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It is not uncommon for patients with obsessive-compulsive disorder (OCD) to present with symptoms that suggest possible risk. This can include apparent risk, which reflects the content of obsessional fears, and genuine risk arising as the unintended consequence of compulsive behaviors. In both situations, risk can cause confusion in relation to diagnosis and treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. Guidance is offered to support clinical decision making and treatment planning.

Empathy is regarded as dynamic risk factor of child sexual offending. However, empathy research in the context of child sexual abuse suffers from various problems. First, prior studies failed to differentiate between pedophilic and nonpedophilic sexual offenders. Second, there is no distinction made between cognitive and affective empathy. Third, cognitive and affective empathy toward emotional states of specific age groups (children and adults) has not been adequately addressed. The current study tackles these shortcomings investigating offending and nonoffending pedophiles and multiple aspects of empathy using self-reports and objective behavioral measures. Participants included 85 pedophilic men who committed hands-on child sexual offenses (P+CSO), 72 pedophilic men who never committed hands-on child sexual offenses (P-CSO), and 128 nonoffending teleiophilic male controls (TC). Several affective and cognitive aspects of empathy were assessed using the Multifaceted Empathy Test (MET) and the Interpersonal Reactivity Index (IRI). Whereas in self-reports (IRI) P+CSO scored lower than TC (P-CSO intermediate) in cognitive perspective-taking abilities, a performance-based measure (MET) revealed evidence for a better differentiation of emotional states in P-CSO as compared with P+CSO (TC intermediate). In addition, P+CSO and P-CSO showed significantly higher affective resonance while observing children (MET), which was paralleled by higher self-reported levels of personal distress in social situations (IRI). The results indicate evidence for higher general affective empathic resonance to children in pedophilic men but superior cognitive empathy abilities in nonoffending pedophiles only, which may act as a protective factor in the prevention of sexual offending. Together, these findings underline the importance of accounting for multiple facets of empathy when targeting pedophilia and child sexual offending. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.

Background: Pedophilic disorder is characterized by increased sexual interest towards children, with comparatively lesser interest towards adults. In real life, the behavior of subjects with pedophilic disorder is shaped by evaluative processes in response to sexually relevant cues. Therefore, brain activation during anticipation of sexually relevant cues is of potential interest. Whereas previous research demonstrated reduced activation when viewing adult (non-preferred) sexual stimuli in pedophilic sex offenders (PSOs), it is not known if anticipation of preferred versus unpreferred stimuli will elicit differential brain activation., Methods: Two fMRI studies (1.5 and 7 Tesla) were conducted in separate samples, each with 26 subjects (13/13 PSOs/controls) to assess brain activity during expectancy of subsequent adult (non-preferred) sexual stimuli. In the second study (7 Tesla) additionally child (preferred) cues were presented., Results: As predicted, expectancy of adult sexual stimuli generated smaller dorsal anterior cingulate cortex (dACC) activation in PSOs in both studies, driven by stronger activation during expectancy of adult erotic stimuli in non-pedophilic controls (HCs). In the second study, PSOs showed significantly increased activations in dACC during expectancy of child stimuli compared with expectancy of adult stimuli. This difference was significantly greater compared to the same contrast in HCs, thus demonstrating preference specificity of dACC activation., Conclusion: Our findings support the notion of decreased brain activation to adult cues in PSOs and preference specificity in neural response during expectancy of erotic stimuli. The localization of these cue reactivity differences in the salience network supports the interpretation that PSOs show abnormally increased preparatory activation even before relevant sexual stimuli are actually presented., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Comparison of pedophilic individuals who do and do not refrain from sexually engaging with children may offer critically important information regarding the differential contributors to pedophilic attraction versus behavior. This study compared 5 traits that are potentially contributory to pedophilic attraction or behavior in both minor-attracted persons (MAPs) who refrain from sexually engaging with minors (nonacting MAPs) and those who have acted on pedophilic attractions and subsequently entered the criminal justice system (forensic MAPs)., Methods: Subjects included 195 nonacting MAPs, 50 forensic MAPs, and 60 healthy controls. Data on nonacting MAPs were drawn from an online survey, and data on the other 2 groups were based on prior in-person evaluations. Measures included the Millon Clinical Multiaxial Inventory-II (MCMI-II), Barratt Impulsiveness Scale (BIS-11), the MAP Questionnaire, and the Sexual History Questionnaire (SHQ)., Results: Both MAP groups scored higher than healthy controls on the domains of socially inhibited personality traits, propensity toward cognitive distortions, and subjects' own childhood sexual abuse (CSA). Forensic MAPs scored higher than nonacting MAPs on the CSA domain, but the 2 MAP groups differed little on the other 2 domains. Forensic MAPs also scored higher than the other 2 groups on the antisocial domain, whereas nonacting MAPs did not differ from controls on this measure. Nonacting MAPs scored higher than controls on impulsivity., Conclusions: Antisocial personality traits may be a primary driver of pedophilic behavior that is unrelated to pedophilic attraction. Socially inhibited personality traits and propensity toward cognitive distortions are associated with pedophilic attraction, although the direction of causation is not clear. CSA seems to increase the risk of both attraction and behavior.

