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Jansen JM, Franse ME. Executive functioning in antisocial behavior: A multi-level systematic meta-analysis. Clin Psychol Rev 2024; 109:102408. [PMID: 38430781 DOI: 10.1016/j.cpr.2024.102408] [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] [Received: 05/23/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Neurobiological information - including executive functioning - is increasingly relevant for forensic clinical practice, as well as for the criminal justice system. Previous meta-analyses report that antisocial populations show impaired performance on executive functioning tasks, but these meta-analyses are outdated, have limitations in their methodological approach, and are therefore in need of an update. The current multi-level meta-analysis including 133 studies (2008-2023) confirms impaired performance in executive functioning (d=.42), but studies are heterogeneous. Several moderator analyses showed that neuropsychological test used, type of executive function component, and control group characteristics moderated the overall effect. Specifically, matching psychiatric problems in the non-antisocial control group eliminated any differences in executive functioning between groups. No moderation effects were found for assessment quality, hot or cold executive functions, and various population characteristics. These results could indicate that the assessment of executive functioning in antisocial populations may be less relevant for recidivism risk assessment than thought, although this should first be assessed in prospective longitudinal studies. Executive functioning could potentially be used to identify or screen for individuals with certain treatment needs or be used as a responsivity factor, especially in disorders which are often underdiagnosed in criminal justice settings.
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Affiliation(s)
- Jochem Milan Jansen
- Institute for Criminal Law & Criminology, Faculty of Law, Leiden University, Leiden, Netherlands; Inforsa, Arkin, Amsterdam, The Netherlands.
| | - Melanie Elisabeth Franse
- Netherlands Institute of Forensic Psychiatry and Psychology, Department of Science and Education, Herman Gorterstraat 5, 3511EW Utrecht, Netherlands; Institute of Education and Child Studies, Faculty of Social Sciences, Leiden University, Wassenaarseweg 52, 2333AK Leiden, Netherlands
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2
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Letkiewicz AM, Li LY, Hoffman LMK, Lieberman L, Hsu KJ, Shankman SA. Cognitive inflexibility and heightened error monitoring are related to lower sexual functioning. Int J Psychophysiol 2024; 196:112281. [PMID: 38104774 PMCID: PMC10843768 DOI: 10.1016/j.ijpsycho.2023.112281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Sexual functioning is an important predictor of well-being and relationship satisfaction. Previous research indicates that several aspects of cognitive function are related to sex-related behaviors and functioning among individuals with sex-related disorders, neurological disorders, and in older adults; however, this has been relatively underexamined in younger populations. To examine this, the present study assessed whether behavioral and/or neurophysiological measures of cognitive function are associated with sexual functioning in a community sample of young 489 adults (64 % female) ages 18-30. Cognitive flexibility (n = 460) and inhibition (n = 466) were measured using neuropsychological assessment (D-KEFS), and conflict monitoring and error monitoring were measured by event-related potentials (conflict N2: n = 394; error-related negativity: n = 389). After separately testing relations between the different measures of cognitive function and sexual functioning, we assessed whether results (1) remained after covarying for externalizing and internalizing dimensions (PID-5; n = 489) or (2) varied by gender. Finally, we tested whether any aspects of cognitive function were unique predictors of sexual functioning. Cognitive flexibility and error monitoring (i.e., error-related negativity) were both significantly related to sexual functioning among males and females, such that poorer cognitive flexibility and heightened error monitoring were related to lower sexual functioning. No significant effects emerged for inhibition or conflict monitoring. In a multiple regression model, cognitive flexibility and error monitoring each accounted for a unique portion of variance in sexual functioning beyond other aspects of cognitive function and psychopathology-related traits. Results suggest that cognitive function is a meaningful correlate of sexual functioning in young adulthood, which should be considered further in future research.
