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Mbiydzenyuy NE, Joanna Hemmings SM, Shabangu TW, Qulu-Appiah L. Exploring the influence of stress on aggressive behavior and sexual function: Role of neuromodulator pathways and epigenetics. Heliyon 2024; 10:e27501. [PMID: 38486749 PMCID: PMC10937706 DOI: 10.1016/j.heliyon.2024.e27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Stress is a complex and multifaceted phenomenon that can significantly influence both aggressive behavior and sexual function. This review explores the intricate relationship between stress, neuromodulator pathways, and epigenetics, shedding light on the various mechanisms that underlie these connections. While the role of stress in both aggression and sexual behavior is well-documented, the mechanisms through which it exerts its effects are multifarious and not yet fully understood. The review begins by delving into the potential influence of stress on the Hypothalamic-Pituitary-Adrenal (HPA) axis, glucocorticoids, and the neuromodulators involved in the stress response. The intricate interplay between these systems, which encompasses the regulation of stress hormones, is central to understanding how stress may contribute to aggressive behavior and sexual function. Several neuromodulator pathways are implicated in both stress and behavior regulation. We explore the roles of norepinephrine, serotonin, oxytocin, and androgens in mediating the effects of stress on aggression and sexual function. It is important to distinguish between general sexual behavior, sexual motivation, and the distinct category of "sexual aggression" as separate constructs, each necessitating specific examination. Additionally, epigenetic mechanisms emerge as crucial factors that link stress to changes in gene expression patterns and, subsequently, to behavior. We then discuss how epigenetic modifications can occur in response to stress exposure, altering the regulation of genes associated with stress, aggression, and sexual function. While numerous studies support the association between epigenetic changes and stress-induced behavior, more research is necessary to establish definitive links. Throughout this exploration, it becomes increasingly clear that the relationship between stress, neuromodulator pathways, and epigenetics is intricate and multifaceted. The review emphasizes the need for further research, particularly in the context of human studies, to provide clinical significance and to validate the existing findings from animal models. By better understanding how stress influences aggressive behavior and sexual function through neuromodulator pathways and epigenetic modifications, this research aims to contribute to the development of innovative protocols of precision medicine and more effective strategies for managing the consequences of stress on human behavior. This may also pave way for further research into risk factors and underlying mechanisms that may associate stress with sexual aggression which finds application not only in neuroscience, but also law, ethics, and the humanities in general.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Basic Science Department, School of Medicine, Copperbelt University, P.O Box 71191, Ndola, Zambia
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Sian Megan Joanna Hemmings
- Division of Molecular Biology & Human Genetics, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Thando W. Shabangu
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Lihle Qulu-Appiah
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
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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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Scarpazza C, Costa C, Battaglia U, Berryessa C, Bianchetti ML, Caggiu I, Devinsky O, Ferracuti S, Focquaert F, Forgione A, Gilbert F, Pennati A, Pietrini P, Rainero I, Sartori G, Swerdlow R, Camperio Ciani AS. Acquired Pedophilia: international Delphi-method-based consensus guidelines. Transl Psychiatry 2023; 13:11. [PMID: 36653356 PMCID: PMC9849353 DOI: 10.1038/s41398-023-02314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Idiopathic and acquired pedophilia are two different disorders with two different etiologies. However, the differential diagnosis is still very difficult, as the behavioral indicators used to discriminate the two forms of pedophilia are underexplored, and clinicians are still devoid of clear guidelines describing the clinical and neuroscientific investigations suggested to help them with this difficult task. Furthermore, the consequences of misdiagnosis are not known, and a consensus regarding the legal consequences for the two kinds of offenders is still lacking. The present study used the Delphi method to reach a global consensus on the following six topics: behavioral indicators/red flags helpful for differential diagnosis; neurological conditions potentially leading to acquired pedophilia; neuroscientific investigations important for a correct understanding of the case; consequences of misdiagnosis; legal consequences; and issues and future perspectives. An international and multidisciplinary board of scientists and clinicians took part in the consensus statements as Delphi members. The Delphi panel comprised 52 raters with interdisciplinary competencies, including neurologists, psychiatrists, neuropsychologists, forensic psychologists, expert in ethics, etc. The final recommendations consisted of 63 statements covering the six different topics. The current study is the first expert consensus on a delicate topic such as pedophilia. Important exploitable consensual recommendations that can ultimately be of immediate use by clinicians to help with differential diagnosis and plan and guide therapeutic interventions are described, as well as future perspectives for researchers.
