Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

A Review of Academic Use of the Term "Minor Attracted Persons"

Although it originated within online pro-pedophile groups, the term "minor attracted person" (MAPs) has been adopted by some academic researchers as a neutral and non-stigmatizing alternative to the term "pedophile." The transferral of this term from pedophile advocates to academic scholarship has been highly controversial. Claims that the use of the term "minor attracted people" normalizes or endorses pedophilia deserve closer scrutiny. This paper is based on a rapid evidence review of all peer-reviewed papers between 2015 and 2023 that used variants of the term "minor attracted" in their title and/or abstract. After screening, 30 studies were identified for review. Our analysis took a thematic approach to understanding the construction and use of the term MAPs in this scholarship. The analysis found that the term MAPs was operationalized in different and contradictory ways, however, the literature broadly agreed that MAPs constitute an oppressed sexual minority who are subject to undue stigmatization and discrimination. We point to the similarities between this sympathetic framing of MAPs and the political goals of the pro-pedophile advocacy groups that created the term MAPs, and from which many MAPs studies recruit their research participants. The review concludes that, in the absence of adequate self-reflexivity and awareness of bias, academic collaborations with pro-pedophile groups can produce work that minimizes the risk and harm of child sexual abuse and has the potential to delegitimize child sexual abuse prevention and treatment efforts.

The Effectiveness of Educational Interventions for Mental Health Professionals in Reducing Stigmatization Toward People with Pedophilia: A Meta-Analysis

Mental Health Professionals (MHP) often harbor strong negative attitudes toward people with a sexual attraction to children, hindering the provision of essential treatment. This reluctance stems from pervasive stigmatization, contributing to mental health issues among people with pedophilia and exacerbating risk factors associated with child sexual abuse. Limited research and small sample sizes in prior studies underscore the need to conduct a meta-analysis, examining the effectiveness of educational interventions as a tool for reducing stigmatization toward people with pedophilia in MHP. Eight studies meeting specific inclusion criteria were identified through a literature search. These criteria included (a) peer-reviewed empirical, (b) quantitative data, (c) a focus on attitudes toward people with pedophilia, (d) a sample of MHP that might come in contact with people with pedophilia (or the general public), (e) the intervention is educational, (f) the educational intervention is based on people with pedophilia, (g) pre- and post-test data, and (h) be written in English. Comparable variables within these studies encompassed dangerousness, social distance, intentionality, deviance, punitiveness, anger, sympathy, and motivation to treat. The intervention significantly improved perceptions of dangerousness (d = 0.65), social distance (d = 0.33), intentionality (d = 0.38), and punitiveness (d = 0.77). However, it showed non-significant effects on deviance (d = 0.22), anger (d = -0.22), sympathy (d = -0.12), and motivation to treat (d = -0.04). These findings indicate that educational interventions can reduce MHP stigmatization toward people with pedophilia, especially with contact-based and sufficiently prolonged interventions.

Investigating child sexual abuse material availability, searches, and users on the anonymous Tor network for a public health intervention strategy

Tor is widely used for staying anonymous online and accessing onion websites; unfortunately, Tor is popular for distributing and viewing illicit child sexual abuse material (CSAM). From 2018 to 2023, we analyse 176,683 onion domains and find that one-fifth share CSAM. We find that CSAM is easily available using 21 out of the 26 most-used Tor search engines. We analyse 110,133,715 search sessions from the Ahmia.fi search engine and discover that 11.1% seek CSAM. When searching CSAM by age, 40.5% search for 11-year-olds and younger; 11.0% for 12-year-olds; 8.2% for 13-year-olds; 11.6% for 14-year-olds; 10.9% for 15-year-olds; and 12.7% for 16-year-olds. We demonstrate accurate filtering for search engines, introduce intervention, show a questionnaire for CSAM users, and analyse 11,470 responses. 65.3% of CSAM users first saw the material when they were children themselves, and half of the respondents first saw the material accidentally, demonstrating the availability of CSAM. 48.1% want to stop using CSAM. Some seek help through Tor, and self-help websites are popular. Our survey finds commonalities between CSAM use and addiction. Help-seeking correlates with increasing viewing duration and frequency, depression, anxiety, self-harming thoughts, guilt, and shame. Yet, 73.9% of help seekers have not been able to receive it.

