1
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Pinto J, Comprido C, Moreira V, Maccarone MT, Cogoni C, Faustino R, Pignatelli D, Cera N. The Complex Role Played by the Default Mode Network during Sexual Stimulation: A Cluster-Based fMRI Meta-Analysis. Behav Sci (Basel) 2024; 14:570. [PMID: 39062393 PMCID: PMC11273531 DOI: 10.3390/bs14070570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/14/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
The default mode network (DMN) is a complex network that plays a significant and active role during naturalistic stimulation. Previous studies that have used naturalistic stimuli, such as real-life stories or silent or sonorous films, have found that the information processing involved a complex hierarchical set of brain regions, including the DMN nodes. The DMN is not involved in low-level features and is only associated with high-level content-related incoming information. The human sexual experience involves a complex set of processes related to both external context and inner processes. Since the DMN plays an active role in the integration of naturalistic stimuli and aesthetic perception with beliefs, thoughts, and episodic autobiographical memories, we aimed at quantifying the involvement of the nodes of the DMN during visual sexual stimulation. After a systematic search in the principal electronic databases, we selected 83 fMRI studies, and an ALE meta-analysis was calculated. We performed conjunction analyses to assess differences in the DMN related to stimulus modalities, sex differences, and sexual orientation. The results show that sexual stimulation alters the topography of the DMN and highlights the DMN's active role in the integration of sexual stimuli with sexual schemas and beliefs.
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Affiliation(s)
- Joana Pinto
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal (C.C.)
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Camila Comprido
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal (C.C.)
| | - Vanessa Moreira
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal (C.C.)
| | | | - Carlotta Cogoni
- Instituto de Biofísica e Engenharia Biomédica, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal;
| | - Ricardo Faustino
- Research Unit in Medical Imaging and Radiotherapy, Cross I&D Lisbon Research Center, Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-125 Lisbon, Portugal;
| | - Duarte Pignatelli
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Nicoletta Cera
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal (C.C.)
- Research Unit in Medical Imaging and Radiotherapy, Cross I&D Lisbon Research Center, Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-125 Lisbon, Portugal;
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2
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LeMay CC, Stinson JD. Persons With Histories of Traumatic Brain Injury and Problematic Sexual Behavior: An Exploratory Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:183-206. [PMID: 34963350 DOI: 10.1177/0306624x211066831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Persons with traumatic brain injuries (TBI) who have engaged in problematic or illegal sexual behavior present with complex assessment and intervention needs yet remain understudied within the empirical literature. In the current exploratory analysis, important differences in adaptive and clinical functioning, adverse childhood experiences, and criminal offense history are examined in 25 persons with previous brain injury, 118 persons with intellectual disability but no known TBI, and 103 persons with no history of brain injury or intellectual disability, all of whom have engaged in problematic sexual behavior and who were residing in secure forensic inpatient care. Group differences were examined using comparisons of means and chi-squares. Results highlight important differences in education and employment experiences, diagnostic presentation, exposure to childhood maltreatment, and justice system involvement and characteristics of their sexual offense victims. Associations with prior literature and future research directions are discussed.
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3
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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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4
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Boschetti A, Camperio Ciani A, Scarpazza C. Sexual offenses and the brain. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:161-179. [PMID: 37633708 DOI: 10.1016/b978-0-12-821375-9.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Sexual offenses are a great concern worldwide due to the devastating physical and psychological consequences the victims of such crimes often experience. It is an important task to investigate potential mechanisms that may underlie sexual offending and predispose an individual for such antisocial behavior. Advanced techniques in neuroscience are increasingly used to uncover biomarkers in psychiatric disorders and organic brain disease. As this type of research is flourishing, preliminary studies with the aim to explore the neural basis of sex offenders have started to appear. To this purpose, researchers began to study the brain's structural and functional changes and the neurocognitive profiles of sex offenders, in comparison to nonoffenders and nonsex offenders, or among different subtypes of sex offenders. Most of the research to date has focused on pedophilia, with some inconsistent findings, which hampers the translation of the results into the forensic and clinical context. Any attempt to increase convergent evidence may profit from the harmonization of data analysis and avoidance of methodological inconsistencies, which can account for the different results across studies. Today, uncovering the neural basis of sex offences has to become a priority, not only for clinical interventions, but might also be important knowledge for crime prevention.
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Affiliation(s)
- Angela Boschetti
- Department of General Psychology, University of Padova, Padova, Italy
| | - Andrea Camperio Ciani
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Cristina Scarpazza
- Department of General Psychology, University of Padova, Padova, Italy; Translational Cognitive and NeuroImaging Lab, IRCCS Camillo Hospital, Venice, Italy.
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5
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Kirenskaya AV, Vasilev NG, Garakh ZV, Novototsky-Vlasov VY, Tkachenko AA. [Specificity of visual event-related potentials to subthreshold presentation of erotic pictures in pedophilia]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:99-108. [PMID: 38147389 DOI: 10.17116/jnevro202312312199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To study visual event-related potentials (ERPs) associated with presentation of erotic pictures in backward masking condition in order to investigate perception, attention and information processing underlying the initiation and maintenance of abnormal sexual behavior in pedophilia. MATERIAL AND METHODS Participants (58 males committed sexual offenses against children) were divided into the pedophilia group (n=38) and the control group without disorders of sexual preference (n=20). Three types of stimuli were used: neutral pictures of nature (S1), adult heterosexual erotic pictures (S2) and erotic pictures with children (S3). Posterior N1 (N140) and anterior N1 (N120) and P3 (P320) ERP components were included in analysis. RESULTS In both groups, the perception of erotic stimuli was accompanied by a significant increase in the amplitude and prolongation of the latency of the N140 and P320 components (p<0.001). N140 changes were characterized by right-hemispheric bias in both groups, however, asymmetry was observed for amplitude in the control group, and for latency - in the pedophilia group; besides, reactivity to S3 stimuli was weaker than to S2 ones in the pedophilia group. N120 amplitude was elevated significantly in response to S2 stimuli in the control group, and no changes were found in the pedophilia group. Between-group differences were revealed for early negative components N140 and N120, which parameters were entered as predictors into classification model based on discriminant analysis. The obtained accuracy of model was 87.23%. CONCLUSION The specificity of neurophysiological reactions to erotic pictures in pedophilic patients corroborates the concept of disease as general neurodevelopmental disorder.
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Affiliation(s)
- A V Kirenskaya
- Serbsky National Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | - N G Vasilev
- Serbsky National Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | - Z V Garakh
- Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences, Moscow, Russia
| | - V Y Novototsky-Vlasov
- Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences, Moscow, Russia
| | - A A Tkachenko
- Serbsky National Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
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6
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Altered Neural and Behavioral Response to Sexually Implicit Stimuli During a Pictorial-Modified Stroop Task in Pedophilic Disorder. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:292-300. [PMID: 37124357 PMCID: PMC10140453 DOI: 10.1016/j.bpsgos.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/15/2022] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Pedophilic disorder (PD) entails sexual attraction to prepubertal children. A risk factor for committing child sexual abuse in PD is impaired cognitive control. However, the underlying neurocognitive mechanisms remain unclear. Methods We performed a case-control study including 51 self-identified and help-seeking males with PD and 55 matched healthy control subjects. Functional magnetic resonance imaging and a pictorial-modified Stroop task involving computer-generated sexually implicit images were used to measure response time and brain activation. Increases in response time during the pictorial-modified Stroop task are presumably due to image-induced interference in executive functions required for task performance. Results In PD, during the presentation of images of children compared with adults, we found increased response time (p = .005; 848 ± 92 ms vs. 826 ± 88 ms), and compared with healthy control subjects, we found increased activation in the occipital, temporal (bilateral hippocampus), parietal, frontal, cingulate, and left insular cortices; caudate (bilaterally); thalamus (mediodorsal); and cerebellum. Conclusions Presentation of child images was associated with response interference in PD and increased engagement of brain regions involved in the processing of sexual stimuli, visual perception, self-referential thought, and executive function. We conclude that processing of child images is associated with functional and behavioral alterations in PD.
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7
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Speer L, Schuler M, Keil J, Moran JK, Pantazidis P, Amelung T, Florack J, Beier KM, Senkowski D. Sexual preference for prepubescent children is associated with enhanced processing of child faces in juveniles. Eur Child Adolesc Psychiatry 2022; 31:261-274. [PMID: 33230608 PMCID: PMC8837509 DOI: 10.1007/s00787-020-01684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Child sexual abuse offences (CSOs) represent a severe ethical and socioeconomic burden for society. Juveniles with a sexual preference for prepubescent children (PP) commit a large percentage of CSOs, but have been widely neglected in neuroscience research. Aberrant neural responses to face stimuli have been observed in men with pedophilic interest. Thus far, it is unknown whether such aberrations exist already in PP. A passive face-viewing paradigm, including the presentation of child and adult faces, was deployed and high-density electroencephalography data were recorded. The study group comprised 25 PP and the control group involved 22 juveniles with age-adequate sexual preference. Attractiveness ratings and evoked brain responses were obtained for the face stimuli. An aberrant pattern of attractiveness ratings for child vs. adult faces was found in the PP group. Moreover, elevated occipital P1 amplitudes were observed for adult vs. child faces in both groups. At longer latency (340-426 ms), a stronger negative deflection to child vs. adult faces, which was source localized in higher visual, parietal and frontal regions, was specifically observed in the PP group. Our study provides evidence for enhanced neural processing of child face stimuli in PP, which might reflect elevated attention capture of face stimuli depicting members from the sexually preferred age group. This study expands our understanding of the neural foundations underlying sexual interest in prepubescent children and provides a promising path for the uncovering of objective biomarkers of sexual responsiveness to childlike body schemes in juveniles.
