How Common is Men's Self-Reported Sexual Interest in Prepubescent Children?

Explicit measures for emotional congruence with children are related to sexual interests in a male community sample, but not implicit measures

This study sought to disentangle several phenotypic correlates of pedophilic sexual interests, such as emotional congruence with children and lack of empathy. We utilized Implicit Association Tests and self-report questionnaires for emotional congruence with children and analyzed the psychometric properties of these measures. Further, we analyzed the associations between these measures and self-reported pedophilic sexual interests and empathy. The sample consisted of 110 adult community males (prevalence of sexual interest in children at least to some extent: 5.5%) with or without child-related jobs (43.6% vs. 56.4%) recruited online in the general population. Overall, we found equivocal parameters for reliability of the implicit and explicit measures of emotional congruence with children (α = 0.29 to 0.76). The self-reported emotional congruence with children was only weakly linked to the implicit positive evaluations of children (r = 0.170, p = 0.039), not linked to empathy except for distress in social interactions (r = 0.199, p = 0.019), and moderately linked to deviant sexual interests in children (r = 0.321 to 0.404, p < 0.001), especially in men working with children (R2 = 0.04, p = 0.027). Further studies are warranted to expand the sample to the offender population and explore the more complex network of constructs related to pedophilia.

Testing the Factor Structure and Construct Validity of the German Version of Gray et al.'s (2003) Sexual Fantasy Questionnaire

Gray et al.'s (2003) Sexual Fantasy Questionnaire (SFQ) is becoming an increasingly used self-report measure of sexual fantasy use. The current study analyzed the factorial structure and construct validity of the behavioral items of the SFQ using a nomological network of other sexuality-related measures in a large German-speaking sample (N = 846). Participants' (27.7% females) mean age was 30.8 years (SD = 11.0). Exploratory factor analysis revealed a 65-item scale comprising five-factors, which were termed: normophilic sexual fantasies, sexualized aggression, sexualized submission, submissive courtship, and bodily functions. This German version of the SFQ was found to have high construct validity indicated by its association with other related constructs. Based on these results, we argue that the SFQ is a valid self-report measure that can be used in both research and clinical practice (foremost the factors sexualized aggression and sexualized submission). Suggestions for future research are discussed in light of the results and the study's limitations.

Childhood Adversity and Offense-Supportive Cognitions Among Czech Adults with a Sexual Interest in Violence or Children

Individuals with paraphilic interests in sexual violence or children may be more likely to sexually offend if they possess offense-supportive cognitions. These cognitions may develop in response to childhood adversity. However, this idea is largely based on research in men convicted of sexual offenses and may not generalize to non-incarcerated adults with paraphilic interests. In a sample of 178 adults screened for paraphilic interests in violence or children (from the general Czech population), we hypothesized that childhood sexual abuse and emotional neglect would be associated with offense-supportive cognitions about rape and child molestation. Participants came from a nationally representative sample of Czech adults and were selected if they self-reported high levels of sexual interest in violence and/or children. Participants completed an online survey with self-report measures of sexual orientation, offense-supportive cognitions (Bumby RAPE and MOLEST scales), and childhood sexual abuse and emotional neglect (Childhood Trauma Questionnaire). Controlling for gender, age, and sexual orientation, we found that both rape-supportive cognitions and child molestation-supportive cognitions were significantly associated with higher levels of childhood sexual abuse, but not emotional neglect. These findings indicate that childhood sexual abuse may lead to offense-supportive cognitions among men and women with paraphilia.

How online data informs forensic mental health evaluations of sexual behavior: An overview

The Internet plays a pervasive role in modern life including the expression of human sexuality and sexual offending. A range of online sexual activities may be of interest in forensic mental health evaluations (FMHE), including those which are clearly illegal or those which are legal but functionally problematic. Online sexual offenses will clearly prompt forensic evaluators to consider the role of the Internet in these offending behaviors. The Internet may also be relevant in forensic evaluations of contact sexual offending including informing on history of mixed or cross-over offending, and Internet-facilitated contact offenses. A review of Internet-data may span several online domains, many of which provide the user with substantial anonymity and would likely not be available to the evaluator unless provided through the process of discovery. Early guidelines for the review of Internet-data in FMHEs have been proposed and support the Internet as a useful source of collateral data in the conduct of forensic evaluations of sexual behavior.

"You Feel Like You Did Something So Wrong": Women's Experiences of a Loved One's Child Sexual Abuse Material Offending

This article examines the experiences of female partners and relatives of child sexual abuse material offenders and the (il)legibility of their experiences within prevailing theoretical frameworks and policy responses to violence against women. Drawing on survey and interview data with clients of a specialist support agency, we situate the lack of understanding and support available to these women within the systematic depoliticization of child sexual abuse. The article traces how women developed their own social critique of child sexual exploitation as a form of gendered violence and called for a feminist reengagement with the politics of child sexual abuse.

Online Communities for Child-Attracted Persons as Informal Mental Health Care: Exploring Self-Reported Wellbeing Outcomes

Online support communities are gaining attention among child-attracted persons (CAPs). Though research has largely focused on the negative consequences these environments create for potential offending, they may also provide a beneficial alternative to more formal treatment settings. To assess the utility for clinical and therapeutic purposes, this analysis focused on subcultural dynamics to examine self-reported wellbeing outcomes of participation in a Dutch forum for CAPs. A total of 15 semi-structured interviews were conducted with moderators, members and mental health professionals involved in the community. Thematic analyses demonstrated that by means of informal social control, bonds of trust and social relational education, the network aims to regulate the behavior and enhance the wellbeing of its marginalized participants. Key outcomes include a decreased sense of loneliness and better coping with stigma, to the point that participants experience less suicidal thoughts. Association with prosocial peers also helps to set moral boundaries regarding behavior towards children, although we cannot fully rule out potential adverse influences. Online support networks offer a stepping stone to professional care that fits individual needs of CAPs, while also providing an informal environment that overcomes limitations of physical therapy and that extents principles of existing prevention and desistance approaches.

