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.

Validation of the Revised Screening Scale for Pedophilic Interests (SSPI-2) in Portugal.

The accurate assessment of pedophilic sexual interests is crucial for the treatment and management of individuals who have sexually offended children. This study aimed to validate the Revised Screening Scale for Pedophilic Interests (SSPI-2) in a Portuguese sample of 170 men convicted of sexual offenses against children, 104 serving sentences in the community, and 66 in prison. The findings indicated that SSPI-2 demonstrated good convergent validity, as evidenced by its significant and positive associations with the "sexual deviance" item of SVR-20, the number of previous convictions for sexual crimes against children, and having 3 or more child victims, which is associated with high sensitivity and specificity in distinguishing men who show greater sexual arousal to children than to adults. Furthermore, the SSPI-2 exhibited good divergent validity, with no significant correlations observed with a self-report measure of psychopathy or with a nonsexual criminal history.

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.

Validating the Screening Scale of Pedophilic Crime Scene Behavior.

The Screening Scale of Pedophilic Crime Scene Behavior (SSPC) is a seven-item structured rating scale assessing pedophilic sexual arousal. In the current study, we cross-validated the scale's convergent validity using multiple measures of sexual interest in children (clinical diagnosis of pedophilia, the high fixation/low social competence type of the MTC:CM4, and phallometric assessment of sexual interests toward children) in two independent samples (USA and Canada). In both samples and in relation to all three criteria, the SSPC showed acceptable (phallometry) to excellent (clinical assessment) diagnostic accuracy. Furthermore, the SSPC showed incremental validity in relation to the Screening Scale for Pedophilic Interest and at times outperformed it in convergent validity analyses. The current study also provides psychometric information that can help users choose an appropriate SSPC cutoff score.

Neurodevelopmental Differences, Pedohebephilia, and Sexual Offending: Findings from Two Online Surveys.

The neurodevelopmental theory of pedohebephilia states that sexual interests in children arise from early neurodevelopmental perturbations, as, for example, evidenced by increased non-right-handedness, more childhood head injuries, and reduced intelligence and height. As corroborating evidence largely rests on samples of convicted men, we conducted online surveys among German-speaking (Study 1, N = 199) and English-speaking men (Study 2, N = 632), specifically targeting community members with pedohebephilic or teleiophilic interests. Although we detected theoretically meaningful sexual interest patterns in an embedded viewing time task, we could not detect expected neurodevelopmental differences between teleiophilic and pedohebephilic men in either of the two studies. Strikingly, pedohebephilic men who reported convictions for sexual offenses emerged as shorter and less intelligent than pedohebephilic men without convictions in Study 2. While elucidating possible third variable confounds, results have to be interpreted cautiously because of the methodological problems inherent to non-matched case control designs.

Test-Retest Reliability and Temporal Agreement of Direct and Indirect Sexual Interest Measures.

The Explicit and Implicit Sexual Interest Profile (EISIP) is a multimethod measure of sexual interest in children and adults. It combines indirect latency-based measures such as the Implicit Association Test (IAT), Viewing Time (VT), and explicit self-report measures. This study examined test-retest reliability and absolute temporal agreement of the EISIP over a 2-week interval in persons who were convicted of sexual offenses against children (n = 33) and nonoffending controls (n = 48). Test-retest reliability of the aggregated EISIP measures was high across the whole sample (rtt = .90, intraclass correlation coefficient [ICC] = .90) with the IAT yielding the lowest retest correlations (rtt = .66, ICC = .66). However, these indicators of relative reliability only quantify the temporal stability of individual differences within the group, not the detectability of individual change. Absolute temporal agreement as assessed via Bland-Altman plots ranged from one fourth to three thirds of a standardized unit in the sexual preference scores. This implies that individual change has to exceed medium to large standardized effect sizes to be distinguishable from spontaneous temporal variation in the EISIP measures. Overall, scores of combined measures were largely superior to single measures in terms of both absolute and relative reliability.

Measuring Pedophilic Sexual Interest.

