The utility of the diagnosis of pedophilia: a comparison of various classification procedures

Automaticity of Early Sexual Attention: An Event-Related Potential Study

A promising line of research on forensic assessment of paraphilic sexual interest focuses on behavioral measures of visual attention using sexual stimuli as distractors. The present study combined event-related potentials (ERPs) with behavioral measures to investigate whether detection of a hidden sexual preference can be improved with ERPs. Normal variants of sexual orientation were used for a proof-of-concept investigation. Accordingly, 40 heterosexual and 40 gay men participated in the study. Within each group, half of the participants were instructed to hide their sexual orientation. The results showed that a match between sexual orientation and stimulus delays responses and influences ERP before motor responses. Late ERP components showed higher potential in differentiating hidden sexual preferences than motor responses, thereby showing how ERPs can be used in combination with reaction time measures to potentially facilitate the detection of hidden sexual preferences.

"I Would Report It Even If They Have Not Committed Anything": Social Service Students' Attitudes Toward Minor-Attracted People

This study explores future mental health providers' assumptions about minor-attracted people, using data from a survey of 200 students preparing for entry into social service professions at a public university in the state of Utah. Survey results show that more than half of the students believe clients who identify themselves as pedophiles must be automatically reported to the police, which has implications for providers' understandings about the term "pedophile," as well as their knowledge of guidelines for when clinicians may break client confidentiality. This belief was not significantly affected by taking ethics courses, nor courses that discussed mandated reporting guidelines. Despite this finding, 91% of students did not believe that they would need to report a client who had attractions to children, but who had never committed a sexual offense against a child. The majority of students indicated a willingness to work with minor-attracted clients, and commonly indicated in comments that they wanted more information about MAPs and when to break client confidentiality in their programs of study. Study results indicate a need for education among social service students about these issues.

Widespread and interrelated gray matter reductions in child sexual offenders with and without pedophilia: Evidence from a multivariate structural MRI study

AIM

To further investigate the neuroanatomical correlates of child sexual offending and disentangle them from the neural correlates of pedophilia, using a multivariate analytical approach in order to minimize loss of statistical power.

METHODS

This study presents structural MRI data on gray matter in an incarcerated, male population of 22 pedophilic and 21 non-pedophilic child sexual offenders, and 20 violent non-sexual offender controls, based on a multivariate whole-brain approach using source-based morphometry.

RESULTS

We identify a network of several neuroanatomical regions exhibiting interrelated reduced gray matter in both child sexual offender groups relative to controls, comprising extensive clusters in the bilateral cerebellum and frontal lobe, as well as smaller clusters in the bilateral parietal, temporal, and occipital lobes, the bilateral basal ganglia, the medial cingulate and the hippocampus.

CONCLUSION

Our results speak to the interpretation that there are inter- and possibly connectivity-related brain structural abnormalities in child sexual offenders that are not (only) pertaining to pedophilia per se. Interpretations and limitations of the present data are discussed and recommendations for future works are given.

Measuring Pedophilic Sexual Interest

INTRODUCTION

Pedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of established techniques aimed at assessing people with sexual interest in children.

AIM

To provide a foundation from which to understand existing methods available for the assessment of people with pedophilic sexual interests, including strengths and limitations of each approach.

METHODS

A group of clinical experts provide a clinically oriented, narrative review on assessment methods for pedophilic sexual interest, including the rationale behind each method and its implementation. Evidence on validity supporting the techniques, limitations, and ethical issues is also discussed.

RESULTS

The assessment methods were grouped according to the following categories: self-report, genital psychophysiological assessment, indirect measurement, and behavioral measurement of pedophilic interest. Although most techniques performed well in discriminating child sexual offenders with pedophilic interest from distinct comparison groups, there are several limitations, including the current lack of standardization and the ethical challenges posed by this sensitive area.

CLINICAL IMPLICATIONS

An understanding of the different measures available for the assessment of problematic sexual interests plays a vital role in forensic clinical determinations of risk of recidivism and in the identification of treatment targets for men who have committed sexual offenses. Several independent but complimentary methods exist to assess sexual interest. Ongoing work on the international standardization of assessment based on methodologically sound research aimed at determining best practices will address some of the shortcomings of these assessments while improving their reliability.

STRENGTHS & LIMITATIONS

This article provides a general review on a number of methods aimed at assessing pedophilic interest. However, these methods mirror clinical practice largely used within North America and parts of continental Europe. As a result of cultural differences, opposing paradigms on assessment and treatment of pedophilia, and diverse legal regulation between jurisdictions and countries, these practices may not be applicable on an international scale where other special procedures may be required.

