State of the Art Treatment Options for Actual and Potential Sexual Offenders and New Prevention Strategies.

Sexual violence is a significant and devastating issue for men and women throughout the world. Its consequences are not only disastrous for victims of sexual violence but are also extremely costly (estimated cost of $41,000 per rape) for society. Successful treatment of sexual offenders is therefore an important goal for society as well as for victims and offenders themselves. Over the years, multiple treatment approaches for sex offenders have been developed. Treatment programs range from the risk-need-responsivity (RNR) model, which focuses on providing tailored treatment for high-risk and low-risk offenders, to psychodynamic models. This article presents an overview for clinicians of state-of-the-art offender treatment, describing the most common treatment approaches, in particular the RNR model, cognitive-behavioral programs (relapse prevention programs, sexual offender treatment programs), psychodynamic approaches (transference-focused psychotherapy, mentalization-based therapy), the Good Lives Model, as well as pharmacological options. In addition, it provides an evaluation of the various treatment programs. However, given the fact that most acts of sexual violence will never be reported to the police, the question arises if treating convicted perpetrators is enough. Do we need rather-in terms of preventive work-a program for potential sexual offenders and men with delinquent sexual fantasies? Given the prevalence of sexual violence and its impact on victims, society, and the medical community, it would be remiss not to try to reach potential/unconvicted perpetrators. This article offers novel ideas and a project the goal of which is to prevent sexual offenses against women by introducing the "I CAN CHANGE" program from Hannover Medical School.

Preventing Sexual Abuse: Perspectives of Minor-Attracted Persons About Seeking Help.

The primary aim of this exploratory research was to gain information from minor-attracted persons (MAPs) about their (a) formal and informal experiences with help-seeking for minor attraction, (b) perceived barriers to seeking help for concerns about minor attraction, and (c) treatment priorities as identified by consumers of these services. A nonrandom, purposive sample of MAPs (n = 293, 154 completed all questions) was recruited via an online survey. Results show that 75% of participants did seek formal help from a professional; however, just less than half of them found the experience to be helpful. Characteristics of helpful therapeutic encounters included nonjudgmental attitudes, knowledge about minor attraction, and viewing clients in a person-centered and holistic way. Barriers to help seeking included uncertainty about confidentiality, fear of negative reaction or judgment, difficulties finding a therapist knowledgeable about MAPs, and financial constraints. Understanding or reducing attraction to minors were common treatment goals, but participants also prioritized addressing general mental health and well-being related to depression, anxiety, loneliness, and low self-esteem. Implications for effective and ethical counseling and preventive interventions for MAPs are discussed.

Estrategias de persuasión percibidas por adolescentes en situaciones de engaño pederasta por Internet (online grooming) / Persuasion strategies perceived by adolescents in situations of online grooming

El engaño pederasta por Internet (online grooming) es el proceso por el cual un adulto consigue victimizar sexualmente a un menor valiéndose de los medios que ofrece Internet. El objetivo de este estudio fue analizar la prevalencia de las estrategias de persuasión e influencia utilizadas por adultos para manipular e involucrar a menores en el engaño pederasta por Internet, así como las diferencias atendiendo al sexo. Inicialmente, 2731 adolescentes de entre 12 y 15 años (50,6% chicas) completaron un cuestionario sobre solicitudes e interacciones sexuales con adultos y otro sobre persuasión basado en los principios de influencia de Cialdini (2001). 408 Menores (14,9%) se vieron implicados en el engaño pederasta durante el último año (61,3% mujeres; edad media= 14,23; DT= 0,92). Se encontró una utilización altamente frecuente de los principios de influencia, siendo el más experimentado el principio de simpatía (hasta un 50,9%). Las chicas experimentaron más frecuentemente todos los principios excepto el de autoridad, en el que no hubo diferencias. Estos hallazgos proporcionan información útil para entender y prevenir la victimización sexual de los menores en Internet