INTRODUCTION: Pedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of established techniques aimed at assessing people with sexual interest in children. AIM: To provide a foundation from which to understand existing methods available for the assessment of people with pedophilic sexual interests, including strengths and limitations of each approach. METHODS: A group of clinical experts provide a clinically oriented, narrative review on assessment methods for pedophilic sexual interest, including the rationale behind each method and its implementation. Evidence on validity supporting the techniques, limitations, and ethical issues is also discussed. RESULTS: The assessment methods were grouped according to the following categories: self-report, genital psychophysiological assessment, indirect measurement, and behavioral measurement of pedophilic interest. Although most techniques performed well in discriminating child sexual offenders with pedophilic interest from distinct comparison groups, there are several limitations, including the current lack of standardization and the ethical challenges posed by this sensitive area. CLINICAL IMPLICATIONS: An understanding of the different measures available for the assessment of problematic sexual interests plays a vital role in forensic clinical determinations of risk of recidivism and in the identification of treatment targets for men who have committed sexual offenses. Several independent but complimentary methods exist to assess sexual interest. Ongoing work on the international standardization of assessment based on methodologically sound research aimed at determining best practices will address some of the shortcomings of these assessments while improving their reliability. STRENGTHS & LIMITATIONS: This article provides a general review on a number of methods aimed at assessing pedophilic interest. However, these methods mirror clinical practice largely used within North America and parts of continental Europe. As a result of cultural differences, opposing paradigms on assessment and treatment of pedophilia, and diverse legal regulation between jurisdictions and countries, these practices may not be applicable on an international scale where other special procedures may be required. CONCLUSION: A number of techniques have been used within clinical and research settings that vary from self-report to objective measures. Most methods have demonstrated efficacy. Continued work to combine evidence and experience from diverse populations and multiple countries will improve the quality of the methods available. Carvalho J, Bradford J, Murphy L, et al. Measuring Pedophilic Sexual Interest. J Sex Med 2020;17:378-392.

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.

Diagnostic Issues in the Paraphilias.

PURPOSE OF REVIEW: To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis. RECENT FINDINGS: Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests lead them to sexually offend. Even among these clients, research has, for the most part, failed to distinguish those who meet criteria for a paraphilia from those who do not, thereby limiting the possibility of drawing firm conclusions regarding the value of a paraphilic diagnosis. Speculations regarding the etiology of the paraphilias are for the most part limited to those who sexually offend and these theories do not distinguish those who do, or do not, meet paraphilic criteria. Treatment of sex offenders, when effective, appears to have the same impact regardless of whether or not clients meet criteria for a paraphilia. In terms of prognosis, it was only among untreated child molesters that a paraphilic diagnosis (in this case "pedophilia") predicted long-term outcome. In the face of these problems, we suggest a dimensional approach to diagnoses may represent an improvement over the current categorical model.

Pedophilia-Themed Obsessive-Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention.

Fears of sexually harming children are fairly common among clients suffering from obsessive-compulsive disorder (OCD), yet these symptoms are largely unrecognized and frequently misdiagnosed by mental health professionals. Specifically, clients with pedophilia-themed OCD (P-OCD) experience excessive worries and distressing intrusive thoughts about being sexually attracted to, and sexually violating, children. Expressing these concerns may provoke misjudgments from uninformed mental health professionals that a client is presenting instead with pedophilic disorder. This misdiagnosis and subsequent improper interventions can then contribute to increased fear, anxiety, and in many cases, depression, in affected clients. Therefore, it is imperative that mental health professionals first possess a good understanding of this common manifestation of OCD. As such, in this article, we described obsessions and compulsions typical of P-OCD, in order to inform the reader of the distinctive differences between P-OCD and pedophilic disorder. Information about how to assess for P-OCD symptoms is then provided, followed by suggestions on how to tailor aspects of exposure and response prevention to treat this specific form of OCD.

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.

Evidence of Construct Validity in the Assessment of Hebephilia.

Hebephilia refers to a persistent intense sexual interest in pubescent children. Although not as widely studied as pedophilia, studies of hebephilia have indicated convergence in self-report and sexual arousal. The present study expanded on previous work by examining convergent and divergent validity across indicators of hebephilia that included self-report, sexual behavior, and sexual arousal in a sample of 2238 men who had sexually offended. We included men who denied such interest and specifically examined the overlap between hebephilia and pedophilia and examined pedohebephilia (i.e., sexual interests in both prepubescent and pubescent children). Results indicated that there was considerable convergence across indicators of hebephilia. The results suggested poor divergent validity between hebephilia and pedophilia, as there was substantial overlap between the two constructs across analyses. Finally, a distinct pattern of sexual arousal was found in offenders with pedohebephilia. The results of the present study were discussed with a focus on implications for the assessment of sexual interest in children and the conceptualization of pedohebephilia.

