Janina Neutze

Predictors of Child Pornography Offenses and Child Sexual Abuse in a Community Sample of Pedophiles and Hebephiles

Little is known about factors that distinguish men who act upon their self-identified sexual interest in prepubescent or pubescent children from those who do not. Even less is known about pedophiles or hebephiles who are not involved with the criminal justice system. In this study, a sample of 155 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia (or paraphilia not otherwise specified for those who were sexually attracted to pubescent children). Two sets of group comparisons were conducted on sociodemographic variables and measures of dynamic risk factors. The first set was based on recent activity and compared men who had committed child pornography only or child sexual abuse offenses in the past six months with men who remained offense-free during the same period. The second set was based on lifetime offense history (excluding the most recent six months) and compared child pornography offenders with child sexual abuse offenders and men who had committed both kinds of offenses. Overall, there were more similarities than differences between groups.

Can pedophiles be reached for primary prevention of child sexual abuse? First results of the Berlin Prevention Project Dunkelfeld (PPD)

The Berlin Prevention Project Dunkelfeld (PPD) aims to prevent child sexual abuse (CSA) by targeting men who fear they may sexually abuse children, and who seek help without being mandated to do so. This article aims to demonstrate that a pedophilic or hebephilic sexual preference is very common among these men, to show how these men can be reached, and to document their determination to find help. The target group was informed of the project and encouraged to respond via a media campaign. A telephone screening was conducted over the first 18 months. Of the 286 who completed the screening (60.1% of the respondents), 84.3% (N = 241) were interviewed by a clinician. Of the interviewees, 57.7% (N = 139) and 27.8% (N = 67) expressed a sexual preference for prepubescent and pubescent minors, respectively, and 10.8% (N = 26) for mature adults. The remaining 3.7% (N = 9) could not be reliably categorized. As (potential) child molesters with a respective sexual preference can be reached via a media campaign, efforts to prevent CSA ought to be expanded to target this group.

Potential and Dunkelfeld offenders: Two neglected target groups for prevention of child sexual abuse

Little is known about men who have not yet committed child sexual abuse but may be at risk of doing so (potential offenders) and the factors that distinguish these men from undetected child sexual abuse offenders with a sexual interest in children (Dunkelfeld offenders). The present study describes and compares potential and Dunkelfeld offenders, which can be viewed as ideal target groups for (primary) prevention efforts with respect to child sexual abuse. Also, this study seeks to demonstrate the feasibility of using a telephone screening procedure to conduct research with these groups. Using a computer assisted telephone interview (CATI), data on demographics, mental health, sexuality, criminal history, and victim characteristics were collected from respondents in a nation-wide media campaign, which informed potential (re-)offenders of child sexual abuse of a research and treatment project. Many participants reported recurrent sexual fantasies involving minors, as well as related distress, suggesting a high prevalence of pedophilia and hebephilia. More than half feared they would sexually abuse a minor, and Dunkelfeld offenders reported 3.2 victims on average. Group comparisons revealed that Dunkelfeld offenders were, for example, more likely to perceive themselves being at risk of offending, compared to potential offenders. The results suggest that targeting potential and Dunkelfeld offenders could prove a worthwhile approach in the prevention of child sexual abuse.

Undetected and detected child sexual abuse and child pornography offenders

Current knowledge about risk factors for child sexual abuse and child pornography offenses is based on samples of convicted offenders, i.e., detected offenders. Only few studies focus on offenders not detected by the criminal justice system. In this study, a sample of 345 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia or hebephilia (paraphilia not otherwise specified), were assured of confidentiality, and self-reported lifetime sexual offending against prepubescent and/or pubescent children. Two sets of group comparisons were conducted on self-report data of risk factors for sexual reoffending. Measures of risk factors address the following dimensions identified in samples of convicted offenders: sexual preferences (i.e. co-occurring paraphilias), sexual self-regulation problems, offense-supportive cognitions, diverse socio-affective deficits, and indicators of social functioning (e.g., education, employment). Men who admitted current or previous investigation or conviction by legal authorities (detected offenders) were compared with those who denied any detection for their sexual offenses against children (undetected offenders). Group comparisons (detected vs. undetected) were further conducted for each offense type separately (child pornography only offenders, child sexual abuse only offenders, mixed offenders). Although there were more similarities between undetected and detected offenders, selected measures of sexual-self regulation problems, socio-affective deficits, and social functioning data demonstrated group differences.