When Kinks Come to Life: An Exploration of Paraphilic Behaviors and Underlying Predictors

Paraphilia is defined as a condition in which sexual excitement relies on fantasizing about and/or participating in unusual sexual behavior. Although recent studies have assessed the concordance between paraphilic interests and paraphilic behaviors, few studies have studied which individual traits and demographics predict engaging in paraphilic behaviors, or the level of concordance between arousal and behavior. The current study replicated and expanded Joyal and Carpentier's 2022 study. We assessed concordance between paraphilic arousal and behavior. Further, we assessed the impact of Dark Tetrad traits, impulsivity, social desirability and demographic variables on engaging in paraphilic behaviors using self-report questionnaires in a sample from the general population and FetLife. Finally, we were interested in whether these individual differences moderated the concordance between arousal and behavior. Results indicated high concordance between paraphilic arousal and behavior for all paraphilias except pedophilia and hebephilia. Younger, male participants were more likely to engage in various paraphilias than women and older participants. Machiavellianism was linked with lower paraphilic behavior, particularly impulsive or risky ones. Psychopathy predicted engaging in more deviant or illegal paraphilias, whereas sadism only showed an association for engaging in frotteurism and narcissism was not a predictor for engaging in any paraphilia. For several paraphilias, individual traits moderated the effect of arousal on behavior. Implications of these findings and future directions are discussed.

The Viewing Reaction Time as a Diagnostic Tool of Pedohebephilia in the Dunkelfeld

Diagnosing pedohebephilia is fraught with obstacles given the tabooed nature of this sexual preference. The viewing reaction time effect (VRT) provides a non-intrusive indirect measure of sexual interest in minors. In forensic populations, the ability of the difference between the latencies while viewing child and adult sexual stimuli (VRT index) to discern child sexual offenders from a range of control groups has been ascertained meta-analytically. Given that the effect has been studied almost exclusively in forensic samples, its dependence or independence on prior overt (deviant) sexual behavior remains unclear. The present study sought to examine the relationship of prior sexual and non-sexual behaviors with the VRT in a sample of 282 self-referring, help-seeking men with and without pedohebephilia with and without a history of prior child sexual offenses (CSO) or a use of child sexual abuse materials (CSAM) recruited outside a forensic context. We found that (1) the clinical diagnosis of pedohebephilia but not prior CSO or CSAM showed a significant association with the VRT index; (2) the discriminatory ability of the VRT index did not differ significantly between samples with and without a history of prior overt sexual behavior with children; (3) the VRT index correlated positively with a behavioral marker of pedohebephilia in a subsample of individuals with prior judicially detected or undetected overt sexual behavior with children; and (4) in the same subsample, the VRT index correlated positively with markers of sexual interests in minors or hypersexuality but not of antisociality. Equivalence testing failed to refute a potential effect of prior sexual behavior on the VRT index. Our study showed that the VRT may provide an unintrusive diagnostic tool for pedohebephilia. The effect of prior overt sexual behavior with children needs further examination.

The prevalence of mental disorders among incarcerated adult men convicted of child sexual exploitation material offences

OBJECTIVE

Despite the growing body of research on individuals convicted of child sexual exploitation material (CSEM), relatively little is known about the prevalence of mental disorders in this population. The aim of the present study was to describe the prevalence of mental disorders among individuals convicted of CSEM offenses.

METHODS

This cross-sectional study examined data from 66 individuals serving a sentence for CSEM offenses in the Austrian prison system who underwent a clinical assessment between 2002 and 2020. Diagnoses were based on the German version of the Structured Clinical Interview for Axis I and Axis II disorders.

RESULTS

In the total sample, n = 53 individuals (80.3%) were diagnosed with a mental disorder. Twenty-seven individuals (40.9%) had an Axis I disorder and n = 47 (71.2%) had an Axis II disorder. More than two-thirds of the sample, n = 47 (71.2%), had a personality disorder diagnosis, with cluster B personality disorders being the most frequent mental disorders. More than half of the sample, n = 43 (65.2%), had a diagnosis of pedophilic disorder, of which n = 9 (13.6%) were of the exclusive type. Twenty-eight persons (42.4%) showed evidence of a hypersexual disorder.

CONCLUSIONS

In line with previous research, the present sample of convicted CSEM offenders showed a comparatively high prevalence of personality disorders and paraphilic disorders, particularly pedophilic disorders. Additionally, the rate of hypersexual disorder symptoms was considerably high. These findings should be considered for the development of successful risk management strategies for this population.

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Secret-keeping in therapy by clients who are sexually attracted to children

Objective This study investigated the reasons why pedohebephilic clients disclose their sexual attraction to children in therapy and the experiences associated with this decision among English-speaking samples. Method: The pre-registered online survey combined (1) quantitative correlational data of self-reported improvement, alliance, therapist reaction to disclosure, and the belief that mandatory reporting laws were in place, and (2) qualitative data about reasons for disclosure or no disclosure as well as perceived consequences. The sample consisted of pedohebephilic people who have been clients in therapy and have disclosed (n = 96) or not disclosed (n = 40). Results: While the disclosure and no disclosure groups did not differ in improvement or beliefs about mandatory reporting, those who had disclosed reported a stronger alliance. Clients who did not perceive the therapist's reaction as supportive reported less improvement than the no disclosure group. Thematic analysis of qualitative data identified three themes concerning motives for disclosing or not disclosing and a fourth regarding differential impacts of disclosure. Discussion: This study indicates that disclosing pedohebephilia does not in and of itself lead to improvement but is contingent on a therapist's reaction.

"Stigmatization and perceived dangerousness for intrafamilial child sexual abuse of fathers with a history of sexual offenses and paraphilic interests: Results from a survey of legal psychological experts"

BACKGROUND

Intrafamilial child sexual abuse (ICSA) is a puzzling phenomenon that is not well understood by researches. Nevertheless, psychologists are demanded to assess the risk for child maltreatment by family courts regarding male caregivers with a history of sex offenses and/or paraphilic interests.

OBJECTIVE

The aim of this study was to assess legal psychological experts' perspective on risk assessment in family court proceedings regarding ICSA, their opinions regarding the necessity of contact limitations between fathers/stepfathers who might impose a risk for ICSA, and experts' stigmatization of minor-attracted persons.

PARTICIPANTS AND SETTING

153 psychological experts working in family court proceedings were assessed via an online survey.

