Sex offenders: risk assessment, risk factors and treatment / Agressores sexuais: avaliação de risco, fatores de risco e tratamento

Abstract

Sex offending is a modality of crime with high rates of recidivism. In countries like Brazil, where there is no legal life sentence, attempts to treat sex offenders and reduce risk of recidivism are extremely important. Treatment for sex offenders has strong evidence to be effective. The best evidence-based treatment recommendations for sex offenders would be a well-designed cognitive behavioral-oriented therapy program and hormonal therapy, since these approaches can be complementary and potentiate each other. The combination is associated with best results, as compared to monotherapy. Surgical orchiectomy has strong evidence of success in risk reduction, in spite of all possible criticism. However, hormonal or surgical therapy for sex offenders management are not properly regulated in Brazil and depend on individual initiatives. For non-violent or "hands-off" sex offenders, serotonergic drugs are acceptable as first choice. In general the treatment can reduce the rates of recidivism by one third. However there are important limitations in our capacity to predict future criminal behavior. Using actuarial risk assessment tools we can just provide a probability, but not discriminate the patients who will certainly re-offend from those who will not. The psychiatric and legal aspects of this topic will be discussed in the present paper.

Key words: Forensic psychiatry, Sex offenses/prevention & control, Evaluation, Prognosis, Criminology, Recurrence