Atypical Sexual Interests Research Articles

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning.

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

Emotional Congruence with Children: An Empirical Examination of Different Models in Men with a History of Sexually Offending Against Children.

Emotional congruence with children (ECWC) is a psychologically meaningful risk factor for sexual offending against children (SOC). Based on previous research and theory, three models have been proposed to explain ECWC: Blockage, Sexual Domain, and Psychological Immaturity. Using structural equation modelling in a routine correctional sample of men adjudicated for sexual offences (n = 983), we found little support for all three of these models. Instead, we found that atypical sexual interests, alone, best explained ECWC, with a moderate relationship to ECWC. Using the predictors associated with each of the three models of ECWC, we identified three classes of men with a history of SOC who are high in ECWC using latent class analyses (n = 377). These three classes generally did not replicate the three models of ECWC. We instead propose three subgroups of men with histories of SOC who are high in ECWC, characterized respectively by: relationship deficits; youth and loneliness; and high sexual and general criminality. High levels of ECWC are predictive of a higher risk of sexual recidivism, regardless of class association; however, these subgroups are differentially at risk for some types of recidivism. Our findings suggest that ECWC is a multi-faceted construct, which is still not well understood.

What can the eyes tell us about atypical sexual preferences as a function of sex and age? Linking eye movements with child-related chronophilias.

Visual attention plays a central role in current theories of sexual information processing and is key to informing the use of eye-tracking techniques in the study of typical sexual preferences and more recently, in the study of atypical preferences such as pedophilia (prepubescent children) and hebephilia (pubescent children). The aim of this theoretical-empirical review is to connect the concepts of a visual attention-based model of sexual arousal processing with eye movements as indicators of atypical sexual interests, to substantiate the use of eye-tracking as a useful indirect measure of sexual preferences according to sex and age of the stimuli. Implications for research are discussed in terms of recognizing the value, scope and limitations of eye-tracking in the study of pedophilia and other chronophilias in males and females, and the generation of new hypotheses using this type of indirect measure of human sexual response.

Development of the atypical sexual interests (self-report) scale: the dimensional structure of paraphilia

According to the DSM-5, an individual is diagnosed with a paraphilic disorder when there are persistent behaviours or fantasies that cause distress and/or impairment. However, there is limited research on assessing a continuum of paraphilic interest. The current study sampled 1,650 individuals (age range = 18–93 years, M = 33.64, SD = 16.1) from the general population in assessing a novel 53-item scale – Atypical Sexual Interests Scale (ASIS) – that measures six atypical interests: devotism, frotteurism, voyeurism, exhibitionism, sexual sadism, and sexual masochism. Factor analyses identified that the six-factor model was a poor fit, with the former suggesting a four-factor model; 21 poorly performing items were consequently removed from the scale, and a second confirmatory factor analysis was run. While the six-factor model was a better fit on the refined ASIS compared to unitary and four-factor models, three subscales (frotteurism, voyeurism and exhibitionism) possibly ‘tap into’ a single courtship deviation construct.

The impact of childhood trauma, personality, and sexuality on the development of paraphilias

PurposeParaphilia can be defined as a condition in which the sexual excitement rely on fantasizing and/or participating in unusual sexual behaviour. The last decades have been rich with new studies investigating the prevalence of paraphilic desires and behaviours among the general population as well as clarifying the boundary between paraphilic and normophilic. However, few studies have focused on paraphilic interests' nomological network. MethodsThe project aimed to assess the prevalence of paraphilias among the general population, including a sub-group of people with self-reported atypical sexual interests. Furthermore, the relationship between Childhood Traumatic Experiences, Personality Traits, Hypersexuality, Pornography Consumption and Paraphilic Arousal was examined through mediation analysis. Analyses were conducted on a sample of N = 372 participants. ResultsAnalyses revealed a difference in the prevalence between sexual fantasy and sexual arousal, with a majority of self-reported arousal being lower than fantasy. Furthermore, mediation analyses revealed that the relationship between trauma and arousal is mediated by hypersexuality, problematic pornography consumption and personality traits. ConclusionsAbuses during childhood are the starting point of an over-involvement in sexuality, which increase the likelihood of developing atypical sexual interest or behaviour. Implications will be discussed.

Atypical Sexual Interests in Compulsive Sexual Behavior: Results From a Phallometric Study.

