Phallometric Research Articles

262 Viewing time and penile plethysmography measurement in a group of admitting pedophiles

262 Viewing time and penile plethysmography measurement in a group of admitting pedophiles

The Impacts of Sexual Arousal and Its Suppression on Executive Functioning

Suppression of certain types of reflexive emotional responses is thought to temporarily deplete executive functions (EF), as evidenced by poorer performance on measures of EF, but does not deplete other, lower-order cognitive processes. This study examined whether similar decrements in performance on EF tests would occur following suppression of sexual arousal. A sample of 44 male college students underwent baseline cognitive assessment (EF and lower-order cognitive processes), followed by experimental manipulation consisting of exposure to sexually explicit audiovisual stimuli. Sexual arousal was monitored using penile plethysmography. In this study, 21 participants were assigned to a suppression condition and were instructed to suppress sexual arousal during the video, while 23 were assigned to an arousal condition and were instructed to allow themselves to become aroused. Following experimental manipulation, cognition was reassessed. Unexpectedly, results showed EF decrements in the arousal group but not in the suppression group. As expected, only EF was affected by experimental manipulation, with no group differences in lower-order cognitive processes. Thus, the findings suggest that sexual arousal is associated with temporary decrements in EF performance, at least among young, primarily White, male college students. The results contribute to understanding why sexually charged situations are sometimes associated with poor decisions or unsafe/reckless sexual practices.

Can music cue sexual arousal?

The preparation hypothesis posits that women's genital responses (vasocongestion and lubrication) occur automatically in the presence of any sexual stimulus to prevent injuries from sexual activities. It follows that women's genital responses should be easily conditioned to non-sexual cues that reliably predict impending sexual activities. It has been difficult, however, to demonstrate classical conditioning of genital responses in women in the laboratory. In the current study, we used music as an auditory conditioned stimulus (CS) and vignette narrations of consensual sex, non-consensual sex, and neutral (nonsexual) interactions as unconditioned stimuli (US). Eighteen women (range=18–27 years, M=21.9 years, SD=2.2 years,) and 18 men (range=19–29 years, M=22.8 years, SD=2.8 years) were exposed to three neutrally-rated classical music pieces, each paired with a different type of vignette. Participants were exposed to 3 pre-acquisition trials, 12 acquisition trials, and a minimum of 9 extinction trials. After each trial, participants were asked to rate the CS (or the US in CS-US pairings) on pleasantness, anxiousness, and perceived sexual arousal. Vaginal photoplethysmography and penile plethysmography were used to assess changes in genital responses. The sexual vignettes produced genital responses and the nonsexual vignettes did not. We did not observe conditioning of genital responses to music in either sex, but did so for men's and women's feelings of sexual arousal toward songs paired with a consensual sex story. The results were not consistent with the preparation hypothesis.

Increasing Valid Profiles in Phallometric Assessment of Sex Offenders with Child Victims: Combining the Strengths of Audio Stimuli and Synthetic Characters.

Penile plethysmography (PPG) is a measure of sexual interests that relies heavily on the stimuli it uses to generate valid results. Ethical considerations surrounding the use of real images in PPG have further limited the content admissible for these stimuli. To palliate this limitation, the current study aimed to combine audio and visual stimuli by incorporating computer-generated characters to create new stimuli capable of accurately classifying sex offenders with child victims, while also increasing the number of valid profiles. Three modalities (audio, visual, and audiovisual) were compared using two groups (15 sex offenders with child victims and 15 non-offenders). Both the new visual and audiovisual stimuli resulted in a 13% increase in the number of valid profiles at 2.5mm, when compared to the standard audio stimuli. Furthermore, the new audiovisual stimuli generated a 34% increase in penile responses. All three modalities were able to discriminate between the two groups by their responses to the adult and child stimuli. Lastly, sexual interest indices for all three modalities could accurately classify participants in their appropriate groups, as demonstrated by ROC curve analysis (i.e., audio AUC=.81, 95% CI [.60, 1.00]; visual AUC=.84, 95% CI [.66, 1.00], and audiovisual AUC=.83, 95% CI [.63, 1.00]). Results suggest that computer-generated characters allow accurate discrimination of sex offenders with child victims and can be added to already validated stimuli to increase the number of valid profiles. The implications of audiovisual stimuli using computer-generated characters and their possible use in PPG evaluations are also discussed.

