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Unterhorst K, Gerwinn H, Pohl A, Kärgel C, Massau C, Ristow I, Kneer J, Amelung T, Walter H, Beier K, Walter M, Schiffer B, Kruger THC, Stirn A, Ponseti J. An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition. J Sex Res 2020; 57:397-408. [PMID: 30489159 DOI: 10.1080/00224499.2018.1539462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (Mage 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.
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Affiliation(s)
- K Unterhorst
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - H Gerwinn
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - A Pohl
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - C Kärgel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - C Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - I Ristow
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology
| | - J Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School
| | - T Amelung
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin
| | - H Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin
| | - K Beier
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin
| | - M Walter
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology
- Department of Psychiatry, Eberhard Karls University of Tübingen
| | - B Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - T H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School
| | - A Stirn
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - J Ponseti
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
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Schuler M, Mohnke S, Amelung T, Dziobek I, Lemme B, Borchardt V, Gerwinn H, Kärgel C, Kneer J, Massau C, Pohl A, Tenbergen G, Weiß S, Wittfoth M, Waller L, Beier KM, Walter M, Ponseti J, Schiffer B, Kruger THC, Walter H. Empathy in pedophilia and sexual offending against children: A multifaceted approach. Journal of Abnormal Psychology 2019; 128:453-464. [PMID: 31045397 DOI: 10.1037/abn0000412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Jonas Kneer
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy
| | | | | | | | | | - Matthias Wittfoth
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy
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3
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Gibbels C, Sinke C, Kneer J, Amelung T, Mohnke S, Beier KM, Walter H, Schiltz K, Gerwinn H, Pohl A, Ponseti J, Foedisch C, Ristow I, Walter M, Kaergel C, Massau C, Schiffer B, Kruger THC. Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders. J Clin Med 2019; 8:E947. [PMID: 31261903 PMCID: PMC6678781 DOI: 10.3390/jcm8070947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023] Open
Abstract
High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach.
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Affiliation(s)
- Charlotte Gibbels
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Jonas Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Sebastian Mohnke
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Klaus Michael Beier
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Kolja Schiltz
- Department of Forensic Psychiatry, Ludwig Maximilians University Munich, 80336 Munich, Germany
| | - Hannah Gerwinn
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Alexander Pohl
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Jorge Ponseti
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Carina Foedisch
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Inka Ristow
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
- Department of Psychiatry, University of Tübingen, 72076 Tübingen, Germany
| | - Christian Kaergel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Claudia Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany.
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Kruger THC, Sinke C, Kneer J, Tenbergen G, Khan AQ, Burkert A, Müller-Engling L, Engler H, Gerwinn H, von Wurmb-Schwark N, Pohl A, Weiß S, Amelung T, Mohnke S, Massau C, Kärgel C, Walter M, Schiltz K, Beier KM, Ponseti J, Schiffer B, Walter H, Jahn K, Frieling H. Author Correction: Child sexual offenders show prenatal and epigenetic alterations of the androgen system. Transl Psychiatry 2019; 9:95. [PMID: 30778045 PMCID: PMC6379480 DOI: 10.1038/s41398-019-0417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The affiliations. Originally, Kolja Schilz was named last in the affiliations, implying that he is the senior author. This has been corrected; Kolja Schilz is now mentioned after Martin Walter in both the html and PDF versions of the article.