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Affiliation(s)
- Lara Speer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Sexology and Sexual Medicine, Charitéplatz 1, 10117, Berlin, Germany.
| | - Miriam Schuler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Sexology and Sexual Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Julian Keil
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Biological Psychology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - James K Moran
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pierre Pantazidis
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Sexology and Sexual Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Till Amelung
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Sexology and Sexual Medicine, Charitéplatz 1, 10117, Berlin, Germany
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jakob Florack
- Child and Adolescent Psychiatry, Vivantes Hospital Berlin, Berlin, Germany
| | - Klaus M Beier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Sexology and Sexual Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Senkowski
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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8
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Schuler M, Mohnke S, Amelung T, Beier KM, Walter M, Ponseti J, Schiffer B, Kruger THC, Walter H. Neural processing associated with Cognitive Empathy in Pedophilia and Child Sexual Offending. Soc Cogn Affect Neurosci 2021; 17:712-722. [PMID: 34907428 PMCID: PMC9340114 DOI: 10.1093/scan/nsab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 11/01/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Behavioral studies found evidence for superior cognitive empathy (CE) in pedophilic men without a history of child sexual offending (P-CSO) compared to pedophilic men with a history of CSO (P+CSO). Functional magnetic resonance imaging (fMRI) studies also point to differences between P-CSO and P+CSO. Neural processing associated with CE has not yet been investigated. Therefore, the present study aimed to explore the neural correlates of CE in subjects with pedophilia with (P+CSO) and without (P-CSO) child sexual offending. 15 P+CSO, 15 P-CSO, and 24 teleiophilic male controls (TC) performed a CE task during fMRI. We observed reduced activation in the left precuneus (Pcu) and increased activation in the left anterior cingulate cortex (ACC) in P-CSO compared to P+CSO. P-CSO also showed stronger connectivity between these regions, which might reflect a top-down modulation of the Pcu by the ACC toward an increased self-focused emotional reaction in social situations. There was also evidence for increased right superior temporal gyrus activation in P-CSO that might constitute a potentially compensatory recruitment due to the dampened Pcu activation. These findings provide first evidence for altered neural processing of CE in P-CSO and underline the importance of addressing CE in pedophilia and CSO in order to uncover processes relevant to effective prevention of child sexual abuse.
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Affiliation(s)
- Miriam Schuler
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Till Amelung
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine
| | - Klaus M Beier
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department for Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Jorge Ponseti
- Department for Integrative Psychiatry, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Bochum, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tillmann H C Kruger
- Divison of Clinical Psychology and Sexual Medicine. Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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9
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Klöckner MS, Jordan K, Kiehl KA, Nyalakanti PK, Harenski CL, Müller JL. Widespread and interrelated gray matter reductions in child sexual offenders with and without pedophilia: Evidence from a multivariate structural MRI study. Psychiatry Clin Neurosci 2021; 75:331-340. [PMID: 34346537 DOI: 10.1111/pcn.13292] [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: 01/23/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Mona S Klöckner
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Göttingen, Göttingen, Germany.,Research Department Transnational Politics, Peace Research Institute Frankfurt, Frankfurt, Germany
| | - Kirsten Jordan
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Kent A Kiehl
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Prashanth K Nyalakanti
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Carla L Harenski
- The Mind Research Network & Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Jürgen L Müller
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Göttingen, Göttingen, Germany
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10
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Brideau-Duquette M, Boucher O, Tremblay J, Robert M, Bouthillier A, Lepore F, Nguyen DK. Insular Cortex Response to Static Visual Sexual Stimuli. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. According to previous research, the insula is important for processing salient and emotional stimuli, but its precise role remains elusive. By combining high spatial and temporal resolution, intracranial electroencephalography (iEEG) might contribute to filling this gap. Four drug-resistant epileptic patients with intracranial electrodes in the insula were instructed to watch and rate pictures with sexual content and neutral pictures. Event-related potentials (ERPs) were computed separately for both types of stimuli. Ninety-three percent of the anterior insula (AI) and 85% of the posterior insula (PI) contacts showed differences between ERPs. AI-positive deflections tended to have an earlier onset than PI-positive deflections. The results suggest that the AI generates a P300-like response and contributes to the early phase of the late positive potential, both components found enhanced while viewing emotional stimuli in the ERP literature. The present findings are interpreted as congruent with the role of the AI in maintaining attention to salient stimuli.
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Affiliation(s)
- Mathieu Brideau-Duquette
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Canada
- Département de Psychologie, Université de Montréal, Canada
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Montréal, Canada
| | - Olivier Boucher
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Canada
- Département de Psychologie, Université de Montréal, Canada
- CHUM, Service de Psychologie, Montréal, Canada
| | - Julie Tremblay
- Centre de recherche du CHU Sainte-Justine, Montréal, Canada
| | - Manon Robert
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Canada
| | | | - Franco Lepore
- Département de Psychologie, Université de Montréal, Canada
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Montréal, Canada
| | - Dang Khoa Nguyen
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Canada
- CHUM, Service de Neurologie, Montréal, Canada
- Département de Neurosciences, Université de Montréal, Canada
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11
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Krylova M, Ristow I, Marr V, Borchardt V, Li M, Witzel J, Drumkova K, Harris JA, Zacharias N, Schiltz K, Amelung T, Beier KM, Kruger THC, Ponseti J, Schiffer B, Walter H, Kärgel C, Walter M. MEG reveals preference specific increases of sexual-image-evoked responses in paedophilic sexual offenders and healthy controls. World J Biol Psychiatry 2021; 22:257-270. [PMID: 32623929 DOI: 10.1080/15622975.2020.1789216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Paedophilic disorder is characterised by sexual attraction towards children. Classification of a counterpart as sexually attractive likely occurs rapidly, and involves both conscious and unconscious attentional and cognitive processes. Magnetoencephalography (MEG) is an imaging method especially well-suited to examine visual and attentional processes triggered by sexual images within the range of milliseconds. METHODS We investigated brain responses to sexual images depicting adults (frequent) and children (infrequent stimulus) in seventeen paedophilic patients with a history of child sexual offending (P + CSO) and twenty healthy controls (HC) during a passive visual oddball paradigm. Event-related fields (ERF) were measured to extract the magnetic visual mismatch negativity (vMMNm), and how it relates to the processing of different classes of sexual stimuli. RESULTS P + CSO exhibited significantly longer vMMNm latencies (100-180 ms post-stimulus) than HC. Moreover, P + CSO showed widespread increased amplitudes in response to child images starting from P3a and P3b components and lasting up to 400 ms post-stimulus presentation localised in frontal and temporal brain regions. CONCLUSIONS This study uncovers the first MEG differences in automatic change detection between P + CSO and HC during the presentation of subliminal sexual images of adults and children, contributing towards a better understanding of the neurobiological processes of P + CSO.
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Affiliation(s)
- Marina Krylova
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Psychiatry, Eberhard Karls University, Tübingen, Germany
| | - Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa Marr
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Joseph A Harris
- Department of Psychology, Bradley University, Peoria, IL, USA
| | - Norman Zacharias
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University of Magdeburg, Magdeburg, 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
| | - 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
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Medical School, Kiel, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, 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
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Psychiatry, Eberhard Karls University, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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12
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Arsalidou M, Vijayarajah S, Sharaev M. Basal ganglia lateralization in different types of reward. Brain Imaging Behav 2021; 14:2618-2646. [PMID: 31927758 DOI: 10.1007/s11682-019-00215-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Reward processing is a fundamental human activity. The basal ganglia are recognized for their role in reward processes; however, specific roles of the different nuclei (e.g., nucleus accumbens, caudate, putamen and globus pallidus) remain unclear. Using quantitative meta-analyses we assessed whole-brain and basal ganglia specific contributions to money, erotic, and food reward processing. We analyzed data from 190 fMRI studies which reported stereotaxic coordinates of whole-brain, within-group results from healthy adult participants. Results showed concordance in overlapping and distinct cortical and sub-cortical brain regions as a function of reward type. Common to all reward types was concordance in basal ganglia nuclei, with distinct differences in hemispheric dominance and spatial extent in response to the different reward types. Food reward processing favored the right hemisphere; erotic rewards favored the right lateral globus pallidus and left caudate body. Money rewards engaged the basal ganglia bilaterally including its most anterior part, nucleus accumbens. We conclude by proposing a model of common reward processing in the basal ganglia and separate models for money, erotic, and food rewards.