Correlates of admitted sexual interest in children among individuals convicted of child pornography offenses.

Recent research on a risk assessment tool for child pornography offending suggests that admission of sexual interest in children is a risk factor for any sexual recidivism. Admission is easily vulnerable to lying, however, or to refusals to respond when asked about sexual interests. This may become a particular issue when individuals are concerned about the potential impact of admission of sexual interest on sentencing and other risk-related decisions. In this study, we identified the following behavioral correlates (coded yes/no) of admission of sexual interest in children in the risk tool development sample of 286 men convicted of child pornography offenses: (a) never married (54% of sample), (b) child pornography content included child sexual abuse videos (64%), (c) child pornography content included sex stories involving children (31%), (d) evidence of interest in child pornography spanned 2 or more years (55%), (e) volunteered in a role with high access to children (7%), and (f) engaged in online sexual communication with a minor or officer posing as a minor (10%). When summed, the average score on this Correlates of Admission of Sexual Interest in Children (CASIC) measure was 2.21 (SD = 1.22, range 0-6) out of a possible 6, and the CASIC score was significantly associated with admission of sexual interest in children, area under the curve (AUC) = .71, 95% CI [ .65, .77]. The CASIC had a stronger relationship with admission in a small cross-validation sample of 60 child pornography offenders, AUC = .81, 95% CI [.68, .95]. CASIC scores may substitute for admission of sexual interest in risk assessment involving those with child pornography offenses. (PsycINFO Database Record

The Revised Screening Scale for Pedophilic Interests (SSPI-2): Development and Criterion-Related Validation.

The Screening Scale for Pedophilic Interests (SSPI) is a structured rating scale of four child victim characteristics: number, age, gender, and relationship of victims. Sexual offenders against children who score higher on the SSPI are more likely to be identified as having pedophilic sexual arousal and are more likely to sexually reoffend. Recent research suggests that child pornography offending is a valid and perhaps independent indicator of pedophilia. In this study, we examined whether child pornography offending would add to the criterion-related validity of the SSPI. In the construction sample of 950 offenders with child victims, the SSPI with a fifth item of child pornography (Screening Scale for Pedophilic Interests-2 [SSPI-2]) was significantly associated with phallometrically assessed sexual arousal to children. In a validation sample of 950 offenders with child victims, the SSPI-2 was again related to phallometrically assessed sexual arousal to children, outperforming the original SSPI. We recommend clinicians and researchers use the SSPI-2 as a structured method of assessing pedophilic sexual interests based on offending behavior.

The Revised Screening Scale for Pedophilic Interests: Predictive and Concurrent Validity.

This study examined the predictive and concurrent validity of the Screening Scale for Pedophilic Interests (SSPI) and its recent revision (SSPI-2), using a large sample of 2,416 sex offenders deemed not to be in need of civil management in New York State. Both SSPI and SSPI-2 scores were significantly and positively related to sexual rearrest, but the SSPI-2 provided greater discrimination in rearrest within 5 years across possible scores. Neither measure significantly added to the prediction of sexual rearrest provided by the Static-99R. We also found evidence of concurrent validity, as both measures were positively and significantly correlated with clinician ratings of sexual preoccupation, emotional identification with children, and sexual offense-related cognitions (convergent validity), but were not significantly related to clinician ratings of self-regulation problems, noncompliance with supervision, or antisocial personality (divergent validity). Overall, the results suggest that the SSPI-2 is a specific and useful screening measure of pedophilic sexual interests among sex offenders with child victims.

[Treatment structures for men with pedosexual problems]. / Versorgungsstrukturen für Männer mit pädosexueller Problematik.

Pedophilia is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal and behavior. Less than 50% of all child abusers fulfill the diagnostic criteria and an even smaller part exclusively has a preference for children. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Outpatient treatment and treatment in forensic psychiatry clinics, sociotherapeutic facilities and in correction facilities are different aspects of prevention. So-called grey area projects (Dunkelfeldprojekte) are special facilities of primary and secondary prevention. The aim is to prevent sexual abuse by reducing and controlling of risk factors.

Are Child Abusers Sexually Attracted to Submissiveness? Assessment of Sex-Related Cognition With the Implicit Association Test.