CONCLUSION

A number of techniques have been used within clinical and research settings that vary from self-report to objective measures. Most methods have demonstrated efficacy. Continued work to combine evidence and experience from diverse populations and multiple countries will improve the quality of the methods available. Carvalho J, Bradford J, Murphy L, et al. Measuring Pedophilic Sexual Interest. J Sex Med 2020;17:378-392.

Preventing Sexual Abuse: Perspectives of Minor-Attracted Persons About Seeking Help

The primary aim of this exploratory research was to gain information from minor-attracted persons (MAPs) about their (a) formal and informal experiences with help-seeking for minor attraction, (b) perceived barriers to seeking help for concerns about minor attraction, and (c) treatment priorities as identified by consumers of these services. A nonrandom, purposive sample of MAPs (n = 293, 154 completed all questions) was recruited via an online survey. Results show that 75% of participants did seek formal help from a professional; however, just less than half of them found the experience to be helpful. Characteristics of helpful therapeutic encounters included nonjudgmental attitudes, knowledge about minor attraction, and viewing clients in a person-centered and holistic way. Barriers to help seeking included uncertainty about confidentiality, fear of negative reaction or judgment, difficulties finding a therapist knowledgeable about MAPs, and financial constraints. Understanding or reducing attraction to minors were common treatment goals, but participants also prioritized addressing general mental health and well-being related to depression, anxiety, loneliness, and low self-esteem. Implications for effective and ethical counseling and preventive interventions for MAPs are discussed.

Psychopathy, Neuroticism, and Abusive Behavior in Low Risk Child Sex Offenders

Personality traits are considered as an important aspect in the assessment of child sex offenders (CSOs). The current study sought to elucidate the association between neuroticism, psychopathy, and abusive behavior in low risk CSOs. 43 pedophilic CSOs and 21 controls (CTLs) completed the NEO-Personality Inventory-Revised (NEO-PI-R), Psychopathy Checklist: Screening Version (PCL:SV), and Multiphasic Sex Inventory (MSI). Our results revealed small differences in PCL scores between CSOs and CTLs, with comparatively low levels of psychopathy in both groups. Higher levels of neuroticism were associated with higher PCL scores, in both CSOs and CTLs. However, higher PCL scores in CSOs did not correlate with higher MSI total scores on the subscale child molest. These findings suggest an ambiguous role of psychopathy in CSOs: higher levels of psychopathy co-occur with higher levels of neuroticism, but psychopathy does apparently not modulate abusive behavior, at least not in low risk offenders, as currently investigated.

Neuropsychological profile of pedophilic child sexual offenders compared with an IQ-matched non-offender sample - Results of a pilot study

Child sexual offenders have been found to have a lower average IQ than the general population. Several studies indicate that they also exhibit executive dysfunction, but the specificity of this dysfunction is unclear; the inconclusive results have been attributed to methodological problems and the heterogeneity of the population. Our study aimed to describe the neuropsychological profiles of convicted child sexual offenders with pedophilia (n = 15). To control for IQ-related effects on neuropsychological performance, we compared the sample with an IQ-matched control group (n = 15). Test scores in both groups were significantly lower than the norms, but we did not find significant differences between the two study groups. The findings of our pilot study indicate that the neuropsychological deficits of pedophilic sexual offenders are unspecific rather than the result of a pedophilia-specific brain dysfunction.

Diminished fronto-limbic functional connectivity in child sexual offenders

BACKGROUND

Child sexual abuse and neglect have been related to an increased risk for the development of a wide range of behavioral, psychological, and sexual problems and increased rates of suicidal behavior. Contrary to the large amount of research focusing on the negative mental health consequences of child sexual abuse, very little is known about the characteristics of child sexual offenders and the neuronal underpinnings contributing to child sexual offending.

METHODS AND SAMPLE

This study investigates differences in resting state functional connectivity (rs-FC) between non-pedophilic child sexual offenders (N = 20; CSO-P) and matched healthy controls (N = 20; HC) using a seed-based approach. The focus of this investigation of rs-FC in CSO-P was put on prefrontal and limbic regions highly relevant for emotional and behavioral processing.

RESULTS

Results revealed a significant reduction of rs-FC between the right centromedial amygdala and the left dorsolateral prefrontal cortex in child sexual offenders compared to controls.

