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Revue Medicale de Liege Mar 2021Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that involve children, in a general sense. This... (Review)
Review
Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that involve children, in a general sense. This sexual deviation is often linked to personal distress, to a significant alteration of personal, family, professional and social life, in a general sense. In our modern Western societies, paedophilia and the perversions associated with it are punishable by law. Paedophilia is a concept that is very ancient, complex and particularly diverse in its many clinical presentations. Its societal impact is very important and contrasts with the real knowledge of this issue among non-specialists, or even among specialists. Based on expert clinical experience gathered at the courts and on an exhaustive review of current literature on the subject, the authors propose an update of the concept of paedophilia. In the first part of this work, the authors will discuss several aspects such as the historical background and the clinical aspects and nosography of paedophilia. This literature review will be accompanied by short clinical vignettes, based on the authors' clinical experience.
Topics: Child; Humans; Pedophilia
PubMed: 33682389
DOI: No ID Found -
Archives of Disease in Childhood Dec 2001
Topics: Child; Child, Preschool; Female; Humans; Interpersonal Relations; Male; Pedophilia; Public Opinion; Safety
PubMed: 11719339
DOI: 10.1136/adc.85.6.495 -
Europe's Journal of Psychology Jun 2018This article presents a review of the literature that pertains to the experiences of therapists who work directly with child sex offenders and/or people with pedophilia.... (Review)
Review
This article presents a review of the literature that pertains to the experiences of therapists who work directly with child sex offenders and/or people with pedophilia. We draw together results from studies that attempted to identify how therapists experience such work and how they were personally impacted by it. Usually, such studies are embedded within one of the following theoretical frameworks: Secondary traumatic stress, compassion fatigue, vicarious traumatization and burnout. Most literature on the topic has therefore sought to determine to what extent and why, work-related stress responses may occur among these therapists. The aim of this paper is therefore to provide insight into this, arguably, important line of research, while evaluating the current knowledge as well as providing recommendations for future research efforts.
PubMed: 30008959
DOI: 10.5964/ejop.v14i2.1493 -
Archives of Sexual Behavior Feb 2022The neurodevelopmental theory of pedohebephilia states that sexual interests in children arise from early neurodevelopmental perturbations, as, for example, evidenced by...
The neurodevelopmental theory of pedohebephilia states that sexual interests in children arise from early neurodevelopmental perturbations, as, for example, evidenced by increased non-right-handedness, more childhood head injuries, and reduced intelligence and height. As corroborating evidence largely rests on samples of convicted men, we conducted online surveys among German-speaking (Study 1, N = 199) and English-speaking men (Study 2, N = 632), specifically targeting community members with pedohebephilic or teleiophilic interests. Although we detected theoretically meaningful sexual interest patterns in an embedded viewing time task, we could not detect expected neurodevelopmental differences between teleiophilic and pedohebephilic men in either of the two studies. Strikingly, pedohebephilic men who reported convictions for sexual offenses emerged as shorter and less intelligent than pedohebephilic men without convictions in Study 2. While elucidating possible third variable confounds, results have to be interpreted cautiously because of the methodological problems inherent to non-matched case control designs.
Topics: Body Height; Child; Child Abuse, Sexual; Humans; Male; Pedophilia; Sex Offenses; Sexual Behavior; Surveys and Questionnaires
PubMed: 34993718
DOI: 10.1007/s10508-021-02228-w -
Psychiatria Polska Feb 2022The main objective of the study was not only to show the scale of child sexual abuse by clergy itself, but rather presentation of the manner in which perpetrators act...
OBJECTIVES
The main objective of the study was not only to show the scale of child sexual abuse by clergy itself, but rather presentation of the manner in which perpetrators act and what their motivations are.
METHODS
It involved aqualitative and quantitative analysis of documentation gathered by the Foundation dedicated to supporting victims of sexual abuse by clergy. For the purpose of the study the authors prepared a survey which included information pertaining to the circumstances of the abuse, the abuser, the aggrieved person, as well as legal and non-legal consequences (sanctions). Finally, information pertaining to 80 criminal cases from 2001-2019 in which the perpetrator (member of the clergy) was sentenced by afinal and binding judgment was gathered.
RESULTS
On the basis of analysis of the empirical material, various models of the perpetrators' modi operandi have been developed, which included also the methods of selecting the victims or types of actions taken to keep the abuse of minors secret. As part of the analyzes, the characteristics of the aggrieved persons were also developed, and the characteristics specific to various models of clergy behavior were distinguished.
CONCLUSIONS
Attention should be drawn to the fact that in many of the cases the clergy perpetrated child sexual abuse consisted in direct physical violence, as well as regular sexual intercourse. Also, not all perpetrators were required to undergo appropriate diagnostic tests in order to verify whether they have a disorder of sexual preference in the form of pedophilia. In the studied group of cases, in every third case the perpetrator, after disclosure of the acts, was transferred to another parish, where other similar acts took place.
Topics: Catholicism; Child; Child Abuse, Sexual; Clergy; Crime Victims; Humans; Minors; Pedophilia
PubMed: 35569154
DOI: 10.12740/PP/OnlineFirst/123883 -
Current Psychiatry Reports Apr 2024Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of... (Review)
Review
PURPOSE OF REVIEW
Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives.
