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Swaminath S, Simons RM, Hatwan ML. Understanding Pedophilia: A Theoretical Framework on the Development of Sexual Penchants. JOURNAL OF CHILD SEXUAL ABUSE 2023; 32:732-748. [PMID: 37463124 DOI: 10.1080/10538712.2023.2236602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
Pedophilia is a significant public health problem. Despite its cost to society, little effort has been directed toward understanding idiographic differences in the development and maintenance of pedophilia. Extant literature emphasizes biological underpinnings and predictors of re-offense. In this article, we posit that pedophilic penchants in males originate due to language, cognition, emotions, and emotion regulation. Adverse childhood experiences, such as emotional and sexual abuse, are posited as a major contributor to the etiology of pedophilia. However, not all individuals attracted to minors present with similar childhood adversities. The development of pedophilia, in the absence of such direct training (childhood adversities), is difficult to comprehend. Relational frame theory, a comprehensive account of human language and cognition, aids in deciphering the idiographic underpinnings of pedophilia. The role of maladaptive emotion regulation in maintaining pedophilia is also described. This article presents examples of how relational frames are established and activated in distressing contexts. Finally, implications for future research are discussed.
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2
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Scarpazza C, Costa C, Battaglia U, Berryessa C, Bianchetti ML, Caggiu I, Devinsky O, Ferracuti S, Focquaert F, Forgione A, Gilbert F, Pennati A, Pietrini P, Rainero I, Sartori G, Swerdlow R, Camperio Ciani AS. Acquired Pedophilia: international Delphi-method-based consensus guidelines. Transl Psychiatry 2023; 13:11. [PMID: 36653356 PMCID: PMC9849353 DOI: 10.1038/s41398-023-02314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Idiopathic and acquired pedophilia are two different disorders with two different etiologies. However, the differential diagnosis is still very difficult, as the behavioral indicators used to discriminate the two forms of pedophilia are underexplored, and clinicians are still devoid of clear guidelines describing the clinical and neuroscientific investigations suggested to help them with this difficult task. Furthermore, the consequences of misdiagnosis are not known, and a consensus regarding the legal consequences for the two kinds of offenders is still lacking. The present study used the Delphi method to reach a global consensus on the following six topics: behavioral indicators/red flags helpful for differential diagnosis; neurological conditions potentially leading to acquired pedophilia; neuroscientific investigations important for a correct understanding of the case; consequences of misdiagnosis; legal consequences; and issues and future perspectives. An international and multidisciplinary board of scientists and clinicians took part in the consensus statements as Delphi members. The Delphi panel comprised 52 raters with interdisciplinary competencies, including neurologists, psychiatrists, neuropsychologists, forensic psychologists, expert in ethics, etc. The final recommendations consisted of 63 statements covering the six different topics. The current study is the first expert consensus on a delicate topic such as pedophilia. Important exploitable consensual recommendations that can ultimately be of immediate use by clinicians to help with differential diagnosis and plan and guide therapeutic interventions are described, as well as future perspectives for researchers.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padova, Padova, Italy. .,Padova Neuroscience Center (PNC), University of Padova, Padova, Italy. .,IRCCS S. Camillo Hospital, Venezia, Italy.
| | - Cristiano Costa
- grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Department of Neuroscience, University of Padova, Padova, Italy
| | - Umberto Battaglia
- grid.5608.b0000 0004 1757 3470Department of Applied Psychology, FISPPA – University of Padova, Padova, Italy
| | - Colleen Berryessa
- grid.430387.b0000 0004 1936 8796School of Criminal Justice, Rutgers University, Newark, NJ USA
| | - Maria Lucia Bianchetti
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Ilenia Caggiu
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Orrin Devinsky
- grid.137628.90000 0004 1936 8753Epilepsy Center, NYU School of Medicine, New York, USA
| | - Stefano Ferracuti
- grid.7841.aDepartment of Human Neurosciences Sapienza Università di Roma, Rome, Italy
| | - Farah Focquaert
- grid.5342.00000 0001 2069 7798Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Arianna Forgione
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Fredric Gilbert
- grid.1009.80000 0004 1936 826XEthics, Policy & Public Engagement (EPPE) ARC Centre of Excellence for Electromaterials Science (ACES), Faculty of Arts, University of Tasmania, Hobart, Australia
| | | | - Pietro Pietrini
- grid.462365.00000 0004 1790 9464IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Innocenzo Rainero
- grid.7605.40000 0001 2336 6580Neurology I, Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Turin, Italy
| | - Giuseppe Sartori
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Russell Swerdlow
- grid.412016.00000 0001 2177 6375University of Kansas Medical Center, Kansas City, KS USA
| | - Andrea S. Camperio Ciani
- grid.5608.b0000 0004 1757 3470Department of Applied Psychology, FISPPA – University of Padova, Padova, Italy
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3
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Lievesley R, Harper CA, Swaby H, Woodward E. Identifying and working with appropriate treatment targets with people who are sexually attracted to children. JOURNAL OF SEX & MARITAL THERAPY 2022:1-20. [PMID: 36522827 DOI: 10.1080/0092623x.2022.2149437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research has shown that people within society experience sexual attractions to children, and a substantial number of these seek support related to this. However, professional practices around working with minor-attracted persons (MAPs) are variable. Clinicians possess low levels of knowledge about this population and are unclear about the correct treatment goals. In this work we explored the prioritization of different treatment goals by MAPs (n = 150), before investigating the demographic, sexuality-related, and psychological predictors of treatment target prioritization. Self-compassion drove many treatment targets among MAPs. We offer recommendations about how professionals might work collaboratively and effectively with this population.
