"Sex in a Relationship" versus "Sex During a One-Night Stand": The Link Between Mental Representations of Consensual Sexuality, Mating Strategies, and Sexual Experience in Heterosexual Women and Men.

Sexual scripts, that is, the mental representations of sexual behavior, are highly influenced by mating strategies and sexual experience. The relationship between these factors and sexual scripts is, however, poorly understood. Therefore, we assessed how long-term (e.g., "sex in a relationship") and short-term (e.g., "one-night stand") strategies, as well as experience with highly scripted sexual practices (BDSM: bondage-discipline, dominance-submission, sadism-masochism), influence verbalized sexual script composition and detailedness. To this end, 204 heterosexual men and women generated both a "sex in a relationship" and a "one-night stand" script. Regarding mating strategies, both men and women generated shorter "sex in a relationship" scripts than "one-night stand" scripts, due to a shorter approach (flirting) phase. In addition, in the "sex in a relationship" script, women generated longer foreplay phases than men. Regarding sexual experience, in the "sex in a relationship" script, individuals with high-BDSM experience generated longer foreplay phases than individuals with middle- or low-BDSM experience. This pattern was reversed in the "one-night stand" script. These results provide empirical support for interactions between mating strategies and individual experience with regard to the mental representations of sexual activity and gender behavior. Understanding this relationship may enable us to better predict sexual encounters and may help to prevent conflicting or abusive situations.

Online sexual solicitation by adults and peers - Results from a population based German sample.

Prevalence of Internet use among adolescents is high, but little is known about the online sexual activities of German adolescents. This study aimed to describe the 12-month prevalence of German adolescents' online sexual experiences with a focus on Online Sexual Solicitation (OSS, subjectively negative online sexual experiences with a peer or any sexual online experience, positive or negative, with an adult). A sample of male and female adolescents aged 14-17 (N=2238) was recruited using online survey panel. The sample was representative for gender and education. Subjects completed an online survey reporting their online sexual activities (i.e., sexual conversation, exchanging pictures, and cybersex) with peers (14-17y.) and/or adults (≥18y.). Findings illustrated that 51.3% (n=1148) of adolescents had experienced online sexual activity, which mostly involved peers (n=969; 84.4%). In contrast, 23.2% (n=519) of the adolescents experienced OSS with 2.6% (n=57) reporting subjectively negative online sexual interactions with peers and 22.2% (n=490) reporting online sexual interactions with adults, of which 10.4% (n=51) were perceived as negative. The findings suggest that adolescents frequently engage in sexual interactions on the Internet with only a relatively small number perceiving such contacts as exploitative. In addition, females and adolescents with incomplete family situation, foreign nationality, higher education, homo- or bisexual orientation, and those without perceived social support reported OSS significantly more often.

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.

A clinical and demographic comparison between a forensic and a general sample of female patients with schizophrenia.

Diagnoses of psychiatric diseases do not include criminal behavior. In schizophrenia, a non-negligible subgroup is incarcerated for capital and other crimes. Most studies that compared offender and non-offender patients with schizophrenia have only focused on male patients. With this study, we compared demographic and disease-related characteristics between 35 female incarcerated forensic patients (fSZ) and 35 female inpatients with schizophrenia (SZ). Basic clinical documentation and basic forensic clinical documentation revealed significant clinical and demographic differences between the two groups. Compared to SZ, fSZ were more severely clinically impaired, showing higher rates of comorbid alcohol and substance disorder, more suicide attempts, had more previous hospitalizations, and were younger at disease onset. Regarding demographic variables, fSZ showed a higher rate of unemployment and homelessness and had to rely more often on housing and legal guardianships compared to SZ. These results suggest that female forensic patients with schizophrenia are more severely affected by clinical and non-clinical variables requiring an adapted intervention program. These results may also indicate two developmental trajectories for criminal and non-criminal schizophrenia in females.

"To see or not to see: that is the question." The "Protection-Against-Schizophrenia" (PaSZ) model: evidence from congenital blindness and visuo-cognitive aberrations.

