Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
ANOVA, Karolinska University Hospital, Stockholm, Sweden.
Acta Psychiatr Scand. 2021 Apr;143(4):363-374. doi: 10.1111/acps.13273. Epub 2021 Jan 22.
Pedophilic disorder (PD) is characterized bypersistent, intense sexual attraction to prepubertal children that the individual has acted on, or causes marked distress or interpersonal difficulty. Although prior research suggests that PD has neurodevelopmental underpinnings, the evidence remains sparse. To aid the understanding of etiology and treatment development, we quantified neurobiological and clinical correlates of PD.
We compared 55 self-referred, help-seeking, non-forensic male patients with DSM-5 PD with 57 age-matched, healthy male controls (HC) on clinical, neuropsychological, and structural brain imaging measures (cortical thickness and surface area, subcortical and white matter volumes). Structural brain measures were related to markers for aberrant neurodevelopment including IQ, and the 2nd to 4th digit ratio (2D:4D).
PD was associated with psychiatric disorder comorbidity and ADHD and autism spectrum disorder symptoms. PD patients had lower total IQ than HC. PD individuals exhibited cortical surface area abnormalities in regions belonging to the brain's default mode network and showed abnormal volume of white matter underlying those regions. PD subjects had smaller hippocampi and nuclei accumbens than HC. Findings were not related to history of child-related sexual offending. IQ correlated negatively with global expression of PD-related brain features and 2D:4D correlated with surface area in PD.
In the largest single-center study to date, we delineate psychiatric comorbidity, neurobiological and cognitive correlates of PD. Our morphometric findings, their associations with markers of aberrant neurodevelopment, and psychiatric comorbidities suggest that neurodevelopmental mechanisms are involved in PD. The findings may need consideration in future development of clinical management of PD patients.
恋童癖障碍（PD）的特征是对青春期前儿童持续、强烈的性吸引，个体已经采取了行动，或导致明显的痛苦或人际困难。尽管先前的研究表明 PD 具有神经发育基础，但证据仍然很少。为了帮助理解病因和治疗发展，我们量化了 PD 的神经生物学和临床相关性。
我们将 55 名自我报告、寻求帮助、非法医男性 PD 患者与 57 名年龄匹配的健康男性对照组（HC）进行比较，比较了临床、神经心理学和结构脑成像测量值（皮质厚度和表面积、皮质下和白质体积）。结构脑测量值与异常神经发育的标志物有关，包括智商和第 2 至第 4 指比率（2D：4D）。
PD 与精神障碍共病和 ADHD 及自闭症谱系障碍症状有关。PD 患者的总智商低于 HC。PD 患者在属于大脑默认模式网络的区域中存在皮质表面积异常，并显示这些区域下的白质体积异常。PD 患者的海马体和伏隔核比 HC 小。研究结果与与儿童相关的性犯罪史无关。智商与 PD 相关脑特征的总体表达呈负相关，2D：4D 与 PD 的表面积呈正相关。
在迄今为止最大的单中心研究中，我们描绘了 PD 的精神共病、神经生物学和认知相关性。我们的形态计量学发现及其与异常神经发育标志物的关联，以及精神共病，表明神经发育机制与 PD 有关。这些发现可能需要在未来 PD 患者的临床管理中加以考虑。
