Direct and indirect measures of sexual maturity preferences differentiate subtypes of child sexual abusers

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.

"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.

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

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

Impairment of Both Reward and Punishment Learning in Males Who Have Sexually Offended Against a Child

Prior studies suggest that persons with a sexual offense against a child (PSOCs) present with an impairment in learning from reinforcement, which may contribute to the behavioral dysregulation often seen in PSOCs. Therefore, gaining more insight into the nature of this impairment seems essential to better understand child sexual (re)offending. Using a passive avoidance task, we found that PSOCs (n = 57) have difficulties with selecting behaviors that are associated with reward and suppressing behaviors that are associated with punishment relative to nonoffending men (n = 33), but not compared with persons with a nonsexual offense history (n = 31). The latter ability was particularly compromised in nonpedophilic PSOCs. By unraveling a source of pathology in the mechanisms that are involved in behavioral control, this study helps setting a step toward new, more tailored, therapeutic approaches.

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.

Measuring Pedophilic Sexual Interest

INTRODUCTION

Pedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of established techniques aimed at assessing people with sexual interest in children.

AIM

To provide a foundation from which to understand existing methods available for the assessment of people with pedophilic sexual interests, including strengths and limitations of each approach.

METHODS

A group of clinical experts provide a clinically oriented, narrative review on assessment methods for pedophilic sexual interest, including the rationale behind each method and its implementation. Evidence on validity supporting the techniques, limitations, and ethical issues is also discussed.

RESULTS

The assessment methods were grouped according to the following categories: self-report, genital psychophysiological assessment, indirect measurement, and behavioral measurement of pedophilic interest. Although most techniques performed well in discriminating child sexual offenders with pedophilic interest from distinct comparison groups, there are several limitations, including the current lack of standardization and the ethical challenges posed by this sensitive area.

CLINICAL IMPLICATIONS

An understanding of the different measures available for the assessment of problematic sexual interests plays a vital role in forensic clinical determinations of risk of recidivism and in the identification of treatment targets for men who have committed sexual offenses. Several independent but complimentary methods exist to assess sexual interest. Ongoing work on the international standardization of assessment based on methodologically sound research aimed at determining best practices will address some of the shortcomings of these assessments while improving their reliability.

STRENGTHS & LIMITATIONS

This article provides a general review on a number of methods aimed at assessing pedophilic interest. However, these methods mirror clinical practice largely used within North America and parts of continental Europe. As a result of cultural differences, opposing paradigms on assessment and treatment of pedophilia, and diverse legal regulation between jurisdictions and countries, these practices may not be applicable on an international scale where other special procedures may be required.

CONCLUSION

A number of techniques have been used within clinical and research settings that vary from self-report to objective measures. Most methods have demonstrated efficacy. Continued work to combine evidence and experience from diverse populations and multiple countries will improve the quality of the methods available. Carvalho J, Bradford J, Murphy L, et al. Measuring Pedophilic Sexual Interest. J Sex Med 2020;17:378-392.

Age of Onset and Its Correlates in Men with Sexual Interest in Children

INTRODUCTION

Current discussions in the field of sex research concern the age at which sexual interest in children occurred or awareness emerged.

AIM

To investigate the age of onset (AOO) and its correlates in men with sexual interest in children.

METHODS

Using 2 samples (study 1, patients from an outpatient treatment center, n = 26; study 2, an online survey using 3 recruitment paths, n = 94), we assessed self-reported AOO of sexual interest in children, its flexibility, its exclusiveness, and individuals' motivation to change it. We further examined the interrelation between these variables.

MAIN OUTCOME MEASURE

AOO as the self-reported age at which participants retrospectively felt sexually attracted to children for the first time.

RESULTS

We found broad ranges in AOO (study 1: mean 20.0 ± 10.7; study 2: mean 17.0 ± 8.7), flexibility, and exclusiveness (in studies 1 and 2, 7.7% and 22.3%, respectively, reported that their sexual interest is exclusively in children). The earlier participants felt sexually attracted to children for the first time, the more they were attracted exclusively in children and the less they perceived it to be flexible. Participants who reported rather exclusive sexual interest in children were less likely to perceive it as flexible. The more participants reported on flexibility, the more they were motivated to change it. The earlier participants of study 2 felt sexually attracted to children for the first time, the less they were motivated to change.

CLINICAL IMPLICATIONS

The variety of our results indicates the contradiction of overall rules for individuals with sexual interest in children.

STRENGTH & LIMITATIONS

We included individuals with sexual interest in children from different contexts (eg, forensic vs non-forensic). Our results are in line with previous findings. However, both studies included rather small samples, limiting generalizability. There is not yet consent about how to operationalize AOO.