The causes of schizophrenia are still unknown. For the last 100 years, though, both "absent" and "perfect" vision have been associated with a lower risk for schizophrenia. Hence, vision itself and aberrations in visual functioning may be fundamental to the development and etiological explanations of the disorder. In this paper, we present the "Protection-Against-Schizophrenia" (PaSZ) model, which grades the risk for developing schizophrenia as a function of an individual's visual capacity. We review two vision perspectives: (1) "Absent" vision or how congenital blindness contributes to PaSZ and (2) "perfect" vision or how aberrations in visual functioning are associated with psychosis. First, we illustrate that, although congenitally blind and sighted individuals acquire similar world representations, blind individuals compensate for behavioral shortcomings through neurofunctional and multisensory reorganization. These reorganizations may indicate etiological explanations for their PaSZ. Second, we demonstrate that visuo-cognitive impairments are fundamental for the development of schizophrenia. Deteriorated visual information acquisition and processing contribute to higher-order cognitive dysfunctions and subsequently to schizophrenic symptoms. Finally, we provide different specific therapeutic recommendations for individuals who suffer from visual impairments (who never developed "normal" vision) and individuals who suffer from visual deterioration (who previously had "normal" visual skills). Rather than categorizing individuals as "normal" and "mentally disordered," the PaSZ model uses a continuous scale to represent psychiatrically relevant human behavior. This not only provides a scientific basis for more fine-grained diagnostic assessments, earlier detection, and more appropriate therapeutic assignments, but it also outlines a trajectory for unraveling the causes of abnormal psychotic human self- and world-perception.

Association between brain structure and phenotypic characteristics in pedophilia.

Studies applying structural neuroimaging to pedophiles are scarce and have shown conflicting results. Although first findings suggested reduced volume of the amygdala, pronounced gray matter decreases in frontal regions were observed in another group of pedophilic offenders. When compared to non-sexual offenders instead of community controls, pedophiles revealed deficiencies in white matter only. The present study sought to test the hypotheses of structurally compromised prefrontal and limbic networks and whether structural brain abnormalities are related to phenotypic characteristics in pedophiles. We compared gray matter volume of male pedophilic offenders and non-sexual offenders from high-security forensic hospitals using voxel-based morphometry in cross-sectional and correlational whole-brain analyses. The significance threshold was set to p < .05, corrected for multiple comparisons. Compared to controls, pedophiles exhibited a volume reduction of the right amygdala (small volume corrected). Within the pedophilic group, pedosexual interest and sexual recidivism were correlated with gray matter decrease in the left dorsolateral prefrontal cortex (r = -.64) and insular cortex (r = -.45). Lower age of victims was strongly associated with gray matter reductions in the orbitofrontal cortex (r = .98) and angular gyri bilaterally (r = .70 and r = .93). Our findings of specifically impaired neural networks being related to certain phenotypic characteristics might account for the heterogeneous results in previous neuroimaging studies of pedophilia. The neuroanatomical abnormalities in pedophilia seem to be of a dimensional rather than a categorical nature, supporting the notion of a multifaceted disorder.

Shortened night sleep impairs facial responsiveness to emotional stimuli.

Sleep deprivation deteriorates mood, impairs the recognition of facial expressions, and affects the ability to regulate emotions. The present study investigated the effect of partial sleep deprivation on facial responses to emotional stimuli. Thirty-three healthy undergraduates were tested twice: after a night with (i) 8h and (ii) 4h sleep. Self-reported sleepiness and sustained attention (Psychomotor Vigilance Task) were assessed. Emotional reactivity was measured with facial Electromyogram (EMG) while participants were asked to respond with either compatible or incompatible facial muscles to emotional stimuli in order to study whether partial sleep deprivation caused slower reactions mainly in response to incompatible stimuli (due to an additional effort to suppress the compatible reaction caused by decreased inhibitory control) or in response to both compatible and incompatible stimuli. Self-reported sleepiness and reaction times in a sustained attention task significantly increased after one night of partial sleep deprivation. Facial reactions to emotional stimuli were decelerated. No significant interaction between sleep restriction and compatibility of the muscle to the picture valence could be observed. Hence, volitional facial reactions in response to emotional stimuli were slower after one night of reduced sleep, but affective inhibitory control was not significantly impaired. However, slowed facial responding to emotional stimuli may affect social interaction after sleep restriction.

[Specific outpatient treatment for forensic patients after release]. / Ambulante Sicherungsnachsorge für Massregelvollzugspatienten: Ergebnisse des zweiten bayerischen Modellprojekts.

OBJECTIVE: Efficacy of outpatient aftercare for forensic patients was investigated. Furthermore, concrete aspects of treatment in forensic outpatient clinics were described. METHODS: A population of n=105 "high-risk-offenders" suffering from psychiatric disorders treated in special outpatient aftercare facilities after release from inpatient treatment was followed using several documentation methods and by analyzing patients' criminal records. RESULTS: The population showed a very low criminal recidivism rate (2.0%, average time at risk: 3 years and 8 months). No case of heavy delinquency (violent or sexual offenses) was registered. Patients showed good psychopathological stability over the treatment period. CONCLUSIONS: Specialized aftercare of released forensic patients provides a considerable increase in public security. Patients are protected from psychopathological decompensation by professional supervision after release. Finally, costs in the field of forensic psychiatry can very likely be reduced through outpatient treatment.

