Context: Psychotic disorders are associated with an increased risk of aggressive behavior and violent crime. Whether there is also an association with sex offending is unknown.Objectives: To estimate the lifetime prevalence of arrests for sexual offenses (with and without physical aggression) among men and women with psychotic disorders, the moderating effects of comorbid personality disorders and substance use disorders, and the prevalence rates for 4 specific psychotic disorders. Design:We examined official records of arrests for sexual offenses with and without physical aggression to compare persons hospitalized with a psychotic disorder with those who had never been hospitalized. Results: Among the men, 2.2% were hospitalized with psychotic disorders. These men committed 8.4% of the physicallyaggressivesexualoffensesand9.0%ofthenon-physically aggressive sexual offenses of the men in the cohort. Compared with men who had never been hospitalized, men with psychotic disorders without a personality disorder or a substance use disorder were not at increased risk of arrest for physically aggressive sexual offenses but were 3 times more likely to have been arrested for non-physically aggressive sexual offenses. Psychotic disorders with comorbid personality disorders or substance use disorders were associated with a 6-fold increased risk of physically aggressive sex offending and a 3-to 5-fold increased risk of non-physically aggressive sex offending.Conclusions: Psychotic disorders comorbid with personality disorders and substance use disorders are associated withanincreasedriskofsexoffendingwithandwithoutphysical aggression. Mental health policy and practice need to take account of these findings to improve functional outcome among persons with psychotic disorders.