Widespread and interrelated gray matter reductions in child sexual offenders with and without pedophilia: Evidence from a multivariate structural MRI study.

AIM: To further investigate the neuroanatomical correlates of child sexual offending and disentangle them from the neural correlates of pedophilia, using a multivariate analytical approach in order to minimize loss of statistical power. METHODS: This study presents structural MRI data on gray matter in an incarcerated, male population of 22 pedophilic and 21 non-pedophilic child sexual offenders, and 20 violent non-sexual offender controls, based on a multivariate whole-brain approach using source-based morphometry. RESULTS: We identify a network of several neuroanatomical regions exhibiting interrelated reduced gray matter in both child sexual offender groups relative to controls, comprising extensive clusters in the bilateral cerebellum and frontal lobe, as well as smaller clusters in the bilateral parietal, temporal, and occipital lobes, the bilateral basal ganglia, the medial cingulate and the hippocampus. CONCLUSION: Our results speak to the interpretation that there are inter- and possibly connectivity-related brain structural abnormalities in child sexual offenders that are not (only) pertaining to pedophilia per se. Interpretations and limitations of the present data are discussed and recommendations for future works are given.

Multimodal neuroimaging measures and intelligence influence pedophile child sexual offense behavior.

Pedophilia is a heterogeneous disorder for which the neurobiological correlates are not well established. In particular, there are no biological markers identifying individuals with high risk to commit child sexual offense (CSO). Pedophiles with CSO (P+CSO; N = 73), pedophiles without CSO (P-CSO; N = 77), and non-pedophilic controls (NPC; N = 133) were assessed using multimodal structural neuroimaging measures including: cortical thickness (CT), surface area (SA), and white matter fractional anisotropy (FA), as well as full scale IQ (FSIQ) performance. Cortex-wise mediation analyses were used to assess the relationships among brain structure, FSIQ and CSO behavior. Lower FSIQ performance was strongly predict with P+CSO (Wald Chi2 = 13.0, p = 3.1 × 10-5). P+CSO had lower CT in the right motor cortex and pronounced reductions in SA spanning the bilateral frontal, temporal, cingulate, and insular regions (PFWE-corrected < 0.05). P+CSO also had lower FA particularly in the corpus callosum (PFWE-corrected < 0.05). The relationship between SA and P+CSO was significantly mediated by FSIQ, particularly in the prefrontal and anterior insular cortices (PFWE-corrected < 0.05). Within P+CSO, left prefrontal and right anterior cingulate SA negatively correlated with number of CSOs (PFWE-corrected < 0.05). This study demonstrates converging neurobiological findings in which P+CSO had lower FSIQ performance, reduced CT, reduced SA, and reduced FA, compared to P-CSO as well as NPC. Further, FSIQ potentially mediates abuse by pedophiles via aberrant SA, whereas the CT and FA associations were independent of FSIQ differences. These findings suggest aberrant neuroanatomy and lower intelligence as a potential core feature underlying child sexual abuse behavior by pedophiles.

Pedophilic sex offenders are characterised by reduced GABA concentration in dorsal anterior cingulate cortex.

A pedophilic disorder is characterised by abnormal sexual urges towards prepubescent children. Child abusive behavior is frequently a result of lack of behavioral inhibition and current treatment options entail, next to suppressing unchangeable sexual orientation, measures to increase cognitive and attentional control. We tested, if in brain regions subserving attentional control of behavior and perception of salient stimuli, such inhibition deficit can be observed also on the level of inhibitory neurotransmitters. We measured GABA concentration in the dorsal anterior cingulate cortex (dACC) and in a control region, the pregenual anterior cingulate cortex (pgACC) in pedophilic sex offenders (N = 13) and matched controls (N = 13) using a 7 Tesla STEAM magnetic resonance spectroscopy (MRS). In dACC but not in the control region pedophilic sex offenders showed reduced GABA/Cr concentrations compared to healthy controls. The reduction was robust after controlling for potential influence of age and gray matter proportion within the MRS voxel (p < 0.04). Importantly, reduced GABA/Cr in patients was correlated with lower self-control measured with the Barratt Impulsiveness Scale (p = 0.028, r = -0.689). In a region related to cognitive control and salience mapping, pedophilic sex offenders showed reduction of the inhibitory neurotransmitter GABA which may be seen as a neuronal correlate of inhibition and behavioral control.

