Archives of Sexual Behavior, VoL 21, No. 1, 1992
Psychological Characteristics of a Sample of Male Street Prostitutes Patricia M. Simon, M.S.W., Ph.D., 1,9 Edward V. Morse, Ph.D., 1 Howard J. Osofsky, M.D., Ph.D., 1 Paul M. Balson, M.D., M.P.H., 1 and H. Richard Gaumer, Ph.D. 1
Two hundred and eleven male street prostitutes were interviewed and administered the SCL 90-R psychological symptom checklist. When compared to nonpatient normals, male prostitutes exhibited significantly higher levels of psychopathology. However, when compared to adult p,sychiatric outpatients, male prostitutes exhibited significantly less psychopathology on all symptom dimensions of the SCL 90-R except paranoid ideation. The male prostitutes' elevated scores on the psychological symptom checklist may reflect their response to an often dangerous and chaotic environment. However, it is as likely that their psychological functioning leads them to this particular milieu. KEY WORDS: prostitution; psychopathology.
INTRODUCTION Studies of male prostitutes have received little attention in the scientific literature. Most published reports are anecdotal, based on contact with a limited number of subjects and are designed and conducted using qualitative rather than quantitative methods. Using primarily unstructured interviews and observational techniques, these reports suggest that male prostitutes possess a variety of negative personality characteristics (laziness, intellectual dullness, immaturity, inability to relate to others) and This research was supported in part by a grant from the National Institute of Mental Health (MH44191-02). 1Department of Psychiatry, Louisiana State University Medicai Center, 1542 Tulane Avenue, New Orleans, Louisiana 70112. 2To whom all correspondence should be addressed. 33 0004.0002/92/0200-0033506.50/0 © 1992PlenumPublishingCorporation
34
Simon, Morse, Osofsky, Balson, and Gaumer
various types of psychopathology including psychosis and psychopathy that predispose them to pursue this deviant occupation (Butts, 1947; Coombs, 1974; Craft, 1966; Esselstyn, 1968; Freyhan, 1947; Ginsberg, 1967; Lloyd, 1976; MacNamara, 1965; Redhardt, 1954). To date, a systematic study of the psychological characteristics of a large sample of male street prostitutes has not been reported. This paper describes and discusses the psychological characteristics of a relatively large sample of male street prostitutes and uses as its bases of analysis a standardized psychological assessment instrument, the SCL-90-R, and data gathered from in-depth personal interviews.
METHODS A sample of 211 adult (18 years or older) male street prostitutes was drawn from an estimated population of 500 male prostitutes working in New Orleans. Subjects were recruited to fill quotas based on a 2 x 2 x 2 sampling frame design where differences in age group (under age 25 and age 25 and older), drug use patterns (iv vs. non-iv), and race (white vs. nonwhite), formed the eight cells. The use of this particular sampling frame produced a minimum of 25 subjects per cell and facilitated comparisons of psychological characteristics across the groupings. For the purposes of this study, a male street prostitute was defined as a biological male who receives payment, either in money or in trade, in exchange for sexual favors. A street prostitute was defined as a person who solicits primarily on the streets or in a hustler bar. A period of 1 year was spent observing the behavior patterns of male prostitutes in their working environment, pretesting data collection instruments, and conducting a pilot study. Although the pilot study was carried out in the field setting, legal constraints moved data collection for the larger project to the offices of the Louisiana State University Medical Center located in close proximity to major prostitution areas in the city of New Orleans. Subjects were either recruited directly by field workers or were referred to the field workers by community contacts or other prostitutes. The continued presence of a researcher in the field (2 years) provided a constant flow of male prostitute subjects for the study and supplied ongoing evidence of subjects engaging in the act of soliciting for prostitution. All data were collected between October 1988 and August 1989. Prostitutes were eligible for the study after successfully answering a series of screening questions which were designed in content and street language such that only working male street prostitutes would understand and be able to answer correctly. Confidentiality was maintained by taking
Psychological Characteristics of Male Prostitutes
35
no names or legal identification information; however, the risk of multiple sampling of the same subject was eliminated by the use of a computerized vital statistics program. The program identified each subject by height, weight, birth date, race, eye color, hair color, dental status, tatoos, distinguishing body characteristics, and intravenous (iv) drug use (identified by visible needle tracks and/or self-report of use during the previous 5 years). Sociodemographic and life-style information was obtained by means of a semistructured interview schedule. Reliability and validity checks were placed throughout the instrument. Following CDC-approved human immunodeficiency virus (HIV) pretest counseling, blood was drawn for ELISA screening (enzyme-linked immunosorbent assay). ELISA-positive sera were confirmed using a commercial Western Blot (DuPont). Criterion for Western Blot positivity utilized was having at least two of the