CONCLUSION

We recommend a differentiated perspective on individuals with sexual interest in children and on different forms of pedophilia in the diagnostic construct. Tozdan S, Briken P. Age of Onset and Its Correlates in Men with Sexual Interest in Children.Sex Med 2019;7:61-71.

Stimuli used in the measurement of problematic sexual interests

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.

Reinforcement learning in child molesters

BACKGROUND

Child molesters form a heterogeneous group, but one generally shared characteristic is maladaptive, rigid behaviour. Impairments in reinforcement learning may explain these maladaptive tendencies, but this has not been systematically investigated. Further, it is not known if such impairments vary with subtype of child molesters.

AIMS

To investigate the presence of impairments in reinforcement learning among child molesters and to test for differences in patterns of impairment with subtype.

METHODS

A group of 59 child molesters was recruited from several prisons in a two-stage screening process, the first using records and the second interview; a comparison group of 33 offenders who had never committed a sex offence and who denied paedophile ideation was similarly recruited; 36 nonoffender comparison men were recruited by social media and word of mouth. Each was asked to perform a probabilistic reversal learning task, in which stimulus-outcome contingencies had to be learned.

RESULTS

Child molesters, as a group, made significantly more errors on the probabilistic reversal learning task than the nonoffenders; the comparison offenders and the nonoffenders gained similar scores, although findings may have been confounded by older age in the child molester group. Nonpaedophilic child molesters had significantly worse scores than paedophilic child molesters.

CONCLUSIONS

Child molesters, especially those not diagnosed with paedophilia, have deficits during both the acquisition and reversal of contingencies, suggesting reinforcement learning deficits that may undermine their capacity to benefit maximally from therapy without preliminary work to repair those deficits, possibly in conjunction with extending the offender programmes. Testing before programme entry would enable accurate targeting of scarce resources in this respect.

Approach and Avoidance Tendencies Toward Picture Stimuli of (Pre-)Pubescent Children and Adults: An Investigation in Pedophilic and Nonpedophilic Samples

The presence of pedophilic sexual interests is considered of high importance for predicting recidivism among individuals who have committed sexual offenses. However, objective and valid assessment methods that are robust against confounding issues such as cognitive capacity and manipulation are sparse. We applied the Approach-Avoidance Task (AAT) for detecting sexual interests in 38 pedophilic men (18 primarily attracted to boys) and 27 male nonpedophilic (11 gay) participants. The AAT relies on automatic approach and avoidance tendencies, independent of cognitive abilities such as memory capacity and intelligence. Approach-avoidance tendencies toward stimuli depicting seminude prepubescent boys and girls as well as men and women are reported. The results were consistent with previous research on the utility of the AAT: Except for pedophiles attracted to girls, the mean AAT scores (approach minus avoidance reaction time for each stimulus category) were positive only for stimuli of the preferred category. A multivariate binary logistic regression approach revealed 80% overall accuracy in differentiating pedophilic from nonpedophilic participants.

Assessing Sexual Interest in Children Using the Go/No-Go Association Test

The present study investigated whether a latency-based Go/No-Go Association Task (GNAT) could be used as an indirect measure of sexual interest in children. A sample of 29 individuals with a history of exclusive extrafamilial offenses against a child and 15 individuals with either a history of exclusive intrafamilial or mixed offenses (i.e., against both adults and children) were recruited from a treatment center in the United States. Also, a sample of 26 nonoffenders was recruited from a university in the United Kingdom. All participants completed the Sexual Fantasy-GNAT, a Control-GNAT, and two self-report measures of sexual fantasy. It was hypothesized that, relative to the two comparison groups, the extrafamilial group would respond faster on the block that paired "sexual fantasy" and "children." Also, GNAT scores were expected to correlate with child-related sexual fantasies. Support was found for both hypotheses. Response-latency indices were also found to effectively distinguish the extrafamilial group, as well as those who self-reported using child-related sexual fantasies. The implications of these findings, along with the study's limitations and suggestions for future research, are discussed.

Keep Faith in Yourself! A Pilot Study on the Relevance of Specific Self-Efficacy for Modifying Sexual Interest in Children Among Men With a Risk to Sexually Abuse Children

Among 26 pedophilic/hebephilic men, we investigated (1) the relationship between "specific self-efficacy for modifying a sexual interest in children" (SSIC) and actual sexual interest in children and (2) whether changes in SSIC are associated with changes in sexual interest in children. Results showed that the more clients believe they are able to influence their sexual interest in children, the less strong they perceive their sexual interest in children to be. Furthermore, an increase in SSIC is associated with a decrease in sexual interest in children. We suggest avoiding generalized statements about the immutability of sexual interest in children.