CONCLUSION & RECOMMENDATIONS

Given that, in the healthy brain, there is a strong top-down inhibitory control of prefrontal over limbic structures, these results suggest that diminished rs-FC between the amygdala and the dorsolateral prefrontal cortex and may foster sexual deviance and sexual offending. A profound understanding of these concepts should contribute to a better understanding of the occurrence of child sexual offending, as well as further development of more differentiated and effective interventions.

Taxometric Analysis of the Latent Structure of Pedophilic Interest

The present study examined the latent structure of pedophilic interest. Using data from phallometric tests for pedophilic interest across four samples of offenders (ns = 805, 632, 531, 261), taxometric analyses were conducted to identify whether pedophilic interest is best characterized as taxonic or dimensional. Across the samples, the majority of analyses supported taxonic latent structure in pedophilic interest. Visual inspection of taxometric curves indicated trichotomous latent structure (i.e., three-ordered classes) may characterize pedophilic interest in these samples. In a second step of taxometric analysis, the results supported trichotomous latent structure, indicating the presence of a complement taxon and two pedophilic taxa. In comparison with the complement taxon, the men in the first pedophilic taxon were non-exclusively pedophilic and had similar rates of sexual recidivism and sexual compulsivity. The men in the second pedophilic taxon were exclusively pedophilic, had more child victims and total victims, sexually re-offended at a higher rate, and were more sexually compulsive. The finding of trichotomous latent structure in pedophilic interest is both consistent and inconsistent with previous taxometric studies and has implications for research, assessment, and treatment of pedophilic interest.

Approach and Avoidance Tendencies Toward Picture Stimuli of (Pre-)Pubescent Children and Adults: An Investigation in Pedophilic and Nonpedophilic Samples

The presence of pedophilic sexual interests is considered of high importance for predicting recidivism among individuals who have committed sexual offenses. However, objective and valid assessment methods that are robust against confounding issues such as cognitive capacity and manipulation are sparse. We applied the Approach-Avoidance Task (AAT) for detecting sexual interests in 38 pedophilic men (18 primarily attracted to boys) and 27 male nonpedophilic (11 gay) participants. The AAT relies on automatic approach and avoidance tendencies, independent of cognitive abilities such as memory capacity and intelligence. Approach-avoidance tendencies toward stimuli depicting seminude prepubescent boys and girls as well as men and women are reported. The results were consistent with previous research on the utility of the AAT: Except for pedophiles attracted to girls, the mean AAT scores (approach minus avoidance reaction time for each stimulus category) were positive only for stimuli of the preferred category. A multivariate binary logistic regression approach revealed 80% overall accuracy in differentiating pedophilic from nonpedophilic participants.

Diagnostic Issues in the Paraphilias

PURPOSE OF REVIEW

To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis.

RECENT FINDINGS

Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests lead them to sexually offend. Even among these clients, research has, for the most part, failed to distinguish those who meet criteria for a paraphilia from those who do not, thereby limiting the possibility of drawing firm conclusions regarding the value of a paraphilic diagnosis. Speculations regarding the etiology of the paraphilias are for the most part limited to those who sexually offend and these theories do not distinguish those who do, or do not, meet paraphilic criteria. Treatment of sex offenders, when effective, appears to have the same impact regardless of whether or not clients meet criteria for a paraphilia. In terms of prognosis, it was only among untreated child molesters that a paraphilic diagnosis (in this case "pedophilia") predicted long-term outcome. In the face of these problems, we suggest a dimensional approach to diagnoses may represent an improvement over the current categorical model.

The Revised Screening Scale for Pedophilic Interests: Predictive and Concurrent Validity

This study examined the predictive and concurrent validity of the Screening Scale for Pedophilic Interests (SSPI) and its recent revision (SSPI-2), using a large sample of 2,416 sex offenders deemed not to be in need of civil management in New York State. Both SSPI and SSPI-2 scores were significantly and positively related to sexual rearrest, but the SSPI-2 provided greater discrimination in rearrest within 5 years across possible scores. Neither measure significantly added to the prediction of sexual rearrest provided by the Static-99R. We also found evidence of concurrent validity, as both measures were positively and significantly correlated with clinician ratings of sexual preoccupation, emotional identification with children, and sexual offense-related cognitions (convergent validity), but were not significantly related to clinician ratings of self-regulation problems, noncompliance with supervision, or antisocial personality (divergent validity). Overall, the results suggest that the SSPI-2 is a specific and useful screening measure of pedophilic sexual interests among sex offenders with child victims.

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.

