Reexamining predictors of trial outcomes in New York State's sex offender civil management process.

OBJECTIVE: In 2007, New York enacted the Sex Offender Management and Treatment Act, empowering the state to civilly manage individuals who have committed sexual offenses (respondents) and are deemed to have a mental abnormality (MA) that predisposes them to sexually recidivate after serving their criminal sentences. We sought to replicate and extend a previous study (Lu et al., 2015) to identify factors predicting legal decisions. HYPOTHESES: We predicted, on the basis of previous research, that clinical information (e.g., diagnosis) as well as empirically supported risk factors (e.g., sexual deviance) would predict trial outcomes. METHOD: We analyzed multiple pieces of demographic, criminogenic, and clinical data on three nested subsamples of respondents on the basis of the legal process: MA consent (n = 713), MA trial (n = 316), and disposition hearing (n = 643). The binary outcomes of interest were as follows: For the MA consent subsample, it was whether the respondent waived their MA trial; for the MA trial subsample, it was whether the respondent was found at trial to have an MA; and for the disposition hearing, it was whether the respondent was ordered to inpatient or outpatient civil management. RESULTS: The strongest predictor of waiving the trial was geographic location; respondents outside New York City and Long Island were more likely to waive their trials (ORs = 2.38-3.37). The strongest predictors of MA trial and disposition hearing outcomes were Diagnostic and Statistical Manual of Mental Disorders diagnoses; pedophilia (ORs = 4.05-7.22) and sexual sadism (ORs = 2.68-7.03) diagnoses increased the likelihood of an MA finding and confinement order. CONCLUSIONS: Judges and juries give significant weight to clinical information, particularly pedophilia diagnoses, when making civil management legal decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Coprophilia and Coprophagia: A Literature Review.

BACKGROUND: Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one's own or another person's excrement, has also been observed in some patients with coprophilia. AIMS: The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia. METHODS: Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms "coprophilia," "coprophagia," "paraphilia NOS," and "other specified paraphilic disorder" restricted to English. RESULTS: Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines. CONCLUSIONS: Understanding the psychological and biological factors that may contribute to these disorders' manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.

Paraphilias, Sociodemographic and Forensic Profiles of Men Convicted of Sexual Offenses in Turkey.

This study investigated the psychiatric, paraphilic, and forensic profiles of men who were convicted of sexual offenses. It also examined childhood trauma exposure in the group with potential paraphilia. The study was performed in the closed prison located in the Istanbul Silivri Penal Institutions Campus. The interview data of 100 men convicted of sexual offenses were obtained from the psychiatric interview notes based on the DSM-5 criteria, the results of the 28-item Childhood Trauma Questionnaire administered to the participants with paraphilia, and the forensic profiles from examination files. It was found that 39% of individuals were drug users and 36% were alcohol users. Considering the crime scenes, 42% of men convicted of sexual offenses committed the offense in their own house. Pedophilia was the most common among men with paraphilia (59%). The victim age was significantly lower (p < .001), and the male victim ratio was higher (p < .05) in the group with paraphilia than in the group without paraphilia. Sexual offenses against children aged 10 years and below and against males may be suggestive of paraphilia and an increased risk of recidivism.

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.

Sex-biased gene regulation varies across human populations as a result of adaptive evolution.

OBJECTIVES: Studies of human sexual dimorphism and gender disparities in health focus on ostensibly universal molecular sex differences, such as sex chromosomes and circulating hormone levels, while ignoring the extraordinary diversity in biology, behavior, and culture acquired by different human populations over their unique evolutionary histories. MATERIALS AND METHODS: Using RNA-Seq data and whole genome sequences from 1000G and HGDP, we investigate variation in sex-biased gene expression across 11 human populations and test whether population-level variation in sex-biased expression may have resulted from adaptive evolution in regions containing sex-specific regulatory variants. RESULTS: We find that sex-biased gene expression in humans is highly variable, mostly population-specific, and demonstrates between population reversals. Expression quantitative trait locus mapping reveals sex-specific regulatory regions with evidence of recent positive natural selection, suggesting that variation in sex-biased expression may have evolved as an adaptive response to ancestral environments experienced by human populations. DISCUSSION: These results indicate that sex-biased gene expression is more flexible than previously thought and is not generally shared among human populations. Instead, molecular phenotypes associated with sex depend on complex interactions between population-specific molecular evolution and physiological responses to contemporary socioecologies.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior.

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Salivary testosterone levels are associated with Compulsive Sexual Behavior (CSB) in men but not in women in a community sample.

