Intelligence, Memory, and Handedness in Pedophilia

Neuropsychological Functioning in Sexual Offenders With and Without Pedophilic Disorder

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.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

Pedohebephilia and Perceived Non-coercive Childhood Sexual Experiences: Two Non-matched Case-Control Studies

Research on the link between childhood sexual abuse experiences (CSAE) and pedohebephilia is limited by its focus on events that the respondents rate as abusive. We asked 199 German-speaking (Study 1) and 632 English-speaking (Study 2) men with and without self-reported pedohebephilia to complete the Childhood Trauma Questionnaire (CTQ) and scales to assess perceived non-coercive childhood sexual experiences with adults (PNCSE-A), and peers (PNCSE-P, only Study 2). A substantial number of participants with PNCSE-A disagreed with all items of the CTQ Sexual Abuse subscale (e.g., 35% and 26% of pedohebephilic men in Studies 1 and 2, 38% of teleiophilic men in Study 2). While pedohebephilic men reported more CSAE than teleiophilic men, the effects for PNCSE-A did not consistently point in the expected direction. In Study 2, conviction status for sexual offenses among pedohebephilic men was linked to higher rates of CSAE, PNCSE-A, PNCSE-P, physical neglect, and physical abuse. Pedohebephilic men in Study 2 also reported more PNCSE-P than teleiophilic men. Our results highlight the importance of assessing different (positive or neutral) perceptions of CSAE. Better controlled designs (e.g., matched case-control studies) are needed to substantiate whether and how perceived non-coercive childhood sexual experiences relate to pedohebephilia and sexual offending.

Altered Neural and Behavioral Response to Sexually Implicit Stimuli During a Pictorial-Modified Stroop Task in Pedophilic Disorder

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.

Primary Health Professionals' Beliefs, Experiences, and Willingness to Treat Minor-Attracted Persons

There is a desire and need among minor-attracted persons (MAPs) to access support within the community, and this often begins with an approach to healthcare providers working in general medical/mental health settings. However, little is known about the experiences of these non-specialist professionals in relation to their beliefs, knowledge, and decision-making processes when working with patients who disclose sexual attractions to children. Using an online survey, this study explored the knowledge, comfort, competence, and treatment willingness of 220 non-specialist healthcare providers when faced with patients who disclose sexual attractions to children. We investigated how often such disclosures were made, clinician stigma, treatment priorities, and professionals' willingness to report MAPs to external agencies because of their sexual attractions. Some key differences were found when comparing primary medical vs. mental health professionals, including increased likelihood to view MAPs as dangerous, unable to control behaviors and that sexual attractions are an avoidable choice, in the former group. Both groups prioritized mental health treatment targets above controlling attractions and living with stigmatized attractions, although controlling or changing attractions were still relatively high priorities. Results indicated a need for further training, focusing on increasing comfort around working with MAPs, as this was associated with a greater willingness to work with this group. We identify current gaps in service provision for MAPs seeking professional support and discuss recommendations for professional training.

Neurodevelopmental Differences, Pedohebephilia, and Sexual Offending: Findings from Two Online Surveys

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.

Risk Factors for Sexual Offenses Committed by Men With or Without a Low IQ: An Exploratory Study

Although risk factors associated with offending and recidivism are relatively well-established for mainstream sexual offenses, much less is known about men with a low IQ who have sexually offended (MIQSO), let alone those with forensic involvement. In this exploratory study, 137 convicted for the commission of at least one sexual offense and found not criminally responsible because a mental disorder were recruited in a maximum-security hospital. They were all assessed with the SORAG (static risk factors) and the RSVP (dynamic risk factors). Compared with MIQSO (N = 76), men with an average or higher IQ who have sexually offended (MSO, N = 61) obtained significantly higher scores on static factors related with general delinquency (histories of alcohol abuse, non-violent criminality, violent criminality, and sexual offense) and dynamic factors related with sexual delinquency, paraphilia, and recidivism (chronicity, psychological coercion, escalation, sexual deviance, and substance abuse). In contrast, MIQSO obtained significantly higher scores on major mental illness, problems with planning and problems with self-awareness. Logistic regressions revealed that both the SORAG and RSVP were useful to predict group membership. It is concluded that risk factors related with general and sexual delinquency better describe offenses committed by MSO, whereas risk factors related with mental disorder, lack of insight and contextual impulsivity better describe offenses committed by MIQSO.

