Minor-Attracted Men's Lived Experiences of Romantic Attraction.

Studies of minor-attracted persons have mainly focused on their sexual attractions, and little is known about their romantic attractions. This online qualitative survey study collected 74 self-identified minor-attracted men's anonymous accounts of romantic attraction to minors. Using reflexive thematic analysis, three themes were identified and interpreted: (1) Falling in Love; (2) Recognizing Limitations to Attraction and Relationship Development; (3) Making Sense and Meaning of Romantic Attraction to Minors. Overall, romantic attraction to minors resembles romantic attraction to adults. Findings have implications for how conceptualization, assessment, and treatment of minor attraction may each consider both sexual and romantic domains.

Using reaction time procedures to assess implicit attitudes toward violence in a nonconvicted male sample.

In this study, we sought to capture implicit attitudes toward violence by administering response latency measures. We then examined their associations with explicit (e.g., assessed with self-report) attitudes toward violence and self-reported violent behavior in a combined sample of males from a Canadian university and males from the general community (N = 251; 156 students and 95 community members). To date, there have been mixed findings regarding these associations; some of this inconsistency may be due to the difficulty in accurately conceptualizing and assessing implicit attitudes toward violence. Therefore, we administered three response latency measures to assess this construct: a violence evaluation implicit association test (VE-IAT), a personalized VE-IAT (P-VE-IAT), and a violence evaluation relational responding task, along with three self-report measures of explicit attitudes toward violence and three self-report measures of violent behavior. More positive implicit attitudes toward violence were related to more positive explicit attitudes toward violence (for VE-IAT and P-VE-IAT; r = 0.18 to 0.22), greater likelihood of violence (for VE-IAT; r = 0.18 and for P-VE-IAT; r = 0.16), and greater propensity for violence (for the VE-IAT; r = 0.16). All measures of explicit attitudes toward violence and violent behavior were moderately to strongly associated with one another (r = 0.42 to 0.81). Furthermore, implicit attitudes toward violence explained additional variance in some violent outcomes above explicit attitudes alone. Our findings suggest that scores on certain reaction time measures are important for understanding likelihood and propensity for violence, especially when combined with explicit attitude measures.

Convergent and Divergent Validity of the Child Pornography Offender Risk Tool (CPORT) in a Clinical Sample From California.

The Child Pornography Offender Risk Tool (CPORT) is a seven-item actuarial risk assessment tool that is used to estimate the potential for sexual recidivism among men convicted of child sexual exploitation material (CSEM; legally referred to as child pornography) offenses. In the current study, we examined the convergent and divergent validity of the CPORT in a clinical sample of 224 men on federal probation in the United States who were convicted of at least one type of CSEM offense. CPORT scores were significantly, moderately, and positively correlated with scores on another sexual offense risk assessment tool, the Risk Matrix 2000 (RM2000/S), showing broad evidence of convergent validity, and was nonsignificantly associated with scores on a general offense risk assessment tool, the Level of Service/Case Management Inventory (LS/CMI), showing evidence of divergent validity. There was also evidence of specific convergent validity; for example, the CPORT item reflecting prior criminal history was most strongly related to the Criminal History domain of the LS/CMI, and CPORT items reflecting sexual interest in children were significantly and strongly associated with self-reported sexual interest in children from the clinical evaluation. We also examined the impact of including clinical information in the scoring of the CPORT. Including this information reduced the amount of missing scores, but the impact on predictive accuracy is not yet known. Implications for clinical practices are discussed.

Evaluating Child Sexual Abuse Perpetration Prevention Efforts: A Systematic Review.

Many child sexual abuse prevention efforts focus on the prevention of victimization, through education of children and parents, bystander training, and policies and practices in youth-serving organizations (e.g. requiring criminal record checks). However, there has been growing attention to child sexual abuse perpetration prevention, targeted at individuals who are at risk of perpetration. We conducted a systematic review of studies reporting outcomes for child sexual abuse perpetration prevention interventions. Only seven studies were identified in our review, with five intended for adults and two intended for children. Four of the five adult studies had significant methodological concerns, precluding strong conclusions from these studies. We concluded that higher-quality evaluations of perpetration prevention efforts are greatly needed. We also identified intrafamilial perpetration prevention, particularly interventions for parents or caregivers, as a critical gap in the literature. Suggestions for child sexual abuse perpetration intervention evaluation and delivery are discussed.

Sending, receiving, and nonconsensually sharing nude or near-nude images by youth.