Background and aims: Despite the inclusion of Compulsive Sexual Behavior (CSB) as a diagnostic entity in the ICD-11 and the increasing number of studies addressing psychological factors leading to its onset and maintenance, little is known about the role of hormonal factors when accounting for this clinical condition (especially in women). This study aimed to provide insights into the association between testosterone levels (i.e., the androgen more intimately linked to sexual desire and arousability) and CSB in both men and women. Methods: A total of 80 participants (40 men [Mage = 22.31; SD = 2.93] and 40 women [Mage = 21.79; SD = 2.06]) provided a saliva sample for the estimation of the level of free testosterone and completed a battery of measures assessing CSB and other related sexual domains (sexual sensation seeking and online/offline sexual behavior). Results: In men, salivary testosterone had a positive and significant correlation with three scales assessing CSB (r between 0.316 and 0.334). In women, these correlations were small and non-significant (r between 0.011 and 0.079). In both men and women, the level of salivary testosterone had small non-significant correlations with the other domains of sexual behavior assessed. Discussion and conclusions: Individuals' level of testosterone may contribute to the etiopathogenesis of CSB, but only in men. In women, alternative psychological -i.e., motivational, behavioral, or cognitive- processes may be playing a more central role in the expression of this condition.

Discrimination, stigma and mental health: what's next?

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.

The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022.

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

Capacity to love and problematic sexuality: the role of defense mechanisms and psychopathological suffering.

BACKGROUND: Limitation to the capacity to love is often a feature of a suffering personality. AIM: We aimed to investigate the role of the capacity to love in hypersexual behavior, considering both distress and defense mechanisms as possible psychological mediators. METHODS: Through an online platform, we recruited a convenience sample of 521 subjects (390 [74.9%] females and 131 [25.1%] males; mean [SD] age, 26.46 [5.89] years). OUTCOMES: Recruited subjects completed a psychometric protocol that included completion of the following measurement tools: (1) the Capacity to Love Inventory (CTL-I), (2) the Hypersexual Behavior Inventory (HBI), (3) the 30-item self-report Defense Mechanisms Rating Scale, and (4) the Brief Symptom Inventory. We then performed correlation and regression analyses and used a mediation model for data analysis. RESULTS: A significant negative relationship between the capacity to love and hypersexual behavior was found. Furthermore, indirect effects were also statistically significant, supporting the hypothesis that limitation to the capacity to love is related to hypersexuality through the paths of psychological distress and immature defense mechanisms. Finally, compared to the other subjects, those with pathological scores for the HBI showed significantly lower scores on the CTL-I, which suggested limitations to the capacity to love. CLINICAL IMPLICATIONS: The relationship between limitation to the capacity to love and hypersexuality is fundamental to the diagnostic process in persons with problematic sexuality and psychopathological distress. STRENGTHS AND LIMITATIONS: This study is the first, to our knowledge, to highlight the role of the capacity to love in sexual behavior, although future studies in specific clinical sample groups would be suitable for further investigation of the relationships among the considered variables. CONCLUSION: The etiology of limitation in the capacity to love is related to dysfunctional aspects of psychological functioning, such as psychological distress and immature defense mechanisms, and these factors together generate problematic sexuality such as hypersexual behavior. Our results highlight the central role in mental and sexual health of the capacity to love. Based on these findings, clinicians should take these aspects into consideration for diagnosis and treatment of patients presenting with problematic sexuality.

Between submission and pain. Shades of BDSM practices. / Miedzy zaleznoscia a bólem. Odcienie praktyk BDSM.

Many people are interested in BDSM practices. Some people practice and others fantasize about participating in these practices. Several elements are related to BDSM practices that are usually unaccepted in a close relationship, such as a strong dependence of one partner on the other or inflicting pain. BDSM practitioners create various relationships, and in a broader context, their communities. From a clinical perspective, an important issue is whether BDSM relation is consensual and serves the personal and relationship development or it can be a premise for the diagnosis of a paraphilic disorder, or recognizing abuse or mechanism of trauma repetition Adequate understanding of the behaviors that may be described by a patient practicing BDSM requires, however, getting to know the specifics of such relationships. The mental and sexual health professional would be able then to evaluate them adequately, without referring to a subjective norm or bias on stereotype or prejudice.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools.

Background and aims: Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. Method: Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. Results: A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. Discussion and conclusions: This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Ove hurts. An old cliché reborn a propos of a clinical case / Dolores de amor. Un cliché renacido a propósito de un caso clínico

Introduction: The spectrum of sexually motivated behaviors is extremely wide, including behaviors that are not biologically reprductive and hold exclusively ludic functions. We refer to the persistent and recurrent patterns of sexual arousal resulting from the exposure to non-normative sexual stimuli as paraphilias, and they are paradigmatic of the broad heterogeneity of human sexuality. Among these, paraphilic infantilism was first reported in the scientific literature by Tuchman and Lachman in 1964. It is characterized by the presence of sexual arousal or pleasure when playing childhood roles or using objects proper of childhood.Objective: We intend to describe a clinical case, with a focus on the atypical profile of sexual interests and behaviors comprising paraphilic infantilism and sadomasochism phenomena. We also seek to discuss the understanding of these phenomena in the context of the global clinical picture, their nosological framework, and their implication in the psychotherapeutic process.Methodology: In this study, we present the clinical case of a patient observed in the outpatient clinic of the first author. A targeted literature review was carried out through a bibliographic search in the PubMed database and a selection of reference works in the Sexology field. These data provided a basis from which we develop our clinical discussion of the case.Results: This article illustrates the case of a patient referred for psychotherapeutic intervention due to an anxious-depressive syndrome. During follow-up, a cluster of sexual behaviors was observed that involved preferential sexual interest for role-playing as a baby, and practices that involved physical suffering, dominance and submission. Conclusions: Paraphilia is a controversial clinical category...(AU)

