The Viewing Reaction Time as a Diagnostic Tool of Pedohebephilia in the Dunkelfeld.

Diagnosing pedohebephilia is fraught with obstacles given the tabooed nature of this sexual preference. The viewing reaction time effect (VRT) provides a non-intrusive indirect measure of sexual interest in minors. In forensic populations, the ability of the difference between the latencies while viewing child and adult sexual stimuli (VRT index) to discern child sexual offenders from a range of control groups has been ascertained meta-analytically. Given that the effect has been studied almost exclusively in forensic samples, its dependence or independence on prior overt (deviant) sexual behavior remains unclear. The present study sought to examine the relationship of prior sexual and non-sexual behaviors with the VRT in a sample of 282 self-referring, help-seeking men with and without pedohebephilia with and without a history of prior child sexual offenses (CSO) or a use of child sexual abuse materials (CSAM) recruited outside a forensic context. We found that (1) the clinical diagnosis of pedohebephilia but not prior CSO or CSAM showed a significant association with the VRT index; (2) the discriminatory ability of the VRT index did not differ significantly between samples with and without a history of prior overt sexual behavior with children; (3) the VRT index correlated positively with a behavioral marker of pedohebephilia in a subsample of individuals with prior judicially detected or undetected overt sexual behavior with children; and (4) in the same subsample, the VRT index correlated positively with markers of sexual interests in minors or hypersexuality but not of antisociality. Equivalence testing failed to refute a potential effect of prior sexual behavior on the VRT index. Our study showed that the VRT may provide an unintrusive diagnostic tool for pedohebephilia. The effect of prior overt sexual behavior with children needs further examination.

Reexamining predictors of trial outcomes in New York State's sex offender civil management process.

OBJECTIVE: In 2007, New York enacted the Sex Offender Management and Treatment Act, empowering the state to civilly manage individuals who have committed sexual offenses (respondents) and are deemed to have a mental abnormality (MA) that predisposes them to sexually recidivate after serving their criminal sentences. We sought to replicate and extend a previous study (Lu et al., 2015) to identify factors predicting legal decisions. HYPOTHESES: We predicted, on the basis of previous research, that clinical information (e.g., diagnosis) as well as empirically supported risk factors (e.g., sexual deviance) would predict trial outcomes. METHOD: We analyzed multiple pieces of demographic, criminogenic, and clinical data on three nested subsamples of respondents on the basis of the legal process: MA consent (n = 713), MA trial (n = 316), and disposition hearing (n = 643). The binary outcomes of interest were as follows: For the MA consent subsample, it was whether the respondent waived their MA trial; for the MA trial subsample, it was whether the respondent was found at trial to have an MA; and for the disposition hearing, it was whether the respondent was ordered to inpatient or outpatient civil management. RESULTS: The strongest predictor of waiving the trial was geographic location; respondents outside New York City and Long Island were more likely to waive their trials (ORs = 2.38-3.37). The strongest predictors of MA trial and disposition hearing outcomes were Diagnostic and Statistical Manual of Mental Disorders diagnoses; pedophilia (ORs = 4.05-7.22) and sexual sadism (ORs = 2.68-7.03) diagnoses increased the likelihood of an MA finding and confinement order. CONCLUSIONS: Judges and juries give significant weight to clinical information, particularly pedophilia diagnoses, when making civil management legal decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Coprophilia and Coprophagia: A Literature Review.

BACKGROUND: Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia. AIMS: The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia. METHODS: Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English. RESULTS: Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines. CONCLUSIONS: Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

Paraphilic Interests Versus Behaviors: Factors that Distinguish Individuals Who Act on Paraphilic Interests From Individuals Who Refrain.

Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States (N = 744), aged 19-42 years (M = 29.2; SD = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.

The Development, Content Validation, and Pilot Testing of the Paraphilic Interests and Disorders Scale.

The prevalence rates of paraphilic interests and disorders in the general population have been understudied, in large part due to the lack of a standardized assessment measure. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 provides little information regarding the prevalence of paraphilic disorders. The present study involved the development of a self-report measure, Paraphilic Interests and Disorders Scale (PIDS), that can be used to assess for the eight paraphilic interests/disorders in the DSM-5 for use with general population samples. Study 1 established the content validity of the PIDS using feedback from 22 experts in the field, and recommendations from these experts were utilized to modify the measure. In Study 2, the PIDS was piloted on 100 individuals in the general population, which supported the feasibility of implementation and its limited-efficacy. While the PIDS requires further psychometric support, the current research suggests the PIDS is a promising tool to gather self-report, population-based data on DSM-5 paraphilic interests and disorders.

Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes.

BACKGROUND: Exposure to traumatic experiences represent one factor that may contribute to the development of hypersexual behaviors. AIM: We investigated the associations between posttraumatic stress symptoms and hypersexual behaviors by analyzing survey data from 2 samples. METHOD: The first sample consisted of n = 585 college students, and the second consisted of n = 786 adults recruited via Amazon's Mechanical Turk (MTurk), n = 337 of whom completed a 6-month follow-up survey. We conducted 3 hierarchical regression analyses adjusting for age, gender, sexual orientation, impulsivity, drug use, alcohol use, and gambling. OUTCOMES: The primary outcomes for this investigation were associations between posttraumatic stress symptoms, measured using the PTSD Checklist for DSM-IV and DSM-5 (PCL-C and PCL-5), and hypersexual behaviors, measured using the Hypersexual Behavior Inventory (HBI). RESULTS: A significant regression, R2 = 0.230, R2adjusted = 0.211, F (14,570) = 12.17, P < .001, revealed posttraumatic stress symptoms were associated with hypersexual behaviors in the university student sample (ß = 0.154). A significant regression using the MTurk sample, R2 = 0.403, R2adjusted = 0.392, F (14,771) = 37.13, P < .001, confirmed this finding (ß = 0.259). In addition, a significant regression, R2 = 0.562, R2adjusted = 0.541, F (15,321) = 27.42, P < .001, indicated that posttraumatic stress symptoms were longitudinally associated with increased hypersexual behaviors (ß = .190) after adjusting for all variables, including baseline hypersexuality. CLINICAL TRANSLATION: Results suggest that individuals experiencing posttraumatic stress symptoms are at increased risk for current and future hypersexual behaviors. STRENGTHS & LIMITATIONS: This investigation involved secondary analyses of adults who had gambled at least once in their lives and findings may not generalize to those who have never gambled. Furthermore, longitudinal findings may be impacted by selection bias (42% completion rate) and may not generalize to follow up periods longer than 6-months. CONCLUSION: This study provides support for the hypothesis that posttraumatic stress symptoms are associated with increased hypersexual behavior, and further research is indicated to explore the etiology and directionality of this relationship. Rosansky JA, Borgogna NC, Kraus SW, et al. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022;19:1813-1823.

Are Female Paraphilias Hiding in Plain Sight? Risqué Male-Male Erotica for Women in Sinophone and Anglophone Regions.

Female-oriented male-male erotica is a genre of popular culture often know as Boys' Love (BL), yaoi, and danmei. It is one of the largest by-and-for women sexual subcultures and a global phenomenon. With the largest data sets in the field, we ask: Which risqué sexual content do Sinophone (Chinese-speaking) and Anglophone (English-speaking) participants particularly enjoy in BL and does this differ between cultures?, and Are there sub-demographics in Sinophone and in Anglophone culture who enjoy particular forms of risqué sexual content in BL and do these forms relate also to enjoyment of particular storylines and concern with legal issues? The material studied meets the DSM-5 definition of the paraphilic, and little is known about paraphilias in women or in the general population. Using Categorical Principal Component Analysis we explored one 15-response question from our Sinophone (N = 1922) and Anglophone (N = 1715) BL fandom surveys: Which risqué sexual content do you particularly enjoy in BL? We also tested for associations with seven demographic and other BL content-related questions. Notably, the component structure was nearly replicated between the two independent samples, in order of strength: BDSM Specialist, Mechanoid/Animal Sex Specialist, Underage Sex Specialist, and Minority Paraphilia Specialist. In both samples, it was the avid BL fans and/or those who liked explicitly sexual stories, a largely overlapping demographic, who most engage the risqué content, while, for the Sinophone, this included also more non-heterosexual and/or other-gendered people. We conclude that women's paraphilias have been largely overlooked because they might be expressed more commonly through fantasy than action, that their mass expression has awaited both the means and the market force, and that current conceptualization of, and assumptions about, paraphilias is overly modeled on that of men.

Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI).

In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.

[Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory]. / Aggressivität, Assertivität und sexuelle Devianz: Eine empirisch-quantitative Prüfung der Stoller'schen Perversionstheorie.

Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory Objectives: The main aim of the present study was to empirically examinate the psychodynamic-founded perversion theory of Robert D. Stoller (1979), particularly his assumption of a transformation of aggressive impulses into sexual deviant fantasies due to traumatic experiences. Methods: In the present study different aspects of the theory were examined by using a sample (N = 954) of individuals convicted of sexually motivated offenses who had been clinically and forensically assessed between 2002 and 2018 at the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. As a part of the psychological testing procedure, German-speaking questionnaires for the assessment of aggressiveness and assertiveness were applied. Results: The results indicated that participants with a diagnosis of paraphilia showed significantly less spontaneously expressed aggression and less social competence compared to individuals without such a diagnosis. Conclusions: The findings of the present study are in line with the core assumptions of Stoller's perversion theory by demonstrating an inverse relationship between the diagnosis of paraphilia and self-reported aggression.

The Paraphilias and Medical Licensure in the United States.

BACKGROUND: As part of their mission to protect the public from exploitation, state medical boards query physicians about a wide range of topics prior to licensure, including in some cases whether the applicant has been diagnosed with or been treated for paraphilias or paraphilic disorders. AIM: We investigated the prevalence of questions inquiring about the applicants' history of paraphilias and paraphilic disorders on applications for medical licensure. METHODS: The allopathic medical licensure application forms for each of the 50 United States and the District of Columbia were reviewed. Medical boards with questions pertaining to paraphilias or paraphilic disorders were asked how many affirmative responses had been obtained in the prior 5 years and how they would treat an affirmative response. OUTCOMES: Eight medical boards inquired about paraphilias or paraphilic disorders, however there was no evidence of an affirmative response to these questions in the prior 5 years. RESULTS: Of the 51 applications reviewed, 8 (16%) inquired whether the applicant had, was diagnosed with, or had been treated for a paraphilia or paraphilic disorder. The wording of the questions was variable and often failed to distinguish between paraphilias and paraphilic disorders. All but one medical board responded to requests for further information. The medical board staff members stated that an affirmative response would result in case-by-case review, including request for further information and possibly an in-person appearance before the board. None of the medical boards were willing or able to provide a formal count of affirmative responses in the last 5 years. CLINICAL IMPLICATIONS: Medical boards may be contributing to the stigma experienced by both physicians and patients with diverse sexual interests. The benefit of retaining these questions is not clear. STRENGTHS AND LIMITATIONS: This study is the first to investigate the use of paraphilias and paraphilic disorders as screening questions for medical licensure. Data regarding the number of affirmative responses were limited by the medical boards' inability or unwillingness to respond to share the information. CONCLUSIONS: Eliminating or modifying physician licensing application questions pertaining to paraphilias and paraphilic disorders may decrease the stigma encountered by persons with diverse sexual interests. Removal also may diminish the barriers to accessing health care services for both physicians and patients with diverse sexualities. If the questions are retained, they should conform to the current DSM-5 nosology, which distinguishes between the mere presence of a paraphilia and a diagnosis of a paraphilic disorder. Cranstoun LM, Moser C. The Paraphilias and Medical Licensure in the United States. J Sex Med 2021;18:1130-1133.

[Interrater reliability of the criteria-based assessment of criminal responsibility in paraphilic disorders]. / Interrater-Reliabilität der kriteriengeleiteten Beurteilung der Schuldfähigkeit bei paraphilen Störungen.

BACKGROUND: For the assessment of criminal responsibility in the context of sexual delinquency, the evaluation of the severity of a paraphilic disorder and the ability to be controlled are of particular importance. Established assessment criteria are insufficiently operationalized. AIM AND METHODS: The existing criteria were tested by experts of various professional groups with respect to the reliability. For this purpose, 14 experts assessed the criteria of 2 different sets of criteria based on 2 case vignettes (see electronic supplementary material). RESULTS AND CONCLUSION: The interrater reliability (IRR) with reference to the criteria of Briken and Müller was higher than the previously established criteria of Boetticher et al. The evaluation of the subjective importance of the criteria of both assessment scales showed that all criteria were rated as at least of average importance. It could thus be useful to initially include both sets of criteria for a greater transparency in the assessment process and to investigate this procedure in further studies.

Conceptualization, History, and Future of the Paraphilias.

There is no accepted definition of the term paraphilia despite its being listed as an essential feature of a class of mental disorders known as the paraphilic disorders. The origin of the term, history of its inclusion as a diagnosis, and logical flaws inherent in the various definitions are discussed in this review. We examine the basis for pathologizing individuals with paraphilias, consider what paraphilias can tell us about how humans develop their sexual interests, and question the usefulness of dividing sexual interests into paraphilias and normophilias. The construct of the paraphilias appears to be poorly conceived and has outlived its usefulness.