The virtual people set: developing computer-generated stimuli for the assessment of pedophilic sexual interest.

The implicit assessment of pedophilic sexual interest through viewing-time methods necessitates visual stimuli. There are grave ethical and legal concerns against using pictures of real children, however. The present report is a summary of findings on a new set of 108 computer-generated stimuli. The images vary in terms of gender (female/male), explicitness (naked/clothed), and physical maturity (prepubescent, pubescent, and adult) of the persons depicted. A series of three studies tested the internal and external validity of the picture set. Studies 1 and 2 yielded good-to-high estimates of observer agreement with regard to stimulus maturity levels by two methods (categorization and paired comparison). Study 3 extended these findings with regard to judgments made by convicted child sexual offenders.

Sexual sadism: current diagnostic vagueness and the benefit of behavioral definitions.

The phenomenon of sexual sadism was first scientifically described by Richard von Krafft-Ebing in 1999 as a sexual preference disorder that focuses on the infliction of suffering, pain, or humiliation to achieve sexual gratification. The present article reviews the historical development of the term sexual sadism, including the current descriptive nosology of psychiatric classification. Despite clear definitions that specify the sexual objects, duration, and distress necessary for a disorder, evidence for the diagnostic reliability for sexual sadism in the forensic domain is mixed. We argue that the reliance on the patient's willingness to divulge corresponding violent sexual fantasies is the Achilles' heel of the diagnosis. In an attempt to improve agreement across diagnosticians, we argue for the use of behavioral indicators. We summarize the extant research on the Severe Sexual Sadism Scale (SESAS), which is a file-based observer rating of pertinent crime-scene actions. We conclude that the analysis of crime-scene behavior, as achieved with the SESAS, can provide a useful complement for the clinical diagnosis in forensic psychiatry and psychology.

Recidivism in female offenders: PCL-R lifestyle factor and VRAG show predictive validity in a German sample.

A clear and structured approach to evidence-based and gender-specific risk assessment of violence in female offenders is high on political and mental health agendas. However, most data on the factors involved in risk-assessment instruments are based on data of male offenders. The aim of the present study was to validate the use of the Psychopathy Checklist Revised (PCL-R), the HCR-20 and the Violence Risk Appraisal Guide (VRAG) for the prediction of recidivism in German female offenders. This study is part of the Munich Prognosis Project (MPP). It focuses on a subsample of female delinquents (n = 80) who had been referred for forensic-psychiatric evaluation prior to sentencing. The mean time at risk was 8 years (SD = 5 years; range: 1-18 years). During this time, 31% (n = 25) of the female offenders were reconvicted, 5% (n = 4) for violent and 26% (n = 21) for non-violent re-offenses. The predictive validity of the PCL-R for general recidivism was calculated. Analysis with receiver-operating characteristics revealed that the PCL-R total score, the PCL-R antisocial lifestyle factor, the PCL-R lifestyle factor and the PCL-R impulsive and irresponsible behavioral style factor had a moderate predictive validity for general recidivism (area under the curve, AUC = 0.66, p = 0.02). The VRAG has also demonstrated predictive validity (AUC = 0.72, p = 0.02), whereas the HCR-20 showed no predictive validity. These results appear to provide the first evidence that the PCL-R total score and the antisocial lifestyle factor are predictive for general female recidivism, as has been shown consistently for male recidivists. The implications of these findings for crime prevention, prognosis in women, and future research are discussed.

Empathy in sexually sadistic offenders: an experimental comparison with non-sadistic sexual offenders.

Previous studies suggest that severe sexual sadism and psychopathy are phenotypically different, although both are characterized by deficits in emotional processing. We assessed empathic capacity in a sample of 12 sexual sadists in comparison with 23 non-sadistic offenders using the Multifaceted Empathy Test (MET). All participants were forensic patients under mandatory treatment orders who had committed sexual offenses. The MET is a computerized rating task that differentiates and measures cognitive and emotional components of empathy, or perspective-taking versus compassionate components. To identify the effects of possible empathy deficits caused by psychopathic traits, we controlled both samples for psychopathy as a covariate, measured by the Psychopathy Checklist-Revised (PCL-R). According to our results, sexual sadists did not differ from non-sadistic sexual offenders with regard to emotional empathy for either positive or negative stimuli. The results suggest that severe sexual sadism is a distinct, pathological sexual arousal response, not a deficit in emotional processing.