METHOD

Jahnke's Stigma Inventory was used as well as a questionnaire tapping into different contact limitations, the perception of child maltreatment risk, and parental capacity. Network analysis was conducted to multivariately investigate item intercorrelations.

RESULTS

Fathers/stepfathers with a diagnosed pedophilic disorder are being regarded as most dangerous, 71 % of the experts agreed with the necessity of a complete contact ban. Reduced parental capacity and increased risk for child maltreatment was observed with regard to sexual offending history and paraphilias.

CONCLUSIONS

Psychological experts in family court proceedings hardly discriminate between sexual offending and paraphilic interests which might be associated with stigmatizing attitudes and lack of experience. An increasing cooperation between family psychologists and experts of forensic risk assessment might reduce the risk of stigmatization and may contribute to more adequate risk assessments for ICSA thus aiding to prevent children from sexual victimization or misinformed risk management interventions.

"Falling Through the Cracks": A Retrospective Exploration of the Barriers to Help-Seeking Among Men Convicted of Sexual Crimes

The prevalence and impact of sexual abuse is of global concern, and the alarming rates of victimization have inspired a focus on its prevention. Whilst research has begun to explore the experiences of non-offending individuals to inform prevention initiatives, there is limited exploration of those who have struggled with their sexual interests and go on to commit sexual crime. Arguably these individuals hold key information about gaps in service provision, which may inform approaches to crime prevention. This study aimed to provide a phenomenological exploration of the pre-offense experiences of convicted individuals' beliefs about help-seeking, their desires for support, and any barriers that might have prevented them from coming forward for help. Semi-structured interviews were conducted with 14 individuals convicted of sexual offenses (n = 13 against children; n = 1 sexually motivated violence), and interpretative phenomenological analysis elicited three superordinate themes: Desperation, Barriers to Help-seeking and A Way Forward. The findings shed light on the distressing experience of living with sexual interests that are so openly rejected by society and the many ways participants attempted to cope with this, including multiple failed attempts to seek help. Implications and limitations are discussed.

Cognitive and Affective Impacts of Antistigma Interventions Surrounding People with a Sexual Interest in Children

Prevalent conflation between having a sexual interest in children and engaging in sexually abusive behavior contributes greatly to elevated levels of stigma directed at people living with a sexual interest in children. Contemporary quantitative research employing stigma intervention techniques has produced promising results in decreasing stigmatizing attitudes toward this population. This study aims to expand on this research by qualitatively analyzing the impact of two antistigma interventions. Content and thematic analysis were used to examine N = 460 responses to two open-ended questions featured in an anonymous online survey, which explored the cognitive and emotional impact of the interventions, respectively. A total of nine themes were identified. Four themes pertained to positive/supportive views and emotional responses reflecting the challenging of stereotypes, gaining new perspective, personalized reflections, and recognizing the impacts of stigma. Three themes reflected negative views and emotional responses, which concerned minimization and normalization, adverse personal experiences, and disbelief and mistrust. Finally, two themes reflected mixed views and emotional responses, specifically the difficulty in reconciling emotional and cognitive responses. The data indicated that both interventions showed potential to impact participants' viewpoints positively. Findings offer insights into how future research can be designed and interventions can be developed more effectively.

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

Correspondence of Child Age and Gender Distribution in Child Sexual Exploitation Material and Other Child Content With Age and Gender of Child Sexual Assault Victims

Accessing child sexual exploitation material (CSEM; child pornography in legal statutes) can indicate sexual interest in children. It logically follows then that the age and gender of the depicted children may reflect specific interests in those age/gender groups, and if so, may correspond to age and gender of any known contact offending victims. We had data on CSEM characteristics and child victims for 71 men convicted of CSEM offenses who also had contact sexual offenses against children; some had also sexually solicited children online. Sixty-four men had 134 prior or concurrent child victims, and 14 men reoffended directly against 17 children during follow-up. There were significant, positive associations (with moderate to large effect sizes) between age and gender of children depicted in CSEM and age and gender of child contact or solicitation victims. Examining future offending, though with only 14 recidivists, all men who sexually reoffended against a girl had more girl CSEM content, and all men who sexually reoffended against a boy had more boy CSEM content. Our results suggest that CSEM characteristics can reflect child preferences. This information can be relevant in clinical settings, police investigations, and community risk management, though it does not rule out interest in, or offending against, victims of other ages or gender. We discuss these findings in the context of other evidence regarding victim cross-over, and suggest future research.

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.

The Development, Content Validation, and Pilot Testing of the Paraphilic Interests and Disorders Scale

The prevalence rates of paraphilic interests and disorders in the general population have been understudied, in large part due to the lack of a standardized assessment measure. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 provides little information regarding the prevalence of paraphilic disorders. The present study involved the development of a self-report measure, Paraphilic Interests and Disorders Scale (PIDS), that can be used to assess for the eight paraphilic interests/disorders in the DSM-5 for use with general population samples. Study 1 established the content validity of the PIDS using feedback from 22 experts in the field, and recommendations from these experts were utilized to modify the measure. In Study 2, the PIDS was piloted on 100 individuals in the general population, which supported the feasibility of implementation and its limited-efficacy. While the PIDS requires further psychometric support, the current research suggests the PIDS is a promising tool to gather self-report, population-based data on DSM-5 paraphilic interests and disorders.

Konsum von Missbrauchsabbildungen: Prävalenz, Ätiologie, Fallpriorisierung und Prognose

Der Konsum von Missbrauchsabbildungen hat sich im Hellfeld in den letzten Jahren immer wieder verdoppelt. Dieses erhöhte Fallaufkommen stellt Polizei, Bewährungshilfe und forensische Therapeuten vor eine Vielzahl neuer Herausforderungen. In diesem Beitrag sollen daher aktuelle theoretische Modelle und empirische Erkenntnisse dargestellt werden, um Praktiker in ihrer täglichen Arbeit zu unterstützen. Im Einzelnen sollen das Ausmaß der Problematik und ätiologische Erklärungsmodelle dargestellt werden. Darauffolgend werden empirische Erkenntnisse zu Konsumenten von Missbrauchsabbildungen aufgeführt und diese mit Tätern, die zusätzlich auch Hands-On-Delikte begehen, verglichen. Ferner wird die Problematik von „Crossover“-Tätern diskutiert. Abschließend werden Ansätze vorgestellt, um Fälle in der polizeilichen Ermittlungsarbeit zu priorisieren sowie um das Rückfallrisiko von Konsumenten von Missbrauchsabbildungen vorherzusagen.