The link between Compulsive Sexual Behavior (CSB) and atypical sexual interests is elusive. This study aimed to provide preliminary insights into the relationship between both aspects. The study sample comprised 61 self-identified straight men. CSB was measured through a composite self-report index assessing symptoms of CSB, whereas sexual interests -atypical and normophilic- were assessed objectively through penile plethysmography. The CSB index had small, non-significant correlation with greater sexual response to different sexual stimuli (rgeneral sexual responsiveness=.127 [95% CI: -.137, .384]). In terms of overall sexual interest, increased scores on the CSB index had small, non-significant correlation with a higher preference for younger sexual stimuli (r = -.098 [95% CI: -.499, .215]) and persuasive sex (r = .10 [95% CI: -.168, .316]). Finally, CSB had a moderate correlation with sexual response when presented with stimuli depicting "female toddler coercive" (r = .27 [95% CI: -.083, .544]). We conclude that our findings do not support the hypotheses that CSB is significantly related to an increased arousability across sexual stimuli. The study findings also suggest that CSB may be, to a small degree, predisposed to experience sexual attraction toward children. Given the preliminary nature of the study, these conclusions warrant further research. Alternative explanations for the study findings related to the particular components of CSB that may be related to typical and atypical sexual interests are also considered.

Pornography Use, Offense-Supportive Cognitions, Atypical Sexual Interests, and Sexual Offending against Children

ABSTRACT The effects of pornography are hotly debated in the scientific literature, especially its potentially negative influence on sexual offending. While studies do not support direct effects of pornography use on sexual offending, pornography is hypothesized to have a catalytic effect among men who are predisposed to sexually offend due to the presence of other risk factors. Using a sample of 241 men varying in sexual offending history, this study examined the associations of different types of pornography consumption, offense-supportive cognitions, and atypical sexual interests on sexual offending against boys or girls. Bivariate analyses support the idea that people seek pornography that matches their sexual interests. Multivariate analyses revealed that the only type of pornography associated with contact sexual offending against boys or girls was child pornography, as it had incremental validity predicting number of victims beyond offense-supportive cognitions and atypical sexual interests. Moderation analyses suggested that, as hypothesized, child pornography consumption amplifies the effect of sexual interests for boys on sexual offending against boy victims. However, that moderation effect was not found for sexual offending against girls. Clinical and research implications are discussed, focusing on the importance of including measures of pornography consumption within forensic assessment and management protocols.

Offence-Supportive Cognitions, Atypical Sexuality, Problematic Self-Regulation, and Perceived Anonymity Among Online and Contact Sexual Offenders Against Children.

Cognitions that support sexual offending, atypical sexuality, and problems with self-regulation are important indicators of offending among men who engage in contact sexual offences against children (e.g., Hanson & Morton-Bourgon, 2005). While sexual interest in children-a major indicator of atypical sexuality-has been identified as a risk factor for online sexual offending against children (Seto & Eke, 2015), several other indicators, such as offence-supportive cognitions, sexual preoccupation, sexual coping, and perceived anonymity-a presumed risk factor for online sexual offending-have not yet been investigated among men who use the internet to solicit children or to consume child sexual exploitation material. This study investigated the associations between offence-supportive cognitions, atypical sexuality, self-regulation using sex, and perceived anonymity with sexual offending behaviors against children in a sample of 241 men convicted of various sexual and non-sexual offences. Results from logistic regressions show that offence-supportive cognitions, sexual interests in children, and sexual coping, but not sexual preoccupation and perceived anonymity, are associated with either or both online and contact sexual offending behaviors against children. Our results support the prior finding showing that men with online sexual offences are more paraphilic or sexually preoccupied then men with only contact offences against children. They also suggest that offence-supportive cognitions, atypical sexual interests, and sexual coping may be motivating factors, and therefore relevant risk factors, for online sexual offending against children.

Offence-Supportive Cognitions, Atypical Sexuality, Problematic Self-Regulation, and Perceived Anonymity Among Online and Contact Sexual Offenders Against Children

Cognitions that support sexual offending, atypical sexuality, and problems with self-regulation are important indicators of offending among men who engage in contact sexual offences against children (e.g., Hanson & Morton-Bourgon, 2005). While sexual interest in children-a major indicator of atypical sexuality-has been identified as a risk factor for online sexual offending against children (Seto & Eke, 2015), several other indicators, such as offence-supportive cognitions, sexual preoccupation, sexual coping, and perceived anonymity-a presumed risk factor for online sexual offending-have not yet been investigated among men who use the internet to solicit children or to consume child sexual exploitation material. This study investigated the associations between offence-supportive cognitions, atypical sexuality, self-regulation using sex, and perceived anonymity with sexual offending behaviors against children in a sample of 241 men convicted of various sexual and non-sexual offences. Results from logistic regressions show that offence-supportive cognitions, sexual interests in children, and sexual coping, but not sexual preoccupation and perceived anonymity, are associated with either or both online and contact sexual offending behaviors against children. Our results support the prior finding showing that men with online sexual offences are more paraphilic or sexually preoccupied then men with only contact offences against children. They also suggest that offence-supportive cognitions, atypical sexual interests, and sexual coping may be motivating factors, and therefore relevant risk factors, for online sexual offending against children.