Functional cortical and subcortical abnormalities in pedophilia: a combined study using a choice reaction time task and fMRI.

INTRODUCTION: Pedophiles show sexual interest in prepubescent children but not in adults. Research into the neurofunctional mechanisms of paraphilias has gathered momentum over the last years. AIM: To elucidate the underlying neural processing of sexual interest among pedophiles and to highlight the differences in comparison with nonparaphilic sexual interest in adults. METHODS: Nine pedophilic patients and 11 nonpedophilic control subjects underwent functional magnetic resonance imaging (fMRI) while viewing pictures of nude (prepubescents, pubescents, and adults) and neutral content, as well as performing a concomitant choice reaction time task (CRTT). MAIN OUTCOME MEASURES: Brain blood oxygen level-dependent (BOLD) signals and response latencies in the CRTT during exposure to each picture category. RESULTS: Analysis of behavioral data showed group differences in reaction times regarding prepubescent and adult but not pubescent stimuli. During stimulation with pictures displaying nude prepubescents, pedophiles showed increased BOLD response in brain areas known to be involved in processing of visual sexual stimuli. Comparison of pedophilic patients with the control group discovered differences in BOLD responses with respect to prepubescent and adult but not to pubescent stimuli. Differential effects in particular occurred in the cingulate gyrus and insular region. CONCLUSIONS: The brain response of pedophiles to visual sexual stimulation by images of nude prepubescents is comparable with previously described neural patterns of sexual processing in nonpedophilic human males evoked by visual stimuli depicting nude adults. Nevertheless, group differences found in the cingulate gyrus and the insular region suggest an important role of these brain areas in pedophilic sexual interest. Furthermore, combining attention-based methods like CRTT with fMRI may be a viable option for future diagnostic procedures regarding pedophilia.

[Schizophrenic diseases, psychosis and homicide: the importance of community psychiatry for the prevention of offences]. / Schizophreniforme Erkrankungen, Psychose und Tötungsdelikte: Die Bedeutung sozialtherapeutischer Maßnahmen zur Prävention von Delikten.

OBJECTIVE: Even though homicides of psychotic patients are relatively rare, they have a great impact on the public opinion about the mentally ill. Current literature indicates that psychotic patients are at an increased risk to commit violent offences. The risk of this group to commit a homicide is even more increased. The question of our study was to find out whether past homicides of schizophrenic patients could have been avoided if treatment had been administered properly. METHODS: Review of 39 homicide cases, committed by patients who had been psychotic during the offence. RESULTS: 10.2 % of the homicides could have been prevented in the absence of mistakes of therapists or legal authorities. Another 15.4 % of the homicides could have probably been avoided in case of communication between the treating therapists and family of the patient previously to the offence. CONCLUSIONS: The whole family of the patient should be involved in the therapy. Possibilities are home visits on the basis of community care. Furthermore, threats of psychotic patients should be taken seriously.

Psychopathy and sexual sadism.

Psychopathic personality disorder and sexual sadism share several common characteristics, such as emotional detachment from the suffering of others or the preparedness to inflict pain or injuries. Based on a sample of 100 male forensic patients (all of them sex offenders, half of them sadistic), the concept of psychopathy and sexual sadism as a unified construct was tested empirically. Pooling indicator variables for psychopathic and sexually sadistic disorders showed that a two-factorial solution yielded a better fit than a single-factor model. The two factors identified psychopathy and sexual sadism as separate latent variables. More specifically, the data were compatible with a path model in which affective deficits and behavioral disinhibition of the psychopathy domain are precursors to sexually sadistic conduct.

Assessing measurement invariance of PCL-R assessments from file reviews of North American and German offenders.

Cross-cultural research on psychopathy necessitates assessment methods that are generalizable across linguistic and cultural differences. Multiple-group confirmatory factor analysis was used to compare the factorial structure of Psychopathy Checklist-Revised (PCL-R) assessments obtained from file reviews of North-American (N=2622) and German (N=443) male offenders. The analyses indicated that the 18 item, 4-factor model of the PCL-R obtained with the standard PCL-R protocol (interview and file review) also holds for file review data. On a factor-by-factor level, the data are commensurate with strong factorial invariance of factor loadings and item thresholds for the Interpersonal and Lifestyle factors, and with likely metric invariance for the Affective factor. The Antisocial factor showed structural differences between the two samples. The results imply that cultural or environmental factors more strongly influence the judgment and/or expression of antisociality. Based on the results, cross-cultural comparisons between North-American and German offenders in terms of PCL-R psychopathy should be limited to the Interpersonal and Lifestyle factors. Further research using data obtained through the standard protocol (i.e., interview plus file information) is encouraged.