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Affiliation(s)
- Cristina Scarpazza
- Department of General Psychology, University of Padova, Padova, Italy. .,Padova Neuroscience Center (PNC), University of Padova, Padova, Italy. .,IRCCS S. Camillo Hospital, Venezia, Italy.
| | - Cristiano Costa
- grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Department of Neuroscience, University of Padova, Padova, Italy
| | - Umberto Battaglia
- grid.5608.b0000 0004 1757 3470Department of Applied Psychology, FISPPA – University of Padova, Padova, Italy
| | - Colleen Berryessa
- grid.430387.b0000 0004 1936 8796School of Criminal Justice, Rutgers University, Newark, NJ USA
| | - Maria Lucia Bianchetti
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Ilenia Caggiu
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Orrin Devinsky
- grid.137628.90000 0004 1936 8753Epilepsy Center, NYU School of Medicine, New York, USA
| | - Stefano Ferracuti
- grid.7841.aDepartment of Human Neurosciences Sapienza Università di Roma, Rome, Italy
| | - Farah Focquaert
- grid.5342.00000 0001 2069 7798Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Arianna Forgione
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Fredric Gilbert
- grid.1009.80000 0004 1936 826XEthics, Policy & Public Engagement (EPPE) ARC Centre of Excellence for Electromaterials Science (ACES), Faculty of Arts, University of Tasmania, Hobart, Australia
| | | | - Pietro Pietrini
- grid.462365.00000 0004 1790 9464IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Innocenzo Rainero
- grid.7605.40000 0001 2336 6580Neurology I, Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Turin, Italy
| | - Giuseppe Sartori
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Russell Swerdlow
- grid.412016.00000 0001 2177 6375University of Kansas Medical Center, Kansas City, KS USA
| | - Andrea S. Camperio Ciani
- grid.5608.b0000 0004 1757 3470Department of Applied Psychology, FISPPA – University of Padova, Padova, Italy
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Popovic D, Wertz M, Geisler C, Kaufmann J, Lähteenvuo M, Lieslehto J, Witzel J, Bogerts B, Walter M, Falkai P, Koutsouleris N, Schiltz K. Patterns of risk-Using machine learning and structural neuroimaging to identify pedophilic offenders. Front Psychiatry 2023; 14:1001085. [PMID: 37151966 PMCID: PMC10157073 DOI: 10.3389/fpsyt.2023.1001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Background Child sexual abuse (CSA) has become a focal point for lawmakers, law enforcement, and mental health professionals. With high prevalence rates around the world and far-reaching, often chronic, individual, and societal implications, CSA and its leading risk factor, pedophilia, have been well investigated. This has led to a wide range of clinical tools and actuarial instruments for diagnosis and risk assessment regarding CSA. However, the neurobiological underpinnings of pedosexual behavior, specifically regarding hands-on pedophilic offenders (PO), remain elusive. Such biomarkers for PO individuals could potentially improve the early detection of high-risk PO individuals and enhance efforts to prevent future CSA. Aim To use machine learning and MRI data to identify PO individuals. Methods From a single-center male cohort of 14 PO individuals and 15 matched healthy control (HC) individuals, we acquired diffusion tensor imaging data (anisotropy, diffusivity, and fiber tracking) in literature-based regions of interest (prefrontal cortex, anterior cingulate cortex, amygdala, and corpus callosum). We trained a linear support vector machine to discriminate between PO and HC individuals using these WM microstructure data. Post hoc, we investigated the PO model decision scores with respect to sociodemographic (age, education, and IQ) and forensic characteristics (psychopathy, sexual deviance, and future risk of sexual violence) in the PO subpopulation. We assessed model specificity in an external cohort of 53 HC individuals. Results The classifier discriminated PO from HC individuals with a balanced accuracy of 75.5% (sensitivity = 64.3%, specificity = 86.7%, P 5000 = 0.018) and an out-of-sample specificity to correctly identify HC individuals of 94.3%. The predictive brain pattern contained bilateral fractional anisotropy in the anterior cingulate cortex, diffusivity in the left amygdala, and structural prefrontal cortex-amygdala connectivity in both hemispheres. This brain pattern was associated with the number of previous child victims, the current stance on sexuality, and the professionally assessed risk of future sexual violent reoffending. Conclusion Aberrant white matter microstructure in the prefronto-temporo-limbic circuit could be a potential neurobiological correlate for PO individuals at high-risk of reoffending with CSA. Although preliminary and exploratory at this point, our findings highlight the general potential of MRI-based biomarkers and particularly WM microstructure patterns for future CSA risk assessment and preventive efforts.
