The joy of being frightened: Fear experience in psychopathy.

OBJECTIVE: Psychopathic traits are associated with abnormalities in fear processing. While traditional theories focus on a lack of fear, Hosker-Field et al. (2016) provided a new perspective. They suggested that individuals with elevated psychopathic traits may experience threatening situations with appreciation or positivity, resulting in reduced negative fear responses and heightened positive responses (fear enjoyment hypothesis, FEH). METHOD: Our study aimed to refine Hosker-Field et al.'s (2016) study design, addressing methodological limitations and improving the inconsistent operationalization of fear experience in the literature. In an online sample of 353 participants from the general population, we examined the relationship between the FEH and relevant psychopathic traits, specifically those derived from the PCL-R framework (i.e., SRP 4 Factor 1), and from a more trait-based approach to psychopathy with assumed links to fearlessness (i.e., TriPM Boldness). RESULTS: By employing linear mixed effect models, we extended Hosker-Field et al.'s correlational analysis and provided further evidence for the FEH, particularly in relation to psychopathic traits measured using the PCL-R framework. The results regarding Boldness, however, are somewhat inconclusive. CONCLUSION: The present study enhances existing research on fear deficits in psychopathy by assessing the subjective experience of individuals facing threat.

Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis.

The present meta-analysis is an update of the meta-analysis by Schmucker and Lösel [Campbell Syst. Rev. 2017; 13: 1-75], which synthesized evidence on sexual recidivism as an indicator of treatment effectiveness in persons with sexual offense histories. The updated meta-analysis includes 37 samples comprising a total of 30,394 individuals with sexual offense histories, which is nearly three times the sample size reported by Schmucker and Lösel (2017: 28 samples, N = 9781). In line with Schmucker and Lösel (2017), the mean treatment effect was small with an odds ratio of 1.54 [95% CI 1.22, 1.95] (p < .001). A moderator analysis suggested three predictors of importance, i.e., risk level, treatment specialization, and author confounding. Greater treatment effectiveness was suggested in high- and medium-compared to low-risk individuals and in specialized compared to non-specialized treatments. Authors affiliated with treatment programs reported larger effectiveness than independent authors. These findings were overall in line with Schmucker and Lösel (2017), though the effects of risk level and treatment specialization were stronger in the current meta-analysis. The findings of the updated meta-analysis reinforce the evidence for the first and second principle of the Risk-Need-Responsivity model. The results may support researchers and decision-makers in interpreting the current evidence on sexual recidivism as an indicator of treatment effectiveness, and, based on that, implement and carry out informative, methodologically sound evaluations of ongoing treatment programs in persons with sexual offense histories.

Deep Learning in the Identification of Electroencephalogram Sources Associated with Sexual Orientation.

INTRODUCTION: It is unclear if sexual orientation is a biological trait that has neurofunctional footprints. With deep learning, the power to classify biological datasets without an a priori selection of features has increased by magnitudes. The aim of this study was to correctly classify resting-state electroencephalogram (EEG) data from males with different sexual orientation using deep learning and to explore techniques to identify the learned distinguishing features. METHODS: Three cohorts (homosexual men, heterosexual men, and a mixed sex cohort), one pretrained network on sex classification, and one newly trained network for sexual orientation classification were used to classify sex. Further, Grad-CAM methodology and source localization were used to identify the spatiotemporal patterns that were used for differentiation by the networks. RESULTS: Using a pretrained network for classification of males and females, no differences existed between classification of homosexual and heterosexual males. The newly trained network was able, however, to correctly classify the cohorts with a total accuracy of 83%. The retrograde activation using Grad-CAM technology yielded distinctive functional EEG patterns in the Brodmann area 40 and 1 when combined with Fourier analysis and a source localization. DISCUSSION: This study shows that electrophysiological trait markers of male sexual orientation can be identified using deep learning. These patterns are different from the differentiating signatures of males and females in a resting-state EEG.

Neuroelectric Correlates of Human Sexuality: A Review and Meta-Analysis.

Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.

Automaticity of Early Sexual Attention: An Event-Related Potential Study.

A promising line of research on forensic assessment of paraphilic sexual interest focuses on behavioral measures of visual attention using sexual stimuli as distractors. The present study combined event-related potentials (ERPs) with behavioral measures to investigate whether detection of a hidden sexual preference can be improved with ERPs. Normal variants of sexual orientation were used for a proof-of-concept investigation. Accordingly, 40 heterosexual and 40 gay men participated in the study. Within each group, half of the participants were instructed to hide their sexual orientation. The results showed that a match between sexual orientation and stimulus delays responses and influences ERP before motor responses. Late ERP components showed higher potential in differentiating hidden sexual preferences than motor responses, thereby showing how ERPs can be used in combination with reaction time measures to potentially facilitate the detection of hidden sexual preferences.

Fearless but anxious? A systematic review on the utility of fear and anxiety levels to classify subtypes of psychopathy.

Psychopathic traits have been linked to anomalies in experiencing fear and anxiety. It remains unclear, however, to what extent fear and anxiety levels are useful parameters to effectively distinguish between subtypes of psychopathy. Therefore, we aimed to elucidate whether different psychopathic phenotypes (primary and secondary psychopathy) can be delineated based on fear/anxiety levels. To investigate associations between psychopathic traits and conscious experiences of fear and/or anxiety a systematic qualitative review of studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen studies were included in the review. We found some evidence for attenuated fear/anxiety levels in primary psychopathy. In secondary psychopathy, the experience of fear/anxiety seemed rather intact. Moreover, primary psychopathy might be associated with a more positive appraisal of the conscious feeling of fear. We reason that consciously experienced fear and anxiety are distinctly related to primary and secondary psychopathy. Due to a lack of consistent and comprehensive operationalizations of fear and anxiety, however, conclusions about their potential to differentiate psychopathic subtypes should be drawn with caution.

Rational, emotional, or both? Subcomponents of psychopathy predict opposing moral decisions.

Recent research has documented a small but significant correlation between psychopathic capacities and utilitarian moral judgment, although the findings are generally inconsistent and unclear. We propose that one way to make sense of mixed findings is to consider variation in perspective-taking capacities of psychopathic individuals. With this in mind, we had criminal offenders (n = 60), who varied in their psychopathy levels according to the Psychopathy Checklist-Revised (PCL-R), respond to common sacrificial moral dilemmas (e.g., trolley dilemmas) under different conditions. In a baseline condition, participants simply responded to the sacrificial moral dilemmas as is typically done in previous research. In an "emotion-salient" condition, participants had to reason about the emotions of another person after solving moral dilemmas (deliberative processing). In the "emotion-ambiguous" condition, participants saw images of people in distress, after solving moral dilemmas, but did not have to explicitly reason about such emotions (spontaneous processing). The four PCL-R facets predicted distinct interference effects depending on spontaneous versus deliberative processing of hypothetical victim's emotions. The findings suggest that the use of a multi-faceted approach to account for cognitive and moral correlates of psychopathy may help address previously mixed results. Implications and future directions for theory and research are discussed.

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.

Indirect and Neuropsychological Indicators of Pedophilia.

The present study aimed to differentiate pedophilic child sex offenders (CSOs) from nonoffending controls (CTLs), as well as contact from noncontact CSOs. For this purpose, we investigated 21 contact CSOs, 20 noncontact CSOs (child pornography offenders), as well as 21 CTLs on neuropsychological test measures and indirect test measures of sexual interest. Multiple logistic regression models showed that three parameters of indirect tests and two neuropsychological test parameters allowed the differentiation of CSOs from CTLs with a maximum accuracy of 87%. The profile of contact and noncontact CSOs was remarkably similar and the optimal model for this group differentiation had a maximum accuracy of 66%, with slightly increased levels of risk-taking behavior and greater susceptibility for perceptual interference in contact CSOs than in noncontact CSOs. The findings suggest that standardized, objective methods can support the assessment of sexual offenders against children in forensic psychiatry and legal psychology.

A view behind the mask of sanity: meta-analysis of aberrant brain activity in psychopaths.