Sex Offender Risk Assessment and Management

Sexual violence is common and can have profound effects on victims compared with other forms of violence. This violence includes unwelcome and forced sexual contact on adults or children. Assessment of individuals who perpetrate sexual violence starts with a comprehensive biopsychosocial evaluation after a finding of guilt. Clinicians should then evaluate risk. Based on this assessment, a risk management plan should be developed, directed at the specific risk of the offender. Management options include external control (eg, incarceration, probation), psychotherapeutic interventions, pharmacologic interventions, and treatment of comorbidity. This organized approach aids in reducing the risk of future sexual violence.

Reliability and validity of the DSM-IV-TR and proposed DSM-5 criteria for pedophilia: Implications for the ICD-11 and the next DSM

We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in children. Participants were evaluated by two independent psychiatrists with an interview and questionnaire regarding demographic characteristics, sexual history, and self-reported sexual interests; they also completed phallometric and visual reaction time testing. Kappa was .59 for ever meeting DSM-IV-TR criteria for pedophilia and .52 for ever meeting the proposed DSM-5 criteria for pedohebephilia. Ever meeting DSM-IV-TR diagnosis was significantly related to self-reported index of sexual interest in children (highest AUC=.81, 95% CI=.70-.91, p<.001) and to indices of sexual interest in children from phallometric testing (AUC=.70; 95% CI=.52-.89; p<.05) or a computerized assessment based on visual reaction time and self-report (AUC=.75; 95% CI=.62-.88; p<.005). Ever meeting the proposed DSM-5 "diagnosis" was similarly related to self-report (AUC=.84, 95% CI=.74-.94, p<.001) and to the two objective indices, with AUCs of .69 (95% CI=.53-.85; p<.05) and .77 (95% CI=.64-.89; p<.001), respectively. Because the pDSM-5 criteria did not produce significantly better reliability or validity results and users are more familiar with the current DSM-5 criteria, we believe these results suggest the revision of DSM-5 and development of ICD-11 could benefit from drawing on the current DSM-5 criteria, which are essentially the same as DSM-IV-TR except for a distinction between having a paraphilia (the interest) and a paraphilic disorder (the paraphilia plus clinically significant distress or impairment).

Mental health diagnoses and recidivism in paroled offenders

Although the issue of mental illness among offender populations has received attention in the last number of years, there are a number of issues related to mental illness among such groups that require more study. One such topic relates to the association between mental illness, actuarially assessed risk of recidivism, and observed rates of reoffending. In the present investigation, file information was reviewed to determine the presence of a variety of mental health conditions. Actuarially based risk assessment data were also collected for participants as well as information regarding suspension, new charges, and convictions. A sample of 136 offenders housed in a halfway house operated by Correctional Service of Canada was included in the present investigation. Results indicated very high rates of serious mental illness in this high-risk population. Offenders with borderline personality disorder and attention deficit hyperactivity disorder were significantly more likely to recidivate or be suspended. Suspensions refer to administrative decisions to place an offender in jail due to problematic behaviour (typically involving a breach of his release conditions or new charges/convictions). Offenders with a diagnosis of paraphilic disorder were significantly less likely to recidivate or be suspended. Results are discussed in light of the available literature.

Sexual sadism in sexual offenders and sexually motivated homicide

This article gives a clinically oriented overview of forensically relevant forms of sexual sadism disorder and its specific relationship to sexual homicide. In sexual homicide perpetrators, peculiar patterns of sexual sadism may be a motivational pathway to kill. Sexual sadism increases the risk for reoffending in sexual offenders. Through psychotherapy and pharmacological interventions, treatment of sadistic sex offenders has to consider special characteristics that may be different from those of nonsadistic sex offenders. Many of these offenders share a combination of sexual sadistic motives and an intact self-regulation, sometimes combined with a high level of sexual preoccupation.

Assessment of the paraphilias

Paraphilias are recurrent, persistent, and intense sexual interests in atypical objects or activities. The most commonly encountered paraphilias in sexological or forensic settings are pedophilia, sexual sadism, exhibitionism, and voyeurism. Paraphilias are often comorbid with other sexual, mood, and personality disorders. Assessment and diagnosis require an integration of multiple sources of clinical information, given the limits and biases of self-report (through clinical interview or questionnaires). Clinicians ideally have access to more objective assessment methods, such as phallometric testing of sexual arousal. The accurate assessment and diagnosis of paraphilias is essential to effective treatment and management.

