Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Sexualwissenschaft und Sexualmedizin, Luisenstraße 57, 10117, Berlin, Germany.
J Prev (2022). 2024 Dec;45(6):881-900. doi: 10.1007/s10935-024-00792-0. Epub 2024 Sep 13.
Sexual interest in minors (i.e., pedophilia and hebephilia) is considered a risk factor for Child Sexual Abuse (CSA) and the use of Child Sexual Abuse Material (CSAM). This study examined the long-term development of CSA, CSAM use, associated cognitions, and quality of life among self-referred, help-seeking individuals diagnosed with pedophilic or hebephilic disorder (PHD) outside the judicial system. Of the 110 eligible men who had undergone therapy for PHD due to psychological distress or risk of offending, 56 were available for follow-up assessment 1-11 years after treatment. Behavioral manifestations, offense-supportive cognitions, and quality of life were evaluated using interviews and psychometric measures. At follow-up, 7.7% of participants with a history of CSA had re-offended, whereas 89.1% of previous CSAM users reported recidivism, although with less severe material. No new CSA offenses occurred among those without prior CSA. Treatment led to increased cognitive victim empathy and reductions in CSA-supportive and CSAM-supportive attitudes, but only the latter improvement persisted through follow-up. Participants exhibited elevated CSA-supportive attitudes relative to community norms at all time points and diminished quality of life at follow-up. Pedophilic and hebephilic disorder carry a persistent risk of sexual offending, particularly regarding CSAM use. Therapeutic gains in offense-supportive cognitions may erode over time without ongoing care. A comprehensive public health approach encompassing early detection, prevention, and expanded treatment access that addresses both the risk of reoffending and overall well-being is crucial for reducing sexual victimization and improving mental health outcomes for individuals from this target group.
性偏好于未成年人（即恋童癖和恋少癖）被认为是儿童性虐待（CSA）和使用儿童性虐待材料（CSAM）的风险因素。本研究调查了自我报告、寻求帮助的个体在司法系统之外被诊断为恋童癖或恋少癖障碍（PHD）后，CSA、CSAM 使用、相关认知和生活质量的长期发展情况。在因心理困扰或犯罪风险而接受治疗的 110 名符合条件的患有 PHD 的男性中，有 56 名在治疗后 1-11 年内可进行随访评估。使用访谈和心理计量测量评估行为表现、支持犯罪的认知和生活质量。在随访时，7.7%有 CSA 病史的参与者再次犯罪，而 89.1%以前使用过 CSAM 的参与者报告再次犯罪，尽管材料的严重程度较低。没有 CSA 先前犯罪的参与者没有发生新的 CSA 犯罪。治疗导致 CSA 支持性态度的认知受害者同情增加，并且减少 CSA 支持性和 CSAM 支持性态度，但只有后者的改善在随访中持续存在。与社区规范相比，参与者在所有时间点都表现出 CSA 支持性态度，并且在随访时生活质量下降。恋童癖和恋少癖障碍持续存在性犯罪的风险，特别是关于 CSAM 使用的风险。在没有持续护理的情况下，支持犯罪的认知方面的治疗收益可能会随着时间的推移而减弱。对于减少性受害和改善来自该目标群体的个体的心理健康结果，需要采取全面的公共卫生方法，包括早期发现、预防和扩大治疗机会，既要解决再次犯罪的风险，又要解决整体幸福感。
