Review of medical reports on pedophilia

A paedophile scan to prevent child sexual abuse in child care? A thought experiment to problematize the notion of alignment in Responsible Research and Innovation

Responsible Research and Innovation (RRI) is a science policy concept that gained traction from 2000 onwards in the EU and US, in which alignment on purposes and values between different stakeholders is a key aspect. This thought experiment problematizes this particular notion: ethically acceptable and societally desirable outcomes are not necessarily achieved when alignment is a consequence of early closure. To argue this point, we took the example of the potential development of scanning technology for the detection of paedophilia among job applicants, for which indicators of broad societal support were found in an RRI project on neuroimaging. We analysed this case by looking through several lenses, obtained by structured and non-structured literature searches. We explored how facts and values are masked when a taboo topic is considered. This results in the black boxing of the problem definition, potential solutions and development trajectories. Complex unstructured problems can thus be perceived as manageable structured problems, which can in turn lead to irresponsible policies surrounding technology development. Responsible processes of research and technology development thus require the involvement of a critical reflector who is alert to signs of early closure and who prevents foreclosure of ongoing reflexive deliberation. There is an important role for ethical, legal and societal aspect studies within the framework of RRI. This paper shows that the concepts of "value/fact diversity masking" and "early discursive closure" are new avenues for RRI research.

Sexual abuse of minors within the Catholic Church and other institutions : A literature review

Sexual violence against children remains a global public health problem. The health sector has an opportunity and responsibility to be part of the multisector collaboration to prevent and respond to sexual abuse of minors. The following article presents a critical analysis of hitherto published empirical studies that examine the extent and variety of sexual abuse of minors within the Catholic Church and other institutions. The analysis consists of 40 studies concerning the Catholic Church and 13 studies concerning other institutions not belonging to the Catholic Church. We report the characteristics of the offenders and the offenses. Furthermore, the devastating consequences for children abused by members of powerful institutions are discussed. Knowledge on the role of institutions in sexual abuse of minors and psychological distress following these experiences is necessary to point the way to improvements in prevention and intervention strategies. This literature review is part of a larger research project on the sexual abuse of minors in the context of the Catholic Church in Germany (MHG Study) that is conducted by an interdisciplinary team of psychologists, psychiatrists, criminologists, and sociologists and is funded by the German Bishops' Conference.

Mapeando las opiniones de los franceses sobre la castración química de delincuentes sexuales que abusan de niños y adolescentes

Sex offenses to children or young adolescents have become a growing public concern. Chemical castration is currently considered as the best available societal response to child sex abuse. It abolishes testosterone secretion, its effects are reversible and side effects are minor. It has been argued that offering convicted sex offenders with the possibility to be treated may be in contradiction with the bioethics principle of autonomy because the person has really no other choice -- the alternative is usually a lengthy confinement sentence. In view of this controversy, we explored lay people’s and physicians’ views regarding the acceptability of chemical castration. Fifty participants (among them five physicians) judged the acceptability of castration in each of 36 scenarios consisting of all combinations of four factors: aggressor’s age (21 vs. 41-year old); (b) victim(s)’ age (5, 8, or 14-year old); (c) aggressor’s psychiatric status (no psychiatric antecedents, suffers from sexual deviation, or recidivist); and (d) family’s attitude (hostile to any kind of castration vs. approve castration). Participants’ ratings of acceptability were, on the average, very high, and 68% of participants considered that chemical castration was fully justified in all the cases that were shown. A small minority (8%) considered that first time offenders of young adolescents, without psychiatric antecedents, should not be chemically castrated. Another minority position (24%) expressed doubts regarding chemical castration of first time offenders without antecedents but they never strongly opposed it. Implications for bioethics are discussed.

The Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges

A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodological challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.

Elderly residents at risk for being victims or offenders

The phenomenon of elderly sexual offenders is poorly catalogued, and is especially complex. In institutions, elderly people are often unrecognized victims of sexual abuse but are also at great risk for doing abuse toward vulnerable victims like children. The lack of attention to an elder's basic needs can endanger or impair not only his or her health or safety but also that of other people living close together. In this article, for the first time we describe an episode of sexual abuse realized by an institutionalized patient toward a young visitor. This specific risk factor in a residential care home for elderly may lead to a variety of negative behavioral outcomes, including the perpetration of child sexual offending. As the elderly population will increase tremendously in the next years, it is necessary to better understand the motivations and psychological factors relating to elderly sex offenders, to prevent these offenses, and to define standards for surveillance of residents who are potential perpetrators.

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias

OBJECTIVES

The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions.

METHODS

The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990-2009 for SSRIs) (1969-2009 for antiandrogen treatments), supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability and feasibility.

CONCLUSIONS

An algorithm was proposed with six levels of treatment for different categories of paraphilias.