The Role of Major Mental Illness in Problematic Sexual Behavior

Much controversy has surrounded the question about whether or not mental disorder, and more specifically major mental illness (MMI), is associated with sexual violence. This chapter reviews the literature describing the relationship between MMI and problematic sexual behavior. It examines the implications of MMI for risk assessment and formulation, and discusses how to incorporate MMI into risk conceptualization and management. The chapter explores the current approaches to integrating MMI issues into treatment for sexual violence and the evidence to date on effective interventions with individuals with MMI who also engage in problematic sexual behavior. General responsivity refers to the type of interventions best suited to the client. For individuals with MMI, it appears that cognitive‐behavioral therapy to address the problematic sexual behavior as well as the psychotic symptoms remains the most effective mode of intervention. With respect to specific responsivity, clinicians must be attuned to the cognitive, emotional, and motivational symptoms associated with MMI.