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Affiliation(s)
- Allison M Letkiewicz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
| | - Lilian Y Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Lija M K Hoffman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Lynne Lieberman
- Northwell Health, Center for Traumatic Stress, Resilience, and Recovery, Glen Oaks, NY, USA
| | - Kevin J Hsu
- Department of Psychological and Social Sciences, Pennsylvania State University, Abington, PA, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
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3
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Picard EH, Bopp LL, Rosenfeld B. Neuropsychological Functioning in Sexual Offenders With and Without Pedophilic Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:43-56. [PMID: 37749338 DOI: 10.1007/s10508-023-02689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023]
Abstract
This study sought to examine neuropsychological functioning in men with pedophilic disorder (PD), in order to assess whether findings from prior neuropsychological studies are replicated in a diverse sample including men with non-contact sexual offenses. It was hypothesized that when non-contact offenders are included in the study, a slowed processing speed will emerge as the only finding unique to men with PD. A comprehensive neuropsychological battery was administered to 58 men convicted of a sexual offense, 20 of whom were classified as having PD. The sample included men with contact sexual offenses (n = 33), non-contact sexual offenses (n = 5), and child sexual abuse material (CSAM) offenses (n = 20). Test performance was compared by PD status. Participants with PD performed significantly better on verbal memory and visual discrimination than those without PD. Men with PD made more errors on a set-shifting task but no significant differences were seen in domains of attention, intellectual functioning, visual learning and memory, visuospatial ability, or language ability. Effect sizes were generally small, although some medium effects were seen (visual discrimination and verbal learning and memory). Scores in both groups (with and without PD) were generally in the average range across tasks. Within the subgroup of CSAM offenders, minimal differences emerged between those with and without PD, although those with PD were slower on visuomotor set-shifting but made fewer errors (d = - 0.89). CSAM offenders with PD were in the high average range on many tasks of intellectual functioning; however, a potential trend was identified such that CSAM offenders without PD had lower scores on a task of verbal learning and memory, with medium effect sizes observed. As few differences in neuropsychological functioning emerged when comparing offenders with and without PD, differences demonstrated in prior research may be better attributed to contact offending status rather than sexual interest.
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Affiliation(s)
- Emilie H Picard
- Department of Psychiatry, University of Virginia Medical Center, West Complex, Rm. 4472, 1300 Jefferson Park Ave., Charlottesville, VA, 22903, USA.
| | - Lillian L Bopp
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, New York, NY, USA
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Storch M, Kanthack M, Amelung T, Beier KM, Krueger THC, Sinke C, Walter H, Walter M, Schiffer B, Schindler S, Schoenknecht P. Hypothalamic volume in pedophilia with or without child sexual offense. Eur Arch Psychiatry Clin Neurosci 2023; 273:1295-1306. [PMID: 36370175 PMCID: PMC10449687 DOI: 10.1007/s00406-022-01501-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
The hypothalamus regulates sexual behavior and is simultaneously associated with aggression and violence. Consequently, this brain region is relevant in research of pedophilia and child sexual offenses (CSO). The distinction between these two phenomena is of great importance and was the object of consideration of this study. We analyzed exclusively men, including 73 pedophilic offenders who committed CSO, an equal number of people with pedophilia but without such offenses, and 133 non-pedophilic, non-offending subjects who formed the control group. All data were collected in a multicenter in vivo study and analyzed using a semi-automated segmentation algorithm for 3-Tesla magnetic resonance images. Men with pedophilia who committed CSO on average had a 47 mm3 smaller hypothalamus per side than people without committed CSO. This effect was driven by both the group of non-offending people with pedophilia and the control group. By contrast, the exploratory comparison of pedophilic persons without CSO with the control group showed no significant difference. The present study demonstrates a deviant hypothalamic structure as a neurobiological correlate of CSO in pedophiles, but not in people with pedophilia who have not committed CSO. Thus, it strengthens the argument to distinguish between sexual offending and paraphilic sexual preferences.
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Affiliation(s)
- Melanie Storch
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany.