Patterns of risk-Using machine learning and structural neuroimaging to identify pedophilic offenders

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.

Qualitative Analysis of Minor Attracted Persons' Subjective Experience: Implications for Treatment

Treatment for Minor Attracted Persons is inadequate and difficult to access. This qualitative study examined community-based MAPs' responses to narrative questions about their experiences and what they want society to understand, using an iterative thematic analysis. Notable responses from the participants included: 1) sexual attraction does not equal action; 2) minor attraction is immutable; 3) stigma leads to psychological burden; 4) therapy should aim to reduce distress, not change sexual feelings; and 5) sexual behavior can be controlled and remain within legal parameters. Further understanding of MAPs' experiences is key for developing more efficacious treatment modalities to help them live meaningful lives without endangering children.

Stigmatisation of People with Deviant Sexual Interest: A Comparative Study

Background: Pedophilia is a deviant sexual interest subject to more public stigma and punitive attitudes than others. Pedophilia has received a disproportionate amount of scholarly attention in comparison to other deviant sexual interests. To address this, the present study offers a comparison of the public stigma and punitive attitudes associated with pedophilia, fetishism, and hypersexuality. Methods: Recruited in Australia, one-hundred and twelve individuals participated in an anonymous online survey. Stigmatising and punitive attitudes toward pedophilia, fetishism, and hypersexuality were assessed via sub-scales of perceived dangerousness, deviance, intentionality, and punitive attitudes. Results: Participants held harsher punitive attitudes toward people with pedophilia and thought them to be more deviant and dangerous than people with fetishism and hypersexuality. Participants perceived hypersexuality to be more dangerous and deviant than fetishism. No consistent combination of perceived dangerousness, deviance, and intentionality predicted punitive attitudes toward all conditions. Rather, combinations of punitive attitude predictors were unique across conditions. Conclusions: This research articulates the unparalleled public stigma and punitive attitudes faced by people with pedophilia, compared to people with fetishism and hypersexuality. Findings which suggest that public stigma is stronger for hypersexuality than it is for fetishism are relatively novel, as are the observed predictors of punitive attitudes toward each condition. Knowledge produced by this study contributes to an improved conceptualisation of how the public views individuals who experience deviant sexual interests.

Identifying and working with appropriate treatment targets with people who are sexually attracted to children

Research has shown that people within society experience sexual attractions to children, and a substantial number of these seek support related to this. However, professional practices around working with minor-attracted persons (MAPs) are variable. Clinicians possess low levels of knowledge about this population and are unclear about the correct treatment goals. In this work we explored the prioritization of different treatment goals by MAPs (n = 150), before investigating the demographic, sexuality-related, and psychological predictors of treatment target prioritization. Self-compassion drove many treatment targets among MAPs. We offer recommendations about how professionals might work collaboratively and effectively with this population.

Viewing Time Measures of Sexual Interest and Sexual Offending Propensity: An Online Survey of Fathers

Relative viewing times (VTs)-time required to view and evaluate sexually salient images-discriminate individuals with a sexual interest in children, as indirectly indexed by their history of sexual offending against children, from those without such history. In an online sample of 652 fathers, we measured VTs and sexual attraction ratings to child and adult images. We assessed participants' sexual offending history and propensity (self-reported likelihood to have a sexual contact with a child, a non-consensual sexual contact with an adult, and propensity toward father-daughter incest). In contrast with VT studies involving clinical or forensic samples, VTs and attraction ratings failed to discriminate participants with a sexual offending history. VTs successfully distinguished participants with a propensity to sexually offend against children but failed to identify those with a propensity toward incest. Conversely, attraction ratings distinguished participants with a propensity toward incest but failed to identify those with a propensity to sexually offend against children. Correlations between VTs and attraction ratings were small. Results illustrate, for the first time, the distribution of VT measures in community fathers, support the feasibility of online administration of VT tasks to detect propensity to sexually offend against children, and indicate that sexual interest in children and incest propensity are distinct.

Outpatient Therapists' Perspectives on Working With Persons Who Are Sexually Interested in Minors

Minor-attracted persons (MAPs; i.e., people who are sexually interested in children and adolescents below the age threshold of legal consent for sexual activity) exhibit high psychological distress but report difficulties finding therapeutic help and are reluctant to start treatment due to fears of therapist stigmatization. This research sought to elucidate the link between outpatient therapists' stigmatizing attitudes toward non-offending versus offending MAPs and therapists' willingness to treat MAPs as well as how stigmatization was related to treatment-relevant aspects such as perceived MAP treatment needs, treatment barriers, and specific MAP treatment skills. Results from a brief, anonymous online survey conducted among N = 427 Swiss outpatient therapists working in the primary healthcare system are reported. Although therapists were less stigmatizing than the general public, considerable individual differences in the stigmatization of non-offending MAPs emerged. Stigmatizing attitudes toward non-offending MAPs and a perceived lack of specific treatment competences were negatively related to therapists' willingness to treat MAPs. A network analysis revealed direct links between subjectively perceived MAP treatment competence and treatment willingness and between treatment willingness and social distance attitudes. Other stigmatizing attitudes were only indirectly linked to treatment willingness through preferred social distance. It is a paradox that therapists believe that MAPs should greatly benefit from secondary prevention but many are unwilling to provide therapy (45% in case of non-offending MAPs vs. 63% in case of offending MAPs) or do not feel competent to provide MAPs with professional help (47% with and 88% of therapists without previous MAP treatment experience). Implications for increasing therapists' treatment willingness are discussed.

