Sex offenders

Abstract Sex offenders are incarcerated in substantial numbers for a variety of nonviolent and violent crimes, with or without diagnoses of paraphilic disorder. The treatment of sex offenders in correctional contexts is arguably one of the most challenging undertakings for psychiatrists. Sex offenders are a highly stigmatized population that typically engenders intense negative feelings in both the professional and lay communities. The growing number of sex offenses in recent years has had a profound impact on public perception. The potential contributions of psychiatry to sex offender management span a considerable segment of the patient’s life: from postarrest evaluation and emergent care through adjudication in the courts, incarceration, possible civil commitment, and supervised release. Nevertheless, psychiatrists, as physicians and healers, bring much-needed medical expertise to the discussion. Foremost is the ability of psychiatry to demonstrate that sex offenders are a heterogeneous population. Further, a rational, effective, and humane approach to the social problem of sex offending depends on accurate assessment, diagnosis, management, and treatment approaches to the individual. Psychiatrists can also inform the ongoing debate about competency, dangerousness, the appropriateness of civil commitment, lifelong sex offender registration, compulsory medication, and other medically relevant issues in sex offender management. This chapter reviews the nosology, assessment, diagnosis, and best and evidence-based practices relevant to the care of sex offenders in correctional settings.