- Department of Biology, University of Leipzig, 04103, Leipzig, Germany.
| | - Maria Kanthack
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstr. 10, 04103, Leipzig, 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, 10117, Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 10117, 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, 10117, Berlin, Germany
| | - Tillmann H C Krueger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hanover, Germany
- Center for Systems Neuroscience Hannover, Hanover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hanover, 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, 10117, Berlin, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-Von Guericke-University Magdeburg, 39106, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Jena, 07743, Jena, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791, Bochum, Germany
| | - Stephanie Schindler
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstr. 10, 04103, Leipzig, Germany
| | - Peter Schoenknecht
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Hospital Leipzig, 04103, Leipzig, Germany
- Out-Patient Department for Sexual-Therapeutic Prevention and Forensic Psychiatry, University Hospital Leipzig, 04103, Leipzig, Germany
- Academic Saxon State Hospital Arnsdorf, 01477, Arnsdorf, Germany
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Ristow I, Kärgel C. The Role of Atypical Sexual Preference and Behavior in Neuroelectrophysiological Research of Human Sexual Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:607-610. [PMID: 33575945 PMCID: PMC9886628 DOI: 10.1007/s10508-021-01927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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Szczypiński J, Wypych M, Krasowska A, Wiśniewski P, Kopera M, Suszek H, Marchewka A, Jakubczyk A, Wojnar M. Abnormal behavioral and neural responses in the right dorsolateral prefrontal cortex during emotional interference for cognitive control in pedophilic sex offenders. J Psychiatr Res 2022; 151:131-135. [PMID: 35477077 DOI: 10.1016/j.jpsychires.2022.04.012] [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: 12/17/2021] [Revised: 03/17/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Studies within the last decade have reported neural and behavioral differences in cognitive control between men with the pedophilic disorder who commit (CSO+) and do not commit (CSO-) child sexual abuse. Prior studies reported a higher number of errors in Go/Nogo task and lower activity of the prefrontal cortex in NoGo trials, in CSO+ compared with CSO-. Moreover, negative mood was reported as a risk factor for child sexual abuse in pedophilic men. We aimed to examine differences in brain function and behavior between CSO+ and CSO- patients regarding emotional interference on cognitive processes and inhibition. We recruited CSO+ (n = 11) and CSO- (n = 14) patients as well as matched healthy controls (HC) (n = 17). Participants performed the affective Go/NoGo task in a block-design functional magnetic resonance imaging experiment. The task comprised the following four conditions: Negative Go, including only Go stimuli and negatively valenced pictures; Negative NoGo, including 50% of Go and 50% of NoGo trials as well as negatively valenced pictures; and two corresponding conditions with neutral pictures. Brain analysis was restricted to the dorsolateral prefrontal (DLPFC), orbitofrontal, and anterior cingulate cortices. The HC and CSO- groups, but not the CSO+ group, showed significantly slower reactions in negative blocks compared with neutral blocks. Brain analysis revealed increased activation in the right DLPFC during emotional interference contrast (Negative > Neutral) in the HC and CSO- groups; however, there was decreased activation in the CSO+ group. In the CSO+ group, negative distractors did not increase cognitive control processes, which was observed in the CSO- and HC groups at the behavioral and neural levels. These results support previous reports indicating offender status is associated with cognitive and emotional impairments.
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Affiliation(s)
- Jan Szczypiński
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland; Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Pasteur 3, 02-093, Warsaw, Poland.
| | - Marek Wypych
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Pasteur 3, 02-093, Warsaw, Poland
| | - Aleksandra Krasowska
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland
| | - Paweł Wiśniewski
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland
| | - Hubert Suszek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Artur Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Pasteur 3, 02-093, Warsaw, Poland
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland; Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
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7
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Weidacker K, Kärgel C, Massau C, Krueger THC, Walter M, Ponseti J, Walter H, Schiffer B. Interference inhibition in offending and non-offending pedophiles: A preliminary event-related fMRI study. Neuropsychologia 2022; 173:108301. [PMID: 35697089 DOI: 10.1016/j.neuropsychologia.2022.108301] [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: 11/05/2021] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
The ability to inhibit behavior is thought to be an import skill for avoiding criminal conduct, especially when combined with personal predispositions or criminogenic needs such as a pedophilic preference disorder. While previous research emphasized the relationship between impulsivity and child sexual offending, not pedophilia per se, studies on the underlying neurobiological mechanisms in subdomains of impulsivity remained scarce. Here, we focused on interference inhibition and examined event-related functional magnetic resonance imaging (fMRI) data of three groups of men performing a color-word Stroop task: (1) pedophiles with a history of CSO (P+CSO, n = 11), (2) pedophiles without a history of CSO (P-CSO, n = 8) and (3) non-pedophilic, non-offending healthy controls (HC, n = 10). On the behavioral level, P+CSO revealed increased Stroop interference as compared to P-CSO and HC. Moreover, increased Stroop interference in P+CSO was accompanied by enhanced conflict-related activity in left superior parietal cortex and precentral gyrus as compared to P-CSO. Albeit behavioral analyses of error and post-error processing revealed no significant between-group differences, P-CSO showed increased post-error-related activity in left posterior cingulate, precuneus and middle temporal gyrus as compared to P+CSO. Our preliminary data highlight inhibition deficits in offending as compared to non-offending pedophiles or healthy men and suggest that functional alterations in attention reallocation and impulse suppression/control may moderate the risk for committing CSO in men suffering from pedophilia.