Media Coverage of Pedophilia and Its Impact on Help-Seeking Persons with Pedophilia in Germany—A Focus Group Study

The public stigma associated with pedophilia, the sexual attraction to prepubescent children, is tremendous. Previous research indicates that undifferentiated media coverage plays an essential role in perpetuating the public stigma by falsely equating pedophilia and child sexual abuse (CSA) and thus may stop persons suffering from a pedophilic disorder from seeking professional help. Until now, a comprehensive examination of positive as well as negative media effects on affected individuals is missing. Therefore, the present study explores if and how media coverage impacts the lives of help-seeking persons with pedophilia by conducting four qualitative focus group discussions with a clinical sample (N = 20) from the German Prevention Network “Kein Täter werden”. Present results demonstrate that media coverage of pedophilia was perceived as mostly undifferentiated, even though participants observed an increase in fact-based reporting over the years. Moreover, it seems that media coverage has strong emotional and behavioral consequences for patients (e.g., negative reporting reduced self-esteem). In sum, our results highlight that differentiated media coverage could play a key role in supporting help-seeking persons with pedophilic disorder, while the impact of undifferentiated media coverage appears to be mostly negative. Therefore, our results point to the need to reframe pedophilia using differentiated media coverage to help affected persons receive treatment efficiently and thereby prevent CSA.

The Prevalence of Sexual Interest in Children and Sexually Harmful Behavior Self-Reported by Men Recruited Through an Online Crowdsourcing Platform

This study examined the feasibility of using crowdsourcing to recruit men who self-report sexual interest in children or sexually problematic behavior involving children. Crowdsourcing refers to the use of the internet to reach a large number of people to complete a specific task. A nonrepresentative sample of men (N = 997) participated in a brief self-report survey examining age of attraction, sexual interest in children, proclivity toward sexual offenses involving children, and history of sexual offending. Almost a quarter of the sample (23.1%) indicated some degree of sexual interest in children, propensity to sexually offend against children, and/or actual offending behavior. We present our data broken down by type of interest or behavior and examine the frequency of these outcomes. Findings are likely to be of value to those considering the viability of crowdsourcing to overcome the limitations or challenges of face-to-face research on stigmatizing interests and behaviors. Findings also contribute to estimating prevalence of self-reported sexual interest in children, and sexual offending behavior toward children, across different countries.

Concordance and Discordance between Paraphilic Interests and Behaviors: A Follow-Up Study

Although paraphilic interests represent significant risk factors for recidivism among sexual offenders, little is known about the magnitude of concordance between paraphilic interests and behaviors in the general population. The goal of this follow-up study was to conduct secondary analyses based on a sample of 1040 adults (475 men; 565 women) recruited in the general population. Levels of associations and active concordance (having both interest and experience), passive concordance (having neither interest nor experience), active discordance (having experience without interest) and passive discordance (having interest without experience) between paraphilic interest and corresponding behavior were assessed. Concordance and discordance indexes were also computed, as well as regressions and moderation analyses. As expected, paraphilic interests predicted corresponding behaviors, although the mean active concordance rate was only approximately 50%. Concordance rates varied with gender and the criminal nature (legal vs. illegal) of paraphilia. Paraphilic interests in adults from the general population may not have the same predictive value as that observed in medico-legal contexts. The possible role of other moderators in the concordance between paraphilic interest and behavior in non-clinical populations should be assessed. These findings have implications for sexual abuse prevention programs aiming at individuals in the community.

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.

"We Do Exist": The Experiences of Women Living with a Sexual Interest in Minors

The current body of the literature studying minor-attracted persons (MAPs) predominantly focuses on the experiences of men who experience sexual attractions to children. To shed more light on the experiences of women within this population, we conducted anonymous semi-structured interviews with six self-identified female MAPs, who were recruited through online support forums for individuals with sexual attractions to children. Interpretative phenomenological analysis (IPA) was used to analyze the interview transcripts. Two superordinate themes were identified from the dataset that highlighted the uniqueness of the experience of being a woman within the MAP community ("A minority within a minority") and themes of social isolation and the effects of this on identity ("A lonely secret existence"). The findings reported here highlight how the experiences of female MAPs both converge with and diverge from their male counterparts in important ways. We discuss the implications of these experiences in relation to more effective service provision for women who are sexually attracted to children.

Women with Sexual Interest in Children - Results from an Online Survey Among a Non-Forensic Female Sample

Little research has examined adult women's sexual interest in children, particularly in non-forensic samples. We aimed to describe characteristics of women with sexual interest in children by recruiting 52 women (mean age: 33.2 years) who have a self-identified sexual interest in children under the age of 14 years into an anonymous online self-report study. Measures of interest referred to general characteristics (e.g., age, education level), general sexuality (e.g., sexual orientation, masturbation), and sexual interest in children (e.g., exclusivity, motivation to change). Results showed that women with sexual interest in children are similar to non-forensic samples of men with sexual interest in children in previous studies and rather differ from women from the general population regarding the investigated characteristics in this study. Our results clearly indicate that women with sexual interest in children need to be taken into account in future research and clinical practice. Treatment programs preventing sexual offenses against children or the consumption of abuse material need to explicitly address females as well.

Acceptance of Sexual Interest in Minors in Self-Referred Individuals Under Treatment - An Exploratory Pilot Study

Some therapists/scientists argue that “acceptance” of sexual interest in minors (SIM), i.e., the integration of the sexual preference into the individual self-concept, is a prerequisite for dealing with SIM in a responsible way. However, if one assumes that – even in some persons – SIM might change over time, “acceptance” could also run counter to therapeutic targets because the motivation to change as well as the specific self-efficacy for modifying SIM might be reduced. This exploratory pilot study analyzes the relationship between acceptance of SIM and (1) dynamic risk for contact sexual reoffending, (2) SIM and frequency of the use of child/adolescent (sexual abuse) imagery, (3) frequency of sexual desire/behavior toward children/adolescents, and (4) the change of the level of acceptance of SIM during the course of treatment. The majority of the participants (N = 79) was not exclusively interested in children (85%) and used child pornography but did not commit child sexual abuse (54%). Acceptance of SIM, frequency of the use of child/adolescent (sexual abuse) imagery and frequency of sexual desire/behavior toward children/adolescents are assessed via self-report questionnaires, dynamic risk for contact sexual reoffending is measured by STABLE-2007. Pretreatment data are analyzed via Spearman’s correlation (N = 79). Intragroup analysis compares acceptance of SIM from pre- and posttreatment (n = 35). There was no correlation between acceptance of SIM and dynamic risk for contact sexual reoffending. However, there was a medium, positive correlation between acceptance of SIM and the frequency of the use of legal imagery of children, a positive correlation between the item “My inclination is an integral part of my personality” and the frequency of the use of legal imagery of children, and a positive correlation between acceptance of SIM and the frequency of sexual activities with minors. Acceptance of SIM did not change during the course of treatment. The results suggest that “acceptance” of SIM has to be discussed in a differentiated way, i.e., as possibly being associated with positive and negative outcomes as well.