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Affiliation(s)
- Tillmann H. C. Kruger
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christopher Sinke
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jonas Kneer
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Gilian Tenbergen
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Abdul Qayyum Khan
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Burkert
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Linda Müller-Engling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hannah Gerwinn
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Nicole von Wurmb-Schwark
- Forensische Genetik und Rechtsmedizin, am Institut für Hämatopathologie Hamburg GmbH, Hamburg, Germany
| | - Alexander Pohl
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Simone Weiß
- 0000 0001 2187 5445grid.5718.bInstitute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Massau
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Christian Kärgel
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Walter
- 0000 0001 1018 4307grid.5807.aDepartment of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany ,0000 0001 2190 1447grid.10392.39Department of Psychiatry, University of Tübingen, Tübingen, Germany
| | - Kolja Schiltz
- 0000 0004 1936 973Xgrid.5252.0Department of Forensic Psychiatry, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus M. Beier
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorge Ponseti
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Boris Schiffer
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Jahn
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kruger THC, Sinke C, Kneer J, Tenbergen G, Khan AQ, Burkert A, Müller-Engling L, Engler H, Gerwinn H, von Wurmb-Schwark N, Pohl A, Weiß S, Amelung T, Mohnke S, Massau C, Kärgel C, Walter M, Schiltz K, Beier KM, Ponseti J, Schiffer B, Walter H, Jahn K, Frieling H. Child sexual offenders show prenatal and epigenetic alterations of the androgen system. Transl Psychiatry 2019; 9:28. [PMID: 30659171 PMCID: PMC6338724 DOI: 10.1038/s41398-018-0326-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.
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Affiliation(s)
- Tillmann H. C. Kruger
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christopher Sinke
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jonas Kneer
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Gilian Tenbergen
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Abdul Qayyum Khan
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexandra Burkert
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Linda Müller-Engling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Harald Engler
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hannah Gerwinn
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Nicole von Wurmb-Schwark
- Forensische Genetik und Rechtsmedizin, am Institut für Hämatopathologie Hamburg GmbH, Hamburg, Germany
| | - Alexander Pohl
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Simone Weiß
- 0000 0001 2187 5445grid.5718.bInstitute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Massau
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Christian Kärgel
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Walter
- 0000 0001 1018 4307grid.5807.aDepartment of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany ,0000 0001 2190 1447grid.10392.39Department of Psychiatry, University of Tübingen, Tübingen, Germany
| | - Kolja Schiltz
- 0000 0004 1936 973Xgrid.5252.0Department of Forensic Psychiatry, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus M. Beier
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorge Ponseti
- 0000 0001 2153 9986grid.9764.cInstitute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - Boris Schiffer
- 0000 0004 0490 981Xgrid.5570.7Division of Forensic Psychiatry, Deptartment of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Jahn
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- 0000 0000 9529 9877grid.10423.34Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kunath J, Granert O, Pohl A, Gerwinn H, Stirn A, Beier K, Walter H, Walter M, Schiffer B, Krüger T, Ponseti J. 204 The “functional magnetic resonance imaging” (fMRI) as a meaningful tool for the differentiation of sexual preferences. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Gerwinn H, Weiß S, Tenbergen G, Amelung T, Födisch C, Pohl A, Massau C, Kneer J, Mohnke S, Kärgel C, Wittfoth M, Jung S, Drumkova K, Schiltz K, Walter M, Beier KM, Walter H, Ponseti J, Schiffer B, Kruger THC. Clinical characteristics associated with paedophilia and child sex offending - Differentiating sexual preference from offence status. Eur Psychiatry 2018; 51:74-85. [PMID: 29625377 DOI: 10.1016/j.eurpsy.2018.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 10/17/2022] Open
Abstract
Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.