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Affiliation(s)
- Marie Arsalidou
- Department of Psychology, National Research University Higher School of Economics, Moscow, Russian Federation. .,Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada.
| | - Sagana Vijayarajah
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Maksim Sharaev
- Skolkovo Institute of Science and Technology, Moscow, Russian Federation
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13
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Scarpazza C, Finos L, Genon S, Masiero L, Bortolato E, Cavaliere C, Pezzaioli J, Monaro M, Navarin N, Battaglia U, Pietrini P, Ferracuti S, Sartori G, Camperio Ciani AS. Idiopathic and acquired pedophilia as two distinct disorders: an insight from neuroimaging. Brain Imaging Behav 2021; 15:2681-2692. [PMID: 33507519 PMCID: PMC8500885 DOI: 10.1007/s11682-020-00442-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023]
Abstract
Pedophilia is a disorder of public concern because of its association with child sexual offense and recidivism. Previous neuroimaging studies of potential brain abnormalities underlying pedophilic behavior, either in idiopathic or acquired (i.e., emerging following brain damages) pedophilia, led to inconsistent results. This study sought to explore the neural underpinnings of pedophilic behavior and to determine the extent to which brain alterations may be related to distinct psychopathological features in pedophilia. To this aim, we run a coordinate based meta-analysis on previously published papers reporting whole brain analysis and a lesion network analysis, using brain lesions as seeds in a resting state connectivity analysis. The behavioral profiling approach was applied to link identified regions with the corresponding psychological processes. While no consistent neuroanatomical alterations were identified in idiopathic pedophilia, the current results support that all the lesions causing acquired pedophilia are localized within a shared resting state network that included posterior midlines structures, right inferior temporal gyrus and bilateral orbitofrontal cortex. These regions are associated with action inhibition and social cognition, abilities that are consistently and severely impaired in acquired pedophiles. This study suggests that idiopathic and acquired pedophilia may be two distinct disorders, in line with their distinctive clinical features, including age of onset, reversibility and modus operandi. Understanding the neurobiological underpinnings of pedophilic behavior may contribute to a more comprehensive characterization of these individuals on a clinical ground, a pivotal step forward for the development of more efficient therapeutic rehabilitation strategies.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padova, Via Venezia 8, 25131, Padova, PD, Italy. .,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Livio Finos
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Sarah Genon
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Laura Masiero
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Elena Bortolato
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Camilla Cavaliere
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Jessica Pezzaioli
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Merylin Monaro
- Department of General Psychology, University of Padova, Via Venezia 8, 25131, Padova, PD, Italy
| | - Nicolò Navarin
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padova, Italy
| | - Umberto Battaglia
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Pietro Pietrini
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Sartori
- Department of General Psychology, University of Padova, Via Venezia 8, 25131, Padova, PD, Italy
| | - Andrea S Camperio Ciani
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
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14
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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15
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Turner D, Briken P. Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review. J Sex Med 2019; 15:77-93. [PMID: 29289377 DOI: 10.1016/j.jsxm.2017.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/28/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Different pharmacologic agents are used in the treatment of paraphilic disorders in sexual offenders or men with a risk of sexual offending, with luteinizing hormone-releasing hormone (LHRH) agonists being the agents introduced more recently to treatment regimens. AIM To summarize the relevant literature concerning LHRH agonist treatment of paraphilic disorders in sexual offenders and update the previously published systematic review by Briken et al (J Clin Psychiatry 2003;64:890-897). METHODS The PubMed and Google Scholar databases were searched for literature published from January 2003 through October 2017 using the following key words: LHRH agonists, GnRH agonists, antiandrogens AND paraphilia, pedophilia, sex offenders. OUTCOMES Evaluation of the effectiveness and side effects of LHRH agonist treatment of paraphilic disorders in sexual offenders. RESULTS After screening for duplicates and applying specific selection criteria, the search yielded 24 eligible studies reporting on a sample of 256 patients. There is increasing evidence that LHRH agonists are more effective than steroidal antiandrogens in lowering paraphilic sexual thoughts and behaviors. Current research also is based on methods that might be less susceptible to faking (eg, eye-tracking, brain imaging, and viewing-time measures). Side effects occurring most frequently are fatigue, hot flashes, depressive mood, weight gain, high blood pressure, diabetes, gynecomastia, loss of erectile function, and loss of bone mineral density. CLINICAL IMPLICATIONS Although LHRH agonists seem to be the most effective drugs in the treatment of paraphilic fantasies and behaviors, they should be reserved for patients with a paraphilic disorder and the highest risk of sexual offending because of their extensive side effects. STRENGTHS AND LIMITATIONS This systematic review considers all types of research on LHRH agonist treatment in patients with paraphilic disorders, thereby providing a complete overview of the current state of research. However, most studies are case reports or observational studies and randomized controlled clinical trials have not been conducted or published. CONCLUSIONS LHRH agonists are a useful treatment when combined with psychotherapy in patients with a paraphilic disorder and the highest risk of sexual offending. However, throughout treatment, close monitoring of side effects is needed and ethical concerns must always be kept in mind. Turner D, Briken P. Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review. J Sex Med 2018;15:77-93.
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Affiliation(s)
- Daniel Turner
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - 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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Cazala F, Fonteille V, Moulier V, Pélégrini-Issac M, De Beaurepaire C, Abondo M, Bodon-Bruzel M, Cano J, Cochez F, Fouli T, Thevenon C, Dauba B, Pugeat M, Stoléru S. Brain responses to pictures of children in men with pedophilic disorder: a functional magnetic resonance imaging study. Eur Arch Psychiatry Clin Neurosci 2019; 269:713-729. [PMID: 30094544 DOI: 10.1007/s00406-018-0933-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
Structural and functional neuroimaging techniques have recently been used to investigate the mechanisms of sexual attraction to children, a hallmark of pedophilic disorder, and have reported many contradictory or non-replicated findings. Here, our purpose was to identify through functional magnetic resonance imaging the brain responses of 25 male outpatients with pedophilic disorder to visual stimuli depicting children (VSc) and to compare them with 24 male healthy controls matched on sexual orientation (to female or male adults), age, and handedness. No region was differentially activated across the two groups in response to VSc. However, as shown by a random-effects statistical analysis (cluster-level pFWE-corrected < 0.05), in patients with pedophilia, but not in controls, the presentation of VSc induced a bilateral activation in the lateral occipital and temporal cortices, in particular in the right inferior temporal gyrus, as well as an activation in the declive of the cerebellar vermis. In addition, in patients the level of bilateral activation in the above-mentioned regions was positively correlated with ratings of perceived sexual arousal elicited by VSc. These results implicate these regions as possible candidate areas mediating sexual arousal in patients with pedophilic disorder.
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Affiliation(s)
- Fadwa Cazala
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, Bron, 69500, France
| | - Véronique Fonteille
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France.,Centre Hospitalo-Universitaire et Université de Saint-Etienne, Saint-Etienne, France
| | - Virginie Moulier
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France.,Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-sur-Marne, France
| | - Mélanie Pélégrini-Issac
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB) Paris, Paris, France
| | | | - Marlène Abondo
- Antenne Rennaise du Centre de Ressources Régional sur les Auteurs de Violences Sexuelles de Bretagne, CHU Pontchaillou, Rennes, France
| | | | - Jean Cano
- CHRU de Tours, Hôpital Trousseau, Tours, France.,ERIOS-CRIAVS Aquitaine, Centre Hospitalier Charles-Perrens, Bordeaux, France
| | | | - Taoufik Fouli
- Département Santé-Justice du Centre Hospitalier Esquirol, Limoges, France
| | | | - Bernard Dauba
- Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, Bron, 69500, France.,AP-HP, Centre d'Investigation Clinique-1421, Pitié-Salpêtrière University Hospital, Paris, France
| | - Michel Pugeat
- Université Claude Bernard Lyon 1, INSERM U1060 and Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, Bron, France
| | - Serge Stoléru
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France. .,Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, Bron, 69500, France. .,Institut du Cerveau et de la Moelle épinière, Sorbonne Université, CNRS, INSERM, Centre de neuroimagerie de recherche (CENIR), Paris, France.
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17
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Ristow I, Foell J, Kärgel C, Borchardt V, Li S, Denzel D, Witzel J, Drumkova K, Beier K, Kruger THC, Ponseti J, Schiffer B, Schiltz K, Walter H, Walter M. Expectation of sexual images of adults and children elicits differential dorsal anterior cingulate cortex activation in pedophilic sexual offenders and healthy controls. NEUROIMAGE-CLINICAL 2019; 23:101863. [PMID: 31158692 PMCID: PMC6545409 DOI: 10.1016/j.nicl.2019.101863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/02/2019] [Accepted: 05/19/2019] [Indexed: 01/08/2023]
Abstract
Background Pedophilic disorder is characterized by increased sexual interest towards children, with comparatively lesser interest towards adults. In real life, the behavior of subjects with pedophilic disorder is shaped by evaluative processes in response to sexually relevant cues. Therefore, brain activation during anticipation of sexually relevant cues is of potential interest. Whereas previous research demonstrated reduced activation when viewing adult (non-preferred) sexual stimuli in pedophilic sex offenders (PSOs), it is not known if anticipation of preferred versus unpreferred stimuli will elicit differential brain activation. Methods Two fMRI studies (1.5 and 7 Tesla) were conducted in separate samples, each with 26 subjects (13/13 PSOs/controls) to assess brain activity during expectancy of subsequent adult (non-preferred) sexual stimuli. In the second study (7 Tesla) additionally child (preferred) cues were presented. Results As predicted, expectancy of adult sexual stimuli generated smaller dorsal anterior cingulate cortex (dACC) activation in PSOs in both studies, driven by stronger activation during expectancy of adult erotic stimuli in non-pedophilic controls (HCs). In the second study, PSOs showed significantly increased activations in dACC during expectancy of child stimuli compared with expectancy of adult stimuli. This difference was significantly greater compared to the same contrast in HCs, thus demonstrating preference specificity of dACC activation. Conclusion Our findings support the notion of decreased brain activation to adult cues in PSOs and preference specificity in neural response during expectancy of erotic stimuli. The localization of these cue reactivity differences in the salience network supports the interpretation that PSOs show abnormally increased preparatory activation even before relevant sexual stimuli are actually presented. We studied expectancy-related brain activity in pedophilic offenders and controls. Activation during anticipation elicits reactivity differences in salience network. Brain activation during expectancy was stronger compared to picture perception. Effects in dACC of patients and controls were found in 2 fMRI studies (1.5 and 7 T). DACC activation during expectancy revealed preference specificity in both groups.