INTRODUCTION: There is growing evidence about the prevalence of sending, receiving, or resharing nude images by youth (sexting). Less is known about the demographic, technology use, and social context correlates of sexting. Using logistic regression, we looked at predictors of sexting behaviors in minors. METHODS: Participants were a market panel sample of 394 youths aged 9-12 and 602 youths aged 13-17 (Mage = 13.5, SD = 2.50, 60.3% females) recruited for an anonymous online survey in the United States. The survey comprised questions about demographic characteristics, sexting behaviors, technology use, attitudes, and perceived norms. The four outcomes were sending nude or near-nude images or videos (images), receiving images sent without the depicted person's knowledge, nonconsensually resharing images, or having one's own images nonconsensually reshared. RESULTS: Regression analyses showed gender, gender/sexual minority status, use of dating apps and particular online platforms, self-sharing and resharing attitudes, and friend norms predicted sending images. Age, resharing attitudes, and friend norms all predicted receiving nude images of other youths. Household income, geographic location, some online platforms, resharing attitudes, and friend norms all predicted nonconsensual resharing of nudes. Age, use of encrypted apps, and friend norms predicted having one's own image nonconsensually reshared. CONCLUSIONS: We partially replicated prior research by finding associations between age and gender. Further, we identified technology use factors including the use of dating apps and particular platforms. Attitudes about sexting and perceived friend norms were robust across sexting behaviors, suggesting these factors are potentially important for intervention.

Correspondence of Child Age and Gender Distribution in Child Sexual Exploitation Material and Other Child Content With Age and Gender of Child Sexual Assault Victims.

Accessing child sexual exploitation material (CSEM; child pornography in legal statutes) can indicate sexual interest in children. It logically follows then that the age and gender of the depicted children may reflect specific interests in those age/gender groups, and if so, may correspond to age and gender of any known contact offending victims. We had data on CSEM characteristics and child victims for 71 men convicted of CSEM offenses who also had contact sexual offenses against children; some had also sexually solicited children online. Sixty-four men had 134 prior or concurrent child victims, and 14 men reoffended directly against 17 children during follow-up. There were significant, positive associations (with moderate to large effect sizes) between age and gender of children depicted in CSEM and age and gender of child contact or solicitation victims. Examining future offending, though with only 14 recidivists, all men who sexually reoffended against a girl had more girl CSEM content, and all men who sexually reoffended against a boy had more boy CSEM content. Our results suggest that CSEM characteristics can reflect child preferences. This information can be relevant in clinical settings, police investigations, and community risk management, though it does not rule out interest in, or offending against, victims of other ages or gender. We discuss these findings in the context of other evidence regarding victim cross-over, and suggest future research.

The Predictive Validity of the Revised Screening Scale for Pedophilic Interests (SSPI-2).

The Revised Screening Scale for Pedophilic Interests (SSPI-2) is a five-item measure that assesses for pedohebephilia (sexual attraction to prepubescent and pubescent children) based on child victim characteristics. We aimed to replicate findings by Seto, Sandler et al. (2017) by examining the predictive validity of the SSPI-2 in an independent sample of 626 men referred for a sexological assessment because of sexual offending against children. SSPI-2 scores were associated with an increased likelihood of sexual recidivism but were not significantly associated with non-sexually violent or non-violent recidivism. When they were entered together, the SSPI-2 did not contribute additional variance to the Static-99R in the prediction of sexual recidivism. Results are consistent with the findings of Seto, Sandler et al. (2017) and suggest that higher scores on the SSPI-2 may be indicative of an increased risk for sexual recidivism in individuals who have sexually offended against children.

Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample.

BACKGROUND: Hypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain. AIM: The present study was an independent psychometric examination of 2 of the most commonly used measures of Compulsive Sexual Behavior Disorder; specifically, the gender invariance of the latent structure, reliability (test retest, internal consistency), and external correlates (concurrent validity) of these measures. METHODS: The Sexual Compulsivity Scale and the Hypersexual Behavior Inventory were completed by 2 nonclinical online community samples of cisgender women (ns = 525 and 359), cisgender men (ns = 419 and 364), and transgender or non-binary individuals (ns = 38 and 11). OUTCOMES: Criterion based measures of sexual history and total sexual outlet (number of orgasms per week) were gathered to validate Sexual Compulsivity Scale and Hypersexual Behavior Inventory total and factor scores. RESULTS: Results supported the factorial validity of both assessment measures: correlated 3 factor solutions were established through exploratory factor analysis of 1 sample, and confirmatory factor analysis in the second sample. Multiple group confirmatory factor analysis, conducted on the 2 combined samples, also supported the gender invariance of the 3-factor solutions. Additional basic psychometric indices of test-retest and internal consistency reliability and criterion-related (concurrent) validity conducted across the 2 online samples were supported. CLINICAL IMPLICATIONS: Common measures of hypersexuality have potential for use in its assessment, treatment, and management. STRENGTHS & LIMITATIONS: Study strengths include: the inclusion of 2 fairly large and diverse online samples, thorough checks for insufficient effort/validity of responding, validity and reliability methodology (ie, measurement at multiple time points, obtaining behavioral indicators of sexual health), and a comprehensive set of psychometric analyses to inform conclusions regarding the external validity, reliability, and latent structure of hypersexuality measures across gender groups. Study limitations include: potential concerns related to validity and accuracy of responding owing to a reliance on self-report, the potential for selection bias, and limiting the examination of the latent structure of hypersexuality to cisgender men and women such that the results may not generalize to gender diverse populations. CONCLUSION: Hypersexuality is a multidimensional construct, with a common latent structure among cisgender men and women, consistency in measurement over time, and meaningful concurrent associations with behavioral criteria that have relevance for sexual health. Olver ME, Kingston DA, Laverty EK, et al. Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample. J Sex Med 2022;19:331-346.

