Abstract
BackgroundThe risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown.MethodsWe recruited a consecutive sample of 55 help-seeking, non-correctional adult men diagnosed with DSM-5 PD at a university-affiliated sexual medicine outpatient unit in Sweden. PD participants were compared with 57 age-matched, non-clinical control men on four literature-based dynamic risk domains and self-rated child sexual abuse risk.ResultsPD participants scored higher than controls on all tested domains (0–3 points); expectedly so for pedophilic attraction (2.5 vs. 0.0, Cohen’s d = 2.40, 95% confidence interval (CI): [1.91–2.89]), but also for sexual preoccupation (1.6 vs. 1.0, d = 1.11, 95% CI: [0.71–1.51]), impaired self-regulation (1.4 vs. 1.0, d = 0.44, 95% CI: [0.06 to 0.81]), impaired cognitive empathy and antisocial traits (0.9 vs. 0.1, d = 1.18, 95% CI: [0.78–1.59]), and self-rated child sexual abuse risk (1.0 vs. 0.0, d = 1.56, 95% CI: [1.13–1.98]). When summarizing all five domains into a pre-specified composite score (0–15 points), PD subjects scored substantially higher than matched control men (7.5 vs. 2.1, d = 2.12, 95% CI: [1.65–2.59]). Five (9%) PD participants self-reported any previous conviction for a contact child sexual offense and eight (15%) for possession of child sexual abuse material or non-contact sexual offending (adult or child victim). Eighteen subjects (34%) acknowledged past week, child-related sexual behaviors.ConclusionSelf-referred, help-seeking men with PD scored higher (small to very large effect sizes) than non-clinical control men on psychiatric measures of dynamic risk of child sexual abuse suggested in prior research with correctional samples diagnosed with PD. Our findings, including the composite risk measure, might inform clinical practice, but needs validation against actual sexual offending behavior.
Highlights
Pedophilic Disorder (PD) is defined as intense and persistent sexual attraction to prepubescent children associated with negative consequences for the individual or others (American Psychiatric Association, 2013)
We evaluated PD symptoms based on DSM-5 criteria and used a prespecified composite measure (SChiMRA, see Supplementary Material) developed by us to quantify self-rated risk of sexual offending against children and past week sexually abusive behavior toward children
PD participants scored higher compared to controls on all dynamic sexual offending risk domains and the predefined composite risk score (Table 2)
Summary
Pedophilic Disorder (PD) is defined as intense and persistent sexual attraction to prepubescent children associated with negative consequences for the individual or others (American Psychiatric Association, 2013). A methodological problem with prior PD research is that most studies concern individuals involved with the criminal justice system. This entails substantial risks that findings secondary to selection biases following subject status as an identified and convicted child sexual offender diagnosed with PD may be over-interpreted as causal for the pedophilic attraction as such. Individuals are increasingly seeking help for PD in sexual medicine contexts and general psychiatry settings, such as the German prevention project Dunkelfeld (Schaefer et al, 2010; Knack et al, 2019). The risk of child sexual abuse among non-forensic, non-correctional patients with Pedophilic Disorder (PD) is largely unknown
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