Child sexual abuse and its determinants among children in Addis Ababa Ethiopia: Systematic review and meta-analysis

Child sexual abuse is a significant public health concern and a breach of basic human rights affecting millions of children each year globally. It is typically not reported by victims, hence it remains usually concealed. Except for single studies with varying reports, there is no national studies conducted on child sexual abuse in Ethiopia. Therefore, this review determined the pooled magnitude and determinants of sexual abuse among children in Ethiopia. Potential articles were searched from PubMed, Science Direct, Scopus, and Web of science using relevant searching key terms. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the quality of all selected articles. Data were analyzed using STATA Version 14 software. Publication bias was checked using Egger's test and funnel plot. Cochran's chi-squared test and I2 values were used to assess heterogeneity. A random-effects model was applied during meta-analysis. The pooled prevalence of sexual abuse among 5,979 children in Ethiopia was 41.15% (95% CI: 24.44, 57.86). Sex of children (OR: 2.14, 95%CI: 1.12, 4.06), smoking (OR: 4.48, 95%CI: 1.26, 76.79), khat chewing (OR: 3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22, 10.25) were the determinants of child sexual abuse. The main perpetrators of sexual abuse against children were neighbors, boy/girlfriends, family members, school teachers, and stranger person. Child sexual abuse commonly took place in the victim's or perpetrator's home, school, and neighbor's home. This review revealed that the magnitude of child sexual abuse in Ethiopia was relatively high and multiple factors determined the likelihood of sexual violence against children. Thus, policy-makers and concerned stakeholders should strengthen comprehensive sexual and reproductive health education to reduce the magnitude and consequences of child sexual abuse. Moreover, support with special attention should be given to children with mental illness and physical disabilities.

Looping Disruption: A Relational Mechanism Enhancing Treatment Readiness among Individuals Convicted of Sexual Offending?

Many convicted individuals do not enter or complete treatment programs in prisons, which limits effective rehabilitation and prevention of recidivism. Treatment readiness is suggested to be an important construct when addressing this problem. Nevertheless, the underlying processes (e.g., how readiness factors interact) are not well studied, and even less is known regarding readiness in the sub-population of individuals convicted of sexual offenses. This paper aims to open up the "black box" and explore psychosocial and context-specific processes behind treatment readiness from the vantage point of the individuals' lived experiences. In-depth interviews were conducted with 19 adult men convicted of sexual offenses in Swedish prisons, treatment participants (N = 13) as well as non-participants (N = 6). The thematic analysis illustrates readiness obstacles in terms of unintended antagonistic forces in the correctional system operating in the opposite direction of rehabilitative objectives. Nonetheless, a hypothesized relational mechanism, looping disruption, initiated by a non-punitive and supportive response (from prison staff, therapists, close ones, or inmates) to the convicted individual's negative behaviors or emotions, appeared to reverse such negative, punitive loops, contributing to the mobilization of treatment readiness. Implications for theory, policy, and practice are discussed.

"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.

The Potential for Anti-Stigma Interventions to Change Public Attitudes Toward Minor-Attracted Persons: A Replication and Extension of Jara and Jeglic's Study

From a public health perspective, ensuring access to, and uptake of, support services for people concerned about their sexual thoughts and behavior is essential to the prevention of child sexual abuse. However, public and fiscal support for these services can be adversely affected by negative preconceptions regarding minor-attracted persons (MAPs); negative stigma may also limit MAPs' engagement with such services. Using a randomized-control design, the present study replicated and extended a recent US study to test effects of different modes of educational messaging to reduce negative attitudes toward MAPs in Australia. Participants were recruited nationally via a Qualtrics XM online survey platform. The final sample (n = 178) were aged 18-84 (M = 47.57 years, SD = 17.34; 49% male). Participants completed the Attitudes Toward Minor Attracted Persons (ATMAP) scale prior to being randomly assigned to one of four conditions (written text [facts only]; written text [myth and facts]; info-video [myths and facts]; and control). Following intervention (or control) the ATMAP was readministered; those in experimental groups also completed a comprehension test. Mixed between-within subjects analysis of covariance revealed significant reductions in pre-post scores on the ATMAP scale, but no significant differences were found across intervention types, or the control. Scores indicated that older participants were less negative in their attitudes compared to younger participants, both before and after intervention. Findings suggest that educating the public may improve attitudes toward MAPs, but more knowledge is required on how to best disseminate messages to maximize impact.

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.

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.

