Till Amelung

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.

Androgen deprivation therapy of self-identifying, help-seeking pedophiles in the Dunkelfeld

Androgen deprivation therapy (ADT) is considered an effective strategy in sexual offender treatment. However, the evidence base concerning its effects on sexual arousal control is limited. Past research has focused almost exclusively on men in forensic contexts. The present retrospective observational study provided data on ADT in a sample of self-identifying, help-seeking pedohebephilic men applying for a one-year group therapy program. Factors possibly influencing the readiness to take up or discontinue ADT were presented. Effects of a combination of ADT and group psychotherapy program on changes in paraphilic sexual behavior and associated psychological factors were examined. The proportion of men having taken up ADT was rather small (n=15). Greater awareness of potentially risky situations to commit child sexual offenses and self-rated uncontrollability of sexual urges were identified as characterizing men resorting to ADT. Additionally, these men were initially more open to include medical treatment. Examination of the effects of ADT and psychotherapy was limited to a sample of six men providing complete data sets. Descriptive data demonstrated a reduction of paraphilic sexual behaviors, an increase of risk-awareness and self-efficacy, and a decrease of offense-supportive cognitions and self-esteem. The present study underlined the importance of careful education and monitoring of self-identifying, help-seeking pedohebephilic patients interested in ADT concerning the effects and side effects of the treatment in a clinical context.

Evidence for superior neurobiological and behavioral inhibitory control abilities in non‐offending as compared to offending pedophiles

Neurobehavioral models of pedophilia and child sexual offending suggest a pattern of temporal and in particular prefrontal disturbances leading to inappropriate behavioral control and subsequently an increased propensity to sexually offend against children. However, clear empirical evidence for such mechanisms is still missing. Using a go/nogo paradigm in combination with functional magnetic resonance imaging (fMRI) we compared behavioral performance and neural response patterns among three groups of men matched for age and IQ: pedophiles with (N = 40) and without (N = 37) a history of hands‐on sexual offences against children as well as healthy non‐offending controls (N = 40). As compared to offending pedophiles, non‐offending pedophiles exhibited superior inhibitory control as reflected by significantly lower rate of commission errors. Group‐by‐condition interaction analysis also revealed inhibition‐related activation in the left posterior cingulate and the left superior frontal cortex that distinguished between offending and non‐offending pedophiles, while no significant differences were found between pedophiles and healthy controls. Both areas showing distinct activation pattern among pedophiles play a critical role in linking neural networks that relate to effective cognitive functioning. Data therefore suggest that heightened inhibition‐related recruitment of these areas as well as decreased amount of commission errors is related to better inhibitory control in pedophiles who successfully avoid committing hands‐on sexual offences against children. Hum Brain Mapp 38:1092–1104, 2017.

Decoding Pedophilia: Increased Anterior Insula Response to Infant Animal Pictures

Previous research found increased brain responses of men with sexual interest in children (i.e., pedophiles) not only to pictures of naked children but also to pictures of child faces. This opens the possibly that pedophilia is linked (in addition to or instead of an aberrant sexual system) to an over-active nurturing system. To test this hypothesis we exposed pedophiles and healthy controls to pictures of infant and adult animals during functional magnetic resonance imaging of the brain. By using pictures of infant animals (instead of human infants), we aimed to elicit nurturing processing without triggering sexual processing. We hypothesized that elevated brain responses to nurturing stimuli will be found – in addition to other brain areas – in the anterior insula of pedophiles because this area was repeatedly found to be activated when adults see pictures of babies. Behavioral ratings confirmed that pictures of infant or adult animals were not perceived as sexually arousing neither by the pedophilic participants nor by the heathy controls. Statistical analysis was applied to the whole brain as well as to the anterior insula as region of interest. Only in pedophiles did infants relative to adult animals increase brain activity in the anterior insula, supplementary motor cortex, and dorsolateral prefrontal areas. Within-group analysis revealed an increased brain response to infant animals in the left anterior insular cortex of the pedophilic participants. Currently, pedophilia is considered the consequence of disturbed sexual or executive brain processing, but details are far from known. The present findings raise the question whether there is also an over-responsive nurturing system in pedophilia.