Meta-Analyses of Fraternal and Sororal Birth Order Effects in Homosexual Pedophiles, Hebephiles, and Teleiophiles

This study investigated the relations between numbers of older brothers, numbers of older sisters, and the odds of homosexuality in later-born males, including males who are most attracted sexually to prepubescent or early pubescent children (pedohebephiles) and males who are most attracted sexually to adults (teleiophiles). The authors meta-analyzed data from 24 samples of homosexual and heterosexual men, originally reported in 18 studies, and totaling 18,213 subjects. The results confirmed that older brothers increase the odds of same-sex preference in pedohebephiles as they do in teleiophiles. They also replicated the recent finding that older sisters have a similar but weaker statistical association with the odds of homosexuality. These findings have two theoretical implications. First, the findings for older brothers and older sisters indicate some commonality in the factors that influence sexual preference in teleiophiles and those that influence sexual preference in pedohebephiles. Second, the finding for older sisters confirms a prediction stemming from the hypothesis that male fetuses stimulate maternal antibodies that increase the odds of homosexuality in later-born males. Such immunization could result from miscarried as well as full-term fetuses, and number of older sisters should correlate with number of male fetuses miscarried before gestation of the subject.

MEG reveals preference specific increases of sexual-image-evoked responses in paedophilic sexual offenders and healthy controls

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.

Development and Preliminary Validation of the Pedophilic Fantasies, Desires, and Activities Questionnaire

Although sexual interest in children is a risk factor for recidivism of sexual offenses against children, there is a dearth of measures for assessing its current level in patients with pedophilic disorder. The objective was to develop the Pedophilic Fantasies, Desires, and Activities Questionnaire (PFDAQ) to assess the current level of sexual interest in patients with pedophilic disorder. In total, 57 patients with pedophilic disorder and 53 controls were recruited. In addition to the PFDAQ, participants were presented with other measures of sexual interest. PFDAQ scores were significantly higher in patients than in controls and were correlated with other measures of sexual interest. Three PFDAQ scores were correlated with a phallometric index of preference for children. These results suggest that the PFDAQ may be valid and potentially useful for assessing the current level of pedophilic attraction.

Timing of peripubertal steroid exposure predicts visuospatial cognition in men: Evidence from three samples

Experiments in male rodents demonstrate that sensitivity to the organizational effects of steroid hormones decreases across the pubertal window, with earlier androgen exposure leading to greater masculinization of the brain and behavior. Similarly, some research suggests the timing of peripubertal exposure to sex steroids influences aspects of human psychology, including visuospatial cognition. However, prior studies have been limited by small samples and/or imprecise measures of pubertal timing. We conducted 4 studies to clarify whether the timing of peripubertal hormone exposure predicts performance on male-typed tests of spatial cognition in adulthood. In Studies 1 (n = 1095) and 2 (n = 173), we investigated associations between recalled pubertal age and spatial cognition in typically developing men, controlling for current testosterone levels in Study 2. In Study 3 (n = 51), we examined the relationship between spatial performance and the age at which peripubertal hormone replacement therapy was initiated in a sample of men with Isolated GnRH Deficiency. Across Studies 1-3, effect size estimates for the relationship between spatial performance and pubertal timing ranged from. -0.04 and -0.27, and spatial performance was unrelated to salivary testosterone in Study 2. In Study 4, we conducted two meta-analyses of Studies 1-3 and four previously published studies. The first meta-analysis was conducted on correlations between spatial performance and measures of the absolute age of pubertal timing, and the second replaced those correlations with correlations between spatial performance and measures of relative pubertal timing where available. Point estimates for correlations between pubertal timing and spatial cognition were -0.15 and -0.12 (both p < 0.001) in the first and second meta-analyses, respectively. These associations were robust to the exclusion of any individual study. Our results suggest that, for some aspects of neural development, sensitivity to gonadal hormones declines across puberty, with earlier pubertal hormone exposure predicting greater sex-typicality in psychological phenotypes in adulthood. These results shed light on the processes of behavioral and brain organization and have implications for the treatment of IGD and other conditions wherein pubertal timing is pharmacologically manipulated.

EMDR Treatment of Childhood Sexual Abuse for a Child Molester: Self-Reported Changes in Sexual Arousal

Expanding on previous findings that eye movement desensitization and reprocessing (EMDR) therapy may alter deviant sexual arousal in adult child molesters with a history of childhood sexual abuse (CSA), this article describes the changes reported following the application of EMDR therapy to the memories of CSA in an adult male who had sexually offended against prepubescent children. The client had previously completed a cognitive behavioral intervention to address his offending behavior. EMDR therapy took place over 11 months and consisted of 32 sessions, including preparation and review phases. The aim of the therapy was to alleviate current reported distress and symptoms of posttraumatic stress disorder (PTSD) related to his memories of CSA. The client reported positive changes in emotional, cognitive, and physiological functioning, consistent with reductions on a range of subscales of the Trauma Symptom Inventory 2 and the Inventory of Altered Self-Capacities. However, on completion of therapy, he also reported a reduction in the frequency and strength of sexual arousal to children, which was maintained at a 3-year follow-up, although this was not a target for treatment. The experiences described during the EMDR process by this client are discussed and related to the adaptive information processing (AIP) model and previous findings on reported changes in sexual arousal in this client group.