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Affiliation(s)
- Hannah Gerwinn
- Department of Neurology, Medical School, Kiel University, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Simone Weiß
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Gilian Tenbergen
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Department of Psychology, State University of New York at Oswego, 7060 State Route 104, 13126 Oswego, NY, USA
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Födisch
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Alexander Pohl
- Department of Neurology, Medical School, Kiel University, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Claudia Massau
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Jonas Kneer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Kärgel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Matthias Wittfoth
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Stefanie Jung
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Krassimira Drumkova
- State Hospital for Forensic Psychiatry Uchtspringe, Schnöggersburger Weg 1, 39576 Stendal, Germany
| | - Kolja Schiltz
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany; Department of Forensic Psychiatry, Psychiatric Hospital, LMU Munich, Nußbaumstr. 7, 80336 München, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany; Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Osianderstr. 24, 72076 Tübingen, Germany
| | - Klaus M Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Niemannsweg 147, 24105 Kiel, Germany
| | - Boris Schiffer
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Forensic Psychiatry, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany; Institute of Forensic Psychiatry, University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Ponseti J, Bruhn D, Nolting J, Gerwinn H, Pohl A, Stirn A, Granert O, Laufs H, Deuschl G, Wolff S, Jansen O, Siebner H, Briken P, Mohnke S, Amelung T, Kneer J, Schiffer B, Walter H, Kruger THC. Decoding Pedophilia: Increased Anterior Insula Response to Infant Animal Pictures. Front Hum Neurosci 2018; 11:645. [PMID: 29403367 PMCID: PMC5778266 DOI: 10.3389/fnhum.2017.00645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Previous research found increased brain responses of men with sexual interest in children (i.e., pedophiles) not only to pictures of naked children but also to pictures of child faces. This opens the possibly that pedophilia is linked (in addition to or instead of an aberrant sexual system) to an over-active nurturing system. To test this hypothesis we exposed pedophiles and healthy controls to pictures of infant and adult animals during functional magnetic resonance imaging of the brain. By using pictures of infant animals (instead of human infants), we aimed to elicit nurturing processing without triggering sexual processing. We hypothesized that elevated brain responses to nurturing stimuli will be found - in addition to other brain areas - in the anterior insula of pedophiles because this area was repeatedly found to be activated when adults see pictures of babies. Behavioral ratings confirmed that pictures of infant or adult animals were not perceived as sexually arousing neither by the pedophilic participants nor by the heathy controls. Statistical analysis was applied to the whole brain as well as to the anterior insula as region of interest. Only in pedophiles did infants relative to adult animals increase brain activity in the anterior insula, supplementary motor cortex, and dorsolateral prefrontal areas. Within-group analysis revealed an increased brain response to infant animals in the left anterior insular cortex of the pedophilic participants. Currently, pedophilia is considered the consequence of disturbed sexual or executive brain processing, but details are far from known. The present findings raise the question whether there is also an over-responsive nurturing system in pedophilia.
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Affiliation(s)
- Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Daniel Bruhn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Julia Nolting
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Hannah Gerwinn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Alexander Pohl
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Aglaja Stirn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Helmut Laufs
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Kiel University, Medical School, Kiel, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Kiel, Germany
| | - Hartwig Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jonas Kneer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital Bochum, Bochum, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tillmann H. C. Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
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9
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Ponseti J, Dähnke K, Fischermeier L, Gerwinn H, Kluth A, Müller J, Vogel S, Stirn A. Sexual Responses Are Facilitated by High-Order Contextual Cues in Females but Not in Males. Evol Psychol 2018; 16:1474704918761103. [PMID: 29566568 PMCID: PMC10481071 DOI: 10.1177/1474704918761103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 01/19/2018] [Indexed: 01/23/2023] Open
Abstract
Sexual responses are thought to be controlled by a brain module called the sexual module. Sexual strategies of males and females vary to a great extent, and sexual responses of males and females may be affected by their sexual strategies. However, the current view of the sexual module is that of a unisex module. This might be questionable since brain modules are defined as evolved cognitive mechanisms to solve adaptive problems which are different for males and females. We hypothesize that the sexual module responds differently in the presence of complex (high-order) contextual cues that are related to gender-dimorphic sexual strategies in males and females. We conducted a priming experiment in which stimuli related to sexual strategies were disentangled from their sexual meaning. Nonsexual priming pictures related to either economic resources or social interactions preceded a sexual-target picture in order to test whether the primes were able to modulate the subjective sexual response to the sexual target. In a control condition, priming pictures without relation to mating preferences but with similar emotional impact were presented. In males, sexual responses were similar in the experimental and control conditions. In females, however, primes related to economic resources or social interactions modulated sexual arousal significantly more than the control primes. Our findings suggest that brain modules dedicated to process the experimental primes were functionally connected with the sexual module in females more than in males, making females' sexual responses more prone to the impact of high-order cultural cues than males' sexual responses. A gender-dimorphic connectivity of the sexual module may be the way in which gender-dimorphic sexual strategies are implemented in the human mind.