Independent Component Analysis of Resting-State Functional Magnetic Resonance Imaging in Pedophiles.

INTRODUCTION: Neuroimaging and other studies have changed the common view that pedophilia is a result of childhood sexual abuse and instead is a neurologic phenomenon with prenatal origins. Previous research has identified differences in the structural connectivity of the brain in pedophilia. AIM: To identify analogous differences in functional connectivity. METHODS: Functional magnetic resonance images were recorded from three groups of participants while they were at rest: pedophilic men with a history of sexual offenses against children (n = 37) and two control groups: non-pedophilic men who committed non-sexual offenses (n = 28) and non-pedophilic men with no criminal history (n = 39). MAIN OUTCOME MEASURE: Functional magnetic resonance imaging data were subjected to independent component analysis to identify known functional networks of the brain, and groups were compared to identify differences in connectivity with those networks (or "components"). RESULTS: The pedophilic group demonstrated wide-ranging increases in functional connectivity with the default mode network compared with controls and regional differences (increases and decreases) with the frontoparietal network. Of these brain regions (total = 23), 20 have been identified by meta-analytic studies to respond to sexually relevant stimuli. Conversely, of the brain areas known to be those that respond to sexual stimuli, nearly all emerged in the present data as significantly different in pedophiles. CONCLUSION: This study confirms the presence of significant differences in the functional connectivity of the brain in pedophilia consistent with previously reported differences in structural connectivity. The connectivity differences detected here and elsewhere are opposite in direction from those associated with anti-sociality, arguing against anti-sociality and for pedophilia as the source of the neuroanatomic differences detected.

The (in)consistency of changes in brain macrostructure in male paedophiles: A combined T1-weighted and diffusion tensor imaging study.

Thus far, four studies have used magnetic resonance imaging (MRI) to test for differences in brain structure between paedophilic (i.e. sexually attracted to pre-pubescent children) and teleiophilic (i.e. sexually attracted to adults) men, revealing divergent results. To re-examine this issue, we acquired high resolution structural T1-weighted and diffusion MRI scans of the brain in 24 paedophilic and 32 teleiophilic men. We performed voxel-based morphometry (VBM) of the T1-weighted images and tract-based spatial statistics (TBSS) of the diffusion tensor imaging data to search for grey and white matter differences between groups. In contrast to previous studies, less than half of the individuals in our paedophilic group had a record of sexual offences against children, as subjects were partially recruited from two outpatient facilities of a child sexual abuse prevention project for self-acknowledged paedophiles. After adjustment for multiple comparisons and controlling for important confounding factors, we did not find any significant grey or white matter differences between the paedophilic and teleiophilic subjects. Together with the inconsistencies in the literature, these results argue against consistent structural differences at the macroanatomical scale between paedophiles and teleiophiles.

Hebephilia: A Postmortem Dissection.

In 2008, the concept of hebephilia, which denotes an erotic preference for "pubescent children," was suggested by Blanchard and his team for inclusion in the DSM-5 (Blanchard et al., 2009). Four years later, the APA's Board of Trustees opted for the status quo and rejected that proposal. This essay sheds light on the reason for this rejection. I consider three important questions related to hebephilia: Does hebephilia exist? Is it a disease? And what would have been the social consequences of including it in the DSM? I argue that if Blanchard failed to convince others that hebephilia should be included in the DSM-5, it is not because he focused too much on the first question and was unable to offer a convincing answer to the second one, but because he made the mistake of dismissing the third one as extraneous. The DSM is not intended to be a pure research manual, and a category like hebephilia cannot be evaluated without taking into account its potential forensic impact. In part or in whole, the decision to include a new diagnostic category in the DSM is, and always should be, a political decision.

Connectivity and functional profiling of abnormal brain structures in pedophilia.