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Affiliation(s)
| | - Craig A Harper
- NTU Psychology, Nottingham Trent University, Nottingham, UK
| | - Helen Swaby
- Department of Counselling, Bishop Grosseteste University, Lincoln, UK
| | - Ellie Woodward
- NTU Psychology, Nottingham Trent University, Nottingham, UK
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4
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Lehmann RJB, Brouillette-Alarie S, Pedneault A, Knight RA. Validating the Screening Scale of Pedophilic Crime Scene Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4085-4096. [PMID: 35896938 PMCID: PMC9663345 DOI: 10.1007/s10508-022-02354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
The Screening Scale of Pedophilic Crime Scene Behavior (SSPC) is a seven-item structured rating scale assessing pedophilic sexual arousal. In the current study, we cross-validated the scale's convergent validity using multiple measures of sexual interest in children (clinical diagnosis of pedophilia, the high fixation/low social competence type of the MTC:CM4, and phallometric assessment of sexual interests toward children) in two independent samples (USA and Canada). In both samples and in relation to all three criteria, the SSPC showed acceptable (phallometry) to excellent (clinical assessment) diagnostic accuracy. Furthermore, the SSPC showed incremental validity in relation to the Screening Scale for Pedophilic Interest and at times outperformed it in convergent validity analyses. The current study also provides psychometric information that can help users choose an appropriate SSPC cutoff score.
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Affiliation(s)
- Robert J B Lehmann
- Department of Psychology, MSB Medical School Berlin, Institute of Psychology, Rüdesheimer Str. 50, 14197, Berlin, Germany.
| | | | - Amelie Pedneault
- Department of Criminal Justice and Criminology, Washington State University, Pullman, WA, USA
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5
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Seto MC. Clinical and Conceptual Problems With Pedophilic Disorder in the DSM-5-TR. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1833-1837. [PMID: 35471678 DOI: 10.1007/s10508-022-02336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Michael C Seto
- Royal Ottawa Health Care Group, 1804 Highway 2 East, Brockville, ON, K6V 5W7, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
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6
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Nicol SJ, Harris DA, Ogilvie J, Kebbell MR, Craig C, Knight R. Evading Detection: What Do We Know about Men Charged with Extrafamilial Child Sexual Abuse following Delayed Detection? JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:333-352. [PMID: 35243955 DOI: 10.1080/10538712.2022.2047856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/24/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
Most child sexual abuse (CSA) remains unreported and undetected. Despite this, much of what we know about perpetrators of CSA is derived from samples of convicted CSA offenders. Significant knowledge gaps remain about those who have evaded detection. This study addresses this gap with an in-depth content analysis of the case files of ten convicted child sexual offenders (CSOs) with the longest detection lag, selected from a broader group (n = 349) of men incarcerated at the Massachusetts Treatment Center (MTC). Participants were examined on a range of offender characteristics including Adverse Childhood Experiences (ACEs), cognitive distortions, antisocial traits, indicators of pedophilia and Machiavellian or narcissistic traits, offense facilitating factors, and grooming behavior. A tentative profile emerged with the following characteristics: direct experience of childhood abuse, various cognitive distortions, specialized rather than versatile criminal history, pedophilic traits, Machiavellian traits, and engaging in a range of offense-facilitating behaviors including grooming. We provide insight into offenders who evade detection for CSA and set the foundation for further research to inform prevention strategies for law enforcement agencies and child-serving organizations.
