Unfortunately, the incidence of sexual assault has increased over the past decade, and the long-term management of sex offenders has been fervently debated in our society. In the United States, approximately 234,000 sexual offenders are under the custody of correctional agencies each day, and more than half are under conditional supervision in the community.
Sexual victimization is routinely prosecuted, but sex offenders have a high rate of recidivism and are up to 10 times more likely to be re-arrested for another violent sexual assault than individuals convicted of other crimes. With state legislatures increasingly passing legislation to allow for the civil commitment of repeat sexual offenders to mental health facilities and the creation of sex offender registries, psychiatrists have found themselves thrust into this nexus of society and the legal system. Forensic psychiatrists are often asked to evaluate individuals accused or convicted of sexual offenses for a variety of purposes, including the assessment of dangerousness, risk for recidivism, involuntary commitment, inclusion in a state's sex offender registry, competency, and criminal responsibility. Like most other forensic evaluations, the assessment of sexual offenders involves performing a comprehensive psychiatric evaluation, reviewing available police reports and criminal history, and contacting available collateral sources of information to verify information provided by the defendant. In addition, the accurate assessment of individuals involved in sexual crimes requires a detailed sexual history and careful evaluation for deviant sexual arousal patterns. Sexual assessment questionnaires are often used as a guide to aid in the clinical assessment of sexual history and behavioral patterns. Common sexual assessment scales include the Derogatis Sexual Functioning Inventory and the Multiphasic Sex Inventory. Areas of deviant sexual interests endorsed on such questionnaires can then be routinely examined during subsequent clinical evaluations.