Child sex tourism - prevalence of and risk factors for its use in a German community sample

Background

To investigate the prevalence of child sex tourism (CST) in a large German community sample, and to compare those who made use of CST with other child sexual abusers regarding established characteristics and risk factors for child sexual abuse.

Methods

Adult German men were recruited through a German market research panel and questioned by means of an anonymous online survey. Group assignment was accomplished based on information on previous sexual contacts with children and previous use of CST. Characteristics and risk factors were compared between the groups using t- and Chi-square tests. Binary logistic regression analysis was performed to predict CST. Data collection was conducted in 2013, data analysis in January 2015.

Results

Out of 8718 men, 36 (0.4%) reported CST use. The CST group differed from the nonCST group (n = 96; 1.1%) with regard to pedophilic sexual and antisocial behaviors as well as own experiences of sexual abuse. Social difficulties, pedophilic sexual interests, and hypersexuality were not distinct features in the CST group. Own experiences of sexual abuse, child prostitution use, and previous conviction for a violent offense predicted CST in a logistic regression model.

Conclusions

This study is a first step to gain insight into the prevalence and characteristics of men using CST. Findings could help to augment prevention strategies against commercial forms of sexual abuse in developed as well as in developing countries by fostering the knowledge about the characteristics of perpetrators.

A Meta-Analysis of Viewing Time Measures of Sexual Interest in Children

Due to unobtrusiveness and ease of implementation, viewing time (VT) measures of sexual interest in children have sparked increasing research interest in forensic contexts over the last two decades. The current study presents two meta-analyses of VT measures adapted to assess pedophilic interest to determine their discrimination between sexual offenders against children (SOC) and non-SOC groups as well as convergent validity (associations with other measures of sexual interest in children). On average, VT measures showed moderate discrimination between criterion groups (fixed-effect d = 0.60, 95 % CI [0.51, 0.68], N = 2705, k = 14) and significant convergent validity with self-reports, penile plethysmography, Implicit Association Tests, and offence behavioral measures ranging from r = .18 to r = .38. VT measures, however, provided better discrimination for adults (fixed-effect d = 0.78, 95 % CI [0.64, 0.92]) than adolescent samples (fixed-effect d = 0.50, 95 % CI [0.40, 0.61]), Q _between = 9.37, p = .002. Moreover, compared to absolute scores, using pedophilic difference scores within adult samples substantially increased VT measures' validity (fixed-effect d = 1.03, 95 % CI [0.82, 1.25], N = 414, k = 7). Results are discussed in terms of their theoretical and applied implications for forensic contexts.

Being Sexually Attracted to Minors: Sexual Development, Coping With Forbidden Feelings, and Relieving Sexual Arousal in Self-Identified Pedophiles

This article aims to provide more insight into pedophilic attraction and risk and protective factors for offending in nonclinical pedophiles. Fifteen participants were interviewed about sexuality, coping, and sexual self-regulation. Many participants struggled with acknowledging pedophilic interest in early puberty and experienced psychological difficulties as a result. Furthermore, many committed sex offenses during adolescence when they were still discovering their feelings. Early recognition of risk factors and early start of interventions seem vital in preventing offending. Moreover, results suggest that risk for offending can be diminished by creating more openness about pedophilia and by providing pedophiles with social support and control.

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

Consistent evidence exists for sexual interest in children in nonclinical/nonforensic male populations. However, prevalences for community men's self-reported sexual interest in children have been based on indiscriminate definitions including postpubescent individuals, age-restricted samples, and/or small convenience samples. The present research assessed men's self-reported sexual interest in children (including child prostitution and child sex tourism) on the community level and examined the link between strictly defined sexual fantasies and behaviors involving prepubescent children. In an online survey of 8,718 German men, 4.1% reported sexual fantasies involving prepubescent children, 3.2% reported sexual offending against prepubescent children, and 0.1% reported a pedophilic sexual preference. Sexual fantasies involving prepubescent children were positively related to sexual offending against prepubescent children. Sexual interest in children was associated with subjectively perceived need for therapeutic help. In contrast to findings from forensic samples, men who reported child pornography use exclusively were identified as a subgroup differing from contact sexual offenders against prepubescent children and men who reported both child pornography use and contact sexual offenses against prepubescent children. The empirical link between child-related sexual fantasies and sexual victimization of prepubescent children and high levels of subjective distress from this inclination underscore the importance of evidence-based child sexual abuse prevention approaches in the community. Findings are discussed in terms of their relation to pedophilic disorder.

Are Sex Drive and Hypersexuality Associated with Pedophilic Interest and Child Sexual Abuse in a Male Community Sample?