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Affiliation(s)
- Samuel J Nicol
- Griffith University, Mount Gravatt, Queensland, Australia
| | - Danielle A Harris
- Griffith University, Mount Gravatt, Queensland, Australia
- Deputy Director-Research, Griffith Youth Forensic Service and a Senior Lecturer in the School of Criminology and Criminal Justice, Griffith University
| | - James Ogilvie
- Griffith University, Mount Gravatt, Queensland, Australia
| | - Mark R Kebbell
- Griffith University, Mount Gravatt, Queensland, Australia
| | - Cameron Craig
- Forensic Behavioural Services Unit, Child Protection Offender Registry, Queensland Police Service, Australia
| | - Raymond Knight
- Brandeis University, Waltham, Massachusetts, United States of America
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Lievesley R, Swaby H, Harper CA, Woodward E. Primary Health Professionals' Beliefs, Experiences, and Willingness to Treat Minor-Attracted Persons. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:923-943. [PMID: 35084616 PMCID: PMC8793822 DOI: 10.1007/s10508-021-02271-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 05/31/2023]
Abstract
There is a desire and need among minor-attracted persons (MAPs) to access support within the community, and this often begins with an approach to healthcare providers working in general medical/mental health settings. However, little is known about the experiences of these non-specialist professionals in relation to their beliefs, knowledge, and decision-making processes when working with patients who disclose sexual attractions to children. Using an online survey, this study explored the knowledge, comfort, competence, and treatment willingness of 220 non-specialist healthcare providers when faced with patients who disclose sexual attractions to children. We investigated how often such disclosures were made, clinician stigma, treatment priorities, and professionals' willingness to report MAPs to external agencies because of their sexual attractions. Some key differences were found when comparing primary medical vs. mental health professionals, including increased likelihood to view MAPs as dangerous, unable to control behaviors and that sexual attractions are an avoidable choice, in the former group. Both groups prioritized mental health treatment targets above controlling attractions and living with stigmatized attractions, although controlling or changing attractions were still relatively high priorities. Results indicated a need for further training, focusing on increasing comfort around working with MAPs, as this was associated with a greater willingness to work with this group. We identify current gaps in service provision for MAPs seeking professional support and discuss recommendations for professional training.
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Affiliation(s)
- Rebecca Lievesley
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.
| | - Helen Swaby
- Department of Counselling, Bishop Grosseteste University, Lincoln, UK
| | - Craig A Harper
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Ellie Woodward
- Department of Psychology, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
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Jones SJ, Ó Ciardha C, Elliott IA. Identifying the Coping Strategies of Nonoffending Pedophilic and Hebephilic Individuals From Their Online Forum Posts. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2021; 33:793-815. [PMID: 33084517 PMCID: PMC8419289 DOI: 10.1177/1079063220965953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Individuals who identify as pedophilic or hebephilic, and who do not offend, are increasingly visible in online discourse and as a focus of research. Developing knowledge about this population will offer insights into their psychological needs and, potentially, into the mechanisms and strategies individuals use to live offense-free lives. This study examined coping strategies among members of an online forum supporting pedohebephilic individuals who do not wish to offend. Forum users' posts were analyzed using thematic analysis. Eleven themes emerged, which were classifiable into three superordinate themes around (a) the acceptance of pedophilia, (b) strategies to stay safe, and (c) dealing with sexual arousal. These themes offer insight into the varying strategies used by these individuals to cope with stress and/or to remain offense-free. Understanding whether these strategies are adaptive or maladaptive may help develop better support services for those who have not offended and may inform prevention efforts.
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Affiliation(s)
| | - Caoilte Ó Ciardha
- University of Kent, Canterbury, UK
- Caoilte Ó Ciardha, School of Psychology, Keynes College, University of Kent, Canterbury CT2 7NP, UK.
| | - Ian A. Elliott
- Ministry of Justice, London, UK
- University College London, UK
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9
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Abstract
There is no accepted definition of the term paraphilia despite its being listed as an essential feature of a class of mental disorders known as the paraphilic disorders. The origin of the term, history of its inclusion as a diagnosis, and logical flaws inherent in the various definitions are discussed in this review. We examine the basis for pathologizing individuals with paraphilias, consider what paraphilias can tell us about how humans develop their sexual interests, and question the usefulness of dividing sexual interests into paraphilias and normophilias. The construct of the paraphilias appears to be poorly conceived and has outlived its usefulness.