Executive Functioning in Pedophilia and Child Sexual Offending

OBJECTIVES Pedophilia (P) is a psychiatric disease associated with sexual attraction toward children and often accompanied by child sexual offending (CSO). Consequently, it is important to address the understanding of executive dysfunctions that may increase the probability of CSO. Moreover, this research field has been lacking to disentangle executive deficits associated with pedophilia (as a deviant sexual preference) from those associated with CSO (as a deviant sexual behavior). METHODS The German multi-sided research network NeMUP offers the opportunity to overcome these limitations. By applying the Cambridge Automated Neuropsychological Test Battery in four carefully matched groups of men: (1) pedophiles with (N=45) and (2) without (N=45) a history of sexual offending against children; (3) child molesters without pedophilia (N=19), and (4) non-offending controls (N=49), we were able to analyze executive functioning in pedophilia and CSO independently. RESULTS Both CSO groups as compared to both non-CSO groups exhibited worsened response inhibition ability. However, only non-pedophilic offenders showed additionally disabled strategy use ability. Regarding set-shifting abilities, the P+CSO group showed the best performance. We also found that performances were affected by age: only in pedophiles, response inhibition worsened with age, while age-related deficits in set-shifting abilities were restricted to non-pedophilic participants. The latter also differentiated between both sexual preference groups. CONCLUSIONS Our results are the first to demonstrate that executive dysfunctions are related to offense status rather than pedophilic preference. Furthermore, there was evidence for differentiating age and performance correlations between pedophiles and non-pedophiles, which warrants further investigation. (JINS, 2017, 23, 460-470).

Is Emotional Congruence With Children Associated With Sexual Offending in Pedophiles and Hebephiles From the Community

Although emotional congruence with children (ECWC) is a risk factor for sexual offending against children, its conceptual validity has hardly been researched. This study aims to explore the construct of ECWC by evaluating the factor structure of the Child Identification Scale (CIS-R) and its relation to facets of sexual preference and child sexual abuse behaviors. It was hypothesized that the measure comprises consistent subscales that are differently associated with aspects of sexual preference and sexual offending against children. CIS-R data of a sample of 217 adult male pedophiles from the community were used for an exploratory principal component analysis (PCA). Group comparisons and a multinomial logistic regression analysis were conducted after including a non-pedophilic control group of 22 adult men. PCA revealed a three-factor solution for the CIS-R accounting for 30% of variance. Group comparisons found differences in overall scores and the factor labeled “Attachment to Children” between subgroups of sexual age and gender preference, but not between contact, online, and non-offenders. The regression analysis showed a pedophile sexual preference and the interaction between a hebephile sexual age preference and the factor “Attachment to Children” being associated with past offending behavior. The results indicate a wish to attach to children as core feature of the CIS-R measure assessing ECWC. It is discussed whether this is an inherent feature of pedophilia or rather an independent aspect being differently distinct in pedophiles.

The association of sexual preference and dynamic risk factors with undetected child pornography offending

ABSTRACT The risk for using child abuse images (CAI) is difficult to assess, especially as it mostly remains undetected by legal authorities. The present study investigates the association of aspects of sexual preference and dynamic risk factors with CAI only and mixed offending (CAI and child sexual abuse) over lifetime and within six months prior to assessment. A sample of 190 undetected, self-identified pedo- and/or hebephiles was investigated. Multinomial logistic regression analyses revealed that sexual preoccupation is of great importance, especially for recent CAI only and mixed offending, as well as lifetime mixed offending. Although inconclusive, a sexual preference for early-pubescent children seems to be of interest for recent and lifetime offending. A sexual preference for prepubescent children, additional paraphilias and sexualised coping have shown some, although no statistically meaningful association with lifetime offending. Gender preference, exclusivity of pedohebephilia and offence-supportive attitudes did not show any significant relation with offending behaviour.