Although much is currently known about hypersexuality (in the form of excessive sexual behavior) among sexual offenders, the degree to which hypersexual behavior is linked to paraphilic and especially pedophilic interests in non-forensic populations has not been established.The purpose of the present study was to elucidate the associations between total sexual outlets(TSO) and other sex drive indicators, antisocial behavior, pedophilic interests, and sexual offending behavior in a large population-based community sample of males. The sample included 8,718 German men who participated in an online study. Hypersexual behavior as measured by self-reported TSO, self-reported sex drive, criminal history, and pedophilic interests were assessed. In moderated hierarchical logistic regression analyses self-reported contact sexual offending against children was linked to sexual fantasizing about children and anti sociality.There was no association between aggregated sex drive, and sexual abusive behaviour in the multivariate analyses. In contrast, self-reported child pornography consumption was associated with sex drive, sexual fantasies involving children, and anti sociality. Nevertheless, in convicted sexual offenders anti sociality, sexual preoccupation (like hypersexuality), and pedophilic interest are important predictors of sexual reoffending against prepubescent children.Therefore, in clinical practice an assessment of criminal history and pedophilic interests in hypersexual individuals and vice versa hypersexuality in antisocial or pedophilic men should be considered [corrected].

The Role of Sexual Images in Online and Offline Sexual Behaviour With Minors

Sexual images have long been associated with sexual interest and behaviour with minors. The Internet has impacted access to existing content and the ability to create content which can be uploaded and distributed. These images can be used forensically to determine the legality of the behaviour, but importantly for psychiatry, they offer insight into motivation, sexual interest and deviance, the relationship between image content and offline sexual behaviour, and how they might be used in online solicitation and grooming with children and adolescents. Practitioners will need to consider the function that these images may serve, the motivation for their use and the challenges of assessment. This article provides an overview of the literature on the use of illegal images and the parallels with existing paraphilias, such as exhibitionism and voyeurism. The focus is on recent research on the Internet and sexual images of children, including the role that self-taken images by youth may play in the offending process.

Punitive attitudes against pedophiles or persons with sexual interest in children: does the label matter?

In the present research, we addressed the question of whether people harbor punitive attitudes against individuals sexually interested in children even if no sexual offense is mentioned and whether this effect is amplified by the clinical label pedophilia. In two online studies (total N = 345), participants rated the extent to which they saw individuals sexually interested in children as necessarily committing child sexual abuse (dangerousness), responsible for their sexual interest (intentionality), and clinically disordered (deviance) before judging their endorsement of means of punishment (punitive attitudes). Participants were randomly assigned to one of two conditions in which either the "pedophilia" label or the descriptive term "sexual interest in (prepubescent) children" was included in all items. Across both studies, results showed high degrees of punitive attitudes against sexually deviant men, an effect that was particularly pronounced if the pedophilia label was present. Whereas this was only latently observable in Study 1 (concealed by a suppression effect of reduced ascriptions of intentionality), in Study 2 no such suppression was observed. Unlike any other stigma we know of, punitive attitudes against pedophiles were associated positively with social desirability, suggesting that participants saw it as particularly socially desirable to condemn someone based on their deviant sexual interest.

Assessment methods and management of hypersexuality and paraphilic disorders

PURPOSE OF REVIEW

The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition introduced some important changes in the conceptualization of hypersexuality and paraphilic disorders. The destigmatization of nonnormative sexual behaviors could be viewed as positive, However, other changes are more controversial. In order to stimulate new research approaches and provide mental healthcare providers with appropriate treatment regimes, validated assessment and treatment methods are needed. The purpose of this article is to review the studies published between January 2013 and July 2014 that aimed at assessing the psychometric properties of the currently applied assessment instruments and treatment approaches for hypersexuality and hypersexual disorders or paraphilias and paraphilic disorder.

RECENT FINDINGS

Currently existing instruments can validly assess hypersexual behaviors in different populations (e.g. college students, gay and bisexual men, and patients with neurodegenerative disorders) and cultural backgrounds (e.g. Germany, Spain, and USA). Concerning the assessment of paraphilias, it was shown that combining different assessment methods show a better performance in distinguishing between patients with paraphilias and control groups. In addition to psychotherapeutic treatment, pharmacological agents aiming at a reduction of serum testosterone levels are used for hypersexual behaviors as well as paraphilic disorders.

SUMMARY

Although the currently applied assessment and treatment methods seem to perform quite well, more research about the assessment and evidence-based treatment is needed. This would help to overcome the existing unresolved issues concerning the conceptualization of hypersexual and paraphilic disorders.