Paraphilia and Antisociality: Motivations for Sexual Offending May Differ for American Whites and Blacks.

There has been little research on the sexual offending behavior of different racial groups. This study compares the characteristics and risk factors for American, non-Hispanic Whites (n =797) and Blacks (n = 788) who had been convicted of a sexual crime in New Jersey. The results indicated that Whites appeared more paraphilic whereas Blacks displayed higher antisociality. Despite the differences, however, the Static-99R, sexual recidivism risk tool, predicted equally well for both racial groups: Whites (area under the curve [AUC] = .76) and Blacks (AUC = .78). The findings suggest that there may be opportunities to improve treatment for the individuals at risk for sexual offending by tailoring interventions to the distinctive risk-relevant characteristics of Whites and Blacks.

Hanging disguised as bondage: accidental or suicidal death?

The concept of autoerotic asphyxiation refers to the use of devices or substances intended to enhance one's arousal by inducing cerebral hypoxia, which can involuntarily lead to death. Although in most cases death occurs accidentally, it is nonetheless true that the same devices might be used by the practitioners in order to attempt suicide. The case of a 34-year-old practitioner of autoerotic asphyxiation found dead in his apartment with bondage-like ligatures and masking is reported here. The case raised some issues concerning the accidental or suicidal nature of the act. The aspects taken into account in the management of the case are discussed, along with a compared approach to the data provided by literature.

The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia.

INTRODUCTION: The Revised Screening Scale for Pedophilic Interests (SSPI-2) was developed as a screening measure for pedophilia (sexual interest in prepubescent children), but the SSPI-2 items reflect offending against both prepubescent and pubescent children, roughly corresponding to victims under age 15. AIM: We examined whether the SSPI-2 is better interpreted as a measure of pedohebephilia (sexual interest in both prepubescent and pubescent children) by reanalyzing the original SSPI-2 data and reporting its new psychometric properties. METHODS: The sample was comprised of 1,900 men whose clinical assessment data were entered into an archival database. All men in the sample had at least 1 child victim. Phallometric indices based on sexual responses to children relative to adults were used to classify individuals as having pedophilia only, hebephilia only (sexual interest in pubescent children), or pedohebephilia. MAIN OUTCOME MEASURE: The 5 SSPI-2 items were scored based on official file information sent by the referral source and self-disclosures about offending history made during the assessment. RESULTS: The phallometric indices revealed that pedohebephilia was most frequently observed (24%), followed by hebephilia only (16%) and pedophilia only (1%). Classification accuracy analyses suggest that the SSPI-2 may be more appropriately interpreted as a measure of pedohebephilia than hebephilia only; there were too few cases of pedophilia only for classification analysis. Sensitivity, specificity, and positive and negative predictive values are presented to assist users in selecting appropriate SSPI-2 cut-offs. CLINICAL IMPLICATIONS: The SSPI-2 should be interpreted as a measure of pedohebephilia when used in clinical practice or research, and test users should select the most appropriate cut-off score based on their assessment context. Classification accuracy results are modest, and the scale may be most appropriately used in research or as a screening measure. STRENGTHS & LIMITATIONS: The study used a comprehensive clinical database with well-validated measures. A limitation is that the dataset did not contain other assessment measures of sexual interest in children, and we were unable to examine if the SSPI-2 could detect pedophilia only due to its low base rate. CONCLUSION: The SSPI-2 may be best conceptualized as a measure of pedohebephilia. Further, there was significant overlap between pedophilia and hebephilia; pedophilia only was rarely observed. Stephens S, Seto MC, Cantor JM, et al. The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia. J Sex Med 2019;16:1655-1663.

Legal and Policy Implications in Mexico of Changes in ICD-11 Paraphilic Disorders.

