The German Dunkelfeld Project: A Pilot Study to Prevent Child Sexual Abuse and the Use of Child Abusive Images

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.

Similar Age Preference but Different Attentional Control in Mandatory Hospitalized Individuals who Have Committed Sexual Offenses Against Children and Non-hospitalized Individuals With Self-Reported Sexual Interest in Children

Thirty-two forensic persons who have committed sexual offenses against children (FP-SOC), 26 non-forensic persons of whom most have committed sexual offenses against children (NFP-SOC), 14 forensic persons who have not committed sexual offenses against children but have committed other offenses (FP-NSOC), and 53 non-forensic persons who have not committed sexual offenses against children (NFP-NSOC) were instructed to solve a cognitive task, while sexual distractors were presented simultaneously. Behavioral performance and eye movements were measured. FP-SOC and NFP-SOC exhibit same age preference patterns for children and adults, but both groups differ significantly with respect to sexual attentional control. Moderate discrimination accuracy and moderate effect sizes resulted for sexual interest, and good discrimination accuracy and large effect sizes were found for attentional control. Good attentional control in the NFP-SOC, probably reflecting superior sexual self-control and self-regulation abilities, might contribute to a better recognition and control of environmental factors in sexual risk situations, preventing them from being detected and convicted. Otherwise, strong cognitive distortions might serve for them as offense justification. We conclude that those non-forensic persons with sexual offense histories against children (NFP-SOC) with sexual interest in children, good attentional self-control and strong cognitive distortions represent a problematic group which should receive more attention regarding further research but also therapy. Future studies should include more suitable and larger control groups, appropriate instruments to measure independent variables, and investigate whether different classifications of pedophilic interest would be better suited to describe the eye movement patterns of our study participants.

Preventing Child Sexual Abuse and the Use of Child Sexual Abuse Materials: Following up on the German Prevention Project Dunkelfeld

Sexual interest in minors (i.e., pedophilia and hebephilia) is considered a risk factor for Child Sexual Abuse (CSA) and the use of Child Sexual Abuse Material (CSAM). This study examined the long-term development of CSA, CSAM use, associated cognitions, and quality of life among self-referred, help-seeking individuals diagnosed with pedophilic or hebephilic disorder (PHD) outside the judicial system. Of the 110 eligible men who had undergone therapy for PHD due to psychological distress or risk of offending, 56 were available for follow-up assessment 1-11 years after treatment. Behavioral manifestations, offense-supportive cognitions, and quality of life were evaluated using interviews and psychometric measures. At follow-up, 7.7% of participants with a history of CSA had re-offended, whereas 89.1% of previous CSAM users reported recidivism, although with less severe material. No new CSA offenses occurred among those without prior CSA. Treatment led to increased cognitive victim empathy and reductions in CSA-supportive and CSAM-supportive attitudes, but only the latter improvement persisted through follow-up. Participants exhibited elevated CSA-supportive attitudes relative to community norms at all time points and diminished quality of life at follow-up. Pedophilic and hebephilic disorder carry a persistent risk of sexual offending, particularly regarding CSAM use. Therapeutic gains in offense-supportive cognitions may erode over time without ongoing care. A comprehensive public health approach encompassing early detection, prevention, and expanded treatment access that addresses both the risk of reoffending and overall well-being is crucial for reducing sexual victimization and improving mental health outcomes for individuals from this target group.

Sexual fulfilment, wellbeing and risk considerations for people with sexual attractions to children

Research focused on understanding the experiences of individuals with sexual attractions to children and their pursuit of sexual fulfilment faces notable limitations, primarily stemming from ethical and legal challenges, and pervasive social stigma. This review paper explores these challenges and outlines the connections between sexual fulfilment, treatment goals and overall wellbeing. We consider the importance of sexual satisfaction in promoting mental and physical health, and its potential role in reducing the risk of sexually abusive behaviors. Recognizing that promoting healthier and more fulfilling lives extends beyond risk mitigation, the paper highlights future research avenues such as exploring the conceptualization and achievement of sexual satisfaction. In examining alternative perspectives, including the potential risk enhancement associated with achieving sexual fulfilment, we also argue the need for an evidence-based approach and robust research agenda to inform and guide interventions. Through these considerations, the paper aims to encourage a more informed and compassionate understanding of sexual fulfilment for people with sexual attractions to children.