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Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Jens Foell
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Shijia Li
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Dominik Denzel
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Klaus 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
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, 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-Univesität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Department of Psychiatry, Eberhard Karls University, Tübingen, Germany; Max Planck Institute for Biological Cybernetics Tübingen, Germany.
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18
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Babchishin KM, Seto MC, Fazel S, Långström N. Are There Early Risk Markers for Pedophilia? A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders. JOURNAL OF SEX RESEARCH 2019; 56:203-212. [PMID: 30064261 PMCID: PMC6225987 DOI: 10.1080/00224499.2018.1492694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Although prior research suggests associations between parental characteristics and later sexual offending in offspring, possible links between early pregnancy-related factors and sexual offending remain unclear. Early risk markers unique to sexual offending, however, may be more prominent among sexual offenders with atypical sexual interests, such as individuals involved with child sexual exploitation material (CSEM; also referred to as child pornography). We examined the prospective association between parental and pregnancy-related risk markers and a behavioral indicator of pedophilic interest, CSEM offending. All 655 men born in Sweden and convicted of CSEM offending between 1988 to 2009 were matched 1:5 on sex, birth year, and county of birth in Sweden to 3,928 controls without sexual or nonsexual violent convictions. Paternal age (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI] [1.1, 1.7]), parental education (AOR = 0.8, 95% CI [0.6, 0.9]), parental violent criminality (AOR = 2.9, 95% CI [2.2, 3.8]), number of older brothers (AOR = 0.8, 95% CI [0.6, 0.9] per brother), and congenital malformations (AOR = 1.7, 95% CI [1.2, 2.4]) all independently predicted CSEM convictions. This large-scale, nationwide study suggests parental risk markers for CSEM offending. We did not, however, find convincing evidence for pregnancy-related risk markers, with the exception of congenital malformations and having fewer older brothers.
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Affiliation(s)
- Kelly M Babchishin
- a Forensic Research Unit, The Royal's Institute of Mental Health Research
| | - Michael C Seto
- a Forensic Research Unit, The Royal's Institute of Mental Health Research
| | - Seena Fazel
- b Department of Psychiatry , University of Oxford
| | - Niklas Långström
- c Department of Medical Epidemiology and Biostatistics , Karolinska Institute; and Department of Neuroscience, Uppsala University
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Fonteille V, Redouté J, Lamothe P, Straub D, Lavenne F, Le Bars D, Raverot V, Moulier V, Marchand JJ, Vittoz A, Leriche C, Pugeat M, Stoléru S. Brain processing of pictures of children in men with pedophilic disorder: A positron emission tomography study. NEUROIMAGE-CLINICAL 2019; 21:101647. [PMID: 30612938 PMCID: PMC6412007 DOI: 10.1016/j.nicl.2018.101647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 12/11/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
Abstract
Although structural and functional neuroimaging techniques have recently been used to investigate the mechanisms of sexual attraction to children, a hallmark of pedophilic disorder, the differences in the processing of child sexual stimuli between men attracted to children and those attracted to adults remain unclear. Here, our purpose was to identify through positron emission tomography the brain responses of 15 male outpatients with pedophilic disorder to validated visual sexual stimuli depicting children (VSSc) and to compare them with 15 male healthy controls matched for sexual orientation (to female or male adults), age, and handedness. The patients' sample comprised both offenders and non-offenders. In response to VSSc, the between-groups analysis showed that activation in the right inferior temporal cortex [Brodmann area (BA) 20] was lower in patients than in controls. Moreover, in patients but not in controls, the presentation of VSSc induced an activation in a more caudal region of the right inferior temporal gyrus (BA 37) and in the left middle occipital gyrus (BA 19). In addition, in patients the level of activation in the caudal right inferior temporal gyrus was positively correlated with ratings of sexual arousal elicited by VSSc, whereas this correlation was negative in BA 20. These results implicate the right inferior temporal gyrus as a possible candidate area mediating sexual arousal in patients with pedophilic disorder and suggest that two of its areas play opposite, i.e., activating and inhibitory, roles. Images of children activate the pedophilic patients' right Brodmann area (BA) 37. Images of children (IC) activate the pedophilic patients' left BA 19. Right BA37 activation correlates with pedophilic patients' rating of sexual arousal. IC induce lower right BA 20 activation in pedophilic patients than in controls.
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Affiliation(s)
- Véronique Fonteille
- Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, 59 Boulevard Pinel, Bron F-69500, France
| | - Jérôme Redouté
- CERMEP-Imagerie du Vivant, 59 Boulevard Pinel, 69677, France
| | - Pierre Lamothe
- Service Médico-Psychologique Régional, Centre Hospitalier Le Vinatier, BP 30039, 95 bd Pinel, Bron Cedex 69678, France
| | - Dominique Straub
- CRIAVS Rhône-Alpes - Délégation de St Étienne, Hôpital Bellevue, Pavillon 5 bis, Bvd Pasteur, Saint-Étienne 42055, France
| | - Frank Lavenne
- CERMEP-Imagerie du Vivant, 59 Boulevard Pinel, 69677, France
| | - Didier Le Bars
- CERMEP-Imagerie du Vivant, 59 Boulevard Pinel, 69677, France
| | - Véronique Raverot
- Centre de Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, Bron, 69677, France
| | - Virginie Moulier
- Unité de Recherche Clinique, EPS Ville Evrard, 202 avenue Jean Jaurès, Neuilly-sur-Marne 93330, France
| | - Jean-Jacques Marchand
- Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, 59 Boulevard Pinel, Bron F-69500, France
| | - Aurélie Vittoz
- Service Médico-Psychologique Régional, Centre Hospitalier Le Vinatier, BP 30039, 95 bd Pinel, Bron Cedex 69678, France
| | - Charlotte Leriche
- Service Médico-Psychologique Régional, Centre Hospitalier Le Vinatier, BP 30039, 95 bd Pinel, Bron Cedex 69678, France
| | - Michel Pugeat
- Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, 59 Boulevard Pinel, Bron F-69500, France
| | - Serge Stoléru
- Hospices Civils de Lyon, Groupement Hospitalier Est, Fédération d'Endocrinologie, 59 Boulevard Pinel, Bron F-69500, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, Porte 45, 16 avenue Paul Vaillant-Couturier, Villejuif Cedex 94807, France; Corresponding author at: Inserm U1178, Hôpital Paul Brousse, Porte 45, 16 avenue Paul Vaillant-Couturier, Villejuif Cedex 94807, France..
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20
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Jordan K, Wild TSN, Fromberger P, Müller I, Müller JL. Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review. Front Psychiatry 2019; 10:940. [PMID: 32038314 PMCID: PMC6985439 DOI: 10.3389/fpsyt.2019.00940] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Abstract
The use of biomarkers in medicine is a common and valuable approach in several clinical fields. Understanding the relationship between measurable biological processes and clinical outcomes not only is indispensable in the face of understanding physiological processes in healthy as well as in diseased organisms but also for understanding and evaluating treatment effects. Therefore, also in the context of forensic psychiatry, biomarkers and their potentially beneficial effects are of growing interest. The objective of this review is to examine if there are biomarkers that may serve as a tool to support diagnostic process, treatment evaluation, and risk assessment of pedophilic individuals and child sexual offenders. In the first part, we present an overview of the current neurobiological, as well as physiological and psychophysiological approaches to characterize pedophilia and child sexual offending. Secondly, we discuss and evaluate the impact of these approaches on the development of biomarkers for diagnosis, therapy, and risk assessment in pedophilic subjects and child sexual offenders. We conclude that a lot of research has already enhanced our neurobiological knowledge about pedophilia and child sexual offending. Although there surely exist promising parameters and approaches, in our view currently none of these is ready yet to serve as a clinically applicable diagnostic, response, or predictive biomarker for pedophilia and child sexual offending. Therefore, further work remains to be done. The development of a composite diagnostic biomarker to assess deviant sexual interest, combining several measures like functional magnetic resonance imaging, electroencephalogram, eye tracking, and behavioral approaches seems to be most promising. A valid and reliable measurement of deviant sexual interest, insensitive to manipulations could significantly support clinical diagnostic process. Similarly, regarding therapy evaluation and risk assessment, a composite biomarker to assess inhibitory control functions seems to be promising. Furthermore, the application of the Research Domain Criteria-approach, a new approach for investigating and classifying mental disorders, offers the possibility to take research to a new level.