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Affiliation(s)
- Jorge Ponseti
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Kim Dähnke
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Leona Fischermeier
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Hannah Gerwinn
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Amelie Kluth
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Jens Müller
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Susanne Vogel
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
| | - Aglaja Stirn
- Medical School, Institute of Sexual Medicine, Forensic Psychiatry and Psychotherapy, Kiel University, Kiel, Germany
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10
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Schiffer B, Amelung T, Pohl A, Kaergel C, Tenbergen G, Gerwinn H, Mohnke S, Massau C, Matthias W, Weiß S, Marr V, Beier KM, Walter M, Ponseti J, Krüger THC, Schiltz K, Walter H. Gray matter anomalies in pedophiles with and without a history of child sexual offending. Transl Psychiatry 2017; 7:e1129. [PMID: 28509903 PMCID: PMC5534964 DOI: 10.1038/tp.2017.96] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 12/21/2022] Open
Abstract
Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.
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Affiliation(s)
- B Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Bochum, Germany
- Institute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - T Amelung
- Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - A Pohl
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - C Kaergel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Bochum, Germany
- Institute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - G Tenbergen
- Hannover Medical School, Department of Psychiatry, Hannover, Germany
| | - H Gerwinn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - S Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - C Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital, Bochum, Germany
- Institute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - W Matthias
- Hannover Medical School, Department of Psychiatry, Hannover, Germany
| | - S Weiß
- Institute of Forensic Psychiatry, University of Duisburg-Essen, Duisburg, Germany
| | - V Marr
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
- Clinical Affective Neuroimaging Laboratory, Department for Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - K M Beier
- Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - M Walter
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
- Clinical Affective Neuroimaging Laboratory, Department for Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - J Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Medical School, Kiel University, Kiel, Germany
| | - T H C Krüger
- Hannover Medical School, Department of Psychiatry, Hannover, Germany
| | - K Schiltz
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
- Department of Forensic Psychiatry, Psychiatric Hospital of the University of Munich, Munich, Germany
| | - H Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Berlin, Germany
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11
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Kärgel C, Massau C, Weiß S, Walter M, Borchardt V, Krueger THC, Tenbergen G, Kneer J, Wittfoth M, Pohl A, Gerwinn H, Ponseti J, Amelung T, Beier KM, Mohnke S, Walter H, Schiffer B. Evidence for superior neurobiological and behavioral inhibitory control abilities in non-offending as compared to offending pedophiles. Hum Brain Mapp 2016; 38:1092-1104. [PMID: 27767244 DOI: 10.1002/hbm.23443] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/21/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023] Open
Abstract
Neurobehavioral models of pedophilia and child sexual offending suggest a pattern of temporal and in particular prefrontal disturbances leading to inappropriate behavioral control and subsequently an increased propensity to sexually offend against children. However, clear empirical evidence for such mechanisms is still missing. Using a go/nogo paradigm in combination with functional magnetic resonance imaging (fMRI) we compared behavioral performance and neural response patterns among three groups of men matched for age and IQ: pedophiles with (N = 40) and without (N = 37) a history of hands-on sexual offences against children as well as healthy non-offending controls (N = 40). As compared to offending pedophiles, non-offending pedophiles exhibited superior inhibitory control as reflected by significantly lower rate of commission errors. Group-by-condition interaction analysis also revealed