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Margari A, De Agazio G, Marzulli L, Piarulli FM, Mandarelli G, Catanesi R, Carabellese FF, Cortese S. Autism spectrum disorder (ASD) and sexual offending: A systematic review. Neurosci Biobehav Rev 2024; 162:105687. [PMID: 38685290 DOI: 10.1016/j.neubiorev.2024.105687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
The relationship between autism spectrum disorder (ASD) and sexual offending (SO) is an overlooked issue, both in clinical practice and in research. Based on a pre-specified protocol (PROSPERO: CRD42024501598), we systematically searched Pubmed and Scopus, between January 1st, 1994 and January 12th, 2024, for articles related to SO in ASD. Study quality was assessed with study design-specific tools (Study Quality Assessment Tools, NHLBI, NIH). We found 19 relevant publications (five cross-sectional studies, two case-control studies, and 12 case reports). Seven of the studies were deemed of "good" quality, the rest as "fair". Included studies addressed three key aspects: 1) psychopathological characteristics of individuals with ASD that increase the risk of committing SO; 2) intervention strategies for individuals with ASD and SO; 3) involvement of individuals with ASD and SO in the justice system. Overall, while there is an increasing interest in this topic, more rigorous study designs, including randomised controlled trials, are needed to inform clinical practice and healthcare and social policies.
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Affiliation(s)
- Anna Margari
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy
| | - Gabriele De Agazio
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Marzulli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Maria Piarulli
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari "Aldo Moro", Bari, Italy
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Catanesi
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy
| | - Felice Francesco Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy.
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
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[Personality and therapy motivation of child sexual offenders]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 64:350-364. [PMID: 30829173 DOI: 10.13109/zptm.2018.64.4.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Personality and therapy motivation of child sexual offenders Objective: This pilot study examined the interrelationship between pathological narcissism, impaired personality organization, sexual delinquency, and therapy motivation from a psychoanalytic perspective in a sample of child sexual offenders. METHOD 42 forensic outpatients who had committed child sexual offenses completed a set of self-reports (PNI, IPO-16, ADP-IV, FPTM). RESULTS We found a positive correlation between pathological narcissism and impairment of personality organization. Though the levels of vulnerable narcissism were above average, no pathology of personality organization was present in this sample. Results also did not reveal a negative correlation between the severity of personality impairment and therapy motivation. The sample showed diverging results regarding correlations between narcissism and facets of therapy motivation: Higher levels of narcissism were associated with increased feelings of suffering but also denial of any need for help. CONCLUSIONS In this sample, a restrictive diagnosis of narcissistic personality disorders according toDSMand ICD criteria seems to underestimate their prevalence. The construct of therapy motivation should be adjusted to outpatient forensic treatment.
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Barra S, Bessler C, Landolt MA, Aebi M. Patterns of Adverse Childhood Experiences in Juveniles Who Sexually Offended. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2018; 30:803-827. [PMID: 29188752 DOI: 10.1177/1079063217697135] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Juveniles who sexually offended (JSOs) are differentially burdened with adverse childhood experiences (ACEs). The present study used Latent Class Analysis (LCA) to derive subtypes of JSOs according to their patterns of 10 different ACEs. An extensive file analysis of 322 male JSOs ( M = 14.14, SD = 1.94) revealed five subtypes with (a) multiple (9.0%), (b) mainly family related (17.1%), (c) mainly peer related (21.7%), (d) mainly neglectful (18.6%), and (e) little/no (33.5%) ACEs. Differences among ACE subtypes with regard to several offense and victim characteristics (e.g., the use of penetration or violence, the choice of a child, a male, a stranger, or multiple victims) were examined. Whereas no differences were found for the use of physical violence or the choice of male, stranger, or multiple victims, binary logistic regressions revealed associations of the multiple-ACE subtype with the choice of a child victim, the family-ACE subtype with the use of penetration as well as further nonsexual delinquency, the peer-ACE subtype with the use of penetration and the choice of a child victim, and the neglect-subtype with the choice of a child victim. Additional analyses including single ACE categories instead of LCA-derived subtypes supported these results. Findings highlight the need for a comprehensive consideration of ACEs in research and clinical work to understand developmental pathways to juvenile sexual offending.