Online grooming is the process by which an adult sexually victimizes a minor using the means offered by the Internet. The objective of this study was to analyze the prevalence of persuasion and influence strategies used by aggressors to manipulate and involve minors in online grooming, as well as gender differences. The initial sample consisted of 2731 adolescents between 12 and 15 years of age (50.6% girls) who completed a questionnaire on sexual solicitations and interactions with adults and another on persuasion based on the principles of influence of Cialdini (2001). 408 Minors (14.9%) were involved in grooming during the previous year (61.3% girls, mean age= 14.23, DT= 0.92). It was found a highly frequent use of the principles of influence, being the principle of sympathy the most experienced (up to 50.9%). Girls experienced more frequently all the principles of influence except the principle of authority, in which there were no gender differences. These findings provide useful information for understanding and preventing sexual victimization of minors on the Internet

Increasing Valid Profiles in Phallometric Assessment of Sex Offenders with Child Victims: Combining the Strengths of Audio Stimuli and Synthetic Characters.

Penile plethysmography (PPG) is a measure of sexual interests that relies heavily on the stimuli it uses to generate valid results. Ethical considerations surrounding the use of real images in PPG have further limited the content admissible for these stimuli. To palliate this limitation, the current study aimed to combine audio and visual stimuli by incorporating computer-generated characters to create new stimuli capable of accurately classifying sex offenders with child victims, while also increasing the number of valid profiles. Three modalities (audio, visual, and audiovisual) were compared using two groups (15 sex offenders with child victims and 15 non-offenders). Both the new visual and audiovisual stimuli resulted in a 13% increase in the number of valid profiles at 2.5 mm, when compared to the standard audio stimuli. Furthermore, the new audiovisual stimuli generated a 34% increase in penile responses. All three modalities were able to discriminate between the two groups by their responses to the adult and child stimuli. Lastly, sexual interest indices for all three modalities could accurately classify participants in their appropriate groups, as demonstrated by ROC curve analysis (i.e., audio AUC = .81, 95% CI [.60, 1.00]; visual AUC = .84, 95% CI [.66, 1.00], and audiovisual AUC = .83, 95% CI [.63, 1.00]). Results suggest that computer-generated characters allow accurate discrimination of sex offenders with child victims and can be added to already validated stimuli to increase the number of valid profiles. The implications of audiovisual stimuli using computer-generated characters and their possible use in PPG evaluations are also discussed.

Using a Facebook profile in determining the motive of homicide.

Ritual homicides may be affective (emotional), but usually they are premediated, instrumental, or predatory. In the case under review, the Facebook profile of the assailant helped to determine the motive of the homicide, which seemed to be ritualistic in nature. Therein, a 56-year-old male sustained 48 stab wounds and other knife injuries. On the wall in a room above the body, a pentagram was drawn with the victim's blood, followed by a few words which can be associated with a "Satanic" ritual. Searching through the Facebook profile of the culprit, Satanism as a leading motive of the homicide was eventually excluded. The most interesting point of this case was the evaluation of a sentence used as a Facebook status, which greatly contributed to confirm the paedophilic nature of the murder.

Brain pathology in pedophilic offenders: evidence of volume reduction in the right amygdala and related diencephalic structures.

CONTEXT: Pedophilic crime causes considerable public concern, but no causative factor of pedophilia has yet been pinpointed. In the past, etiological theories postulated a major impact of the environment, but recent studies increasingly emphasize the role of neurobiological factors, as well. However, the role of alterations in brain structures that are crucial in the development of sexual behavior has not yet been systematically studied in pedophilic subjects. OBJECTIVE: To examine whether pedophilic perpetrators show structural neuronal deficits in brain regions that are critical for sexual behavior and how these deficits relate to criminological characteristics. DESIGN: Amygdalar volume and gray matter of related structures that are critical for sexual development were compared in 15 nonviolent male pedophilic perpetrators (forensic inpatients) and 15 controls using complementary morphometric analyses (voxel-based morphometry and volumetry). Psychosocial adjustment and sexual offenses were also assessed. RESULTS: Pedophilic perpetrators showed a significant decrease of right amygdalar volume, compared with healthy controls (P = .001). We observed reduced gray matter in the right amygdala, hypothalamus (bilaterally), septal regions, substantia innominata, and bed nucleus of the striae terminalis. In 8 of the 15 perpetrators, enlargement of the anterior temporal horn of the right lateral ventricle that adjoins the amygdala could be recognized by routine qualitative clinical assessment. Smaller right amygdalar volumes were correlated with the propensity to commit uniform pedophilic sexual offenses exclusively (P = .006) but not with age (P = .89). CONCLUSIONS: Pedophilic perpetrators show structural impairments of brain regions critical for sexual development. These impairments are not related to age, and their extent predicts how focused the scope of sexual offenses is on uniform pedophilic activity. Subtle defects of the right amygdala and closely related structures might be implicated in the pathogenesis of pedophilia and might possibly reflect developmental disturbances or environmental insults at critical periods.