Examining the time course of genital and subjective sexual responses in women and men with concurrent plethysmography and thermography

Sexual response is a dynamic process, though there is limited knowledge of the time course and relationships among its psychological and physiological components. To address this gap, we concurrently assessed self-reported sexual arousal, genital temperature (with thermography), and genital vasocongestion (with vaginal photoplethysmography [VPP] or penile plethysmography [PPG]) during sexual and nonsexual films in 28 androphilic women (attracted to men) and 27 gynephilic men (attracted to women). Men and women had similarly strong agreement between subjective and genital responses (sexual concordance) with thermography, but this agreement was stronger in men than women with PPG/VPP. The time course of changes in self-reported arousal was most similar to changes in genital temperature (i.e., time to onset and peak response). Time-lagged correlations and multilevel modeling revealed changes in the strength of relationships between aspects of sexual response over time. Results highlight the dynamic nature of sexual response and drawbacks of relying on zero-order correlations to characterize sexual concordance.

Inhibiting Sexual Arousal to Children: Correlates and Its Influence on the Validity of Penile Plethysmography.

The current study examined the extent to which 1136 men were able to inhibit their sexual arousal on a phallometric assessment, when instructed to do so. Although the observed changes between the two conditions (i.e., Normal and Suppression) were small to moderate in magnitude, the change was not more than what would be expected by measurement error for most participants (e.g., 83% of pedophilic sex offenders against children did not successfully inhibit their sexual arousal in the Suppression condition). There were very few variables that were associated with the ability to suppress. Higher Pedophilia Index scores in the Suppression condition predicted a greater likelihood of sexual recidivism among sex offenders (hazard ratio=1.17, 95% CI [1.04, 1.32]), but the ability to suppress sexual arousal was not found to predict sexual recidivism. The current study highlights the importance of accounting for measurement error and found that, when doing so, most sex offenders against children are unable to successfully inhibit their sexual arousal to children when instructed to do so, and that the ability to suppress sexual arousal is not associated with recidivism.

Procedure to validate sexual stimuli: reliability and validity of a set of sexual stimuli in a sample of young colombian heterosexual males.

Penile plethysmography – or phallometric assessment – is a very relevant evaluation for sexual health. The objective of this research is to suggest a guideline to validate sexual stimuli and validate a set of sexual stimuli in young heterosexual men. Six videos of 3:15 minute-long were used. A total of 24 men were assessed. Objective sexual arousal, rapid change of peripheral temperature, pulse, the International Index of Erectile Function-5, Self-Assessment Manikin, Multidimensional Scale to Assess Subjective Sexual Arousal and socio-psycho-sexual questions were used. The results showed three sexual excerpts which were clearly superior to the others – something discordant with the subjective opinion of researchers. These three sexual excerpts generated internally consistent measurements; moreover, good indicators of external validity have been observed with statistically significant differences as expected. Furthermore, with healthy young population, it has been shown that the three stimuli produce objective sexual arousal if used together.

Comparison of arousal and preference assessment outcomes for sex offenders with intellectual disabilities.

We compared outcomes of arousal and preference assessments for five adult male alleged sexual offenders with intellectual disabilities. Arousal assessments involved the use of the penile plethysmograph to measure changes in penile circumference to both deviant (males and females under the age of 18) and nondeviant (males and females over the age of 18) video clips. Paired-stimulus preference assessments were arranged to present still images from the video clips used in the arousal assessments. Results showed correspondence between the assessments for four out of the five participants. Implications are discussed for the use of preference assessment methodology as a less intrusive assessment approach for sexual offender assessments.

Reliability and validity of the DSM-IV-TR and proposed DSM-5 criteria for pedophilia: Implications for the ICD-11 and the next DSM