A randomized controlled add-on trial of fluoxetine and cognitive behavioral therapy for help-seeking men with a sexual interest in children: presentation of the PARACHUTES trial protocol and initial feasibility data

Background

Sexual Interest in Children (SIC) is a major risk factor for sexual offending, yet clinical trials are sparse. The present protocol outlines a randomized controlled trial (RCT) that aims to investigate the effectiveness of fluoxetine and Cognitive Behavioral Therapy (CBT) in help-seeking men with SIC.

Methods

Adult men contacting the Swedish telephone helpline PrevenTell are screened for inclusion and invited to further assessment on site. One hundred and eleven men with SIC (defined as DSM-5 pedophilic disorder or hebephilia) will be randomized (1:1:1 ratio) to receive one of three interventions for 14 weeks: (1) an internet-administered psychoeducational program (iPP), (2) iPP and the addition of fluoxetine 20-40 mg or (3) iPP and the addition of internet-administered CBT (iCBT). Exclusion criteria include severe psychiatric illness, contraindicating treatment and an elevated risk of committing hands-on sexual offences. Symptom intensity is assessed at baseline, pre-treatment, every other week for 12 weeks, and post treatment. The primary outcome measure is the Sexual Interest in Children: Current Assessment Scale (SIC: CAS) that quantifies sexual behaviors associated with SIC as well as perceived distress and impairment. Secondary outcomes include measures of dynamic risk-factors for committing sexual offences.

Results

The data collected during the initial 20 months of recruitment were analyzed to predict the required number of individuals to be screened and estimate the probable length of the data collection phase. As of March 2022 to November 2023, 146 men have called PrevenTell and disclosed a sexual interest in minors. Following pre-screening, 110 men were excluded from participation in the trial. Current SSRI therapy was the primary reason for exclusion (n = 24; 22%), followed by an elevated risk of committing hands-on sexual offences (n = 14; 13%). Among the 31 men who underwent the screening procedure on site, 26 were allocated to either iPP, iPP+fluoxetine, or iPP+iCBT. The recruitment rate indicates that the trial will be concluded within the pre-estimated timeframe.

Discussion

This is the first RCT of treatment with SSRI and iCBT in a population of help-seeking men with SIC. The significance of this trial and its methodological strengths and limitations are discussed.

The Relevance of Hypersexuality and Impulsivity in Different Groups of Treatment-Seekers With and Without (Exclusive) Pedophilia

Hypersexuality and impulsivity are regarded as risk factors for sexual offending against children. Studies exploring these factors in undetected men who offended or are at risk of offending are rare. This study aims to investigate hypersexuality and impulsivity in treatment-seeking men with and without a diagnosis of (exclusive) pedophilia who committed child sexual abuse (CSA), consumed child sexual abuse images (CSAI), or feel at risk of offending sexually. Data were obtained from three child abuse prevention projects in Bamberg, Germany. We employed self-report (BIS-11, HBI), objective measures (TSO), and risk assessment tools (STABLE-2007). We computed Bayesian ordinal logit and binomial generalized linear models to explore differences between groups and to predict lifetime CSA and CSAI. Hypersexuality scores were particularly pronounced in patients with exclusive and non-exclusive pedophilia. Patients without pedophilia scored similarly to nonclinical samples. Impulsivity measures did not consistently differ between groups. We could not predict lifetime CSA and CSAI using impulsivity and hypersexuality measures. Sexual rather than general impulsivity seems to be an issue in men with pedophilia. The motivation to offend in patients without pedophilia is discussed.

Accessing child sexual abuse material: Pathways to offending and online behaviour

BACKGROUND

Most research examining the consumption of online child sexual abuse material (CSAM) has focused on offenders' demographic and psychological characteristics. While such research may assist in the development of therapeutic interventions with known offenders, it has little to offer the development of interventions for the vast majority of offenders who are never caught.

OBJECTIVE

To learn more about the offending strategies of CSAM offenders, in order to inform prevention efforts to deter, disrupt, and divert individuals from their pursuit of CSAM.

PARTICIPANTS & SETTING

Seventy-five male CSAM offenders, who were living in the community and were voluntarily participating in a treatment programme.