Mixed Emotions: An Incentive Motivational Model of Sexual Deviance

Sexual offending behavior is a complex and multifaceted phenomenon. Most existing etiological models describe sexual offending behavior as a variant of offending behavior and mostly include factors referring to disinhibition and sexual deviance. In this article, we argue that there is additional value in describing sexual offending behavior as sexual behavior in terms of an incentive model of sexual motivation. The model describes sexual arousal as an emotion, triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. Consequently, we describe sexual offending behavior in terms of this new model with emphasis on the development of deviant sexual interests and preferences. Summarized, the model states that because sexual arousal itself is an emotion, there is a bidirectional relationship between sexual self-regulation and emotional self-regulation. Not only can sex be used to regulate emotional states (i.e., sexual coping), emotions can also be used, consciously or automatically, to regulate sexual arousal (i.e., sexual deviance). Preliminary support for the model is drawn from studies in the field of sex offender research as well as sexology and motivation research.

Brain responses to pictures of children in men with pedophilic disorder: a functional magnetic resonance imaging study

Structural and functional neuroimaging techniques have recently been used to investigate the mechanisms of sexual attraction to children, a hallmark of pedophilic disorder, and have reported many contradictory or non-replicated findings. Here, our purpose was to identify through functional magnetic resonance imaging the brain responses of 25 male outpatients with pedophilic disorder to visual stimuli depicting children (VSc) and to compare them with 24 male healthy controls matched on sexual orientation (to female or male adults), age, and handedness. No region was differentially activated across the two groups in response to VSc. However, as shown by a random-effects statistical analysis (cluster-level p_FWE-corrected < 0.05), in patients with pedophilia, but not in controls, the presentation of VSc induced a bilateral activation in the lateral occipital and temporal cortices, in particular in the right inferior temporal gyrus, as well as an activation in the declive of the cerebellar vermis. In addition, in patients the level of bilateral activation in the above-mentioned regions was positively correlated with ratings of perceived sexual arousal elicited by VSc. These results implicate these regions as possible candidate areas mediating sexual arousal in patients with pedophilic disorder.

Bioethical Issues and Secondary Prevention for Nonoffending Individuals with Pedophilia

Child sexual abuse is a global problem with significant emotional, psychological, and financial implications to victims, perpetrators, and society. Most child sexual abuse prevention programs target young children or those who have already engaged in abusive behavior, in order to prevent further offending. There are numerous secondary prevention programs targeting individuals at-risk of various health conditions in an effort to reduce the likelihood they will go on to experience a particular illness or disease. Considerable research exists regarding the risk factors for engaging in child sexual abuse and more specifically the factors contributing to reoffense. We argue that engaging in secondary prevention programs for people with pedophilia, in order to prevent child sexual abuse, is an ethically responsible and necessary practice. Secondary prevention programs with this focus are reviewed, along with the implications of mandatory reporting in doing this work.

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

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

"I Know Correlation Doesn't Prove Causation, but . . .": Are We Jumping to Unfounded Conclusions About the Causes of Sexual Offending?

Identifying causes of sexual offending is the foundation of effective and efficient assessment, intervention, and policy aimed at reducing sexual offending. However, studies vary in methodological rigor and the inferences they support, and there are differences of opinion about the conclusions that can be drawn from ambiguous evidence. To explore how researchers in this area interpret the available empirical evidence, we asked authors of articles published in relevant specialized journals to identify (a) an important factor that may lead to sexual offending, (b) a study providing evidence of a relationship between that factor and sexual offending, and (c) the inferences supported by that study. Many participants seemed to endorse causal interpretations and conclusions that went beyond the methodological rigor of the study they identified. Our findings suggest that some researchers may not be adequately considering methodological issues when making inferences about the causes of sexual offending. Although it is difficult to conduct research in this area and all research designs can provide valuable information, sensitivity to the limits methodology places on inferences is important for the sake of accuracy and integrity, and to stimulate more informative research. We propose that increasing attention to methodology in the research community through better training and standards will advance scientific knowledge about the causes of sexual offending, and improve the effectiveness and efficiency of practice and policy.

