Archives of Sexual Behavior

, Volume 45, Issue 5, pp 1163–1172 | Cite as

Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study

  • Elena Baur
  • Mats ForsmanEmail author
  • Pekka Santtila
  • Ada Johansson
  • Kenneth Sandnabba
  • Niklas Långström
Original Paper


Prior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.


Paraphilic behavior Sexually coercive behavior Twin study Genetics Family environment DSM-5 


  1. Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Journal of the American Academy of Psychiatry and the Law, 16, 153–168.Google Scholar
  2. Abel, G. G., & Rouleau, J. L. (1990). The nature and extent of sexual assault. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 9–21). New York: Plenum Press.CrossRefGoogle Scholar
  3. Abrahams, N., Devries, K., Watts, C., Pallitto, C., Petzold, M., Shamu, S., & García-Moreno, C. (2014). Worldwide prevalence of non-partner sexual violence: A systematic review. Lancet, 383, 1648–1654.CrossRefPubMedGoogle Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
  5. Beech, A. R., & Harkins, L. (2012). DSM-IV paraphilia: Descriptions, demographics and treatment interventions. Aggression and Violent Behavior, 17, 527–539.CrossRefGoogle Scholar
  6. Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., … Stevens, M. R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.Google Scholar
  7. Blanchard, R., Kuban, M. E., Klassen, P., Dickey, R., Christensen, B. K., Cantor, J. M., & Blak, T. (2003). Self-reported head injuries before and after age 13 in pedophilic and nonpedophilic men referred for clinical assessment. Archives of Sexual Behavior, 32, 573–581.CrossRefPubMedGoogle Scholar
  8. Dennis, J. A., Khan, O., Ferriter, M., Huband, N., Powney, M. J., & Duggan, C. (2012). Psychological interventions for adults who have sexually offended or are at risk of offending. The Cochrane Library, 12, 1–95.Google Scholar
  9. Durant, L. E., Carey, M. P., & Schroder, K. E. (2002). Effects of anonymity, gender, and erotophilia on the quality of data obtained from self-reports of socially sensitive behaviours. Journal of Behavioral Medicine, 25(5), 439–467.CrossRefGoogle Scholar
  10. Eisen, S., Neuman, R., Goldberg, J., Rice, J., & True, W. (1989). Determining zygosity in the Vietnam Era Twin Registry: An approach using questionnaires. Clinical Genetics, 35(6), 423–432.CrossRefPubMedGoogle Scholar
  11. Fazel, S., Lichtenstein, P., Grann, M., & Långström, N. (2011). Risk of violent crime in individuals with epilepsy and traumatic brain injury: A 35-year Swedish population study. PLoS Medicine, 8(12), e1001150. doi: 10.1371/journal.pmed.1001150.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Firestone, P., Kingston, D. A., Wexler, A., & Bradford, J. M. (2006). Long-term follow-up of exhibitionists: Psychological, phallometric, and offense characteristics. Journal of the American Academy of Psychiatry and the Law, 34(3), 349–359.PubMedGoogle Scholar
  13. Forbes, G. B., & Adams-Curtis, L. E. (2001). Experiences with sexual coercion in college males and females: Role of family conflict, sexist attitudes, acceptance of rape myths, self-esteem, and the Big-Five personality factors. Journal of Interpersonal Violence, 16(9), 865–889.CrossRefGoogle Scholar
  14. Forsman, M., Johansson, A., Santtila, P., Sandnabba, K., & Långström, N. (2015). Sexually coercive behavior following childhood maltreatment. Archives of Sexual Behavior, 44(1), 149–156.CrossRefPubMedGoogle Scholar
  15. Forsman, M., & Långström, N. (2012). Child maltreatment and adult violent offending: Population-based twin study addressing the ‘cycle of violence’ hypothesis. Psychological Medicine, 42(9), 1977–1983.CrossRefPubMedGoogle Scholar
  16. Freund, K. (1990). Courtship disorder. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 195–207). New York: Plenum Press.CrossRefGoogle Scholar