10 years later: Revisiting Seto’s (2012) conceptualization of orientation to sexual maturity among pedohebephilic persons

Emerging research has examined the experiences of individuals who are sexually attracted to children. This study collected both quantitative and qualitative data from individuals with self-identified pedohebephilic attractions ( n = 116). Several analyses were used to assess whether the sample characteristics followed Seto’s (2012) conceptual outline of pedophilia as an orientation to sexual maturity. The three developmental characteristics of gender-based sexual orientation were explored using survey and interview data. Overlapping patterns with relation to the age of onset, expressions of both sexual and romantic attractions, and stability of such attraction over time were found. As noted by researchers and clinicians in this area, there are clear clinical implications associated with a shift in the conceptualization of sexual attraction to children. Such etiological conceptualizations are often poorly understood and/or conflated with sociocultural understandings and reactions. Despite resistance to such conceptualizations, the findings indicate that orientation to sexual maturity closely mirrors the developmental trajectory of gender sexual orientation, as outlined in Seto’s seminal paper.

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.

Challenges and Solutions to Implementing a Community-Based Wellness Program for Non-Offending Minor Attracted Persons

Child sexual abuse is a significant public health concern that has long-lasting consequences for victims and their families and poses a significant financial cost to the public. Prevention efforts, including sex offender treatment programs, are intended to prevent further instances of sexual abuse. Most sexual offenses, however, are committed by individuals who are not yet known as sexual offenders, and therefore traditional sex offender treatment programs fall short of this goal. It is crucial to provide services to people who may be at risk for committing a sexual offense and those who have not offended, including those individuals who are attracted to children. While primary prevention programs such as Prevention Project Dunkelfeld and Talking for Change have begun to address this issue internationally, there are significant barriers to providing preventive services of this nature to non-offending minor attracted persons (NOMAPs) in the United States. Barriers include concerns about mandated reporting laws, stigmatization, and lack of knowledge by therapists about MAPs. This paper explores these barriers and provides solutions for practitioners to offer services to this population. This paper includes the development of specific programming for non-offenders and specialized training for clinicians who work with non-offenders as used by The Global Prevention Project.

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

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

"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.

Can Nonoffending Pedophiles Be Reached for the Primary Prevention of Child Sexual Abuse by Addressing Nonoffending Individuals Who Are Attracted to Minors in the United States? New Strategies With The Global Prevention Project

This paper introduces a new prevention strategy against child sexual abuse (both offline and online) in the United States. The Global Prevention Project is a supportive treatment program designed for nonoffending minor-attracted persons who reside in the community. Attraction to minors and the underlying scientific terms (pedophilia/hebephilia) are discussed and a framework is provided for how to implement such a program in the United States. Our treatment modality is described to provide transparency in our clinical work. We discuss challenges encountered in this domain with possible solutions and the legal ramifications of preventing child sexual abuse behaviors by targeting nonoffending individuals.

Changing the paradigm: Using strategic communications to promote recognition of child sexual abuse as a preventable public health problem

Child sexual abuse (CSA) is common, severe, and substantively contributes to the global burden of disease through its impact on physical, mental, and behavioral health problems. While CSA is preventable through non-justice system response efforts, the vast majority of resources support criminal justice efforts to identify, prosecute, punish and monitor offenders after CSA has already occurred. Policy makers have not supported CSA prevention efforts in part because the public does not view CSA as a preventable public health problem. Here, we describe a program of research to be conducted to bridge the gaps between expert and public opinion about CSA as a preventable public health problem. We propose such research use a three-step approach to alter the way experts communicate about CSA to increase audiences' understanding of CSA as preventable. The three steps are: 1) identify consensus expert and public perspectives about CSA and the differences between these perspectives; 2) develop and test communication strategies to align public with expert perspectives; and 3) broadly disseminate validated communication strategies. Through this approach, we seek to develop and disseminate an informed communications strategy that effectively and accurately translates the science of CSA prevention to the public and the media.

The Association between Maladaptive Coping and Treatment Motivation in Individuals who are Sexually Attracted to Children Living in the Community

There is a need for community treatment programs for people who are sexually attracted to children, but individuals report difficulty accessing services. Individuals who are sexually attracted to children (n = 293) completed an online anonymous survey that revealed a significant positive association between maladaptive coping and two factors of the treatment motivation measure. The association between maladaptive coping and treatment motivation was attenuated at higher levels of ego dystonic distress/aversion. Results highlight the importance of targeting stigma toward those who are sexually attracted to children to increase treatment seeking behavior.

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.

