Sexual Deviance: Theory, Assessment and Treatment. - Review - book reviews

Journal of Sex Research,  Nov, 1998  by Michael H. Miner

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Sexual Deviance: Theory, Assessment and Treatment. Edited by D. Richard Laws and William O'Donohue. New York: Guilford Press, 1997, 514 pages. Hardcover, $60.00.

Reviewed by Michael H. Miner, Ph.D., University of Minnesota, Program in Human Sexuality, 1300 South Second Street, Suite 180, Minneapolis, MN 55454; e-mail: mminer@famprac.umn.edu

Drs. Laws and O'Donohue take on the very ambitious project of informing the professional community on the myriad of theories, assessment procedures and treatment techniques that have been applied, and continue to be applied to individuals who exhibit sexual behaviors that are either unusual or socially proscribed. This edited volume contains the contributions of many noted authorities and, with certain exceptions, provides the reader with very thorough and challenging reviews of what is known about the paraphilias listed in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Therein lies both this book's strengths and weaknesses.

Sexual Deviance: Theory, Assessment and Treatment is the first book I am aware of that attempts to treat all of the behaviors that are characterized as paraphilias in one volume. There have been a number of very good books in recent years that have reviewed the literature and discussed theories of etiology and treatment of sexual abuse or sexual aggression, and there are some volumes that address such issues as fetishes, transsexualism, and sadomasochism, but this is the only inclusive resource for all of the behaviors that make up the paraphilias as defined by DSM-IV.

In general, the book is aimed at the practicing clinician who may have occasion to treat individuals with psychosexual disorders. While researchers may find some of the chapters on psychopathology and theory useful, such reviews have, for the most part, been published elsewhere.

In the introduction to the volume, Drs. Laws and O'Donohue spend a great deal of space discussing the weaknesses of the DSM categorization of paraphilic behavior. They convincingly point out that much is missed and much is convoluted by the DSM topological system; however, they then organize this book by DSM diagnostic categories. Specifically, the book is organized so that for each DSM category there is first a chapter that discusses psychopathology and theory and then a chapter that discusses assessment and treatment.

The psychopathology and theory chapters provide a description of the ways that particular behaviors have been described and categorized to form a particular disorder, discuss the epidemiological data available for a particular constellation of behaviors, and discuss co-factors and associated problems. Additionally, the initial chapter on each disorder provides a critical review of the literature addressing theories of etiology, as well as an assessment of the need for future research and the directions of such research. The second chapter in each set provides information on treatment and assessment. The expressed purpose of these chapters is to provide an overview of the issues of assessment, the types of assessment procedures that have been used, and the strengths and weaknesses of assessment instruments and procedures. A critical review of the treatment literature is also a salient part of the assessment and treatment chapters, although the quality of this review varies across chapters. The assessment and treatment chapters then provide practical suggestions for treatment procedures and address the future research needs in the assessment and/or treatment of each constellation of behaviors. Forensic issues are addressed in the chapters on psychopathology and treatment, as well as in the assessment and treatment chapters. This leads to some redundancy.

The choice of the DSM framework for organizing this volume results in some strange chapter content. For instance, Chapter 6, the psychopathology and theory chapter on Frotteurism, is a very readable and inclusive description of the Courtship Disorder theory, including the report of a study designed to test this theory. However, it tells us little specific to Frotteurism. In fact, most of the research described in the chapter involves people who have been involved in exhibitionism, voyeurism and preferential rape, not Frotteurism. Another odd result of the organization of this book is Chapter 13, which describes assessment and treatment of masochism in sex offenders, rather than focusing on masochism per se. This chapter obviously took the strategy of addressing the masochistic tendencies of sex offenders, because the preceding chapter by Baumeister and Butler emphasizes that masochism is not a particularly pathological set of behaviors, nor do masochists tend to have significant psychiatric and/or behavioral co-factors. Thus, most masochists do not come to the attention of treatment providers.

The editors do stray from their general organization by including chapters on rape, which is not a DSM disorder, and chapters on medical models of deviance, medical interventions in sexual deviance, and female sexual deviance. The review of the literature presented in the psychopathology and theory chapter on rape was particularly good and inclusive. Also, a very useful aspect to the chapter on assessment and treatment of rape was a section that reviews many of the standardized instruments used for assessment of sex offenders. This review, while not complete in terms of the range of possible instruments in each area of assessment, did cover the most widely used instruments.