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Affiliation(s)
- Charles Moser
- Diverse Sexualities Research and Education Institute, San Francisco, California 94109, USA;
| | - Peggy J Kleinplatz
- Department of Family Medicine and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K2P 0X4, Canada;
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10
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Carvalho J, Bradford J, Murphy L, Briken P, Fedoroff P. Measuring Pedophilic Sexual Interest. J Sex Med 2020; 17:378-392. [PMID: 31932255 DOI: 10.1016/j.jsxm.2019.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Joana Carvalho
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal; HEI-Lab: Digital Human-Environment and Interactions Labs, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal.
| | - John Bradford
- Forensic Division, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Royal Institute of Mental Health Research, Ottawa, ON, Canada; St Joseph's Healthcare, Hamilton, ON, Canada
| | - Lisa Murphy
- Royal Institute of Mental Health Research, Ottawa, ON, Canada; Sexual Behaviours Clinic, The Royal and Division of Forensic Psychiatry, University of Ottawa, Ottawa, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Fedoroff
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Royal Institute of Mental Health Research, Ottawa, ON, Canada; Sexual Behaviours Clinic, The Royal and Division of Forensic Psychiatry, University of Ottawa, Ottawa, Canada
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Camperio Ciani AS, Scarpazza C, Covelli V, Battaglia U. Profiling acquired pedophilic behavior: Retrospective analysis of 66 Italian forensic cases of pedophilia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 67:101508. [PMID: 31785728 DOI: 10.1016/j.ijlp.2019.101508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Neurological disorders can be mis-diagnosed as psychiatric ones. This might happen to pedophilia emerging as a symptom of brain insult (i.e. acquired pedophilic behavior). This paper aims to delineate a behavioral profile that might help to identify defendants whose pedophilic behavior is likely to be the consequence of a neurological disorder. Through a systematic review of the literature, seventeen clinical and behavioral variables of the modus operandi and victimology that can distinguish between acquired and developmental pedophilic behavior have been collected. Seven of these were found to be consistent behavioral indicators (i.e. red flags) for acquired pedophilia. Cluster hierarchical analysis on the seventeen variables collected through the systematic review of the literature on cases of acquired pedophilic behavior was applied to a new dataset including 66 Italian closed cases of pedophilia. Stepwise regression and correlation analyses were carried out to further examine the differences between the clusters identified in the cluster analysis. Results revealed that the new sample was partitioned into two clusters. Individuals with ascertained acquired pedophilia were grouped together. The clusters widely differed for the prevalence of red flags (mean number of red flags in each cluster: 2.14 ± 0.79 vs 4.96 ± 0.93, p < 0.001), while no between cluster difference emerged for the other clinical and behavioral variables. Regression analysis provided a robust model that included the three most significant red flags that explain over 64.5% of the variance (absence of masking, spontaneous confession and offenders older age). An organic origin of pedophilic behavior should be suspected if red flags are present in a defendant charged with pedophilia. In those cases, an in depth trans-disciplinary neuroscientific investigation is advocated. The behavioral profile identified might help to provide a proper assessment of defendants.
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Affiliation(s)
- Andrea S Camperio Ciani
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy.
| | | | - Valeria Covelli
- Department of General Psychology, University of Padova, Padova, Italy
| | - Umberto Battaglia
- Department of General Psychology, University of Padova, Padova, Italy
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12
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Mundy CL, Cioe JD. Exploring the relationship between paraphilic interests, sex, and sexual and life satisfaction in non-clinical samples. CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2018-0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Limited research has indicated that paraphilic interests and behaviours do not necessarily decrease sexual and life satisfaction; some research suggests such interests may actually enhance satisfaction. The present study assessed how paraphilic-associated interests and behaviours were related to sexual and life satisfaction in a sample of 173 men and 356 women. Paraphilic interest rates were similar to existing population-based studies. Men reported significantly higher levels of most paraphilic interests than women, apart from masochism. Those with paraphilic interests rarely felt negatively affected. However, those interested in criminal paraphilic interests or both criminal and legally feasible paraphilic interests had lower levels of sexual satisfaction when they did not engage in paraphilia-associated sexual behaviour. The sexual satisfaction of those interested only in legally feasible paraphilic interests was not impacted whether or not they engaged in paraphilia-associated sexual behaviour. Further analyses indicated that those without a paraphilic interest and those who have a paraphilic interest and have disclosed to their partner have higher levels of sexual satisfaction than those who have not disclosed to their partner or who do not have a stable partner. Additionally, among those who had disclosed to a partner, sexual satisfaction was not affected whether the individual engaged in the paraphilic interest with or without their partner. These results suggest a multifaceted relationship that warrants further consideration and examination.
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Affiliation(s)
| | - Jan D. Cioe
- University of British Columbia Okanagan, Kelowna, BC
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13
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Kruger THC, Sinke C, Kneer J, Tenbergen G, Khan AQ, Burkert A, Müller-Engling L, Engler H, Gerwinn H, von Wurmb-Schwark N, Pohl A, Weiß S, Amelung T, Mohnke S, Massau C, Kärgel C, Walter M, Schiltz K, Beier KM, Ponseti J, Schiffer B, Walter H, Jahn K, Frieling H. Child sexual offenders show prenatal and epigenetic alterations of the androgen system. Transl Psychiatry 2019; 9:28. [PMID: 30659171 PMCID: PMC6338724 DOI: 10.1038/s41398-018-0326-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.