three major bands positive (p24, gp41, and gp120 or gp160). Psychological status was assessed through the administration of the SCL-90-R (Derogatis, 1977). The SCL90-R is a 90-item self-report symptom inventory designed to primarily reflect the psychological symptom patterns of psychiatric and medical patients (Derogatis et al., 1976). Respondents rate each item on a 5-point scale ranging from not at all (0) to extremely (4) indicating the degree to which each symptom has caused them discomfort during the previous week. The SCL 90-R provides scores on nine primary psychological symptom dimensions and three global indices of distress. Internal consistency (a = 0.77-0.90) and test-retest reliability are very high (Derogatis et al., 1976). Briefly stated, the nine primary symptom dimensions assessed are (i) Somatization: reflects the degree of conscious distress arising from perceptions of bodily dysfunctions. (ii) Obsessive-compulsive: reflects symptoms of cognitive dysfunction as well as those identified with the standard clinical syndrome of the same name. (iii) Interpersonal sensitivity: focuses on feelings of personal inadequacy and inferiority. (iv) Depression: reflects a broad range of symptoms associated with clinical depression such as dysphoric mood, loss of energy, and feelings of hopelessness. (v) Anxiety: composed of a set of symptoms and signs associated with high levels of manifest anxiety such as nervousness and its somatic correlates, vi) Hostility: reflects thoughts, feelings, or actions that are characteristic of the negative affect state of anger. (vii) Phobic anxiety: focuses on the more pathognomonic and disruptive manifestations of a persistent fear response characteristic of phobic anxiety. (viii) Paranoid ideation: focuses on paranoid behavior as disordered thinking characterized by projective thought, suspiciousness, and grandiosity. (ix) Psychoticism: The psychoticism scale represents a continuum from mild interpersonal alienation to evidence of psychosis.
36
Simon, Morse, Osofsky, Baison, and Gaumer
The three global indices of distress associated with the SCL-90-R are the Global Severity Index (GSI) which serves as a summary measure of the number of symptoms experienced and the intensity of perceived distress related to those symptoms; the Positive Symptom Distress Index (PSDI) measuring the subject's intensity of distress regardless of the number of symptoms he reports; and the Positive Symptom Total (PST) which is a simple count of the number of symptoms endorsed. There are currently three major normative samples for the SCL-90R: a sample of 973 nonpatient normals; a sample of 1002 psychiatric outpatients; and a sample of 112 adolescent psychiatric outpatients (Derogatis, 1977). The following presentation utilizes data generated from two of these normative groups, nonpatient normals and adult psychiatric outpatients. Based on previous literature (i.e., Craft, 1966; Coombs, 1974; Esselstyn, 1968) and anecdotal reports from both the police and popular press, it was expected that the male prostitute subjects would exhibit extreme levels of psychopathology. Because male prostitutes are usually presented as violent individuals with chaotic and unstable family and work histories, the researchers expected to interview subjects who were angry, hostile, and exhibiting psychological symptoms consistent with psychiatric patients considered severely emotionally disturbed. However, during the interview portion of the research protocol the investigators, who were both trained clinicians and researchers, noted that the subjects were on the whole calm, cooperative, insightful, and extremely open. On only two occasions did the interviewers feel they might be dealing with an individual who could be diagnosed, based on DSM-III-R criteria, as having a serious thought disorder. These initial qualitative impressions provided the impetus for a more standardized examination of the psychological characteristics of male prostitutes using the SCL-90-R.
RESULTS Sociodemographic Characteristics A comparison of the sociodemographic characteristics of the male prostitute sample and the two normative groups is presented in Table I. The mean age of the nonpatient normal sample, the male and female adult psychiatric outpatient sample, and the male prostitute sample are 46, 31.2, 30.9, and 26.9 years, respectively. While the normative samples are composed of a two thirds or greater proportion of whites, the male prostitute
37
Psychological Characteristics of Male Prostitutes Table I. Sociodemographic Characteristics of Male Prostitutes and Normative Groups
Characteristic
Male prostitutes (n = 211)
Nonpatient normals ° (n = 973)
Adult psychiatric outpatient malesa (n = 425)
26.9
46
31.2
30.9
49.8 50.2
86.8 13.2
65.6 35.4
68.6 31.4
71.1 4.3 15.2 9.4
-84.6 b 15.4 --
54.0 32.1 -13.9
39.7 32.8 -27.5
A g e (.~) Race (%) White Nonwhite Marital status (%) Single Married Divorced Other
Adult psychiatric outpatient femalesa (n = 577)
aSource: Derogatis, 1977. bSingle or married.
sample is 50% white. The marital status of both normative samples and the male prostitutes was similar. Within the sample of male prostitutes studied, no statistically significant differences in levels of psychological symptomatology were found based on age, race, or iv drug use. Additionally, differences in subjects' level of education, father's occupation, and number of years in prostitution were not related to either the number of psychological symptoms endorsed or the level of distress associated with the endorsed symptoms.
