Background: Sexual interest in children (SIC) is a significant riskfactor for committing sexual offences against children, including child sexual abuse material (CSAM) offences. In addition to the risk of offending, individuals with SIC often experience significant psychological distress and interpersonal difficulties. From a sexual violence prevention perspective, effective and accessible community based treatment options for individuals with identified risk factors for sexual offending are crucial. Furthermore, family members of sexual offenders face substantial emotional, psychological and social strains. Nonetheless, the healthcare needs of close relatives of CSAM offenders remain poorly explored.
Aims: The overall aim of this PhD project is to enhance clinical knowledge of SIC among men seeking outpatient care by comprehensively assessing their clinical profiles, investigating potential neurodevelopmental factors, outlining a methodology for evaluating treatment options, and advancing the understanding of healthcare needs among their close relatives. Specific aims include: (1) to describe the clinical profiles of individuals who contact the national Swedish telephone helpline PrevenTell, with a special focus on those reporting a sexual interest in children; (2) to assess psychiatric comorbidity, cognitive ability, and brain structure in men with a DSM-5 diagnosis of pedophilic disorder (PeD) in comparison with healthy controls (HCs); (3) to design and conduct an initial evaluation of a randomized controlled trial (RCT) to investigate the effectiveness of treatment with fluoxetine and internet-delivered cognitive behavioral therapy (iCBT) for the reduction of problematic sexual behaviors in men with SIC; and (4) to explore the impact on female partners of the discovery that their significant other is suspected of CSAM offences.
Method: In Study I, individuals who called PrevenTell (n = 1,573) were interviewed about sociodemographic characteristics, problematic sexual behavior(s), and mental health. In Study II, men with a DSM-5 diagnosis of PeD (n = 55) were compared to age- and sex-matched HCs (n = 57)on psychiatric measures, cognitive testing, and structural brain imaging measures. In Study III, the methodology of an ongoing RCT was outlined together with initial feasibility data. In Study IV, semi-structured-interviews were conducted with eight women partnered with men participating in Study III.
Results: In Study I, 346 respondents (24%) reported a sexual interest in children; the majority of respondents were men (n = 332; 96%), with amedian age of 33 years (range 16−76). Most reported a preference for girls (n = 260; 80%), with the most common age preference being 11–14 years (n = 123; 43%). The use of CSAM was reported by 215 (63%) respondents and 51 individuals (15%) disclosed a history of committing child sexual abuse (CSA).
In Study II, men with PeD exhibited higher rates of comorbid psychiatric conditions compared to HCs, including clinically significant symptoms of attention-deficit/hyperactivity disorder (ADHD; d = 0.65; p = 0.009) and autism spectrum disorder (ASD; d = 1.57; p < 0.001). Cognitive testing indicated lower full-scale IQ (FSIQ) among the PeD group, although average scores remained within the normative range. Neuroimaging analyses revealed widespread structural brain differences, primarily in regions associated with the default mode network. These patterns remained largely consistent after adjusting for potential confounding variables. Observed neurodevelopmental traits and structural brain differences, together with correlations with lower FSIQ and the 2nd to 4th digit ratio (2D:4D), suggest that neurodevelopmental factors may contribute to the etiology of PeD.
In Study III, interactions with the target population and data collectionare proceeding as planned. Data are also being collected to assess potential selection bias. It is anticipated that approximately one in five men undergoing screening will meet eligibility criteria and be enrolled in the RCT. The most common reasons for exclusion to date are current treatment with selective serotonin reuptake inhibitors (SSRIs) (n = 24;22%) and an elevated risk of committing hands-on child sexual abuse (n= 14; 13%). Participant enrollment began in March 2022 and is ongoing; findings related to the study’s primary aim are therefore not yet available and are not included in this thesis.
In Study IV, female partners of suspected CSAM offenders were found to experience a significant adverse impact on their mental health, including suicidal ideation. There was a subsequent need for crisis support, medical evaluation, and counseling in response to disclosure of their partner’s crime and sexual interest. The results further showed that the women experienced barriers that obstructed their access to healthcare services.
Conclusion: This thesis demonstrates that men with SIC can be reached outside correctional contexts and engaged in non-anonymous outpatient assessment, treatment, and research. Participants frequently presented with complex psychiatric and criminogenic characteristics, including high rates of CSAM use, prior sexual offence convictions, and significant comorbidities such as depression, anxiety, suicidality, and elevated symptoms of neurodevelopmental disorders. Findings highlight both the need for and the feasibility of specialized outpatient services that integrate psychiatric and clinical forensic expertise, alongside comprehensive psychiatric evaluations and tailored treatment strategies. The feasibility of conducting RCTs in this population was demonstrated, providing a foundation for future treatment development. Finally, the results highlight significant psychological distress among partners, emphasizing the need for improved clinical support and targeted interventions for affected close relatives.
Umeå: Umeå University, 2025. , p. 92
Sex Offenses/Prevention and control, Child Abuse, Sexual, Pedophilia, Help-Seeking Behavior, Neurodevelopmental Disorders, Neuroimaging, Fluoxetine, Cognitive Behavioral Therapy, Family, Spouses, Psychological distress, Health Services Accessibility
2025-12-05, Bergasalen, Målpunkt QA, plan 0, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)