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Affiliation(s)
- David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Forensic Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
- *Correspondence: David Popovic,
| | - Maximilian Wertz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Forensic Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Carolin Geisler
- Department of Dermatology, Venereology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joern Kaufmann
- Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Johannes Lieslehto
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Joachim Witzel
- Central State Forensic Psychiatric Hospital of Saxony-Anhalt, Uchtspringe, Germany
| | - Bernhard Bogerts
- Salus Institut, Salus gGmbH, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Forensic Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany
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6
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Baltodano-Calle MJ, Onton-Díaz M, Gonzales GF. Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review. Andrologia 2022; 54:e14561. [PMID: 35995581 DOI: 10.1111/and.14561] [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: 05/24/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022] Open
Abstract
Sexual delinquency is a global problem where those with paraphilic disorders, such as paedophiles, are more likely to commit and reoffend. Androgen deprivation therapy (ADT) has been suggested as a solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for paraphilias. The importance of testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti-androgens, GnRH agonists and GnRH antagonists) and the effect of testosterone replacement therapy will be reviewed. The relationship between androgens, brain, sexual behaviour and pathophysiology of paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to androgens and a higher methylation state of the androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion, androgens represent a significant part of the pathophysiology of paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long-term ADT in paraphilic patients.
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Affiliation(s)
| | - Melisa Onton-Díaz
- Faculty of Medicine, Cayetano Heredia Peruvian University., Lima, Peru
| | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru
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Jahn K, Kurz B, Sinke C, Kneer J, Riemer O, Ponseti J, Walter M, Beier KM, Walter H, Frieling H, Schiffer B, Kruger THC. Serotonin system-associated genetic and epigenetic changes in pedophilia and child sexual offending. J Psychiatr Res 2021; 145:60-69. [PMID: 34871921 DOI: 10.1016/j.jpsychires.2021.11.042] [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] [Received: 07/29/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022]
Abstract
Numerous studies have shown associations between anomalies of the serotonergic system and impulsive behavior, depression, or traumatic life events. However, it is currently unknown, whether pedophilia or child sexual offending (CSO) is also related to alterations of the serotonergic system. Using a two by two factorial paradigm within a multisite consortium (NeMUP*) study cohort, we analyzed whether the SLC6A4-linked polymorphic region (SLC6A4LPR) or the SLC6A4 (transporter) and HTR3A (receptor) promotor methylation rates differed with regard to a pedophilic preference and/or child sexual offending. Methylation rates of HTR3A showed significant differences between child sexual offenders and non-offenders, with child sexual offenders showing lower methylation rates. Moreover, HTR3A methylation rates showed significant negative correlations with the Child Trauma Questionnaire (CTQ) subscale "sexual violence", and the number of sexual offenses committed. Interestingly, we also found pedophilia-related alterations in 5HT3A as well as SLC6A4 methylation rates. For HTR3A we detected significant higher methylation rates in subjects with a pedophilic sexual preference, whereas for SLC6A4 methylation rates were reduced, indicating a possible downregulation of the serotonergic system in total. Although there were no significant group differences concerning the SLC6A4LPR, we found a significant correlation of the SLC6A4 methylation rate with this polymorphism in pedophilia. The present study suggests an involvement of epigenetic alterations of the serotonergic system in pedophilia and child sexual offending as well as own experience of sexual violence. While such an environmental factor may account for the epigenetic changes seen in child sexual offending, this was not seen in pedophilia. These findings will hopefully inspire further research in this underinvestigated field which should aim at validating and extending these initial results.