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Affiliation(s)
- K Weidacker
- School of Psychology, University of Swansea, Swansea, Wales, United Kingdom; Division of Forensic Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3; 44791 Bochum, Germany
| | - C Kärgel
- Division of Forensic Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3; 44791 Bochum, Germany
| | - C Massau
- Division of Forensic Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3; 44791 Bochum, Germany
| | - T H C Krueger
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - M Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - J Ponseti
- Institute of Sexual and Forensic Medicine, University Hospital Kiel, Germany
| | - H Walter
- Division of Mind and Brain, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
| | - B Schiffer
- Division of Forensic Psychiatry and Psychotherapy, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3; 44791 Bochum, Germany.
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8
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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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Jahnke S, Schmidt AF, Klöckner A, Hoyer J. Neurodevelopmental Differences, Pedohebephilia, and Sexual Offending: Findings from Two Online Surveys. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:849-866. [PMID: 34993718 PMCID: PMC8888371 DOI: 10.1007/s10508-021-02228-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
The neurodevelopmental theory of pedohebephilia states that sexual interests in children arise from early neurodevelopmental perturbations, as, for example, evidenced by increased non-right-handedness, more childhood head injuries, and reduced intelligence and height. As corroborating evidence largely rests on samples of convicted men, we conducted online surveys among German-speaking (Study 1, N = 199) and English-speaking men (Study 2, N = 632), specifically targeting community members with pedohebephilic or teleiophilic interests. Although we detected theoretically meaningful sexual interest patterns in an embedded viewing time task, we could not detect expected neurodevelopmental differences between teleiophilic and pedohebephilic men in either of the two studies. Strikingly, pedohebephilic men who reported convictions for sexual offenses emerged as shorter and less intelligent than pedohebephilic men without convictions in Study 2. While elucidating possible third variable confounds, results have to be interpreted cautiously because of the methodological problems inherent to non-matched case control designs.
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Affiliation(s)
- Sara Jahnke
- Department of Health Promotion and Development, University of Bergen, 5020, Bergen, Norway.
| | - Alexander F Schmidt
- Department of Psychology, Social & Legal Psychology, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Andrea Klöckner
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Hoyer
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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10
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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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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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Wittström F, Långström N, Landgren V, Rahm C. Risk Factors for Sexual Offending in Self-Referred Men With Pedophilic Disorder: A Swedish Case-Control Study. Front Psychol 2020; 11:571775. [PMID: 33324285 PMCID: PMC7726190 DOI: 10.3389/fpsyg.2020.571775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background The risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown. Methods We recruited a consecutive sample of 55 help-seeking, non-correctional adult men diagnosed with DSM-5 PD at a university-affiliated sexual medicine outpatient unit in Sweden. PD participants were compared with 57 age-matched, non-clinical control men on four literature-based dynamic risk domains and self-rated child sexual abuse risk. Results PD participants scored higher than controls on all tested domains (0-3 points); expectedly so for pedophilic attraction (2.5 vs. 0.0, Cohen's d = 2.40, 95% confidence interval (CI): [1.91-2.89]), but also for sexual preoccupation (1.6 vs. 1.0, d = 1.11, 95% CI: [0.71-1.51]), impaired self-regulation (1.4 vs. 1.0, d = 0.44, 95% CI: [0.06 to 0.81]), impaired cognitive empathy and antisocial traits (0.9 vs. 0.1, d = 1.18, 95% CI: [0.78-1.59]), and self-rated child sexual abuse risk (1.0 vs. 0.0, d = 1.56, 95% CI: [1.13-1.98]). When summarizing all five domains into a pre-specified composite score (0-15 points), PD subjects scored substantially higher than matched control men (7.5 vs. 2.1, d = 2.12, 95% CI: [1.65-2.59]). Five (9%) PD participants self-reported any previous conviction for a contact child sexual offense and eight (15%) for possession of child sexual abuse material or non-contact sexual offending (adult or child victim). Eighteen subjects (34%) acknowledged past week, child-related sexual behaviors. Conclusion Self-referred, help-seeking men with PD scored higher (small to very large effect sizes) than non-clinical control men on psychiatric measures of dynamic risk of child sexual abuse suggested in prior research with correctional samples diagnosed with PD. Our findings, including the composite risk measure, might inform clinical practice, but needs validation against actual sexual offending behavior.