We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in children. Participants were evaluated by two independent psychiatrists with an interview and questionnaire regarding demographic characteristics, sexual history, and self-reported sexual interests; they also completed phallometric and visual reaction time testing. Kappa was .59 for ever meeting DSM-IV-TR criteria for pedophilia and .52 for ever meeting the proposed DSM-5 criteria for pedohebephilia. Ever meeting DSM-IV-TR diagnosis was significantly related to self-reported index of sexual interest in children (highest AUC=.81, 95% CI=.70–.91, p<.001) and to indices of sexual interest in children from phallometric testing (AUC=.70; 95% CI=.52–.89; p<.05) or a computerized assessment based on visual reaction time and self-report (AUC=.75; 95% CI=.62–.88; p<.005). Ever meeting the proposed DSM-5 “diagnosis” was similarly related to self-report (AUC=.84, 95% CI=.74–.94, p<.001) and to the two objective indices, with AUCs of .69 (95% CI=.53–.85; p<.05) and .77 (95% CI=.64–.89; p<.001), respectively. Because the pDSM-5 criteria did not produce significantly better reliability or validity results and users are more familiar with the current DSM-5 criteria, we believe these results suggest the revision of DSM-5 and development of ICD-11 could benefit from drawing on the current DSM-5 criteria, which are essentially the same as DSM-IV-TR except for a distinction between having a paraphilia (the interest) and a paraphilic disorder (the paraphilia plus clinically significant distress or impairment).

A Meta-Analysis of Viewing Time Measures of Sexual Interest in Children.

Due to unobtrusiveness and ease of implementation, viewing time (VT) measures of sexual interest in children have sparked increasing research interest in forensic contexts over the last two decades. The current study presents two meta-analyses of VT measures adapted to assess pedophilic interest to determine their discrimination between sexual offenders against children (SOC) and non-SOC groups as well as convergent validity (associations with other measures of sexual interest in children). On average, VT measures showed moderate discrimination between criterion groups (fixed-effect d=0.60, 95% CI [0.51, 0.68], N=2705, k=14) and significant convergent validity with self-reports, penile plethysmography, Implicit Association Tests, and offence behavioral measures ranging from r=.18 to r=.38. VT measures, however, provided better discrimination for adults (fixed-effect d=0.78, 95% CI [0.64, 0.92]) than adolescent samples (fixed-effect d=0.50, 95% CI [0.40, 0.61]), Q between=9.37, p=.002. Moreover, compared to absolute scores, using pedophilic difference scores within adult samples substantially increased VT measures' validity (fixed-effect d=1.03, 95% CI [0.82, 1.25], N=414, k=7). Results are discussed in terms of their theoretical and applied implications for forensic contexts.

Recidivism Risk Assessment for Adult Sexual Offenders.

Sexual offending is a significant public health problem in the USA due to its prevalence and the substantial impact it has on victims, victims' families, and the legal and mental health systems. The assessment of sexual offender recidivism risk is an important aspect of developing effective management strategies for sexual offenders in terms of placement, treatment, and other interventions. Researchers have developed numerous tools to aid in the assessment of sexual violence recidivism risk, including actuarial measures, structured professional judgment methods, and psychophysiologic assessment of sexual interests. The Static-99R and Sexual Violence Risk-20 are two instruments that have received substantial research attention for their ability to accurately compare offenders' risk of recidivism to normative group data. Penile plethysmography and visual reaction time are used to evaluate subjects' responses to sexual stimuli in an effort to characterize offenders' sexual arousal and interest, respectively. Though current research has focused on risk assessment tools' predictive utility, future research will need to examine the impact that actuarial and structured professional judgment tools have on reducing recidivism if they are to have relevance in the management of sexual offenders.

How Ego Depletion Affects Sexual Self-Regulation: Is It More Than Resource Depletion?

Rational thinking and decision making are impacted when in a state of sexual arousal. The inability to self-regulate arousal can be linked to numerous problems, like sexual risk taking, infidelity, and sexual coercion. Studies have shown that most men are able to exert voluntary control over their sexual excitation with various levels of success. Both situational and dispositional factors can influence self-regulation achievement. The goal of this research was to investigate how ego depletion, a state of low self-control capacity, interacts with personality traits—propensities for sexual excitation and inhibition—and cognitive absorption, to cause sexual self-regulation failure. The sexual responses of 36 heterosexual males were assessed using penile plethysmography. They were asked to control their sexual arousal in two conditions, with and without ego depletion. Results suggest that ego depletion has opposite effects based on the trait sexual inhibition, as individuals moderately inhibited showed an increase in performance while highly inhibited ones showed a decrease. These results challenge the limited resource model of self-regulation and point to the importance of considering how people adapt to acute and high challenging conditions.

Regression to the Mean Mimicking Changes in Sexual Arousal to Child Stimuli in Pedophiles.