Psychological Symptoms of Male Prostitutes Compared With Normative Groups The mean scores of the 211 male street prostitutes are both higher and statistically significantly different from those of the nonpatient normals on all symptom dimensions of the SCL-90-R. Table II shows the mean scores and standard deviations for both the male prostitute sample and the normals. The mean scores for nonpatient normals and male prostitutes on the PST which measures the total number of symptoms endorsed by respondents are statistically significantly different with a mean of 19.29 for the normals as compared to 44.64 for the male prostitutes. These data indicate that the sample of male prostitutes experience more than twice as many psychological symptoms as the general population. On the PSDI measuring symptom intensity, there is a statistically significant difference
38
Simon, Morse, Osofsky, Balson, and G a u m e r
Table II. T Tests, Means, and Standard Deviations of SCL-90-R Scale Scores for Male Prostitutes and the Nonpatient Normative Group
Male prostitutes (n = 211) Symptom dimension
Nonpatient normals (n = 973)
x
SD
x
SD
ta
Somatization
0.66
0.67
0.36
0.42
6.23
Obsessive-compulsive
1.11
0.82
0.39
0.45
12.33
Interpersonal sensitivity
1.13
0.87
0.29
0.39
13.70
Depression
1.25
0.87
0.36
0.44
14.43
Anxiety
0.94
0.86
0.30
0.37
10.58
Hostility
0.87
0.83
0.30
0.40
9.71
Phobic anxiety
0.69
0.80
0.13
0.31
9.98
Paranoid ideation
1.38
0.89
0.34
0.44
16.50
Psychoticism
0.90
0.80
0.14
0.25
13.62
GSI
1.00
0.71
0.31
0.31
13.80
PSDI
1.94
0.73
1.32
0.42
11.89
44.64
22.73
19.29
15.48
15.41
PST
ap
Psychological Characteristics of a Sample of Male Street Prostitutes Patricia M. Simon, M.S.W., Ph.D., 1,9 Edward V. Morse, Ph.D., 1 Howard J. Osofsky, M.D., Ph.D., 1 Paul M. Balson, M.D., M.P.H., 1 and H. Richard Gaumer, Ph.D. 1
Two hundred and eleven male street prostitutes were interviewed and administered the SCL 90-R psychological symptom checklist. When compared to nonpatient normals, male prostitutes exhibited significantly higher levels of psychopathology. However, when compared to adult p,sychiatric outpatients, male prostitutes exhibited significantly less psychopathology on all symptom dimensions of the SCL 90-R except paranoid ideation. The male prostitutes' elevated scores on the psychological symptom checklist may reflect their response to an often dangerous and chaotic environment. However, it is as likely that their psychological functioning leads them to this particular milieu. KEY WORDS: prostitution; psychopathology.
INTRODUCTION Studies of male prostitutes have received little attention in the scientific literature. Most published reports are anecdotal, based on contact with a limited number of subjects and are designed and conducted using qualitative rather than quantitative methods. Using primarily unstructured interviews and observational techniques, these reports suggest that male prostitutes possess a variety of negative personality characteristics (laziness, intellectual dullness, immaturity, inability to relate to others) and This research was supported in part by a grant from the National Institute of Mental Health (MH44191-02). 1Department of Psychiatry, Louisiana State University Medicai Center, 1542 Tulane Avenue, New Orleans, Louisiana 70112. 2To whom all correspondence should be addressed. 33 0004.0002/92/0200-0033506.50/0 © 1992PlenumPublishingCorporation
34
Simon, Morse, Osofsky, Balson, and Gaumer
various types of psychopathology including psychosis and psychopathy that predispose them to pursue this deviant occupation (Butts, 1947; Coombs, 1974; Craft, 1966; Esselstyn, 1968; Freyhan, 1947; Ginsberg, 1967; Lloyd, 1976; MacNamara, 1965; Redhardt, 1954). To date, a systematic study of the psychological characteristics of a large sample of male street prostitutes has not been reported. This paper describes and discusses the psychological characteristics of a relatively large sample of male street prostitutes and uses as its bases of analysis a standardized psychological assessment instrument, the SCL-90-R, and data gathered from in-depth personal interviews.