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Affiliation(s)
- Kirsten Jordan
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Goettingen, Goettingen, Germany
| | - Tamara Sheila Nadine Wild
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Goettingen, Goettingen, Germany
| | - Peter Fromberger
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Goettingen, Goettingen, Germany
| | - Isabel Müller
- Asklepios Forensic Psychiatric Hospital, Goettingen, Germany
| | - Jürgen Leo Müller
- Forensic Psychiatry and Psychotherapy, Clinic of Psychiatry and Psychotherapy, University Medical Center, University of Goettingen, Goettingen, Germany.,Asklepios Forensic Psychiatric Hospital, Goettingen, Germany
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21
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Ristow I, Li M, Colic L, Marr V, Födisch C, von Düring F, Schiltz K, Drumkova K, Witzel J, Walter H, Beier K, Kruger THC, Ponseti J, Schiffer B, Walter M. Pedophilic sex offenders are characterised by reduced GABA concentration in dorsal anterior cingulate cortex. NEUROIMAGE-CLINICAL 2018; 18:335-341. [PMID: 29876253 PMCID: PMC5987735 DOI: 10.1016/j.nicl.2018.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/14/2017] [Accepted: 01/15/2018] [Indexed: 12/14/2022]
Abstract
A pedophilic disorder is characterised by abnormal sexual urges towards prepubescent children. Child abusive behavior is frequently a result of lack of behavioral inhibition and current treatment options entail, next to suppressing unchangeable sexual orientation, measures to increase cognitive and attentional control. We tested, if in brain regions subserving attentional control of behavior and perception of salient stimuli, such inhibition deficit can be observed also on the level of inhibitory neurotransmitters. We measured GABA concentration in the dorsal anterior cingulate cortex (dACC) and in a control region, the pregenual anterior cingulate cortex (pgACC) in pedophilic sex offenders (N = 13) and matched controls (N = 13) using a 7 Tesla STEAM magnetic resonance spectroscopy (MRS). In dACC but not in the control region pedophilic sex offenders showed reduced GABA/Cr concentrations compared to healthy controls. The reduction was robust after controlling for potential influence of age and gray matter proportion within the MRS voxel (p < 0.04). Importantly, reduced GABA/Cr in patients was correlated with lower self-control measured with the Barratt Impulsiveness Scale (p = 0.028, r = -0.689). In a region related to cognitive control and salience mapping, pedophilic sex offenders showed reduction of the inhibitory neurotransmitter GABA which may be seen as a neuronal correlate of inhibition and behavioral control.
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Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Department of Neurology, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Vanessa Marr
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Carina Födisch
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Felicia von Düring
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Boris Schiffer
- University of Duisburg-Essen, Institute of Forensic Psychiatry, Essen, Germany; LWL-University Hospital, Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Bochum, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany; Department of Neurology, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Department of Psychiatry, Eberhard Karls University, Tübingen, Germany; Max Planck Institute for Biological Cybernetics Tübingen, Germany.
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22
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Ponseti J, Bruhn D, Nolting J, Gerwinn H, Pohl A, Stirn A, Granert O, Laufs H, Deuschl G, Wolff S, Jansen O, Siebner H, Briken P, Mohnke S, Amelung T, Kneer J, Schiffer B, Walter H, Kruger THC. Decoding Pedophilia: Increased Anterior Insula Response to Infant Animal Pictures. Front Hum Neurosci 2018; 11:645. [PMID: 29403367 PMCID: PMC5778266 DOI: 10.3389/fnhum.2017.00645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Previous research found increased brain responses of men with sexual interest in children (i.e., pedophiles) not only to pictures of naked children but also to pictures of child faces. This opens the possibly that pedophilia is linked (in addition to or instead of an aberrant sexual system) to an over-active nurturing system. To test this hypothesis we exposed pedophiles and healthy controls to pictures of infant and adult animals during functional magnetic resonance imaging of the brain. By using pictures of infant animals (instead of human infants), we aimed to elicit nurturing processing without triggering sexual processing. We hypothesized that elevated brain responses to nurturing stimuli will be found - in addition to other brain areas - in the anterior insula of pedophiles because this area was repeatedly found to be activated when adults see pictures of babies. Behavioral ratings confirmed that pictures of infant or adult animals were not perceived as sexually arousing neither by the pedophilic participants nor by the heathy controls. Statistical analysis was applied to the whole brain as well as to the anterior insula as region of interest. Only in pedophiles did infants relative to adult animals increase brain activity in the anterior insula, supplementary motor cortex, and dorsolateral prefrontal areas. Within-group analysis revealed an increased brain response to infant animals in the left anterior insular cortex of the pedophilic participants. Currently, pedophilia is considered the consequence of disturbed sexual or executive brain processing, but details are far from known. The present findings raise the question whether there is also an over-responsive nurturing system in pedophilia.
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Affiliation(s)
- Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Daniel Bruhn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Julia Nolting
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Hannah Gerwinn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Alexander Pohl
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Aglaja Stirn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Helmut Laufs
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Kiel, Germany
| | - Hartwig Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jonas Kneer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital Bochum, Bochum, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tillmann H. C. Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
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Abstract
OBJECTIVES Pedophilia (P) is a psychiatric disease associated with sexual attraction toward children and often accompanied by child sexual offending (CSO). Consequently, it is important to address the understanding of executive dysfunctions that may increase the probability of CSO. Moreover, this research field has been lacking to disentangle executive deficits associated with pedophilia (as a deviant sexual preference) from those associated with CSO (as a deviant sexual behavior). METHODS The German multi-sided research network NeMUP offers the opportunity to overcome these limitations. By applying the Cambridge Automated Neuropsychological Test Battery in four carefully matched groups of men: (1) pedophiles with (N=45) and (2) without (N=45) a history of sexual offending against children; (3) child molesters without pedophilia (N=19), and (4) non-offending controls (N=49), we were able to analyze executive functioning in pedophilia and CSO independently. RESULTS Both CSO groups as compared to both non-CSO groups exhibited worsened response inhibition ability. However, only non-pedophilic offenders showed additionally disabled strategy use ability. Regarding set-shifting abilities, the P+CSO group showed the best performance. We also found that performances were affected by age: only in pedophiles, response inhibition worsened with age, while age-related deficits in set-shifting abilities were restricted to non-pedophilic participants. The latter also differentiated between both sexual preference groups. CONCLUSIONS Our results are the first to demonstrate that executive dysfunctions are related to offense status rather than pedophilic preference. Furthermore, there was evidence for differentiating age and performance correlations between pedophiles and non-pedophiles, which warrants further investigation. (JINS, 2017, 23, 460-470).
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24
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Kärgel C, Massau C, Weiß S, Walter M, Borchardt V, Krueger THC, Tenbergen G, Kneer J, Wittfoth M, Pohl A, Gerwinn H, Ponseti J, Amelung T, Beier KM, Mohnke S, Walter H, Schiffer B. Evidence for superior neurobiological and behavioral inhibitory control abilities in non-offending as compared to offending pedophiles. Hum Brain Mapp 2016; 38:1092-1104. [PMID: 27767244 DOI: 10.1002/hbm.23443] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/21/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023] Open
Abstract
Neurobehavioral models of pedophilia and child sexual offending suggest a pattern of temporal and in particular prefrontal disturbances leading to inappropriate behavioral control and subsequently an increased propensity to sexually offend against children. However, clear empirical evidence for such mechanisms is still missing. Using a go/nogo paradigm in combination with functional magnetic resonance imaging (fMRI) we compared behavioral performance and neural response patterns among three groups of men matched for age and IQ: pedophiles with (N = 40) and without (N = 37) a history of hands-on sexual offences against children as well as healthy non-offending controls (N = 40). As compared to offending pedophiles, non-offending pedophiles exhibited superior inhibitory control as reflected by significantly lower rate of commission errors. Group-by-condition interaction analysis also revealed inhibition-related activation in the left posterior cingulate and the left superior frontal cortex that distinguished between offending and non-offending pedophiles, while no significant differences were found between pedophiles and healthy controls. Both areas showing distinct activation pattern among pedophiles play a critical role in linking neural networks that relate to effective cognitive functioning. Data therefore suggest that heightened inhibition-related recruitment of these areas as well as decreased amount of commission errors is related to better inhibitory control in pedophiles who successfully avoid committing hands-on sexual offences against children. Hum Brain Mapp 38:1092-1104, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christian Kärgel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Claudia Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Simone Weiß
- Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Martin Walter
- Department of Psychiatry, Otto v. Guericke University, Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany.,Department for Behavioral Neurology, Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Leipziger Str. 44, Magdeburg, 39120, Germany.,Department of Psychiatry and Psychotherapy, University Tübingen, Osianderstr. 24, Tübingen, 72076, Germany
| | - Viola Borchardt
- Department for Behavioral Neurology, Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Tillmann H C Krueger
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Gilian Tenbergen
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Jonas Kneer
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Matthias Wittfoth
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Alexander Pohl
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Hannah Gerwinn
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Jorge Ponseti
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Till Amelung
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin (Charité), Luisenstr. 57, Berlin, 10117, Germany
| | - Klaus M Beier
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin (Charité), Luisenstr. 57, Berlin, 10117, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, University Medicine Berlin (Charité), Charitéplatz 1, Berlin, 10117, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, University Medicine Berlin (Charité), Charitéplatz 1, Berlin, 10117, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
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25
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Ponseti J, Granert O, Van Eimeren T, Jansen O, Wolff S, Beier K, Deuschl G, Huchzermeier C, Stirn A, Bosinski H, Roman Siebner H. Assessing paedophilia based on the haemodynamic brain response to face images. World J Biol Psychiatry 2016; 17:39-46. [PMID: 26452682 DOI: 10.3109/15622975.2015.1083612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Objective assessment of sexual preferences may be of relevance in the treatment and prognosis of child sexual offenders. Previous research has indicated that this can be achieved by pattern classification of brain responses to sexual child and adult images. Our recent research showed that human face processing is tuned to sexual age preferences. This observation prompted us to test whether paedophilia can be inferred based on the haemodynamic brain responses to adult and child faces. METHODS Twenty-four men sexually attracted to prepubescent boys or girls (paedophiles) and 32 men sexually attracted to men or women (teleiophiles) were exposed to images of child and adult, male and female faces during a functional magnetic resonance imaging (fMRI) session. RESULTS A cross-validated, automatic pattern classification algorithm of brain responses to facial stimuli yielded four misclassified participants (three false positives), corresponding to a specificity of 91% and a sensitivity of 95%. CONCLUSIONS These results indicate that the functional response to facial stimuli can be reliably used for fMRI-based classification of paedophilia, bypassing the problem of showing child sexual stimuli to paedophiles.
