Kirsten Jordan

Thirty-two forensic persons who have committed sexual offenses against children (FP-SOC), 26 non-forensic persons of whom most have committed sexual offenses against children (NFP-SOC), 14 forensic persons who have not committed sexual offenses against children but have committed other offenses (FP-NSOC), and 53 non-forensic persons who have not committed sexual offenses against children (NFP-NSOC) were instructed to solve a cognitive task, while sexual distractors were presented simultaneously. Behavioral performance and eye movements were measured. FP-SOC and NFP-SOC exhibit same age preference patterns for children and adults, but both groups differ significantly with respect to sexual attentional control. Moderate discrimination accuracy and moderate effect sizes resulted for sexual interest, and good discrimination accuracy and large effect sizes were found for attentional control. Good attentional control in the NFP-SOC, probably reflecting superior sexual self-control and self-regulation abilities, might contribute to a better recognition and control of environmental factors in sexual risk situations, preventing them from being detected and convicted. Otherwise, strong cognitive distortions might serve for them as offense justification. We conclude that those non-forensic persons with sexual offense histories against children (NFP-SOC) with sexual interest in children, good attentional self-control and strong cognitive distortions represent a problematic group which should receive more attention regarding further research but also therapy. Future studies should include more suitable and larger control groups, appropriate instruments to measure independent variables, and investigate whether different classifications of pedophilic interest would be better suited to describe the eye movement patterns of our study participants.

This data analysis was initiated to further understand the infrequent yet intense instances of sexual arousal and signs of decompensation that emerge after exposing men who have committed sexual offenses against children to experimental sexual stimuli. We analyzed retrospectively and exploratory data of a self-developed sexual arousal questionnaire (“Current-State-of-Emotions-Questionnaire”, CSEQ) with the following objectives: (i) examine subjective sexual arousal changes elicited during confrontation with experimental sexual stimuli, (ii) analyze these sexual arousal changes at an individual level to detect large responses, and (iii) ask for associations between large responses in sexual arousal and individual characteristics of participants, e.g., demographic, clinical, and criminological parameters. The sample consisted of 241 adult, male Germans, comprising four groups: Ten individuals who have committed sexual offenses against children and have been placed in forensic psychiatric facilities (ISOCFP), 31 non-hospitalized individuals with sexual interest in children (ISIC), eight individuals who have committed other offenses and have been placed in forensic psychiatric facilities (IOFP), and 192 individuals without sexual interest in children and offense histories (IWO). We found a significant increase in subjective sexual arousal after confrontation with sexual stimuli (three experiments: initial orientation: Z = −4.819, p < .001, sexual distractor task: Z = −2.954, p = .003, stimulus rating: Z = −6.899, p < .001). Up to 14.3% of participants indicated high sexual arousal values before, but mainly after the experiments, with 20.0% of ISOCFP, 12.9% of ISIC, 12.5% of IOFP, and 14.6% of IWO. ISOCFP and ISIC with high sexual arousal were more likely to be diagnosed with paraphilia (pedophilia) and/or affective disorders, and to receive anti-depressive treatment. We assume a higher emotional lability or/and reduced emotion regulation abilities in those individuals. A careful weighing up of anticipated scientific knowledge gain and a potentially, though rare, increased risk of recidivism or decompensation seems indispensable.

Confronting persons with sexual stimuli to measure sexual interest is common practice in experimental forensic research. In own projects, the presentation of such stimuli resulted in strong individual increase of subjective sexual arousal in some participants and premature study termination for one forensic inpatient due to increased emotional lability and decompensation. It cannot be excluded that the confrontation with sexual images could have increased the risk for (sexual) recidivism in these few patients. Thus, we exploratively analyzed individual, self-indicated sexual arousal of 241 forensic inpatients, outpatients and non-forensic participants before and after being confronted with sexual stimuli in three different experiments. We found moderate, but significant increase in experienced subjective sexual arousal after all experiments. Looking at individual cases, up to 14% of participants indicated high sexual arousal values. The patients among them were more likely to be diagnosed with paraphilia (pedophilia) or affective disorders, and to receive anti-depressive treatment. We assume a higher emotional lability or/and reduced emotion regulation abilities in those patients. By means of this data analysis, we want to sensitize researchers to potentially dangerous consequences of sexual stimulus presentation. A careful weighing up of anticipated scientific knowledge gain and a potentially increased risk of recidivism or decompensation seems indispensable.

Aim: To further investigate the neuroanatomical correlates of child sexual offending and disentangle them from the neural correlates of pedophilia, using a multivariate analytical approach in order to minimize loss of statistical power.Methods: This study presents structural MRI data on gray matter in an incarcerated, male population of 22 pedophilic and 21 non‐pedophilic child sexual offenders, and 20 violent non‐sexual offender controls, based on a multivariate whole‐brain approach using source‐based morphometry.Results: We identify a network of several neuroanatomical regions exhibiting interrelated reduced gray matter in both child sexual offender groups relative to controls, comprising extensive clusters in the bilateral cerebellum and frontal lobe, as well as smaller clusters in the bilateral parietal, temporal, and occipital lobes, the bilateral basal ganglia, the medial cingulate and the hippocampus.Conclusion: Our results speak to the interpretation that there are inter‐ and possibly connectivity‐related brain structural abnormalities in child sexual offenders that are not (only) pertaining to pedophilia per se. Interpretations and limitations of the present data are discussed and recommendations for future works are given.

