Victim Selection Patterns in Sexual Offenders With Severe Mental Illness: An Exploratory Forensic Evaluation Study

Sexual offenders with severe mental illness (SMI) remain underexamined, particularly regarding victim-selection patterns that may inform risk assessment and management. This study compared victim-related and selected clinical characteristics between sexual offenders with and without SMI in a court-referred forensic psychiatric evaluation sample.

This retrospective study included 86 male sexual offenders referred for forensic psychiatric evaluation between 2009 and 2022. Participants were categorized into an SMI group (n = 21; schizophrenia-spectrum/other psychotic disorders or bipolar-related disorders) and a non-SMI group (n = 65). Group comparisons were conducted using bivariate analyses, and exploratory logistic regression examined victim-related correlates of SMI status.

Compared with non-SMI offenders, offenders with SMI were more likely to have adult victims and stranger victims. In the final model, adult victim (odds ratio (OR) = 4.40, 95% confidence interval (CI) 1.30-14.91) and stranger victim (OR = 3.81, 95% CI 1.16-12.46) remained associated with SMI status. Substance use disorder was more common in the non-SMI group.

In this exploratory forensic sample, sexual offenders with SMI showed distinct victim-selection patterns. Because the SMI subgroup was small and consisted predominantly of schizophrenia-spectrum disorders, these findings should be interpreted cautiously and regarded as preliminary.