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Affiliation(s)
- Tillmann H. C. Kruger
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christopher Sinke
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jonas Kneer
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Gilian Tenbergen
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Abdul Qayyum Khan
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Burkert
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Linda Müller-Engling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Harald Engler
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hannah Gerwinn
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Nicole von Wurmb-Schwark
- Forensische Genetik und Rechtsmedizin, am Institut für Hämatopathologie Hamburg GmbH, Hamburg, Germany
| | - Alexander Pohl
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Simone Weiß
- 0000 0001 2187 5445grid.5718.bInstitute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Massau
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Christian Kärgel
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Walter
- 0000 0001 1018 4307grid.5807.aDepartment of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany ,0000 0001 2190 1447grid.10392.39Department of Psychiatry, University of Tübingen, Tübingen, Germany
| | - Kolja Schiltz
- 0000 0004 1936 973Xgrid.5252.0Department of Forensic Psychiatry, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus M. Beier
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorge Ponseti
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Boris Schiffer
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Jahn
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Lehmann RJB, Dahle KP, Schmidt AF. Primer on the Contribution of Crime Scene Behavior to the Forensic Assessment of Sexual Offenders. EUROPEAN PSYCHOLOGIST 2018. [DOI: 10.1027/1016-9040/a000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Over the last decades several attempts in developing incrementally valid risk indicators above and beyond standard actuarial and dynamic risk assessment instruments have been undertaken without much success. The current review will summarize current developments regarding the validity of detailed crime scene analysis for forensic assessments of sexual offenders. To this end, this overview will focus on two issues: First, we will discuss the issue of sexual offender risk assessment based on crime scene information. Second, we will outline how crime scene behavior contributes to the assessment of sexual interest in children. In each section we will introduce the reader to new approaches and instruments for risk assessment and diagnosing pedophilic sexual interest based on crime scene information, respectively, and discuss their validity. Finally, we will discuss the implications of these recent developments for risk assessment, risk management, offender treatment, and future research.
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Affiliation(s)
| | | | - Alexander F. Schmidt
- Department of Psychology, Medical School Hamburg, Germany
- Department of Psychology, Johannes Gutenberg University Mainz, Germany
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Krueger RB, Reed GM, First MB, Marais A, Kismodi E, Briken P. Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11). ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1529-1545. [PMID: 28210933 PMCID: PMC5487931 DOI: 10.1007/s10508-017-0944-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 05/12/2023]
Abstract
The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.
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Affiliation(s)
- Richard B Krueger
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
- Department of Psychiatry, New York Presbyterian Hospital, New York, NY, USA.
- Sexual Behavior Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #45, New York, NY, 10032, USA.
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adele Marais
- Department of Psychiatry and Mental Health, Groote Schur Hospital, University of Cape Town, Observatory, South Africa
| | - Eszter Kismodi
- , Geneva, Switzerland
- Global Health Justice Partnership, Yale Law School, New Haven, CT, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Merrick WA. Changes in DSM-5 Diagnostic Criteria for Paraphilic Disorders. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:2173-2179. [PMID: 27620321 DOI: 10.1007/s10508-016-0845-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- William A Merrick
- Sand Ridge Secure Treatment Center Evaluation Unit, 301 Troy Dr., Building 14, Madison, WI, 53704, USA.
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18
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19
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Tenbergen G, Wittfoth M, Frieling H, Ponseti J, Walter M, Walter H, Beier KM, Schiffer B, Kruger THC. The Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges. Front Hum Neurosci 2015; 9:344. [PMID: 26157372 PMCID: PMC4478390 DOI: 10.3389/fnhum.2015.00344] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 05/29/2015] [Indexed: 12/13/2022] Open
Abstract
A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodological challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.
