Sanctuary for the Abused

Saturday, July 23, 2005

Mood, Substance Abuse Disorders Common Among Sex Offenders

Joan Arehart-Treichel

It’s likely that deviant sexual attractions or antisocial personalities are at the root of sexual crimes, but many sexual offenders also have a mental illness.

Most sexual offenders have paraphilias or antisocial personalities and in many cases also have depression, bipolar disorder, or an impulse control disorder.

These findings come from a study conducted by Neal Dunsieth, M.D., an assistant clinical professor of psychiatry at Wright State University in Dayton, Ohio, and colleagues and are reported in the March Journal of Clinical Psychiatry.

"To our knowledge," they noted, "ours is now the largest group of sexual offenders evaluated using structured clinical interviews for psychiatric disorders, personality disorders, and paraphilias."

Their study included 113 convicted sexual offenders voluntarily participating in an 18-month, residential, sexual-offender treatment program in Columbus, Ohio, between 1996 and 2001. All were male, aged 18 years or older, and 35 years old on average. About two-thirds of the subjects were white, and one-third were African American. All were convicted of at least one sexual offense. None, however, admitted to a sexually sadistic murder.

Upon admission to the treatment program, all participants were evaluated with a number of structured clinical tools including the Structured Clinical Interview for DSM-IV Axis I Disorders, augmented with modules for DSM-IV impulse control disorders not elsewhere classified and sexual disorders; the Structured Clinical Interview for DSM-IV Axis II Disorders; a history of sexual and physical abuse; a history of psychotic, mood, anxiety, eating, substance use, impulse control, and paraphilic disorders in first-degree relatives; a review of medical and legal records and polygraph examinations.

Not surprisingly, 74 percent of sexual offenders were found to have a paraphilia, 56 percent met criteria for antisocial personality disorder, 28 percent met criteria for borderline personality disorder, and 25 percent met criteria for narcissistic personality disorder. More unexpectedly, however, many had other diagnoses. Fifty-eight percent had a mood disorder, 35 percent had bipolar disorder, 38 percent had an impulse control disorder, and 23 percent had an anxiety disorder. Moreover, 85 percent qualified, according to DSM-IV criteria, for a lifetime diagnosis of substance abuse disorder.

In addition, offenders with paraphilias were much more likely than other offenders to have mood, anxiety, and impulse control disorders. More than half of the subjects had been victims of sexual abuse themselves, while more than a quarter had been victims of incest.

The study did have some limitations, Dunsieth and his team noted. For example, no non-sexual-offender control group was used in the study, and investigators who diagnosed subjects for psychiatric disorders were not blinded to their sexual offenses. Nonetheless, Dunsieth told Psychiatric News, the results imply that clinical psychiatrists should "assess mental illness in sexual offenders and note a strong correlation between deviant sexual attraction [paraphilias] and an increased incident of mental illness."

"Overall this is a very positive study," Richard Krueger, M.D., medical director of the Sexual Behavior Clinic at New York State Psychiatric Institute, said in an interview. For one thing, he said, "it is very difficult to do this kind of study. Often departments of correction or parole are resistant to involvement in academic studies." For another, he added, "they did a family history of sexual offenders, which is not often reported, and I think that is an important contribution."

He agreed with Dunsieth that the study results "highlight the importance of a full psychiatric assessment of individuals involved with sexual crimes. Often they get plugged into sexual-offender programs without a psychiatric evaluation."

"This is a welcomed study reminding us that the sexual-offender population is a heterogeneous group composed of multiple overlapping diagnostic subgroups," Charles Smith, M.D., clinical director of the Whiting Forensic Division of the Connecticut Valley Hospital in Middletown, Conn., told Psychiatric News. "This diagnostic heterogeneity has serious implications for the design of social policy to ensure public safety by containing the behavior of known sexual offenders. Dunsieth and colleagues demonstrate very convincingly that subgroups of sexual offenders can be identified with divergent therapeutic problems and differential treatment concerns. It is a reasonable extrapolation of this work to envision treatment interventions and risk-reduction strategies tailored to, and optimized for, different sexual offender subgroups."

"The study does offer hope," Smith added, "that treatment of comorbid mental health conditions among some sexual offenders may be an effective approach to decreasing offender recidivism."

The sexual offender treatment program on which this study was based and data collection for the study were financed by the Ohio Adult Parole Authority.