inhibition-related activation in the left posterior cingulate and the left superior frontal cortex that distinguished between offending and non-offending pedophiles, while no significant differences were found between pedophiles and healthy controls. Both areas showing distinct activation pattern among pedophiles play a critical role in linking neural networks that relate to effective cognitive functioning. Data therefore suggest that heightened inhibition-related recruitment of these areas as well as decreased amount of commission errors is related to better inhibitory control in pedophiles who successfully avoid committing hands-on sexual offences against children. Hum Brain Mapp 38:1092-1104, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christian Kärgel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Claudia Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Simone Weiß
- Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
| | - Martin Walter
- Department of Psychiatry, Otto v. Guericke University, Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany.,Department for Behavioral Neurology, Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Leipziger Str. 44, Magdeburg, 39120, Germany.,Department of Psychiatry and Psychotherapy, University Tübingen, Osianderstr. 24, Tübingen, 72076, Germany
| | - Viola Borchardt
- Department for Behavioral Neurology, Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Tillmann H C Krueger
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Gilian Tenbergen
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Jonas Kneer
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Matthias Wittfoth
- Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Carl-Neuberg Strasse 1, Hannover, 30625, Germany
| | - Alexander Pohl
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Hannah Gerwinn
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Jorge Ponseti
- Department for Integrative Psychiatry Kiel, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts Kiel University, Medical School, Kiel, Niemannsweg 147, Kiel, 24105, Germany
| | - Till Amelung
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin (Charité), Luisenstr. 57, Berlin, 10117, Germany
| | - Klaus M Beier
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin (Charité), Luisenstr. 57, Berlin, 10117, Germany
| | - Sebastian Mohnke
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, University Medicine Berlin (Charité), Charitéplatz 1, Berlin, 10117, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, University Medicine Berlin (Charité), Charitéplatz 1, Berlin, 10117, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital Bochum, Alexandrinenstraße 1-3, Bochum, 44791, Germany.,Department of Psychiatry and Psychotherapy, Institute of Forensic Psychiatry, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany
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12
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Gerwinn H, Pohl A, Granert O, van Eimeren T, Wolff S, Jansen O, Deuschl G, Huchzermeier C, Stirn A, Siebner HR, Ponseti J. The (in)consistency of changes in brain macrostructure in male paedophiles: A combined T1-weighted and diffusion tensor imaging study. J Psychiatr Res 2015; 68:246-53. [PMID: 26228426 DOI: 10.1016/j.jpsychires.2015.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
Thus far, four studies have used magnetic resonance imaging (MRI) to test for differences in brain structure between paedophilic (i.e. sexually attracted to pre-pubescent children) and teleiophilic (i.e. sexually attracted to adults) men, revealing divergent results. To re-examine this issue, we acquired high resolution structural T1-weighted and diffusion MRI scans of the brain in 24 paedophilic and 32 teleiophilic men. We performed voxel-based morphometry (VBM) of the T1-weighted images and tract-based spatial statistics (TBSS) of the diffusion tensor imaging data to search for grey and white matter differences between groups. In contrast to previous studies, less than half of the individuals in our paedophilic group had a record of sexual offences against children, as subjects were partially recruited from two outpatient facilities of a child sexual abuse prevention project for self-acknowledged paedophiles. After adjustment for multiple comparisons and controlling for important confounding factors, we did not find any significant grey or white matter differences between the paedophilic and teleiophilic subjects. Together with the inconsistencies in the literature, these results argue against consistent structural differences at the macroanatomical scale between paedophiles and teleiophiles.