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Affiliation(s)
- Gilian Tenbergen
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Matthias Wittfoth
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Helge Frieling
- Laboratory for Molecular Neuroscience, Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Jorge Ponseti
- Department of Sexual Medicine, University Hospital Schleswig-Holstein , Kiel , Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Medical Faculty University Hospital Magdeburg , Magdeburg , Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Charité - University Clinic Berlin , Berlin , Germany
| | - Klaus M Beier
- Institute of Sexology and Sexual Medicine, Charité - University Clinic Berlin , Berlin , Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum , Bochum , Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
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20
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Sadomasochism in Sickness and in Health: Competing Claims from Science, Social Science, and Culture. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-014-0039-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Bailey JM. A failure to demonstrate changes in sexual interest in pedophilic men: comment on Müller et Al. (2014). ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:249-252. [PMID: 25030122 DOI: 10.1007/s10508-014-0338-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- J Michael Bailey
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208-2710, USA,
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22
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Santtila P, Antfolk J, Räfså A, Hartwig M, Sariola H, Sandnabba NK, Mokros A. Men's sexual interest in children: one-year incidence and correlates in a population-based sample of Finnish male twins. JOURNAL OF CHILD SEXUAL ABUSE 2015; 24:115-34. [PMID: 25747416 DOI: 10.1080/10538712.2015.997410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In a study of 1,310 Finnish adult male twins we found that sexual interest in children aged 12 or younger was reported by 0.2% of the sample. Sexual interest in children aged 15 or younger was reported by 3.3%. Participants reporting sexual interest in children aged 15 or younger were younger, reported stronger sexual desire, and had experienced more childhood sexual and nonsexual abuse. The present study is the first to give a population-based estimate of the incidence of sexual interest in children among adult men. The 12-month incidence of sexual interest in children below the age of 16 years is roughly comparable to the one-year incidence of major depression or the lifetime prevalence of transvestitic fetishism.
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Jahnke S, Imhoff R, Hoyer J. Stigmatization of people with pedophilia: two comparative surveys. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:21-34. [PMID: 24948422 DOI: 10.1007/s10508-014-0312-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 02/13/2014] [Accepted: 02/25/2014] [Indexed: 05/28/2023]
Abstract
Despite productive research on stigma and its impact on people's lives in the past 20 years, stigmatization of people with pedophilia has received little attention. We conducted two surveys estimating public stigma and determining predictors of social distance from this group. In both studies, pedophilia was defined as a "dominant sexual interest in children." The survey was comprised of items measuring agreement with stereotypes, emotions, and social distance (among others). Responses were compared with identical items referring to either people who abuse alcohol (Study 1), sexual sadists or people with antisocial tendencies (Study 2). Study 1 was conducted in two German cities (N = 854) and Study 2 sampled 201 English-speaking online participants. Both studies revealed that nearly all reactions to people with pedophilia were more negative than those to the other groups, including social distance. Fourteen percent (Study 1) and 28 % (Study 2) of the participants agreed that people with pedophilia should better be dead, even if they never had committed criminal acts. The strongest predictors of social distance towards people with pedophilia were affective reactions to this group (anger and, inversely, associated, pity) and the political attitude of right-wing authoritarianism (Study 1). Results strongly indicate that people with pedophilia are a stigmatized group who risk being the target of fierce discrimination. We discuss this particular form of stigmatization with respect to social isolation of persons with pedophilia and indirect negative consequences for child abuse prevention.
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Affiliation(s)
- Sara Jahnke
- Clinical Psychology and Psychotherapy, Technische Universität Dresden, Hohe Straße 53, 01187, Dresden, Germany,
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24
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Mohnke S, Müller S, Amelung T, Krüger TH, Ponseti J, Schiffer B, Walter M, Beier KM, Walter H. Brain alterations in paedophilia: A critical review. Prog Neurobiol 2014; 122:1-23. [DOI: 10.1016/j.pneurobio.2014.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/25/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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25
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Briken P, Fedoroff JP, Bradford JW. Why can't pedophilic disorder remit? ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1237-1239. [PMID: 24938588 DOI: 10.1007/s10508-014-0323-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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26
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Abstract
Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented.
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27
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Dahle KP, Lehmann RJB, Richter A. Die Screening Skala Pädophilen Tatverhaltens. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2014. [DOI: 10.1007/s11757-014-0261-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Abstract
This article outlines a community-based collaboration in Toronto, Canada that led to an official response to the APA's call for comments and suggestions regarding diagnostic criteria revisions for the DSM-5 with a focus on disorders that have or may have an impact on the lives of LGBTQ people. We identified two diagnostic categories: gender dysphoria and paraphilias. The diagnostic categories and their respective disorders are deconstructed utilizing a critical queer analysis with recommendations for change. In addition, we explore the limitations of the APA review process itself and politics within the APA and the LGBTQ communities.
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Affiliation(s)
- Andrea Daley
- a School of Social Work , York University , Toronto , Ontario , Canada
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29
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Abstract
This paper critiques changes in the diagnositic criteria for the paraphilias as set out in the DSM-5. In addition to general areas of concern, five specific problem areas are identified. This includes: definitions by exclusion; culturally based criteria; ignoring etiology; minimizing consent issues; and lack of field trials. A suggestion to improve the diagnostic criteria is offered.