Are There Early Risk Markers for Pedophilia? A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders

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.

Brain processing of pictures of children in men with pedophilic disorder: A positron emission tomography study

Although structural and functional neuroimaging techniques have recently been used to investigate the mechanisms of sexual attraction to children, a hallmark of pedophilic disorder, the differences in the processing of child sexual stimuli between men attracted to children and those attracted to adults remain unclear. Here, our purpose was to identify through positron emission tomography the brain responses of 15 male outpatients with pedophilic disorder to validated visual sexual stimuli depicting children (VSSc) and to compare them with 15 male healthy controls matched for sexual orientation (to female or male adults), age, and handedness. The patients' sample comprised both offenders and non-offenders. In response to VSSc, the between-groups analysis showed that activation in the right inferior temporal cortex [Brodmann area (BA) 20] was lower in patients than in controls. Moreover, in patients but not in controls, the presentation of VSSc induced an activation in a more caudal region of the right inferior temporal gyrus (BA 37) and in the left middle occipital gyrus (BA 19). In addition, in patients the level of activation in the caudal right inferior temporal gyrus was positively correlated with ratings of sexual arousal elicited by VSSc, whereas this correlation was negative in BA 20. These results implicate the right inferior temporal gyrus as a possible candidate area mediating sexual arousal in patients with pedophilic disorder and suggest that two of its areas play opposite, i.e., activating and inhibitory, roles.

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Images of children activate the pedophilic patients' right Brodmann area (BA) 37.

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Images of children (IC) activate the pedophilic patients' left BA 19.

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Right BA37 activation correlates with pedophilic patients' rating of sexual arousal.

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IC induce lower right BA 20 activation in pedophilic patients than in controls.

Diagnostic Issues in the Paraphilias

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

The Hebephiliac: Pedophile or Teleiophiliac?

The current study aims to fill the gap on hebephile sex offenders by comparing them to a group of pedophile offenders as well as a group of teleiophile offenders. The focus of the study is to examine the victims' and offenders' characteristics, the crime characteristics, and the modus operandi used by a sample of 111 male sex assaults currently serving a sentence for sexual crimes in Korea. Looking at all the comparisons conducted, it seems that the hebephiliac is not more similar to the pedophile nor the teleiophiliac. He is in fact a mix of both. Aside from certain characteristics that make hebephiliacs different from the other two subtypes of sex offenders (e.g., sadism, travelling longer than 2 km to commit the crime, history of bipolar disorder), they mainly share characteristics of both groups. The current study uncovers very important differences that could prove useful for the management of these cases by the actors of the criminal justice system.

Multimodal neuroimaging measures and intelligence influence pedophile child sexual offense behavior

Pedophilia is a heterogeneous disorder for which the neurobiological correlates are not well established. In particular, there are no biological markers identifying individuals with high risk to commit child sexual offense (CSO). Pedophiles with CSO (P+CSO; N = 73), pedophiles without CSO (P-CSO; N = 77), and non-pedophilic controls (NPC; N = 133) were assessed using multimodal structural neuroimaging measures including: cortical thickness (CT), surface area (SA), and white matter fractional anisotropy (FA), as well as full scale IQ (FSIQ) performance. Cortex-wise mediation analyses were used to assess the relationships among brain structure, FSIQ and CSO behavior. Lower FSIQ performance was strongly predict with P+CSO (Wald Chi² = 13.0, p = 3.1 × 10^-5). P+CSO had lower CT in the right motor cortex and pronounced reductions in SA spanning the bilateral frontal, temporal, cingulate, and insular regions (P_{FWE-corrected} < 0.05). P+CSO also had lower FA particularly in the corpus callosum (P_{FWE-corrected} < 0.05). The relationship between SA and P+CSO was significantly mediated by FSIQ, particularly in the prefrontal and anterior insular cortices (P_{FWE-corrected} < 0.05). Within P+CSO, left prefrontal and right anterior cingulate SA negatively correlated with number of CSOs (P_{FWE-corrected} < 0.05). This study demonstrates converging neurobiological findings in which P+CSO had lower FSIQ performance, reduced CT, reduced SA, and reduced FA, compared to P-CSO as well as NPC. Further, FSIQ potentially mediates abuse by pedophiles via aberrant SA, whereas the CT and FA associations were independent of FSIQ differences. These findings suggest aberrant neuroanatomy and lower intelligence as a potential core feature underlying child sexual abuse behavior by pedophiles.

