en el desarrollo para las conductas paraflicas. El papel del abuso emocional en la ninez como un factor del desarrollo importante como contribuyente, y la relacion entre el abuso sexual en la ninez y la pedolia tienen importancia teorica. Ademas, los resultados tienen implicaciones para la prevencion del abuso en la ninez y el trata miento de los ofensores sexuales.