Understanding and Challenging Stigma Associated With Sexual Interest in Children: A Systematic Review

The stigmatization of people with pedophilia was previously identified as a "blind spot" in stigma research. This systematic review updates and expands on Jahnke and Hoyer's 2013 review to understand (1) factors contributing to stigma toward people with sexual interest in children, (2) experiences of stigma, and (3) how stigma can be challenged and reduced. Thematic synthesis was used to analyze data from 35 studies from the United Kingdom, United States, The Netherlands, Germany, Canada, Norway, Australia, and New Zealand. Overarching themes were (1) misperceptions and stereotypes, (2) negative affective responses, (3) discrimination, (4) mental distress, (5) internalized public stigma, (6) negative effects of disclosure, and (7 and 8) informative and humanizing interventions. Findings highlighted substantial prevalence of stigma toward and amongst people with sexual interest in children, and methodological limitations of extant research. An agenda for future research is discussed, emphasizing how stigma can be challenged.

Designing Effective Digital Advertisements to Prevent Online Consumption of Child Sexual Exploitation Material

The necessity of developing effective and innovative primary prevention strategies is a pressing objective in stemming the harm caused by the production and consumption of child sexual exploitation material (CSEM). Digital media interventions - including search engine advertisements - hold promise as prevention tools to deflect potential users away from CSEM and redirect them to therapeutic services. This study aimed to establish an evidence base for effective advertising in this context by creating mock-up helpline advertisements and testing them in focus groups and interviews with staff and clients of New Zealand's major treatment service providers for harmful sexual behavior. Prior to testing these advertisements in situ (on online platforms), this paper reports on a foundational creative and qualitative investigation of effective advertisements - what imagery, text, and design features are most likely to succeed in diverting people away from seeking CSEM and encouraging them to reach out to a helpline? The findings of this study offer deeper understanding of the mindset, emotions, and barriers to reaching out that are experienced by onset CSEM users, as well as suitability of certain imagery and text for advertising in this context, and thereby contribute to strengthening primary prevention efforts in combatting CSEM consumption.

An Exploration of Service Providers' Experiences With Latinos Convicted of a Sex Offense

Despite the growing Latino presence in the U.S. criminal justice system and among those who have committed sex offenses specifically, little is known about the barriers and challenges faced by this population when accessing treatment services. This study sought to gather more information about responsivity factors that may be specific to Latinos who have committed sexual offenses. Service providers who worked with Latinos convicted of sexual offenses completed an online survey and answered questions regarding perceived challenges and barriers they encountered when working with Latino clients and were asked to provide recommendations concerning services and treatment provision. Service providers frequently reported issues related to a lack of culturally sensitive services, bilingual professionals, and clients' limited knowledge about the U.S. legal system. Among service providers with experience working with undocumented Latino immigrants, some indicated specific challenges such as stressors related to their immigration status and a lack of resources. Professionals' recommendations were consistent with the challenges reported and findings are discussed as they pertain to responsivity issues in the provision of treatment services to Latino individuals who have committed sexual offenses.

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 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.

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.

Attenuation of Deviant Sexual Fantasy across the Lifespan in United States Adult Males

Deviant sexual fantasy is identified as a risk factor for sexual offending, yet no study has examined deviant sexual fantasy across the lifespan in nonoffending adult males. To bridge this gap, this study examined the frequencies of normative and deviant sexual fantasies among 318 nonoffending adult males in the United States. Participants were recruited via Amazon Mechanical Turk™. Participants took two inventories that assessed demographics and types of sexual fantasies. Normality tests, means tests, Kruskal-Wallis 1-way analyses of variance (ANOVAs), binary logistic regressions, and odds ratio post hoc analyses were conducted. Deviant sexual fantasies progressively declined across all three age groups, while normative sexual fantasy did not. Results suggest that deviant sexual fantasy changes across the lifespan. Applicability of the findings to applied settings, such as sexually violent predator evaluations, is discussed. Limitations and future considerations are addressed.

Child Sexual Abuse: The Need for a Perpetration Prevention Focus

In the evolution of efforts to reduce child sexual abuse (CSA) rates in the United States, there has been a gradual shift to add preventive measures to after-the-fact interventions (i.e., interventions and policies implemented after the abuse has already happened, such as services and treatment for victims and punishment, treatment, and management of offenders). Prevention of CSA perpetration, however, is often missing from these efforts, despite decades of experts calling for broader prevention solutions. The current paper describes the scope of the problem of CSA, highlights problems with an over-reliance on after-the-fact interventions, and describes promising perpetration-focused CSA prevention interventions. While most existing preventive efforts focus on teaching children to protect themselves from incurring sexual harm, perpetration prevention efforts may hold more promise by addressing the onset of harmful behavior. As such, perpetration prevention efforts can contribute to a more robust and comprehensive approach to CSA - an approach that focuses on prevention of harm from occurring in the first place, as well as responding once harm has occurred.

Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder

Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.