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Affiliation(s)
- Hannah Gerwinn
- Department of Neurology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Alexander Pohl
- Department of Neurology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Thilo van Eimeren
- Department of Neurology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Stephan Wolff
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Kiel University, Medical School, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Christian Huchzermeier
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Centre for Integrative Psychiatry Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Aglaja Stirn
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Centre for Integrative Psychiatry Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Centre for Integrative Psychiatry Kiel, Niemannsweg 147, 24105, Kiel, Germany
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Streibelt M, Gerwinn H, Hansmeier T, Thren K, Müller-Fahrnow W. SIMBO: Ein Screening-Instrument zur Feststellung des Bedarfs an Medizinisch-Beruflich Orientierten Maßnahmen in der medizinischen Rehabilitation - Analysen zur Konstruktvalidität und Prognosegüte. REHABILITATION 2007; 46:266-75. [DOI: 10.1055/s-2007-970583] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Abstract
Ten years after its introduction, the German Pension Insurance's quality assurance programme is firmly established within the rehabilitation system. Regular, substantive reporting to rehabilitation centres and pension insurance organisations has contributed to improving the quality of rehabilitation. Legal codification of quality assurance stipulations has existed since 2001. The programme is in constant development, e. g. by optimization of patient interviewing and inclusion of evidence-based clinical practice guidelines. New programmes, e. g. in inpatient rehabilitation of children and youths or in outpatient rehabilitation, are being developed together with the German health care organizations. In the field of vocational rehabilitation quality assurance had started out with a conceptual study followed by projects concerning client interviewing, evaluation of documentation instruments, and analyses relative to the most important outcome factor, namely the vocational reintegration results achieved. External quality assurance is a mayor input factor for the rehabilitation centres' internal quality management. In future, rehabilitation centres will be asked to demonstrate the appropriate use of this information. It will remain the centres' decision which method of quality management system implementation they choose. Quality assurance results of every centre are planned to be made publicly accessible in the medium term, in particular to the insureds. Moreover, the results of the quality assurance programmes are intended to clearly impact the allocation of patients as well as the remuneration of the rehabilitation centres concerned. Quality assurance and quality management will continue to play a major role in the political discussion of health care.
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Affiliation(s)
- U Egner
- Deutsche Rentenversicherung Bund, Berlin.
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15
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Klosterhuis H, Zwingmann C, Gerwinn H. [Transfer of research findings into the practice of rehabilitation and effects on the development and stabilization of the infrastructure of rehabilitation sciences--the pension insurance perspective]. REHABILITATION 2005; 44:316-22. [PMID: 16208595 DOI: 10.1055/s-2005-867052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The programme for research in rehabilitation has been established by the Federal Ministry of Education and Research and the German Pension Insurance scheme in 1998 to further develop the methodology in this field. In addition to other effects, the large number of projects has strengthened the research structure in Germany. An important aim of the programme is the transfer of the research findings into the practice of rehabilitation. The initiators also organize this transformation process in terms of a long-term task. The paper describes the transfer of findings in the topics selected by the Pension Insurance scheme: patient education, access to rehabilitation, and vocational orientation in medical rehabilitation. Furthermore, additional activities concerning the transfer are outlined. To improve the practice of rehabilitation by transferring research findings is of great importance for the Pension Insurance scheme.
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Affiliation(s)
- H Klosterhuis
- Deutsche Rentenversicherung Bund, Bereich 0430 -- Reha-Qualitätssicherung, Epidemiologie und Statistik, Berlin.
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16
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Müller-Fahrnow W, Greitemann B, Radoschewski FM, Gerwinn H, Hansmeier T. Berufliche Orientierung in der medizinischen Rehabilitation und Leistungen zur Teilhabe am Arbeitsleben. REHABILITATION 2005; 44:287-96. [PMID: 16208592 DOI: 10.1055/s-2005-867003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Return-to-work and protection of work-related participation is stated as a primary objective of rehabilitation by the statutory pension insurance institutes. A general continuous management of work-related participation in rehabilitation is a prerequisite for optimal results in view of stay in work and return to work. This means an extended vocational orientation in medical rehabilitation, individualized occupational rehabilitation according to need and capacity in connection with closer linkages between medical and occupational rehabilitation. In the course of the "Rehabilitation Sciences" research funding programme and beyond it, quite a few research projects and scientific activities aimed at development, testing and evaluation of -new screenings and diagnostic instruments with better findings of vocational related needs in medical and occupational rehabilitation, -specific methods of therapy and models for treatment settings with immediate reference to the work related restriction and capacity, as well as -models of the organization and forms of cooperation between medical and occupational rehabilitation. This paper reviews the projects and findings in these research fields in relation to the requirements for an increase of general continuous vocational orientation in rehabilitation.
