Q. I am a lawyer and need scientific evidence linking certain types of disorders to child sex abuse. Are there any studies linking polymorphous perverse disorders to child sex offenders? Are there any clinical studies linking narcissistic personality disorder to child sex offenders?

A. I am not aware of any official psychiatric diagnosis called polymorphous perverse disorder. (Perhaps you are harking back to Freud's characterization of human sexuality as polymorphously perverse?) Now, regarding the link between pedophilia/sexual offenders and narcissistic personality disorder (NPD) or narcissism: generally, there are some connections in the literature.

For example, Bridges et al (J Pers Assess 1998 Apr;70(2):365-85 carried out a Rorschach investigation of defensiveness, self-perception, interpersonal relations, and affective states in incarcerated pedophiles. They found that, like other incarcerated men, the pedophiles exhibited disturbances in self-worth (either poor self-esteem or excessive self-focus), and chronic oppositionality and hostility. The pedophiles also demonstrated many core personality features associated with Narcissistic Personality Disorder--indeed, the authors considered them examples of "failed narcissism".

Similarly, Gacono et al (J Clin Psychol 2000 Jun;56(6):757-77) carried out a Rorschach comparison of psychopaths, sexual homicide perpetrators, and nonviolent pedophiles. Pathological narcissism was seen to some degree in all groups, though there were other differences noted. Narcissistic pathology has also been implicated in a variety of other kinds of crime, including sexual crimes against adults (see Akhtar & Thomson, Am J Psychiatry 1982;139:12-20). You may also want to see the article by Berger et al (J Personal Disord 1999 Summer;13(2):175-86) on sadistic and antisocial traits in sexual offenders.

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May 2002

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