The Neuropsychological Function of Older First-Time Child Exploitation Material Offenders: A Pilot Study

Despite the growing incidence of child exploitation offences, there is little knowledge of the neuropsychological function of older child exploitation material offenders (CEMOs). Given that studies have reported that sex offenders demonstrate deficits attributed to frontal and temporal lobe function, the aim of this pilot study was to investigate the frontotemporal function of older first-time child exploitation material offenders (FTCEMOs). The neuropsychological performance of 11 older FTCEMOs was compared with 34 older historical sex offenders (HSOs) and 32 older nonsex offender (NSO) controls. Forty-five percent of FTCEMOs admitted to a pedophilic interest, which was significantly lower than those reported by HSOs. FTCEMOs provided significantly higher intellectual function scores than HSOs. Results revealed no evidence of mild or major neurocognitive disorder in FTCEMOs. Although the groups were not significantly different, compared with normative data, FTCEMOs reported a high incidence of impairment on a measure of decision making and on a measure of facial emotional recognition.

Clinical characteristics associated with paedophilia and child sex offending - Differentiating sexual preference from offence status

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.

Leg Length Versus Torso Length in Pedophilia: Further Evidence of Atypical Physical Development Early in Life

Adult men's height results from an interaction among positive and negative influences, including genetic predisposition, conditions in utero, and influences during early development such as nutritional quality, pathogen exposure, and socioeconomic status. Decreased height, reflected specifically as a decreased leg length, is strongly associated with increased risk of poorer health outcomes. Although prior research has repeatedly shown that pedophiles are shorter than nonpedophiles, the largest study to date relied on self-reported height. In the present study, pedophiles demonstrated reduced measured height and reduced leg length as compared with teleiophiles. Given the prenatal and early childhood origins of height, these findings contribute additional evidence to a biological, developmental origin of pedophilia. In addition, the magnitude of this height difference was substantially larger than that found in children exposed to a variety of early environmental stressors, but similar to that seen in other biologically based neurodevelopmental disorders.

Executive Functioning in Pedophilia and Child Sexual Offending

OBJECTIVES

Pedophilia (P) is a psychiatric disease associated with sexual attraction toward children and often accompanied by child sexual offending (CSO). Consequently, it is important to address the understanding of executive dysfunctions that may increase the probability of CSO. Moreover, this research field has been lacking to disentangle executive deficits associated with pedophilia (as a deviant sexual preference) from those associated with CSO (as a deviant sexual behavior).

METHODS

The German multi-sided research network NeMUP offers the opportunity to overcome these limitations. By applying the Cambridge Automated Neuropsychological Test Battery in four carefully matched groups of men: (1) pedophiles with (N=45) and (2) without (N=45) a history of sexual offending against children; (3) child molesters without pedophilia (N=19), and (4) non-offending controls (N=49), we were able to analyze executive functioning in pedophilia and CSO independently.

RESULTS

Both CSO groups as compared to both non-CSO groups exhibited worsened response inhibition ability. However, only non-pedophilic offenders showed additionally disabled strategy use ability. Regarding set-shifting abilities, the P+CSO group showed the best performance. We also found that performances were affected by age: only in pedophiles, response inhibition worsened with age, while age-related deficits in set-shifting abilities were restricted to non-pedophilic participants. The latter also differentiated between both sexual preference groups.

CONCLUSIONS

Our results are the first to demonstrate that executive dysfunctions are related to offense status rather than pedophilic preference. Furthermore, there was evidence for differentiating age and performance correlations between pedophiles and non-pedophiles, which warrants further investigation. (JINS, 2017, 23, 460-470).

Independent Component Analysis of Resting-State Functional Magnetic Resonance Imaging in Pedophiles

INTRODUCTION

Neuroimaging and other studies have changed the common view that pedophilia is a result of childhood sexual abuse and instead is a neurologic phenomenon with prenatal origins. Previous research has identified differences in the structural connectivity of the brain in pedophilia.

AIM

To identify analogous differences in functional connectivity.

METHODS

Functional magnetic resonance images were recorded from three groups of participants while they were at rest: pedophilic men with a history of sexual offenses against children (n = 37) and two control groups: non-pedophilic men who committed non-sexual offenses (n = 28) and non-pedophilic men with no criminal history (n = 39).

MAIN OUTCOME MEASURE

Functional magnetic resonance imaging data were subjected to independent component analysis to identify known functional networks of the brain, and groups were compared to identify differences in connectivity with those networks (or "components").

