Aggressive sexual fantasy in men with schizophrenia who commit contact sex offences against women

A search of Home Office records was completed for all 80 restricted hospital order inpatients with schizophrenia, resident in any hospital in England and Wales during May 1997, with an index conviction for a contact sex offence against a woman committed whilst psychotic. Almost one quarter of the men (19) had aggressive sexual fantasies at the time of their index offences and in 13 of these men the fantasy was sadistic in nature. Men with aggressive sexual fantasies were more likely to have a history of sexual offending before the onset of schizophrenia, when compared with men without such fantasies; and more likely to have evidence of disturbed and adverse childhood experiences as indicated by a range of childhood variables, again when compared with men without such fantasies. However, controlling for other variables, only childhood social isolation and childhood deviant sexual behaviour remained significantly associated with future presence of aggressive sexual fantasy at the time of the index sex offence. A thorough examination of fantasy life should be regarded as being an important component of a comprehensive assessment and treatment programme for psychotic sex offenders.