The idea of a teacher engaging in sexual activity with a young student is disturbing and may lead to the consideration that mental illness fuels this behavior. In 2004, Debra Lafave, a 23-year-old teacher, was arrested for having sex with a 14-year-old male student. Her attorney, on the basis of his client’s history of extremes of mood and other symptoms of bipolar illness, prepared an insanity defense. He stated, “Here we have a woman that, by every societal standard, can get a date, can get a man. Yet, she destroyed her career, destroyed her marriage. I believe the only logical reason why Debra Lafave did what she did was because of her mental illness.” According to 3 psychiatrists for the defense, she suffered from bipolar disorder. Ultimately, Lafave accepted a plea bargain.19
Currently, there is little empirical evidence related to the presence of mental illness in female sexual offenders overall. In a study of 15 women charged with a sexual offense who were referred to a psychiatric facility for forensic evaluation, one-half (n = 7) had mild mental retardation or borderline intellectual function, one-third (n = 5) were depressed, and one-fifth (n = 3) were psychotic. None had posttraumatic stress disorder (PTSD), and substance use was rarely associated with the crimes.20 Another study showed that female sex offenders had a personal history of more severe sexual abuse, were more likely to have attempted suicide, and were more likely to have received a diagnosis of PTSD than their male counterparts.21
The following vignette is an amalgamation of several different cases described by the media.22 It high-lights several characteristics common among women who sexually abuse their students.
Mrs Smith was a 28-year-old, high school biology teacher in a small town. She was well liked by students, parents, and colleagues. Students easily identified with her because of her youthful appearance. Soon after she started teaching, rumors surfaced that photos of her wearing seductive attire were available on the Internet. Although this caused a stir within the school, the administration did not become involved. Mrs Smith admitted that these pictures were of her, appeared contrite, and explained that they were taken some time ago; the incident was forgotten relatively quickly.
During the fall of the next school year, Mrs Smith began attending many high school football games. Unbeknownst to others, she started paying close attention to one of the players, who was also one of her students. Joe was a 14-year-old varsity linebacker who was unusually tall for his age. He did not often socialize with his teammates and was considered a loner.
Mrs Smith initially contacted Joe by e-mail, offering to assist him with his homework after school in her classroom. He accepted, flattered by the attention from an attractive, young female teacher. These tutorial sessions then moved to her home on Thursday evenings. Mrs Smith began asking him increasingly personal questions during these sessions. Initially, she inquired how he felt about various female classmates, and then eventually about his past sexual activities.
After 6 months, she encouraged him to take an overnight trip with her to a museum located a few hours away. She told him that his parents might be uncomfortable with the idea, so she encouraged him to tell them that he was spending the night at a friend’s house. It was during this trip that Mrs Smith and Joe first engaged in sexual activity, which both later described as consensual. Following the initial encounter, their meetings took place with increasing frequency: at first limited to hotels, then in her car, and finally in her classroom during her free period.
Joe’s parents noticed that his school performance was slipping and his few friends denied any recent contact with him. Concerned, his parents searched his room. Under his bed, they found a number of love letters from Mrs Smith, and they discovered on his computer a file containing photos of Mrs Smith and their son engaging in sexual activity. Joe’s parents approached the school board and the police with their findings.
Allegations of sexual misconduct by an educator are often made to the school board rather than to the police. These reports almost always concern inappropriate physical contact, not verbal or visual abuse,10 and false accusations are uncommon.2 The consequences of the abuse reported by students often include negative ef-fects on academic achievement, fear of repercussion, and health problems.3,4 As for the educators, many go on to teach again. For those women who are prosecuted, there is some debate concerning whether they are less severely punished than male sex offenders.23
Psychiatrists may find themselves treating either victims or perpetrators of educator sexual misconduct. Similar to other forms of abuse of minors, a physician is legally obligated to inform the appropriate authorities—regardless of the perpetrator. This may include a call to local law enforcement, depending on the urgency of the situation. Some experts who have studied mandatory reporting laws for sexual abuse of children suggest that other alternatives, such as the construction of a clinical treatment plan for the minor and the offender in lieu of obligatory reporting, may lead to better protection for minors and improved treatment for offenders.24
Little literature exists specifically on the effects of educator sexual misconduct on children. Clinicians should be aware that any child who has been abused is more likely to develop suicidal ideation,25 depression, and diminished self-esteem.26 Victims may suffer from a sense of betrayal, given that the abuse was perpetrated by someone whom they were encouraged to trust.2 Clinicians may also need to address the victim’s mistaken assumption that the abuse is socially acceptable, since it was perpetrated by someone who should serve as a role model.3,4
It is important to realize that the abuse extends to the child’s family, so family therapy and individual therapy for the parents may be warranted. Parents may require intensive therapy for feelings of guilt, self-blame, depression, and denial, especially if they are the primary care providers for their abused child in the period immediately following the abuse.
In treating the perpetrators of educator sexual misconduct, be aware that a serious violation of the teacher’s professional boundaries has occurred and work on better delineating those boundaries and highlighting to the offenders the ways in which they abused their power.27,28 Different treatment approaches may be required for offenders who victimize young children (pedophiles) than for those who target high school–aged children (the teacher/lover or heterosexual nurturer category). If the crimes are prosecuted, these potentially high-profile offenders may have limited housing and employment options secondary to a requirement to register as a sex offender. It is unclear whether standard sex offender treatment and relapse prevention treatment are effective in this population.