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Affiliation(s)
- J Paul Fedoroff
- Integrated Forensic Program, Royal Ottawa Mental Health Centre, University of Ottawa Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada.
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30
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Blanchard R. A dissenting opinion on DSM-5 pedophilic disorder. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:675-8. [PMID: 23677282 DOI: 10.1007/s10508-013-0117-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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31
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Zucker KJ. DSM-5: call for commentaries on gender dysphoria, sexual dysfunctions, and paraphilic disorders. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:669-674. [PMID: 23797860 DOI: 10.1007/s10508-013-0148-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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32
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Malón A. Pedophilia: a diagnosis in search of a disorder. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1083-1097. [PMID: 22367174 DOI: 10.1007/s10508-012-9919-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 06/21/2011] [Accepted: 12/26/2011] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Agustin Malón
- Faculty of Human Sciences and Education, University of Zaragoza, 22003, Huesca, Spain.
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33
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Hames R, Blanchard R. Anthropological data regarding the adaptiveness of hebephilia. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:745-747. [PMID: 22644593 DOI: 10.1007/s10508-012-9972-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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34
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Mokros A, Osterheider M, Nitschke J. [Pedophilia. Prevalence, etiology, and diagnostics]. DER NERVENARZT 2012; 83:355-8. [PMID: 21909808 DOI: 10.1007/s00115-011-3322-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pedophilia is a disorder of sexual preference that increases the risk for committing sexual offenses against children. Consequently, pedophilia is not only relevant in psychiatric therapy and prognostics, but also greatly influences the public attitude towards criminality. Public opinion seems to equate pedophilia with child sexual abuse and vice versa which leads to stigmatization of patients and may impede treatment. The present paper provides information on recent studies on the potential origins of the disorder and introduces new diagnostic methods. Moreover, the article presents estimates on the prevalence of pedophilic sexual interest.
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Affiliation(s)
- A Mokros
- Abteilung für Forensische Psychiatrie und Psychotherapie, Bezirksklinikum Regensburg, Universität Regensburg, Universitätsstr. 84, 93053, Regensburg, Deutschland.
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35
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Krause R. Gibt es ein weibliches Äquivalent zur männlichen Perversion? FORUM DER PSYCHOANALYSE 2012. [DOI: 10.1007/s00451-012-0108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Abstract
In this article, I discuss the question of the pathological nature of various sexual orientations and paraphilias and provide arguments for and against the inclusion of various paraphilias in future versions of the DSM. Practically, it is proposed that most of the paraphilias can be usefully conceptualized as involving sexual behaviors directed toward non-consenting individuals. From a Darwinian standpoint, it seems clear that at least some of the paraphilias should not be considered to be pathological because they are potentially associated with enhanced fitness.
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Affiliation(s)
- Vernon L Quinsey
- Department of Psychology, Queen's University, Kingston, ON, K7L 3S9, Canada.
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37
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Abstract
Whether homosexuality should be described as one among many paraphilic sexual interests or an altogether different dimension of sexual interest has long been discussed in terms of its political and social implications. The present article examined the question instead by comparing the major correlates and other features of homosexuality and of the paraphilias, including prevalence, sex ratio, onset and course, fraternal birth order, physical height, handedness, IQ and cognitive neuropsychological profile, and neuroanatomy. Although those literatures remain underdeveloped, the existing findings thus far suggest that homosexuality has a pattern of correlates largely, but not entirely, distinct from that identified among the paraphilias. At least, if homosexuality were deemed a paraphilia, it would be relatively unique among them, taxonometrically speaking.
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Affiliation(s)
- James M Cantor
- Sexual Behaviours Clinic, Law and Mental Health Program, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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38
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Abstract
In this article, I address the question of whether pedophilia in men can be construed as a male sexual orientation, and the implications for thinking of it in this way for scientific research, clinical practice, and public policy. I begin by defining pedophilia and sexual orientation, and then compare pedophilia (as a potential sexual orientation with regard to age) to sexual orientations with regard to gender (heterosexuality, bisexuality, and homosexuality), on the bases of age of onset, correlations with sexual and romantic behavior, and stability over time. I conclude with comments about the potential social and legal implications of conceptualizing pedophilia as a type of sexual orientation in males.
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Affiliation(s)
- Michael C Seto
- Integrated Forensic Program, Royal Ottawa Health Care Group, 1804 Highway 2 East, Brockville, ON, K6V 5W7, Canada.