The study, "Psychiatric and Legal Features of 113 Men Convicted of Sexual Offenses," is posted online for paid subscribers at
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Monday, July 18, 2005

Changing the Course of Depression by Changing the Environment

Doctors: How many women in your practice are leaving your office with prescriptions for antidepressants? Yet do you know what questions to ask that can help you determine if their depression is the result of an emotionally abusive environment that has them feeling anxious, stressed, overwhelmed, lost, alone, and as though they're going crazy? Depressed? You bet. And most of you would be too if you lived in this constant state of emotional war zone still almost unrecognizable by our culture even today.

It has taken us decades to jump in with both feet to really dissect the intricacies of physical and sexual abuse, but emotional abuse is still barely perceptible on the horizon. And being understood … unless you've lived in it, you cannot begin to understand the “crazy making” that goes on behind closed doors …many in homes that look like the perfect Camelot from the outside.

What Is An Emotionally Abusive Environment?

It is any scenario where one person in a relationship (parent, boss, romantic partner, or even just best friends), feels more entitled, deserving, and/or more powerful than the other person … and then spends vast amounts of time proving that theory to their “lesser” partner.

For example, in one husband/wife relationship I consulted on, the husband demands from his wife every day, “Tell me what you're worth, honey … and don't get it wrong or there will be hell to pay.” And his wife must respond each day, “I'm worth 29 cents, honey… The price of a bullet.”

This emotional brainwashing day after day is a constant message to this woman that she is absolutely worthless. That her thoughts, actions, needs, and wants matter not. That her job in life is to essentially do whatever he “allows” her to do.

One woman I know has a husband who checks her odometer every day to determine if she indeed went exactly where she told him she went.

Yet another must answer her husband's calls by the third ring or she will be punished when she comes home.

Still another controlling man goes through his wife's purse, closet, and any personal areas she has, to show her that she had better not hide anything from him.

Many like to play mind games such as controlling who their spouse may see or even speak to on the phone. Often even relatives are not “allowed” to call the house as the husband may see this as an invasion of his privacy and a loss of control of his spouse to “outsiders.” Some of these “subservient” women are not even allowed access or information regarding the family finances.

Why Do They Take It?

All these narcissistic individuals are so great at hypnotizing their “loved ones” into believing that they must indeed accept this treatment that the victims truly become confused, exhausted, and lost as to who they are any more. Many almost lose their own identity in these environments that do not promote each individual's needs or wants but focus all attention on the needs and wants of the narcissist.

By the time the “victim” comes to you, she may indeed seem like the crazy one. Many exhibit signs of Post Traumatic Stress Syndrome as well, when to all outward appearances there has been no trauma. Of course, physical symptoms related to stress may also be prevalent.

Not Just Spouses or Intimate Partners

While most easily identifiable in intimate relationships, the same damage can be inflicted in any relationship. A mother of grown children can make their lives miserable with her controlling, manipulative behavior and condemning and accusing commentary. A boss who takes credit for his or her employee's work and then is the tyrannical leader at the helm, can lead employees to becoming empty-eyed, “deer in the headlights.” A teenaged girl with a critical teacher can have trouble sleeping and can fall prey to the same depressive feelings that the wife of the physical abuser succumbs to. All are relationships where pathologically narcissistic people, with their “stealth” behavior, can cause vast damage without ever even attracting attention.

While narcissistic people can be of either gender, odds are you will see mostly women victims who are willing to discuss these issues, once you identify them. However, keep in mind that men may be equally affected by this type of subtle and emotional brainwashing. Yet men may not be as willing to talk about their feelings, so you may have to dig a little deeper.

What Can You Do?

Become more aware of what emotional abuse looks like and then consider options for emotional support for your clients, in addition to supporting them through their depressive episodes until such time as they can find an emotionally healthy, safe environment.

First of all, go rent the old movie Gaslight. Made in 1944, nearly 40 years before Narcissistic Personality Disorder was an official diagnosis, one can clearly see the “crazy-making” behavior that is so cunningly applied by the narcissist to his victim. While the motive of the villain is criminal in this film, the behaviors are classic narcissist none-the-less. I have actually had clients of mine watch this film for 20 minutes and call me to tell me that they had to throw up as the recognition of the destructive brainwashing was so clear to them, that seeing it in the 3rd person suddenly turned on a light of recognition in their own lives.

Secondly, I give you a list of but a few questions that you can ask your client to help reveal if they are living in a toxic, emotionally abusive environment, (which may have already led to physical and/or sexual abuse as well.) If you client answers yes to a majority of these questions, then they are probably dealing with a destructive, narcissistic relationship.