RESULTS

The pedophilic group demonstrated wide-ranging increases in functional connectivity with the default mode network compared with controls and regional differences (increases and decreases) with the frontoparietal network. Of these brain regions (total = 23), 20 have been identified by meta-analytic studies to respond to sexually relevant stimuli. Conversely, of the brain areas known to be those that respond to sexual stimuli, nearly all emerged in the present data as significantly different in pedophiles.

CONCLUSION

This study confirms the presence of significant differences in the functional connectivity of the brain in pedophilia consistent with previously reported differences in structural connectivity. The connectivity differences detected here and elsewhere are opposite in direction from those associated with anti-sociality, arguing against anti-sociality and for pedophilia as the source of the neuroanatomic differences detected.

The Puzzle of Male Chronophilias

In this article, I return to the idea that pedophilia, a sexual interest in prepubescent children, can be considered a sexual orientation for age, in conjunction with the much more widely acknowledged and discussed sexual orientation for gender. Here, I broaden the scope to consider other chronophilias, referring to paraphilias for age/maturity categories other than young sexually mature adults. The puzzle of chronophilias includes questions about etiology and course, how chronophilias are related to each other, and what they can tell us about how human (male) sexuality is organized. In this article, I briefly review research on nepiophilia (infant/toddlers), pedophilia (prepubescent children), hebephilia (pubescent children), ephebophilia (postpubescent, sexually maturing adolescents), teleiophilia (young sexually mature adults, typically 20s and 30s), mesophilia (middle-aged adults, typically 40s and 50s), and gerontophilia (elderly adults, typically 60s and older) in the context of a multidimensional sexual orientations framework. Relevant research, limitations, and testable hypotheses for future work are identified.

Cognitional Impairment: Is There a Role for Cognitive Assessment in the Treatment of Individuals Civilly Committed Pursuant to the Sexually Violent Predator Act?

Sexually Violent Predator statutes allow the involuntary treatment of individuals who are found to pose a threat to public safety. Most sex offender treatment programs rely on cognitive interventions to reduce the risk of recidivism. The purpose of this study was to examine (a) whether individuals with paraphilia diagnoses have cognitive deficits compared with the general population; (b) whether individuals diagnosed with pedophilia differed on cognitive performance when compared with individuals diagnosed with paraphilia not otherwise specified (NOS), nonconsent; and (c) whether individuals with paraphilia plus antisocial personality disorder (ASPD) differed in cognitive performance when compared with individuals with a paraphilia diagnosis only. The sample consisted of 170 males (M age = 50.21; SD = 10.22) diagnosed with pedophilia or paraphilia NOS, nonconsent, who were detained or civilly committed to a forensic psychiatric hospital. Assessments included Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Wechsler Abbreviated Scale of Intelligence (WASI), and Wide Range Achievement Test 4 (WRAT4). Individuals diagnosed with pedophilia and paraphilia NOS, nonconsent, obtained lower scores than matched controls based on the RBANS Immediate Memory, Visuospatial/Constructional, Delayed Memory indices and Total Score. In comparison with individuals with paraphilia NOS, nonconsent, those with pedophilia diagnosis had lower scores on the RBANS Delayed Memory. Individuals diagnosed with a paraphilia disorder combined with ASPD demonstrated trends toward lower IQ scores than those with a paraphilia diagnosis only. Treatment programs can improve their chance of success by assessment of cognitive processes, and offer therapy in a style that is consistent with the cognitive abilities of their clients.

Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample

Little research has been conducted to examine paraphilic sexual interests in nonclinical samples. The little that exists suggests that atypical sexual interests are more common in men than in women, but the reasons for this difference are unknown. In this study, we explored the prevalence of paraphilic interests in a nonclinical sample of men and women. We expected that men would report greater arousal (or less repulsion) toward various paraphilic acts than women. We also examined putative correlates of paraphilias in an attempt to explain the sex difference. In all, 305 men and 710 women completed an online survey assessing sexual experiences, sexual interests, as well as indicators of neurodevelopmental stress, sex drive, mating effort, impulsivity, masculinity/femininity, and socially desirable responding. As expected, significant sex differences were found, with men reporting significantly less repulsion (or more arousal) to the majority of paraphilic acts than women. Using mediation analysis, sex drive was the only correlate to significantly and fully mediate the sex difference in paraphilic interests. In other words, sex drive fully accounted for the sex difference in paraphilic interests. The implications of these findings for understanding the etiology of atypical sexual interests are discussed.

