270 JOURNAL OF FORENSIC PSYCHIATRY
Vol. 12 No. 2
Perhaps the crime that causes the greatest public outcry in a civilized
society is that of child homicide (Atmore, 1999; Doyle, 1996; Lamhars-
Winkleman, 1994), though in statistical terms it is very rare (Prins, 1991;
McDonald, 1995; World Health Organization, 1998). Moreover, with one
or two notable exceptions, over the past two decades child homicide has
declined in the majority of western countries, including Britain (Pritchard,
1996; World Health Organization, annual statistics 1974–98). None the less,
the public’s disquiet continues and centres upon the ‘lurking stranger’ per-
ceived of as the stereotypical child molester (Bagley, 1997; Atmore, 1999).
However, international research shows that murders and sexual assaults of
children predominately occur within the family, rather than by an extra-
familial assailant. In the case of intra-familial homicide, almost invariably
the psychiatric dimension is very prominent in the parent who kills
(D’Orban, 1990; Somander and Rammer, 1991; Bourget and Labelle, 1992;
Falkov, 1996; Wilczynski and Morris, 1993; De Silva and Oates, 1993;
Stroud, 1997).
Child sexual abuse also occurs more often within the family, rather than
being extra-familial, as found in research from agency reports and from adult
survivors and recall studies (e.g. Finkelhor, 1994; Bagley and Thurston, 1996;
Fischer and McDonald, 1998; Pritchard and Bagley, 2000). However, ‘extra-
family’ offenders are more likely to be prosecuted, partly because of the
difculty in bringing intra-family offences to successful prosecution (Cox
and Pritchard, 1997; Fischer and McDonald, 1998; Pritchard and Bagley,
2000). Despite the relative hiatus between psychiatric and child protection
research there is a convergence of ndings around the adult sequelae of child
sex abuse, with suicidal behaviour as an extreme outcome (Hawton
.,
et al
., 1992; Bagley and Ramsay, 1997; Stanley and Penhale,
1985; Famularo
1999).
et al
With respect to suicidal behaviour of child sex assailants, with a few
notable exceptions (Wild, 1988; Walford ., 1990) there has been virtually
et al
nothing in the literature, though in regard to child murderers, suicide follow-
ing murder is a well-known sequence (West, 1965; Coid, 1983; Stroud, 1997;
Appleby
., 1999). This reects the problem of trying to study such
et al
assailants as, relatively, it is much easier to study the victims, for whom there
is immediate sympathy and concern, than the perpetrators, who are an elusive
and unattractive group. Yet there could be important lessons that could con-
tribute to both improved child protection and suicide prevention if there
were a better appreciation of this child protection–forensic psychiatry inter-
face.
The present study builds upon earlier pilot work on male child sex abusers
(CSA) (Cox and Pritchard, 1997), and explores, from within a general popu-
lation of two English counties (population 2.4 million people), a 2-year cohort
of men charged with a sexual offence against a child. This is juxtaposed against