METHODS

Participants completed a detailed self-report questionnaire focussing on their pathways to offending and their online behaviour.

RESULTS

Most participants reported that they did not initially seek out CSAM but that they first encountered it inadvertently or became curious after viewing legal pornography. Their involvement in CSAM subsequently progressed over time and their offending generally became more serious. The most notable feature of participants' online behaviour was the relative lack of sophisticated technical expertise. Opportunity and other situational factors emerged as mediators of offending frequency. Offending patterns were affected by participants' psychological states (e.g., depression, anger, stress), offline relationships and commitments (e.g., arguments with spouse, loss of job), and online experiences (e.g., blocked sites, viruses, warning messages).

CONCLUSIONS

Findings suggest that many offenders are receptive to change and may be potentially diverted from their offending pathway.

The Need for a Prevention Program for Child Sexual Abuse in Brazil: A Report of Shortfall Care to Pedophilia and its Critical Consequences

From a case report of a person with pedophilic disorder, this paper focuses on the issue of pedophilia, child sexual abuse, and the need for specific prevention and treatment strategies in Brazil. It seems inevitable to increase awareness for this topic within the mental health care system to protect children and reduce the risk for sexual offense in individuals at-risk. This is a case report of an individual, known by medical-psychiatric and forensic facilities for a past history of patricide, who revealed his pedophilic fantasies and behavior belatedly. To assess a pedophilic disorder and screen for other paraphilic contents, a screening questionnaire and clinical interview were used during the patient hospitalization in 2020 for a proper evaluation of sexual history and past offending behaviors. A review of the literature on pedophilia prevention programs was also carried out. WW is a middle-aged man admitted to a psychiatric unit for a severe episode of major depressive disorder and at risk of suicide. During recovery, he reported pedophilic fantasies and behaviors in his life. Sexual fantasies involving children and actual sexual offenses have remained unknown to mental health professionals and unreported to legal authorities. WW's case alarmingly emphasizes the need for the training of health care professionals and for preventive strategies in Brazil for those who are at risk of engaging in offending sexual behaviors in a combined and intensive effort to protect children from sexual offense.

Evaluating Child Sexual Abuse Perpetration Prevention Efforts: A Systematic Review

Many child sexual abuse prevention efforts focus on the prevention of victimization, through education of children and parents, bystander training, and policies and practices in youth-serving organizations (e.g. requiring criminal record checks). However, there has been growing attention to child sexual abuse perpetration prevention, targeted at individuals who are at risk of perpetration. We conducted a systematic review of studies reporting outcomes for child sexual abuse perpetration prevention interventions. Only seven studies were identified in our review, with five intended for adults and two intended for children. Four of the five adult studies had significant methodological concerns, precluding strong conclusions from these studies. We concluded that higher-quality evaluations of perpetration prevention efforts are greatly needed. We also identified intrafamilial perpetration prevention, particularly interventions for parents or caregivers, as a critical gap in the literature. Suggestions for child sexual abuse perpetration intervention evaluation and delivery are discussed.

Originalbeiträge (Originals). Der Zusammenhang zwischen der Strukturachse nach OPD-2 und dem statischen/dynamischen Risiko für das Begehen von sexuellem Kindesmissbrauch bei 30 Männern mit sexuellem Interesse an Minderjährigen aus dem Dunkelfeld – eine Pilotstudie

The Relation between the OPD-2 Axis Structure and the Static/Dynamic Risk for Committing Child Sexual Abuse in a Sample of 30 Men with Sexual Interest in Minors from the Dark Field - A Pilot Study Objectives: The present pilot study examined the relation between the OPD-2 axis structure of 30 men with a sexual interest in minors from the dark field and their static and dynamic risk factors for committing child sexual abuse.

METHODS

Two independent raters estimated the structural dimensions based on notes from outpatient psychotherapy sessions using the OPD-2 structure checklist.The interrater reliability of the structural data was moderate. Pearson/Spearman correlations between these structural data and the previously assessed static and dynamic risk were calculated.

RESULTS

Attachment was the only structural dimension to correlate significantly positively moderately with the dynamic risk.The less integrated the structural dimension of attachment was, the more pronounced the dynamic risk was.