Despite its 0.5-1% lifetime prevalence in men and its general societal relevance, neuroimaging investigations in pedophilia are scarce. Preliminary findings indicate abnormal brain structure and function. However, no study has yet linked structural alterations in pedophiles to both connectional and functional properties of the aberrant hotspots. The relationship between morphological alterations and brain function in pedophilia as well as their contribution to its psychopathology thus remain unclear. First, we assessed bimodal connectivity of structurally altered candidate regions using meta-analytic connectivity modeling (MACM) and resting-state correlations employing openly accessible data. We compared the ensuing connectivity maps to the activation likelihood estimation (ALE) maps of a recent quantitative meta-analysis of brain activity during processing of sexual stimuli. Second, we functionally characterized the structurally altered regions employing meta-data of a large-scale neuroimaging database. Candidate regions were functionally connected to key areas for processing of sexual stimuli. Moreover, we found that the functional role of structurally altered brain regions in pedophilia relates to nonsexual emotional as well as neurocognitive and executive functions, previously reported to be impaired in pedophiles. Our results suggest that structural brain alterations affect neural networks for sexual processing by way of disrupted functional connectivity, which may entail abnormal sexual arousal patterns. The findings moreover indicate that structural alterations account for common affective and neurocognitive impairments in pedophilia. The present multimodal integration of brain structure and function analyses links sexual and nonsexual psychopathology in pedophilia.

Brain alterations in paedophilia: a critical review.

Psychosocial and biological factors have been implicated in paedophilia, such as alterations in brain structure and function. The purpose of this paper is to review the expanding body of literature on this topic including brain abnormality case reports, as well as structural and functional neuroimaging studies. Case studies of men who have committed sexual offences against children implicate frontal and temporal abnormalities that may be associated with impaired impulse inhibition. Structural neuroimaging investigations show volume reductions in paedophilic men. Although the findings have been heterogeneous, smaller amygdala volume has been replicated repeatedly. Functional neuroimaging investigations demonstrate an overlap between paedophiles and teleiophiles during sexual arousal processing. While it is controversial among studies regarding group differences, reliable discrimination between paedophilic and teleiophilic men may be achieved using functional activation patterns. Nevertheless, the heterogeneous findings published so far suggest further research is necessary to disentangle the neurobiological mechanisms of paedophilic preference. A number of methodological confounds have been identified, which may account for the inconsistent results that could prove to be beneficial for future investigations.

Rorschach e pedofilia: a fidedignidade no teste-reteste / Rorschach and pedophilia: a reliability at test-retest / Rorschach y pedofilia: la confianza en el test-retest

Esse estudo buscou investigar as características de personalidade de um indivíduo pedófilo, e evidenciar a fidedignidade do Rorschach no teste-reteste. O participante, com 38 anos de idade, masculino, respondeu a entrevista e ao método de Rorschach, em duas etapas. Os principais achados revelam: a) uma tendência à fragmentação na percepção de si e dos outros; b) autoimagem negativa e desfavorável em relação ao corpo e suas funções; c) problemas nas relações interpessoais, falhas na capacidade de empatia; d) déficit no ajustamento perceptivo da realidade; e) vulnerabilidade a pressões subjetivas e impulsividade. Esses resultados mantiveram-se estáveis comparando-se as duas aplicações, permitindo ampliar a compreensão dos elementos psicológicos envolvidos na pedofilia, que se mantem, e apoiam a fidedignidade do Rorschach no teste-reteste.(AU)

The present study aimed to investigate the personality characteristics of a pedophile, and to make evident the Rorschach’s reliability at the test-retest. The participant, a male of 38 years old, answered to the interview and the Rorschach’s test, in two steps. The main findings revealed: a) a tendency to fragmentation in the perception of himself and others; b) negative and unfavourable self image related to the body and its functionalities; c) problems in interpersonal relationships, lacks in empaty capabilities; d) deficits in the perceptive adjustments of reality;e) vulnerability to subjective pressures and impulsivity. These results kept stable when comparing two applications, allowing to further increase the comprehension of the psychological elements involved in pedophilia, that showed to be sustained, and support the reliability of the Rorschach at test-retest.(AU)

Ese estudio ha buscado investigar las características de personalidad de una persona pedófila, y dejar clara la fidedignidad del Rorschach en test-retest. El participante, con edad de 38 años, del sexo masculino, contestó la entrevista y al método de Rorschach en dos etapas. Los resultados indican: a) una tendencia a la fragmentación en la percepción de uno mismo y de los otros; b) autoimagen negativa y desfavorable en relación al cuerpo y sus funciones; c) problemas en las relaciones interpersonales, fallas en la capacidad de empatía; déficit en el ajuste perceptivo de la realidad; e) vulnerabilidad a las presiones subjetivas e impulsividad. Esos resultados se mantuvieron estables al comparar con las dos aplicaciones, permitiendo ampliar la comprensión de los elementos psicológicos relacionados a la pedofilia, que se mantienen, y apoyan la confianza del Rorschach en el test-retest.(AU)

