Changed processing of visual sexual stimuli under GnRH-therapy--a single case study in pedophilia using eye tracking and fMRI
- PMID: 24885644
- PMCID: PMC4036749
- DOI: 10.1186/1471-244X-14-142
Changed processing of visual sexual stimuli under GnRH-therapy--a single case study in pedophilia using eye tracking and fMRI
Abstract
Background: Antiandrogen therapy (ADT) has been used for 30 years to treat pedophilic patients. The aim of the treatment is a reduction in sexual drive and, in consequence, a reduced risk of recidivism. Yet the therapeutic success of antiandrogens is uncertain especially regarding recidivism. Meta-analyses and reviews report only moderate and often mutually inconsistent effects.
Case presentation: Based on the case of a 47 year old exclusively pedophilic forensic inpatient, we examined the effectiveness of a new eye tracking method and a new functional magnetic resonance imaging (fMRI)-design in regard to the evaluation of ADT in pedophiles. We analyzed the potential of these methods in exploring the impact of ADT on automatic and controlled attentional processes in pedophiles. Eye tracking and fMRI measures were conducted before the initial ADT as well as four months after the onset of ADT. The patient simultaneously viewed an image of a child and an image of an adult while eye movements were measured. During the fMRI-measure the same stimuli were presented subliminally. Eye movements demonstrated that controlled attentional processes change under ADT, whereas automatic processes remained mostly unchanged. We assume that these results reflect either the increased ability of the patient to control his eye movements while viewing prepubertal stimuli or his better ability to manipulate his answer in a socially desirable manner. Unchanged automatic attentional processes could reflect the stable pedophilic preference of the patient. Using fMRI, the subliminal presentation of sexually relevant stimuli led to changed activation patterns under the influence of ADT in occipital and parietal brain regions, the hippocampus, and also in the orbitofrontal cortex. We suggest that even at an unconscious level ADT can lead to changed processing of sexually relevant stimuli, reflecting changes of cognitive and perceptive automatic processes.
Conclusion: We are convinced that our experimental designs using eye tracking and fMRI could prospectively add additional and valuable information in the evaluation of ADT in paraphilic patients and sex offenders. But with respect to the limited significance of this single case study, these first results are preliminary and further studies have to be conducted with healthy subjects and patients.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4036749/bin/1471-244X-14-142-1.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4036749/bin/1471-244X-14-142-2.gif)
![Figure 3](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4036749/bin/1471-244X-14-142-3.gif)
![Figure 4](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4036749/bin/1471-244X-14-142-4.gif)
![Figure 5](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/4036749/bin/1471-244X-14-142-5.gif)
Similar articles
-
Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review.J Sex Med. 2018 Jan;15(1):77-93. doi: 10.1016/j.jsxm.2017.11.013. J Sex Med. 2018. PMID: 29289377
-
Eye movements in pedophiles: automatic and controlled attentional processes while viewing prepubescent stimuli.J Abnorm Psychol. 2013 May;122(2):587-599. doi: 10.1037/a0030659. Epub 2012 Dec 3. J Abnorm Psychol. 2013. PMID: 23206281
-
Androgen deprivation therapy of self-identifying, help-seeking pedophiles in the Dunkelfeld.Int J Law Psychiatry. 2012 May-Jun;35(3):176-84. doi: 10.1016/j.ijlp.2012.02.005. Epub 2012 Mar 13. Int J Law Psychiatry. 2012. PMID: 22420933
-
The role of testosterone in sexuality and paraphilia--a neurobiological approach. Part II: testosterone and paraphilia.J Sex Med. 2011 Nov;8(11):3008-29. doi: 10.1111/j.1743-6109.2011.02393.x. Epub 2011 Jul 28. J Sex Med. 2011. PMID: 21797985 Review.
-
Pharmacotherapy of paraphilias with long-acting agonists of luteinizing hormone-releasing hormone: a systematic review.J Clin Psychiatry. 2003 Aug;64(8):890-7. doi: 10.4088/jcp.v64n0806. J Clin Psychiatry. 2003. PMID: 12927003 Review.
Cited by
-
Eye tracking and child sexual offenders: a systematic review.Forensic Sci Res. 2021 Jul 30;6(2):133-140. doi: 10.1080/20961790.2021.1940737. eCollection 2021. Forensic Sci Res. 2021. PMID: 34377570 Free PMC article.
-
Testosterone-Lowering Medication and Its Association With Recidivism Risk in Individuals Convicted of Sexual Offenses.Sex Abuse. 2021 Jun;33(4):475-500. doi: 10.1177/1079063220910723. Epub 2020 Mar 13. Sex Abuse. 2021. PMID: 32167420 Free PMC article.
-
Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review.Front Psychiatry. 2020 Jan 21;10:940. doi: 10.3389/fpsyt.2019.00940. eCollection 2019. Front Psychiatry. 2020. PMID: 32038314 Free PMC article. Review.
-
Pedophilic sex offenders are characterised by reduced GABA concentration in dorsal anterior cingulate cortex.Neuroimage Clin. 2018 Jan 31;18:335-341. doi: 10.1016/j.nicl.2018.01.018. eCollection 2018. Neuroimage Clin. 2018. PMID: 29876253 Free PMC article.
-
Androgen Deprivation Alters Attention to Sexually Provocative Visual Stimuli in Elderly Men.Sex Med. 2017 Dec;5(4):e245-e254. doi: 10.1016/j.esxm.2017.10.001. Sex Med. 2017. PMID: 29150010 Free PMC article.
References
-
- American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Washington D.C: American Psychiatric Publishing; 2000.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical