Reply #51

Introduction.  Child molestation or other pedophilic behavior may result as a consequence of a brain disorder.

Aim.  To characterize the mechanisms of pedophilic behavior associated with neurological diseases.

Methods.  We report eight patients with pedophilic behavior as a manifestation of their brain disorder and review the literature.

Main Outcome Measures.  The sexual, neuropsychiatric, and neurological aspects of a series of patients.

Results.  All eight developed sexual behavior toward prepubescent children in mid- to late-life coincident with the development of a neurological disorder. Five had limited insight, anxiety, or concern for their behavior and tended to have frontal lobe executive deficits. Most of this group had frontally predominant disorders. Two others retained insight and concern in the context of marked hypersexuality. This second group had treated Parkinson's disease and resembled reports of pedophilic behavior from subcortical lesions. The further presence of right temporal lobe-amygdala involvement may have predisposed to specific sexual preoccupation in some patients.

Conclusions.  Brain disorders may release a predisposition to sexual attraction for children through disinhibition with frontal disease, sexual preoccupation with right temporal disease, or hypersexuality with subcortical disease in non-motor basal ganglia, hypothalamus, or septal nuclei. Differentiating these mechanisms of pedophilic behavior from brain disease could facilitate targeted interventions. Mendez M and Shapira JS. Pedophilic behavior from brain disease. J Sex Med 2011;8:1092–1100.

http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2010.02172.x/abstract;jsessionid=202AB1C2FC934EDCF2AA40456D6D5571.d02t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Abnormal amygdala activation profile in pedophilia

Alexander Sartorius MD, Dipl. Phys.,
Matthias Ruf Dipl. Ing.,
Christine Kief Dipl. Psych.,
Traute Demirakca Dr. Dipl.-Psych.,
Josef Bailer Prof. Dr. Dipl.-Psych.,
Gabriele Ende Priv.-Doz. Dr. rer. nat.,
Fritz A. Henn Prof. MD, PhD,
Andreas Meyer-Lindenberg Prof. MD, PhD,
Harald Dressing Prof. MD

Abstract

Despite considerable public interest research in neurobiological correlates of pedophilia is scarce. Since amygdala activation is central for emotional valuation, arousal, and salience, we investigated the activation profile of this structure in 10 male subjects with pedophilia (exclusively attracted to boys), all convicted sex-offenders and sentenced to forensic psychiatric treatment along with ten male heterosexual matched controls. We used a sexually non-explicit functional Magnetic Resonance Imaging (fMRI) paradigm with images of men, women, boys or girls randomly embedded in neutral target/non-target geometrical symbols. We applied statistical parametric mapping (SPM2) and SPSS 14 for image processing and analysis. While controls activated significantly less to pictures of children compared to adults, the activation profile was reversed in subjects with pedophilia, who exhibited significantly more activation to children than adults. The highest activation was observed for boys in the patient group, and for women in control participants. Our data show enhanced activation to children’s pictures even in an incidental context and suggest the provocative hypothesis that a normally present mechanism for reduced emotional arousal for children relative to adults is reversed in pedophilia, suggesting a neural substrate associated with deviant sexual preference in this condition. More extensive research in this field would be of benefit for both the victims and the offenders.
Alexander Sartorius and Matthias Ruf contributed equally to the paper.
European Archives of Psychiatry and Clinical Neuroscience European Archives of Psychiatry and Clinical Neuroscience
http://link.springer.com/article/10.1007%2Fs00406-008-0782-2?LI=true

Pedophilia is Linked to Reduced Activation in Hypothalamus and Lateral Prefrontal Cortex During Visual Erotic Stimulation

Martin Walter
,
Joachim Witzel
,
Christine Wiebking
,
Udo Gubka
,
Michael Rotte
,
Kolja Schiltz
,
Felix Bermpohl
,
Claus Tempelmann
,
Bernhard Bogerts
,
Hans Jochen Heinze
,
Georg Northoffemail address


Background

Although pedophilia is of high public concern, little is known about underlying neural mechanisms. Although pedophilic patients are sexually attracted to prepubescent children, they show no sexual interest toward adults. This study aimed to investigate the neural correlates of deficits of sexual and emotional arousal in pedophiles.
Methods

Thirteen pedophilic patients and 14 healthy control subjects were tested for differential neural activity during visual stimulation with emotional and erotic pictures with functional magnetic resonance imaging.
Results

Regions showing differential activations during the erotic condition comprised the hypothalamus, the periaqueductal gray, and dorsolateral prefrontal cortex, the latter correlating with a clinical measure. Alterations of emotional processing concerned the amygdala–hippocampus and dorsomedial prefrontal cortex.
Conclusions

Hypothesized regions relevant for processing of erotic stimuli in healthy individuals showed reduced activations during visual erotic stimulation in pedophilic patients. This suggests an impaired recruitment of key structures that might contribute to an altered sexual interest of these patients toward adults.

http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2806%2901300-X/abstract

Assessment of Pedophilia Using Hemodynamic Brain Response to Sexual Stimuli
Jorge Ponseti, PhD; Oliver Granert, MSc; Olav Jansen, Prof MD; Stephan Wolff, MSc; Klaus Beier, Prof MD, PhD; Janina Neutze, MSc; Günther Deuschl, Prof MD; Hubertus Mehdorn, Prof MD; Hartwig Siebner, Prof MD; Hartmut Bosinski, Prof MD

Context Accurately assessing sexual preference is important in the treatment of child sex offenders. Phallometry is the standard method to identify sexual preference; however, this measure has been criticized for its intrusiveness and limited reliability.

Objective To evaluate whether spatial response pattern to sexual stimuli as revealed by a change in the blood oxygen level–dependent signal facilitates the identification of pedophiles.

Design During functional magnetic resonance imaging, pedophilic and nonpedophilic participants were briefly exposed to same- and opposite-sex images of nude children and adults. We calculated differences in blood oxygen level–dependent signals to child and adult sexual stimuli for each participant. The corresponding contrast images were entered into a group analysis to calculate whole-brain difference maps between groups. We calculated an expression value that corresponded to the group result for each participant. These expression values were submitted to 2 different classification algorithms: Fisher linear discriminant analysis and κ -nearest neighbor analysis. This classification procedure was cross-validated using the leave-one-out method.

Setting Section of Sexual Medicine, Medical School, Christian Albrechts University of Kiel, Kiel, Germany.

Participants We recruited 24 participants with pedophilia who were sexually attracted to either prepubescent girls (n = 11) or prepubescent boys (n = 13) and 32 healthy male controls who were sexually attracted to either adult women (n = 18) or adult men (n = 14).

Main Outcome Measures Sensitivity and specificity scores of the 2 classification algorithms.

Results The highest classification accuracy was achieved by Fisher linear discriminant analysis, which showed a mean accuracy of 95% (100% specificity, 88% sensitivity).

Conclusions Functional brain response patterns to sexual stimuli contain sufficient information to identify pedophiles with high accuracy. The automatic classification of these patterns is a promising objective tool to clinically diagnose pedophilia.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1107448#qundefined