Rorschach e pedofilia: a fidedignidade no teste-reteste / Rorschach and pedophilia: a reliability at test-retest / Rorschach y pedofilia: la confianza en el test-retest

Esse estudo buscou investigar as características de personalidade de um indivíduo pedófilo, e evidenciar a fidedignidade do Rorschach no teste-reteste. O participante, com 38 anos de idade, masculino, respondeu a entrevista e ao método de Rorschach, em duas etapas. Os principais achados revelam: a) uma tendência à fragmentação na percepção de si e dos outros; b) autoimagem negativa e desfavorável em relação ao corpo e suas funções; c) problemas nas relações interpessoais, falhas na capacidade de empatia; d) déficit no ajustamento perceptivo da realidade; e) vulnerabilidade a pressões subjetivas e impulsividade. Esses resultados mantiveram-se estáveis comparando-se as duas aplicações, permitindo ampliar a compreensão dos elementos psicológicos envolvidos na pedofilia, que se mantem, e apoiam a fidedignidade do Rorschach no teste-reteste...

The present study aimed to investigate the personality characteristics of a pedophile, and to make evident the Rorschach’s reliability at the test-retest. The participant, a male of 38 years old, answered to the interview and the Rorschach’s test, in two steps. The main findings revealed: a) a tendency to fragmentation in the perception of himself and others; b) negative and unfavourable self image related to the body and its functionalities; c) problems in interpersonal relationships, lacks in empaty capabilities; d) deficits in the perceptive adjustments of reality;e) vulnerability to subjective pressures and impulsivity. These results kept stable when comparing two applications, allowing to further increase the comprehension of the psychological elements involved in pedophilia, that showed to be sustained, and support the reliability of the Rorschach at test-retest...

Ese estudio ha buscado investigar las características de personalidad de una persona pedófila, y dejar clara la fidedignidad del Rorschach en test-retest. El participante, con edad de 38 años, del sexo masculino, contestó la entrevista y al método de Rorschach en dos etapas. Los resultados indican: a) una tendencia a la fragmentación en la percepción de uno mismo y de los otros; b) autoimagen negativa y desfavorable en relación al cuerpo y sus funciones; c) problemas en las relaciones interpersonales, fallas en la capacidad de empatía; déficit en el ajuste perceptivo de la realidad; e) vulnerabilidad a las presiones subjetivas e impulsividad. Esos resultados se mantuvieron estables al comparar con las dos aplicaciones, permitiendo ampliar la comprensión de los elementos psicológicos relacionados a la pedofilia, que se mantienen, y apoyan la confianza del Rorschach en el test-retest...

Association between brain structure and phenotypic characteristics in pedophilia.

Studies applying structural neuroimaging to pedophiles are scarce and have shown conflicting results. Although first findings suggested reduced volume of the amygdala, pronounced gray matter decreases in frontal regions were observed in another group of pedophilic offenders. When compared to non-sexual offenders instead of community controls, pedophiles revealed deficiencies in white matter only. The present study sought to test the hypotheses of structurally compromised prefrontal and limbic networks and whether structural brain abnormalities are related to phenotypic characteristics in pedophiles. We compared gray matter volume of male pedophilic offenders and non-sexual offenders from high-security forensic hospitals using voxel-based morphometry in cross-sectional and correlational whole-brain analyses. The significance threshold was set to p < .05, corrected for multiple comparisons. Compared to controls, pedophiles exhibited a volume reduction of the right amygdala (small volume corrected). Within the pedophilic group, pedosexual interest and sexual recidivism were correlated with gray matter decrease in the left dorsolateral prefrontal cortex (r = -.64) and insular cortex (r = -.45). Lower age of victims was strongly associated with gray matter reductions in the orbitofrontal cortex (r = .98) and angular gyri bilaterally (r = .70 and r = .93). Our findings of specifically impaired neural networks being related to certain phenotypic characteristics might account for the heterogeneous results in previous neuroimaging studies of pedophilia. The neuroanatomical abnormalities in pedophilia seem to be of a dimensional rather than a categorical nature, supporting the notion of a multifaceted disorder.