CONCLUSIONS

The correlation between the structural dimension of attachment and the dynamic riskmay provide first indications of the potential of structure-oriented psychotherapeutic interventions formodifying dynamic risk in individuals with a sexual interest in minors from the dark field. The limitations of the methodological approach constrain the significance of the findings, prompting further research on the relation between structure and risk.

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.

International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications

BACKGROUND

Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence.

OBJECTIVE

The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations.

RESULTS

Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children.

DISCUSSION

Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.

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.

"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.

Fantasy Sexual Material Use by People with Attractions to Children

PURPOSE OF REVIEW

With the Internet allowing consumers easy access to fantasy and fictional sexual materials (FSM), it is becoming increasingly important to understand the context of their use among specific populations. Of particular, social, clinical, and legal interest is FSM use by people who are attracted to children and whether this may have a risk-enhancing or protective impact on their likelihood of committing a contact or non-contact sexual offence.

RECENT FINDINGS

There is a lack of data currently available in relation to the use of FSM by those with sexual attractions to children. Evidence from allied areas appears to show no meaningful associations between FSM use and sexual aggression. We propose a novel research program and some initial research questions that provide a theoretical framework for more evidence-based inquiry on FSM use by people who experience attractions to children.

Hypothalamic volume in pedophilia with or without child sexual offense

The hypothalamus regulates sexual behavior and is simultaneously associated with aggression and violence. Consequently, this brain region is relevant in research of pedophilia and child sexual offenses (CSO). The distinction between these two phenomena is of great importance and was the object of consideration of this study. We analyzed exclusively men, including 73 pedophilic offenders who committed CSO, an equal number of people with pedophilia but without such offenses, and 133 non-pedophilic, non-offending subjects who formed the control group. All data were collected in a multicenter in vivo study and analyzed using a semi-automated segmentation algorithm for 3-Tesla magnetic resonance images. Men with pedophilia who committed CSO on average had a 47 mm3 smaller hypothalamus per side than people without committed CSO. This effect was driven by both the group of non-offending people with pedophilia and the control group. By contrast, the exploratory comparison of pedophilic persons without CSO with the control group showed no significant difference. The present study demonstrates a deviant hypothalamic structure as a neurobiological correlate of CSO in pedophiles, but not in people with pedophilia who have not committed CSO. Thus, it strengthens the argument to distinguish between sexual offending and paraphilic sexual preferences.

Is the Affordable Care Act Medicaid Expansion Associated With Reported Incidents of Child Sexual Abuse?

There is substantial evidence that adequate access to healthcare among low-income adults through the Affordable Care Act Medicaid expansion mitigates risk factors associated with childhood maltreatment, including parental financial insecurity, substance use, and poor mental health. Indeed, studies identified reduced reports of child neglect in states that expanded Medicaid, relative to those that did not. However, it is unknown whether Medicaid expansion is associated with reported child sexual abuse (CSA). We present findings from a study evaluating the association of Medicaid expansion with incidents of CSA reported to child protective services. Using a difference-in-differences approach, we analyzed data from the National Child Abuse and Neglect Data System to examine the effects of state-level adoption of the Medicaid expansion on CSA reports per 100,000 children across 2008-2018. Results indicated no statistically significant association between Medicaid expansion and CSA incidents. We discuss potential reasons for differential association of macro-level policies on types of child maltreatment.

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.

Realization, Self-View, and Disclosure of Pedophilia: A Content Analysis of Online Posts

In order to treat individuals with pedophilia¹ who are at risk of committing offenses, disclosure of the attraction must first take place. The aim of this study was to understand processes of initial recognition of pedophilic attraction, disclosure, and help-seeking. We conducted a qualitative content analysis of online posts from self-identified individuals with pedophilia, finding four categories: (1) Awareness and Initial Self-View (with emotions including denial, shame, and fear), (2) Disclosure (typically made to family, friends, or therapists, but also done online in an anonymous way), (3) People's Reactions to Disclosure (ranging from rejection to support), and (4) Current Self-View (including minimization, distortions, despair, resignation, and non-offending/anti-contact commitment). Our findings highlight the internal process experienced by individuals with pedophilia when first recognizing their attraction to minors, what is involved in disclosure, the importance of others' reactions after disclosure, and the factors that can reinforce a non-offending commitment. Clinical and social implications are discussed.

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.