The sexual preference for prepubertal children (pedophilia) is generally assumed to be a lifelong condition. Müller et al. (2014) challenged the notion that pedophilia was stable. Using data from phallometric testing, they found that almost half of 40 adult pedophilic men did not show a corresponding arousal pattern at retest. Critics pointed out that regression to the mean and measurement error might account for these results. Müller et al. contested these explanations. The present study shows that regression to the mean in combination with low reliability does indeed provide an exhaustive explanation for the results. Using a statistical model and an estimate of the retest correlation derived from the data, the relative frequency of cases with an allegedly non-pedophilic arousal pattern was shown to be consistent with chance expectation. A bootstrap simulation showed that this outcome was to be expected under a wide range of retest correlations. A re-analysis of the original data from the study by Müller et al. corroborated the assumption of considerable measurement error. Therefore, the original data do not challenge the view that pedophilic sexual preference is stable.

Investigation of the labial photoplethysmograph (LPG) in the idiographic assessment of female sexual interest: its viability in the forensic context

This paper presents a viability study of the labial photoplethysmograph (LPG) in the physiologic assessment of female sexual function and investigates whether it would meet the requirements of a female sex offender assessment. Evaluation of physiologic components of female sexual responding is technically challenging and there are several limitations that present some unique challenges to forensic clinicians. The present study was designed to investigate the effectiveness of the LPG as a measure of female sexual arousal with a view to evaluating it as an analogous technique to phallometric testing for male sex offenders. Seventeen sexually healthy women were evaluated. General and genital physiological measurements were taken at baseline and in response to erotic and control stimuli. The correspondence between subjective appraisal of arousal and physiological responses was also undertaken. Findings indicated a clear and unequivocal measureable response to the sexual stimuli using the LPG but challenges remain and are discussed.

A cognitive-based indicator of deviant sexual interest: Concurrent validation of the Stroop task

ABSTRACTOne of the strongest predictors of sexual recidivism is sexual deviance [Hanson, R. K., & Bussière, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348–362. doi:10.1037/0022-006X.66.2.348]. Phallometric testing, the most commonly used method of assessing sexual deviance, has elicited methodological and ethical criticisms, while self-report is vulnerable to social desirability and poor insight. To overcome these limitations, researchers have utilised cognitive measures, including a modified Stroop task, to measure deviant sexual interests among sex offenders using victim selection as a comparison measure. However, the results have been inconclusive. The current study explored the validity of the modified Stroop task as a measure of deviant sexual interest among a non-offending sample of 570 females and 223 male participants, using self-report as the comparison measure. The results indicated a significant gender difference in concurrent validity; there was a significant relationship between self-reported deviance and deviant word Stroop performance for male but not for female respondents, suggesting the Stroop is a viable option for assessing sexual deviance among males. Implications of these findings are discussed relative to sexual recidivism risk assessment.

Sensitivity and Specificity of the Phallometric Test for Hebephilia.

The phallometric test has been examined most widely in the literature with regard to its ability to detect pedophilia; however, it has become of increasing interest to clinicians and researchers to ascertain to what extent the test accurately detects hebephilia: Whereas pedophilia refers to an adult's sexual interest in prepubescent children (age 10 or younger, on average), hebephilia refers to an adult's sexual interest in pubescent children (ages 11-14, on average). The aim of this study was to estimate the accuracy of volumetric phallometry in distinguishing pedophilic men and hebephilic men from men who are teleiophilic (primarily sexually interested in adults, age 17 or older). A retrospective chart review was conducted on the cumulate database of a large phallometric laboratory and clinic to identify a group of 239 men who committed sexual offenses against extrafamilial adults age 17 or older and a group of 996 men who committed sexual offenses against extrafamilial children age 14 or younger, all of whom professed a greater sexual interest in adults over children. The sensitivity and specificity of the phallometric test is calculated for its accuracy in distinguishing sexual preferences for children spanning various age ranges. Receiver operator characteristic curves were highly significant for each classification decision: Using its previously established cut-point of +0.25 standard deviation (SD) units, the phallometric test detected hebephilia with a sensitivity and specificity of 70.0% and 90.7%, detected pedophilia with 46.9% and 100%, and detected pedohebephilia with 75.3% and 90.7%. At a new cut-point of +0.0 SD units, the sensitivity and specificity of the test for pedophilia was 71.9% and 95.3%. Volumetric phallometry significantly distinguishes teleiophilic sex offenders from each of pedophilic, hebephilic, and pedohebephilic sex offenders and can serve as a reliable diagnostic test of sexual age preference among men who deny sexual interest in children.

Standardization of Penile Plethysmography Testing in Assessment of Problematic Sexual Interests.

