Sexual Aggression

A small article appeared in the New York Times on March 24, 1999, in which it was noted that Samuel Manzie, a 17-year-old who had pleaded guilty to strangling 11-year-old Eddie Werner as he sold candy door to door, offered to testify at the trial of a 45-year-old man who had sodomized Manzie when he was 14 years old (Robert Hanley. "Youth Offers to Testify He Agreed to Sex with Man, 45." p. A24). The relation among sexual victimization, physical abuse, and subsequent aggression forms the core subject of Sexual Aggression.

Although the title suggests violent sexual interactions, such as rape, the book deals more broadly with sexual encounters that extend beyond the boundaries of sanctioned behavior. Shaw clarifies the use of the title by defining sexual aggression as involving "the use of threat, intimidation, exploitation of authority, or force with the aim of imposing one's sexual will on a nonconsenting person for the purpose of personal gratification that may or may not be predominantly sexual in nature."

The book is divided into two main sections -- one entitled "Overview of Sexually Aggressive Behavior and Its Psychological Consequences" and the other "Phenomenology and Assessment of Sexually Aggressive Behavior and Treatment Considerations." There are 11 chapters, authored by both physicians and psychologists. The book discusses in an objective, well-authenticated manner the many facets of sexual development throughout childhood. The chapter entitled "Development of Sexual Behavior Problems in Children" by Toni Cavanagh Johnson is particularly useful not only for therapists and others involved in the diagnosis of and response to sexual abuse but also for practitioners dealing with children. This chapter provides a clear and well-organized discussion of normal and healthy as well as problematic forms of sexual behavior in which children engage. A list of 21 forms of behavior that indicate sexual development that has gone awry is provided. I found this list to be particularly helpful when fielding phone calls about children who seem to be more sexually aware than expected. For instance, how serious is it to find two six-year-old boys engaged in oral sex with each other? Is this normal exploratory behavior? Is it an indication that one boy has been sexually abused? Does it mean that one of the youngsters will go on to become a juvenile and ultimately an adult sexual offender?

Although childhood sexuality is reviewed, the main emphasis of the book is on juvenile sexual offenders. This emphasis is linked to the fact that juveniles are frequently implicated in violent crimes: adolescents between the ages of 15 and 18 years make up 6 percent of the population, but they are involved in 25 percent of "index crimes" (e.g., homicide, burglary, and forcible rape). Women and children are frequently their victims. It has been estimated that 10 percent of adolescent girls and women between 13 and 21 years of age are sexually assaulted each year and that such victims are three to four times as likely to be assaulted again in the following year. Shaw focuses on girls and women as victims, but he also provides one of the more comprehensive reviews of male victims and female perpetrators. In fact, the root of aggressive sexual behavior in some juvenile offenders is their own victimization as boys by female perpetrators. For instance, in the chapter called "Assessment of Adolescent Sex Offenders," the authors specifically note that adolescent boys may not have understood the abusive nature of a sexual encounter with an older female partner, and may even have termed it "getting lucky," whereas such an encounter could have represented the point at which the boy's normal sexual development became derailed.

The portion of the book on therapy is a comprehensive discussion of various types of counseling, behavior-modification strategies, and drug therapies. It appears to assess realistically the likelihood of a positive outcome of any intervention, noting that one of the main challenges is to change the mindset of perpetrators so that they move away from their own narcissistic needs and achieve empathy with their victims. Motivation appears to be a key factor in the success of the various treatment programs. Empirical evidence suggests that some optimism is warranted with respect to the possibility of breaking the pattern of sexual aggression among adolescent offenders.

There are many strengths to Sexual Aggression and no apparent shortcomings. The chapters include case scenarios that help to highlight and illustrate important clinical points. The book avoids sweeping overstatements and simplistic solutions. For instance, though the root of sexual aggression is often victimization of the perpetrator as a child, this fact is not used as a defense or as an excuse for the gravity of the offense. Although the book has many authors, it is homogeneous; the chapters conform to a fairly uniform style, and there is a recurrence of themes and ideas that reinforces the main points without becoming repetitive. This comprehensive review will be a useful resource for both newcomers to the field and experienced practitioners dealing with sexual aggression.

Reviewed by Carol D. Berkowitz, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

"The literature on delinquent behavior and related disturbances is voluminous, yet the subject matter can often be quite narrow in scope. This book, however, is an exception, and that alone makes it a special contribution. The contributors come from diverse backgrounds.... The book does provide an excellent summary of our current knowledge and would be a welcome addition to the libraries of clinicians working with young people who have been victims or perpetrators of sexual aggression."-- "Psychiatric Times"

"There are many strengths to "Sexual Aggression" and no apparent shortcomings. The chapters include case scenarios that help to highlight and illustrate important clinical points.... Although the book has many authors, it is homogeneous; the chapters conform to a fairly uniform style, and there is a recurrence of themes and ideas that reinforces the main points without becoming repetitive. This comprehensive review will be a useful resource for both newcomers to the field and experienced practitioners dealing with sexual aggression."-- "New England Journal of Medicine"

"[T]his volume presents a good compilation of what is know and not known from research findings. Most of the chapters are clearly written with a minimum of theoretical interpretation of the findings. The frequent case studies are to the point and help the reader understand both the behavior of the offender and the consequences to the victims."-- "Choice"