Drew A Kingston

HOPE Program

There has been renewed interest in the conceptualization and diagnosis of conditions marked by excessive sexuality. Researchers and clinicians have often utilized orgasm frequency (e.g., total sexual outlet) as an indicator of hypersexuality. Indeed, some have proposed seven or more (7+) orgasms by any means in a typical week as indicating hypersex...

Background Hypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain. Aim The present study was an independent psychometric...

We examined the incremental contributions of static and dynamic sexual violence risk assessment in a multisite sample of 1,289 men treated for sexual offending. The study extends validation work that established new risk categories and recidivism estimates for the Violence Risk Scale–Sexual Offense version (VRS-SO), using the risk assessment common...

Much controversy has surrounded the question about whether or not mental disorder, and more specifically major mental illness (MMI), is associated with sexual violence. This chapter reviews the literature describing the relationship between MMI and problematic sexual behavior. It examines the implications of MMI for risk assessment and formulation,...

We examined the prevalence of hypersexuality in two combined Canadian adult community samples totalling 1,857 respondents (female n = 960, male n = 835, other n = 60, missing n = 2). Participants were recruited from social media to complete an online sexual behaviour survey that included two measures of compulsive sexual behaviour disorder— the Sex...

The present study examined latent constructs of dynamic sexual violence risk and need, as measured by the Violence Risk Scale-Sexual Offense version (VRS-SO), as a function of Indigenous ancestry among a Canadian federal sample of 1,063 treated men convicted for a sexual offense. Multigroup confirmatory factor analysis of VRS-SO dynamic items ratin...

Objective: The present study is an extension and update of Olver, Nicholaichuk, Kingston, and Wong's (2014) prospective multisite examination of sexual violence risk and treatment change on a large federal Canadian sample of 570 treated sexual offenders rated pretreatment and posttreatment on the Violence Risk Scale-Sexual Offense version (VRS-SO)...

We examined the latent structure and taxonicity of hypersexuality in large university and community samples of male and female respondents. Participants completed the Hypersexual Behavior Inventory (HBI) and Sexual Compulsivity Scale (SCS), each as part of larger anonymous online surveys of sexual behavior. Exploratory factor analyses (EFA) were pe...

We examined the predictive properties of the Level of Service Inventory–Ontario Revision (LSI-OR) in a sample of 604 provincially incarcerated men with mental illness from a correctional mental health facility followed up nearly 2 years after release. Recidivism base rates and LSI-OR scores were relatively consistent across major mental disorder ca...

Purpose of review: To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis. Recent findings: Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests...

Background Interventions for offenders with mental illness have tended to be confined to treatment of illness, with the expectation that symptom reduction will be accompanied by reduced criminal recidivism, but recent evidence suggests that other treatment targets may be more effective against recidivism. Aim The aim of this study was to examine t...

The present study sought to develop updated risk categories and recidivism estimates for the Violence Risk Scale-Sexual Offense version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003-2017), a sexual offender risk assessment and treatment planning tool. The overarching purpose was to increase the clarity and accuracy of communicating risk assess...

The present study examined the association of psychiatric symptomatology, criminal attitudes, and treatment changes within these domains to violent and general recidivism in a sample of 614 mentally disordered offenders. Significant pre–post changes were found on multiple measures of criminal attitudes, symptomatology, and readiness for change. Ant...

Hypersexuality, or extreme normophilic sexual urges and behaviors, is a controversial construct that was recently considered as a candidate disorder for the DSM-5 and was rejected. It was also rejected for inclusion in Section III (Conditions for Further Study). Nonetheless, it has been found to be an important predictor of recidivism among sex off...

Sexual violence is common and can have profound effects on victims compared with other forms of violence. This violence includes unwelcome and forced sexual contact on adults or children. Assessment of individuals who perpetrate sexual violence starts with a comprehensive biopsychosocial evaluation after a finding of guilt. Clinicians should then e...

The present study examined the predictive properties of Violence Risk Scale–Sexual Offender version (VRS-SO) risk and change scores among Aboriginal and non-Aboriginal sexual offenders in a combined sample of 1,063 Canadian federally incarcerated men. All men participated in sexual offender treatment programming through the Correctional Service of...

Situational factors likely play a role in date rape. The sexual inhibition hypothesis suggests that men are typically sexually inhibited by violence and non-consent, but that inhibition can also be disrupted. We attempted to determine if female nudity reduces inhibition of sexual arousal to non-consensual cues in sexually non-aggressive men. In two...