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Affiliation(s)
- Jorge Ponseti
- a Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School , Kiel , Germany
| | - Oliver Granert
- b Department of Neurology , Kiel University, Medical School , Kiel , Germany
| | - Thilo Van Eimeren
- b Department of Neurology , Kiel University, Medical School , Kiel , Germany
| | - Olav Jansen
- c Department of Radiology and Neuroradiology , Kiel University, Medical School , Kiel , Germany
| | - Stephan Wolff
- c Department of Radiology and Neuroradiology , Kiel University, Medical School , Kiel , Germany
| | - Klaus Beier
- d Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Günther Deuschl
- b Department of Neurology , Kiel University, Medical School , Kiel , Germany
| | - Christian Huchzermeier
- a Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School , Kiel , Germany
| | - Aglaja Stirn
- a Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School , Kiel , Germany
| | | | - Hartwig Roman Siebner
- b Department of Neurology , Kiel University, Medical School , Kiel , Germany.,f Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark.,g Department of Neurology , Copenhagen University Hospital Bispebjerg , Bispebjerg , Denmark
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26
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Knott V, Impey D, Fisher D, Delpero E, Fedoroff P. Pedophilic brain potential responses to adult erotic stimuli. Brain Res 2015; 1632:127-40. [PMID: 26683083 DOI: 10.1016/j.brainres.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022]
Abstract
Cognitive mechanisms associated with the relative lack of sexual interest in adults by pedophiles are poorly understood and may benefit from investigations examining how the brain processes adult erotic stimuli. The current study used event-related brain potentials (ERP) to investigate the time course of the explicit processing of erotic, emotional, and neutral pictures in 22 pedophilic patients and 22 healthy controls. Consistent with previous studies, early latency anterior ERP components were highly selective for erotic pictures. Although the ERPs elicited by emotional stimuli were similar in patients and controls, an early frontal positive (P2) component starting as early as 185 ms was significantly attenuated and slow to onset in pedophilia, and correlated with a clinical measure of cognitive distortions. Failure of rapid attentional capture by erotic stimuli suggests a relative reduction in early processing in pedophilic patients which may be associated with relatively diminished sexual interest in adults.
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Affiliation(s)
- Verner Knott
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Danielle Impey
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Emily Delpero
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Paul Fedoroff
- Forensic Research Unit, University of Ottawa, Institute of Mental Health Research, Ottawa, ON, Canada
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Abstract
The neuroanatomical correlates of human sexual desire, arousal, and behavior have been characterized in recent years with functional brain imaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Here, we briefly review the results of functional neuroimaging studies in humans, whether healthy or suffering from sexual disorders, and the current models of regional and network activation in sexual arousal. Attention is paid, in particular, to findings from both regional and network studies in the past 3 years. We also identify yet unanswered and pressing questions of interest to areas of ongoing investigations for psychiatric, scientific, and forensic disciplines.
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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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Poeppl TB, Eickhoff SB, Fox PT, Laird AR, Rupprecht R, Langguth B, Bzdok D. Connectivity and functional profiling of abnormal brain structures in pedophilia. Hum Brain Mapp 2015; 36:2374-86. [PMID: 25733379 DOI: 10.1002/hbm.22777] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/24/2015] [Accepted: 02/17/2015] [Indexed: 12/25/2022] Open
Abstract
Despite its 0.5-1% lifetime prevalence in men and its general societal relevance, neuroimaging investigations in pedophilia are scarce. Preliminary findings indicate abnormal brain structure and function. However, no study has yet linked structural alterations in pedophiles to both connectional and functional properties of the aberrant hotspots. The relationship between morphological alterations and brain function in pedophilia as well as their contribution to its psychopathology thus remain unclear. First, we assessed bimodal connectivity of structurally altered candidate regions using meta-analytic connectivity modeling (MACM) and resting-state correlations employing openly accessible data. We compared the ensuing connectivity maps to the activation likelihood estimation (ALE) maps of a recent quantitative meta-analysis of brain activity during processing of sexual stimuli. Second, we functionally characterized the structurally altered regions employing meta-data of a large-scale neuroimaging database. Candidate regions were functionally connected to key areas for processing of sexual stimuli. Moreover, we found that the functional role of structurally altered brain regions in pedophilia relates to nonsexual emotional as well as neurocognitive and executive functions, previously reported to be impaired in pedophiles. Our results suggest that structural brain alterations affect neural networks for sexual processing by way of disrupted functional connectivity, which may entail abnormal sexual arousal patterns. The findings moreover indicate that structural alterations account for common affective and neurocognitive impairments in pedophilia. The present multimodal integration of brain structure and function analyses links sexual and nonsexual psychopathology in pedophilia.
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Affiliation(s)
- Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Kärgel C, Massau C, Weiß S, Walter M, Kruger THC, Schiffer B. Diminished functional connectivity on the road to child sexual abuse in pedophilia. J Sex Med 2015; 12:783-95. [PMID: 25615561 DOI: 10.1111/jsm.12819] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pedophilia is a disorder recognized for its impairment to the individual and for the harm it may cause to others. However, the neurobiology of pedophilia and a possible propensity to sexually abuse children are not well understood. In this study, we thus aimed at providing new insights in how functional integration of brain regions may relate to pedophilia or child sexual abuse (CSA). METHOD By using functional magnetic resonance imaging (fMRI) technique, we compared functional connectivity at rest (RSFC) between pedophiles who engaged (P+CSA; N = 12) or did not engage (P-CSA; N = 14) in CSA and healthy controls (HCs; N = 14) within two networks: (i) the default mode network and (ii) the limbic network that has been linked to pedophilia before. RESULTS Pedophiles who engaged in CSA show diminished RSFC in both networks compared with HC and P-CSA. Most importantly, they showed diminished RSFC between the left amygdala and orbitofrontal as well as anterior prefrontal regions. Though significant age differences between groups could not be avoided, correlation control analysis did not provide evidence for the assumption that the RSFC effects were related to age differences. CONCLUSION We found significantly diminished RSFC in brain networks critically involved in widespread motivational and socio-emotional processes. These results extend existing models of the functional neuroanatomy of pedophilia and CSA as altered RSFC between these regions were related to CSA rather than pedophilia and thus may account for an increased propensity to engage in CSA in people suffering from pedophilia.
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Affiliation(s)
- Christian Kärgel
- Institute of Forensic Psychiatry, LVR-Clinics Essen, University of Duisburg-Essen, Essen, Germany
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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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Habermeyer B, Esposito F, Händel N, Lemoine P, Kuhl HC, Klarhöfer M, Mager R, Mokros A, Dittmann V, Seifritz E, Graf M. Response inhibition in pedophilia: an FMRI pilot study. Neuropsychobiology 2014; 68:228-37. [PMID: 24247250 DOI: 10.1159/000355295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/26/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The failure to inhibit pleasurable but inappropriate urges is associated with frontal lobe pathology and has been suggested as a possible cause of pedophilic behavior. However, imaging and neuropsychological findings about frontal pathology in pedophilia are heterogeneous. In our study we therefore address inhibition behaviorally and by means of functional imaging, aiming to assess how inhibition in pedophilia is related to a differential recruitment of frontal brain areas. METHOD Eleven pedophilic subjects and 7 nonpedophilic controls underwent fMRI while performing a go/no-go task composed of neutral letters. RESULTS Pedophilic subjects showed a slower reaction time and less accurate visual target discrimination. fMRI voxel-level ANOVA revealed as a main effect of the go/no-go task an activation of prefrontal and parietal brain regions in the no-go condition, while the left anterior cingulate, precuneus and gyrus angularis became more activated in the go condition. In addition, a group × task interaction was found in the left precuneus and gyrus angularis. This interaction was based on an attenuated deactivation of these brain regions in the pedophilic group during performance of the no-go condition. The positive correlation between blood oxygen level-dependent imaging signal and reaction time in these brain areas indicates that attenuated deactivation is related to the behavioral findings. CONCLUSION Slower reaction time and less accurate visual target discrimination in pedophilia was accompanied by attenuated deactivation of brain areas belonging to the default mode network. Our findings thus support the notion that behavioral differences might also derive from self-related processes and not necessarily from frontal lobe pathology.