Viewing Time Measures of Sexual Interest and Sexual Offending Propensity: An Online Survey of Fathers.

Relative viewing times (VTs)-time required to view and evaluate sexually salient images-discriminate individuals with a sexual interest in children, as indirectly indexed by their history of sexual offending against children, from those without such history. In an online sample of 652 fathers, we measured VTs and sexual attraction ratings to child and adult images. We assessed participants' sexual offending history and propensity (self-reported likelihood to have a sexual contact with a child, a non-consensual sexual contact with an adult, and propensity toward father-daughter incest). In contrast with VT studies involving clinical or forensic samples, VTs and attraction ratings failed to discriminate participants with a sexual offending history. VTs successfully distinguished participants with a propensity to sexually offend against children but failed to identify those with a propensity toward incest. Conversely, attraction ratings distinguished participants with a propensity toward incest but failed to identify those with a propensity to sexually offend against children. Correlations between VTs and attraction ratings were small. Results illustrate, for the first time, the distribution of VT measures in community fathers, support the feasibility of online administration of VT tasks to detect propensity to sexually offend against children, and indicate that sexual interest in children and incest propensity are distinct.

The Relation Between the Paraphilias and Anxiety in Men: A Case-Control Study.

Despite a multitude of theoretical views, it is still unclear how individuals develop and sustain paraphilic interests (e.g., sexual attraction to children, interest in non-consensual violence). It is also not clear from these views why many paraphilic interests, and especially many paraphilias and paraphilic disorders, are much more common in men than in women. One possible factor affecting male's higher rate of paraphilias is anxiety, because anxiety can potentiate sexual arousal in men. We speculated that paraphilic interests could develop when feelings of anxiety are recurrently generated by atypical sexual stimuli, and when that anxiety repeatedly potentiates sexual arousal, reinforcing sexual response to atypical stimuli. It follows that men with paraphilic interests are susceptible to anxiety disorders, because an anxiety disorder would facilitate the hypothesized developmental process. We conducted a retrospective file review of 1048 consecutive patients (944 male patients retained for analysis) referred to an outpatient sexual behavior clinic at a psychiatric hospital to investigate the link between paraphilias and anxiety. Male patients with a paraphilia had 1.64 greater odds than male patients without a paraphilia of having been diagnosed with an anxiety disorder, but they also had elevated rates of many other types of disorders. Therefore, there does not seem to be a specific link between paraphilias and anxiety in this sample. The discovery of a general link between the paraphilias and psychological disorders in men opens new avenues for studying the developmental origins and consequences of male paraphilic interests.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study.

AIM: We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. BACKGROUND: Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. METHODS: We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. RESULTS: We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. CONCLUSION: Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

The Effects of Acute Transcranial Direct Current Stimulation on Attentional Bias in Pedophilic Disorder: A Preregistered Pilot Study.

OBJECTIVES: Individuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic attention bias for child-related stimuli as well as reduced activity in the dorsolateral prefrontal cortex (dlPFC), a brain area involved in cognitive control, including control over sexual arousal. In this preregistered pilot study, we are the first to investigate whether acutely increasing prefrontal activity could reduce the putative pedophilic attention bias. MATERIALS AND METHODS: We delivered a single 20-min session of active anodal versus sham transcranial direct current stimulation (tDCS) over the left dlPFC to 16 SOC with PD and 16 matched healthy controls, while they performed a task requiring controlled attention to computer-generated images of clothed and nude children and adults. We collected responses unobtrusively by recording eye movements. RESULTS: Our results did not support the presence of the expected automatic attention bias across outcome measures. Nonetheless, we found a response facilitation with child targets in patients and, unexpectedly, in controls, likely due to unwanted salience effects. Active versus sham tDCS reduced this bias across groups, as indicated by a significant group*condition interaction (p = 0.04). However, no attentional bias and no tDCS effects on attentional responses to child and adult images emerged following tDCS. CONCLUSIONS: These results suggest enhanced cognitive control in response to salient stimuli during active tDCS. Thus, to assist future studies on neuromodulation in PD, we provide suggestions for design improvement.

