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

Abstract

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.

Acquired Pedophilia: international Delphi-method-based consensus guidelines

“…Acquired pedophilic behavior (hereafter referred to as acquired pedophilia for brevity) refers to the insurgence of enacted pedophilic interests and/or urges as a symptom of brain insult of neurological origin [9,10]. The onset of acquired pedophilia has been described as a consequence of frontotemporal dementia [11,12], traumatic brain injury [13], surgical lesion [14], brain [15], or notochord [16] neoplasms, and multiple sclerosis [17,18] in individuals who have never overtly manifested pedophilic behavior before.…”

“…In other words, the brain regions in which the synergic functioning is abnormal in the two forms of pedophilia are unknown. Regarding idiopathic pedophilia, some studies have attempted to shed light on structural or functional alterations [42,[47][48][49][50][51][52][53][54][55], but a recent meta-analysis concluded that the results do not spatially converge across different studies [10]; in other words, different studies have reported different results. Thus, to date, there are no consistent subtle brain alterations associated with developmental pedophilia.…”

“…Indeed, acquired pedophilia can emerge following lesions in the frontal lobe [13,15,56,57], globus pallidum [58] (cases 4 and 6), hippocampus [14,58,59], etc. However, despite being spatially heterogeneous within the brain, all these brain regions localize to a shared network as they are functionally linked to the same brain regions, namely, the orbitofrontal cortex bilaterally and the posterior midline structures, including the precuneus and the posterior cingulate cortex [10].…”

“…Despite recent advances in the understanding of this disorder [9,10,60], the behavioral and clinical characterization of acquired pedophiles, the contribution of neuroscientific methodologies to the diagnosis and differential diagnosis of developmental pedophilia and the consequences of misdiagnosis remain underinvestigated. Similarly, the forensic and legal implications remain controversial.…”

“…Although this seems a topic of secondary importance, given the rarity of acquired pedophilia, which is described in a limited number of cases within the scientific literature [10,60], recent evidence suggests that acquired pedophilia prevalence might be higher than previously expected but may pass unrecognized as an in-depth neuroscientific investigation aiming to understand the origin of offenses toward children is very seldom performed [60]. It is thus of the utmost importance to clarify the behavioral and clinical characterization of acquired pedophiles to help clinicians clarify which behavioral red flags could raise the suspicion of an acquired origin of pedophilia.…”