INTRODUCTION: The World Health Organization (WHO) has made substantial changes to the classification of paraphilic disorders for the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), recently approved by the World Health Assembly. The most important is to limit paraphilic disorders primarily to persistent and intense patterns of atypical sexual arousal involving non-consenting individuals, manifested through persistent sexual thoughts, fantasies, urges, or behaviors, that have resulted in action or significant distress. AIM: To analyze the legal, regulatory, and policy implications of the changes in the ICD-11 classification of paraphilic disorders for forensic practice, health systems, adjudication of sex offenders, and the provision of treatment in Mexico. METHODS: An expert Mexican advisory group was appointed to conduct this evaluation following an assessment guide provided by the WHO. MAIN OUTCOME MEASURES: The WHO assessment guide covered (i) laws related to sexual behaviors; (ii) the relationship between legal and clinical issues for non-forensic health professionals; (iii) implications of mental disorder classification for forensic practice; (iv) other implications of ICD-11 paraphilic disorders proposals; and (v) contextual issues. RESULTS: A variety of factors in Mexico make it highly unlikely that appropriate, evidence-based treatments for paraphilic disorders will be provided to those who need them, even if they seek treatment voluntarily and have not committed a crime. Mexican law focuses on the punishment of specific sexual behaviors rather than on underlying disorders. A paraphilic disorder would not be considered sufficient grounds for exemption from criminal responsibility. The application and scope of mental health evaluations in Mexican legal proceedings are quite limited, and individuals who commit sexual crimes almost never undergo forensic evaluations to establish the presence of paraphilic disorders. Psychiatric services may be mandated for sex offenders in highly specific circumstances but cannot exceed the duration of the criminal sentence. CLINICAL IMPLICATIONS: Evaluation and treatment guidelines should be developed based on international evidence and standards and promulgated for use with individuals with paraphilic disorders in forensic and non-forensic poopulations. The much greater specificity and operationalization of the ICD-11 guidelines as compared with the ICD-10 guidelines provide a better basis for identification and case formulation. STRENGTHS & LIMITATIONS: Major strengths of this analyses were that it was conducted to facilitate international comparability across several participating countries and the fact that it was conducted by a diverse multidisciplinary group representing various relevant legal, forensic and and clinical sectors. A limitation was that it was only possible to examine relevant federal laws and those of Mexico City rather than those of all 32 Mexican states. CONCLUSION: The descriptions of paraphilic disorders in the ICD-11 could support substantial improvements in the treatment of individuals with paraphilic disorders and the adjudication of sex offenders in Mexico, but specific changes in Mexican law would be required. Martínez-López JNI, Robles R, Fresán A, et al. Legal and Policy Implications in Mexico of Changes in ICD-11 Paraphilic Disorders. J Sex Med 2019;16:1623-1637.

Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany.

INTRODUCTION: Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published. AIM: This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany. METHODS: A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization. MAIN OUTCOME MEASURES: Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany. RESULTS: Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system. CLINICAL IMPLICATIONS: The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized. STRENGTHS & LIMITATIONS: The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts. CONCLUSION: A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders. Briken P, Boetticher A, Krueger RB, et al. Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. J Sex Med 2019;16:1615-1622.

A Validation Study of the Spanish Version of the Hypersexual Behavior Inventory (HBI): Paper-and-Pencil Versus Online Administration.

Hypersexuality is a problematic behavior characterized by the combination of an excessive sexual desire and the pathological inability to control it. This study presents the psychometric properties of the Spanish paper-and-pencil and online versions of the Hypersexual Behavior Inventory (HBI), one of the most popular scales to assess this issue. A total of 2,250 participants (1,070 men) completed a translated version of the HBI (1,450 in paper-and-pencil; 800 online). The exploratory factor analysis yielded three factors that explained 67.53% of total variance for the HBI paper-and-pencil version. This factor structure was confirmed in the HBI online version through confirmatory factor analysis (CFA). Factorial, structural, scalar and error variance-invariance according to gender was also confirmed through multigroup CFA. Reliability of the total score and subscales ranged between .89 and .96. Likewise, correlations with other related scales were positive and significant (r between .511 and .743). Temporal stability one year after the first application was .77 (paper-and-pencil format) and .68 (online version). These results support the reliability and validity of the HBI and justify its use in the assessment of hypersexuality in Spanish-speaking countries.

International review of sexual behaviour assessment labs.

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic in Canada; the Medical University of South Carolina's Sexual Behaviours Clinic and Laboratory in the US; the Laboratory of Evolutionary Sexology and Psychopathology in the Czech Republic; and the Laboratory of Forensic Sexology in Russia. An overview of examinee demographics and types of cases assessed is provided for each lab. Assessment protocols, including psychometric measures and objective measures of sexual interest and arousal, such as penile plethysmography or eye-tracking, are also reviewed. The differences across labs may lead to interesting and productive cross-cultural investigations and studies about the efficacy of specific assessment methods.

Stimuli used in the measurement of problematic sexual interests.

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.