Widespread and interrelated gray matter reductions in child sexual offenders with and without pedophilia: Evidence from a multivariate structural MRI study.

AIM: To further investigate the neuroanatomical correlates of child sexual offending and disentangle them from the neural correlates of pedophilia, using a multivariate analytical approach in order to minimize loss of statistical power. METHODS: This study presents structural MRI data on gray matter in an incarcerated, male population of 22 pedophilic and 21 non-pedophilic child sexual offenders, and 20 violent non-sexual offender controls, based on a multivariate whole-brain approach using source-based morphometry. RESULTS: We identify a network of several neuroanatomical regions exhibiting interrelated reduced gray matter in both child sexual offender groups relative to controls, comprising extensive clusters in the bilateral cerebellum and frontal lobe, as well as smaller clusters in the bilateral parietal, temporal, and occipital lobes, the bilateral basal ganglia, the medial cingulate and the hippocampus. CONCLUSION: Our results speak to the interpretation that there are inter- and possibly connectivity-related brain structural abnormalities in child sexual offenders that are not (only) pertaining to pedophilia per se. Interpretations and limitations of the present data are discussed and recommendations for future works are given.

Unraveling sexual associations in contact and noncontact child sex offenders using the single category - implicit association test.

Previous studies found associations between children and sex in child sex offenders (CSOs) using the Implicit Association Test (IAT). We used a modification of this task, the Single Category-Implicit Association Test (SC-IAT) to unravel child-sex associations in CSOs. Using the SC-IAT, we were able to test whether CSOs indeed hold stronger child-sex associations relative to adult-sex associations, compared to adult sex offenders and nonoffenders. Furthermore, we examined whether contact CSOs differed from noncontact CSOs in their child-sex associations. The hypothesis that CSOs would have stronger child-sex associations, relative to their adult-sex associations, than adult sex offenders and nonoffenders was confirmed. No difference between contact CSOs and noncontact CSOs was found. Although the Sex SC-IAT was able to distinguish CSOs from nonoffenders, the sensitivity and specificity of the test was poor (AUC of .65) and needs refinement. The results of this study support the existence of a child-sex association as a distinctive characteristic of CSOs. These findings are discussed in the context of theories on deviant cognitions in CSOs and risk for sexual offending.

Executive function profiles of pedophilic and nonpedophilic child molesters.

There is increasing evidence of neurocognitive dysfunction among child molesters, supporting the notion of brain anomalies among pedophiles. However, approximately half of child molesters are not pedophilic (i.e., are not primarily attracted to children), and neurocognitive differences between pedophilic (PED) and nonpedophilic (NPED) child molesters are not well understood. The purpose of this study was to assess neurocognition, specifically executive functioning (EF), among phallometrically defined PED and NPED child molesters, relative to nonsexual offenders (NSO). Participants (N = 89) were compared on seven EF domains. Results revealed that (a) child molesters exhibited an overall executive profile that was different from that of NSOs, with PEDs differing from NSOs but not from NPEDs; (b) child molesters on the whole performed better than NSOs on abstract reasoning and more poorly on inhibition; and (c) PEDs performed better than NPEDs on planning and exhibited better overall performance accuracy relative to NPEDs. These results suggest that PEDs exhibit a more deliberate, planful response style characterized by greater self-monitoring; whereas NPEDs appear to respond more impulsively. The current report further elucidates neurocognition among child molesters and highlights the need for future research examining subtypes of child molesters.

Executive dysfunctions in pedophilic and nonpedophilic child molesters.

INTRODUCTION: There is some evidence that child molesters show neuropsychological abnormalities which might reflect specific structural and/or functional brain alterations, but there are also inconsistencies in the existing findings which need to be clarified. Most of the different outcomes can either be explained by the fact that different types of child molesters were examined or by not having accounted for basically confounding factors such as age, education/intelligence, or criminality. AIM: The present study therefore sought to determine whether pedophilic and nonpedophilic child molesters, compared to relevant control groups, show different profiles of executive dysfunction when accounting for potentially confounding factors. METHODS: The performance of 30 child molesters (15 pedophilic and 15 nonpedophilic) and 33 age- and education-matched controls (16 nonsexual offenders and 17 healthy controls) was assessed regarding several neuropsychological functions. MAIN OUTCOME MEASURES: Scores on different neurocognitive tests and semistructured diagnostical interviews. RESULTS: Results indicate that pedophilic child molesters exhibited less performance deficits in cognitive functioning than nonpedophilic child molesters. Compared to healthy controls and nonsexual offenders, the pedophilic child molesters only showed executive dysfunction concerning response inhibition, whereas the nonpedophilic child molesters revealed more severe dysfunction, especially on tasks associated with cognitive flexibility and verbal memory. CONCLUSIONS: These results enhance our knowledge about executive dysfunction associated with criminality and/or pedophilia, as they suggest different profiles of impairment between groups. In summary, data suggest that nonpedophilic child molesters showed more severe cognitive deficits than pedophilic child molesters. However, as response inhibition is associated with prefrontal (i.e., orbitofrontal) functioning, the deficits observed in both child molester groups indicate dysfunction in the orbitofrontal cortex. This has to be further examined with functional imaging approaches in larger samples and a full-factorial approach which allows for a clear distinction between criminality and pedophilia in a factorial manner.