Objective: Impaired response inhibition might play a role in child sexual offences. Recording of event-related potentials (ERPs) can help to clarify whether child sexual offenders (CSOs) show an altered processing of stop signals and commission errors., Methods: In the current ERP study, we investigated these processes in a Go/Nogo task on two groups of CSOs, pedophilic contact CSOs and non-contact CSOs (child pornography offenders), as well as on non-offenders as controls., Results: Behaviorally, CSOs showed a slight, but non-significant increase of the false alarm rate to Nogo cues, as compared to controls. The amplitudes of the ERP components N2 and P3 to Nogo cues followed by correctly withhold responses did not vary between CSOs and controls. The analysis of the ERPs to committed errors showed that the Ne amplitudes (reflecting error detection) did not differ between the groups either, whereas the Pe amplitudes (reflecting error evaluation and error awareness) were strongly diminished in CSOs. This diminishment was primarily found in contact CSOs., Conclusions: The findings suggest that response inhibition, processing of stop signals, and error detection are not necessarily impaired in CSOs. However, CSOs appear to dedicate less cognitive resources to the evaluation of committed errors., Significance: This selective alteration could reflect a reduced sense of responsibility for misconduct in this offender group, which might contribute to their delinquent behavior., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Sexual attraction to children occurs in roughly 3 to 9 percent of the population. However, most knowledge about such desires comes from forensic samples, and most studies fail to assess preferred sexual activity and sexual partner. A new multimodal assessment of sexual desire was used to investigate interest in consensual and nonconsensual sex with adults and children in an online sample of men sexually attracted to children (n = 101). Desires were compared across history of sex offending behavior and preferred gender of child victim. Men who have and have not acted on their sexual attractions to children reported similar levels of sexual desire. Men primarily attracted to girls reported greater desire for sex with adults than did men primarily attracted to boys. Results highlight the heterogeneity of men sexually attracted to children as well as possible distinctions across gender of children to whom they are primarily attracted.

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).

The current study examined the extent to which 1136 men were able to inhibit their sexual arousal on a phallometric assessment, when instructed to do so. Although the observed changes between the two conditions (i.e., Normal and Suppression) were small to moderate in magnitude, the change was not more than what would be expected by measurement error for most participants (e.g., 83% of pedophilic sex offenders against children did not successfully inhibit their sexual arousal in the Suppression condition). There were very few variables that were associated with the ability to suppress. Higher Pedophilia Index scores in the Suppression condition predicted a greater likelihood of sexual recidivism among sex offenders (hazard ratio = 1.17, 95% CI [1.04, 1.32]), but the ability to suppress sexual arousal was not found to predict sexual recidivism. The current study highlights the importance of accounting for measurement error and found that, when doing so, most sex offenders against children are unable to successfully inhibit their sexual arousal to children when instructed to do so, and that the ability to suppress sexual arousal is not associated with recidivism.

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. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

We compared outcomes of arousal and preference assessments for five adult male alleged sexual offenders with intellectual disabilities. Arousal assessments involved the use of the penile plethysmograph to measure changes in penile circumference to both deviant (males and females under the age of 18) and nondeviant (males and females over the age of 18) video clips. Paired-stimulus preference assessments were arranged to present still images from the video clips used in the arousal assessments. Results showed correspondence between the assessments for four out of the five participants. Implications are discussed for the use of preference assessment methodology as a less intrusive assessment approach for sexual offender assessments., (© 2016 Society for the Experimental Analysis of Behavior.)

Cognitive mechanisms associated with the relative lack of sexual interest in adults by pedophiles are poorly understood and may benefit from investigations examining how the brain processes adult erotic stimuli. The current study used event-related brain potentials (ERP) to investigate the time course of the explicit processing of erotic, emotional, and neutral pictures in 22 pedophilic patients and 22 healthy controls. Consistent with previous studies, early latency anterior ERP components were highly selective for erotic pictures. Although the ERPs elicited by emotional stimuli were similar in patients and controls, an early frontal positive (P2) component starting as early as 185 ms was significantly attenuated and slow to onset in pedophilia, and correlated with a clinical measure of cognitive distortions. Failure of rapid attentional capture by erotic stimuli suggests a relative reduction in early processing in pedophilic patients which may be associated with relatively diminished sexual interest in adults., (Copyright © 2016. Published by Elsevier B.V.)

Pedophilia is a principal motivator of child molestation, incurring great emotional and financial burdens on victims and society. Even among pedophiles who never commit any offense,the condition requires lifelong suppression and control. Previous comparison using voxel-based morphometry (VBM)of MR images from a large sample of pedophiles and controls revealed group differences in white matter. The present study therefore sought to verify and characterize white matter involvement using diffusion tensor imaging (DTI), which better captures the microstructure of white matter than does VBM. Pedophilics ex offenders (n=24) were compared with healthy, age-matched controls with no criminal record and no indication of pedophilia (n=32). White matter microstructure was analyzed with Tract-Based Spatial Statistics, and the trajectories of implicated fiber bundles were identified by probabilistic tractography. Groups showed significant, highly focused differences in DTI parameters which related to participants’ genital responses to sexual depictions of children, but not to measures of psychopathy or to childhood histories of physical abuse, sexual abuse, or neglect. Some previously reported gray matter differences were suggested under highly liberal statistical conditions (p(uncorrected)<.005), but did not survive ordinary statistical correction (whole brain per voxel false discovery rate of 5%). These results confirm that pedophilia is characterized by neuroanatomical differences in white matter microstructure, over and above any neural characteristics attributable to psychopathy and childhood adversity, which show neuroanatomic footprints of their own. Although some gray matter structures were implicated previously, only few have emerged reliably.

Despite its 0.5-1% lifetime prevalence in men and its general societal relevance, neuroimaging investigations in pedophilia are scarce. Preliminary findings indicate abnormal brain structure and function. However, no study has yet linked structural alterations in pedophiles to both connectional and functional properties of the aberrant hotspots. The relationship between morphological alterations and brain function in pedophilia as well as their contribution to its psychopathology thus remain unclear. First, we assessed bimodal connectivity of structurally altered candidate regions using meta-analytic connectivity modeling (MACM) and resting-state correlations employing openly accessible data. We compared the ensuing connectivity maps to the activation likelihood estimation (ALE) maps of a recent quantitative meta-analysis of brain activity during processing of sexual stimuli. Second, we functionally characterized the structurally altered regions employing meta-data of a large-scale neuroimaging database. Candidate regions were functionally connected to key areas for processing of sexual stimuli. Moreover, we found that the functional role of structurally altered brain regions in pedophilia relates to nonsexual emotional as well as neurocognitive and executive functions, previously reported to be impaired in pedophiles. Our results suggest that structural brain alterations affect neural networks for sexual processing by way of disrupted functional connectivity, which may entail abnormal sexual arousal patterns. The findings moreover indicate that structural alterations account for common affective and neurocognitive impairments in pedophilia. The present multimodal integration of brain structure and function analyses links sexual and nonsexual psychopathology in pedophilia., (© 2015 Wiley Periodicals, Inc.)