PO-01-029 Treatment of people with unusual sexual interests

Paraphilic thoughts and behaviors are quite widespread in the population. Approximately half of the general population has paraphilic thoughts or interests, but not everyone needs psychotherapeutic help. Studies about paraphilic disorders mostly contain samples with sex offenders. The care-givers need guides on how to place and how to handle expressed atypical sexual interests. With help from case studies the difference between a paraphilic disorder and an unusual sexual interest will be shown and criteria for treatment indications will be developed. Standardized risk assessment and actual treatment approaches will be presented. The focus lies on psychotherapeutic treatment. Psychotherapy is indicated and can be helpful when a patient's paraphilic interests are responsible for mental distress or when they involve another person’s psychological distress, injury, or death. For a reasonable treatment (psychotherapy, medication), a standardized risk assessment and knowledge about different forms of psychotherapy are necessary. For treatment of paraphilic interests or disorder which may endanger the patient or others special knowledge about risk assessment is needed. For patients suffering from paraphilic thoughts and/or behaviors without the risk to harm other people different kinds of treatment (p.e. affirmative psychotherapy, couples therapy) can be helpful.

Are There Early Risk Markers for Pedophilia? A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders

Although prior research suggests associations between parental characteristics and later sexual offending in offspring, possible links between early pregnancy-related factors and sexual offending remain unclear. Early risk markers unique to sexual offending, however, may be more prominent among sexual offenders with atypical sexual interests, such as individuals involved with child sexual exploitation material (CSEM; also referred to as child pornography). We examined the prospective association between parental and pregnancy-related risk markers and a behavioral indicator of pedophilic interest, CSEM offending. All 655 men born in Sweden and convicted of CSEM offending between 1988 to 2009 were matched 1:5 on sex, birth year, and county of birth in Sweden to 3,928 controls without sexual or nonsexual violent convictions. Paternal age (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI] [1.1, 1.7]), parental education (AOR = 0.8, 95% CI [0.6, 0.9]), parental violent criminality (AOR = 2.9, 95% CI [2.2, 3.8]), number of older brothers (AOR = 0.8, 95% CI [0.6, 0.9] per brother), and congenital malformations (AOR = 1.7, 95% CI [1.2, 2.4]) all independently predicted CSEM convictions. This large-scale, nationwide study suggests parental risk markers for CSEM offending. We did not, however, find convincing evidence for pregnancy-related risk markers, with the exception of congenital malformations and having fewer older brothers.

From Atypical Sexual Interests to Paraphilic Disorders: The Planned ICD Revisions Related to Paraphilic Disorder

From Atypical Sexual Interests to Paraphilic Disorders: The Planned ICD Revisions Related to Paraphilic Disorder

Gender bias in clinicians\u2019 pathologization of atypical sexuality: a randomized controlled trial with mental health professionals

The psychiatric classification of “normal” versus disordered sexual behavior has been a subject of some dispute. Although atypical sexual interests have been viewed traditionally as typically male, epidemiological data indicate its presence in both genders. We examined how gender and sexual orientation influence whether or not atypical sexual behavior is classified as a mental disorder. Mental health professionals (N = 546) were presented with five case vignettes where subjects exhibit paraphilic behaviors; one case with psychotic symptoms served as the control condition. For each vignette we randomly changed the described subject’s gender (male/female), sexual orientation (homosexual/heterosexual), and presented diagnostic criteria (fulfilled/ambiguous). Female subjects were significantly less pathologized and overall less stigmatized in terms of exhibitionistic, frotteuristic, sexual sadistic and pedophilic behavior. On the other hand, female sexual behavior that fulfilled diagnostic criteria for masochistic disorder was more pathologized. Our results demonstrate that nosologically irrelevant factors, which may be related to different sexual norms for men and women, affect clinicians’ decisions regarding atypical sexuality.