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39
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Blanchard R. Misdiagnoses of pedohebephilia using victim count: a reply to Wollert and Cramer (2011). ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:1081-1088. [PMID: 21850567 DOI: 10.1007/s10508-011-9835-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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40
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Jordan K, Fromberger P, Stolpmann G, Müller JL. The Role of Testosterone in Sexuality and Paraphilia—A Neurobiological Approach. Part II: Testosterone and Paraphilia. J Sex Med 2011; 8:3008-29. [DOI: 10.1111/j.1743-6109.2011.02393.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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42
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Neutze J, Seto MC, Schaefer GA, Mundt IA, Beier KM. Predictors of child pornography offenses and child sexual abuse in a community sample of pedophiles and hebephiles. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2011; 23:212-242. [PMID: 20935341 DOI: 10.1177/1079063210382043] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Little is known about factors that distinguish men who act upon their self-identified sexual interest in prepubescent or pubescent children from those who do not. Even less is known about pedophiles or hebephiles who are not involved with the criminal justice system. In this study, a sample of 155 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia (or paraphilia not otherwise specified for those who were sexually attracted to pubescent children). Two sets of group comparisons were conducted on sociodemographic variables and measures of dynamic risk factors. The first set was based on recent activity and compared men who had committed child pornography only or child sexual abuse offenses in the past six months with men who remained offense-free during the same period. The second set was based on lifetime offense history (excluding the most recent six months) and compared child pornography offenders with child sexual abuse offenders and men who had committed both kinds of offenses. Overall, there were more similarities than differences between groups.
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Affiliation(s)
- Janina Neutze
- Institute of Sexology and Sexual Medicine, Berlin, Germany.
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43
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Wilson RJ, Abracen J, Looman J, Picheca JE, Ferguson M. Pedophilia: an evaluation of diagnostic and risk prediction methods. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2011; 23:260-274. [PMID: 21062948 DOI: 10.1177/1079063210384277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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Kramer R. APA Guidelines ignored in development of diagnostic criteria for pedohebephilia. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:233-235. [PMID: 21052813 DOI: 10.1007/s10508-010-9683-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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First MB. DSM-5 proposals for paraphilias: suggestions for reducing false positives related to use of behavioral manifestations. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1239-44; author reply 1245-1252. [PMID: 20697936 DOI: 10.1007/s10508-010-9657-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Saleh FM, Grudzinskas AJ, Malin HM, Dwyer RG. The management of sex offenders: perspectives for psychiatry. Harv Rev Psychiatry 2010; 18:359-68. [PMID: 21080774 DOI: 10.3109/10673229.2010.533003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the effort to identify and manage sex offenders, the differences between legal and medical/psychiatric terminology and approaches are readily apparent. This article discusses the different definitions and approaches of the two fields and considers both the behaviors that create risk to others and the strategies for reducing that risk. Particular attention is paid to the subcategory of paraphilic sex offenders. Treatment goals, modalities, and efficacies are discussed, as are evolving legal strategies for risk control and the need for interaction between law and medicine/psychiatry in order to accomplish common goals of risk management.
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Affiliation(s)
- Fabian M Saleh
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Franklin K. Hebephilia: quintessence of diagnostic pretextuality. BEHAVIORAL SCIENCES & THE LAW 2010; 28:751-768. [PMID: 21110392 DOI: 10.1002/bsl.934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hebephilia is an archaic term used to describe adult sexual attraction to adolescents. Prior to the advent of contemporary sexually violent predator laws, the term was not found in any dictionary or formal diagnostic system. Overnight, it is on the fast track toward recognition as a psychiatric condition meriting inclusion in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This article traces the sudden emergence and popularity of hebephilia to pressure from the legal arena and, specifically, to the legal mandate of a serious mental abnormality for civil commitment of sex offenders. Hebephilia is proposed as a quintessential example of pretextuality, in which special interests promote a pseudoscientific construct that furthers an implicit, instrumental goal. Inherent problems with the construct's reliability and validity are discussed. A warning is issued about unintended consequences if hebephilia or its relative, pedohebephilia, make their way into the DSM-5, due out in 2013.
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Affiliation(s)
- Karen Franklin
- California School of Professional Psychology, El Cerrito, CA 94530, U.S.A.
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Green R. Sexual preference for 14-year-olds as a mental disorder: you can't be serious!! ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:585-586. [PMID: 20204488 DOI: 10.1007/s10508-010-9602-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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O'Donohue W. A critique of the proposed DSM-V diagnosis of pedophilia. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:587-590. [PMID: 20204487 DOI: 10.1007/s10508-010-9604-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Seto MC. Child pornography use and internet solicitation in the diagnosis of pedophilia. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:591-593. [PMID: 20182786 DOI: 10.1007/s10508-010-9603-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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