[Pedophilia: etiology, diagnostics and therapy]

Implicit Theories of Child Sexual Exploitation Material Offenders: Cross-Cultural Validation of Interview Findings

Offense-supportive cognitions are thought to result from underlying implicit theories (ITs). As child sexual exploitation material (CSEM) users are a distinct type of sex offender, Bartels and Merdian proposed that CSEM offenders hold five different ITs from those endorsed by contact sex offenders (i.e., Unhappy World, Self as Uncontrollable, Child as Sexual Object, Nature of Harm [CSEM variant], and Self as Collector), linked by an assumption about the Reinforcing Nature of the Internet. This article reports a conceptual content analysis of 23 interviews conducted with CSEM offenders in the United Kingdom and Spain. Support for all CSEM-specific ITs was found across both samples, providing an empirical validation of this conceptualization. Finally, four ITs originally identified for contact sex offenders were also identified, namely, Uncontrollability, Child as Sexual Being, Dangerous World, and Nature of Harm. Further validation of CSEM-related ITs is encouraged.

Web-Based Health Services in Forensic Psychiatry: A Review of the Use of the Internet in the Treatment of Child Sexual Abusers and Child Sexual Exploitation Material Offenders

In recent years, web-based health services for a variety of mental disorders have been developed and evaluated. Evidence suggests that guided internet-based therapy can be as effective as conventional face-to-face therapy. In forensic psychiatric practice, few web-based treatments have been implemented up to now. However, to our knowledge, there do not yet exist guided internet-based treatments for child sexual abusers and child sexual exploitation material offenders. This review aims at examining under what conditions patients are most likely to benefit from internet-based treatments. In addition, some computer-based health services in forensic psychiatry will be summarized and their potentials and weaknesses will be discussed. Subsequently, the review focuses on the implications for the development of online treatments for child sexual abusers as well as on a variety of ethical and legal issues that practitioners may encounter during the development, evaluation and delivery of online health services. The review will conclude with proposed quality standards for the development and implementation of web-based interventions for child sexual abusers and child sexual exploitation material offenders. By virtue of the low number of psychotherapists offering therapy to this clientele as well as individual barriers to seeking treatment such as fear of stigmatization, feelings of shame, long access routes, or limited mobility due to physical handicaps, the development of mental eHealth services in this sector could close an important healthcare gap. By increasing the density of supply, more child sexual abusers and child sexual exploitation material offenders would have the chance to engage in treatment and, ultimately, more incidents of sexual assault against minors could be prevented.

[Treatment structures for men with pedosexual problems]

Pedophilia is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal and behavior. Less than 50% of all child abusers fulfill the diagnostic criteria and an even smaller part exclusively has a preference for children. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Outpatient treatment and treatment in forensic psychiatry clinics, sociotherapeutic facilities and in correction facilities are different aspects of prevention. So-called grey area projects (Dunkelfeldprojekte) are special facilities of primary and secondary prevention. The aim is to prevent sexual abuse by reducing and controlling of risk factors.

[Use of virtual reality in forensic psychiatry. A new paradigm?]

BACKGROUND

For more than 20 years virtual realities (VR) have been successfully used in the assessment and treatment of psychiatric disorders. The most important advantages of VR are the high ecological validity of virtual environments, the entire controllability of virtual stimuli in the virtual environment and the capability to induce the sensation of being in the virtual environment instead of the physical environment. VRs provide the opportunity to face the user with stimuli and situations which are not available or too risky in reality. Despite these advantages VR-based applications have not yet been applied in forensic psychiatry.

OBJECTIVES AND METHODS

On the basis of an overview of the recent state-of-the-art in VR-based applications in general psychiatry, the article demonstrates the advantages and possibilities of VR-based applications in forensic psychiatry.

RESULTS AND CONCLUSIONS

Up to now only preliminary studies regarding the VR-based assessment of pedophilic interests exist. These studies demonstrate the potential of ecologically valid VR-based applications for the assessment of forensically relevant disorders. One of the most important advantages is the possibility of VR to assess the behavior of forensic inpatients in crime-related situations without endangering others. This provides completely new possibilities not only regarding the assessment but also for the treatment of forensic inpatients. Before utilizing these possibilities in the clinical practice exhaustive research and development will be necessary. Given the high potential of VR-based applications, this effort would be worth it.

Advances in the understanding and behavioural management of sexual dysfunctions

PURPOSE OF REVIEW

Sexual medicine is a branch often neglected by professionals from different specialties associated with it. However, research in this field has picked up in recent years, owing to recently renewed interest in upholding the sexual rights of the population in general and lesbian, gay, bisexual and transgender groups in particular. The recently released Diagnostic and statistical manual of mental disorders, fifth edition, by the American Psychiatric Association in May 2013 has stirred up the supporters and critics (of Diagnostic and statistical manual of mental disorders, fifth edition) alike.

RECENT FINDINGS

Diagnostic and statistical manual of mental disorders, fifth edition, has updated diagnostic criteria for some of the sexual disorders to improve understanding and diagnostic validity. Certain sexual dysfunctions have been regrouped and sexual response cycle-based classification has been partially withdrawn. Research in the area of behavioral management of sexual dysfunctions has given some novel concepts, particularly for women.

SUMMARY

Although improvements in behavioral management (of sexual dysfunctions) and classification/diagnostic criteria in Diagnostic and statistical manual of mental disorders, fifth edition, is a step forward in the field of sexual medicine, we need to further improve our understanding in many of the lacunae, still bearing on the field of sexual medicine, lest we may fall at the first hurdle.