A map of desire: multidimensional scaling of men's sexual interest in male and female children and adults

BACKGROUND

Men sexually interested in children of a specific combination of maturity and sex tend to show some lesser interest in other categories of persons. Patterns of men's sexual interest across erotic targets' categories of maturity and sex have both clinical and basic scientific implications.

METHOD

We examined the structure of men's sexual interest in adult, pubescent, and prepubescent males and females using multidimensional scaling (MDS) across four datasets, using three large samples and three indicators of sexual interest: phallometric response to erotic stimuli, sexual offense history, and self-reported sexual attraction. The samples were highly enriched for men sexually interested in children and men accused of sexual offenses.

RESULTS

Results supported a two-dimensional MDS solution, with one dimension representing erotic targets' biological sex and the other dimension representing their sexual maturity. The dimension of sexual maturity placed adults and prepubescent children on opposite ends, and pubescent children intermediate. Differences between men's sexual interest in adults and prepubescent children of the same sex were similar in magnitude to the differences between their sexual interest in adult men and women. Sexual interest in adult men was no more associated with sexual interest in boys than sexual interest in adult women was associated with sexual interest in girls.

CONCLUSIONS

Erotic targets' sexual maturity and biological sex play important roles in men's preferences, which are predictive of sexual offending. The magnitude of men's preferences for prepubescent children v. adults of their preferred sex is large.

Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study

Introduction

Studies on characteristics of self-referred men with sexual interest in minors (SIM) and treatment approaches in this group of patients are still relatively rare.

Aim

The aim of this exploratory pilot study was to investigate hypersexuality and impulsivity as 2 dynamic risk factors that could possibly change during treatment in self-referred men with SIM.

Methods

Data were collected at the “Kein Täter Werden (means: not become an offender)” network site in Hamburg. Using self-report questionnaires, the extent of hypersexuality and impulsivity was analyzed with the samples’ pretreatment data via descriptive statistics and compared with nonclinical samples of other studies. The relation between hypersexuality and impulsivity was analyzed via Spearman's correlation coefficient with pretreatment data (N = 77). Intragroup analysis compared hypersexuality and impulsivity from pre- and posttreatment (n = 29).

Main Outcome Measures

Hypersexual Behavior Inventory and Barratt Impulsiveness Scale Version 11.

Results

The degree of generalized impulsivity in the SIM group was comparable to that in nonclinical samples while the degree of hypersexuality was considerably higher than in nonclinical samples. Sixty-four percent of the participants were in the range of clinically relevant hypersexuality. Impulsivity and hypersexuality were weakly positively correlated with each other. During treatment hypersexuality significantly decreased while impulsivity did not differ significantly between before beginning treatment and after (partial) completion.

Conclusion

Hypersexuality, but not impulsivity, was pronounced in the group of self-referred men with SIM and should be targeted in treatment. In order to improve treatment outcome regarding risk reduction in self-referred men with SIM, a focus on treatment approaches that were developed to treat hypersexuality can be expected to be effective while focusing on generalized impulsivity may be less relevant.

Lampalzer U, Tozdan S, von Franqué F, et al. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021;9:100429.

High risk sexual fantasies and sexual offending: An overview of fundamentals and interventions

Although deviant sexual fantasizing has been found to be an etiological factor for sexual offending, not all deviant sexual fantasies increase risk equally. The aim of the present overview is to provide readers with an introduction to key terminology, a primer on central clinical theories, and a summary of the research literature on “high risk” sexual fantasies over the past 50 years. First, the important difference between “sexual fantasy” and “sexual fantasizing” is described. Second, the link between sexual fantasizing and sexual offending is discussed, with a focus on principle moderators such as physiological reaction, personality profile, and offense-supportive beliefs. Third, the different methods used to assess sexual fantasies are discussed. Fourth, the principles and techniques behind four evidence-based approaches to treating “high risk” sexual fantasies are discussed: (1) the behavioral approach, (2) the cognitive approach, (3) the imagination approach, and (4) the mindfulness-based approach. Finally, a call is issued for practice-based quantitative and qualitative research to further explore this clinical phenomenon. The findings of such investigations would advance the field’s understanding of assessment, management, and monitoring best practices for this important forensic population.

Prevalence and correlates of individuals with sexual interest in children: A systematic review

BACKGROUND

Despite debates on what should constitute sexual interest in children in terms of definition and diagnostic criteria and its strong association with individuals who commit sexual offences against children, research in this area has shown that sexual interest in children is also commonly seen in the general population. Studies in this field have investigated its prevalence and its correlates. However, most research on this topic has focused on men and most particularly sex offender populations. When investigating the general population, again the vast majority of studies used male samples and students.

OBJECTIVE

This systematic review aimed to critically evaluate previous research on the prevalence of sexual interest in children across populations and to examine its correlates.

METHODS

A search of relevant databases was conducted as well as a hand search of selected journals to identify eligible papers. Studies meeting the inclusion criteria had their data extracted and were assessed for risk of bias, with a second rater to establish inter-rater reliability.

RESULTS

A total of 30 studies were reviewed and results indicated a mean prevalence rate of sexual interest in children between 2 %-24 %. Findings also indicated correlates such as the presence of mental health problems and adverse childhood experiences. Most studies showed poor external validity, with the majority of them scoring high on risk of bias.

CONCLUSION

Overall, the findings indicate inconsistencies in terms of methodology and definition/diagnostic criteria of sexual interest in children. Further research in this area using recommended methodology to avoid biases is recommended.

