Functional brain correlates of heterosexual paedophilia
Introduction
Paedophilia is a psychiatric disorder of high public concern characterized by intense sexually arousing urges and behaviours focused on sexual activity with a prepubescent child (American Psychiatric Association, 1994). Numerous studies have discussed the associations between behavioural disinhibition, frontal abnormalities, and impaired cognitive executive functioning. Although recent data from neuropsychological, sexual historical, plethysmographic, and neuroimaging investigations suggest that paedophilia is linked to early neurodevelopment perturbations (Cantor et al., 2004, Cohen et al., 2002), the neurobiological basis of the disorder is still unidentified.
Human sexual arousal is a multidimensional experience comprising physiological and psychological processes. Modern imaging techniques allow the in vivo observation of brain activation correlated with sensory or cognitive processing and emotional states (Krueger et al., 2005). Previous studies in healthy humans (Arnow et al., 2002, Beauregard et al., 2001, Bocher et al., 2001, Ferretti et al., 2005, Hamann et al., 2004, Holstege et al., 2003, Karama et al., 2002, Mouras et al., 2003, Park et al., 2001, Redoute et al., 2000, Stoleru et al., 1999, Paul et al., in press e-pub) using functional magnetic resonance imaging (fMRI) or positron emission tomography (PET) and remote sexual stimuli, such as visual erotica, have shown increased neural activity in several areas, including the inferior temporal cortex, the orbitofrontal cortex (OFC), the inferior and superior parietal lobules, the cingulate cortex, the anterior cingulate cortex (ACC), the insula, and the hypothalamus. These activation patterns are considered to represent the perceptual-cognitive, emotional, motivational, and physiological (autonomic and endocrinological) components of sexual arousal as proposed in a neurobehavioural and multifaceted model of neural mechanisms for sexual arousal (Redoute et al., 2000, Stoleru et al., 1999). Briefly, the cognitive component comprises a process of appraisal through which a stimulus is categorized as a sexual incentive and quantitatively evaluated as such. The emotional component includes the specific hedonic quality of sexual arousal, i.e., the pleasure associated with rising arousal and with the perception of specific bodily changes. The motivational component comprises the processes that direct behaviour to a sexual goal, including the perceived urge to express overt sexual behaviour. The autonomic and endocrinological components include various responses (e.g. cardiovascular, respiratory, and genital) leading the subject to a state of physiological readiness for sexual behaviour (Krueger et al., 2006). These four components are conceived to be closely interrelated and coordinated (Redoute et al., 2000).
Regarding deviant human sexual behaviour, several case reports on paedophilic patients and two group studies using voxel-based-morphometry described changes in the prefrontal cortex (PFC), the ventral striatum, the amygdala, and the medial temporal cortex (Mendez et al., 2000, Burns and Swerdlow, 2003, Schiffer et al., 2007, Schiltz et al., 2007). One group study using positron emission tomography (PET) also demonstrated a persistently decreased glucose metabolism in the right inferior temporal and superior ventral frontal gyrus (Cohen et al., 2002). Furthermore, two functional magnetic resonance imaging (fMRI) studies showed varying activations during different visual erotic stimulation paradigms (adult stimuli only and adult vs. child stimuli) in two groups of paedophilic forensic inpatient populations (heterosexual paedophiles and homosexual paedophiles). The results of one study comprised the hypothalamus, the periaqueductal gray, and the dorsolateral prefrontal cortex (Walter et al., 2007, for heterosexual paedophiles and adult stimuli), while those of the second study involved different parts of the PFC, the substantia nigra (SN), and the basal ganglia including caudate nucleus (CN), putamen, and pallidum (Schiffer et al., 2008, for homosexual paedophiles and adult vs. child stimuli).
The current study aimed to test for the first time the hypothesis that heterosexual paedophiles show altered neural activity in those brain regions implicated in sexual arousal, especially the OFC, the dorsolateral prefrontal cortex (DLPFC), the ACC, different limbic structures, including the cingulate gyrus, hypothalamus, and amygdala as well as the thalamus and parts of the basal ganglia. Therefore we used functional magnetic resonance imaging (fMRI) to compare neural activity patterns in a group of paedophile inpatients, who were exclusively attracted to female children, and heterosexually oriented control subjects, while viewing pictures of prepubescent girls and adult women in dressed/neutral vs. nude/sexually arousing mode.
Section snippets
Subjects
A group of eight unmedicated heterosexual paedophile patients, who met the DSM-IV (American Psychiatric Association, 1994) criteria for paedophilia and were exclusively attracted to female children, were recruited from two high-security forensic hospitals. All the patients had a history of at least two non-violent child molestations that were not limited to incest. They were additionally assessed in a routine procedure including the Multiphasic Sex Inventory (MSI) (Deegener, 1995), and the
Sexual arousal ratings
Subjects with both paraphilic and non-paraphilic heterosexual preferences rated the sexual stimuli as equivalently sexually arousing (no main effect of group affiliation: F1,18 = 1.207, p < 0.286). However, one significant interaction effect (F1,18 = 15.863, p < 0.001) indicated that both groups reported their preferred sexual stimuli to be more arousing than the non-preferred stimuli. Furthermore, the t statistics calculated separately for paedophiles and controls in the stimulus conditions (girls vs.
Discussion
The current investigation aimed to test the hypothesis that heterosexual paedophiles show altered neural activity in those brain regions implicated in sexual arousal. In contrast to a previous report (Walter et al., 2007), we therefore used functional magnetic resonance imaging (fMRI) to compare the neural activity patterns of a group of eight paedophile inpatients, who were exclusively attracted to female children, and 12 heterosexually oriented control subjects with regard to their preferred
Acknowledgment
This work was supported by a grant from the German Research Foundation (DFG): Sche 432/10-2.
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