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Affiliation(s)
- Benedikt Habermeyer
- Departments of General and Social Psychiatry, Psychiatric University Hospital, Zurich, Switzerland
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Jordan K, Fromberger P, Laubinger H, Dechent P, Müller JL. Changed processing of visual sexual stimuli under GnRH-therapy--a single case study in pedophilia using eye tracking and fMRI. BMC Psychiatry 2014; 14:142. [PMID: 24885644 PMCID: PMC4036749 DOI: 10.1186/1471-244x-14-142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 04/30/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antiandrogen therapy (ADT) has been used for 30 years to treat pedophilic patients. The aim of the treatment is a reduction in sexual drive and, in consequence, a reduced risk of recidivism. Yet the therapeutic success of antiandrogens is uncertain especially regarding recidivism. Meta-analyses and reviews report only moderate and often mutually inconsistent effects. CASE PRESENTATION Based on the case of a 47 year old exclusively pedophilic forensic inpatient, we examined the effectiveness of a new eye tracking method and a new functional magnetic resonance imaging (fMRI)-design in regard to the evaluation of ADT in pedophiles. We analyzed the potential of these methods in exploring the impact of ADT on automatic and controlled attentional processes in pedophiles. Eye tracking and fMRI measures were conducted before the initial ADT as well as four months after the onset of ADT. The patient simultaneously viewed an image of a child and an image of an adult while eye movements were measured. During the fMRI-measure the same stimuli were presented subliminally. Eye movements demonstrated that controlled attentional processes change under ADT, whereas automatic processes remained mostly unchanged. We assume that these results reflect either the increased ability of the patient to control his eye movements while viewing prepubertal stimuli or his better ability to manipulate his answer in a socially desirable manner. Unchanged automatic attentional processes could reflect the stable pedophilic preference of the patient. Using fMRI, the subliminal presentation of sexually relevant stimuli led to changed activation patterns under the influence of ADT in occipital and parietal brain regions, the hippocampus, and also in the orbitofrontal cortex. We suggest that even at an unconscious level ADT can lead to changed processing of sexually relevant stimuli, reflecting changes of cognitive and perceptive automatic processes. CONCLUSION We are convinced that our experimental designs using eye tracking and fMRI could prospectively add additional and valuable information in the evaluation of ADT in paraphilic patients and sex offenders. But with respect to the limited significance of this single case study, these first results are preliminary and further studies have to be conducted with healthy subjects and patients.
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Affiliation(s)
- Kirsten Jordan
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Peter Fromberger
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Helge Laubinger
- Asklepios Forensic Psychiatric Hospital of Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Peter Dechent
- Department of Cognitive Neurology, Georg-August-University Göttingen, Robert-Koch-St. 40, Göttingen 37075, Germany
| | - Jürgen L Müller
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
- Asklepios Forensic Psychiatric Hospital of Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
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Müller S, Walter H, Christen M. When benefitting a patient increases the risk for harm for third persons - the case of treating pedophilic Parkinsonian patients with deep brain stimulation. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:295-303. [PMID: 24289863 DOI: 10.1016/j.ijlp.2013.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation - given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.
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Affiliation(s)
- Sabine Müller
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany.
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus Christen
- Institute of Biomedical Ethics, Pestalozzistrasse 24, 8032 Zurich, Switzerland
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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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Joyal CC, Beaulieu-Plante J, de Chantérac A. The neuropsychology of sex offenders: a meta-analysis. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2014; 26:149-177. [PMID: 23567470 DOI: 10.1177/1079063213482842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Typically, neuropsychological studies of sex offenders have grouped together different types of individuals and different types of measures. This is why results have tended to be nonspecific and divergent across studies. Against this background, the authors undertook a review of the literature regarding the neuropsychology of sex offenders, taking into account subgroups based on criminological theories. They also conducted a meta-analysis of the data to demonstrate the cognitive heterogeneity of sex offenders statistically. Their main objective was to test the hypothesis to the effect that the neuropsychological deficits of sex offenders are not broad and generalized compared with specific subgroups of participants based on specific measures. In all, 23 neuropsychological studies reporting data on 1,756 participants were taken into consideration. As expected, a highly significant, broad, and heterogeneous overall effect size was found. Taking subgroups of participants and specific cognitive measures into account significantly improved homogeneity. Sex offenders against children tended to obtain lower scores than did sex offenders against adults on higher order executive functions, whereas sex offenders against adults tended to obtain results similar to those of non-sex offenders, with lower scores in verbal fluency and inhibition. However, it is concluded that neuropsychological data on sex offenders are still too scarce to confirm these trends or to test more precise hypotheses. For greater clinical relevance, future neuropsychological studies should consider specific subgroups of participants and measures to verify the presence of different cognitive profiles.
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Affiliation(s)
- Christian C Joyal
- University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada
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Polisois-Keating A, Joyal CC. Functional neuroimaging of sexual arousal: a preliminary meta-analysis comparing pedophilic to non-pedophilic men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1111-1113. [PMID: 24085469 DOI: 10.1007/s10508-013-0198-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ariane Polisois-Keating
- Département de Psychologie, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
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Sescousse G, Caldú X, Segura B, Dreher JC. Processing of primary and secondary rewards: A quantitative meta-analysis and review of human functional neuroimaging studies. Neurosci Biobehav Rev 2013; 37:681-96. [DOI: 10.1016/j.neubiorev.2013.02.002] [Citation(s) in RCA: 393] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/11/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Association between brain structure and phenotypic characteristics in pedophilia. J Psychiatr Res 2013; 47:678-85. [PMID: 23399486 DOI: 10.1016/j.jpsychires.2013.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/07/2013] [Accepted: 01/09/2013] [Indexed: 11/21/2022]
Abstract
Studies applying structural neuroimaging to pedophiles are scarce and have shown conflicting results. Although first findings suggested reduced volume of the amygdala, pronounced gray matter decreases in frontal regions were observed in another group of pedophilic offenders. When compared to non-sexual offenders instead of community controls, pedophiles revealed deficiencies in white matter only. The present study sought to test the hypotheses of structurally compromised prefrontal and limbic networks and whether structural brain abnormalities are related to phenotypic characteristics in pedophiles. We compared gray matter volume of male pedophilic offenders and non-sexual offenders from high-security forensic hospitals using voxel-based morphometry in cross-sectional and correlational whole-brain analyses. The significance threshold was set to p < .05, corrected for multiple comparisons. Compared to controls, pedophiles exhibited a volume reduction of the right amygdala (small volume corrected). Within the pedophilic group, pedosexual interest and sexual recidivism were correlated with gray matter decrease in the left dorsolateral prefrontal cortex (r = -.64) and insular cortex (r = -.45). Lower age of victims was strongly associated with gray matter reductions in the orbitofrontal cortex (r = .98) and angular gyri bilaterally (r = .70 and r = .93). Our findings of specifically impaired neural networks being related to certain phenotypic characteristics might account for the heterogeneous results in previous neuroimaging studies of pedophilia. The neuroanatomical abnormalities in pedophilia seem to be of a dimensional rather than a categorical nature, supporting the notion of a multifaceted disorder.
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Abstract
Paraphilia is a set of disorders characterized by abnormal sexual desires. Perhaps most discussed amongst them, pedophilia is a complex interaction of disturbances of the emotional, cognitive and sexual experience. Using new imaging techniques such as functional magnetic resonance imaging, neural correlates of emotional, sexual and cognitive abnormalities and interactions have been investigated. As described on the basis of current research, altered patterns of brain activity, especially in the frontal areas of the brain, are seen in pedophilia. Building on these results, the analysis of neural correlates of impaired psychological functions opens the opportunity to further explore sexual deviances, which may contribute ultimately to the development of tools for risk assessment, classification methods and new therapeutic approaches.
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Alanko K, Salo B, Mokros A, Santtila P. Evidence for Heritability of Adult Men's Sexual Interest in Youth under Age 16 from a Population‐Based Extended Twin Design. J Sex Med 2013; 10:1090-9. [DOI: 10.1111/jsm.12067] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Habermeyer B, Esposito F, Händel N, Lemoine P, Klarhöfer M, Mager R, Dittmann V, Seifritz E, Graf M. Immediate processing of erotic stimuli in paedophilia and controls: a case control study. BMC Psychiatry 2013; 13:88. [PMID: 23510246 PMCID: PMC3610191 DOI: 10.1186/1471-244x-13-88] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 03/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most neuroimaging studies investigating sexual arousal in paedophilia used erotic pictures together with a blocked fMRI design and long stimulus presentation time. While this approach allows the detection of sexual arousal, it does not enable the assessment of the immediate processing of erotically salient stimuli. Our study aimed to identify neuronal networks related to the immediate processing of erotic stimuli in heterosexual male paedophiles and healthy age-matched controls. METHODS We presented erotic pictures of prepubescent children and adults in an event related fMRI-design to eight paedophilic subjects and age-matched controls. RESULTS Erotic pictures of females elicited more activation in the right temporal lobe, the right parietal lobe and both occipital lobes and erotic pictures of children activated the right dorsomedial prefrontal cortex in both groups. An interaction of sex, age and group was present in the right anteriolateral oribitofrontal cortex. CONCLUSIONS Our event related study design confirmed that erotic pictures activate some of the brain regions already known to be involved in the processing of erotic pictures when these are presented in blocks. In addition, it revealed that erotic pictures of prepubescent children activate brain regions critical for choosing response strategies in both groups, and that erotically salient stimuli selectively activate a brain region in paedophilic subjects that had previously been attributed to reward and punishment, and that had been shown to be implicated in the suppression of erotic response and deception.