Stigmatization of Paraphilias and Psychological Conditions Linked to Sexual Offending

Except for pedophilia, little is known about public attitudes toward paraphilias and psychological conditions that are considered risk factors for sexual offending. In the present study we sought to compare the stigma attached to pedophilia with attitudes toward sexual sadism and antisocial tendencies (Study 1, N = 720) and with attitudes toward necrophilia and zoophilia (Study 2, N = 210) in convenience samples of community individuals. When investigating social distance intentions both studies explicitly referred to people with paraphilic sexual interests or antisocial tendencies who had not committed any crimes. In both studies, people with pedophilia emerged as highly stigmatized even though most participants showed awareness that pedophilic interests cannot be chosen or changed at will. The present studies solidify the evidence that pedophilia occupies a place in the public consciousness as less deserving of acceptance than most other sexual offending risk-relevant conditions, including ones that compare in terms of rarity.

Concordance of Paraphilic Interests and Behaviors

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

Prioritizing Indecent Image Offenders: A Systematic Review and Economic Approach to Understand the Benefits of Evidence-Based Policing Strategies

In 2013, there were an estimated 50,000 individuals involved in downloading and sharing indecent images of children (IIOC) in the United Kingdom (UK). This poses challenges for limited police resources. We argue that police officers can make most effective use of limited resources by prioritizing those offenders who pose the greatest risk of contact offending, by nature of demonstrable pedophilia, hebephilia or dual offending status and thus, those at highest risk must be dealt with first. What is currently lacking is a clear idea of the potential scale of the problem in socio-economic terms and why, therefore, it is so important that evidence-based approaches to offender detection and investigation continue to be a top priority for funders and policy makers. A systematic literature review was undertaken to address two related questions. First, what is the scale of the problem in the UK, in terms of the number of pedophilic and hebephilic individuals who pose a risk of contact offending against a child? Second, what is the potential socio-economic burden generated by the national IIOC suspect pool if left unattended to by targeted police action? Applying population estimates of pedophilia and hebephilia to the male population (16–89 years), we estimate there are between 2,365–5,991 males with paedophila and 12,218–30,952 males with hebephilia who are likely contact offenders. Applying average prevalence and incidence based costing methods to a conservative estimate of one victim per offender, the combined socio-economic burden from these persons could amount to £236-£597 million (incident costs) increasing to £2.9-£7.3 billion (lifetime costs; £3.3-£8.3 billion including QALY measures). Applying the same costs to CEOP (2013) estimate of 50,000 IIOC offenders we estimate that between 6,000 and 27,500 dual offenders could have already committed past contact offenses, contributing an economic burden of between £97–£445 million (incident costs) increasing to £1.2–£5.4 billion (lifetime costs; £1.4–£6.2 billion including QALY measures). Future contact offenses could contribute a further burden of £16–£18.6 million (incident costs) increasing to £198–£227 million (lifetime costs; £226–£260 million including QALY measures). Drawing upon these findings, we argue for the benefits of a research-informed prioritization approach to target IIOC offenders.

The Prevalence of Paraphilic Interests in the Czech Population: Preference, Arousal, the Use of Pornography, Fantasy, and Behavior

The number of population-based studies focused on the prevalence of paraphilic sexual interests in men is very low and for women, the subject remains largely unexplored. The two main aims of this study are to investigate the prevalence of paraphilias and to explore sex differences in an online representative sample of Czech men and women using various dimensions of sexual experience. We collected data about sexual motivations and behavior from a representative online sample of 10,044 Czechs (5,023 men and 5,021 women). In a standardized online interview, participants answered questions about selected dimensions of sexual experience within specific paraphilic patterns: sexual preferences, sexual arousal, sexual fantasies in the past 6 months, pornography use in the past 6 months, and experience with paraphilic behaviors. Our results show that 31.3% of men (n = 1,571) and 13.6% of women (n = 683) admitted to at least one paraphilic preference. Moreover, 15.5% of men and 5% of women reported more than one paraphilic preference. Except for beating/torture and humiliation/submission, in terms of real experience with such behaviors almost all paraphilias were more common among men than among women. Our results indicate that the high prevalence of some paraphilic patterns might render their pathologization problematic.

Risk Factors for Sexual Offending in Self-Referred Men With Pedophilic Disorder: A Swedish Case-Control Study

Background

The risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown.

Methods

We recruited a consecutive sample of 55 help-seeking, non-correctional adult men diagnosed with DSM-5 PD at a university-affiliated sexual medicine outpatient unit in Sweden. PD participants were compared with 57 age-matched, non-clinical control men on four literature-based dynamic risk domains and self-rated child sexual abuse risk.

Results

PD participants scored higher than controls on all tested domains (0-3 points); expectedly so for pedophilic attraction (2.5 vs. 0.0, Cohen's d = 2.40, 95% confidence interval (CI): [1.91-2.89]), but also for sexual preoccupation (1.6 vs. 1.0, d = 1.11, 95% CI: [0.71-1.51]), impaired self-regulation (1.4 vs. 1.0, d = 0.44, 95% CI: [0.06 to 0.81]), impaired cognitive empathy and antisocial traits (0.9 vs. 0.1, d = 1.18, 95% CI: [0.78-1.59]), and self-rated child sexual abuse risk (1.0 vs. 0.0, d = 1.56, 95% CI: [1.13-1.98]). When summarizing all five domains into a pre-specified composite score (0-15 points), PD subjects scored substantially higher than matched control men (7.5 vs. 2.1, d = 2.12, 95% CI: [1.65-2.59]). Five (9%) PD participants self-reported any previous conviction for a contact child sexual offense and eight (15%) for possession of child sexual abuse material or non-contact sexual offending (adult or child victim). Eighteen subjects (34%) acknowledged past week, child-related sexual behaviors.

Conclusion

Self-referred, help-seeking men with PD scored higher (small to very large effect sizes) than non-clinical control men on psychiatric measures of dynamic risk of child sexual abuse suggested in prior research with correctional samples diagnosed with PD. Our findings, including the composite risk measure, might inform clinical practice, but needs validation against actual sexual offending behavior.

The Effects of Acute Transcranial Direct Current Stimulation on Attentional Bias in Pedophilic Disorder: A Preregistered Pilot Study

OBJECTIVES

Individuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic attention bias for child-related stimuli as well as reduced activity in the dorsolateral prefrontal cortex (dlPFC), a brain area involved in cognitive control, including control over sexual arousal. In this preregistered pilot study, we are the first to investigate whether acutely increasing prefrontal activity could reduce the putative pedophilic attention bias.