Assessment of implicit sexual associations in non-incarcerated pedophiles

Offences committed by pedophiles are crimes that evoke serious public concern and outrage. Although recent research using implicit measures has shown promise in detecting deviant sexual associations, the discriminatory and predictive quality of implicit tasks has not yet surpassed traditional assessment methods such as questionnaires and phallometry. The current research extended previous findings by examining whether a combination of two implicit tasks, the Implicit Association Task (IAT) and the Picture Association Task (PAT), was capable of differentiating pedophiles from non-pedophiles, and whether the PAT, which allows separate analysis for male, female, boy and girl stimulus categories, was more sensitive to specific sexual associations in pedophiles than the IAT. A total of 20 male self-reported pedophiles (10 offender and 10 non-offenders) and 20 male self-reported heterosexual controls completed the two implicit measures. Results indicated that the combination of both tasks produced the strongest results to date in detecting implicit pedophilic preferences (AUC = .97). Additionally, the PAT showed promise in decomposing the sexual associations in pedophiles. Interestingly, as there was an equal distribution of offenders and non-offenders in the pedophile group, it was possible to test for implicit association differences between these groups. This comparison showed no clear link between having these implicit sexual associations and actual offending.

Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center

Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

Pedophilia: a diagnosis in search of a disorder

This article presents a critical review of the recent controversies concerning the diagnosis of pedophilia in the context of the preparation of the fifth edition of the DSM. The analysis focuses basically on the relationship between pedophilia and the current DSM-IV-TR's definition of mental disorder. Scholars appear not to share numerous basic assumptions ranging from their underlying ideas about what constitutes a mental disorder to the role of psychiatry in modern society, including irreconcilable theories about human sexuality, which interfere with reaching any kind of a consensus as to what the psychiatric status of pedophilia should be. It is questioned if the diagnosis of pedophilia contained in the DSM is more forensic than therapeutic, focusing rather on the dangers inherent in the condition of pedophilia (dangerous dysfunction) than on its negative effects for the subject (harmful dysfunction). The apparent necessity of the diagnosis of pedophilia in the DSM is supported, but the basis for this diagnosis is uncertain.

Psychopathy among pedophilic and nonpedophilic child molesters

OBJECTIVE

Among men who commit sexual offenses against children, at least 2 distinct groups can be identified on the basis of the age of the primary targets of their sexual interest; pedophiles and nonpedophiles.

METHOD

In the present report, across 2 independent samples of both types of child molesters as well as controls, a total of 104 men (53 pedophilic and 51 nonpedophilic) who had sexually offended against a child age 13 or younger were compared to each other (and to 49 non-sex offender controls) on psychopathy as assessed by the Psychopathic Personality Inventory (PPI).

RESULTS

In both samples of child molesters, the nonpedophiles scored as significantly more psychopathic than the pedophiles.

CONCLUSIONS

These results provide further evidence of the importance of distinguishing between these groups of offenders.

Pedophilia: an evaluation of diagnostic and risk prediction methods

One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

The DSM diagnostic criteria for pedophilia

This paper contains the author's report on pedophilia, submitted on June 2, 2008, to the work group charged with revising the diagnoses concerning sexual and gender identity disorders for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The author reviews the previously published criticisms and empirical research concerning the diagnostic criteria for pedophilia and presents criticism and relevant research of his own. The review shows that the DSM diagnostic criteria for pedophilia have repeatedly been criticized as unsatisfactory on logical or conceptual grounds, and that published empirical studies on the reliability and validity of these criteria have produced ambiguous results. It therefore seems that the current (i.e., DSM-IV-TR) diagnostic criteria need to be examined with an openness to major changes in the DSM-V.

Pedophilia

Pedophilia is defined as a sexual interest in prepubescent children. It is empirically linked with sexual offending against children: Child pornography offenders and sex offenders with child victims are more likely to be pedophiles based on self-report or objective measures of sexual interests. At the same time, some pedophiles have not had any known sexual contact with children, and perhaps half of sex offenders against children would not meet diagnostic criteria for pedophilia. Pedophilia can be diagnosed using a variety of methods and is an important factor to consider in the assessment of sex offenders because pedophilic offenders are more likely to sexually reoffend and require different interventions. There is no evidence to suggest that pedophilia can be changed. Instead, interventions are designed to increase voluntary control over sexual arousal, reduce sex drive, or teach self-management skills to individuals who are motivated to avoid acting upon their sexual interests.