Pedophilia: social, legal and medical aspects

Sexual abuse against children causes a real public response that supports active discussions on the problem of sexual actions against minors both in the legislation, where new legal norms are proposed to regulate and prevent such offensive behavior, and in the medical community, since in some cases the mechanisms of such offenses are associated with specific forms of mental pathology. The aim of this article was the evaluation of the medical, legal and social aspects associated with pedophilia and its role in criminal sexual behavior. Materials and methods. This review included the most influential works in the field of sexology and sexual pathology, official materials of the World Health Organization and the American Psychiatric Association, legal and medical statistical reports. In the result this review reveals the place of pedophilia in mental disorders, the necessity of taking into account current data on the prevalence of abnormal sexual interests in population for work with it, as well as the importance of considering sexual crimes against minors in a broader context, the need to develop psychotherapeutic and preventive approaches.

A Review of Childhood Sexual Abuse Perpetration Prevention Programs

PURPOSE OF REVIEW

The present review examines existing childhood sexual abuse prevention programs that are focused on providing services to individuals who are at risk of perpetration. We describe several perpetrator-oriented prevention programs with evaluation data as well as avenues for future development and research.

RECENT FINDINGS

Perpetration prevention programs can be divided into anonymous and non-anonymous programs. Anonymous programs include those that provide support via helplines and those that provide self-guided digital interventions. Non-anonymous programs provide traditional psychotherapy. There are several prevention programs with limited evaluation data, but no research to date has aggregated these findings and provided a comprehensive assessment of perpetration prevention. There is insufficient evidence to determine whether perpetration prevention programs are effective. More rigorous evaluations of secondary prevention programs are needed. Despite this, early data suggests that perpetration prevention programs are promising.

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.

Creating Honeypots to Prevent Online Child Exploitation

Honeypots have been a key tool in controlling and understanding digital crime for several decades. The tool has traditionally been deployed against actors who are attempting to hack into systems or as a discovery mechanism for new forms of malware. This paper presents a novel approach to using a honeypot architecture in conjunction with social networks to respond to non-technical digital crimes. The tool is presented within the context of Child Exploitation Material (CEM), and to support the goal of taking an educative approach to Internet users who are developing an interest in this material. The architecture that is presented in the paper includes multiple layers, including recruitment, obfuscation, and education. The approach does not aim to collect data to support punitive action, but to educate users, increasing their knowledge and awareness of the negative impacts of such material.

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.

Sexual preference for prepubescent children is associated with enhanced processing of child faces in juveniles

Child sexual abuse offences (CSOs) represent a severe ethical and socioeconomic burden for society. Juveniles with a sexual preference for prepubescent children (PP) commit a large percentage of CSOs, but have been widely neglected in neuroscience research. Aberrant neural responses to face stimuli have been observed in men with pedophilic interest. Thus far, it is unknown whether such aberrations exist already in PP. A passive face-viewing paradigm, including the presentation of child and adult faces, was deployed and high-density electroencephalography data were recorded. The study group comprised 25 PP and the control group involved 22 juveniles with age-adequate sexual preference. Attractiveness ratings and evoked brain responses were obtained for the face stimuli. An aberrant pattern of attractiveness ratings for child vs. adult faces was found in the PP group. Moreover, elevated occipital P1 amplitudes were observed for adult vs. child faces in both groups. At longer latency (340-426 ms), a stronger negative deflection to child vs. adult faces, which was source localized in higher visual, parietal and frontal regions, was specifically observed in the PP group. Our study provides evidence for enhanced neural processing of child face stimuli in PP, which might reflect elevated attention capture of face stimuli depicting members from the sexually preferred age group. This study expands our understanding of the neural foundations underlying sexual interest in prepubescent children and provides a promising path for the uncovering of objective biomarkers of sexual responsiveness to childlike body schemes in juveniles.