  17. Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373(9657), 68–81.CrossRefPubMedGoogle Scholar
  18. Grønnerød, C., Grønnerød, J. S., & Grøndahl, P. (2015). Psychological treatment of sexual offenders against children: A meta-analytic review of treatment outcome studies. Trauma Violence & Abuse, 16(3), 280–290.CrossRefGoogle Scholar
  19. Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual offenders: A meta-analysis of recidivism studies. Journal of Consulting and Clinical Psychology, 73, 1154–1163.CrossRefPubMedGoogle Scholar
  20. Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, 45(2), 260–273.CrossRefPubMedGoogle Scholar
  21. Jewkes, R., Garcia-Moreno, C., & Sen, P. (2002). Sexual violence. In E. G. Krug (Ed.), World report on violence and health (pp. 149–181). Geneva: World Health Organization.Google Scholar
  22. Johansson, A., Jern, P., Santtila, P., von der Pahlen, B., Eriksson, E., Westberg, L., … Sandnabba, N. K. (2013). The genetics of sexuality and aggression (GSA) twin samples in Finland. Twin Research and Human Genetics, 1, 1–7.Google Scholar
  23. Kaplan, M. S., & Krueger, R. B. (2012). Cognitive-behavioral treatment of the paraphilias. Israel Journal of Psychiatry and Related Sciences, 49(4), 291–296.PubMedGoogle Scholar
  24. Kaprio, J., & Koskenvuo, M. (1989). Twins, smoking and mortality: A 12-year prospective study of smoking-discordant twin pairs. Social Science and Medicine, 29(9), 1083–1089.CrossRefPubMedGoogle Scholar
  25. Knight, R. A. (1999). Validation of a typology of rapists. Journal of Interpersonal Violence, 14, 303–330.CrossRefGoogle Scholar
  26. Knight, R. A., & Prentky, R. A. (1990). Classifying sexual offenders: The development and corroboration of taxonomic models. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 23–52). New York: Plenum.CrossRefGoogle Scholar
  27. Knight, R. A., & Thornton, D. (2007). Evaluating and improving risk assessment schemes for sexual recidivism: A long-term follow-up of convicted sexual offenders. Washington, DC: U.S. Department of Justice.Google Scholar
  28. Koss, M. P., & Oros, C. J. (1982). Sexual Experiences Survey: A research instrument investigating sexual aggression and victimization. Journal of Consulting and Clinical Psychology, 50(3), 455–457.CrossRefPubMedGoogle Scholar
  29. Krueger, R. B. (2010). The DSM diagnostic criteria for sexual sadism. Archives of Sexual Behavior, 39(2), 325–345.CrossRefPubMedGoogle Scholar
  30. Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence and health. Lancet, 360, 1083–1088.CrossRefPubMedGoogle Scholar
  31. Kujala, U. M., Kaprio, J., & Koskenvuo, M. (2002). Modifiable risk factors as predictors of all-cause mortality: The roles of genetics and childhood environment. American Journal of Epidemiology, 156(11), 985–993.CrossRefPubMedGoogle Scholar
  32. Langevin, R. (2006). Sexual offenses and traumatic brain injury. Brain and Cognition, 60(2), 206–207.PubMedGoogle Scholar
  33. Långström, N., Enebrink, P., Laurén, E. M., Lindblom, J., Werkö, S., & Hanson, R. K. (2013). Preventing sexual abusers of children from reoffending: Systematic review of medical and psychological interventions. British Medical Journal, 347, f4630.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Långström, N., & Seto, M. C. (2006). Exhibitionistic and voyeuristic behaviour in a Swedish national population survey. Archives of Sexual Behavior, 35(4), 427–435.CrossRefPubMedGoogle Scholar
  35. Lewin, B., Fugl-Meyer, K., Helmius, G., Lalos, A., & Månsson, S. A. (1998). Sex i Sverige: Om sexuallivet i Sverige 1996 [Sex in Sweden: On sexual life in Sweden, 1996]. Stockholm: National Public Health Institute.Google Scholar