The importance of individual differences in pornography use: theoretical perspectives and implications for treating sexual offenders

This article reviews the extant literature regarding pornography's influence on antisocial attitudes, sexual arousal, and sexually aggressive behavior in both noncriminal and criminal samples. The article concludes that when examined in the context of multiple, interacting factors, the findings are highly consistent across experimental and nonexperimental studies and across differing populations in showing that pornography use can be a risk factor for sexually aggressive outcomes, principally for men who are high on other risk factors and who use pornography frequently. Finally, this article presents theoretical implications based on these findings, as well as some clinical implications relevant to the assessment and treatment of sexual offenders.

Child sexual abuse in clinical and forensic psychiatry: a review of recent literature

PURPOSE OF REVIEW

To review papers from the recent literature on child sexual abuse and to highlight the clinical and forensic issues raised and how these have been addressed. Also, to identify new demands and recommend future research.

RECENT FINDINGS

The validity of forensic evaluations depends on the quality of the protocols used and the training of the forensic mental health practitioners involved. Diagnosis of child sexual abuse still depends mainly on the child's allegation of abuse, while anogenital examination yields minimal medical evidence of sexual abuse. The relationship between child sexual abuse and victims' mental health is increasingly being proven, underlining the importance of correct clinical and forensic diagnosis of abuse to permit preventive, therapeutic and legal measures. Sexual offences via the internet have raised new demands.

SUMMARY

Forensic child and adolescent practitioners need to be very highly trained. Evaluation of sexually abused children and adolescents must be accurate to ensure legal validity and be performed with diligence so that alleged victims do not experience recurrence. Practitioners' actions must be referenced against appropriate instruments and they must be prepared for the ethical and forensic dilemmas and new demands that arise in this field.

Examining the Impact of Sex Offender Residence Restrictions on Housing Availability

This study explores the potential impact of residence restrictions on housing availability for registered sex offenders in Camden County, New Jersey ( N = 211). The proportion of registered sex offenders who live within typical exclusionary zones of 1,000 and 2,500 ft of schools, day care centers, churches, and parks is determined using the Geographical Information System mapping technology. The majority of sex offenders live within 2,500 ft of schools (71%) and day care centers (80%), and 88% live within 2,500 ft of any of four hot spots. Comparatively, 80% of nonoffending citizens live within 2,500 ft of such places. Offenders of adult victims live significantly closer to schools compared to those with child victims. The results suggest that a majority of sex offenders would be unable to live in their current homes if residence restrictions were in place, and that few options for housing exist outside of common buffer zones.

Pornography use and sexual aggression: the impact of frequency and type of pornography use on recidivism among sexual offenders

In this study, we examined the unique contribution of pornography consumption to the longitudinal prediction of criminal recidivism in a sample of 341 child molesters. We specifically tested the hypothesis, based on predictions informed by the confluence model of sexual aggression that pornography will be a risk factor for recidivism only for those individuals classified as relatively high risk for re-offending. Pornography use (frequency and type) was assessed through self-report and recidivism was measured using data from a national database from the Royal Canadian Mounted Police. Indices of recidivism, which were assessed up to 15 years after release, included an overall criminal recidivism index, as well as subcategories focusing on violent (including sexual) recidivism and sexual recidivism alone. Results for both frequency and type of pornography use were generally consistent with our predictions. Most importantly, after controlling for general and specific risk factors for sexual aggression, pornography added significantly to the prediction of recidivism. Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups. The importance of conceptualizing particular risk factors (e.g., pornography), within the context of other individual characteristics is discussed.

The relationship between victim age and gender crossover among sex offenders

Some child molesters abuse children of both genders. The purpose of this study was to explore the relationship between gender crossover and victim age. The authors hypothesized that offenders who molested children of both genders would be more likely to have very young victims and that offenders who molested very young children would be more likely to abuse children of both sexes than offenders with older victims. The sample consisted of 362 sex offenders being considered for civil commitment as sexually violent predators in Florida. Data were collected from file reviews. The relationship between victim age and gender crossover was examined using chi-square and multivariate logistic regression analyses. The proportion of offenders with victims of both genders significantly increased as the victims' ages decreased, and sex offenders with preschool-age victims were most likely to have abused both boys and girls. A sex offender with a victim 6 years of age or younger had more than 3 times the odds of having perpetrated sex crimes against both genders than a sex offender with only older victims. Sex offenders with victims of both genders had more than 3 times the odds of having preschool victims. The presence of a major mental illness increased the odds of gender crossover more than threefold. Pedophilia increased the odds of having victims younger than 6 more than 11-fold. Implications for practice are discussed.