Pedophilia is linked to reduced activation in hypothalamus and lateral prefrontal cortex during visual erotic stimulation.

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

Pedophilia: neuropsychological evidence encouraging a brain network perspective.

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

Detecting anomalous sexual interests in juvenile sex offenders.

Phallometric studies suggest that some adolescent sex offenders exhibit anomalous sexual interests. However, there have been ethical and practical objections to the phallometric testing of adolescents. Alternative measures may be needed if we are to understand the role of anomalous sexual interests in adolescent sexual offending. The Screening Scale for Pedophilic Interests (SSPI) was designed as a brief measure of pedophilic interests based on sexual offense history variables: any male victims, more than one victim, any victims under age 12, and any unrelated victims. Score on the SSPI is significantly and positively correlated with phallometrically measured pedophilic interests among adult offenders against children. In this study, the SSPI was scored in three samples of adolescent sex offenders who underwent phallometric testing for pedophilic interests. Scores on the SSPI were positively correlated with a phallometric index of relative sexual arousal to children in all three samples. This relationship was strongest using visual stimuli. The positive relationship between SSPI scores and pedophilic responding held up despite the use of different penile measures, stimulus sets, procedures, and scoring methods. The usefulness of the SSPI as a proxy measure among adolescents is discussed.

The treatment of incest offenders--a hypnotic approach: a brief communication.

Incest has become more prominent in public awareness over the past 15 years. The major focus of this interest has been on the incest survivor. The incest offender has received less attention. A hypnotic approach to treating incest offenders is outlined that involves a seven-stage approach. A case example is presented and future research directions suggested.

Sexual preference for child and aggressive stimuli: comparison of rapists and child molesters using auditory and visual stimuli.

154 Ss were tested using penile plethysmography as part of intake into a voluntary inpatient sex offender treatment program. The testing protocol included slide stimuli of nude males and females in four age categories ranging from age 1 to adult; audiotaped descriptions of sexual activity with children of both genders which included fondling, sexual contact with no resistance, coercive sexual contact, sexual assault, nonsexual assault, and consensual sexual contact with an adult; videotaped depictions of rape of an adult woman, nonsexual assault of an adult woman and consensual sexual involvement with an adult woman, and audiotaped descriptions that paralleled the videotapes. The results indicated that child molesters (male victim) show a decidedly more offense related arousal profile than either child molesters (female victim) or rapists, and that the profiles of child molesters (female victim) and rapists are remarkably similar, although statistically significantly different from each other. Rapists respond significantly more to rape and nonsexual assault than either of the two child molester groups, with child molesters with female victims responding more than those with male victims. In all three groups, the highest level of noncoercive adult responding was to women, with differences among offense groups present for visual stimuli, but not in response to auditory stimuli. Overall, the patterns of results are similar whether they are based on composites across stimulus modality or on the individual stimuli.

Sexual criminality and hypnotizability.

Thirty-three sexual offenders, 18 of whom had been convicted of rape, nine of pedophilia, and six of incest, were studied. Two thirds of the subjects had histories of "spontaneous self-hypnotic" experiences (dissociations); seven of these were DSM-III multiples and six were probable multiples. This group had very high hypnotizability scores. The other one third without histories of "spontaneous self-hypnosis" had normal scores. It was concluded that spontaneous self-hypnosis contributed to the perpetration of the crimes in many of these cases, although other factors also directed the antisocial behaviors.