Introducción: El espectro de conductas con motivación sexual es muy amplio, abarcando conductas que no son biológicamente reproductivas y que sostienen funciones exclusivamente lúdicas. Se denominan parafilias a los patrones persistentes y recurrentes de excitación sexual resultante de la exposición a estímulos sexuales no normativos, y su existencia resulta paradigmática de la amplia heterogeneidad de la sexualidad humana. Entre ellas, el Infantilismo parafílico fue descrito por primera vez en la literatura científica Tuchman y Lachman en 1964 y se caracteriza por obtener excitación o placer sexual a través de la representación de roles infantiles o del uso de objetos propios de la infancia. Objetivo: Nos proponemos describir un caso clínico, enfocando el perfil atípico de intereses y conductas sexuales que comprenden fenómenos de Infantilismo parafílico y Sadomasoquismo. Pretendemos discutir la comprensión de estos fenómenos en el contexto del cuadro clínico global, su marco nosológico y su implicación en el proceso psicoterapéutico. Metodología: Se relata el caso clínico de una paciente observada en el ámbito de la consulta de la primera autora. Se realiza una revisión no sistemática de la literatura científica a través de una búsqueda bibliográfica en la base de datos Pubmed y de la consulta de obras de referencia en el área de la Sexología. Se procede a la discusión clínica, basada en los datos presentados. Resultados: Este artículo ilustra el caso de una paciente, derivada a intervención psicoterapéutica por síndrome ansioso-depresivo. Durante el acompañamiento, se identificó un patrón de respuesta sexual caracterizado por un interés sexual preferencial en representar el rol de un bebé y prácticas que implicaban sufrimiento físico, dominación y sumisión. Conclusiones: La Parafilia es una entidad clínica controvertida...(AU)

Electrocuted to death: A case of an autoerotic fatality with body wrapping, anal masochism, and low abdomen mechanical stimulation.

Autoerotic paraphilic manipulations may be not only incredibly unusual but also hazardous and possibly fatal. Autoerotic experimenters sometimes combine several paraphilic mechanisms, both potentially lethal and non-lethal. A tragic outcome is usually a direct consequence of the life-threatening paraphilic mechanism(s); however, it may also result from an accidental complication arising from the constellation of the paraphilic realization. In this report, we present a case of an autoerotic death of a 30-year-old man who applied two potentially lethal paraphilic mechanisms-body wrapping and foreign body anal insertion-together with two other non-lethal paraphilic activities, autofetishism and transvestitism. However, the man's death ultimately occurred due to another associated autoerotic activity-stimulation of the lower abdomen with an electric massager, which accidentally short-circuited and caused fatal electrocution. Such autoerotic fatalities constitute a distinct subcategory of accidental autoerotic death.

On the current psychotherapeutic situation for persons with pornography use disorder in Germany.

Background and aims: For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand. Methods: Four studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28). Results: The estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%-2.9% of lPUD cases among their patients. 43.2%-61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not. Discussion and conclusions: Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.

The Concept of "Hypersexuality" in the Boundary between Physiological and Pathological Sexuality.

INTRODUCTION: The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, and is understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways and often experienced in a way that is not completely satisfactory. METHODS: Literature up to February 2023 was reviewed, with 25 searches selected. RESULTS: Forty-two articles were included in the review. CONCLUSION: Hypersexuality is a potentially clinically relevant condition consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Spectrum of Gradation (PH-GSS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grades I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.

Structural brain differences related to compulsive sexual behavior disorder.

Background and aims: Compulsive sexual behavior disorder (CSBD) has been included as an impulse control disorder in the International Classification of Diseases (ICD-11). However, the neurobiological mechanisms underlying CSBD remain largely unknown, and given previous indications of addiction-like mechanisms at play, the aim of the present study was to investigate if CSBD is associated with structural brain differences in regions involved in reward processing. Methods: We analyzed structural MRI data of 22 male CSBD patients (mean = 38.7 years, SD = 11.7) and 20 matched healthy controls (HC; mean = 37.6 years, SD = 8.5). Main outcome measures were regional cortical thickness and surface area. We also tested for case-control differences in subcortical structures and the effects of demographic and clinical variables, such as CSBD symptom severity, on neuroimaging outcomes. Moreover, we explored case-control differences in regions outside our hypothesis including white matter. Results: CSBD patients had significantly lower cortical surface area in right posterior cingulate cortex than HC. We found negative correlations between right posterior cingulate area and CSBD symptoms scores. There were no group differences in subcortical volume. Conclusions: Our findings suggest that CSBD is associated with structural brain differences, which contributes to a better understanding of CSBD and encourages further clarifications of the neurobiological mechanisms underlying the disorder.