Pedophilic behavior from brain disease.

INTRODUCTION: Child molestation or other pedophilic behavior may result as a consequence of a brain disorder. AIM: To characterize the mechanisms of pedophilic behavior associated with neurological diseases. METHODS: We report eight patients with pedophilic behavior as a manifestation of their brain disorder and review the literature. MAIN OUTCOME MEASURES: The sexual, neuropsychiatric, and neurological aspects of a series of patients. RESULTS: All eight developed sexual behavior toward prepubescent children in mid- to late-life coincident with the development of a neurological disorder. Five had limited insight, anxiety, or concern for their behavior and tended to have frontal lobe executive deficits. Most of this group had frontally predominant disorders. Two others retained insight and concern in the context of marked hypersexuality. This second group had treated Parkinson's disease and resembled reports of pedophilic behavior from subcortical lesions. The further presence of right temporal lobe-amygdala involvement may have predisposed to specific sexual preoccupation in some patients. CONCLUSIONS: Brain disorders may release a predisposition to sexual attraction for children through disinhibition with frontal disease, sexual preoccupation with right temporal disease, or hypersexuality with subcortical disease in non-motor basal ganglia, hypothalamus, or septal nuclei. Differentiating these mechanisms of pedophilic behavior from brain disease could facilitate targeted interventions.

Pedofilia - considerações atuais

A pedofilia é um transtorno Mental caracterizado por fantasias e/ou pensamentos sexuaisintensos e sexualmente excitantes, por período igual ou superior a seis meses e que envolvam pessoas de até 12 anos de idade.A etiologia desse distúrbio permanece pouco esclarecida. Pesquisas atuais, entretanto, apontam alterações neurológicas, hormonais e psicodinâmicas envolvidas nessa gênese.Diminuição considerável do volume e da massa cinzenta da amídala direita, do hipotálamo bilateral, das regiões septais, da substância innominata e do núcleo da estria terminal foi observada em pedófilos.A ressonância magnética funcional de pedófilos revela que diversas regiões cerebrais são ativadas ou inibidas, durante a estimulação erótica visual.Observa-se aumento dos níveis de testosterona, especialmente naqueles pedófilos que apresentam conduta agressiva.História de abuso sexual e/ou emocional na infância é recorrente e contribui para a compreensão das causas da pedofilia.

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.

Structural brain abnormalities in the frontostriatal system and cerebellum in pedophilia.

Even though previous neuropsychological studies and clinical case reports have suggested an association between pedophilia and frontocortical dysfunction, our knowledge about the neurobiological mechanisms underlying pedophilia is still fragmentary. Specifically, the brain morphology of such disorders has not yet been investigated using MR imaging techniques. Whole brain structural T1-weighted MR images from 18 pedophile patients (9 attracted to males, 9 attracted to females) and 24 healthy age-matched control subjects (12 hetero- and 12 homosexual) from a comparable socioeconomic stratum were processed by using optimized automated voxel-based morphometry within multiple linear regression analyses. Compared to the homosexual and heterosexual control subjects, pedophiles showed decreased gray matter volume in the ventral striatum (also extending into the nucl. accumbens), the orbitofrontal cortex and the cerebellum. These observations further indicate an association between frontostriatal morphometric abnormalities and pedophilia. In this respect these findings may support the hypothesis that there is a shared etiopathological mechanism in all obsessive-compulsive spectrum disorders.

Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign.

BACKGROUND: Orbitofrontal abnormalities are associated with poor impulse control, altered sexual behavior, and sociopathy. OBJECTIVE: To describe a patient with acquired pedophilia and a right orbitofrontal tumor who was unable to inhibit sexual urges despite preserved moral knowledge. DESIGN: Case report. RESULTS: The patient displayed impulsive sexual behavior with pedophilia, marked constructional apraxia, and agraphia. The behavioral symptoms and constructional deficits, including agraphia, resolved following tumor resection. CONCLUSIONS: For patients with acquired sociopathy and paraphilia, an orbitofrontal localization requires consideration. This case further illustrates that constructional apraxia can arise from right prefrontal lobe dysfunction. Agraphia may represent a manifestation of constructional apraxia in the absence of aphasia and ideomotor apraxia.