Neural processing associated with Cognitive Empathy in Pedophilia and Child Sexual Offending

Behavioral studies found evidence for superior cognitive empathy (CE) in pedophilic men without a history of child sexual offending (P-CSO) compared to pedophilic men with a history of CSO (P+CSO). Functional magnetic resonance imaging (fMRI) studies also point to differences between P-CSO and P+CSO. Neural processing associated with CE has not yet been investigated. Therefore, the present study aimed to explore the neural correlates of CE in subjects with pedophilia with (P+CSO) and without (P-CSO) child sexual offending. 15 P+CSO, 15 P-CSO, and 24 teleiophilic male controls (TC) performed a CE task during fMRI. We observed reduced activation in the left precuneus (Pcu) and increased activation in the left anterior cingulate cortex (ACC) in P-CSO compared to P+CSO. P-CSO also showed stronger connectivity between these regions, which might reflect a top-down modulation of the Pcu by the ACC toward an increased self-focused emotional reaction in social situations. There was also evidence for increased right superior temporal gyrus activation in P-CSO that might constitute a potentially compensatory recruitment due to the dampened Pcu activation. These findings provide first evidence for altered neural processing of CE in P-CSO and underline the importance of addressing CE in pedophilia and CSO in order to uncover processes relevant to effective prevention of child sexual abuse.

Discipline as Prevention: Psychoeducational Strategies in Internet Sexual Offending Group Programs

This paper analyzes a UK-based psychoeducational intervention for users of online child sexual exploitation material (CSEM). It is founded on 17 months of anthropological research in group programs with 81 participants and 15 staff. The article argues that group exercises help participants reframe knowledge about their offending, and ultimately reinforce the theoretical concept of discipline (Foucault) toward internal and external surveillance, normalization, and decreased risk. The paper first discusses factors participants believed contributed to offending. It then analyzes the program and participants' experiences, focusing on exercises about the mind (fantasy), Internet usage (disclosure and relationships), needs met by offending (Good Lives and true needs), and planning for the future (relapse prevention). Critical is that participants are encouraged to reengage offline lives and enact discipline on and to the online world. Thus, the article ends with an anthropologically-minded discussion about digital norms, online morality, and implications for Internet offender psychoeducational practice.

Identifying the Coping Strategies of Nonoffending Pedophilic and Hebephilic Individuals From Their Online Forum Posts

Individuals who identify as pedophilic or hebephilic, and who do not offend, are increasingly visible in online discourse and as a focus of research. Developing knowledge about this population will offer insights into their psychological needs and, potentially, into the mechanisms and strategies individuals use to live offense-free lives. This study examined coping strategies among members of an online forum supporting pedohebephilic individuals who do not wish to offend. Forum users' posts were analyzed using thematic analysis. Eleven themes emerged, which were classifiable into three superordinate themes around (a) the acceptance of pedophilia, (b) strategies to stay safe, and (c) dealing with sexual arousal. These themes offer insight into the varying strategies used by these individuals to cope with stress and/or to remain offense-free. Understanding whether these strategies are adaptive or maladaptive may help develop better support services for those who have not offended and may inform prevention efforts.

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.

Collecting and viewing behaviors of child sexual exploitation material offenders

BACKGROUND

The collecting behaviors of child sexual exploitation material (CSEM) offenders provide insight into their cognitions and motivations that have clinical applications.

OBJECTIVE

This study analyzed the CSEM collecting and viewing behaviors of previously convicted offenders.

PARTICIPANTS AND SETTINGS

A postal letter soliciting participation in an online survey was sent to adults previously convicted of CSEM offenses in the United States. Comparison information from a non-offending population of adults within the United States (N = 524) was collected and compared to the CSEM respondents (N = 78).

METHOD

A mixed-methods approach was utilized. The CSEM group was compared to a gender-matched sample from the non-offending group for general adult sexual exploitation material (SEM) viewing. Exploratory analyses of CSEM offender behaviors related to collecting, collection diversity, and recidivism were conducted.

RESULTS

The majority (78%) of the offenders did not organize their content and 74% deleted their entire collection on at least one occasion. Offenders viewed more diverse categories of adult SEM than non-offenders, including more bestiality, hentai, teen, and nudist/naturist material. None of the offenders viewed CSEM exclusively, and 74% viewed more adult SEM than CSEM. The age range of CSEM content viewed did not support highly preferential viewing but did support general novelty seeking. The self-reported recidivism rate was 10%, with infrequent post-conviction CSEM activity.

CONCLUSION

Treatment professionals should not assume that pedophilic interests are the sole or even primary motivator for CSEM behavior. Problematic Internet usage, general pornography consumption, coping issues, or novelty seeking may be more appropriate targets for some offenders.

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.