Child sexual abuse is associated with social anxiety, low self-esteem, and intimacy deficits. This, in combination with the core belief of a dangerous world, might suggest that child abusers are sexually attracted to submissiveness. The Implicit Association Test (IAT) was used to examine this hypothesis. Results indicated that child abusers have a stronger sexual preference for submissiveness than rapists, although there were no differences between child abusers and non-sexual offenders. Multinomial logistic regression analysis revealed that submissive-sexy associations have incremental value over child-sex associations in differentiating child abusers from other offenders. The predictive value of both implicit associations was explored by correlating IAT scores with measures for recidivism risk, aggression, and interpersonal anxiety. Child abusers with stronger child-sex associations reported higher levels of interpersonal anxiety and hostility. More research on implicit cognition in sex offenders is required for a better understanding of what these and similar implicit measures are exactly measuring and what role implicit cognition may play in sexual offending.

Sensitivity and Specificity of the Phallometric Test for Hebephilia.

INTRODUCTION: The phallometric test has been examined most widely in the literature with regard to its ability to detect pedophilia; however, it has become of increasing interest to clinicians and researchers to ascertain to what extent the test accurately detects hebephilia: Whereas pedophilia refers to an adult's sexual interest in prepubescent children (age 10 or younger, on average), hebephilia refers to an adult's sexual interest in pubescent children (ages 11-14, on average). AIM: The aim of this study was to estimate the accuracy of volumetric phallometry in distinguishing pedophilic men and hebephilic men from men who are teleiophilic (primarily sexually interested in adults, age 17 or older). METHODS: A retrospective chart review was conducted on the cumulate database of a large phallometric laboratory and clinic to identify a group of 239 men who committed sexual offenses against extrafamilial adults age 17 or older and a group of 996 men who committed sexual offenses against extrafamilial children age 14 or younger, all of whom professed a greater sexual interest in adults over children. MAIN OUTCOME MEASURES: The sensitivity and specificity of the phallometric test is calculated for its accuracy in distinguishing sexual preferences for children spanning various age ranges. RESULTS: Receiver operator characteristic curves were highly significant for each classification decision: Using its previously established cut-point of +0.25 standard deviation (SD) units, the phallometric test detected hebephilia with a sensitivity and specificity of 70.0% and 90.7%, detected pedophilia with 46.9% and 100%, and detected pedohebephilia with 75.3% and 90.7%. At a new cut-point of +0.0 SD units, the sensitivity and specificity of the test for pedophilia was 71.9% and 95.3%. CONCLUSIONS: Volumetric phallometry significantly distinguishes teleiophilic sex offenders from each of pedophilic, hebephilic, and pedohebephilic sex offenders and can serve as a reliable diagnostic test of sexual age preference among men who deny sexual interest in children.

Heteronormativity and Repronormativity in Sexological "Perversion Theory" and the DSM-5's "Paraphilic Disorder" Diagnoses.

The move from "paraphilias" to "paraphilic disorders," where only the latter constitute mental disorders, has been hailed as a major change to the conception of non-normative sexualities in DSM-5. However, this is a claim that has been criticized by numerous activists and doctors working for removal of all diagnoses of so-called sexual disorders from the APA's manual. This article, written from a critical humanities, queer theory-inflected perspective, examines the historical and ideological grounds underlying the inclusion of the newly branded "paraphilic disorders" in DSM-5. It argues that the diagnosis does nothing to overturn the conservative and utilitarian view of sexuality as genitally oriented and for reproduction that has colored sexological and psychiatric history. It suggests that despite homosexuality no longer being classed as a disorder, an implicit heteronormativity continues to define psychiatric perceptions of sexuality. In sum, this article proposes that (1) the production of the field of psychiatric knowledge concerning "perversion"/"sexual deviation"/"paraphilia"/"paraphilic disorder" is more ideological than properly scientific; (2) the "normophilic" bias of the DSM is a bias in favor of heteronormativity and reproduction; and (3) some sexual practices are valued above others, regardless of claims that the presence of a paraphilic practice itself is no longer a criterion for a diagnosis of mental disorder.

The Imperialism of Historical Arrogance: Where Is the Past in the DSM's Idea of Sexuality?

This article questions the historical awareness of the DSM-5 by investigating first the treatment of prostitution from the Victorian period to today as a means of medicalizing desire; and second, by looking at the category of hebephilia, where modern medicalizing classifications are criticized for ignoring ancient evidence. By this comparative method, the article shows how ignoring historical evidence allows the social and ideological elements in the work of defining psychological sexual diseases to remain concealed.