In Germany, access to outpatient treatment services devoted to the prevention of (further) sexual offenses against minors and child sexual exploitation material (CSEM) offenses is often limited. The therapy project “Prevention of Sexual Abuse” tries to fill this gap by providing treatment to patients with a self-reported sexual interest in children and adolescents, irrespective of whether or not they are pedophilic or prosecuted by the legal justice system. Within the project, a treatment manual was developed which specifically addresses dynamic risk-factors in child sexual abusers and CSEM offenders. The treatment manual was conceived to reduce recidivism risk and to contribute to the enhancement of the patients’ personal well-being. In this paper, results of the accompanying scientific research are presented: offense-supportive attitudes (N = 23), self-reported CSEM use (N = 10), emotional distress (N = 24), and participants’ subjective risk perception of committing (further) sexual offenses (N = 25) reduced during the course of treatment. A reduction of offense-supportive attitudes was further observed from pre-intervention to 1-year follow-up (N = 8). Changes with regard to self-efficacy, quality of life, participants’ self-perceived ability to control sexual impulses toward children and adolescents permanently, and several measures assessing different kinds of sexual recidivism did not, however, reach any level of significance. During an average observation period of 2.4 years, six patients confessed to have conducted new sexual exploitation material offenses, while no further sexual abuse cases were reported (N = 19). Due to the used research design and small sample sizes, treatment effects cannot be inferred and external validity is limited. This notwithstanding, results provide first evidence for a relationship between treatment participation and self-reported recidivism and psychological well-being.

The use of biomarkers in medicine is a common and valuable approach in several clinical fields. Understanding the relationship between measurable biological processes and clinical outcomes not only is indispensable in the face of understanding physiological processes in healthy as well as in diseased organisms but also for understanding and evaluating treatment effects. Therefore, also in the context of forensic psychiatry, biomarkers and their potentially beneficial effects are of growing interest. The objective of this review is to examine if there are biomarkers that may serve as a tool to support diagnostic process, treatment evaluation, and risk assessment of pedophilic individuals and child sexual offenders. In the first part, we present an overview of the current neurobiological, as well as physiological and psychophysiological approaches to characterize pedophilia and child sexual offending. Secondly, we discuss and evaluate the impact of these approaches on the development of biomarkers for diagnosis, therapy, and risk assessment in pedophilic subjects and child sexual offenders. We conclude that a lot of research has already enhanced our neurobiological knowledge about pedophilia and child sexual offending. Although there surely exist promising parameters and approaches, in our view currently none of these is ready yet to serve as a clinically applicable diagnostic, response, or predictive biomarker for pedophilia and child sexual offending. Therefore, further work remains to be done. The development of a composite diagnostic biomarker to assess deviant sexual interest, combining several measures like functional magnetic resonance imaging, electroencephalogram, eye tracking, and behavioral approaches seems to be most promising. A valid and reliable measurement of deviant sexual interest, insensitive to manipulations could significantly support clinical diagnostic process. Similarly, regarding therapy evaluation and risk assessment, a composite biomarker to assess inhibitory control functions seems to be promising. Furthermore, the application of the Research Domain Criteria-approach, a new approach for investigating and classifying mental disorders, offers the possibility to take research to a new level.

In recent years, web-based health services for a variety of mental disorders have been developed and evaluated. Evidence suggests that guided internet-based therapy can be as effective as conventional face-to-face therapy. In forensic psychiatric practice, few web-based treatments have been implemented up to now. However, to our knowledge, there do not yet exist guided internet-based treatments for child sexual abusers and child sexual exploitation material offenders. This review aims at examining under what conditions patients are most likely to benefit from internet-based treatments. In addition, some computer-based health services in forensic psychiatry will be summarized and their potentials and weaknesses will be discussed. Subsequently, the review focuses on the implications for the development of online treatments for child sexual abusers as well as on a variety of ethical and legal issues that practitioners may encounter during the development, evaluation and delivery of online health services. The review will conclude with proposed quality standards for the development and implementation of web-based interventions for child sexual abusers and child sexual exploitation material offenders. By virtue of the low number of psychotherapists offering therapy to this clientele as well as individual barriers to seeking treatment such as fear of stigmatization, feelings of shame, long access routes, or limited mobility due to physical handicaps, the development of mental eHealth services in this sector could close an important healthcare gap. By increasing the density of supply, more child sexual abusers and child sexual exploitation material offenders would have the chance to engage in treatment and, ultimately, more incidents of sexual assault against minors could be prevented.

Despite the successful application of virtual reality (VR) in a wide variety of mental disorders and the obvious potentials that VR provides, the use of VR in the context of criminology and forensic psychology is sparse. For forensic mental health professionals, VR provides some advantages that outrun general advantages of VR, e.g., ecological validity and controllability of social situations. Most important seems to be the unique possibility to expose offenders and to train coping skills in virtual situations, which are able to elicit disorder-relevant behavior—without endangering others. VR has already been used for the assessment of deviant sexual interests, for testing the ability to transfer learned coping skills communicated during treatment to behavior, and for risk assessment of child abusers. This article reviews and discusses these innovative research projects with regard to their impact on current clinical practice regarding risk assessment and treatment as well as other implementations of VR applications in forensic mental health. Finally, ethical guidelines for VR research in forensic mental health are provided.

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.