Misuse of Child Sexual Abuse Images: Treatment Course of a Self-identified Pedophilic Pastor

ABSTRACT The recurrent use of child sexual abuse images (CSAI) for sexual arousal is considered a valid indicator for the existence of a pedophilic preference, which in turn represents a significant risk factor for committing contact offenses against children. Treatment programs for (potentially) sexually delinquent men endeavor to reduce the risk to offend by addressing relevant risk factors and emphasizing functional and socially acceptable alternative behaviors. Users of CSAI are a particular target group for prevention services and it has been suggested that the primary treatment focus should be on sexual self-regulation deficits.

A German Sexological Perspective on Male Chronophilias

In his article ‘‘The Puzzle of Male Chronophilias,’’Seto (2016) gives a comprehensive overview over male sexual age preferences. His model of multi-dimensional sexual preference resembles the three axial model of Beier, Bosinski, and Loewit (2005) whostated:‘‘Thesexualpreferencestructure ingeneralmanifests itself in every human on three basic axes: (1) with regard to the preferred gender of the sex partner (male and/or female), (2) regarding the preferred (body development) age of the sex partner (body scheme of children, adolescents, adults, elderly persons), and(3)regardingthepreferredkindandmodusofsexualactivity with and without sex partner(s) (type, object, method, etc.)...’’ How these three axes manifest determines the stimuli to which each individual is sexually attracted, thus allowing for a huge spectrum of sexual possibilities or‘‘orientations’’as Seto puts it. The German Prevention Project Dunkelfeld, a therapy program for pedophilic and hebephilic men outside the judicial context, has greatly benefited from a conceptualization of human sexual preference in this manner (Beier et al., 2009, 2015). From thebeginningof theproject, thenotion thatall, including tabooed, sexual preferences are relatively stable human conditions was communicated and that their often early development and stabilityover lifemakes themwidely inaccessible to themature individual’spotentialwishforalteration(Beieretal.,2009).Theideas that‘‘pedophilia is a fate, not a choice’’and‘‘pedophilia is a diagnosis, not a crime’’have ever since facilitated a widely decriminalized public discourse over sexual attraction toward minors. At the same time, these ideas demanded for the explicit differentiation between the sexual preference as manifest in sexual fantasies and desires on the one hand, and actual sexual behavior on the other. In the case of attraction toward minors, sexual behavior would encompass actual child sexual offenses and/or the use of child abuse images—behaviors that have disruptive consequences for the sexual ‘‘partners’’or rather victims, given the impossibility of informed consent in such cases. The phrasing‘‘nobody can be held responsible for his or her sexual preference (or sexual orientation), but every adult needs to take responsibility for his or her sexual behavior’’was thus coined to communicate the basic principle of the Dunkelfeld therapy program. Ever since the inauguration of the program and with the help of active media relations, this view has been incorporated into public discourse, also allowing for policy makers to support the approach. Scientifically, Seto (2016) further differentiates the third axis in Beier et al.’s model by including the self-other, anthrozoo, and bios-nekros domain, which may allow for a more precise description of ‘‘kind and modus’’ of desired sexual interactions. Both models, however, await empirical proof. Conceptualizing male chronophilias as sexual orientations might prove a fruitful approach to the study ofdifferent sexual preferences. Seto states in his article that ‘‘it is not required that other sexual orientations parallel what we know about gender orientation, but the parsimonious hypothesis would be that they share similarities in features such as developmental trajectory, phenomenological experience, and behavioral expression.’’ Beieretal. intheirmodelalsostatedanappraisalofsexualpreferences on all three axes (physical gender, physical developmental stage, and kind andmodusof sexual interaction)as resembling sexualgenderorientation:‘‘Thefinalmanifestationofsexualpreference structure (i.e., multi-dimensional sexual orientation in Seto’s words) takes place during youth and remains a constituent for life in its basic features and is invariable. This includes invariability of particular sexual inclinations, which are also manifested from youth onward and which partly, or completely, characterize thesexualstructureofthepersoninvolved’’(Beier&Loewit,2013). & Till Amelung till.amelung@charite.de

Clinical characteristics associated with paedophilia and child sex offending – Differentiating sexual preference from offence status

Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.