MATERIALS AND METHODS

We delivered a single 20-min session of active anodal versus sham transcranial direct current stimulation (tDCS) over the left dlPFC to 16 SOC with PD and 16 matched healthy controls, while they performed a task requiring controlled attention to computer-generated images of clothed and nude children and adults. We collected responses unobtrusively by recording eye movements.

RESULTS

Our results did not support the presence of the expected automatic attention bias across outcome measures. Nonetheless, we found a response facilitation with child targets in patients and, unexpectedly, in controls, likely due to unwanted salience effects. Active versus sham tDCS reduced this bias across groups, as indicated by a significant group*condition interaction (p = 0.04). However, no attentional bias and no tDCS effects on attentional responses to child and adult images emerged following tDCS.

CONCLUSIONS

These results suggest enhanced cognitive control in response to salient stimuli during active tDCS. Thus, to assist future studies on neuromodulation in PD, we provide suggestions for design improvement.

Media Coverage of Pedophilia: Benefits and Risks from Healthcare Practitioners' Point of View

The fierce stigma associated with pedophilia may interfere with attempts to prevent sexual offending. Prior research on the effects of media reports about pedophilia mostly focused on their role in perpetuating stigma in the general population. In order to better understand potential benefits and risks of the media coverage on people with pedophilia and specialized prevention and treatment efforts, we conducted semi-structured qualitative interviews with 11 healthcare practitioners of the German Prevention Network “Don’t offend”. Healthcare practitioners described positive (e.g., raising awareness for prevention offers) as well as negative (e.g., perpetuating the existing public stigma) effects of the media coverage and estimated that only about one-third of media coverage portrays pedophilia realistically. To destigmatize pedophilia and benefit the prevention of child sexual abuse, a fact box for journalists was developed based on practitioners’ expert knowledge.

The relevance of sexual biographies in individuals convicted of child sexual abuse offenses for the development of pedosexual interests and sexual recidivism

In the literature concerning the etiology of pedosexual interests, the potential role of early sexual experiences in childhood and adolescence has been discussed. Several studies demonstrated a link between own sexually abusive experiences in childhood and sexual offending later in life which tends to be even stronger for pedosexual offenders. Furthermore, some findings indicate associations between other developmental factors and deviant sexual interests in adulthood. For the present study, sexual biographical data of N = 223 imprisoned men convicted of sexual offenses against children from Austria was analyzed to retrospectively examine whether own sexually abusive experiences and non-abusive forms of early sexual experiences and behaviors are linked to subsequent pedosexual interests and to sexual recidivism. Previous findings concerning the link between own sexually abusive experiences during childhood and subsequent pedosexual interests could partly be replicated. Furthermore, early masturbation behavior characteristics as well as non-abusive prepubescent sexual experiences were linked to indicators of pedosexual interests and also to sexual recidivism. Exclusively pedophilic men showed the strongest accumulation of early sexual experiences and behaviors. Implications of the findings for theory and risk assessment are discussed.

Help wanted: Lessons on prevention from young adults with a sexual interest in prepubescent children

BACKGROUND

Adolescents and young adults with a sexual interest in young children represent an underserved population. The needs of this group, and their implications for child sexual abuse prevention program development, are not well understood.

OBJECTIVE

The objective of this research is to advance knowledge about adolescents and young adults with a sexual interest in children to better inform the development of effective prevention and mental health efforts.

PARTICIPANTS AND SETTING

The sample consisted of 30 young adults, ages 18-30, from North America, South America, Europe, and Australia.

METHODS

Researchers conducted telephone interviews with participants, and asked about when their interest in children emerged, how they responded to this sexual interest, and what resources could have been helpful during this process. Participants also completed a brief, online survey. Interviews were transcribed and analyzed using Dedoose software.

RESULTS

Participants reported that their sexual interest in children emerged during adolescence, and as part of that process, they experienced a variety of emotions, including fear, shame, and feelings of isolation. Participants also noted the need for role models who are sexually interested in children and successfully navigating life, positive messaging, and support from families and the community.

CONCLUSIONS

Young people with a sexual interest in children are largely hidden, vulnerable, and looking for help. Findings from this research can be used to direct the development of the prevention and mental health programs that are responsive to the needs of this community.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

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.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

The Internalization of Social Stigma Among Minor-Attracted Persons: Implications for Treatment

In this article, we sought to build on existing stigmatization research by examining the extent to which internalized stigmatization (i.e., the personal adoption and incorporation of social views, operationalized as thought suppression-an avoidant coping strategy-and low psychological well-being) among minor-attracted persons (MAPs) may impact upon help-seeking behaviors and their avoidance of children. We adopted a cross-sectional anonymous survey design to recruit a sample of self-identified MAPs (N = 183) from prominent online support fora. We found that increased levels of suppression and lower levels of psychological well-being were associated with lower levels of hope about the future, but higher levels of both shame and guilt about having a sexual interest in minors. Thought suppression was not significantly associated with outcomes related to help-seeking behaviors, but did significantly predict higher rates of actively avoiding children, even after controlling for psychological well-being and other emotional variables. Independently, lower levels of self-reported psychological well-being were associated with a desire for more support and higher rates of actively avoiding children. We explore the potential implications of our data in relation to treating and supporting MAPs within the community, increasing their well-being, and encouraging help-seeking behavior.

Correlates of Chronic Suicidal Ideation Among Community-Based Minor-Attracted Persons

Elevated suicidal risk has been documented in adults who are sexually attracted to minors but the topic has not been adequately investigated, particularly outside the context of the criminal justice system. In this study, risk factors for chronic suicidal ideation were assessed in 333 community-based minor-attracted persons (95% male) via an online survey. Chronic suicidal ideation was endorsed by 38.1% of the participants but was associated neither to history of sexually engaging with a child nor to prior contact with the criminal justice system. In bivariate logistic regression analyses, significant unadjusted correlates included young age, less education, prior mental health treatment, weaker attraction to adult women, history of sexual abuse in the participants' own childhood, and the psychosocial effect of perceived stigma against pedophilia. In multivariable analysis, all these factors except education were uniquely associated with suicidal ideation. These results identify meaningful clinical risk factors and treatment targets in this population.