Psychopathy is a disorder of high public concern because it predicts violence and offense recidivism. Recent brain imaging studies suggest abnormal brain activity underlying psychopathic behavior. No reliable pattern of altered neural activity has been disclosed so far. This study sought to identify consistent changes of brain activity in psychopaths and to investigate whether these could explain known psychopathology. First, we used activation likelihood estimation (p < 0.05, corrected) to meta-analyze brain activation changes associated with psychopathy across 28 functional magnetic resonance imaging studies reporting 753 foci from 155 experiments. Second, we characterized the ensuing regions functionally by employing metadata of a large-scale neuroimaging database (p < 0.05, corrected). Psychopathy was consistently associated with decreased brain activity in the right laterobasal amygdala, the dorsomedial prefrontal cortex, and bilaterally in the lateral prefrontal cortex. A robust increase of activity was observed in the fronto-insular cortex on both hemispheres. Data-driven functional characterization revealed associations with semantic language processing (left lateral prefrontal and fronto-insular cortex), action execution and pain processing (right lateral prefrontal and left fronto-insular), social cognition (dorsomedial prefrontal cortex), and emotional as well as cognitive reward processing (right amygdala and fronto-insular cortex). Aberrant brain activity related to psychopathy is located in prefrontal, insular, and limbic regions. Physiological mental functions fulfilled by these brain regions correspond to disturbed behavioral patterns pathognomonic for psychopathy. Hence, aberrant brain activity may not just be an epiphenomenon of psychopathy but directly related to the psychopathology of this disorder.

[The forensic preventive outpatient clinic in Ansbach : Evaluation of the model project for treatment of psychiatric risk patients]. / Die forensische Präventionsambulanz Ansbach : Evaluation des Modellprojekts zur Behandlung psychiatrischer Risikopatienten.

BACKGROUND: Patients suffering from severe mental disorders and who have an increased risk of violent behavior, tend to be insufficiently cared for until committing a violent offense leads to compulsory placement in a forensic psychiatric clinic. OBJECTIVE: The concept of the preventive outpatient clinic has been recently published in this journal. The aim of the study was to evaluate whether treatment in the outpatient clinic is preventive with respect to violence and whether there is a positive therapeutic outcome. METHOD: The study design was quasi-experimental and longitudinal. The control group consisted of comparable patients from an adjacent healthcare catchment area. Measurements were taken on admission (t0) and after 6 and 12 months of treatment (t1 and t2, respectively). Dynamic risk factors, i.e. subscales C and R of the history clinical risk-20 version 2 (HCR-20 V2) scale and global assessment of functioning (GAF) scale were used as indicators of treatment success, involving both clinician ratings and self-reports. Multiple imputed data for 70 subjects in the experimental group and 51 in the control group were analyzed by mixed effects models with group as a fixed effect. RESULTS: The interaction effect between time and group was statistically significant for the R (risk management) subscale and the GFA values but not for the C (clinical risk) value (after Bonferroni correction), whereby controls were made for multiple testing. CONCLUSION: The hypothesis with respect to the efficacy of the treatment could be maintained regarding risk markers and global assessment of functioning. With respect to clinical parameters there was a positive tendency in the expected direction. The data therefore indicate a positive effect of the preventive outpatient clinic for the patients treated.

The "Dunkelfeld" Project for Self-Identified Pedophiles: A Reappraisal of its Effectiveness.

