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在“暗数”中预防儿童性虐待:一项需要因地制宜科学的公共卫生要务——对柯尼希(2025年)的回应

Preventing Child Sexual Abuse in the 'Dunkelfeld': A Public Health Imperative Requiring Context-Appropriate Science-A Response to König (2025).

作者信息

Beier K M, von Heyden M, Nentzl J, Amelung T

机构信息

Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.

出版信息

J Prev (2022). 2025 Jun 27. doi: 10.1007/s10935-025-00859-6.

Abstract

König's (2025) critique of the German Prevention Project Dunkelfeld mis-applies standards developed for adjudicated ("Hellfeld") offenders to a voluntary, non-forensic prevention setting. We clarify why context-appropriate science is essential for evaluating interventions that reach individuals whose child sexual abuse (CSA) behaviour remains hidden from the justice system. First, the large gap between official recidivism and high self-reported offending is not methodological failure but strong evidence of the well-documented "dark figure" of undetected sexual crime. Second, Germany's unique legal framework (§ 65d SGB V; § 203 StGB) enables confidential, face-to-face treatment and pharmacological options that are infeasible in jurisdictions with mandatory reporting, making Dunkelfeld programmes a public-health imperative. Third, forensic risk tools and the CODC (2007) guidelines lack demonstrated validity for voluntary help-seekers; carefully collected self-report and dynamic risk-factor change therefore constitute the only context-relevant outcome metrics. Fourth, concerns about iatrogenic effects must be interpreted through the Risk-Need-Responsivity lens: specialised, multi-modal interventions such as the Berlin Dissexuality Therapy (BEDIT) show beneficial changes in cognitive and behavioural risk markers, mirroring findings from recent RCTs of internet-delivered CBT and pharmacological therapy. Finally, all German model sites are currently undergoing an independent, multi-year evaluation commissioned by the national health-insurance association. We conclude that preventing CSA and CSAM requires embracing rigorous yet context-sensitive methodologies rather than importing standards that overlook the dark figure. The ethical imperative to prevent harm and offer help to those at risk persists even acknowledging that no intervention guarantees universal success, demanding our most contextually sensitive scientific efforts.

摘要

柯尼希(2025年)对德国“暗场”预防项目的批评,将为已判决(“明场”)罪犯制定的标准错误地应用于一个自愿的、非法医的预防环境。我们阐明了为什么适合具体情境的科学对于评估针对那些其儿童性虐待(CSA)行为仍未被司法系统察觉的个体的干预措施至关重要。首先,官方再犯率与高自我报告犯罪率之间的巨大差距并非方法上的失败,而是未被发现的性犯罪中充分记录的“暗数”的有力证据。其次,德国独特的法律框架(《社会法典》第五编第65d条;《刑法典》第203条)允许进行保密的面对面治疗和药物治疗选择,但在有强制报告要求的司法管辖区这些是不可行的,这使得“暗场”项目成为一项公共卫生要务。第三,法医风险工具和《罪犯矫正与释放委员会》(2007年)指南对自愿寻求帮助者缺乏已证明的有效性;因此,仔细收集的自我报告和动态风险因素变化构成了唯一与情境相关的结果指标。第四,对医源性影响的担忧必须通过“风险-需求-反应性”视角来解读:诸如柏林双性恋治疗(BEDIT)这样的专门的多模式干预措施在认知和行为风险指标上显示出有益变化,这与近期网络提供的认知行为疗法和药物治疗的随机对照试验结果相符。最后,所有德国示范站点目前都在接受由国家医疗保险协会委托进行独立的多年评估。我们得出结论,预防儿童性虐待和儿童性虐待材料(CSAM)需要采用严谨但对情境敏感的方法,而不是引入忽视暗数的标准。即使承认没有一种干预措施能保证普遍成功,但预防伤害并向处于风险中的人提供帮助的道德要求依然存在,这需要我们做出最符合情境的科学努力。

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