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Affiliation(s)
- Steffen Barra
- 1 University Hospital of Psychiatry, Zurich, Switzerland
| | | | - Markus A Landolt
- 2 University of Zurich, Switzerland
- 3 University Children's Hospital Zurich, Switzerland
| | - Marcel Aebi
- 1 University Hospital of Psychiatry, Zurich, Switzerland
- 2 University of Zurich, Switzerland
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Scarpazza C, Pennati A, Sartori G. Mental Insanity Assessment of Pedophilia: The Importance of the Trans-Disciplinary Approach. Reflections on Two Cases. Front Neurosci 2018; 12:335. [PMID: 29867338 PMCID: PMC5964183 DOI: 10.3389/fnins.2018.00335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/30/2018] [Indexed: 01/14/2023] Open
Abstract
A 60 plus-year-old male was charged with pedophilia for forcing a child to touch him inappropriately near a primary school fence. In another case, a 70 plus-year-old male was charged with pedophilia for intimately touching a boy in a cinema. What led them to manifest this socially-inappropriate and legally-relevant behavior? Is there an explanation for the sexually-related behavioral changes emerging late in life of these two men? Indeed, a common point exists between the two men: both were found to suffer from highly-disabling neurological conditions, known to have a potential effect on social behavior. Specifically, a large right frontoparietal meningioma was found to have important influence on the first man's cognition and control inhibition, whereas frontotemporal dementia prevented the second man from understanding the moral disvalue of his sexually-inappropriate behavior and controlling his sexual impulses. In the current presentation, particular emphasis is placed on the logical reasoning supporting the conclusions that both the pedophiles should be considered not guilty by reason of insanity. Furthermore, experimental methods have been used to explore both cases, which rely on the existence of cognitive models for the phenomena under study, the integration of insights offered by different disciplines and the application of a variety of tools and approaches that follow the "convergence of evidence" principle, which could be safely used in court to support a mental insanity claim. Here, we describe how the use of the experimental method could become useful to reduce the uncertainty in mental insanity assessments. The use of a transdisciplinary, scientifically-grounded approach can help to change the way legal phenomena are interpreted. For instance, when assessing mental insanity, consultants should not only investigate the eventual existence of a diagnosis, but should assess the cognitive/affective abilities that are necessary to understand our own behavior and emotions as well as those of others. The criteria for responsibility should be symptoms-based and not diagnosis-based. Since pedophilia is among the most hideous behaviors condemned by society, a more comprehensive and transdisciplinary approach is recommended in court.
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Affiliation(s)
- Cristina Scarpazza
- Department of Psychology, University of Padua, Padova, Italy.,Department of Psychosis Studies, King's College Health Partners, King's College London, London, United Kingdom
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Huband N, Duggan C, McCarthy L, Mason L, Rathbone G. Defence styles in a sample of forensic patients with personality disorder. Personal Ment Health 2014; 8:238-49. [PMID: 25044783 DOI: 10.1002/pmh.1266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 04/30/2014] [Accepted: 06/02/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ego defences, often considered central to clinical work, have received surprisingly little attention in the forensic literature. METHOD In this exploratory study, 114 male inpatients completed the Defence Style Questionnaire (DSQ) following their admission to a specialist personality disorder (PD) service. Change in DSQ scores over time was examined using mixed effects models for those (n = 48) remaining in treatment for at least 18 months. RESULTS Defensive functioning at baseline was less mature in comparison with non-clinical norms, with two other non-forensic PD samples, and with a male paedophile sample, but was unrelated to criminal history. Axis II severity was negatively associated with overall defensive functioning (ODF). Antisocial PD was positively associated with a maladaptive defence style. Borderline PD was negatively associated with self-sacrificing defences. Avoidant PD was negatively associated with both self-sacrificing and adaptive styles. Non-completion of treatment was predicted by low ODF scores and high maladaptive defence style scores at baseline. ODF improved significantly over time in treatment and was predicted by strong antisocial and weak schizotypal PD pathologies. CONCLUSIONS Defence style, as measured by the DSQ, appears to have the potential to inform assessment and measure change in this group of offenders.
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Affiliation(s)
- Nick Huband
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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