Acquired Pedophilia: international Delphi-method-based consensus guidelines

Idiopathic and acquired pedophilia are two different disorders with two different etiologies. However, the differential diagnosis is still very difficult, as the behavioral indicators used to discriminate the two forms of pedophilia are underexplored, and clinicians are still devoid of clear guidelines describing the clinical and neuroscientific investigations suggested to help them with this difficult task. Furthermore, the consequences of misdiagnosis are not known, and a consensus regarding the legal consequences for the two kinds of offenders is still lacking. The present study used the Delphi method to reach a global consensus on the following six topics: behavioral indicators/red flags helpful for differential diagnosis; neurological conditions potentially leading to acquired pedophilia; neuroscientific investigations important for a correct understanding of the case; consequences of misdiagnosis; legal consequences; and issues and future perspectives. An international and multidisciplinary board of scientists and clinicians took part in the consensus statements as Delphi members. The Delphi panel comprised 52 raters with interdisciplinary competencies, including neurologists, psychiatrists, neuropsychologists, forensic psychologists, expert in ethics, etc. The final recommendations consisted of 63 statements covering the six different topics. The current study is the first expert consensus on a delicate topic such as pedophilia. Important exploitable consensual recommendations that can ultimately be of immediate use by clinicians to help with differential diagnosis and plan and guide therapeutic interventions are described, as well as future perspectives for researchers.

Idiopathic and acquired pedophilia as two distinct disorders: an insight from neuroimaging

Pedophilia is a disorder of public concern because of its association with child sexual offense and recidivism. Previous neuroimaging studies of potential brain abnormalities underlying pedophilic behavior, either in idiopathic or acquired (i.e., emerging following brain damages) pedophilia, led to inconsistent results. This study sought to explore the neural underpinnings of pedophilic behavior and to determine the extent to which brain alterations may be related to distinct psychopathological features in pedophilia. To this aim, we run a coordinate based meta-analysis on previously published papers reporting whole brain analysis and a lesion network analysis, using brain lesions as seeds in a resting state connectivity analysis. The behavioral profiling approach was applied to link identified regions with the corresponding psychological processes. While no consistent neuroanatomical alterations were identified in idiopathic pedophilia, the current results support that all the lesions causing acquired pedophilia are localized within a shared resting state network that included posterior midlines structures, right inferior temporal gyrus and bilateral orbitofrontal cortex. These regions are associated with action inhibition and social cognition, abilities that are consistently and severely impaired in acquired pedophiles. This study suggests that idiopathic and acquired pedophilia may be two distinct disorders, in line with their distinctive clinical features, including age of onset, reversibility and modus operandi. Understanding the neurobiological underpinnings of pedophilic behavior may contribute to a more comprehensive characterization of these individuals on a clinical ground, a pivotal step forward for the development of more efficient therapeutic rehabilitation strategies.

Profiling acquired pedophilic behavior: Retrospective analysis of 66 Italian forensic cases of pedophilia

Neurological disorders can be mis-diagnosed as psychiatric ones. This might happen to pedophilia emerging as a symptom of brain insult (i.e. acquired pedophilic behavior). This paper aims to delineate a behavioral profile that might help to identify defendants whose pedophilic behavior is likely to be the consequence of a neurological disorder. Through a systematic review of the literature, seventeen clinical and behavioral variables of the modus operandi and victimology that can distinguish between acquired and developmental pedophilic behavior have been collected. Seven of these were found to be consistent behavioral indicators (i.e. red flags) for acquired pedophilia. Cluster hierarchical analysis on the seventeen variables collected through the systematic review of the literature on cases of acquired pedophilic behavior was applied to a new dataset including 66 Italian closed cases of pedophilia. Stepwise regression and correlation analyses were carried out to further examine the differences between the clusters identified in the cluster analysis. Results revealed that the new sample was partitioned into two clusters. Individuals with ascertained acquired pedophilia were grouped together. The clusters widely differed for the prevalence of red flags (mean number of red flags in each cluster: 2.14 ± 0.79 vs 4.96 ± 0.93, p < 0.001), while no between cluster difference emerged for the other clinical and behavioral variables. Regression analysis provided a robust model that included the three most significant red flags that explain over 64.5% of the variance (absence of masking, spontaneous confession and offenders older age). An organic origin of pedophilic behavior should be suspected if red flags are present in a defendant charged with pedophilia. In those cases, an in depth trans-disciplinary neuroscientific investigation is advocated. The behavioral profile identified might help to provide a proper assessment of defendants.