METHODS A sample of 211 adult (18 years or older) male street prostitutes was drawn from an estimated population of 500 male prostitutes working in New Orleans. Subjects were recruited to fill quotas based on a 2 x 2 x 2 sampling frame design where differences in age group (under age 25 and age 25 and older), drug use patterns (iv vs. non-iv), and race (white vs. nonwhite), formed the eight cells. The use of this particular sampling frame produced a minimum of 25 subjects per cell and facilitated comparisons of psychological characteristics across the groupings. For the purposes of this study, a male street prostitute was defined as a biological male who receives payment, either in money or in trade, in exchange for sexual favors. A street prostitute was defined as a person who solicits primarily on the streets or in a hustler bar. A period of 1 year was spent observing the behavior patterns of male prostitutes in their working environment, pretesting data collection instruments, and conducting a pilot study. Although the pilot study was carried out in the field setting, legal constraints moved data collection for the larger project to the offices of the Louisiana State University Medical Center located in close proximity to major prostitution areas in the city of New Orleans. Subjects were either recruited directly by field workers or were referred to the field workers by community contacts or other prostitutes. The continued presence of a researcher in the field (2 years) provided a constant flow of male prostitute subjects for the study and supplied ongoing evidence of subjects engaging in the act of soliciting for prostitution. All data were collected between October 1988 and August 1989. Prostitutes were eligible for the study after successfully answering a series of screening questions which were designed in content and street language such that only working male street prostitutes would understand and be able to answer correctly. Confidentiality was maintained by taking
Psychological Characteristics of Male Prostitutes
35
no names or legal identification information; however, the risk of multiple sampling of the same subject was eliminated by the use of a computerized vital statistics program. The program identified each subject by height, weight, birth date, race, eye color, hair color, dental status, tatoos, distinguishing body characteristics, and intravenous (iv) drug use (identified by visible needle tracks and/or self-report of use during the previous 5 years). Sociodemographic and life-style information was obtained by means of a semistructured interview schedule. Reliability and validity checks were placed throughout the instrument. Following CDC-approved human immunodeficiency virus (HIV) pretest counseling, blood was drawn for ELISA screening (enzyme-linked immunosorbent assay). ELISA-positive sera were confirmed using a commercial Western Blot (DuPont). Criterion for Western Blot positivity utilized was having at least two of the three major bands positive (p24, gp41, and gp120 or gp160). Psychological status was assessed through the administration of the SCL-90-R (Derogatis, 1977). The SCL90-R is a 90-item self-report symptom inventory designed to primarily reflect the psychological symptom patterns of psychiatric and medical patients (Derogatis et al., 1976). Respondents rate each item on a 5-point scale ranging from not at all (0) to extremely (4) indicating the degree to which each symptom has caused them discomfort during the previous week. The SCL 90-R provides scores on nine primary psychological symptom dimensions and three global indices of distress. Internal consistency (a = 0.77-0.90) and test-retest reliability are very high (Derogatis et al., 1976). Briefly stated, the nine primary symptom dimensions assessed are (i) Somatization: reflects the degree of conscious distress arising from perceptions of bodily dysfunctions. (ii) Obsessive-compulsive: reflects symptoms of cognitive dysfunction as well as those identified with the standard clinical syndrome of the same name. (iii) Interpersonal sensitivity: focuses on feelings of personal inadequacy and inferiority. (iv) Depression: reflects a broad range of symptoms associated with clinical depression such as dysphoric mood, loss of energy, and feelings of hopelessness. (v) Anxiety: composed of a set of symptoms and signs associated with high levels of manifest anxiety such as nervousness and its somatic correlates, vi) Hostility: reflects thoughts, feelings, or actions that are characteristic of the negative affect state of anger. (vii) Phobic anxiety: focuses on the more pathognomonic and disruptive manifestations of a persistent fear response characteristic of phobic anxiety. (viii) Paranoid ideation: focuses on paranoid behavior as disordered thinking characterized by projective thought, suspiciousness, and grandiosity. (ix) Psychoticism: The psychoticism scale represents a continuum from mild interpersonal alienation to evidence of psychosis.