The Detective Work

Here are a sampling of the questions which may open the conversation:

1. Do you struggle with feelings of guilt or blame that any problems in your relationship are your fault?

2. Are you frequently fearful of what your partner's mood might be like when he (or she) comes home at the end of the day?

3. Do you feel constantly exhausted?

4. Are you having trouble sleeping?

5. Do you ever wonder if your partner is telling you the complete truth?

6. Do you feel as though your partner is more important than you are?

7. Do you ever feel as though you are “walking on eggshells” around your partner?

8. Does your partner ever seem as though his (or her) personality can change in no time? For example, he came in the door after work seemingly happy, and in minutes is sullen, angry, quiet, or depressed?

9. Do you ever feel as though you are given the “silent treatment” by your partner? (They will know what you mean if they are.)

10. Do you have to ask your partner's permission to do anything?

11. Do you have limited or no access to your financial accounts?

12. Do you ever have suicidal thoughts?

13. Do you feel as though you are rarely getting your needs met in this relationship, or that your needs always come last?

14. Do you feel as though your partner treats you as though he or she is your parent, not your equal?

Red Flag Narcissistic Behaviors

In addition, you might ask them if any of these situations fit their partner's behavior. If so, they are indeed “red flags” to unhealthy behaviors.

1 Does your partner have a big ego and feel that others are less important than he?

2 Does your partner like to control others and the environment?

3 Does your partner feel that rules don't apply to him?

4 Does he or she take advantage of others to achieve his needs?

5 Does he or she show little respect for others, and may in fact refer to others
as “idiots”?

6 Does he or she often criticize others?

7 Is he or she quick to take offense at comments others offer towards them, if those comments are not complimentary?

8 Does he have a quick temper?

9 Can his personality change at a moment's notice?

10 Does he ever exaggerate the truth or outright lie?

11 Does he deny he has any issues to work on but believes that if everyone will do as he tells them to do, then all will be fine?

12 Does he seem totally oblivious to understanding empathy and compassion for others but demands everyone jump if he is slighted or has his feelings hurt?

13 Does he blame others for all his problems?

14 Did he start out the relationship being very charismatic, charming, romantic, and almost “perfect” but those behaviors changed quickly as he became hardened, abusive, critical, and perhaps violent?

15 Did he suggest love and marriage while only in the relationship for a short time?


These are just a few of the questions that can help determine if your client is living in this dangerous, emotional roller coaster situation. While an antidepressant may help to minimize her outward symptoms of depression, as long as the emotional war zone she lives in continues to hold fast, the cause of her depression will not likely go away.

While most therapists recognize Narcissistic Personality Disorder, narcissism itself is on a scale. Healthy narcissism is what most of us have. We set goals, strive to reach them, believe that we are capable of attaining them, and occasionally, when we stumble and do not reach the goal, we still pick ourselves up and go on. We have enough confidence in ourselves as being valuable people that we do not let occasional mistakes ruin our lives. At the same time, we have empathy and compassion for others.

According to the DSM - IV, Narcissistic Personality Disorder consists of 9 behaviors, which, if a client demonstrates 5 or more of these traits, is considered to have the disorder. These 9 characteristics are:

1.) Grandiose sense of self-importance,
2.) Obsessed with fantasies of unlimited power, success or brilliance,
3.) Is unique, can only be understood by other “worthy” people,
4.) Requires excessive admiration and attention
5.) Extreme sense of entitlement,
6.) Interpersonally exploitive,
7.) Lacks empathy and compassion,
8.) Envious of others,
9.) Arrogant, haughty behavior.

Are Only Those With NPD Dangerous?

My contention is this … just as there is a wide range between healthy narcissism and pathological Narcissistic Personality Disorder, those perpetrators who only display narcissistic traits can prove to be just as detrimental to their partners as those with NPD. Depending upon the codependent's emotional and psychological “baggage,” a partner who only exhibits narcissistic “traits” can still inflict emotional abuse that can, over time, become the emotional brainwashing that leads to depression and other pathology.

If we look back to the “cult” environments of the 70's and 80's, we can see just what a powerful force emotional abuse can be … even to the point of self-destruction, as in the case with Reverend Jim Jones and the vast suicide of his followers.

Then of course, as the murder of Laci Peterson by her husband Scott became front page news, we are left to wonder just what life was like behind closed doors at the Peterson household. With Amber Frey's testimony about her “Perfect Partner” Scott Peterson turning into the perfect monster before her eyes, one can only assume that the sly, manipulative, lying, and controlling predator Peterson, played many more subtle games before he went on to reach the level of murder of his wife and unborn child.