Being Sexually Attracted to Minors: Sexual Development, Coping With Forbidden Feelings, and Relieving Sexual Arousal in Self-Identified Pedophiles

This article aims to provide more insight into pedophilic attraction and risk and protective factors for offending in nonclinical pedophiles. Fifteen participants were interviewed about sexuality, coping, and sexual self-regulation. Many participants struggled with acknowledging pedophilic interest in early puberty and experienced psychological difficulties as a result. Furthermore, many committed sex offenses during adolescence when they were still discovering their feelings. Early recognition of risk factors and early start of interventions seem vital in preventing offending. Moreover, results suggest that risk for offending can be diminished by creating more openness about pedophilia and by providing pedophiles with social support and control.

Diffusion Tensor Imaging of Pedophilia

Pedophilia is a principal motivator of child molestation, incurring great emotional and financial burdens on victims and society. Even among pedophiles who never commit any offense,the condition requires lifelong suppression and control. Previous comparison using voxel-based morphometry (VBM)of MR images from a large sample of pedophiles and controls revealed group differences in white matter. The present study therefore sought to verify and characterize white matter involvement using diffusion tensor imaging (DTI), which better captures the microstructure of white matter than does VBM. Pedophilics ex offenders (n=24) were compared with healthy, age-matched controls with no criminal record and no indication of pedophilia (n=32). White matter microstructure was analyzed with Tract-Based Spatial Statistics, and the trajectories of implicated fiber bundles were identified by probabilistic tractography. Groups showed significant, highly focused differences in DTI parameters which related to participants’ genital responses to sexual depictions of children, but not to measures of psychopathy or to childhood histories of physical abuse, sexual abuse, or neglect. Some previously reported gray matter differences were suggested under highly liberal statistical conditions (p(uncorrected)<.005), but did not survive ordinary statistical correction (whole brain per voxel false discovery rate of 5%). These results confirm that pedophilia is characterized by neuroanatomical differences in white matter microstructure, over and above any neural characteristics attributable to psychopathy and childhood adversity, which show neuroanatomic footprints of their own. Although some gray matter structures were implicated previously, only few have emerged reliably.

Minor Physical Anomalies as a Window into the Prenatal Origins of Pedophilia

Evidence is steadily accumulating to support a neurodevelopmental basis for pedophilia. This includes increased incidence of non-right-handedness, which is a result primarily of prenatal neural development and solidified very early in life. Minor physical anomalies (MPAs; superficial deviations from typical morphological development, such as un-detached earlobes) also develop only prenatally, suggesting them as another potential marker of atypical physiological development during the prenatal period among pedophiles. This study administered the Waldrop Physical Anomaly Scale to assess the prevalence of MPAs in a clinical sample of men referred for assessment following a sexual assault, or another illegal or clinically significant sexual behavior. Significant associations emerged between MPA indices and indicators of pedophilia, including penile responses to depictions of children, number of child victims, and possession of child pornography. Moreover, greater sexual attraction to children was associated with an elevated craniofacial-to-peripheral anomalies ratio. The overall sample demonstrated a greater number of MPAs relative to prior samples of individuals with schizophrenia as well as to healthy controls.

The (in)consistency of changes in brain macrostructure in male paedophiles: A combined T1-weighted and diffusion tensor imaging study

Thus far, four studies have used magnetic resonance imaging (MRI) to test for differences in brain structure between paedophilic (i.e. sexually attracted to pre-pubescent children) and teleiophilic (i.e. sexually attracted to adults) men, revealing divergent results. To re-examine this issue, we acquired high resolution structural T1-weighted and diffusion MRI scans of the brain in 24 paedophilic and 32 teleiophilic men. We performed voxel-based morphometry (VBM) of the T1-weighted images and tract-based spatial statistics (TBSS) of the diffusion tensor imaging data to search for grey and white matter differences between groups. In contrast to previous studies, less than half of the individuals in our paedophilic group had a record of sexual offences against children, as subjects were partially recruited from two outpatient facilities of a child sexual abuse prevention project for self-acknowledged paedophiles. After adjustment for multiple comparisons and controlling for important confounding factors, we did not find any significant grey or white matter differences between the paedophilic and teleiophilic subjects. Together with the inconsistencies in the literature, these results argue against consistent structural differences at the macroanatomical scale between paedophiles and teleiophiles.

The Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges

A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodological challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.