Les troubles paraphiliques dans le DSM-5 : analyse critique et considérations médicolégales

IntroductionThe 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) aimed to improve the reliability of psychiatric diagnoses, to address problems identified in DSM-IV, and to improve its clinical and forensic utility. Some of the changes in the diagnostic criteria for the paraphilic disorders in the DSM-5 were guided by forensic concerns, since these are the ones of most interest to forensic psychiatrists. The aim of this paper is to describe and comment the changes made from DSM-IV to DSM-5 concerning paraphilic disorders, and to discuss their legal implications. MethodsPubMed and Medline search, Scopus, journal and textbook articles have been accessed for a detailed literature review on DSM-5 changes related to paraphilic disorders. We conducted the search using the following keywords: Paraphilia; DSM-5; Diagnosis; Diagnostic criteria. ResultsSeveral minor but important changes have been made to the paraphilic disorders diagnostic criteria in DSM-5. DSM-5 redefines the term “paraphilia” which now refers to non pathological, atypical sexual interests (Criterion A); and introduced the term “paraphilic disorder” which is reserved for individuals who meet both Criterion A and Criterion B (individuals who have clinically significant distress or impairment). The DSM-IV category of “paraphilia not otherwise specified” has been replaced with two disorders in DSM-5, “other specified paraphilic disorder” and “unspecified paraphilic disorder”. Both of these categories are considered to be residual. The decision to use one or other of the two disorders depends on whether the clinician wants to specify explicitly the type of atypical paraphilic focus. These residual categories don’t have the same degree of utility as the specific named categories, and can be misused in forensic contexts. In addition, for all of the paraphilic disorders except pedophilic disorder, there are two new course specifiers, “in full remission” and “in a controlled environment”. The decision to provide a specific duration threshold at which the individual must not have acted on his paraphilic urges nor have experienced any distress or impairment, was mainly motivated by forensic issues. Otherwise, three conditions were considered for inclusion in DSM-5: “hypersexual disorder”, “paraphilic coercive disorder”, and “pedophebophilic disorder”. Hypersexual disorder was defined as intense interest in normal sex that was causing problems. Paraphilic coercive disorder was defined as sexual arousal by coercive sex in men who do not meet the diagnostic criteria for sexual sadism. In pedophebophilic disorder, the range of pathologic sexual interest was extended to include adolescents. These proposed diagnosis have received considerable Criticism, and have been abandoned, largely due to a lack of empirical evidence. ConclusionChanges proposed in the DSM treatment of paraphilic disorders are relatively modest and the core of the DSM-IV diagnostic criteria is retained. Many of the changes that occur in paraphilic disorders diagnostic criteria increase the risk of false-positive diagnoses by making it easier to assign a specific paraphilia to an individual, and must be considered with caution. The classification of certain sexual behaviors as pathological, even in the absence of distress, reveals an underlying moral design. As a result, some authors question the validity and reliability of paraphilic disorders, and suggest revolutionary changes, depathologizing paraphilias and removing them from systems of mental disorder classification.

Differences between biological and sociolegal incest offenders: A meta-analysis

Abstract There is an important theoretical distinction between biological and sociolegal incest offenders, but this is not always recognized in clinical or empirical work. The purpose of the current meta-analysis was to examine the extent to which biological and sociolegal incest offenders differ on a number of theoretically or clinically relevant domains. We compared a total of 4192 biological incest offenders to 2322 sociolegal incest offenders across 27 samples that were disseminated between 1984 and 2012 ( Mdn = 1993). Sociolegal incest offenders exhibited more antisocial tendencies (general self-regulation problems, impulsivity, drug and alcohol problems) compared to biological incest offenders. Biological incest offenders exhibited more psychopathology (repression, mental health difficulties) compared to sociolegal incest offenders. Differences were generally small to moderate in magnitude. Contrary to expectations, there were no meaningful differences between groups on atypical sexual interests ( d s ranged from − 0.09 to 0.11), though sociolegal incest offenders were more likely to have sexual self-regulation problems. One meaningful moderator emerged: whether the biological incest offender group was composed only of biological fathers or of both biological fathers and other biological relatives (e.g., uncles and grandfathers). The theoretical implications of these results are discussed, and areas of future research are highlighted.

Juvenile Sex Offenders.