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., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Antiandrogen therapy (ADT) has been used for 30 years to treat pedophilic patients. The aim of the treatment is a reduction in sexual drive and, in consequence, a reduced risk of recidivism. Yet the therapeutic success of antiandrogens is uncertain especially regarding recidivism. Meta-analyses and reviews report only moderate and often mutually inconsistent effects., Case Presentation: Based on the case of a 47 year old exclusively pedophilic forensic inpatient, we examined the effectiveness of a new eye tracking method and a new functional magnetic resonance imaging (fMRI)-design in regard to the evaluation of ADT in pedophiles. We analyzed the potential of these methods in exploring the impact of ADT on automatic and controlled attentional processes in pedophiles. Eye tracking and fMRI measures were conducted before the initial ADT as well as four months after the onset of ADT. The patient simultaneously viewed an image of a child and an image of an adult while eye movements were measured. During the fMRI-measure the same stimuli were presented subliminally. Eye movements demonstrated that controlled attentional processes change under ADT, whereas automatic processes remained mostly unchanged. We assume that these results reflect either the increased ability of the patient to control his eye movements while viewing prepubertal stimuli or his better ability to manipulate his answer in a socially desirable manner. Unchanged automatic attentional processes could reflect the stable pedophilic preference of the patient. Using fMRI, the subliminal presentation of sexually relevant stimuli led to changed activation patterns under the influence of ADT in occipital and parietal brain regions, the hippocampus, and also in the orbitofrontal cortex. We suggest that even at an unconscious level ADT can lead to changed processing of sexually relevant stimuli, reflecting changes of cognitive and perceptive automatic processes., Conclusion: We are convinced that our experimental designs using eye tracking and fMRI could prospectively add additional and valuable information in the evaluation of ADT in paraphilic patients and sex offenders. But with respect to the limited significance of this single case study, these first results are preliminary and further studies have to be conducted with healthy subjects and patients.

Human faces can motivate nurturing behaviour or sexual behaviour when adults see a child or an adult face, respectively. This suggests that face processing is tuned to detecting age cues of sexual maturity to stimulate the appropriate reproductive behaviour: either caretaking or mating. In paedophilia, sexual attraction is directed to sexually immature children. Therefore, we hypothesized that brain networks that normally are tuned to mature faces of the preferred gender show an abnormal tuning to sexual immature faces in paedophilia. Here, we use functional magnetic resonance imaging (fMRI) to test directly for the existence of a network which is tuned to face cues of sexual maturity. During fMRI, participants sexually attracted to either adults or children were exposed to various face images. In individuals attracted to adults, adult faces activated several brain regions significantly more than child faces. These brain regions comprised areas known to be implicated in face processing, and sexual processing, including occipital areas, the ventrolateral prefrontal cortex and, subcortically, the putamen and nucleus caudatus. The same regions were activated in paedophiles, but with a reversed preferential response pattern., (© 2014 The Author(s) Published by the Royal Society. All rights reserved.)

Multiple factors determine handedness including genetics, prenatal stress and post-natal environmental conditions. Atypical handedness, whether manifest as increased sinistrality or decreased strength of lateral preference, has been noted in a wide variety of populations with neuropathology. Those with atypical sexual preferences, specifically paedophilia, also manifest reduced rates of right-handedness. This paper uses the largest sample of phallometrically assessed men to date to establish the pattern of atypical handedness in paedophilia. Specifically, whereas prior research has largely characterized participants dichotomously as right-handed or non-right-handed and/or used self-report of writing hand, this paper expands upon such reports by using the Edinburgh Handedness Inventory's laterality quotient. Participants' handedness and phallometrically assessed sexual preference were analyzed both as continuous and categorical variables, and the responses of those scoring in the range of ambiguous-handedness were evaluated to ascertain whether they were ambiguously handed or more accurately described as mixed-handed. Results indicated those producing scores in the range of ambiguous-handedness demonstrated response patterns consistent with ambiguous-handedness, rather than mixed-handedness. Paedophiles demonstrated high rates of non-right-handedness primarily manifested as sinistrality, whereas those who had a sexual preference for pubescent children evidenced increased ambiguous-handedness. Results support a view of ambiguous-handedness as less pathological than previously hypothesized, and of a neurodevelopmental origin of paraphilic sexual preferences.

Recent theories in sexuality highlight the importance of automatic and controlled attentional processes in viewing sexually relevant stimuli. The model of Spiering and Everaerd (2007) assumes that sexually relevant features of a stimulus are preattentively selected and automatically induce focal attention to these sexually relevant aspects. Whether this assumption proves true for pedophiles is unknown. It is aim of this study to test this assumption empirically for people suffering from pedophilic interests. Twenty-two pedophiles, 8 nonpedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult while eye movements were measured. Entry time was assessed as a measure of automatic attentional processes and relative fixation time in order to assess controlled attentional processes. Pedophiles demonstrated significantly shorter entry time to child stimuli than to adult stimuli. The opposite was the case for nonpedophiles, as they showed longer relative fixation time for adult stimuli, and, against all expectations, pedophiles also demonstrated longer relative fixation time for adult stimuli. The results confirmed the hypothesis that pedophiles automatically selected sexually relevant stimuli (children). Contrary to all expectations, this automatic selection did not trigger the focal attention to these sexually relevant pictures. Furthermore, pedophiles were first and longest attracted by faces and pubic regions of children; nonpedophiles were first and longest attracted by faces and breasts of adults. The results demonstrated, for the first time, that the face and pubic region are the most attracting regions in children for pedophiles., (© 2013 American Psychological Association)

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., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Paraphilia is a set of disorders characterized by abnormal sexual desires. Perhaps most discussed amongst them, pedophilia is a complex interaction of disturbances of the emotional, cognitive and sexual experience. Using new imaging techniques such as functional magnetic resonance imaging, neural correlates of emotional, sexual and cognitive abnormalities and interactions have been investigated. As described on the basis of current research, altered patterns of brain activity, especially in the frontal areas of the brain, are seen in pedophilia. Building on these results, the analysis of neural correlates of impaired psychological functions opens the opportunity to further explore sexual deviances, which may contribute ultimately to the development of tools for risk assessment, classification methods and new therapeutic approaches.