Spezifische Behandlungsaspekte bipolar erkrankter Frauen

ZusammenfassungIm vorliegenden Artikel werden Besonderheiten im Krankheitsverlauf und in der Pharmakotherapie bipolar erkrankter Frauen diskutiert. Geschlechtstypische Unterschiede betreffen sowohl Symptomatik und Krankheitsverlauf als auch Aspekte, die mit der speziellen biologischen Situation der Frau zusammenhängen. Typisch für bipolare Frauen ist die Dominanz depressiver Krankheitssymptome und das im Vergleich zu bipolaren Männern etwa 8fach höhere Risiko für einen ungünstigen Krankheitsverlauf im Sinne eines „rapid cycling“. Abhängig von der gegenwärtigen Lebensphase sind bezüglich der pharmakologischen Behandlung weiblicher Patientinnen die Aspekte Fertilität, Kontrazeption und Schwangerschaft in besonderem Maße mit einzubeziehen. Trotz hoher Relevanz für den Krankheitsverlauf ist das sexuelle Erleben und Verhalten bipolarer Frauen bisher ebenso wenig untersucht worden wie spezifische sexuelle Veränderungen in manischen und depressiven Erkrankungsphasen.SummaryThis manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patient’s current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.This manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patients current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.

Specific aspects of treatment for women with bipolar affliction

ZusammenfassungIm vorliegenden Artikel werden Besonderheiten im Krankheitsverlauf und in der Pharmakotherapie bipolar erkrankter Frauen diskutiert. Geschlechtstypische Unterschiede betreffen sowohl Symptomatik und Krankheitsverlauf als auch Aspekte, die mit der speziellen biologischen Situation der Frau zusammenhängen. Typisch für bipolare Frauen ist die Dominanz depressiver Krankheitssymptome und das im Vergleich zu bipolaren Männern etwa 8fach höhere Risiko für einen ungünstigen Krankheitsverlauf im Sinne eines „rapid cycling“. Abhängig von der gegenwärtigen Lebensphase sind bezüglich der pharmakologischen Behandlung weiblicher Patientinnen die Aspekte Fertilität, Kontrazeption und Schwangerschaft in besonderem Maße mit einzubeziehen. Trotz hoher Relevanz für den Krankheitsverlauf ist das sexuelle Erleben und Verhalten bipolarer Frauen bisher ebenso wenig untersucht worden wie spezifische sexuelle Veränderungen in manischen und depressiven Erkrankungsphasen.SummaryThis manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patient’s current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.This manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patients current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.

Spezifische Behandlungsaspekte bipolar erkrankter Frauen@@@Specific aspects of treatment for women with bipolar affliction

ZusammenfassungIm vorliegenden Artikel werden Besonderheiten im Krankheitsverlauf und in der Pharmakotherapie bipolar erkrankter Frauen diskutiert. Geschlechtstypische Unterschiede betreffen sowohl Symptomatik und Krankheitsverlauf als auch Aspekte, die mit der speziellen biologischen Situation der Frau zusammenhängen. Typisch für bipolare Frauen ist die Dominanz depressiver Krankheitssymptome und das im Vergleich zu bipolaren Männern etwa 8fach höhere Risiko für einen ungünstigen Krankheitsverlauf im Sinne eines „rapid cycling“. Abhängig von der gegenwärtigen Lebensphase sind bezüglich der pharmakologischen Behandlung weiblicher Patientinnen die Aspekte Fertilität, Kontrazeption und Schwangerschaft in besonderem Maße mit einzubeziehen. Trotz hoher Relevanz für den Krankheitsverlauf ist das sexuelle Erleben und Verhalten bipolarer Frauen bisher ebenso wenig untersucht worden wie spezifische sexuelle Veränderungen in manischen und depressiven Erkrankungsphasen.SummaryThis manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patient’s current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.This manuscript summarizes specific issues in the disease course and pharmacological treatment of women with bipolar disorders. Gender differences relevant to the female biology manifest in symptoms, outcome, and course. The preponderance of depressive symptoms is typical, and the risk of rapid cycling is estimated to be eight times higher for women than for men. Comorbid anxiety and eating disorders occur more frequently in female patients. In planning treatment it is important to take fertility, contraception, and pregnancy into consideration and adjust the pharmacotherapy to harmonize with the patients current phase of life. Little is known about potential sexual dysfunctions of bipolar women. Further research should include clinical and observational studies focusing on gender-specific differences in symptomatology, treatment, and long-term outcome of bipolar disorders.