INTRODUCTION: The "Dunkelfeld" project offers pharmacologic treatment and psychotherapy to self-referred pedophilic patients in an anonymous way. AIM: To provide a re-assessment focusing on the crucial time × group interaction (ie, the treatment effect). METHODS: A recent study reported on the effectiveness of the "Dunkelfeld" program based on intermediate data of a treatment group (TG; n = 53) and a waiting-list control group (CG; n = 22). With psychological indicators, it was concluded that the therapy program changed dynamic risk factors that are associated with sexually offending against children. Although based on an independent groups pre-post design, the original report includes within-group pre- and post-comparisons only, as well as between-group comparisons at the pre- and post-treatment stages. In the current study, an effect size index was computed that compares the change occurring in both groups (TG and CG) with each other (Morris d). Moreover, 95% CI of d were calculated. MAIN OUTCOME MEASURES: The analyses were limited to 12 dynamic risk factors pertaining to emotional dysfunction, offense-supportive attitudes, sexual dysregulation, impression management, and 2 types of delinquent behavior, including recent behavior related to sexual offenses against children and recent use of child sexual abuse images. RESULTS: All 14 indicators showed weak treatment effects at most, with a median d of 0.30. None of the effect sizes was statistically significant (ie, in every case the 95% CI included 0). Further methodologic concerns include a familywise error rate close to 1 and too little statistical power to identify potential effects. CLINICAL IMPLICATIONS: As far as dynamic risk factors are concerned, the data do not show that treatment within the "Dunkelfeld" program leads to any reduction of the proneness to commit sexual offenses against children. STRENGTHS & LIMITATIONS: The current study adds crucial information lacking in the original analysis. Because the re-appraisal has the same limited statistical power as the original study, the current results are tentative in the sense that the possibility of the program being effective cannot be ruled out. A further limitation is that not all of the dynamic risk factors chosen as indicators of possible treatment success have been established as relevant for sexual (re-)offending in prior empirical studies. CONCLUSIONS: The outcome emphasizes the notion that independent groups pretest-posttest designs should be analyzed based on the treatment × time interaction. Mokros A, Banse R. The "Dunkelfeld" Project for Self-Identified Pedophiles: A Reappraisal of its Effectiveness. J Sex Med 2019;16:609-613.

Coercive Sexual Sadism: a Systematic Qualitative Review.

PURPOSE OF REVIEW: Coercive sexual sadism can be distinguished from consensual BDSM (bondage discipline/dominance submission/sadism masochism) role-play and from everyday sadism, a personality trait. The purpose of this paper is to provide a systematic qualitative review of the pertinent literature on coercive sexual sadism from the last three years. RECENT FINDINGS: Clinical assessment of sexual sadism can be made more objective through behavioral checklists based on crime scene actions. The latent structure of sexual sadism is likely dimensional, placing the disorder at the upper end of a continuum of sexually aggressive behavior. Sexual sadism does not seem to increase the risk of violent offense recidivism (including sexual contact offenses) above and beyond the risk implied by established risk factors of delinquency. Coercive sexual sadism denotes a disposition for sexually aggressive behavior. Whether this disposition is put into practice is likely due to other trait and state variables. Treatment studies are completely lacking in the recent literature.

Genetic Variants Associated With Male Pedophilic Sexual Interest.

INTRODUCTION: The etiology of sexual preference disorders (paraphilias) in general and pedophilia in particular remains unknown. There are some indications of biological factors related to pedophilic interest and pedophilic disorder. AIM: To examine single-nucleotide polymorphisms (SNPs) potentially associated with pedophilic sexual interest. METHODS: The sample consisted of 1,672 men 18 to 45 years old from the Genetics of Sex and Aggression sample who had submitted saliva samples. Fifty-four SNPs were genotyped and relevant SNPs were analyzed. MAIN OUTCOME MEASURES: A self-report questionnaire designed specifically for the Genetics of Sex and Aggression sample was used to measure sexual interest in and sexual behavior toward children and adolescents. DNA extraction and genotyping were used to measure possible associations between male pedophilia and SNPs. RESULTS: Before controlling for multiple testing, statistically significant associations were found for SNPs linked to androgen, estrogen, prolactin, corticotrophin, serotonin, and oxytocin. No associations remained significant after controlling for multiple testing. CONCLUSION: The results of the present study suggest a complex biological mechanism affecting adult sexual interest in children. Very small effect sizes characterized the findings, and several polymorphisms related to different hormonal functioning were initially related to the phenotype.

Regression to the Mean Mimicking Changes in Sexual Arousal to Child Stimuli in Pedophiles.

The sexual preference for prepubertal children (pedophilia) is generally assumed to be a lifelong condition. Müller et al. (2014) challenged the notion that pedophilia was stable. Using data from phallometric testing, they found that almost half of 40 adult pedophilic men did not show a corresponding arousal pattern at retest. Critics pointed out that regression to the mean and measurement error might account for these results. Müller et al. contested these explanations. The present study shows that regression to the mean in combination with low reliability does indeed provide an exhaustive explanation for the results. Using a statistical model and an estimate of the retest correlation derived from the data, the relative frequency of cases with an allegedly non-pedophilic arousal pattern was shown to be consistent with chance expectation. A bootstrap simulation showed that this outcome was to be expected under a wide range of retest correlations. A re-analysis of the original data from the study by Müller et al. corroborated the assumption of considerable measurement error. Therefore, the original data do not challenge the view that pedophilic sexual preference is stable.