Long term consequences of child sexual abuse in Saudi Arabia: A report from national study

Child Sexual Abuse (CSA) is a global public health problem that has been found to be linked to negative health outcomes. The aim of this study is to examine the prevalence of different forms of CSA and its impact on chronic diseases, mental health disorders, and health-risk behaviors among adults in Saudi Arabia (SA). A cross-sectional, national survey utilizing Adverse Childhood Experiences International Questionnaire (ACE-IQ) was conducted in SA. Adults (N=10,156) aged ≥18 years were invited to participate. The relationship between CSA variables and outcomes were calculated. The prevalence of life time CSA was 20.8%. Participants who reported CSA had 1.7, 2.2, and 3.8 times the odds of diabetes, coronary heart disease, and obesity diagnosis respectively compared to participants with no CSA. Regarding mental health disorders, CSA had 3.0, 2.6, and 4.1 times the odds of a depression, anxiety, and other mental illness diagnosis respectively. Those reported CSA were identified as having 2.0, 5.5, 5.8, 7.9, and 7.2 times the odds of being a smoker, drinking alcohol, using drugs, out of wedlock sexual relations, and suicidal thoughts respectively. In comparing males and females with CSA, males had the highest odd ratio (5.2) for obesity among the physical and mental health disorders and female had the highest OR (10.7) in out of wedlock sexual relations among the health- risk-behaviors. CSA is a common hidden phenomenon in SA, efforts should be strengthened to increase awareness on consequences, and outcomes in order to build prevention programs.

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.

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

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

Differences in Sexual Interest in Children Between Men Who Commit Undetected Versus Detected Sexual Offenses

This study examined whether men who committed undetected sexual offenses would show more evidence of sexual interest in children than their detected counterparts. It also considered whether denial or minimization of offending history explained observed differences between undetected and detected men. In an archival database of 2,236 men, 96 were undetected and the remainder were detected men who varied in the extent to which they admitted their offending: complete deniers, partial deniers, those who admitted their offense history, and those who disclosed additional unknown offenses. There were differences in self-reported sexual interest in children, but relatively few differences when sexual interest in children was assessed by phallometry or sexual victim history. There were no differences between undetected and detected men who admitted to additional victims. The results suggest that denial is likely more important in understanding group differences on sexual interest in children than detection status.

Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data

BACKGROUND

Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively).

OBJECTIVE

The aim of this study was to describe the characteristics of the users of the Troubled Desire app.

METHODS

The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire.

RESULTS

The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities.

CONCLUSIONS

The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending.

Mandated or Voluntary Treatment of Men Who Committed Child Sexual Abuse: Is There a Difference?

Child sexual abuse is associated with multiple and often severe consequences for people who are affected by it. From the perspective of indicative prevention, the treatment of people who have sexually abused children represents one important strategy, with the assumption that there is often a risk for sexual recidivism. However, there is still very limited knowledge about how men who have not been convicted of child sexual abuse but participate in voluntary treatment (here called non-forensic clients) differ from those who have been convicted and undergo mandated treatment (here called forensic clients). This study compared 22 forensic and 22 non-forensic clients regarding pedophilic interests, static and dynamic risk factors, responsivity features, and treatment progress during an individualized treatment based on the principles of risk, need, and responsivity. We found neither differences in the rates in the DSM-5 diagnosis of pedophilic disorder, nor in risk and responsivity associated scores at the beginning of treatment. In both groups, a low to moderate risk for sexual re-offending was estimated. Both groups improved their functioning on dynamic risk and responsivity factors under treatment, while age at the beginning of therapy also had a positive effect on all outcomes. Non-forensic clients had a higher amount of responsivity associated resources than forensic clients during treatment. The limitations of these results and their implications for further research and prevention approaches are discussed.

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 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.

Sexual Attraction and Falling in Love in Persons with Pedohebephilia

Few studies of pedophilia or hebephilia have included questions about romantic attraction. We conducted an anonymous online survey of 306 men who self-reported as sexually attracted to children. The majority (72%) of participants reported they had fallen in love with a child in their lifetime. Participants reported greater feelings of attachment to children than feelings of infatuation. Though sexual attraction and falling in love were strongly correlated, they were not synonymous. Participants who reported pedohebephilia (defined in this study as attraction to prepubescent and pubescent children) were more likely to have fallen in love with a child than participants who reported pedohebe-ephebophilia (defined as attraction to prepubescent, pubescent, and post-pubescent minors). Also, participants with an exclusive attraction to children were more likely to have fallen in love with a child than participants who were equally attracted to children and adults. The results of this study were consistent with the suggestion of Seto (2012) that pedohebephilia could be considered a form of sexual orientation for age, which includes both sexual and romantic attraction.

