Corrigendum: Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

[This corrects the article DOI: 10.3389/fpsyt.2023.1277225.].

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Corrigendum: Mandated or voluntary treatment of men who committed child sexual abuse: Is there a difference?

[This corrects the article DOI: 10.3389/fpsyt.2021.708210.].

Acceptance of Sexual Interest in Minors in Self-Referred Individuals Under Treatment - An Exploratory Pilot Study.

Some therapists/scientists argue that "acceptance" of sexual interest in minors (SIM), i.e., the integration of the sexual preference into the individual self-concept, is a prerequisite for dealing with SIM in a responsible way. However, if one assumes that - even in some persons - SIM might change over time, "acceptance" could also run counter to therapeutic targets because the motivation to change as well as the specific self-efficacy for modifying SIM might be reduced. This exploratory pilot study analyzes the relationship between acceptance of SIM and (1) dynamic risk for contact sexual reoffending, (2) SIM and frequency of the use of child/adolescent (sexual abuse) imagery, (3) frequency of sexual desire/behavior toward children/adolescents, and (4) the change of the level of acceptance of SIM during the course of treatment. The majority of the participants (N = 79) was not exclusively interested in children (85%) and used child pornography but did not commit child sexual abuse (54%). Acceptance of SIM, frequency of the use of child/adolescent (sexual abuse) imagery and frequency of sexual desire/behavior toward children/adolescents are assessed via self-report questionnaires, dynamic risk for contact sexual reoffending is measured by STABLE-2007. Pretreatment data are analyzed via Spearman's correlation (N = 79). Intragroup analysis compares acceptance of SIM from pre- and posttreatment (n = 35). There was no correlation between acceptance of SIM and dynamic risk for contact sexual reoffending. However, there was a medium, positive correlation between acceptance of SIM and the frequency of the use of legal imagery of children, a positive correlation between the item "My inclination is an integral part of my personality" and the frequency of the use of legal imagery of children, and a positive correlation between acceptance of SIM and the frequency of sexual activities with minors. Acceptance of SIM did not change during the course of treatment. The results suggest that "acceptance" of SIM has to be discussed in a differentiated way, i.e., as possibly being associated with positive and negative outcomes as well.

Mandated or Voluntary Treatment of Men Who Committed Child Sexual Abuse: Is There a Difference?

Child sexual abuse is associated with multiple and often severe consequences for people who are affected by it. From the perspective of indicative prevention, the treatment of people who have sexually abused children represents one important strategy, with the assumption that there is often a risk for sexual recidivism. However, there is still very limited knowledge about how men who have not been convicted of child sexual abuse but participate in voluntary treatment (here called non-forensic clients) differ from those who have been convicted and undergo mandated treatment (here called forensic clients). This study compared 22 forensic and 22 non-forensic clients regarding pedophilic interests, static and dynamic risk factors, responsivity features, and treatment progress during an individualized treatment based on the principles of risk, need, and responsivity. We found neither differences in the rates in the DSM-5 diagnosis of pedophilic disorder, nor in risk and responsivity associated scores at the beginning of treatment. In both groups, a low to moderate risk for sexual re-offending was estimated. Both groups improved their functioning on dynamic risk and responsivity factors under treatment, while age at the beginning of therapy also had a positive effect on all outcomes. Non-forensic clients had a higher amount of responsivity associated resources than forensic clients during treatment. The limitations of these results and their implications for further research and prevention approaches are discussed.

Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study.

