Sexual Offenses

A Public Health Approach to Intervening With Youth in Schools

Whether or not sexual offending behavior-or the predisposition to such-is a mental illness, there are patients with traditional mental illnesses who also present with sexually inappropriate and even sexual offending behavior.

The goal of this article is to further assist psychiatrists in tackling some of the more difficult financial issues in hopes of managing and reducing risk.

Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.

An analysis of data on nearly 104,000 veterans of the Afghanistan and Iraq wars who sought help from the Department of Veterans Affairs (VA) system confirms that substantial numbers returned from their tour of duty with psychiatric problems.

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning. The common paraphilias described include exhibitionism (exposure of genitals to a stranger), pedophilia (sexual activity with a prepubescent child, generally 13 years of age or younger), voyeurism (observing others' sexual activities), fetishism (use of inert objects, such as female undergarments), transvestic fetishism (cross-dressing), sexual sadism (inflicting suffering or humiliation), sexual masochism (being humiliated, beaten, bound or made to suffer) and frotteurism (touching, rubbing against a nonconsenting person).

Dr Muller describes a case of a patient with a paranoid psychosis who clearly needs help, yet refuses treatment.

Attempting litigation based on a claim of posttraumatic stress disorder can be difficult. What is the proper DSM definition of PTSD and in what ways can and can't it be used in court to properly defend a client? What should the role of the psychiatrist be in this process?

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

Since the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.

What special issues do psychiatrists face when treating women, children and adolescents, and elderly people with schizophrenia? Are there recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Although a lot remains to be learned, much is already known about the early childhood characteristics that predispose children to antisocial behavior and violence in adolescence and early adulthood, an expert in psychopathology said recently at a National Institutes of Health conference.

Despite the image presented in films, books and television, prostitution places women and children at high risk for PTSD and other comorbid disorders. What experiences lead to this life?

The distress and functional impairment associated with PTSD may make it difficult for IPV victims to benefit from interventions to increase their safety and reduce their exposure to violence. Empirically supported PTSD treatments include pharmacotherapy and cognitive behavioral therapy. Incorporating these treatments into interventions to improve victims' safety and reduce exposure to violence may improve their effectiveness in protecting women from IPV.

Little attention has been paid in the professional literature to a phenomenon that non-professionals have recognized since ancient times: Trauma can lead to personal growth. This article focuses on how traumatic events set processes in motion that produces new perspectives on the self, relationships and philosophy of life. Implications for clinical work with trauma survivors are discussed.

There is a long tradition in psychiatry, reaching at least back to World War I, of studying the response of people who are faced with traumatic circumstances and devising ways to restore them to psychological health. The main focus of this work has been on the ways in which traumatic events are precursors to psychological and physical problems.

Reported by two out of every five college students nationally, heavy episodic or binge drinking may be the most frequently reported and researched mental health problem among college youth. Effective prevention and treatment should reflect the heterogeneity of binge drinking, as it can cause substantial and serious harms.

What is secondary traumatization? The authors discuss current research and implications for this controversial and emerging field of study.

Despite the fact that recent juries have discounted repressed-memory testimony as viable, the emotional cost of such cases still takes its toll. Why are such cases so controversial, and how can psychiatrists avoid their pitfalls?

The very immediacy of the recent terrorist attacks makes the diagnosis of posttraumatic stress disorder problematic since there is no distance of time or space from the event itself. How can clinicians deal with this shift to best treat patients?

After a significant delay, the U.S. Congress passed the Victims of Trafficking and Violence Prevention Act of 2000 to provide support and services to victims of domestic violence. Meanwhile, the findings in the Family Violence Prevention Fund's State by State Report Card on Health Care Laws and Domestic Violence shows state legislation has proved disappointing. Which states do the most in assisting physicians and other health care providers to aid victims of domestic violence?

Men's Reactions to Female Sexual Coercion

Organ donation from brain-dead patients has become a psychiatric issue in Japanese transplant medicine. Brain death is recognized as human death only in the context of organ transplantation in Japan. Since many Japanese physicians deny that brain death constitutes the death of an individual, there is no solid, general consensus in Japan about what constitutes brain death.

Only in recent years has the widening scope of domestic violence achieved such national prominence. Highly publicized cases like the Nicole Brown Simpson murder have brought the issue of domestic violence to worldwide attention. Overall rates of violence against women, including both lethal and nonlethal violence, are much higher.

Differences between the sexes regarding the prevalence, psychopathology and natural history of psychiatric disorders have become the focus of an increasingly large number of epidemiological, biological and psychological studies. A fundamental understanding of sex differences may lead to a better understanding of the underlying mechanisms of diseases, as well as their expression and risks.

At stake is whether the laws defining sanity can actually distinguish between those individuals who are evil and those who are mentally ill, and what role psychiatrists should play when the legal definitions make the difference between life and death. Also under the microscope is the value of forensic psychiatric testimony itself, and whether the message about mental illness is getting through to juries, judges and appellate justices.