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Amanda Alden, MA; Patricia Brennan, PhD; Sheilagh Hodgins, PhD; Sarnoff Mednick, PhD, DrMed

Arch Gen Psychiatry. 2007;64(11):1251-1258.

Context  Psychotic disorders are associated with an increased risk of aggressive behavior and violent crime. Whether there is also an association with sex offending is unknown.

Objectives  To estimate the lifetime prevalence of arrests for sexual offenses (with and without physical aggression) among men and women with psychotic disorders, the moderating effects of comorbid personality disorders and substance use disorders, and the prevalence rates for 4 specific psychotic disorders.

Design  We examined official records of arrests for sexual offenses with and without physical aggression to compare persons hospitalized with a psychotic disorder with those who had never been hospitalized.

Setting  Denmark.

Participants  All 358 180 persons born from January 1, 1944, through December 31, 1947, in Denmark.

Main Outcome Measure  Official arrest records.

Results  Among the men, 2.2% were hospitalized with psychotic disorders. These men committed 8.4% of the physically aggressive sexual offenses and 9.0% of the non–physically aggressive sexual offenses of the men in the cohort. Compared with men who had never been hospitalized, men with psychotic disorders without a personality disorder or a substance use disorder were not at increased risk of arrest for physically aggressive sexual offenses but were 3 times more likely to have been arrested for non–physically aggressive sexual offenses. Psychotic disorders with comorbid personality disorders or substance use disorders were associated with a 6-fold increased risk of physically aggressive sex offending and a 3- to 5-fold increased risk of non–physically aggressive sex offending.

Conclusions  Psychotic disorders comorbid with personality disorders and substance use disorders are associated with an increased risk of sex offending with and without physical aggression. Mental health policy and practice need to take account of these findings to improve functional outcome among persons with psychotic disorders.

Author Affiliations: Department of Psychology, Emory University, Atlanta, Georgia (Ms Alden and Dr Brennan); Institute of Psychiatry, King's College London, London, England (Dr Hodgins); and Institute of Preventive Medicine, Copenhagen, Denmark (Dr Mednick).