While not all environments are fatal as with Jim Jones or Scott Peterson, let's hope that we can become aware of a variety of levels of emotionally toxic environments that our clients might be living in and stem the tied before we lose even one to the destructive side of depression caused by an environment that can be changeable, if intervention can be introduced by a sensitive caregiver.

So, before you simply write the next prescription for an antidepressant for the next woman in your practice who requests one, ask her some of these important questions. And if she answers yes to more than a few, perhaps it's time to find her an emotional support system in the way of social services or psychological intervention, at least at the same time that you write the script for the Wellbutrin or Prozac.

By Mary Jo Fay, RN, MSN

Mary Jo Fay, RN, MSN is a national speaker, award winning author, columnist, and survivor of several narcissistic relationships. Her book, "When Your Perfect Partner Goes Perfectly Wrong - Loving or Leaving the Narcissist in Your Life" is available at or
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Saturday, July 09, 2005


I was a mother and wife at the age of eighteen years old. Not too long into the relationship, verbal and mental abuse became a lifestyle that I lived with for over ten years. It was physical in a sense that everything but the kitchen sink was thrown at me.

My ex was in and out of work in which forced me to work full-time as a waitress. Being on my feet seven days a week, holding heavy trays, working until one o’clock am, raising three kids, and dealing with an abusive relationship left me with Epstein Barr and depression.

Fortunately, I didn’t turn to alcohol or food. Instead, I went bonkers. I would find myself crying in closets and I had no positive outlook towards anything. I was angry, bitter, and depressed.

After ten years of abuse, I left the relationship. I forgive my ex and have moved on. I don’t think about it, talk about it unless there is a legit reason for talking about it, and I haven’t seen or spoken to my ex in over seven years.

I graduated college, moved out of state, remarried, wrote and self-published a book, and became very spiritual. I went through a healing process through writing. I have written several stories about my past as a way to gain closure.

I have a wonderful family, great friends, a good marriage, a beautiful home, and live nearly half a mile from the ocean. I live in warm climate, design handmade crafts, own my own website, and work for my husband three days a week.

I have no complaints and my past to me was as if it never happened. It was so long ago that sometimes I don’t even remember what went on. I now, write for a Women Abuse column at and instruct a workshop on “How To Survive An Abusive Relationship.” We can survive abuse and move on.

When I moved to a new state and started a new life, I worked full-time at my local Humane Society. I worked for 40-60 hours a week. My job consisted of cleaning cages every day in which was very physical. I gave animals shots, and unfortunately I had to euthanize animals. This job was very stressful, but I did it with no complaints and no pain. I came home after an 8-10 hour workday and cooked for my family, and my weekends consisted of food shopping and cleaning my house.

My energy was on fire. I was exercising, walking with friends, going to writing workshops in the evenings, and feeling wonderful.

I had my fourth child (second marriage) and left my job at the Humane Society. I had the privilege of being a stay-at-home mom. This was how I finished my book and published it. How cool is that?

A year after my son was born I started to experience pain. Not major pain at first, but pain in my legs. After a month the pain went to my arms, chest, and then chronic headaches.

Now it has reached a point where my physical illness has become a life challenge. At times, I cannot lift my arms and I have experienced a point in my life where I couldn’t walk. Now that was scary.

I was diagnosed with Fibromyalgia, but the doctor was still unsure about this diagnosis. Fibromyalgia is a common condition associated with muscular pain and fatigue. The cause of Fibromyalgia is unknown. Studies have suggested that people with Fibro have abnormal levels of several of the different chemicals that help transmit and amplify pain signals to and from the brain.

Some studies believe that Fibromyalgia stems from stress, trauma, physical trauma, and abuse.

One would think that all this physical pain would have occurred during my abuse, but for me, this didn’t occur until ten years after the divorce. I could honestly say that my life today is wonderful. We all have our downfalls and problems, but I am living my life as a writer: a life that I have always dreamed of, so why now?

Why after fulfilling my dreams, achieving my goals, and doing what I love to do the most, do I now feel horrible?

Back then was when I felt my worst. I was clinically depressed, being abused, and down right exhausted. Then was when I slept until twelve-noon, had food thrown at me, and cried until my eyes became swollen.

Back then I worked my booty off, took care of three kids no problem, and worked full-time. Now, I am lucky to have one good day ahead of me.

When I compare Now and Then, I see a sad change in my energy and quality of life. I use to exercise like it was going out of style, now it is like pulling tooth and nail just to get me up and walking around my block.

Then I worked day and night and loved the tiredness of hard work, now I have to drag myself just to work three days a week and a measly nine hours a week.

