Klaus M. Beier

How Unusual are the Contents of Paraphilias? Paraphilia-Associated Sexual Arousal Patterns in a Community-Based Sample of Men

INTRODUCTION This is a report of a cross-sectional study on paraphilia-associated sexual arousal patterns (PASAP) among men in a metropolitan city in Germany, EU. AIM To determine the prevalence of PASAP during sexual fantasies, fantasies accompanying masturbation, and real-life sociosexual behavior. METHODS In a cross-sectional study, self-reported sexual history data were collected by questionnaire from 367 volunteers recruited from a community sample of 1,915 men aged 40-79 years. MAIN OUTCOME MEASURES The Derogatis Symptom Checklist-Revised (SCL-90-R) and the Life Satisfaction Questionnaire (LSQ; German original, Fragebogen zur Lebenszufriedenheit, [FLZ]) were administered to obtain a general subjective health measure and a measure of general as well as sex life satisfaction. The Questionnaire on Sexual Experiences and Behaviour was administered to comprehensively assess all relevant sexo-medical data. Results.  The percent of men that reported at least one PASAP was 62.4%. In 1.7% of cases, PASAP were reported to have caused distress. The presence of PASAP was associated with a higher likelihood of being single (odds ratio [OR] 2.6; 95%; confidence interval [CI] 1.047-6.640), masturbating at least once per week (OR 4.4; 95%; CI 1.773-10.914), or having a low general subjective health score (OR 11.9; 95%; CI 2.601-54.553). Pedophilic PASAP in sexual fantasies and in real-life sociosexual behavior was reported by 9.5% and 3.8% of participants, respectively. CONCLUSION The findings suggest that paraphilia-related experience can not be regarded as unusual from a normative perspective. At the same time, many men experience PASAP without accompanying problem awareness or distress, even when PASAP contents are associated with potentially causing harm to others. In view of the relevance for sex life and relationship satisfaction, presence of PASAP should be assessed in all sexual medicine consultations. Future research should focus on conditions in which PASAP reach clinical significance in the sense of mental disorders.

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.

Sexual function and testicular perfusion after inguinal hernia repair with mesh.

BACKGROUND Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear. METHODS In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire. RESULTS Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 +/- 4.8 cm3 versus 9.8 +/- 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensitivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair. CONCLUSIONS So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.

Gender Identity Disorders in Childhood and Adolescence Currently Debated Concepts and Treatment Strategies

INTRODUCTION Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly variable. There is controversy at present over theoretical explanations of the causes of GID and over treatment approaches, particularly with respect to early hormonal intervention strategies. METHODS This review is based on a selective Medline literature search, existing national and international guidelines, and the results of a discussion among experts from multiple relevant disciplines. RESULTS As there have been no large studies to date on the course of GID, and, in particular, no studies focusing on causal factors for GID, the evidence level for the various etiological models that have been proposed is generally low. Most models of these disorders assume that they result from a complex biopsychosocial interaction. Only 2.5% to 20% of all cases of GID in childhood and adolescence are the initial manifestation of irreversible transsexualism. The current state of research on this subject does not allow any valid diagnostic parameters to be identified with which one could reliably predict whether the manifestations of GID will persist, i.e., whether transsexualism will develop with certainty or, at least, a high degree of probability. CONCLUSIONS The types of modulating influences that are known from the fields of developmental psychology and family dynamics have therapeutic implications for GID. As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individuals psychosexual development ist complete. The identity-creating experiences of this phase of development should not be restricted by the use of LHRH analogues that prevent puberty.

Brain alterations in paedophilia: A critical review

Psychosocial and biological factors have been implicated in paedophilia, such as alterations in brain structure and function. The purpose of this paper is to review the expanding body of literature on this topic including brain abnormality case reports, as well as structural and functional neuroimaging studies. Case studies of men who have committed sexual offences against children implicate frontal and temporal abnormalities that may be associated with impaired impulse inhibition. Structural neuroimaging investigations show volume reductions in paedophilic men. Although the findings have been heterogeneous, smaller amygdala volume has been replicated repeatedly. Functional neuroimaging investigations demonstrate an overlap between paedophiles and teleiophiles during sexual arousal processing. While it is controversial among studies regarding group differences, reliable discrimination between paedophilic and teleiophilic men may be achieved using functional activation patterns. Nevertheless, the heterogeneous findings published so far suggest further research is necessary to disentangle the neurobiological mechanisms of paedophilic preference. A number of methodological confounds have been identified, which may account for the inconsistent results that could prove to be beneficial for future investigations.

Low-Dose Cyproterone Acetate Treatment of Sexual Acting Out in Men With Dementia

Increased sexual activity in patients with dementia is problematic for caregivers and has no proven treatment. This report describes two male patients who had dementia with pronounced sexual acting out. One patient had vascular dementia and the other patient had Parkinsons disease with associated dementia. After nonresponse to neuroleptics and sedatives, low-dose cyproterone acetate successfully reduced sexual acting out without relevant side effects in both patients.

The Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges

A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodological challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.

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.