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We examine the characteristics of 53 sex offenders detained in maximum security at the State Hospital, Carstairs, in Scotland. Patients were categorized by diagnosis and four main groups were found: mental handicap, mental illness, mental illness with co-morbid personality disorder and personality disorder alone. As a whole, the patients had experienced multiple areas of deprivation and many had been subject to sexual abuse themselves. Our findings are consonant with other work in this area in noting the importance of deviant fantasy and positive psychotic symptoms. Detailed assessment of mentally disordered sex offenders is recommended, with consequent treatment including pharmacotherapy and a modified cognitive behavioural approach. [ABSTRACT FROM AUTHOR]