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Affiliation(s)
- Benedikt Habermeyer
- Department of General and Social Psychiatry, Psychiatric University Hospital, Zürich, Switzerland.
| | - Fabrizio Esposito
- Department of Medicine and Surgery, University of Salerno, Baronissi, (SA), Italy
| | - Nadja Händel
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
| | - Patrick Lemoine
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
| | - Markus Klarhöfer
- Department of Medical Radiology, MR-Physics, University of Basel, Basel, Switzerland
| | - Ralph Mager
- Department of General and Social Psychiatry, Psychiatric University Hospital, Zürich, Switzerland
| | - Volker Dittmann
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
| | - Erich Seifritz
- Clinic for Affective Disorders and General Psychiatry, Psychiatric University Hospital, Zurich, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
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Vijayaraghavan L, Adolphs R, Kennedy DP, Cassell M, Tranel D, Paradiso S. A selective role for right insula--basal ganglia circuits in appetitive stimulus processing. Soc Cogn Affect Neurosci 2012; 8:813-9. [PMID: 22798397 DOI: 10.1093/scan/nss077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hemispheric lateralization of hedonic evaluation ('liking') and incentive motivation ('wanting') in neural networks connecting the basal ganglia and insula (BG-I) in humans was examined. Participants with brain damage restricted to the BG-I of the right (n = 5) or left (n = 5) hemisphere, and 26 healthy participants matched on age, sex and intelligence quotient were tested on positively and negatively valenced pictures drawn from varied stimulus categories (Vijayaraghavan et al., 2008). Liking was assessed with explicit ratings of pleasantness using a nine-point Likert scale. Wanting was quantified as the amount of work (via repeated keypresses) that participants expended to increase (approach) or decrease (withdraw) viewing time. Right-lesion patients showed abnormally low viewing times and liking ratings for positive images. For a subset of positive images depicting sexual content, right-lesion patients exhibited active withdrawal, while the other two groups approached such stimuli. These results suggest that the right basal ganglia-insula complex plays a greater role than the left in supporting hedonic evaluation and motivational approach to positively valenced stimuli. The finding that active avoidance of stimuli that were not 'liked' was spared in both right- and left-sided lesion subjects suggests that unilateral damage to insula/basal ganglia circuits may not be sufficient to affect general incentive motivation independent of preference.
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Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M. Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms. J Psychoactive Drugs 2012; 44:38-55. [PMID: 22641964 DOI: 10.1080/02791072.2012.662112] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The nucleus accumbens, a site within the ventral striatum, plays a prominent role in mediating the reinforcing effects of drugs of abuse, food, sex, and other addictions. Indeed, it is generally believed that this structure mandates motivated behaviors such as eating, drinking, and sexual activity, which are elicited by natural rewards and other strong incentive stimuli. This article focuses on sex addiction, but we hypothesize that there is a common underlying mechanism of action for the powerful effects that all addictions have on human motivation. That is, biological drives may have common molecular genetic antecedents, which if impaired, lead to aberrant behaviors. Based on abundant scientific support, we further hypothesize that dopaminergic genes, and possibly other candidate neurotransmitter-related gene polymorphisms, affect both hedonic and anhedonic behavioral outcomes. Genotyping studies already have linked gene polymorphic associations with alcohol and drug addictions and obesity, and we anticipate that future genotyping studies of sex addicts will provide evidence for polymorphic associations with specific clustering of sexual typologies based on clinical instrument assessments. We recommend that scientists and clinicians embark on research coupling the use of neuroimaging tools with dopaminergic agonistic agents to target specific gene polymorphisms systematically for normalizing hyper- or hypo-sexual behaviors.
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Affiliation(s)
- Kenneth Blum
- Department of Psychiatry, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL 32610-0256, USA.
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Georgiadis JR, Kringelbach ML. The human sexual response cycle: brain imaging evidence linking sex to other pleasures. Prog Neurobiol 2012; 98:49-81. [PMID: 22609047 DOI: 10.1016/j.pneurobio.2012.05.004] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/21/2012] [Accepted: 05/08/2012] [Indexed: 12/30/2022]
Abstract
Sexual behavior is critical to species survival, yet comparatively little is known about the neural mechanisms in the human brain. Here we systematically review the existing human brain imaging literature on sexual behavior and show that the functional neuroanatomy of sexual behavior is comparable to that involved in processing other rewarding stimuli. Sexual behavior clearly follows the established principles and phases for wanting, liking and satiety involved in the pleasure cycle of other rewards. The studies have uncovered the brain networks involved in sexual wanting or motivation/anticipation, as well as sexual liking or arousal/consummation, while there is very little data on sexual satiety or post-orgasmic refractory period. Human sexual behavior also interacts with other pleasures, most notably social interaction and high arousal states. We discuss the changes in the underlying brain networks supporting sexual behavior in the context of the pleasure cycle, the changes to this cycle over the individual's life-time and the interactions between them. Overall, it is clear from the data that the functional neuroanatomy of sex is very similar to that of other pleasures and that it is unlikely that there is anything special about the brain mechanisms and networks underlying sex.
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Affiliation(s)
- J R Georgiadis
- Department of Neuroscience/Section Anatomy, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
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Urbaniok F, Laubacher A, Hardegger J, Rossegger A, Endrass J, Moskvitin K. Neurobiological determinism: human freedom of choice and criminal responsibility. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2012; 56:174-190. [PMID: 21362643 DOI: 10.1177/0306624x10395474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Several authors have argued that criminal behavior is generally caused by neurobiological deficits. This assumption not only questions the concept of free will and a person's responsibility for his or her own actions but also the principle of guilt in criminal law. When critically examining the current state of research, it becomes apparent that the results are not sufficient to support the existence of a universally valid neurobiological causality of criminal behavior. Moreover, the assumption of total neurobiological determination of human behavior and the impossibility of individual responsibility are characterized by both faulty empiricism and methodical misconceptions. The principle of relative determinism and the analysis of the offender's behavior at the time of the offense thus remain the central and cogent approach to the assessment of criminal responsibility.
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Affiliation(s)
- Frank Urbaniok
- Psychiatric/Psychological Service, Department of Justice, Zurich, Switzerland
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Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: a review and meta-analysis. Neurosci Biobehav Rev 2012; 36:1481-509. [PMID: 22465619 DOI: 10.1016/j.neubiorev.2012.03.006] [Citation(s) in RCA: 231] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 03/03/2012] [Accepted: 03/14/2012] [Indexed: 11/23/2022]
Abstract
In the last fifteen years, functional neuroimaging techniques have been used to investigate the neuroanatomical correlates of sexual arousal in healthy human subjects. In most studies, subjects have been requested to watch visual sexual stimuli and control stimuli. Our review and meta-analysis found that in heterosexual men, sites of cortical activation consistently reported across studies are the lateral occipitotemporal, inferotemporal, parietal, orbitofrontal, medial prefrontal, insular, anterior cingulate, and frontal premotor cortices as well as, for subcortical regions, the amygdalas, claustrum, hypothalamus, caudate nucleus, thalami, cerebellum, and substantia nigra. Heterosexual and gay men show a similar pattern of activation. Visual sexual stimuli activate the amygdalas and thalami more in men than in women. Ejaculation is associated with decreased activation throughout the prefrontal cortex. We present a neurophenomenological model to understand how these multiple regional brain responses could account for the varied facets of the subjective experience of sexual arousal. Further research should shift from passive to active paradigms, focus on functional connectivity and use subliminal presentation of stimuli.
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Moulier V, Fonteille V, Pélégrini-Issac M, Cordier B, Baron-Laforêt S, Boriasse E, Durand E, Stoléru S. A pilot study of the effects of gonadotropin-releasing hormone agonist therapy on brain activation pattern in a man with pedophilia. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2012; 56:50-60. [PMID: 21518701 DOI: 10.1177/0306624x10392191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Gonadotropin-releasing hormone (GnRH) agonists, such as leuprorelin, are recommended in the patients with pedophilia at highest risk of offending. However, the cerebral mechanisms of the effects of these testosterone-decreasing drugs are poorly known. This study aimed to identify changes caused by leuprorelin in a pedophilic patient's brain responses to pictures representing children. Clinical, endocrine, and fMRI investigations were done of a man with pedophilia before leuprorelin therapy and 5 months into leuprorelin therapy. Patient was compared with an age-matched healthy control also assessed 5 months apart. Before therapy, pictures of boys elicited activation in the left calcarine fissure, left insula, anterior cingulate cortex, and left cerebellar vermis. Five months into therapy, all the above-mentioned activations had disappeared. No such activations and, consequently, no such decreases occurred in the healthy control. The results of this pilot study suggest that leuprorelin decreased activity in regions known to mediate the perceptual, motivational, and affective responses to visual sexual stimuli.
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Weston C. Another major function of the anterior cingulate cortex: The representation of requirements. Neurosci Biobehav Rev 2012; 36:90-110. [DOI: 10.1016/j.neubiorev.2011.04.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/01/2011] [Accepted: 04/20/2011] [Indexed: 01/18/2023]
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