  36. Luiselli, J., Aron, M., Marchese, N., Potoczny-Gray, A., & Rossi, E. (2000). Incidence of law-violation behaviour in a community sample of children and adolescents with traumatic brain injury. International Journal of Offender Therapy and Comparative Criminology, 44(6), 647–656.CrossRefGoogle Scholar
  37. Macdowall, W., Gibson, L. J., Tanton, C., Mercer, C. H., Lewis, R., Clifton, S., … Wellings, K. (2013). Lifetime prevalence, associated factors, and circumstances of non-volitional sex in women and men in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet, 382, 1845–1855.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Mann, R. E., Hanson, R. K., & Thornton, D. (2010). Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors. Sexual Abuse: A Journal of Research and Treatment, 22(2), 191–217.CrossRefGoogle Scholar
  39. McGue, M., & Christensen, K. (2007). Social activity and healthy aging: A study of aging Danish twins. Twin Research and Human Genetics, 10(2), 255–265.CrossRefPubMedGoogle Scholar
  40. McGue, M., Osler, M., & Christensen, K. (2010). Causal inference and observational research: The utility of twins. Perspectives on Psychological Science, 5(5), 546–556.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Paulhus, D. L., Hemphill, J. F., & Hare, R. D. (2002). Manual for the Self-Report Psychopathy Scale (SRP-III). Toronto: Multi-Health Systems.Google Scholar
  42. Richters, J., De Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. (2008). Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): Data from a national survey. Journal of Sexual Medicine, 5(7), 1660–1668.CrossRefPubMedGoogle Scholar
  43. Schroder, K. E., Carey, M. P., & Vanable, P. A. (2003). Methodological challenges in research on sexual risk behaviour: II. Accuracy of self-reports. Annals of Behavioral Medicine, 26(2), 104–123.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and intervention. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  45. Simpson, G., Blaszczynski, A., & Hodgkinson, A. (1999). Sex offending as a psychosocial sequel of traumatic brain injury. Journal of Head Trauma Rehabilitation, 14, 567–580.CrossRefPubMedGoogle Scholar
  46. Stoltenborgh, M., van Ijzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment, 16, 79–101.CrossRefPubMedGoogle Scholar
  47. Sugarman, P., Dumughn, C., Saad, K., Hinder, S., & Bluglass, R. (1994). Dangerousness in exhibitionists. Journal of Forensic Psychiatry, 5(2), 287–296.CrossRefGoogle Scholar
  48. Ward, T., & Beech, A. (2006). An integrated theory of sexual offending. Aggression and Violent Behavior, 11, 44–63.CrossRefGoogle Scholar
  49. Ward, T., & Siegert, R. J. (2002). Toward a comprehensive theory of child sexual abuse: A theory knitting perspective. Psychology, Crime & Law, 8, 319–351.CrossRefGoogle Scholar
  50. Xu, W. L., Atti, A. R., Gatz, M., Pedersen, N. L., Johansson, B., & Fratiglioni, L. (2011). Midlife overweight and obesity increase late-life dementia risk: A population-based twin study. Neurology, 76(18), 1568–1574.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Yates, P. M., Hucker, S. J., & Kingston, D. A. (2008). Sexual sadism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 213–230). New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Elena Baur
    • 1
    • 6
  • Mats Forsman
    • 2
    • 3
    Email author
  • Pekka Santtila
    • 4
  • Ada Johansson
    • 4
    • 5
  • Kenneth Sandnabba
    • 4
  • Niklas Långström
    • 2
    • 3
  1. 1.Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
  2. 2.Swedish Prison and Probation ServiceR&D UnitStockholmSweden
  3. 3.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  4. 4.Department of Psychology and LogopedicsAbo Akademi UniversityTurkuFinland
  5. 5.Department of Pharmacology, Institute of Neuroscience and PhysiologySahlgrenska Academy, University of GothenburgGothenburgSweden
  6. 6.LWL-MaßregelvollzugsklinikHerneGermany

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