Response: Avuncularity and Kin Selection in Homosexuals: A Problematic Test or a Problematic Hypothesis?

Here we respond to Vasey et al.'s critical comments regarding our article, "Societal norms rather than sexual orientation influence kin altruism and avuncularity in tribal Urak-Lawoi, Italian, and Spanish adult males" (Camperio Ciani, Battaglia, & Liotta, 2015 , JSR doi:10.1080/00224499.2014.993748). The first regards the selection of the Urak-Lawoi population of Ko Lipeh, which is considered too modern and touristic to be adequate to test the kin selection and avuncular hypothesis for homosexuality. We provide historical evidence of the contrary, and show that the population at the inception of our 10 years research was indeed primitive and tribal, and probands actually grew and lived in such a society. Only a few years after the 2004 tsunami, the island was developed and invaded by mass tourism. The second comment regarded the statistical analysis and interpretation of data. We show that we consistently and conservatively considered the effects of all confounding variables, both with comparative tests, and by a series of multivariate regression analyses. This was the orthodox procedure approved by all other reviewers. In conclusion, even addressing these comments, we maintain that the kin selection and avuncularity hypothesis for homosexuality is not supported by empirical data even in this primitive and tribal society.

Societal Norms Rather Than Sexual Orientation Influence Kin Altruism and Avuncularity in Tribal Urak-Lawoi, Italian, and Spanish Adult Males

Homosexual males could balance their low fitness by increasing benefits to relatives either through kin-directed altruism or by avuncularity (altruistic behavior toward the children of siblings). Evidence in support of kin selection and avuncularity includes the fact that homosexuals seem to be more empathic and altruistic than heterosexuals. Other studies have not confirmed behaviors that increase kin altruism in homosexuals. We explored altruistic behavior and avuncularity in a sample of 278 subjects, either homosexual or heterosexual, from three populations: Italian, Spanish, and Urak-Lawoi, a Southeast Asian tribal population. Among the Urak-Lawoi, the kathoeys, androphilic men who dress and behave as women, were compared with heterosexuals. All populations were rated for societal norms on the expression of affiliative behavior. No greater kin altruism or avuncularity among the kathoeys or in homosexuals in either Mediterranean population was found. Greater avuncularity and kin-directed altruism, independent of sexual orientation, were found among the Urak-Lawoi, and these traits were the least prevalent among the Italians, corresponding to different societal norms. The increase in kin altruism and avuncularity was associated in all males with societal differences and norms on general altruism toward nonkin children, suggesting it is not an adaptive design to maintain homosexuality in humans.

Human homosexuality: a paradigmatic arena for sexually antagonistic selection?

Sexual conflict likely plays a crucial role in the origin and maintenance of homosexuality in our species. Although environmental factors are known to affect human homosexual (HS) preference, sibling concordances and population patterns related to HS indicate that genetic components are also influencing this trait in humans. We argue that multilocus, partially X-linked genetic factors undergoing sexually antagonistic selection that promote maternal female fecundity at the cost of occasional male offspring homosexuality are the best candidates capable of explaining the frequency, familial clustering, and pedigree asymmetries observed in HS male proband families. This establishes male HS as a paradigmatic example of sexual conflict in human biology. HS in females, on the other hand, is currently a more elusive phenomenon from both the empirical and theoretical standpoints because of its fluidity and marked environmental influence. Genetic and epigenetic mechanisms, the latter involving sexually antagonistic components, have been hypothesized for the propagation and maintenance of female HS in the population. However, further data are needed to truly clarify the evolutionary dynamics of this trait.