Connectivity and functional profiling of abnormal brain structures in pedophilia

Despite its 0.5-1% lifetime prevalence in men and its general societal relevance, neuroimaging investigations in pedophilia are scarce. Preliminary findings indicate abnormal brain structure and function. However, no study has yet linked structural alterations in pedophiles to both connectional and functional properties of the aberrant hotspots. The relationship between morphological alterations and brain function in pedophilia as well as their contribution to its psychopathology thus remain unclear. First, we assessed bimodal connectivity of structurally altered candidate regions using meta-analytic connectivity modeling (MACM) and resting-state correlations employing openly accessible data. We compared the ensuing connectivity maps to the activation likelihood estimation (ALE) maps of a recent quantitative meta-analysis of brain activity during processing of sexual stimuli. Second, we functionally characterized the structurally altered regions employing meta-data of a large-scale neuroimaging database. Candidate regions were functionally connected to key areas for processing of sexual stimuli. Moreover, we found that the functional role of structurally altered brain regions in pedophilia relates to nonsexual emotional as well as neurocognitive and executive functions, previously reported to be impaired in pedophiles. Our results suggest that structural brain alterations affect neural networks for sexual processing by way of disrupted functional connectivity, which may entail abnormal sexual arousal patterns. The findings moreover indicate that structural alterations account for common affective and neurocognitive impairments in pedophilia. The present multimodal integration of brain structure and function analyses links sexual and nonsexual psychopathology in pedophilia.

Factor structure of the Edinburgh Handedness Inventory versus the Fazio Laterality Inventory in a population with established atypical handedness

The Edinburgh Handedness Inventory (EHI) has consistently remained the most used handedness inventory despite its limitations. The psychometric properties of handedness inventories, however, are increasingly important due to their use in matching groups for neuroimaging research. This study compared the performance of the EHI and the Fazio Laterality Inventory (FLI) in a population with atypical handedness. Whereas the EHI demonstrated a single-factor loading in this population, the FLI's previously demonstrated single factor dissociated into two factors: fine motor/ballistic movements and expressive/instrumental movements. This dissociation is similar to that seen when tests of cognitive constructs--which tend to load on a single factor in intact populations--dissociate when administered to populations with difficulties in the assessed domain. This pattern of performance lends further support for the use of the FLI to more accurately assess handedness. Future research in other populations with atypical laterality may illuminate additional factors of the FLI.

Patient Characteristics by Type of Hypersexuality Referral: A Quantitative Chart Review of 115 Consecutive Male Cases

Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals. Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic adulterers reported premature ejaculation and later onset of puberty. Designated patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this article nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively.

Arousal, working memory capacity, and sexual decision-making in men

This study investigated whether working memory capacity (WMC) moderated the relationship between physiological arousal and sexual decision making. A total of 59 men viewed 20 consensual and 20 non-consensual images of heterosexual interaction while their physiological arousal levels were recorded using skin conductance response. Participants also completed an assessment of WMC and a date-rape analogue task for which they had to identify the point at which an average Australian male would cease all sexual advances in response to verbal and/or physical resistance from a female partner. Participants who were more physiologically aroused by and spent more time viewing the non-consensual sexual imagery nominated significantly later stopping points on the date-rape analogue task. Consistent with our predictions, the relationship between physiological arousal and nominated stopping point was strongest for participants with lower levels of WMC. For participants with high WMC, physiological arousal was unrelated to nominated stopping point. Thus, executive functioning ability (and WMC in particular) appears to play an important role in moderating men's decision making with regard to sexually aggressive behavior.

When benefitting a patient increases the risk for harm for third persons - the case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation - given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.

The neuropsychology of sex offenders: a meta-analysis

Typically, neuropsychological studies of sex offenders have grouped together different types of individuals and different types of measures. This is why results have tended to be nonspecific and divergent across studies. Against this background, the authors undertook a review of the literature regarding the neuropsychology of sex offenders, taking into account subgroups based on criminological theories. They also conducted a meta-analysis of the data to demonstrate the cognitive heterogeneity of sex offenders statistically. Their main objective was to test the hypothesis to the effect that the neuropsychological deficits of sex offenders are not broad and generalized compared with specific subgroups of participants based on specific measures. In all, 23 neuropsychological studies reporting data on 1,756 participants were taken into consideration. As expected, a highly significant, broad, and heterogeneous overall effect size was found. Taking subgroups of participants and specific cognitive measures into account significantly improved homogeneity. Sex offenders against children tended to obtain lower scores than did sex offenders against adults on higher order executive functions, whereas sex offenders against adults tended to obtain results similar to those of non-sex offenders, with lower scores in verbal fluency and inhibition. However, it is concluded that neuropsychological data on sex offenders are still too scarce to confirm these trends or to test more precise hypotheses. For greater clinical relevance, future neuropsychological studies should consider specific subgroups of participants and measures to verify the presence of different cognitive profiles.