Penile plethysmography (PPG) is an objective measure of sexual arousal for men, commonly used to assess sexual arousal to both abnormal (i.e., paraphilic) and normal stimuli. While PPG has become a standard measure in the assessment and treatment of male sex offenders and men with paraphilic interests in both Canada and the United States, there is a lack of standardization of stimulus sets and interpretation of results between sites. The current article critically reviews the current state of the art while highlighting clinical and research efforts that may be undertaken in an attempt to reduce issues arising from lack of standardization across sites. Types and themes of stimulus sets, assessment apparatuses, laboratory preparation, and testing procedures are discussed. The continued development of standardized testing protocol and procedures across multiple international sites continues to be encouraged to promote unified PPG administration and interpretation, thus further enhancing the practical utility of the measurements and decreasing inter-rater discrepancies and error.

Examining gender specificity of sexual response with concurrent thermography and plethysmography.

Men's genital responses are significantly greater to sexual stimuli of their preferred gender compared to their nonpreferred gender (gender-specific), whereas androphilic (i.e., sexually attracted to men) women's genital responses are similar to sexual stimuli depicting either women or men (gender-nonspecific). This gendered pattern of genital response has only been demonstrated using vaginal photoplethysmography (VPP) in women and primarily penile plethysmography (PPG) in men. These measures assess different aspects of genital vasocongestion, thereby limiting comparisons between genders. Thermography is a newer sexual psychophysiology methodology that measures genital vasocongestion via temperature change and is better suited to assess sexual response between genders because the dependent measure, change in genital temperature, is similar for women and men. Further, previous studies have assessed gender specificity of sexual response across relatively short sexual stimuli, allowing only the examination of initial phases of sexual response. We examined gender specificity of sexual arousal by measuring women's and men's genital responses to lengthier stimuli with concurrent thermography and VPP/PPG. Gynephilic men (i.e., sexually attracted to women; n = 27) and androphilic women (n = 28) viewed 10-min films depicting men masturbating, women masturbating, and a nonsexual film, and reported feelings of sexual arousal while genital responses were assessed. Across measures, men's sexual responses were gender-specific and women's responses were gender-nonspecific, indicating that the gender difference in gender specificity of arousal is robust to methodology and stimulus duration. These findings replicate previous research, extend knowledge of gendered sexual response, and highlight the utility of multimethod approaches in sexual psychophysiology.

Assessment of problematic sexual interests with the penile plethysmograph: an overview of assessment laboratories.

Phallometric testing, or penile plethysmography (PPG), is an objective measure of sexual arousal for males. While extensive research on the reliability and validity of PPG has promoted its reputation as the "gold standard" of objective measurement of sexual arousal, there is a lack of standardization of stimulus sets and interpretation of results between sites. This article describes the laboratory protocol employed for PPG at the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic (SBC) in Ottawa, Ontario, as well as those used by the Sexual Behaviors Clinic and Lab (SBCL) in the Community and Public Safety Psychiatry Division (CPSPD) of the Department of Psychiatry and Behavioral Sciences at Medical University of South Carolina (MUSC) in Charleston, South Carolina. The need for standardization in both testing protocol and stimuli use across sites are highlighted.

Assessment of female sexual arousal in forensic populations.

Sexual offenses cause significant harm to victims, their families, and society as a whole and thus are an important social concern. While it is commonly assumed that sexual offenses are committed solely by males, research has shown that approximately 5% of sex crimes in the USA and Canada are committed by females. Penile plethysmography (PPG) is a method to measure male genital arousal, which is commonly used in the assessment and treatment of male sex offenders and men with paraphilic sexual interests. Similarly, vaginal photoplethysmography (VPP) is a test to measure female genital arousal and is commonly used to assess female sexual dysfunctions. Although VPP is currently the most validated method to measure genital arousal in women, its use with female sex offenders or females with paraphilic sexual interests has been almost nonexistent. One explanation for this is that some research has suggested that female genital arousal may not be category-specific, meaning that women will respond to any sexual cues, not just those involving their preferred sexual interests. However, not all research supports this finding. Due to the potential benefits of using VPP in the assessment and treatment of female sex offenders or females with paraphilic sexual interests, it is important that further research be done before dismissing the use of VPP in forensic populations. The purpose of this article is to review the current research on VPP and its applicability to female sex offenders and females with paraphilic sexual interests.