Sexual offending by juveniles accounts for a sizable percentage of sexual offenses, especially against young children. In this article, recent research on female juvenile sex offenders (JSOs), risk factors for offending in juveniles, treatment, and the ways in which these youth may differ from general delinquents will be reviewed. Most JSOs do not go on to develop paraphilic disorders or to commit sex offenses during adulthood, and as a group, they are more similar to nonsexual offending juvenile delinquents than to adult sex offenders. Recent research has elucidated some differences between youth who commit sex offenses and general delinquents in the areas of atypical sexual interests, the use of pornography, and early sexual victimization during childhood.

The Biological Treatment of Paraphilic Disorders: an Updated Review.

Paraphilic disorders are characterized by atypical sexual interests, fantasies, and behaviors that are subjectively distressing to patients or pose a risk of harm to others. By their very nature, some paraphilic disorders may predispose an individual to commit sexual offenses. The biological treatment of paraphilic disorders, then, is of paramount importance for psychiatry and society at large. Three categories of pharmacologic agents commonly used to treat paraphilic disorders are selective serotonin reuptake inhibitors, synthetic steroidal analogs, and gonadotropin-releasing hormone analogs. Each medication uses a different mechanism of action and has different effects on the physiological and psychological features of paraphilic disorders. In general, these medications have limited high-quality research to support their use. Despite this, some authors have proposed treatment algorithms for individuals with paraphilic disorders of varying severity. These guidelines offer clinicians potentially useful, rational approaches to assessing treatment need in individuals with paraphilic disorders. Recent neuroimaging research suggests that functional magnetic resonance imaging may offer further promise in effectively assessing paraphilic disorders to help direct treatment options.

Juvenile Sex Offenders.

Public policy has tended to treat juvenile sex offenders (JSOs) as adult sex offenders in waiting, despite research that contradicts this notion. Although as a group, JSOs are more similar to general delinquents than to adult sex offenders, atypical sexual interests and sexual victimization during childhood may be a pathway for sexual offending that differentiates some JSOs from their nonsexually delinquent peers. Developmental considerations must be considered in risk assessment evaluations of these youth. This article reviews theories of sexual offending in youth, risk factors for juvenile offending and reoffending, psychopathology in JSOs, risk assessment, and treatment.

Examining the developmental trajectories of adolescent sexual offenders

The aim of the current study was to assess the validity of the sex-plus versus sex-only categorization method for distinguishing between different types of adolescent sex offenders (ASOs; Butler & Seto, 2002). It is hypothesized that this categorization method has utility when attempting to distinguish between generalist and specialist ASOs (Seto & Pullman, 2014). Additionally, further classification of ASOs was attempted using a well known juvenile delinquency classification scheme, early-onset versus late-onset offenders (Moffitt, 1993). The current study was an archival analysis of clinical files from a sample of 158 male ASOs seen for clinical assessment at a Metropolitan Family Court Clinic. Results indicate that sex-plus offenders are more antisocial, exhibit more psychiatric issues, and have greater deficits in general social skills compared to sex-only offenders. Conversely, sex-only offenders were found to have more atypical sexual interests, and were more likely to have greater deficits in romantic relationships compared to sex-plus offenders. Due to a power related limitation, little support was found for the use of the early-onset versus late-onset classification scheme with ASOs. Overall, these results provide further support to the validity of a sex-only versus sex-plus distinction. Given these results mirror those found in the generalist/specialist literature regarding the etiology of ASOs, sex-only and sex-plus offenders may indeed have different etiological pathways: sex-plus offenders are more driven by general antisociality factors, as the generalist perspective suggests, and sex-only offenders are more driven by special factors, as the specialist explanations suggest.

Paraphilic Interests

Little research has been conducted to examine paraphilic sexual interests in nonclinical samples. The little that exists suggests that atypical sexual interests are more common in men than in women, but the reasons for this difference are unknown. In this study, we explored the prevalence of paraphilic interests in a nonclinical sample of men and women. We expected that men would report greater arousal (or less repulsion) toward various paraphilic acts than women. We also examined putative correlates of paraphilias in an attempt to explain the sex difference. In all, 305 men and 710 women completed an online survey assessing sexual experiences, sexual interests, as well as indicators of neurodevelopmental stress, sex drive, mating effort, impulsivity, masculinity/femininity, and socially desirable responding. As expected, significant sex differences were found, with men reporting significantly less repulsion (or more arousal) to the majority of paraphilic acts than women. Using mediation analysis, sex drive was the only correlate to significantly and fully mediate the sex difference in paraphilic interests. In other words, sex drive fully accounted for the sex difference in paraphilic interests. The implications of these findings for understanding the etiology of atypical sexual interests are discussed.