The present study examined the construct validity of the Violence Risk Scale-Sexual Offender version (VRS-SO) through an examination of its factor structure and convergence with psychological measures assessing conceptually relevant constructs in a sample of 732 treated incarcerated adult male sex offenders. The VRS-SO was rated prospectively pre-...

The importance of mental illness as a risk factor for violence has been debated with significant implications for mental health policy and clinical practice. In offender samples, psychopathology tends to be unrelated to recidivism, although some researchers have noted that this relationship may be dependent upon certain moderating factors. In the p...

The treatment of sexual offenders is purported to have evolved over the last 40 years, with new models of practice being developed and implemented based variously on theory, research, and policy. Currently, it is recommended that sex offender treatment follow a cognitive-behavioural approach, adhere to the principles of risk, need, and responsivity...

In this chapter, the extant literature on sexual behaviors that are considered excessive and problematic in both forensic and non-forensic populations is reviewed. Current perspectives regarding conceptualization, diagnosis, assessment, and treatment are also critically reviewed. Although excessive sexual behavior has been variously defined (e.g.,...

Three predominant pathophysiological models have been applied to hypersexuality, which were developed based on observed similarities with obsessive-compulsive disorders, impulse-control disorders, and addictions. Each model was intended to elucidate etiological mechanisms and symptom profile, and facilitate effective treatment. Unfortunately, there...

Hypersexual behavior is an emerging construct that is receiving increased attention from both clinicians and researchers. Several theoretical perspectives exist about hypersexuality and its associated characteristics. Although the role of impulsivity and how it might be linked to hypersexuality are still being investigated, this article attempts to...

The importance of mental illness as a risk factor for violence has been debated with significant implications for mental health policy and clinical practice. In offender samples, mental health diagnoses tend to be unrelated to recidivism, although this effect has been questioned recently in sexual offenders. In the present, prospective investigatio...

The present study was a psychometric examination of Violence Risk Scale-Sexual Offender version (VRS-SO; Wong, S., Olver, M. E., Nicholaichuk, T. P., & Gordon, A. (200334. Wong, S., Olver, M. E., Nicholaichuk, T. P., & Gordon, A. (2003). The violence risk scale: Sexual offender version (VRS-SO). Saskatoon: Regional Psychiatric Centre and University...

In the present study, we examined the degree of change and predictive accuracy of a number of well-known psychological self-report measures intended to identify treatment targets for sexual offenders. Participants included 392 federally incarcerated sexual offenders who participated in low, moderate, or high intensity sexual offender programs offer...

Paraphilias are recurrent, persistent, and intense sexual interests in atypical objects or activities. The most commonly encountered paraphilias in sexological or forensic settings are pedophilia, sexual sadism, exhibitionism, and voyeurism. Paraphilias are often comorbid with other sexual, mood, and personality disorders. Assessment and diagnosis...

In this chapter, we provide an introduction and overview of the empirical literature on sexual offending. The chapter begins with a description of major theoretical models that have been developed to explain the occurrence of sexual offending and highlights their common underpinnings. We then differentiate sexual offenders from other types of crimi...

Objective: We conducted a prospective multisite examination of sexual offender risk and treatment change on a large federal Canadian sample of 676 treated sex offenders followed up for an average of 6.31 years post release. Method: The present study featured the clinical application of a risk assessment and treatment planning tool, the Violence...

The primary purpose of the present study was to examine the validity of commonly utilized ADHD rating scales within an adult forensic population. Participants were 120 patients assessed for dysfunctional anger and impulsive aggression at a hospital-based clinic. Two psychiatrists made independent diagnoses about the presence or absence of ADHD amon...

The self-regulation model (SRM) is a nine-phase, four-pathway offense process model designed specifically for sexual offenders that is now being applied to the treatment of this group in many settings and jurisdictions. In the present prospective study, we evaluated the validity and utility of the SRM in a sample of 275 adult male sexual offenders...

Hypersexuality is a dimensional indicator of sexual interest and behavior and typically includes the frequency, intensity, and time consumed by sexual activity. Hypersexuality has been identified as a psychologically meaningful risk factor for sexual offending. In fact, a relatively high proportion of sexual offenders report hypersexual behavior an...

Hormonal factors are important in multifactorial theories of sexual offending. The relationship between hormones and aggression in nonhumans is well established, but the putative effect in humans is more complex, and the direction of the effect is usually unclear. In this study, a large sample (N = 771) of adult male sex offenders was assessed betw...