Differences in Sexual Interest in Children Between Men Who Commit Undetected Versus Detected Sexual Offenses.

This study examined whether men who committed undetected sexual offenses would show more evidence of sexual interest in children than their detected counterparts. It also considered whether denial or minimization of offending history explained observed differences between undetected and detected men. In an archival database of 2,236 men, 96 were undetected and the remainder were detected men who varied in the extent to which they admitted their offending: complete deniers, partial deniers, those who admitted their offense history, and those who disclosed additional unknown offenses. There were differences in self-reported sexual interest in children, but relatively few differences when sexual interest in children was assessed by phallometry or sexual victim history. There were no differences between undetected and detected men who admitted to additional victims. The results suggest that denial is likely more important in understanding group differences on sexual interest in children than detection status.

A Comparison of Risk Factors Among Discharged Military Veterans and Civilians Involuntarily Hospitalized Under California's Sexually Violent Predator Act.

While military veterans have a lower overall rate of incarceration for criminal offenses than civilians, they have a higher rate of incarceration for violent sexual offenses. Despite military veteran overrepresentation among individuals adjudicated for violent sexual offenses, little is known about their risk factors for sexual offending. This study compared military veterans and civilians who had been involuntarily hospitalized and discharged pursuant to California's Sexually Violent Predator Act. Pedophilic disorder appeared nearly twice as often among veterans than civilians (62.7% vs. 38.7%), whereas antisocial personality disorder was twice as common among civilians compared to veterans (48.1% vs. 23.9%). Consistent with the result for pedophilic disorder, veterans were more likely to target male victims age 13 and below, while civilians tended to target female victims over the age of 13. The results suggest different risk profiles for veterans compared to civilians who have been convicted of sexually violent offenses.

Perceptions of Workplace Violence and Workplace Stress: A Mixed Methods Study of Trauma among Psychiatric Workers.

Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.

Mental health workers' experiences of support and help-seeking following workplace violence: A qualitative study.

The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.

Sexual Attraction and Falling in Love in Persons with Pedohebephilia.

Few studies of pedophilia or hebephilia have included questions about romantic attraction. We conducted an anonymous online survey of 306 men who self-reported as sexually attracted to children. The majority (72%) of participants reported they had fallen in love with a child in their lifetime. Participants reported greater feelings of attachment to children than feelings of infatuation. Though sexual attraction and falling in love were strongly correlated, they were not synonymous. Participants who reported pedohebephilia (defined in this study as attraction to prepubescent and pubescent children) were more likely to have fallen in love with a child than participants who reported pedohebe-ephebophilia (defined as attraction to prepubescent, pubescent, and post-pubescent minors). Also, participants with an exclusive attraction to children were more likely to have fallen in love with a child than participants who were equally attracted to children and adults. The results of this study were consistent with the suggestion of Seto (2012) that pedohebephilia could be considered a form of sexual orientation for age, which includes both sexual and romantic attraction.

Post-traumatic Stress Disorder, Depression, Anxiety Symptoms and Help Seeking in Psychiatric Staff: Trouble de stress post-traumatique, dépression, symptômes d'anxiété et recherche d'aide chez le personnel psychiatrique.

BACKGROUND AND METHODS: In this study, we surveyed 761 psychiatric hospital staff (69% women, 71% full-time, 56% nursing) regarding their exposure to trauma in the workplace; symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety; help seeking; and perceived barriers for help seeking. RESULTS: Significant proportions of staff met the screening cutoffs for probable PTSD (16%), depression (20%), and anxiety (16%). Comorbidity was high, with approximately half of those meeting the screening cutoff for PTSD also meeting the cutoffs for depression or anxiety. Only PTSD symptoms were uniquely associated with exposure to trauma in the workplace, but both PTSD and depression symptoms significantly predicted help seeking. Staff who met one or more screening cutoffs perceived more barriers to help seeking such as difficulty with accessing services. CONCLUSION: Implications for supporting psychiatric staff exposed to trauma are discussed.

Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management.

The current article aims to examine the performance of two brief, dynamic risk measures - the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] - scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.

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.