RECENT FINDINGS
We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.
Topics: Humans; Sex Offenses; Sexual Behavior; Internet
PubMed: 38509408
DOI: 10.1007/s11920-024-01489-1 -
Frontiers in Psychiatry 2023Child sexual abuse (CSA) has become a focal point for lawmakers, law enforcement, and mental health professionals. With high prevalence rates around the world and...
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. , 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%, = 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.
PubMed: 37151966
DOI: 10.3389/fpsyt.2023.1001085 -
The Cochrane Database of Systematic... Oct 2008Sexual offending is both a social problem and a public health issue. To date, no positive treatment effects have been found in quasi-experimental institutional treatment... (Review)
Review
BACKGROUND
Sexual offending is both a social problem and a public health issue. To date, no positive treatment effects have been found in quasi-experimental institutional treatment programmes.
OBJECTIVES
To evaluate effects of psychological interventions on target sexual acts, urges or thoughts for people who have been convicted, or cautioned, for sexual offences.
SEARCH STRATEGY
33 electronic databases including the Cochrane Controlled Trials Register (Issue 4, 2002) were searched. Relevant authors and organisations were contacted for additional data.
SELECTION CRITERIA
Randomised controlled trials (RCTs) involving adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or offences or violent behaviours with a sexual element. Behavioural, cognitive-behavioural, psychodynamic, and psychoanalytic therapies were compared with each other, drug treatment, or standard care.
DATA COLLECTION AND ANALYSIS
Independent assessors selected and assessed studies and extracted data. Data were excluded where more than 50% of participants were lost to follow-up. For binary outcomes, standard estimations of risk ratio (RR) and their 95% confidence intervals (CI) were calculated. Where possible, number-needed-to-treat or harm statistics (NNT, NNH) and their 95% CIs were calculated.
MAIN RESULTS
We included nine RCTs with over 500 male offenders, 231 of whom have been followed up for a decade. Cognitive behavioural therapy (CBT) in groups may reduce re-offence at one year for child molesters when compared with standard care (n=155, 1 RCT, RR any sexual/violent crime - 0.41 CI 0.2 to 0.82, NNT 6 CI 3 to 20). However, when CBT was compared with a trans-theoretical counselling group therapy the former may have increased poor attitudes to treatment (corrected n=38, 1 RCT, RR 2.8 CI 1.26 to 6.22, NNH 2 CI 1 to 5). The largest trial compared broadly psychodynamic group therapy with no treatment for 231 men guilty of paedophilia, exhibitionism or sexual assault. Re-arrest over ten years was greater for those allocated to group therapy (result not statistically significant [n=231, 1 RCT, RR 1.87 CI 0.78 to 4.47]).
AUTHORS' CONCLUSIONS
Limited data make recommendations difficult. One study suggests that a cognitive approach results in a decline in re-offending after one year. Another large study shows no benefit for group therapy and suggests the potential for harm at ten years. The ethics of providing this still-experimental treatment to a vulnerable and potentially dangerous group of people outside of a well-designed evaluative study are debatable. This review proves such studies are possible.
Topics: Humans; Male; Paraphilic Disorders; Psychoanalysis; Psychotherapy; Randomized Controlled Trials as Topic; Sex Offenses
PubMed: 18843670
DOI: 10.1002/14651858.CD004858.pub2 -
Psychiatria Danubina Dec 2019The aim of the study was to compare the characteristics of sex offenders today, and those who committed a sex crime fifteen years ago, in regard to their...
BACKGROUND
The aim of the study was to compare the characteristics of sex offenders today, and those who committed a sex crime fifteen years ago, in regard to their psychiatric-forensic aspects.
SUBJECTS AND METHODS
Data from the University psychiatric hospital Vrapče, Center for forensic psychiatry on court people sent for psychiatric and forensic evaluation, who were accused of sex offense in two time frames (1998-2001 and 2010-2016) were analysed. In total there were 50 and 57 male subjects sent for an evaluation.
RESULTS
In both groups rape was the most prevalent offence, and both groups had the same prevalence of abuse, earlier psychiatric treatment and the majority of offenders were diagnosed with dissocial personality disorder and other personality disorders. Paedophilia was diagnosed in only a minority (14% and 7% respectively) of cases. The latter group (2010-2016) committed more sex offences against children, more often were with no mental disorder and less often had alcohol dependence and mental retardation. Up to one third of the later group were not giving their defence, compared to 4% of the former group.
CONCLUSIONS
Changes in court case law and psychiatrists' usage of diagnostic criteria have influenced the prevalent diagnoses in sex offenders. Paraphilias are not often diagnosed in sex offenders because they do not confirm the act, and in recent years more often use not to give their defence (which makes reaching the diagnosis more challenging).
Topics: Adolescent; Adult; Aged; Alcoholism; Child; Criminals; Croatia; Female; Forensic Psychiatry; Humans; Intellectual Disability; Male; Mental Disorders; Middle Aged; Sex Offenses; Young Adult
PubMed: 32160179
DOI: No ID Found -
BJPsych International Nov 2021Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted... (Review)
Review
Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.
PubMed: 34747938
DOI: 10.1192/bji.2021.17