Background: Most neuroimaging studies investigating sexual arousal in paedophilia used erotic pictures together with a blocked fMRI design and long stimulus presentation time. While this approach allows the detection of sexual arousal, it does not enable the assessment of the immediate processing of erotically salient stimuli. Our study aimed to identify neuronal networks related to the immediate processing of erotic stimuli in heterosexual male paedophiles and healthy age-matched controls., Methods: We presented erotic pictures of prepubescent children and adults in an event related fMRI-design to eight paedophilic subjects and age-matched controls., Results: Erotic pictures of females elicited more activation in the right temporal lobe, the right parietal lobe and both occipital lobes and erotic pictures of children activated the right dorsomedial prefrontal cortex in both groups. An interaction of sex, age and group was present in the right anteriolateral oribitofrontal cortex., Conclusions: Our event related study design confirmed that erotic pictures activate some of the brain regions already known to be involved in the processing of erotic pictures when these are presented in blocks. In addition, it revealed that erotic pictures of prepubescent children activate brain regions critical for choosing response strategies in both groups, and that erotically salient stimuli selectively activate a brain region in paedophilic subjects that had previously been attributed to reward and punishment, and that had been shown to be implicated in the suppression of erotic response and deception.

Background: The failure to inhibit pleasurable but inappropriate urges is associated with frontal lobe pathology and has been suggested as a possible cause of pedophilic behavior. However, imaging and neuropsychological findings about frontal pathology in pedophilia are heterogeneous. In our study we therefore address inhibition behaviorally and by means of functional imaging, aiming to assess how inhibition in pedophilia is related to a differential recruitment of frontal brain areas., Method: Eleven pedophilic subjects and 7 nonpedophilic controls underwent fMRI while performing a go/no-go task composed of neutral letters., Results: Pedophilic subjects showed a slower reaction time and less accurate visual target discrimination. fMRI voxel-level ANOVA revealed as a main effect of the go/no-go task an activation of prefrontal and parietal brain regions in the no-go condition, while the left anterior cingulate, precuneus and gyrus angularis became more activated in the go condition. In addition, a group × task interaction was found in the left precuneus and gyrus angularis. This interaction was based on an attenuated deactivation of these brain regions in the pedophilic group during performance of the no-go condition. The positive correlation between blood oxygen level-dependent imaging signal and reaction time in these brain areas indicates that attenuated deactivation is related to the behavioral findings., Conclusion: Slower reaction time and less accurate visual target discrimination in pedophilia was accompanied by attenuated deactivation of brain areas belonging to the default mode network. Our findings thus support the notion that behavioral differences might also derive from self-related processes and not necessarily from frontal lobe pathology., (© 2013 S. Karger AG, Basel.)

Introduction: Pedophilia is characterized by a persistent sexual interest of an adult for prepubescent children. The development of neuroimaging techniques such as functional Magnetic Resonance Imaging (fMRI) is starting to clarify the cerebral basis of disorders of sexual behavior such as pedophilia, which had been previously suggested by case studies., Objective: To review structural and functional neuroimaging studies of pedophilia., Method: An exhaustive consultation of PubMed and Ovid databases was conducted. We obtained 19 articles presented in the present review of the literature., Results: Case studies have demonstrated various changes of sexual behavior in relation to brain lesions, including the late appearance in adults of a sexual attraction to prepubescent children. In most cases of pedophilia associated with brain lesions, these lesions were located in frontal or in temporal regions. Structural neuroimaging studies have compared pedophiles with healthy subjects and tried to relate pedophilia to anatomical differences between these two groups. The location of structural changes is inconsistent across studies. Recent functional neuroimaging studies have also attempted to investigate the cerebral correlates of pedophilia. Results suggest that the activation pattern found in pedophiles in response to pictures of prepubescent nude girls or boys is similar to the pattern observed in healthy subjects in response to pictures of adult nude women or men. However, regions that become more activated in patients than in healthy controls in response to the presentation of pictures of children vary across studies., Conclusion: Studies that have begun to investigate the cerebral correlates of pedophilia demonstrate that it is possible to explore them through neuroimaging techniques. These initial results have to be confirmed by new studies backed with objective measurements of sexual arousal such as phallometry., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Context: Accurately assessing sexual preference is important in the treatment of child sex offenders. Phallometry is the standard method to identify sexual preference; however, this measure has been criticized for its intrusiveness and limited reliability., Objective: To evaluate whether spatial response pattern to sexual stimuli as revealed by a change in the blood oxygen level-dependent signal facilitates the identification of pedophiles., Design: During functional magnetic resonance imaging, pedophilic and nonpedophilic participants were briefly exposed to same- and opposite-sex images of nude children and adults. We calculated differences in blood oxygen level-dependent signals to child and adult sexual stimuli for each participant. The corresponding contrast images were entered into a group analysis to calculate whole-brain difference maps between groups. We calculated an expression value that corresponded to the group result for each participant. These expression values were submitted to 2 different classification algorithms: Fisher linear discriminant analysis and κ -nearest neighbor analysis. This classification procedure was cross-validated using the leave-one-out method., Setting: Section of Sexual Medicine, Medical School, Christian Albrechts University of Kiel, Kiel, Germany., Participants: We recruited 24 participants with pedophilia who were sexually attracted to either prepubescent girls (n = 11) or prepubescent boys (n = 13) and 32 healthy male controls who were sexually attracted to either adult women (n = 18) or adult men (n = 14)., Main Outcome Measures: Sensitivity and specificity scores of the 2 classification algorithms., Results: The highest classification accuracy was achieved by Fisher linear discriminant analysis, which showed a mean accuracy of 95% (100% specificity, 88% sensitivity)., Conclusions: Functional brain response patterns to sexual stimuli contain sufficient information to identify pedophiles with high accuracy. The automatic classification of these patterns is a promising objective tool to clinically diagnose pedophilia.