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Affiliation(s)
- Felix Wittström
- Center for Sexual Medicine (ANOVA), Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Långström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Valdemar Landgren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Stockholm, Sweden
| | - Christoffer Rahm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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13
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Dillien T, Goethals K, Sabbe B, Brazil IA. Impairment of Both Reward and Punishment Learning in Males Who Have Sexually Offended Against a Child. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:931-957. [PMID: 31462171 DOI: 10.1177/1079063219871579] [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: 06/10/2023]
Abstract
Prior studies suggest that persons with a sexual offense against a child (PSOCs) present with an impairment in learning from reinforcement, which may contribute to the behavioral dysregulation often seen in PSOCs. Therefore, gaining more insight into the nature of this impairment seems essential to better understand child sexual (re)offending. Using a passive avoidance task, we found that PSOCs (n = 57) have difficulties with selecting behaviors that are associated with reward and suppressing behaviors that are associated with punishment relative to nonoffending men (n = 33), but not compared with persons with a nonsexual offense history (n = 31). The latter ability was particularly compromised in nonpedophilic PSOCs. By unraveling a source of pathology in the mechanisms that are involved in behavioral control, this study helps setting a step toward new, more tailored, therapeutic approaches.
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Affiliation(s)
- Tineke Dillien
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijk, Belgium
- University Forensic Centre, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijk, Belgium
- University Forensic Centre, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijk, Belgium
| | - Inti A Brazil
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijk, Belgium
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands
- Centre for Advances in Behavioural Science, Coventry University, UK
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14
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Pezzoli P, Ziogas A, Seto MC, Jaworska N, Mokros A, Fedoroff P, Santtila P. The Effects of Acute Transcranial Direct Current Stimulation on Attentional Bias in Pedophilic Disorder: A Preregistered Pilot Study. Neuromodulation 2020; 24:879-889. [PMID: 33006171 DOI: 10.1111/ner.13285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Individuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic attention bias for child-related stimuli as well as reduced activity in the dorsolateral prefrontal cortex (dlPFC), a brain area involved in cognitive control, including control over sexual arousal. In this preregistered pilot study, we are the first to investigate whether acutely increasing prefrontal activity could reduce the putative pedophilic attention bias. MATERIALS AND METHODS We delivered a single 20-min session of active anodal versus sham transcranial direct current stimulation (tDCS) over the left dlPFC to 16 SOC with PD and 16 matched healthy controls, while they performed a task requiring controlled attention to computer-generated images of clothed and nude children and adults. We collected responses unobtrusively by recording eye movements. RESULTS Our results did not support the presence of the expected automatic attention bias across outcome measures. Nonetheless, we found a response facilitation with child targets in patients and, unexpectedly, in controls, likely due to unwanted salience effects. Active versus sham tDCS reduced this bias across groups, as indicated by a significant group*condition interaction (p = 0.04). However, no attentional bias and no tDCS effects on attentional responses to child and adult images emerged following tDCS. CONCLUSIONS These results suggest enhanced cognitive control in response to salient stimuli during active tDCS. Thus, to assist future studies on neuromodulation in PD, we provide suggestions for design improvement.