Sadism and Violent Reoffending in Sexual Offenders.

A diagnosis of sadism in sexual offenders is commonly regarded as indicative of high risk for violent reoffending. The purpose of the current two studies was to evaluate whether sadism is indeed associated with higher rates of violent (including sexual) reoffending. In Study 1 (meta-analysis), the rate of violent and sexual recidivism was assessed across seven samples of male sex offenders (total N = 2,169) as a function of diagnoses of sexual sadism. In Study 2 (N = 768) the outcome (violent recidivism yes/no) was regressed on sadism, along with behavioral indicators of sexually sadistic offending, and scores from violence risk assessment instruments. In Study 1 (meta-analysis), the overall risk of sadists compared with nonsadists with respect to violent (including sexual contact) reoffending was slightly elevated (by a factor of 1.18), yet not significantly increased. Similarly, the risk of sexual reoffending among sadists was slightly, but not significantly, higher than among nonsadists (factor 1.38). According to Study 2, only a measure of sadistic behavior, not the clinical diagnosis, was associated with violent reoffending. This association, however, was not present once age and customary risk assessment instruments for violence risk were included in the regression. A clinical diagnosis of sexual sadism and behavioral measures of sadism are related to the risk of violent reoffending in sexual offenders. These associations, however, are weak and do not hold once variables relevant for the prediction of violence are controlled for. At the individual level, the risk for future violence in sadists can therefore be adequately described by customary risk assessment instruments.

Men's sexual interest in children: one-year incidence and correlates in a population-based sample of Finnish male twins.

In a study of 1,310 Finnish adult male twins we found that sexual interest in children aged 12 or younger was reported by 0.2% of the sample. Sexual interest in children aged 15 or younger was reported by 3.3%. Participants reporting sexual interest in children aged 15 or younger were younger, reported stronger sexual desire, and had experienced more childhood sexual and nonsexual abuse. The present study is the first to give a population-based estimate of the incidence of sexual interest in children among adult men. The 12-month incidence of sexual interest in children below the age of 16 years is roughly comparable to the one-year incidence of major depression or the lifetime prevalence of transvestitic fetishism.

Predictive and incremental validity of the Static-99, Static-99R, and STABLE-2007 for sexual recidivism: A diagnostic test accuracy network meta-analysis (DTA-NMA).

The Static-99, Static-99R, and STABLE-2007 are internationally well-established instruments for predicting static and dynamic risks of sexual recidivism in individuals convicted of sexual offenses. Previous meta-analyses assessed their predictive and incremental validity, but none has yet compared the two Static versions and the Static-STABLE combinations. Here, we implemented diagnostic test accuracy network meta-analysis (DTA-NMA) to compare all tests and identify optimal cutoffs in one comprehensive analysis. The DTA-NMA included 32 samples comprising 45,224 adult male individuals. More information was available on the Static-99 (22 samples; 34,316 individuals) and the Static-99R (13 samples; 27,243 individuals), compared to the Static-99/STABLE-2007 (three samples; 762 individuals), the Static-99R/STABLE-2007 (two samples; 2,972 individuals), and the STABLE-2007 (three samples; 816 individuals). The primary outcome was the area under the receiver operating characteristic curve (AUC). The secondary outcomes were sensitivity and specificity. Optimal cutoffs were determined using the Youden index. The AUC suggested moderate predictive validity for Static-99 and Static-99R, whereas STABLE-2007 had no predictive value. The optimal cutoff of Static-99R was suggested to have higher specificity than that of Static-99, whereas sensitivity was comparable between instruments. The notion of incremental validity for STABLE-2007 could not be confirmed. This work represents the first meta-analysis to compare Static-99, Static-99R, STABLE-2007, and their combinations in one analysis. Static-99R demonstrated the highest specificity in predicting the risk of sexual recidivism, indicating a potential advantage in detecting true nonrecidivists. The findings are discussed, considering the current recommendations for assessing the risk of sexual recidivism in the criminal justice system. (PsycInfo Database Record (c) 2024 APA, all rights reserved).