Then I had to focus on giving an animal a shot and even euthanize and handle acupuncture, now I cannot even focus on putting a money balance in Quicken.

But yet, people might say, “just keep moving,” “get over it" and "the past is in the past,” as if I could keep my body from feeling physical pain. Granted, some of us may have abused alcohol and food, but we also have the choice to stop. We could see a therapist if we are feeling depressed or the blues, but how can we “stop” feeling physical pain? How does one prevent ever feeling or experiencing a “chronic illness?”

I truly believe that abuse has a lot to do with how we feel physically and mentally. Our soul and spirit are fragile and when someone shatters our soul; our spirit becomes scarred.

I don’t think that we can “control” fibromyalgia or prevent it from happening. One never knows when an illness is going to creep up on them.
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Tuesday, July 05, 2005


About 1 in 3 American women have been physically or sexually assaulted by a husband or boyfriend at some point in their lives. (Common Wealth Fund, Health Concerns Across a Woman's Lifespan: The Commonwealth Fund 1998 Survey of Women's Health, 1999)

A woman is battered every 9 seconds in the United States.

- In the US, a woman is raped every 6 minutes; a woman is battered every 15 seconds.
- In North Africa, 6,000 women are genitally mutilated each day.
- This year, more than 15,000 women will be sold into sexual slavery in China.
- 200 women in Bangladesh will be horribly disfigured when their spurned husbands or suitors burn them with acid.
- More than 7,000 women in India will be murdered by their families and in-laws in disputes over dowries.

Here's what you can do:

You could visit my web site at and please read my blog dedicated to women abuse and teen dating violence:
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Monday, July 04, 2005

Conference to explore issues of faith, domestic violence
GINNIE GRAHAM World Staff Writer

Battered spouses often find conflict in their beliefs in God and violence occurring in their homes.

They hear from faith leaders that divorce is a sin, women must reconcile with their husbands and believers should not go to court against other believers.

So a battered spouse returns to the violent home hoping for better

"Because we were not dealing with the reasons why our clients were staying in these relationships, which had to do with faith, they were dropping out," said Felicia Collins Correia, executive director of the Domestic Violence Intervention Services.

"We had a number of clients coming in with these issues of faith and are paralyzed. We had to educate ourselves."

An interfaith advisory committee was created in the late 1990s to create a bridge between the work of DVIS and the faith community.

Through its work, partnerships have been created in Tulsa for intensive training sessions for faith leaders and annual conferences.

A conference exploring the role faith leaders have in ending domestic violence begins at 8:30 a.m. Tuesday at the Jewish Federation of Tulsa, 2021 E. 71st St.

Three national speakers will provide keynote addresses, lead small group sessions and participate in a panel discussion.

The event is being presented by DVIS and Tulsa Metropolitan Ministries with sponsorships from the Anne and Henry Zarrow Foundation and the Jewish Federation of Tulsa.

The Rev. Dr. Joseph C. Parker Jr., pastor of David's Chapel Missionary Baptist Church in Austin, Texas and former trial attorney, will discuss how a church can support a batterer while holding that person accountable and requiring change.

Nancy Murphy, director of the Northwest Family Life Learning and Counseling Center based in Seattle, will speak about providing a compassionate response to victims of family violence and the role of faith leaders in aiding victims.

Naomi Perry, lead coordinator for the Parent-Child Interaction Training Program in Washington state and therapist at the Harborview Center for Sexual Assault and Traumatic Stress in Seattle, will address how children respond to domestic violence.

"We put on the conferences for the community and for ourselves," Correia said. "We bring in leaders who challenge us and our organization."

Correia said DVIS has been working with the faith community since 1988, when the agency located various spiritual and scriptural references for clients to use in decision making.

"If anything is new, it's that we're not taking the issue and putting it in a corner," Correia said. "We are looking at what our organization can do as a nonprofit to be of help and have partnerships."

Since the training sessions and conferences began, faith leaders are understanding that DVIS is not about breaking up families, Correia said.

The leaders have gained knowledge about not minimizing violence that may occur and how to react to the serious nature of violence in families, she said.

Keeping faith leaders accountable for appropriate counsel -- similar to law enforcement -- is a suggestion from the DVIS interfaith advisory council.

Currently, faith leaders will contact each other with concerns about advice given to families in crisis.

"This is not just us as an outside organization, but us on the inside saying these are important issues," Correia said.

"People now in the faith community understand what our role is and how and when to refer to us."

Ginnie Graham
Copyright 2004
The Tulsa World
Tulsa World (Oklahoma)
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