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Affiliation(s)
- Patrizia Pezzoli
- Institute of Mental Health Research, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Natalia Jaworska
- Institute of Mental Health Research, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Cellular & Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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15
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Münch R, Walter H, Müller S. Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder. Front Psychiatry 2020; 11:558655. [PMID: 33093836 PMCID: PMC7523554 DOI: 10.3389/fpsyt.2020.558655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.
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Affiliation(s)
- Ricarda Münch
- Research Division of Mind and Brain, 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
| | - Henrik Walter
- Research Division of Mind and Brain, 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
| | - Sabine Müller
- Research Division of Mind and Brain, 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
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16
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Gibbels C, Sinke C, Kneer J, Amelung T, Mohnke S, Beier KM, Walter H, Schiltz K, Gerwinn H, Pohl A, Ponseti J, Foedisch C, Ristow I, Walter M, Kaergel C, Massau C, Schiffer B, Kruger THC. Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders. J Clin Med 2019; 8:E947. [PMID: 31261903 PMCID: PMC6678781 DOI: 10.3390/jcm8070947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023] Open
Abstract
High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach.
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Affiliation(s)
- Charlotte Gibbels
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Jonas Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, 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, 10117 Berlin, Germany
| | - Sebastian Mohnke
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Klaus Michael 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, 10117 Berlin, 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, 10117 Berlin, Germany
| | - Kolja Schiltz
- Department of Forensic Psychiatry, Ludwig Maximilians University Munich, 80336 Munich, Germany
| | - Hannah Gerwinn
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Alexander Pohl
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Jorge Ponseti
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Carina Foedisch
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Inka Ristow
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
- Department of Psychiatry, University of Tübingen, 72076 Tübingen, Germany
| | - Christian Kaergel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Claudia Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany.
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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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Franke I, Seipel S, Vasic N, Streb J, Nigel S, Otte S, Dudeck M. Neuropsychological profile of pedophilic child sexual offenders compared with an IQ-matched non-offender sample - Results of a pilot study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:137-141. [PMID: 31122623 DOI: 10.1016/j.ijlp.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/19/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Child sexual offenders have been found to have a lower average IQ than the general population. Several studies indicate that they also exhibit executive dysfunction, but the specificity of this dysfunction is unclear; the inconclusive results have been attributed to methodological problems and the heterogeneity of the population. Our study aimed to describe the neuropsychological profiles of convicted child sexual offenders with pedophilia (n = 15). To control for IQ-related effects on neuropsychological performance, we compared the sample with an IQ-matched control group (n = 15). Test scores in both groups were significantly lower than the norms, but we did not find significant differences between the two study groups. The findings of our pilot study indicate that the neuropsychological deficits of pedophilic sexual offenders are unspecific rather than the result of a pedophilia-specific brain dysfunction.
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Affiliation(s)
- Irina Franke
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany.
| | - Solveig Seipel
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Nenad Vasic
- Clinical Centre Christophsbad, Department of Psychiatry and Psychotherapy, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Stefanie Nigel
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Stefanie Otte
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
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19
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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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20
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Kruger THC, Sinke C, Kneer J, Tenbergen G, Khan AQ, Burkert A, Müller-Engling L, Engler H, Gerwinn H, von Wurmb-Schwark N, Pohl A, Weiß S, Amelung T, Mohnke S, Massau C, Kärgel C, Walter M, Schiltz K, Beier KM, Ponseti J, Schiffer B, Walter H, Jahn K, Frieling H. Child sexual offenders show prenatal and epigenetic alterations of the androgen system. Transl Psychiatry 2019; 9:28. [PMID: 30659171 PMCID: PMC6338724 DOI: 10.1038/s41398-018-0326-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.