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Zwingmann C, Buschmann-Steinhage R, Gerwinn H, Klosterhuis H. Förderschwerpunkt „Rehabilitationswissenschaften”: Ergebnisse - Umsetzung - Erfolge und Perspektiven. REHABILITATION 2004; 43:260-70. [PMID: 15472785 DOI: 10.1055/s-2004-828393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In 1998, the German Federal Ministry of Education and Research (BMBF) and the German pension insurance scheme established a funding programme for research in rehabilitation. This "Rehabilitation Sciences" research funding programme comprises eight regional research networks for eight years in two periods (1998-2002, 2001-2005). In our paper we review the findings of the first funding period in five of the research fields: patient education, need for and access to rehabilitation, vocational training in medical rehabilitation to enhance return to work, comorbid mental disorders in patients with somatic diseases, and gender differences. Several activities aimed at transferring research findings into practice are outlined. Finally, the impact of the funding programme is summarized and perspectives for further funding are given.
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Affiliation(s)
- C Zwingmann
- Verband Deutscher Rentenversicherungsträger, Frankfurt/Main.
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Buschmann-Steinhage R, Gerwinn H, Klosterhuis H, Mitreiter R. [The "rehabilitation sciences" promotional emphasis--a promotional program and its implementation]. Rehabilitation (Stuttg) 1998; 37 Suppl 2:S71-7. [PMID: 10065484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The German Federal Research Ministry and the German pension insurance have set up a special funding programme for medical rehabilitation research. Eight regional research networks with about 70 projects receive funds for a first three year period. Rehabilitation experts from several countries selected the promising networks and studies from more than 100 proposals. In these networks medical and social scientists from universities and other research units cooperate with rehabilitation centers and pension insurance institutes in order to combine forces for the development of German rehabilitation science. The programme aims at improving the research structures and at tackling the major challenges of medical rehabilitation research. The following subjects represent the main fields of the ongoing research: a) etiology, course and prognosis of chronic diseases and their consequences to rehabilitation, b) diagnostics in rehabilitation, c) evaluation and improvement of rehabilitation therapy, d) the patient's perspective in rehabilitation and e) rehabilitation system research. As yet funding is limited to the year 2001. Further support of the networks will depend on the results of a thorough evaluation of the progress of their research and their structural perspective.
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Egner U, Gerwinn H, Müller-Fahrnow W, Schliehe F. [The quality assurance program of mandatory social security in the realm of medical rehabilitation. Concept, status of implementation and prospects]. Rehabilitation (Stuttg) 1998; 37 Suppl 1:S2-7. [PMID: 9706107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The quality improvement programme aims at the comparison of clinics in charge of the statutory pension insurance. The programme has been implemented successively in 1994, supported by researchers and teams of experts on specific subjects. Instruments and procedures have been developed to all programme items including a clinic comparing and information system, thus permitting routine use in practice. Performing regular clinic-comparisons analysing structural quality (equipment, staff, clinical concept, management), procedural quality (recording of rehabilitation process), and outcome quality (success of the rehabilitation estimated by physician and patient) of rehabilitation facilities shall initiate quality competition and stimulate a constant improvement of quality. significant basis, therefore, is a clinic-comparing information and reporting system. The developed instruments and procedures are available for all institutes providing rehabilitation.
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Affiliation(s)
- U Egner
- Humboldt-Universitat zu Berlin Institut fur Rehabilitationswissenschaften, Berlin
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