Impaired Attentional Control in Pedophiles in a Sexual Distractor Task.

Pedophilic disorder, a subtype of paraphilia, is defined as a recurrent sexual interest in prepubescent children, which is characterized by persistent thoughts, fantasies, urges, sexual arousal, or behavior. Besides a deviant sexual preference, sexual preoccupation was found to be a dynamic risk factor for reoffending. Thus, it is conceivable that sex offenders and especially sex offenders against children have difficulties to control their responses to sexual stimuli. In the current study pedophiles, forensic and non-forensic control subjects had to solve a cognitive task, while sexual distractors were presented simultaneously. This kind of task also requires control functions. Therefore, data were analyzed with respect to attentional control while comparing eye movements toward sexual distractors and toward the cognitive task. We were mainly interested in how early (fixation latency) and late (relative fixation time) attentional processes were allocated to both, the cognitive target stimuli and the sexual distractors. Pedophiles demonstrated significantly lower attentional control in the sexual distractor task than both control groups (non-pedophiles). They showed a shorter fixation latency and longer fixation time for sexual distractors than non-pedophiles. Furthermore, pedophiles demonstrated a longer fixation latency and shorter fixation time for cognitive target stimuli. For classification analyses, an attentional control index (ACI) was built, i.e., the difference between eye movements on cognitive target stimuli and sexual distractors. For the ACI of early attentional processes, i.e., fixation latency, a good classification between pedophiles and non-pedophiles was found. We assumed that the measured attentional control represents inhibitory executive functions, specifically interference control. Further studies should examine if low attentional control in pedophiles is due to low motivation to solve the task or rather to a lack of ability to control attention with respect to sexual and/or neutral distractors. Prospectively, this design could be useful to generate hypotheses about clinical important aspects of controllability, the capacity of self-control, and the severity of a paraphilic disorder.

[Port-catheter associated superior vena cava syndrome in a patient with rectum cancer]. / Portkatheter-assoziierte obere Einflussstauung bei einem Patienten mit Rektumkarzinom.

History and clinical findings | A 59-year-old man with metastasized rectum cancer presents at the interdisciplinary emergency care unit with a distinct cyanosis of his face. At that moment the patient himself is out of any complaints. Cyanosis is spreading from his face over his neck to both arms. During the last months he has been treated with folinic acid, 5-fluoruracil, irinotecan and aflibercept via a port-catheter. Except for smoking his further medical history is unremarkable. Examinations | CT-scan shows a port-catheter associated thrombosis with a consecutive superior vena cava syndrome (SCVS). No signs of an acute pulmonary embolism or thoracic aortic aneurysm are detected. Treatment and course | Anticoagulation is started immediately. Due to a short loss of consciousness glucocorticoids and vasopressors are given. As cyanosis continued during next days, a transfemoral percutaneous angioplasty with stent placement was performed. Cyanosis disappears completely and the patient can be discharged. Conclusions | SCVS due to port-catheter associated thrombosis in tumor patients is rare but its prevalence will grow because of increasing numbers of tumor patients, intravenous catheter-systems and pacemakers. Early CT-scan with contrast agent via femoral venous catheter is reasonable for diagnosis and therapy. For tumor percutaneous transluminal angioplasty is a safe and effective option.

Eye movements in pedophiles: automatic and controlled attentional processes while viewing prepubescent stimuli.

Recent theories in sexuality highlight the importance of automatic and controlled attentional processes in viewing sexually relevant stimuli. The model of Spiering and Everaerd (2007) assumes that sexually relevant features of a stimulus are preattentively selected and automatically induce focal attention to these sexually relevant aspects. Whether this assumption proves true for pedophiles is unknown. It is aim of this study to test this assumption empirically for people suffering from pedophilic interests. Twenty-two pedophiles, 8 nonpedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult while eye movements were measured. Entry time was assessed as a measure of automatic attentional processes and relative fixation time in order to assess controlled attentional processes. Pedophiles demonstrated significantly shorter entry time to child stimuli than to adult stimuli. The opposite was the case for nonpedophiles, as they showed longer relative fixation time for adult stimuli, and, against all expectations, pedophiles also demonstrated longer relative fixation time for adult stimuli. The results confirmed the hypothesis that pedophiles automatically selected sexually relevant stimuli (children). Contrary to all expectations, this automatic selection did not trigger the focal attention to these sexually relevant pictures. Furthermore, pedophiles were first and longest attracted by faces and pubic regions of children; nonpedophiles were first and longest attracted by faces and breasts of adults. The results demonstrated, for the first time, that the face and pubic region are the most attracting regions in children for pedophiles.

Diagnostic accuracy of eye movements in assessing pedophilia.

INTRODUCTION: Given that recurrent sexual interest in prepubescent children is one of the strongest single predictors for pedosexual offense recidivism, valid and reliable diagnosis of pedophilia is of particular importance. Nevertheless, current assessment methods still fail to fulfill psychometric quality criteria. AIMS: The aim of the study was to evaluate the diagnostic accuracy of eye-movement parameters in regard to pedophilic sexual preferences. METHOD: Eye movements were measured while 22 pedophiles (according to ICD-10 F65.4 diagnosis), 8 non-pedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult. Fixation latency was assessed as a parameter for automatic attentional processes and relative fixation time to account for controlled attentional processes. MAIN OUTCOME MEASURES: Receiver operating characteristic (ROC) analyses, which are based on calculated age-preference indices, were carried out to determine the classifier performance. Cross-validation using the leave-one-out method was used to test the validity of classifiers. RESULTS: Pedophiles showed significantly shorter fixation latencies and significantly longer relative fixation times for child stimuli than either of the control groups. Classifier performance analysis revealed an area under the curve (AUC) = 0.902 for fixation latency and an AUC = 0.828 for relative fixation time. The eye-tracking method based on fixation latency discriminated between pedophiles and non-pedophiles with a sensitivity of 86.4% and a specificity of 90.0%. Cross-validation demonstrated good validity of eye-movement parameters. CONCLUSIONS: Despite some methodological limitations, measuring eye movements seems to be a promising approach to assess deviant pedophilic interests. Eye movements, which represent automatic attentional processes, demonstrated high diagnostic accuracy.

Initial orienting towards sexually relevant stimuli: preliminary evidence from eye movement measures.

It has been proposed that sexual stimuli will be processed in a comparable manner to other evolutionarily meaningful stimuli (such as spiders or snakes) and therefore elicit an attentional bias and more attentional engagement (Spiering and Everaerd, In E. Janssen (Ed.), The psychophysiology of sex (pp. 166-183). Bloomington: Indiana University Press, 2007). To investigate early and late attentional processes while looking at sexual stimuli, heterosexual men (n = 12) viewed pairs of sexually preferred (images of women) and sexually non-preferred images (images of girls, boys or men), while eye movements were measured. Early attentional processing (initial orienting) was assessed by the number of first fixations and late attentional processing (maintenance of attention) was assessed by relative fixation time. Results showed that relative fixation time was significantly longer for sexually preferred stimuli than for sexually non-preferred stimuli. Furthermore, the first fixation was more often directed towards the preferred sexual stimulus, when simultaneously presented with a non-sexually preferred stimulus. Thus, the current study showed for the first time an attentional bias to sexually relevant stimuli when presented simultaneously with sexually irrelevant pictures. This finding, along with the discovery that heterosexual men maintained their attention to sexually relevant stimuli, highlights the importance of investigating early and late attentional processes while viewing sexual stimuli. Furthermore, the current study showed that sexually relevant stimuli are favored by the human attentional system.