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Affiliation(s)
- Tillmann H. C. Kruger
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christopher Sinke
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jonas Kneer
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Gilian Tenbergen
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Abdul Qayyum Khan
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Burkert
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Linda Müller-Engling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Harald Engler
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hannah Gerwinn
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Nicole von Wurmb-Schwark
- Forensische Genetik und Rechtsmedizin, am Institut für Hämatopathologie Hamburg GmbH, Hamburg, Germany
| | - Alexander Pohl
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Simone Weiß
- 0000 0001 2187 5445grid.5718.bInstitute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Massau
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Christian Kärgel
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Walter
- 0000 0001 1018 4307grid.5807.aDepartment of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany ,0000 0001 2190 1447grid.10392.39Department of Psychiatry, University of Tübingen, Tübingen, Germany
| | - Kolja Schiltz
- 0000 0004 1936 973Xgrid.5252.0Department of Forensic Psychiatry, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus M. Beier
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorge Ponseti
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Boris Schiffer
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Jahn
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Joyal CC, Kärgel C, Kneer J, Amelung T, Mohnke S, Tenbergen G, Walter H, Kruger THC. The Neurobiological Origins of Pedophilia: Not That Simple. J Sex Med 2019; 16:153-154. [PMID: 30621922 DOI: 10.1016/j.jsxm.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Christian C Joyal
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada.
| | - Christian Kärgel
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Jonas Kneer
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Till Amelung
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Sebastian Mohnke
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Gilian Tenbergen
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Henrik Walter
- Université du Quebéc à Trois-Rivières, Trois-Rivières, Quebec, Canada
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22
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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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23
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Fitton L, Bates A, Hayes A, Fazel S. Psychiatric disorders, substance use, and executive functioning in older probationers. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:447-459. [PMID: 30406961 PMCID: PMC7012641 DOI: 10.1002/cbm.2094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/28/2018] [Accepted: 10/02/2018] [Indexed: 05/15/2023]
Abstract
Background Although the number of older people serving community sentences (probation) after conviction for a criminal offence in England and Wales has increased rapidly since about 2006, this population has received little research attention. Aim To examine the mental health, substance use, and executive functioning of older probationers. Methods Thirty‐two male probationers aged 50 years and older were recruited from probation services in the Thames Valley, England, and administered validated semistructured interviews for psychiatric disorders, symptom checklists for depression and substance use, cognitive impairment screens, and neuropsychological tests of executive functioning (examining verbal fluency and response inhibition). Results We found that older probationers presented with a high prevalence of mental health difficulties (overall caseness n = 22; 69%, 95% CI [53–85]) that exceed estimates in the older general population. Prevalences of depression (25%) or alcohol abuse or dependence (19%) were found to be high. In comparison with normative data, however, older probationers did not present with deficits in tested executive functioning. Conclusions and implications for practice Mental health and substance use problems were more prominent than cognitive deficits in this sample of older probationers. Further work should include older community controls to inform service planning and to determine how these mental health factors interact with offending.
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Affiliation(s)
- Lucy Fitton
- Oxford Institute of Clinical Psychology Training, University of Oxford, Warneford Hospital, Oxford, UK
| | | | - Adrian Hayes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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24
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Gerwinn H, Weiß S, Tenbergen G, Amelung T, Födisch C, Pohl A, Massau C, Kneer J, Mohnke S, Kärgel C, Wittfoth M, Jung S, Drumkova K, Schiltz K, Walter M, Beier KM, Walter H, Ponseti J, Schiffer B, Kruger THC. Clinical characteristics associated with paedophilia and child sex offending - Differentiating sexual preference from offence status. Eur Psychiatry 2018; 51:74-85. [PMID: 29625377 DOI: 10.1016/j.eurpsy.2018.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022] Open
Abstract
Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.
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Affiliation(s)
- Hannah Gerwinn
- Department of Neurology, Medical School, Kiel University, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Simone Weiß
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Gilian Tenbergen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Psychology, State University of New York at Oswego, 7060 State Route 104, 13126 Oswego, NY, USA
| | - 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, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Födisch
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Alexander Pohl
- Department of Neurology, Medical School, Kiel University, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Claudia Massau
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Jonas Kneer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Kärgel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Matthias Wittfoth
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Stefanie Jung
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Krassimira Drumkova
- State Hospital for Forensic Psychiatry Uchtspringe, Schnöggersburger Weg 1, 39576 Stendal, Germany
| | - Kolja Schiltz
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany; Department of Forensic Psychiatry, Psychiatric Hospital, LMU Munich, Nußbaumstr. 7, 80336 München, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany; Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Osianderstr. 24, 72076 Tübingen, 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, Charitéplatz 1, 10117 Berlin, 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, Charitéplatz 1, 10117 Berlin, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Boris Schiffer
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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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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26
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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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