Neurocognitive differences between pedophilic and nonpedophilic child molesters.

Although some evidence exists that child molesters may be characterized by structural and functional brain abnormalities, findings across studies are inconsistent. Past cognitive research in this area has been extensively criticized for relying on conceptually weak batteries, measures of questionable reliability, and poorly defined samples (i.e., failing to distinguish between pedophilic and nonpedophilic child molesters). The present study aimed to address the weaknesses of past research by comparing 40 child molesters (20 pedophilic and 20 nonpedophilic) and 20 demographically matched nonoffender controls on six well-defined neurocognitive composite scores of comparable reliability (i.e., semantic knowledge, executive functioning, processing speed, motor speed, auditory memory, and visual memory). Results indicated that pedophilic child molesters exhibit slower processing speed, nonpedophilic child molesters exhibit poorer semantic knowledge, and both molester groups exhibit executive weaknesses as compared to nonoffender controls. This study is the first to compare the two molester types on neurocognitive functions. The observed differences between the molester groups help explain inconsistencies in past research and demonstrate the need to distinguish between the two types of child molesters when studying neurobiologic underpinnings of sexual offending.

The paedophile and his inner world: theoretical and clinical considerations on the analysis of a patient.

The main feature of the treatment of the paedophile is the distance that separates the analyst from the patient. However hard the analyst tries to understand his patient, the paedophile's world appears to him, especially at the beginning of the treatment, incomprehensible, disheartening and distant. This paper describes the analytic therapy of a paedophile patient. The psychopathological organization that dominates his inner world originates from a delusional nucleus in which an object (a child or an adolescent) is idealized and worshipped in place of the parents. This object promises all manner of pleasure and happiness. The positive outcome of this patient leads one to believe that, if analytically treated, some paedophile patients are open to therapeutic transformation.

Psychiatric aspects of sexual abuse involving persons with developmental disabilities.

OBJECTIVE: To consider psychiatric issues that relate to the prevention and management of sexual abuse involving persons with developmental disabilities as either abusers or victims. METHOD: Seven case descriptions illustrate the clinical challenges raised by allegations of sexual abuse. RESULTS: Mental disorders and communication problems often coexist with the cognitive impairment that is primary in developmental disabilities. Pedophilic behaviour prompts allegations of abuse, and posttraumatic stress disorder often follows abuse. Difficulties communicating with others may preclude the detection of abuse or normal legal proceedings once an allegation is made. CONCLUSIONS: Psychiatric expertise applied both directly and indirectly through others is relevant in the prevention of sexual abuse and the management of those with developmental disabilities who are abusers or abused.

Pedophilia and deafness.

Data from 22 cases of deaf individuals suffering from pedophilia are presented along with a tabular summary of recent articles from the deaf press, about deaf victims of pedophilia and deaf pedophiles. Results indicate a number of factors that distinguish deaf pedophiles from hearing pedophiles. First is the prevalence of Primitive Personality Disorder in the deaf group. Corollary to this, with a significant number of pedophiles, competence to stand trial is a major issue. Other significant differences include a high rate of brain damage, illiteracy, poor communication skills, and other psychiatric illnesses. Two of the 22 cases were deaf females with pedophilia. The mean performance IQ of the sample was 102.8 and the distribution of scores was bimodal. Case histories are presented and discussed, and legal issues, prevention, and punishment are addressed.

Simulated paraphilias: a preliminary study of patients who imitate or exaggerate paraphilic symptoms and behaviors.

In a consecutive series of admissions to the Johns Hopkins Sexual Disorders Unit, 4 out of 20 patients appeared to have simulated paraphilic symptoms that further assessment indicated were either exaggerated or not present. The paper presents case histories of these 4 patients. A descriptive comparison is made between these patients and control groups of patients who admitted having paraphilic symptoms and a group of patients accused of having paraphilic symptoms but who denied them. Patients who simulated paraphilias tended to be self-referred (75%) and without current legal charges (100%). None of these patients was referred or sought treatment for pedophilia, in contrast to the other two patient groups, in which pedophilia accounted for 75% of the referrals. Several possible explanations for why patients might simulate paraphilias and implications for therapists who evaluate or treat sex offenders are discussed.

[Multiple sex drive abnormalities in a patient with Klinefelter's syndrome]. / Multiple sexuelle Triebabweichungen bei einem Patienten mit Klinefelter-Syndrom

The authors report various sexual instinct disturbances and, more specifically, exhibitionism and pedophilia of a 25-year-old patient with Klinefelter's syndrome. The patient had committed several punishable offenses and was referred to our specialty clinic for psychologic and psychiatric examinations. Aspects of psychopathology and causal etiopathogenetic relationships of the authors' own observations are discussed and compared with those reported in the literature. Environmental factors are considered to be primarily responsible for the development of sexual perversions. The Klinefelter syndrome as such may be regarded as being of predispositional importance only.

Forensic psychiatry: profiles of two types of sex offenders.

The authors examined records of 239 individuals charged with sexual offenses and referred by the courts to a forensic service. Defendants charged with rape were typically under 30 with histories of antisocial behavior that included other types of violence. Major mental illness was rare in this group. Child molesters in the sample were of no particular age, usually had no history of violent behavior, and had a low incidence of psychosis. The most common secondary diagnosis in both groups was alcohol or drug abuse.