Background: This paper presents data from a research program investigating personality traits or childhood historical factors that may contribute to the motivation for or failure to inhibit pedophilic behavior., Method: The entire sample included 51 male subjects with pedophilic behavior, 53 opiate addicted subjects (69% males), and 84 healthy controls (77% males). Groups were compared on personality traits related to social anxiety/inhibition, impulsivity, propensity for cognitive distortions and psychopathy along with the incidence of sexual abuse in their own childhoods (CSA)., Results: Results supported an increased prevalence of CSA, psychopathic traits and traits related to a propensity for cognitive distortions in the pedophilic group relative to healthy controls. Compared to opiate addicted subjects, pedophilic subjects had higher rates of childhood sexual abuse, more schizoid traits, and lower impulsivity and behavioral psychopathy scores. While the group with pedophilic behavior scored higher than controls on some measures related to social anxiety, they did not differ from the opiate addicted group., Limitations: Measures relied on self-report and demographic variables varied across groups., Conclusion: Subjects with pedophilic behavior may show distinct personality and historical traits related to both inhibitory and motivational factors.

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., (© 2011 International Society for Sexual Medicine.)

This chapter proposes a prospective view on using a real-time functional magnetic imaging (rt-fMRI) brain-computer interface (BCI) application as a new treatment for pedophilia. Neurofeedback mediated by interactive virtual stimuli is presented as the key process in this new BCI application. Results on the diagnostic discriminant power of virtual characters depicting sexual stimuli relevant to pedophilia are given. Finally, practical and ethical implications are briefly addressed., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Sexual arousal and gaze behavior dynamics are used to characterize deviant sexual interests in male subjects. Pedophile patients and non-deviant subjects are immersed with virtual characters depicting relevant sexual features. Gaze behavior dynamics as indexed from correlation dimensions (D2) appears to be fractal in nature and significantly different from colored noise (surrogate data tests and recurrence plot analyses were performed). This perceptual-motor fractal dynamics parallels sexual arousal and differs from pedophiles to non-deviant subjects when critical sexual information is processed. Results are interpreted in terms of sexual affordance, perceptual invariance extraction and intentional nonlinear dynamics.

There are at least two different criteria for assessing pedophilia in men: absolute ascertainment (their sexual interest in children is intense) and relative ascertainment (their sexual interest in children is greater than their interest in adults). The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) used relative ascertainment in its diagnostic criteria for pedophilia; this was abandoned and replaced by absolute ascertainment in the DSM-III-R and all subsequent editions. The present study was conducted to demonstrate the continuing need for relative ascertainment, particularly in the laboratory assessment of pedophilia. A total of 402 heterosexual men were selected from a database of patients referred to a specialty clinic. These had undergone phallometric testing, a psychophysiological procedure in which their penile blood volume was monitored while they were presented with a standardized set of laboratory stimuli depicting male and female children, pubescents, and adults.The 130 men selected for the Teleiophilic Profile group responded substantially to prepubescent girls but even more to adult women; the 272 men selected for the Pedophilic Profile group responded weakly to prepubescent girls but even less to adult women. In terms of absolute magnitude, every patient in the Pedophilic Profile group had a lesser penile response to prepubescent girls than every patient in the Teleiophilic Profile group. Nevertheless, the Pedophilic Profile group had a significantly greater number of known sexual offenses against prepubescent girls, indicating that they contained a higher proportion of true pedophiles. These results dramatically demonstrate the utility-or perhaps necessity-of relative ascertainment in the laboratory assessment of erotic age-preference.

Pedophilia is defined as a sexual interest in prepubescent children. It is empirically linked with sexual offending against children: Child pornography offenders and sex offenders with child victims are more likely to be pedophiles based on self-report or objective measures of sexual interests. At the same time, some pedophiles have not had any known sexual contact with children, and perhaps half of sex offenders against children would not meet diagnostic criteria for pedophilia. Pedophilia can be diagnosed using a variety of methods and is an important factor to consider in the assessment of sex offenders because pedophilic offenders are more likely to sexually reoffend and require different interventions. There is no evidence to suggest that pedophilia can be changed. Instead, interventions are designed to increase voluntary control over sexual arousal, reduce sex drive, or teach self-management skills to individuals who are motivated to avoid acting upon their sexual interests.

Although sex offender risk assessment has progressed greatly over the past decade and a half since most states implemented the sexually violent predator/sexually dangerous person (SVP/SDP) laws, there continues to be limited applicability of such models to intellectually disabled sex offenders because there has been no empirical validation. However, SVP/SDP civil commitment programs have reported increased admission of developmentally disabled sex offenders. Differentiating sexual deviance, the primary factor predisposing most individuals to criminal sexual violence, from impulsive, immature, and inappropriate behavior stemming from cognitive deficits presents yet another challenge to the clinician tasked with performing such evaluations. This article reviews actuarial risk models and their limited applicability to mentally retarded sex offenders and offers a conceptual method of assessing the risk of recidivism in intellectually disabled sex offenders under SVP/SDP evaluation.