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.

A method yielding comparable estimates of the fraternal birth order and female fecundity effects in male homosexuality

The fraternal birth order effect (FBOE) is the finding that older brothers increase the probability of homosexuality in later-born males, and the female fecundity effect (FFE) is the finding that the mothers of homosexual males produce more offspring than the mothers of heterosexual males. In a recent paper, Khovanova proposed a novel method for computing independent estimates of these effects on the same samples and expressing the magnitude and direction of the effects in the same metric. In her procedure, only families with one or two sons are examined, and daughters are ignored. The present study investigated the performance of Khovanova's method using archived data from 10 studies, comprising 14 samples totalling 5390 homosexual and heterosexual subjects. The effect estimate for the FBOE showed that an increase from zero older brothers to one older brother is associated with a 38% increase in the odds of homosexuality. By contrast, the effect estimate for the FFE showed that the increase from zero younger brothers to one younger brother is not associated with any increase in the odds of homosexuality. The former result supports the maternal immune hypothesis of male homosexuality; the latter result does not support the balancing selection hypothesis.

Executive Functions and Social Cognition in Juveniles Who Have Sexually Offended

Although neuropsychological assessments provide valuable information for those working in forensic mental health, few neuropsychological studies concern persons who sexually offend, particularly juveniles who have sexually offended (JSO). It has been suggested that, contrary to current theories, executive function in JSO, as a group, is no more impaired than it is in juvenile delinquents in general. However, JSO with child victims seem to be more impulsive than JSO whose victims are peers or adults. To verify this potentially important (and unexpected) finding, a sample of adolescent males (N = 134; 15.6 ± 1.5 years old) that included JSO, general delinquents, and underprivileged nondelinquents was assessed using a battery of behavioral and psychological tests that focus on impulsivity. No difference was found between groups regarding higher order executive functions as measured with the Wisconsin Card Sorting Task but JSO with child victims were found to be the most impulsive subgroup as evidenced with the Iowa Gambling Task, the Stop-Signal Reaction Task, and the Impulsive scale of the Social Problem Solving Inventory. They also had the highest number of prescriptions for attention deficit hyperactivity disorder (ADHD) medication. These results, which contradict hypotheses derived from assessment of adult sex offenders, illustrate an important difference between the cognitive profiles of adult and juvenile males who sexually offended. They also confirm that JSO whose victims are children appear to be more impulsive.

@myTabu-A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol

Background: There is a high demand for evidence-based and cost-effective treatment concepts for convicted individuals who sexually abused children (ISAC) and individuals who consumed child sexual exploitation material (ICCSEM) under community supervision (CS). The @myTabu-consortium developed a guided web-based intervention for convicted ISAC and ICCSEM under CS consisting of six online modules targeting psychological meaningful risk factors. The study aims to evaluate the effectiveness of this guided web-based intervention in reducing dynamic risk factors and the risk to re-offend compared to a placebo condition. Furthermore, these dynamic risk factors are measured before and after every module to evaluate their individual effectiveness to reduce the respective risk factor as well as risk to re-offend. This clinical trial protocol describes the planned methods as well as the intervention concept. Methods: The methodological design is a placebo controlled randomized add-on trial (N = 582) with follow-ups at 8 points in time. The placebo condition controls for attention and expectation effects and comprises the same amount of modules with a comparable temporal effort as the experimental intervention. The trial is conducted as an add-on to community supervision as usually done. Primary outcomes are dynamic risk factors assessed by self-report risk assessment tools and officially recorded re-offenses. Discussion: To the best of our knowledge, the study is the first to compare the (cost-) effectiveness of a guided web-based intervention for convicted ISAC and ICCSEM under community supervision against a placebo condition. Methodological limitations (e.g., potential ceiling- or volunteers-effects) are discussed. Clinical Trial Registration: German Clinical Trial Register (DRKS 00021256). Prospectively registered: 24.04.2020.