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Affiliation(s)
- Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Laboratory of Molecular Psychiatry, Hannover, Medical School, Hannover, Germany
| | - Bernadett Kurz
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Christopher Sinke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover, Medical School, Hannover, Germany
| | - Jonas Kneer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover, Medical School, Hannover, Germany
| | - Ole Riemer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Laboratory of Molecular Psychiatry, Hannover, Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Klaus M Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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, Berlin Institute of Health, Berlin, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Laboratory of Molecular Psychiatry, Hannover, Medical School, Hannover, Germany; Center for Systems Neurosciences, Hannover, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover, Medical School, Hannover, Germany; Center for Systems Neurosciences, Hannover, Germany.
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8
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Fernandez JA, Fernandez JA, Aga Mohd Jaladin R. Beware of the menacing monsters around us: protecting Malaysian children from sexual abuse. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2021. [DOI: 10.1080/03069885.2021.1938970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Janet Ann Fernandez
- Department of Educational Psychology and Counselling, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Rafidah Aga Mohd Jaladin
- Department of Educational Psychology and Counselling, University of Malaya, Kuala Lumpur, Malaysia
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9
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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Camperio Ciani AS, Scarpazza C, Covelli V, Battaglia U. Profiling acquired pedophilic behavior: Retrospective analysis of 66 Italian forensic cases of pedophilia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 67:101508. [PMID: 31785728 DOI: 10.1016/j.ijlp.2019.101508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Neurological disorders can be mis-diagnosed as psychiatric ones. This might happen to pedophilia emerging as a symptom of brain insult (i.e. acquired pedophilic behavior). This paper aims to delineate a behavioral profile that might help to identify defendants whose pedophilic behavior is likely to be the consequence of a neurological disorder. Through a systematic review of the literature, seventeen clinical and behavioral variables of the modus operandi and victimology that can distinguish between acquired and developmental pedophilic behavior have been collected. Seven of these were found to be consistent behavioral indicators (i.e. red flags) for acquired pedophilia. Cluster hierarchical analysis on the seventeen variables collected through the systematic review of the literature on cases of acquired pedophilic behavior was applied to a new dataset including 66 Italian closed cases of pedophilia. Stepwise regression and correlation analyses were carried out to further examine the differences between the clusters identified in the cluster analysis. Results revealed that the new sample was partitioned into two clusters. Individuals with ascertained acquired pedophilia were grouped together. The clusters widely differed for the prevalence of red flags (mean number of red flags in each cluster: 2.14 ± 0.79 vs 4.96 ± 0.93, p < 0.001), while no between cluster difference emerged for the other clinical and behavioral variables. Regression analysis provided a robust model that included the three most significant red flags that explain over 64.5% of the variance (absence of masking, spontaneous confession and offenders older age). An organic origin of pedophilic behavior should be suspected if red flags are present in a defendant charged with pedophilia. In those cases, an in depth trans-disciplinary neuroscientific investigation is advocated. The behavioral profile identified might help to provide a proper assessment of defendants.
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Affiliation(s)
- Andrea S Camperio Ciani
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy.
| | | | - Valeria Covelli
- Department of General Psychology, University of Padova, Padova, Italy
| | - Umberto Battaglia
- Department of General Psychology, University of Padova, Padova, Italy
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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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12
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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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