A unique challenge posed by advancing scientific knowledge about the biology of human behavior is how to integrate that understanding with the desire to hold ourselves--and one another--morally accountable. As human beings, we are something more than just passive agents whose behavior is the sum product of biologic determinism. Because of the existence of the mind, we are also active agents with the capacity to influence, at least to some extent, our own destinies. Behavior may be determined, but it is not predetermined. We are one of its determinants. Misconduct by a person of sound mind should not be attributed improperly to brain pathology. On the other hand, suffering, legitimate mental disorder, and associated impairments should not be trivialized. Historically, persons who once were labeled "lazy" are often more appropriately understood by modern standards as clinically depressed. Frequently they are more in need of pharmacologic treatments that alter brain chemistry than "a kick in the behind." Gluttony, one of the original cardinal sins, is often more properly understood as morbid obesity, a condition that deserves appropriate medical care. Persons who have alcoholism, once judged morally as "bums in the gutter," are more frequently referred to treatment facilities, such as The Betty Ford Clinic. One should not approach the issue of human sexual behavior without at least some appreciation of moral values and scientific research. Although clearly some persons choose to act in a sexually selfish and self-indulgent fashion with wanton disregard, others seem to be more genuinely burdened and struggle to integrate their sexual desires into an otherwise healthy and fully responsible lifestyle. When a person, whether male or female, seems to be so driven that it becomes difficult to master erotic desires and he or she experiences difficulty serving his or her own best longterm interests, the concept of sexual compulsivity seems to be relevant. Ultimately, a better understanding of any associated neuropathologies may help to facilitate future treatments and public acceptance. The possibility exists, at least in some instances, that a sexually compulsive individual is less an example of a bad person deserving of punishment than a "broken mind" in need of repair. In time, increased knowledge about the precise workings of the brain in reciprocally initiating and sustaining the sexual interests of the mind may facilitate a much clearer appreciation of the issues at hand.

Despite considerable public interest research in neurobiological correlates of pedophilia is scarce. Since amygdala activation is central for emotional valuation, arousal, and salience, we investigated the activation profile of this structure in 10 male subjects with pedophilia (exclusively attracted to boys), all convicted sex-offenders and sentenced to forensic psychiatric treatment along with ten male heterosexual matched controls. We used a sexually non-explicit functional Magnetic Resonance Imaging (fMRI) paradigm with images of men, women, boys or girls randomly embedded in neutral target/non-target geometrical symbols. We applied statistical parametric mapping (SPM2) and SPSS 14 for image processing and analysis. While controls activated significantly less to pictures of children compared to adults, the activation profile was reversed in subjects with pedophilia, who exhibited significantly more activation to children than adults. The highest activation was observed for boys in the patient group, and for women in control participants. Our data show enhanced activation to children's pictures even in an incidental context and suggest the provocative hypothesis that a normally present mechanism for reduced emotional arousal for children relative to adults is reversed in pedophilia, suggesting a neural substrate associated with deviant sexual preference in this condition. More extensive research in this field would be of benefit for both the victims and the offenders.

Although the neuronal mechanisms underlying normal sexual motivation and function have recently been examined, the alterations in brain function in deviant sexual behaviours such as paedophilia are largely unknown. The objective of this study was to identify paedophilia-specific functional networks implicated in sexual arousal. Therefore a consecutive sample of eight paedophile forensic inpatients, exclusively attracted to females, and 12 healthy age-matched heterosexual control participants from a comparable socioeconomic stratum participated in a visual sexual stimulation procedure during functional magnetic resonance imaging. The visual stimuli were sexually stimulating photographs and emotionally neutral photographs. Immediately after the imaging session subjective responses pertaining to sexual desire were recorded. Principally, the brain response of heterosexual paedophiles to heteropaedophilic stimuli was comparable to that of heterosexual males to heterosexual stimuli, including different limbic structures (amygdala, cingulate gyrus, and hippocampus), the substantia nigra, caudate nucleus, as well as the anterior cingulate cortex, different thalamic nuclei, and associative cortices. However, responses to visual sexual stimulation were found in the orbitofrontal cortex in healthy heterosexual males, but not in paedophiles, in whom abnormal activity in the dorsolateral prefrontal cortex was observed. Thus, in line with clinical observations and neuropsychological studies, it seems that central processing of sexual stimuli in heterosexual paedophiles may be altered by a disturbance in the prefrontal networks, which, as has already been hypothesized, may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours. Moreover, these findings may suggest a dysfunction (in the functional and effective connectivity) at the cognitive stage of sexual arousal processing.

The present investigation sought to identify which brain regions distinguish pedophilic from nonpedophilic men, using unbiased, automated analyses of the whole brain. T1-weighted magnetic resonance images (MRIs) were acquired from men who demonstrated illegal or clinically significant sexual behaviors or interests (n = 65) and from men who had histories of nonsexual offenses but no sexual offenses (n = 62). Sexual interest in children was assessed by participants' admissions of pedophilic interest, histories of committing sexual offenses against children, and psychophysiological responses in the laboratory to erotic stimuli depicting children or adults. Automated parcellation of the MRIs revealed significant negative associations between pedophilia and white matter volumes of the temporal and parietal lobes bilaterally. Voxel-based morphometry corroborated the associations and indicated that the regions of lower white matter volumes followed, and were limited to, two major fiber bundles: the superior fronto-occipital fasciculus and the right arcuate fasciculus. No significant differences were found in grey matter or in cerebrospinal fluid (CSF). Because the superior fronto-occipital and arcuate fasciculi connect the cortical regions that respond to sexual cues, these results suggest (1) that those cortical regions operate as a network for recognizing sexually relevant stimuli and (2) that pedophilia results from a partial disconnection within that network.

The etiology of anomalous, or paraphilic, sexual preferences in men is unclear although a growing literature points to their prenatal neurodevelopmental ontogenesis. The present study explored whether this was also apparent in a community sample of 200 heterosexual men by examining their sexual fantasies using the Wilson Sex Fantasy Questionnaire (WSFQ) and several demographic and somatic neurodevelopmental markers, including sibling sex composition, handedness, maternal and paternal age at birth, second to fourth finger length ratios, and fluctuating asymmetry of finger lengths and wrist widths. Responses to the WSFQ were used to quantify the extent of paraphilic interest by computing a variance-quotient (or VQ) previously shown to differentiate paraphilic from conventional heterosexual males. High paraphilic scorers had a significantly greater number of older brothers, higher right-hand 2D:4D, and a trend for lower Edinburgh Handedness Inventory (EHI) scores compared to low-paraphilic scorers. Correlational analysis revealed a significant positive association of VQ scores with number of older brothers and significant negative associations with number of younger brothers and EHI scores (elevated paraphilic interests were correlated with elevated non-right handedness). Correlations between VQ scores and other variables were not significant. It is suggested that processes such as developmental instability and maternal immunity may play a role in variant sexual preferences among otherwise healthy heterosexual men.