This study attempted to validate a clinical typology of dysfunctional anger proposed by DiGiuseppe and Tafrate (2007) using assessment data obtained from 197 participants assessed at an outpatient clinic for anger problems. Several self-report scales assessing anger, hostility, impulsivity and aggression, as well as a structured interview regarding...

This paper forms the second part of a debate led by Marshall, Marshall, and Kingston (2011) regarding the need to address so-called cognitive distortions in sexual offender treatment. In their paper, Marshall et al. argue that so-called cognitive distortions may not necessarily require intense and focused attention or challenge throughout treatment...

In the present study, we evaluated the validity and utility of the self-regulation model in a sample of 275 adult male sexual offenders treated within the Correctional Service of Canada (CSC). Individuals following different self-regulation pathways, as delineated in the SRM, were compared on offence characteristics, static and dynamic risk measure...

The influence of pornography on attitudes and behaviors has been a longstanding question that has provoked considerable debate among researchers (Malamuth, Addison, & Koss, 2000; Marshall, 2000). Evidence associating pornography consumption with aggression would be important, not only for public policy and legislation, but in the assessment and tre...

The field of medicine has moved toward best practices based on evidence. There is pressure on all medical disciplines, including forensic psychiatry, to adopt this approach. Some areas of forensic psychiatry have a stronger scientific basis that clearly fits the definition of evidence-based medicine than do other areas. One of these areas is the as...

In this longitudinal study, the predictive validity of a psychiatric diagnosis of sexual sadism was compared with three behavioral indicators of sadism: index sexual offense violence, sexual intrusiveness, and phallometrically assessed sexual arousal to depictions of sexual or nonsexual violence. Five hundred and eighty six adult male sexual offend...

Sexual and Gender Identity

The aim of this investigation was to describe teachers who sexually offend against youth and the circumstances related to these offenses. Archival Violent Crime Linkage Analysis System reports were obtained from the Royal Canadian Mounted Police, and demographic and criminal characteristics for the offender, as well as information about the victim...

The relationship between pedophilia and recidivism was examined in a sample of 206 extra-familial child molesters assessed at a university teaching hospital between 1982 and 1992. To address definitional issues, pedophilia was defined in one of four ways: (1) a DSM diagnosis made by a psychiatrist; (2) a deviant phallometric profile; (3) a combinat...

This article reviews the extant literature regarding pornography's influence on antisocial attitudes, sexual arousal, and sexually aggressive behavior in both noncriminal and criminal samples. The article concludes that when examined in the context of multiple, interacting factors, the findings are highly consistent across experimental and nonexper...

There has been considerable debate regarding the conceptualization and diagnosis of individuals exhibiting problematic hypersexuality. Various terms such as sexual addiction, sexual compulsivity, and sexual impulsivity have been applied based predominantly on the perceived psychopathological mechanisms guiding the behavior. Unfortunately, such desc...

The purpose of this study is to examine the predictive accuracy of the Risk Matrix 2000 on an independent sample of 351 sexual offenders, followed in the community for an average duration of 11.4 years (range 0-20 years, SD = 4.4 years). For comparison purposes, this study also examines the predictive accuracy of two other risk assessment instrumen...

In this study, we examined the unique contribution of pornography consumption to the longitudinal prediction of criminal recidivism in a sample of 341 child molesters. We specifically tested the hypothesis, based on predictions informed by the confluence model of sexual aggression that pornography will be a risk factor for recidivism only for those...

This study examined factors that could potentially differentiate between sexual, violent and criminal recidivist and non-recidivist incest offenders (n=295). The objective of the study was to extend a previous study conducted on incest offenders by increasing the sample size, adding seven years to the follow-up and attempting to address some of the...

This study examined the utility of the diagnosis of pedophilia in a sample of extra-familial child molesters assessed at a university teaching hospital between 1982 and 1992. Pedophilia was defined in one of four ways: (1) DSM diagnosis made by a psychiatrist; (2) deviant phallometric profile; (3) DSM diagnosis and a deviant phallometric profile; a...

T. Ward and S. M. Hudson (1998) have proposed a self-regulation model of the offence process which is specific to sexual offenders and which attempts to account for the deficiencies in the traditional relapse prevention model as applied to this group of offenders. The self-regulation model is a nine-stage process of offending that addresses both th...

Exhibitionism has historically been viewed as more of a nuisance than a serious criminal justice matter. Research has demonstrated that the number of exhibitionists who are detected re-offending is a significant under-representation of the number who actually re-offend. The objective of this study was to extend a previous study conducted on exhibit...