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

Abstract

Objective: Pedophilia is a disorder of public concern because of its association with child sexual offense and recidivism. Previous neuroimaging studies identified inconsistent brain abnormalities underlying pedophilic behavior both in idiopathic and acquired (i.e., emerging following brain damage) pedophilia. 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. Methods: 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 were run to investigate the presence of consistent neural basis of idiopathic and acquired pedophilic behavior, respectively. The behavioral profiling approach was applied to link identified regions with corresponding psychological processes. Results: While no consistent neuroanatomical alterations have been identified in idiopathic pedophilia, the current results support that all the lesions causing acquired pedophilia localized to a shared resting state network including 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 described as severely impaired in acquired pedophiles. Conclusions: 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 and to develop more efficient therapeutic rehabilitation strategies.

The neuroanatomical bases of pedophilia and the importance of distinguishing genuine vs. acquired types: A systematic review

“…In view of the present results, the same conclusion can be drawn about acquired pedophilia. Interestingly, a recent brain imaging meta-analysis based on 436 men with a pedophilic disorder failed to find any structural difference compared with 449 controls (Scarpazza et al, 2021). Therefore, anomalies of fronto-temporal regions appear to be more closely associated with child sexual abuse (acting out) than pedophilia (Dillien et al, 2020).…”

“…How ever, Baird also stated (correctly) that "those who do develop paedophilia in the context of a neurological condition typically show general behavioural 'disinhibition'" (p. 113). Indeed, a growing number of authors consider acquired pedophilia as a symptom of a larger disinhibition syndrome (Kruger & Kneer, 2021;Scarpazza et al, 2021). For instance, after reviewing 19 cases of acquired pedophilia, Scarpazza and colleagues (2021) reported that they all suffered from a more general impulse control syndrome.…”

“…Although an important distinction is made between child sexual abuse (the behav ior) and pedophilia (fantasies, early onset, sexual preference for children) in forensic psychology, sexology and criminology (Seto, 2019), this nuance is commonly overlooked in neurology (Münch et al, 2020). However, a growing number of authors stress the difference between genuine (paraphilic preference, not only behaviors, which usually emerge during adolescence or young adulthood) and acquired pedophilia (e.g., Camperio Ciani et al, 2019;Scarpazza et al, 2021). As expected, classic signs of neurological disorders distinguish men with genuine pedophilia from those with acquired pedophilia (e.g., no criminal premeditation, no history of sexual crimes, being older than 50-y.-o, no attempt to conceal, giving spontaneous confession; Camperio Ciani et al, 2019).…”

Translational Application of a Neuro-Scientific Multi-Modal Approach Into Forensic Psychiatric Evaluation: Why and How?

“…While certain ethical aspects also are involved (118), the neuro-scientific approach offers a strategy to mitigate these problems, as it adopts methods with significantly lower error rates than the classical assessment. Thus results from unstructured clinical interviews should be integrated with data from standardized and objective neuropsychological and psychopathological tests (31,33) and from laboratory exams (9,22,119) and interpreted in respect of the convergence of evidence principle (14,120).…”

“…Indeed, the major limitation to the introduction of a neuroscientific approach into the legal settings does not come from the judges and jurors, but from scientists themselves who, in accordance with the denial cognitive bias (40,48), prefer to maintain a disputable methodology rather than to improve the overall procedure by adopting a multidisciplinary approach based on the convergence of evidence principle. This problem appears to be specific for forensic psychiatry, while it is not present in clinical psychiatry, as demonstrated by the constant growing of studies that search for potential ways to enhance translational application of neuro-scientific findings into clinical psychiatric settings (53,110,119,(121)(122)(123)(124).…”