36
Simon, Morse, Osofsky, Baison, and Gaumer
The three global indices of distress associated with the SCL-90-R are the Global Severity Index (GSI) which serves as a summary measure of the number of symptoms experienced and the intensity of perceived distress related to those symptoms; the Positive Symptom Distress Index (PSDI) measuring the subject's intensity of distress regardless of the number of symptoms he reports; and the Positive Symptom Total (PST) which is a simple count of the number of symptoms endorsed. There are currently three major normative samples for the SCL-90R: a sample of 973 nonpatient normals; a sample of 1002 psychiatric outpatients; and a sample of 112 adolescent psychiatric outpatients (Derogatis, 1977). The following presentation utilizes data generated from two of these normative groups, nonpatient normals and adult psychiatric outpatients. Based on previous literature (i.e., Craft, 1966; Coombs, 1974; Esselstyn, 1968) and anecdotal reports from both the police and popular press, it was expected that the male prostitute subjects would exhibit extreme levels of psychopathology. Because male prostitutes are usually presented as violent individuals with chaotic and unstable family and work histories, the researchers expected to interview subjects who were angry, hostile, and exhibiting psychological symptoms consistent with psychiatric patients considered severely emotionally disturbed. However, during the interview portion of the research protocol the investigators, who were both trained clinicians and researchers, noted that the subjects were on the whole calm, cooperative, insightful, and extremely open. On only two occasions did the interviewers feel they might be dealing with an individual who could be diagnosed, based on DSM-III-R criteria, as having a serious thought disorder. These initial qualitative impressions provided the impetus for a more standardized examination of the psychological characteristics of male prostitutes using the SCL-90-R.
RESULTS Sociodemographic Characteristics A comparison of the sociodemographic characteristics of the male prostitute sample and the two normative groups is presented in Table I. The mean age of the nonpatient normal sample, the male and female adult psychiatric outpatient sample, and the male prostitute sample are 46, 31.2, 30.9, and 26.9 years, respectively. While the normative samples are composed of a two thirds or greater proportion of whites, the male prostitute
37
Psychological Characteristics of Male Prostitutes Table I. Sociodemographic Characteristics of Male Prostitutes and Normative Groups
Characteristic
Male prostitutes (n = 211)
Nonpatient normals ° (n = 973)
Adult psychiatric outpatient malesa (n = 425)
26.9
46
31.2
30.9
49.8 50.2
86.8 13.2
65.6 35.4
68.6 31.4
71.1 4.3 15.2 9.4
-84.6 b 15.4 --
54.0 32.1 -13.9
39.7 32.8 -27.5
A g e (.~) Race (%) White Nonwhite Marital status (%) Single Married Divorced Other
Adult psychiatric outpatient femalesa (n = 577)
aSource: Derogatis, 1977. bSingle or married.
sample is 50% white. The marital status of both normative samples and the male prostitutes was similar. Within the sample of male prostitutes studied, no statistically significant differences in levels of psychological symptomatology were found based on age, race, or iv drug use. Additionally, differences in subjects' level of education, father's occupation, and number of years in prostitution were not related to either the number of psychological symptoms endorsed or the level of distress associated with the endorsed symptoms.
Psychological Symptoms of Male Prostitutes Compared With Normative Groups The mean scores of the 211 male street prostitutes are both higher and statistically significantly different from those of the nonpatient normals on all symptom dimensions of the SCL-90-R. Table II shows the mean scores and standard deviations for both the male prostitute sample and the normals. The mean scores for nonpatient normals and male prostitutes on the PST which measures the total number of symptoms endorsed by respondents are statistically significantly different with a mean of 19.29 for the normals as compared to 44.64 for the male prostitutes. These data indicate that the sample of male prostitutes experience more than twice as many psychological symptoms as the general population. On the PSDI measuring symptom intensity, there is a statistically significant difference
38
Simon, Morse, Osofsky, Balson, and G a u m e r
Table II. T Tests, Means, and Standard Deviations of SCL-90-R Scale Scores for Male Prostitutes and the Nonpatient Normative Group
Male prostitutes (n = 211) Symptom dimension
Nonpatient normals (n = 973)
x
SD
x
SD
ta
Somatization
0.66
0.67
0.36
0.42
6.23
Obsessive-compulsive
1.11
0.82
0.39
0.45
12.33
Interpersonal sensitivity
1.13
0.87
0.29
0.39
13.70
Depression
1.25
0.87
0.36
0.44
14.43
Anxiety
0.94
0.86
0.30
0.37
10.58
Hostility
0.87
0.83
0.30
0.40
9.71
Phobic anxiety
0.69
0.80
0.13
0.31
9.98
Paranoid ideation
1.38
0.89
0.34
0.44
16.50
Psychoticism
0.90
0.80
0.14
0.25
13.62
GSI
1.00
0.71
0.31
0.31
13.80
PSDI
1.94
0.73
1.32
0.42
11.89
44.64
22.73
19.29
15.48
15.41
PST
ap