The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy.

Background: Although pedophilia is of high public concern, little is known about underlying neural mechanisms. Although pedophilic patients are sexually attracted to prepubescent children, they show no sexual interest toward adults. This study aimed to investigate the neural correlates of deficits of sexual and emotional arousal in pedophiles., Methods: Thirteen pedophilic patients and 14 healthy control subjects were tested for differential neural activity during visual stimulation with emotional and erotic pictures with functional magnetic resonance imaging., Results: Regions showing differential activations during the erotic condition comprised the hypothalamus, the periaqueductal gray, and dorsolateral prefrontal cortex, the latter correlating with a clinical measure. Alterations of emotional processing concerned the amygdala-hippocampus and dorsomedial prefrontal cortex., Conclusions: Hypothesized regions relevant for processing of erotic stimuli in healthy individuals showed reduced activations during visual erotic stimulation in pedophilic patients. This suggests an impaired recruitment of key structures that might contribute to an altered sexual interest of these patients toward adults.

This study investigated whether the previously observed association of pedophilia with lower IQs is an artifact of heterogeneity in referral source. The subjects were 832 adult male patients referred to a specialty clinic for evaluation of their sexual behavior. The patients' erotic preferences for prepubescent, pubescent, or adult partners were assessed with phallometric testing. Full scale IQ was estimated using six subtests from the WAIS-R. The results showed that the relations between pedophilia and lower IQ, lesser education, and increased rates of non-right-handedness were the same in homogeneous groups referred by lawyers or parole and probation officers as they were in a heterogeneous group referred by a miscellany of other sources. Those results, along with secondary analyses in the study, supported the conclusion that the relation between pedophilia and cognitive function is genuine and not artifactual. The findings were interpreted as evidence for the hypothesis that neurodevelopmental perturbations increase the risk of pedophilia in males.

A sample of 404 adult men underwent assessment following illegal or clinically significant sexual behaviors or interests. Patients' assessments included: administration of a modified version of the Edinburgh Handedness Inventory; recording of patients' phallometric (penile) responses to erotic stimuli depicting adults, pubescent children, and prepubescent children of both sexes; and a tabulation of the numbers of patients' victims, ages 0-11, 12-14, 15-16, and 17 and older, of both sexes. In Study 1, patients' right-handedness scores correlated negatively with their phallometric responses to stimuli depicting prepubescent children and positively with stimuli depicting adults, replicating the pattern described in a previous report (Cantor et al., 2004). Unlike the previous study, however, patients' handedness scores did not significantly correlate with their numbers of prepubescent victims. To explore this discrepancy, Study 2 combined the patients from this replication sample with those in the previously reported sample, categorizing them by the sex and age group of greatest erotic interest to them. The odds of non-right-handedness in men offending predominantly against prepubescent children were approximately two-fold higher than that in men offending predominantly against adults and three-fold higher after eliminating those men with intrafamilial (i.e., incest) offenses. Handedness differences between men erotically interested in males versus females were not statistically significant. These results indicate that the rates of non-right-handedness in pedophilia are much larger than previously suggested and are comparable to the rates observed in pervasive developmental disorders, such as autism, suggesting a neurological component to the development of pedophilia and hebephilia.

Although the vast majority of current pathogenetic theories support a neurobiological understanding of psychiatric disorders, the brain functional correlates of pedophilia are largely unknown. Based on prior behavior genetics research on human sexual orientation and phenomenology as well as the phenotypical intersection of pedophilia with other psychiatric spectrum disorders, we hypothesize the involvement of striato-thalamo-cortical processing loops in the formation of pedophilic urges and behaviors. Data from a current neuropsychological pilot study in four pedophiles encourage our brain functional perspective. As deduced from the network model, all four patients exhibited pronounced and circumscribed deficits in cognitive domains mediated by striato-thalamically controlled areas of the frontal cortex. All patients were especially impaired in neuropsychological functions associated with the prefrontal and motor processing loops (e.g., response inhibition, working memory and cognitive flexibility), with a performance level located up to five standard deviations below the normative data. Contrary to this, neuropsychological performances in cognitive domains without a comparable high frontal loading were in all participants unobtrusive. In future, studying gene by environment interactions in combination with functional neuroimaging and neuropsychological assessment is promising to elucidate the pathophysiological relationship of psychiatric disorders that are characterized by inadequate urges and poor behavioral inhibition., (Copyright 2004 Elsevier Ltd.)

A sample of 473 male patients with pedophilia (assessed by the patients' sexual history and penile response in the laboratory to standardized, erotic stimuli) or other problematic sexual interests or behaviors received brief neuropsychological assessments. Neuropsychological measures included a short form of the Wechsler Adult Intelligence Scale--Revised (D. Wechsler, 1981), the Hopkins Verbal Learning Test--Revised (R. H. B. Benedict, D. Schretlen. L. Groninger. & J. Brandt, 1998), the Brief Visuospatial Memory Test--Revised (R. H. B. Benedict, 1997), and the Edinburgh Handedness Inventory (S. M. Williams, 1986). Pedophilia showed significant negative correlations with IQ and immediate and delayed recall memory. Pedophilia was also related to non-right-handedness even after covarying age and IQ. These results suggest that pedophilia is linked to early neurodevelopmental perturbations., (((c) 2004 APA, all rights reserved))

Pedophilia is a complex bio-psycho-social disorder often associated with serious offending. Knowledge about neurobiological correlates that could serve as diagnostic and maybe even as prognostic markers is limited. FMRI examination, which shows neuronal activation in vivo and therefore represents a neurobiological correlate, was not done in pedophilia so far. We report on results of an fMRI examination in a homosexual pedophilic sex offender who differed significantly in neuronal activation during exposure to arousing visual material (young boys in underwear) from normal controls. In self assessment on a visual analogous scale the pedophilic offender scored the pictures of the boys as not being interesting and sexually not stimulating. Nevertheless presentation of the pictures of the boys resulted in the pedophilic offender in a significant activation of the attention network and the right orbitofrontal cortex. In contrast to the controls there was no activation of left hemispheric areas relevant for speech. The study design will be continued in a larger sample to examine whether there is a possible neurobiological correlate of pedophilia which can be changed by therapeutic interventions.