INTRODUCTION: Studies on characteristics of self-referred men with sexual interest in minors (SIM) and treatment approaches in this group of patients are still relatively rare. AIM: The aim of this exploratory pilot study was to investigate hypersexuality and impulsivity as 2 dynamic risk factors that could possibly change during treatment in self-referred men with SIM. METHODS: Data were collected at the "Kein Täter Werden (means: not become an offender)" network site in Hamburg. Using self-report questionnaires, the extent of hypersexuality and impulsivity was analyzed with the samples' pretreatment data via descriptive statistics and compared with nonclinical samples of other studies. The relation between hypersexuality and impulsivity was analyzed via Spearman's correlation coefficient with pretreatment data (N = 77). Intragroup analysis compared hypersexuality and impulsivity from pre- and posttreatment (n = 29). MAIN OUTCOME MEASURES: Hypersexual Behavior Inventory and Barratt Impulsiveness Scale Version 11. RESULTS: The degree of generalized impulsivity in the SIM group was comparable to that in nonclinical samples while the degree of hypersexuality was considerably higher than in nonclinical samples. Sixty-four percent of the participants were in the range of clinically relevant hypersexuality. Impulsivity and hypersexuality were weakly positively correlated with each other. During treatment hypersexuality significantly decreased while impulsivity did not differ significantly between before beginning treatment and after (partial) completion. CONCLUSION: Hypersexuality, but not impulsivity, was pronounced in the group of self-referred men with SIM and should be targeted in treatment. In order to improve treatment outcome regarding risk reduction in self-referred men with SIM, a focus on treatment approaches that were developed to treat hypersexuality can be expected to be effective while focusing on generalized impulsivity may be less relevant. Lampalzer U, Tozdan S, von Franqué F, et al. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021;9:100429.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors.

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

[Risk and Protective Factors Among Sexual Offenders: Relapse Prediction and Changes During Treatment]. / Risiko- und Schutzfaktoren bei sexualdelinquent gewordenen Menschen: Vorhersage erneuter Straftaten und Veränderungen im Behandlungsverlauf.

OBJECTIVE: Investigation of two questions: first, whether sexual/forensic therapists are able to make valid assessments for future criminal behavior and second, whether their treatment changes factors relevant for new offences. METHODS: First, the predictive validity for recidivism of HCR-20 and SAPROF were tested. Second, the dynamic scales of both instruments were analyzed concerning changes during treatment process. RESULTS: Both instruments showed good predictive validity. The dynamic scales scores of HCR-20 did not change, whereas the I- and M-scale scores of SAPROF increased statistically significant. CONCLUSION: The therapists were able to identify high-risk clients and seemed to mainly focus their interventions towards factors associated with new offences.

Which Techniques Are Used in Psychotherapeutic Interventions for Nonparaphilic Hypersexual Behavior?

INTRODUCTION: Attempts to draw a distinction between excessive and so-called normal sexual behavior are discussed controversially. Although no consensus has been reached so far on how to label the phenomenon of clinical relevant excessive sexual behavior, Kafka proposed the term hypersexual disorder. There are only a few empirical studies on the effectiveness of treatment. In the recent systematic review by Hook and colleagues, the total number of subject-related studies amounts to only 14 studies. However, it might be difficult for mental health professionals to fully comprehend the intervention techniques used in the different studies. AIM: The present article aims at reviewing the psychotherapeutic interventions for nonparaphilic hypersexual behavior use. METHOD: Each study mentioned in the recent review by Hook et al. was analyzed with regard to the psychotherapeutic interventions that had been applied. Only studies with positive treatment outcomes were considered. From among those studies, only the interventions which seemed to be sufficiently detailed and which are related to the obvious therapeutic results in the treatment of hypersexual symptoms were chosen. Furthermore, the interventions were assigned to the proposed diagnostic criteria of the hypersexual disorder. RESULTS: The hypothesized mechanisms how certain treatment techniques could change and influence hypersexual symptoms were mostly described in an unsatisfactory way. Interventions were targeted on impairment in social, occupational, or other important areas of functioning, negative mood states, stressful life events, and lack of behavioral control. No specific interventions were included for the risk for physical or emotional harm to self or others. CONCLUSION: Future treatment approaches should explicitly formulate the etiological mechanism and contain interventions for the neglected areas. In addition, a more flexible approach in the treatment of different subgroups with hypersexual behavior might be promising. von Franqué F, Klein V, and Briken P. Which techniques are used in psychotherapeutic interventions for nonparaphilic hypersexual behavior? Sex Med Rev 2015;3:3-10.