(9A) Disorders of a Sexual Preference - Paedophillia (19:11:19) PDF

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Disorders of a Sexual Preference - Paedophilia...

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Forensic Medical Health: Week 9A (19 t h November 2019)

Disorders of a Sexual Preference Children (Paedophilia) Sexual Abuse is not Paedophilia: - People who have a sexual interest in children will be compelled to act on that interest. - People who sexually abuse children must have sexual interest in children (40-50% of offenders are not paedophilic based on sexual arousal/behaviour) - Interest in children is not enough to diagnose paedophilia Prevalence: - Self-reported paedophilic preference in general population is at least 5% - More common in men in offending populations but female population likely to be underestimated - 20% of a male community sample indicated child pornography use

Symptoms and Diagnosis: Paedophilic Disorder: Recurrent, intense, sexually arousing fantasies, sexual urges or behaviours involving sexual activity with a prepubescent child (for longer than 6mths). The individual has either acted on these urges or the urges or fantasies cause marked distress or interpersonal difficulty and the individual must be at least 16 years old and 5 years older than child. Specify: exclusive/nonexclusive type, hetero/homo/bisexual orientation or limited to incest.

Comorbidity Among paedophiles in residential or outpatient treatment: - 2/3 have a lifetime history of mood/anxiety disorders - 60% have lifetime substance abuse history, 51% alcohol as drug of choice Hebephilia: “A sexual preference for children, boys, girls or both, usually of prepubertal or early pubertal age” (ICD10) A distinct paraphilia with distinct sexual arousal patterns with larger responses to a preferred age group Child Pornography as an Indicator: - In an anonymous survey of self-identified paedophiles, a large majority had used child pornography. - 61/100 of child pornography offenders showed greater penile responses to stimuli depicting children compared to adults - 100% of 43 child pornography offenders admitted masturbation whilst watching child pornography. 84% admitted masturbation to fantasies about sex with children Penile Plethysmography: - Child pornography offenders (seeking out what they are attracted to) are 3x more likely to show paedophilic sexual arousal than contact sexual offenders (situational offenders) In a sample of offenders: - Mean age 40 years - 70% met DSM criteria for paedophilia - 30% attracted to pubescent children (60% of these preferred girls) - 13% of paedophiles and 4% of hebephiles have no gender preference

Forensic Medical Health: Week 9A (19 t h November 2019) A lack of empathy is viewed as a dynamic risk factor (the target of treatment/intervention). Particularly important in paedophilia (emotional congruence with children).

Intervention: -

Assumption: paedophilia is a stable sexual preference that is unlikely to change Objective: Reduce paedophilic sexual arousal or increase ability to manage sexual urges and arousal and refrain from acting upon sexual interest in children. Aversion Therapy: unclear how long it lasts Medical treatment: reducing libido, antiandrogens have desired effect

Relapse Intervention: - Identify situations in which individuals are at a high risk of reoffending - Identifying behaviours that do not constitute full-fledged relapses but may be a precursor to a relapse - Develop strategies for avoiding high-risk situations such as spending time alone with a child - Develop coping strategies that can be used in high-risk situations that cannot be avoided - Responding effectively to lapses that do occur...