There is some evidence that hormonal and serotonergic alterations may play a role in the pathophysiology of paraphilias. The aims of the present study were to examine: 1) baseline plasma cortisol, plasma prolactin, and body temperature; and 2) cortisol, prolactin, body temperature, as well as behavioral responses to meta-chlorophenylpiperazine (mCPP) and placebo in pedophiles and normal men. Pedophiles showed significantly lower baseline plasma cortisol and prolactin concentrations and a higher body temperature than normal volunteers. The mCPP-induced cortisol responses were significantly greater in pedophiles than in normal volunteers. In normal volunteers, mCPP-induced a hyperthermic response, whereas in pedophiles no such response was observed. mCPP induced different behavioral responses in pedophiles than in normal men. In pedophiles, but not in normal men, mCPP increased the sensations "feeling dizzy, " "restless," and "strange" and decreased the sensation "feeling hungry". The results suggest that there are several serotonergic disturbances in pedophiles. It is hypothesized that the results are compatible with a decreased activity of the serotonergic presynaptic neuron and a 5-HT2 postsynaptic receptor hyperresponsivity.

Paraphilias may occur with brain disease, but the nature of this relationship is unclear. The authors report 2 patients with late-life homosexual pedophilia. The first met criteria for frontotemporal dementia; the second had bilateral hippocampal sclerosis. Both were professional men with recent increases in sexual behavior. In both, 18-fluorodeoxyglucose positron emission tomography revealed prominent right temporal lobe hypometabolism. These cases and the literature suggest that bilateral anterior temporal disease affecting right more than left temporal lobe can increase sexual interest. A predisposition to pedophilia may be unmasked by hypersexuality from brain disease. These observations have potential implications for all neurologically based paraphilias.

Background: Exhibitionist behaviour focused on children (usually girls) is one of the most frequent forms of sexual child abuse. Exposure in the presence of children signalizes possible pedophil inclinations of the offender. The present paper presents the results of PPG examinations of these offenders with special attention to assessment how often these men have an objective phallographic pedophil orientation. The results of PPG examinations in this group of sexual delinquents are also compared with the findings in a control group of men who report a heterosexual orientation and preference of objects of suitable age., Methods and Results: Using an electrocapacitance phalloplythysmographic apparatus the authors examined 50 men (mean age 36.3 years, range 17-67 years) who committed exhibitionist activities in the presence of girls under 12 years. The PPG examination was made under standard conditions; all examined subjects were shown sets of coloured slides with adult and child objects of hetero and homosexual character. In the same way a control group was examined formed by 50 male volunteers of similar age and social background. The men in the control group responded more frequently and more merkedly by positive vasomotor reactions to adult heterosexual objects than subjects who committed pedophil exhibitionist offences. The latter reacted significantly more often to child objects of both sexes. In more than half the delinquent group (in 26 men) there was an undefined differentiation of age as regards objects of female sex and 6 (12%) men of this group had preference for heterosexual child objects, i.e. an obvious pedophil orientation. In men of the control group only in one case there was an indication of an ill defined differentiation of age, in all the others an unequivocal or clearly indicated preference of heterosexual objects was found., Conclusions: PPG examinations confirmed that only a minor part of subjects committing pedophil exhibitionist offences have a deviant orientation. It was revealed that the most frequent phallographic finding in this group of sexual delinquents is an ill defined differentiation of age in objects of female sex. The investigation confirmed the importance of phalloplethysmography in elucidating sexually motivated structures of offenders of pedophil sexual activities.

Bancroft has proposed a central arousability system as an androgen-sensitive neurophysiological substrate of sexual desire. The present paper describes the author's explorations of a brain-wave measure, the contingent negative variation (CNV), as a putative index of sexual desire under conditions of sexually-relevant stimulation in paedophilic child sex offenders and in non-offender control men. As a group, the former showed undifferentiated CNV responses to adult and child stimuli, unlike non-paedophilic child sex offenders and controls, who showed larger CNVs to adult than to child stimuli. These results suggest that CNV may be usefully developed as an adjunct to penile plethysmographic (PPG) assessment of deviant sexual interests in offenders. Some possible directions for future research are indicated.

Contingent negative variation (CNV) was recorded bilaterally from central electrodes using a "match/mismatch" paradigm in (Study 1) samples of heterosexual men (N = 6), gay men (N = 10) and lesbian women (N = 14) and (Study 2) in samples of child sex offenders (N = 34) and heterosexual control men (N = 19). Sexual orientation was assessed using the Multidimensional Scale of Sexuality (MSS) and the Human Sexuality Questionnaire (HSQ). Separate CNV averages were formed for each condition of stimulation: for Study 1, slides of adult male and female nudes; for Study 2, slides of child, pubescent and adult male and female nudes. Penile plethysmographic (PPG) data were also obtained from 15 of the child sex offender sample while they viewed stimuli of the same categories as were used in the CNV recording. On the basis of their PPG responses to children, child sex offenders were classified as either "pedophiles" or "non-pedophiles". In Study 1 significant Group x Sex (of slide) and Group x Electrode interactions indicated that: (i) heterosexual men (but neither homosexual group) showed significantly larger CNVs to female than to male slides; (ii) both homosexual groups showed significantly asymmetrical (R > L) CNVs. In Study 2, controls showed significantly greater CNVs to adult females than to both adult males and female children. Child sex offenders showed no significant differences in CNV to male and female slides for any age. "Non-pedophiles" showed significantly larger CNVs to female adults than to female children, but "pedophiles" did not. It is concluded that CNV has promise as a measure of both deviant and non-deviant sexual preference.