Preventing Sexual Abuse: Perspectives of Minor-Attracted Persons About Seeking Help

The primary aim of this exploratory research was to gain information from minor-attracted persons (MAPs) about their (a) formal and informal experiences with help-seeking for minor attraction, (b) perceived barriers to seeking help for concerns about minor attraction, and (c) treatment priorities as identified by consumers of these services. A nonrandom, purposive sample of MAPs (n = 293, 154 completed all questions) was recruited via an online survey. Results show that 75% of participants did seek formal help from a professional; however, just less than half of them found the experience to be helpful. Characteristics of helpful therapeutic encounters included nonjudgmental attitudes, knowledge about minor attraction, and viewing clients in a person-centered and holistic way. Barriers to help seeking included uncertainty about confidentiality, fear of negative reaction or judgment, difficulties finding a therapist knowledgeable about MAPs, and financial constraints. Understanding or reducing attraction to minors were common treatment goals, but participants also prioritized addressing general mental health and well-being related to depression, anxiety, loneliness, and low self-esteem. Implications for effective and ethical counseling and preventive interventions for MAPs are discussed.

Non-Offending Minor-Attracted Persons: Professional Practitioners' Views on the Barriers to Seeking and Receiving Their Help

Individuals who are attracted to minors but have abstained from sexual offending (non-offending minor-attracted persons) are an under-researched, hard-to-reach population. The current study explored professionals' perspectives of the barriers this population faces in seeking and receiving help and how these barriers can be reduced. Twenty professionals read an original vignette and answered a series of questions via an online survey. Using an inductive thematic analysis, the accessibility of treatment and perceived risk of disclosure emerged as the main barriers to seeking and receiving help. To reduce these barriers a number of potential solutions were suggested, including increasing publicity, educating the public, and offering enhanced training to professionals. This research should bolster future efforts to prevent child sexual abuse and contribute to strategies focused on helping non-offending minor-attracted persons manage their attraction in a pro-social way.

Is Preventive Treatment for Individuals With Sexual Interest in Children Viable in a Discretionary Reporting Context?

This study explored the viability of preventive treatment services for individuals with sexual interest in children, in jurisdictions without mandatory reporting but where risk-related disclosures to authorities are permitted at therapists' discretion. Health professionals (N = 112) were surveyed regarding their comfort, confidence, knowledge of relevant legal provisions, and personal disclosure thresholds, in relation to a hypothetical scenario of a client confiding pedophilic interest to seek help. Findings were mixed regarding implications for prevention service viability. Despite the complexities of the legal and ethical context of the study setting (New Zealand), predictions regarding professionals' uncertainty in relation to their legal and ethical duties, and displaying a bias toward disclosing information to authorities when permitted, were not fully borne out, although pervasive knowledge inaccuracies and associated training needs were revealed. Instead, general tendencies among respondents were toward comfort, confidence, and the inclination toward maintaining client confidentiality. Yet, widespread variance within the sample, and individuals' thresholds appearing rather unpredictable on the basis of demographic or professional variables, highlights likely barriers for potential clients in feeling safe enough to come forward. Given that preventive treatment viability in this context relies on self-referral, it is suggested that a purpose-designed preventive treatment service, with clear accessible confidentiality and reporting policies that are well within the law, could be the best way forward for viable preventive treatment in discretionary reporting contexts.

Bioethical Issues and Secondary Prevention for Nonoffending Individuals with Pedophilia

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

Understanding Men's Self-Reported Sexual Interest in Children

A few studies have found that even in the general population, a minority of adults-men as well as women-report some sexual interest in a young age group. The purpose of the present study was to identify factors associated with self-reported sexual interest in children among a community-based sample of men. Using an online survey methodology, we examined the extent to which different types of childhood adversities (witnessing parental violence, sexual, physical, and emotional abuse), atypical childhood sexual experiences, and participants' self-reported likelihood of engaging in a variety of sexual behaviors (heightened sexual interest) were related to sexual interest in children (SIC) reported by a non-forensic/non-clinical sample of 173 men. Data were analyzed using hierarchical multiple regression. After controlling for physical and emotional abuse and witnessing parental violence, self-reported experiences of childhood sexual abuse (CSA) significantly increased the amount of variance explained in SIC scores. However, only early masturbation and current heightened sexual interests contributed significantly to the final model. Total variance explained by the model as a whole was 24% (adjusted R² = 20%). Early masturbation and heightened sexual interests significantly mediated the relationship between CSA and SIC scores. Findings add to the small but growing body of literature examining the etiology of pedophilic sexual interests in non-clinical samples.