Changed processing of visual sexual stimuli under GnRH-therapy – a single case study in pedophilia using eye tracking and fMRI

Abstract

BackgroundAntiandrogen 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 presentationBased 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.ConclusionWe 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.

Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review

“…Based on the results of these three case studies, it can be assumed that TLT leads to a decreased activation in brain regions linked with sexual functions, especially with regard to the autonomic, the emotional, and the motivational component of sexual arousal (101)(102)(103). Results of an additional fMRI case study, in which visual sexual stimuli were presented subliminally further indicate that even at an unconscious level, TLT can lead to changes in the processing of sexually relevant stimuli, supposedly reflecting changes in cognitive and perceptive automatic processes (104). Next to fMRI, also eye tracking can be used to depict TLT induced changes.…”

“…Next to fMRI, also eye tracking can be used to depict TLT induced changes. In an eye movement study with a single pedophilic CSO who was presented with pedophilic stimuli, it was found that controlled attentional processes could change under TLT whereas automatic processes remained mostly stable (104). Obviously, case studies can only provide anecdotal evidence for the usability of potential biomarkers.…”

Testosterone-Lowering Medication and Its Association With Recidivism Risk in Individuals Convicted of Sexual Offenses

“…Several studies have shown that CPA, MPA, and GnRH-agonists are all able to reduce sex drive as well as nondeviant and deviant sexual fantasies and behaviors ( Ahn et al, 2013 ; Bradford & Pawlak, 1993 ; Bussmann & Finger, 2009 ; Cooper, 1981 ; Jordan et al, 2014 ; Koo et al, 2014 ; Moulier et al, 2012 ; Rösler & Witztum, 1998 ; Schober et al, 2005 ; Turner et al, 2013 ). Previous meta-analyses about the effectiveness of treatment on the rate of recidivism of individuals who committed sexual offenses have reported medium effect sizes for both hormonal treatments and cognitive behavioral therapy ( Hall, 1995 ; Lösel & Schmucker, 2005 ).…”

Androgen Deprivation Alters Attention to Sexually Provocative Visual Stimuli in Elderly Men

“… 25 This suggests a key role for T levels in facilitating sexual interest in men. Aside from 1 recent case study of a man receiving AD as treatment for pedophilia, 27 we are unaware of any studies that have directly investigated cognitive processing of sexual stimuli in hypogonadal men. Conversely, men with sexual dysfunction can show decreased visual attention to sexual images, 28 demonstrating that altered sexual cognition also can occur in this population.…”