Assessment of pedophilic sexual interest with an attentional choice reaction time task.

Choice-reaction time (CRT) is an experimental information-processing paradigm. Based on an interference effect in visual attention, the CRT method has been shown to be suitable for measuring sexual orientation in men and women. The present study assessed the potential of the CRT to identify deviant (i.e., pedophilic) sexual interest. Participants were patients from forensic-psychiatric hospitals: 21 child molesters and 21 non-sex offenders. The dependent variable was reaction time in an ostensible seek-and-locate task (i.e., identifying the position of a dot superimposed on a picture of a person). There was an interaction effect between stimulus age category and participant group status: Child molesters took longer to respond to pictures of children relative to pictures of adults. Non-sex offenders showed an opposite pattern (i.e., longer reaction times with pictures of adults than with pictures of children). In addition, the data supported the notion of sexual content induced delay: Subjects took longer for the task with nude stimuli than with clothed ones. A subtractive preference index, derived from the reaction times for child and adult stimulus material, allowed distinguishing participants from both groups almost perfectly (ROC-AUC = .998). We conclude that a match of sexual interest with properties of visual stimuli led to a cognitive interference effect: Attentional resources were drawn from the ostensible task of locating the dot towards exploring the picture. This opens up the possibility of using this interference effect (i.e., the delay of response times) for diagnostic purposes.

A cumulative scale of severe sexual sadism.

The article assesses the scale properties of the criterion set for severe sexual sadism in a sample of male forensic patients (N = 100). Half of the sample consists of sexual sadists; the remainder is sampled at random from the general group of nonsadistic sex offenders. Eleven of 17 criteria (plus the additional item of inserting objects into the victim's bodily orifices) of Marshall, Kennedy, Yates, and Serran's list form a cumulative scale. More specifically, this scale comprises all the 5 core criteria that Marshall and his colleagues considered particularly relevant. The resulting 11-item scale of severe sexual sadism is highly reliable (r(tt) = .93) and represents a strong scale (H = .83) of the Guttman type (coefficient of reproducibility = .97). The 11-item scale distinguishes perfectly between sexual sadists and nonsadistic sex offenders in the sample.

Severe sexual sadism--an underdiagnosed disorder? Evidence from a sample of forensic inpatients.

Severe sexual sadism is a disorder of sexual preference that focuses on humiliation and subjugation of the victim, sometimes causing grievous injury or death. Sexual sadists pose a particular risk. However, the diagnosis as such is unreliable and prevalence estimates vary. In a sample of male high-security forensic inpatients who had committed sexual offenses, we found two-thirds of sexual sadists had not been identified as such prior to commitment. Possible reasons for missing the diagnosis are many fold. Present data support the notion that unrecognized sexual sadists more closely resembled non-sadistic sex offenders than accurately diagnosed sadists. In particular, initially unrecognized sexual sadists had less severe previous convictions, less vocational training, and experienced a less supportive upbringing than their correctly identified sadistic counterparts. The latter, in contrast, more often reached media coverage through their offense(s). We conclude that severe sexual sadism is likely an underdiagnosed, yet forensically highly relevant disorder.

Diminished cooperativeness of psychopaths in a prisoner's dilemma game yields higher rewards.

Maladaptive social behavior is one of the defining characteristics of psychopathic personality disorder. Nevertheless, maladaptive social behavior has only rarely been observed among psychopaths in experimentally controlled situations. The authors assessed the behavior of criminal psychopaths from high-security psychiatric hospitals in a computer simulation of a social dilemma situation. The psychopaths showed a markedly higher proneness to competitive (i.e., noncooperative) behavior than did healthy adults from the general population. The odds ratio between defection and being a psychopath was estimated at 7.86 in the sample. The probability to choose selfish instead of cooperative behavior was significantly linked to the following subscales of the Psychopathy Personality Inventory-Revised (S. O. Lilienfeld & M. R. Widows, 2005): rebellious nonconformity, Machiavellian egocentricity, and the total score. On average, the psychopathic participants accumulated higher gain and more strongly exploited their counterpart than did the healthy participants.