Salutogenesis and sexual medicine

ZusammenfassungSalutogenese beinhaltet einen Paradigmenwechsel in der medizinischen Sichtweise. Während die Pathogenese sich darauf beschränkt herauszufinden, was den Menschen krank macht und letztendlich dem Mensch-Maschine-Modell verhaftet bleibt, versucht die Salutogenese, Antworten auf die Frage zu finden, was den Menschen eigentlich gesund erhält. Sie begreift den Menschen als biopsychosoziales Wesen und versucht, diese 3 ineinander greifenden Dimensionen gleichzeitig zu erfassen.Zahlreiche Untersuchungen belegen die Bedeutung sozialer Beziehungen und die damit verbundene Erfüllung psychosozialer Grundbedürfnisse als gesundheitserhaltende Faktoren, die den Menschen vor psychischen und psychosomatischen Störungen schützen. Die psychosozialen Bedürfnisse nach Nähe, Akzeptanz und Geborgenheit können beim erwachsenen Menschen im Rahmen der sexuellen Kommunikation mit dem Intimpartner am intensivsten befriedigt werden. Deshalb zielt ein salutogenetischer Ansatz der Sexualmedizin in erster Linie auf die Erfüllung dieser Grundbedürfnisse ab und stellt nicht die Beseitigung einer Fehlfunktion in den Mittelpunkt der Behandlung, wie dies bei einem pathogenetischen, defizitorientiertem Ansatz der Fall ist.Der therapeutische Fokus wird auf die vorhandenen Ressourcen eines Paares und deren Entwicklungsmöglichkeiten gerichtet. Hierdurch werden unnötige frustrierende Erlebnisse weitgehend vermieden. Dies gilt insbesondere dann, wenn einer oder beide durch Krankheiten bzw. deren Behandlung oder altersbedingte Veränderungen in ihren sexuellen Möglichkeiten beeinträchtigt sind. An einem Fallbeispiel wird die salutogenetische Bedeutung von Sexualität im Kontext einer schweren Erkrankung verdeutlicht und welchen Beitrag eine sexualtherapeutische Intervention bei der Bewältigung einer Tumorerkrankung leisten kann.AbstractSalutogenesis means a paradigmatic change in medicine. While pathogenesis restricts itself to finding out what makes a man ill, salutogenesis tries to find out what keeps him or her healthy. The human being is seen as a biological, psychological, and social creature.There are many studies which show the importance of social relationships and the satisfaction of basic psychosocial needs as protection against psychological or psychosomatic disorders. The psychosocial basic needs for acceptance, intimacy, and security can be best fulfilled by sexual communication with the partner. Therefore a salutogenic approach to sexual medicine focuses mainly on the fulfillment of these needs and not only on the treatment of a sexual dysfunction.Unnecessarily frustrating experiences can thus be avoided, especially when the sexual possibilities of one or both partners are restricted by an illness or its medical treatment. A case report shows how sexual communication and sex therapy can help to cope with a tumor disease.

Salutogenese und Sexualmedizin

ZusammenfassungSalutogenese beinhaltet einen Paradigmenwechsel in der medizinischen Sichtweise. Während die Pathogenese sich darauf beschränkt herauszufinden, was den Menschen krank macht und letztendlich dem Mensch-Maschine-Modell verhaftet bleibt, versucht die Salutogenese, Antworten auf die Frage zu finden, was den Menschen eigentlich gesund erhält. Sie begreift den Menschen als biopsychosoziales Wesen und versucht, diese 3 ineinander greifenden Dimensionen gleichzeitig zu erfassen.Zahlreiche Untersuchungen belegen die Bedeutung sozialer Beziehungen und die damit verbundene Erfüllung psychosozialer Grundbedürfnisse als gesundheitserhaltende Faktoren, die den Menschen vor psychischen und psychosomatischen Störungen schützen. Die psychosozialen Bedürfnisse nach Nähe, Akzeptanz und Geborgenheit können beim erwachsenen Menschen im Rahmen der sexuellen Kommunikation mit dem Intimpartner am intensivsten befriedigt werden. Deshalb zielt ein salutogenetischer Ansatz der Sexualmedizin in erster Linie auf die Erfüllung dieser Grundbedürfnisse ab und stellt nicht die Beseitigung einer Fehlfunktion in den Mittelpunkt der Behandlung, wie dies bei einem pathogenetischen, defizitorientiertem Ansatz der Fall ist.Der therapeutische Fokus wird auf die vorhandenen Ressourcen eines Paares und deren Entwicklungsmöglichkeiten gerichtet. Hierdurch werden unnötige frustrierende Erlebnisse weitgehend vermieden. Dies gilt insbesondere dann, wenn einer oder beide durch Krankheiten bzw. deren Behandlung oder altersbedingte Veränderungen in ihren sexuellen Möglichkeiten beeinträchtigt sind. An einem Fallbeispiel wird die salutogenetische Bedeutung von Sexualität im Kontext einer schweren Erkrankung verdeutlicht und welchen Beitrag eine sexualtherapeutische Intervention bei der Bewältigung einer Tumorerkrankung leisten kann.AbstractSalutogenesis means a paradigmatic change in medicine. While pathogenesis restricts itself to finding out what makes a man ill, salutogenesis tries to find out what keeps him or her healthy. The human being is seen as a biological, psychological, and social creature.There are many studies which show the importance of social relationships and the satisfaction of basic psychosocial needs as protection against psychological or psychosomatic disorders. The psychosocial basic needs for acceptance, intimacy, and security can be best fulfilled by sexual communication with the partner. Therefore a salutogenic approach to sexual medicine focuses mainly on the fulfillment of these needs and not only on the treatment of a sexual dysfunction.Unnecessarily frustrating experiences can thus be avoided, especially when the sexual possibilities of one or both partners are restricted by an illness or its medical treatment. A case report shows how sexual communication and sex therapy can help to cope with a tumor disease.