Journal of Sexual Aggression

An international, interdisciplinary forum for research, theory and

practice

ISSN: 1355-2600 (Print) 1742-6545 (Online) Journal homepage: http://www.tandfonline.com/loi/tjsa20

Previous judicial detection and paedophilic sexual

interest partially predict psychological distress in
a non-forensic sample of help-seeking men feeling
inclined to sexually offend against children

Anna Konrad, Silvia Haag, Gerold Scherner, Till Amelung & Klaus M. Beier

To cite this article: Anna Konrad, Silvia Haag, Gerold Scherner, Till Amelung & Klaus M. Beier
(2017): Previous judicial detection and paedophilic sexual interest partially predict psychological
distress in a non-forensic sample of help-seeking men feeling inclined to sexually offend against
children, Journal of Sexual Aggression, DOI: 10.1080/13552600.2017.1351264

To link to this article: http://dx.doi.org/10.1080/13552600.2017.1351264

Published online: 28 Jul 2017.

Submit your article to this journal

Article views: 6

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=tjsa20

Download by: [University of Michigan] Date: 03 August 2017, At: 14:03

 JOURNAL OF SEXUAL AGGRESSION, 2017
https://doi.org/10.1080/13552600.2017.1351264

Previous judicial detection and paedophilic sexual interest

partially predict psychological distress in a non-forensic sample of
help-seeking men feeling inclined to sexually offend against
children
Anna Konrad, Silvia Haag, Gerold Scherner, Till Amelung and Klaus M. Beier
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin
Berlin, Berlin, Germany
Downloaded by [University of Michigan] at 14:03 03 August 2017

ABSTRACT ARTICLE HISTORY

Little is known about overall psychological distress in paedophiles who are Received 23 May 2016
not formally involved with the criminal justice system. Since knowledge in Revised 18 May 2017
this context could help to optimise intervention efforts, this study aimed to Accepted 25 June 2017
examine the association between distress as measured with the Brief
KEYWORDS
Symptom Inventory (BSI) and preference- and offence-related variables Child sexual abuse; child
in a sample of N = 455 men self-reporting sexual interest in children, of abusive images;
whom 402 were diagnosed as paedophiles. Results showed that 59% psychological distress;
reported clinically relevant levels of distress, with paedophiles being psychopathology;
significantly more distressed than teleiophiles. A regression analysis paedophilia
revealed that a paedophilic preference and prior detection were relevant
predictors for distress. However, past offending behaviour had no
impact and the major part of variance could not be explained. The
results suggest that paedophilia is associated with distress, but other
factors influence whether a paedophilic man is distressed on a clinically
significant level.

Introduction
In the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric
Association, 2013), “recurrent, intense sexually arousing fantasies, sexual urges, or behaviours invol-
ving sexual activity with a prepubescent child” for a period of at least 6 months (criterion A) qualify for
a paedophilic disorder as long as “the individual has acted on these sexual urges, or the sexual urges
or fantasies cause marked distress or interpersonal difficulty” (criterion B; p. 697). As paedophilic inter-
ests have been found to be an important risk factor for sexual recidivism in child sexual offenders
(Hanson & Morton-Bourgon, 2005), the characteristics and psychopathology of people feeling sexu-
ally attracted to children have been a focus of research in order to learn more about this group and
customise intervention.
In this context, several studies have found high levels of overall psychological impairment (Fisher,
Beech, & Browne, 1999) or comorbid psychiatric disorders in sex offenders with and without paedo-
philia (Dunsieth et al., 2004; Galli et al., 1999; Kafka & Hennen, 2002; Leue, Borchardt, & Hoyer, 2004;
Raymond, Coleman, Ohlerking, Christensen, & Miner, 1999). However, Seto (2008) argued that these
high levels of psychopathology among identified sex offenders could be attributed to a self-selection
effect, since most research relied on forensic samples assumed to exhibit elevated scores of psychia-
tric symptoms. In contrast, less is known about psychological distress and overall psychopathology in

CONTACT Anna Konrad Anna.Konrad@charite.de

© 2017 National Organisation for the Treatment of Abusers
 2 A. KONRAD ET AL.

paedophiles who are not formally involved with the criminal justice system. Although overall psy-
chopathological aspects (e.g. depression and anxiety) are not considered criminogenic needs and
seem not to be related to sexual recidivism (Mann, Hanson, & Thornton, 2010), they are highly
relevant when it comes to therapeutic interventions. For example, strength-based approaches
argue that treatment should not be restricted to addressing dynamic risk factors, but should
rather emphasise the strengths of clients, decrease shame, and increase self-esteem in order to
build resilience to live a healthy and prosocial life (Marshall, Marshall, Serran, & O’Brien, 2011).
Therefore, a better understanding of the relationship of paedophilia and subjective psychological
impairment could improve treatment planning and outcomes. Moreover, it might contribute to
the ongoing discussion on whether paedophilia is actually a mental disorder if persons do not
feel distressed or impaired by their sexual interests and have not yet acted upon them (Gert &
Culver, 2009; Green, 2002; Malón, 2012; Soble, 2004; Wakefield, 2011). Findings on overall psycho-
logical impairment in paedophiles might contribute to answering the questions around prefer-
ence-related distress in paedophiles.
Downloaded by [University of Michigan] at 14:03 03 August 2017

Psychological distress and current psychopathological impairment

A common instrument used to measure subjective psychological impairment in a person seeking
treatment is the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1977) or as a short version,
the Brief Symptom Inventory (BSI; Derogatis, 1993). Based on the concept of patients self-reporting
their symptomatic psychological and somatic impairment, Derogatis (1977) developed the SCL-90-R
and the BSI to measure current psychopathology by asking for the extent of experienced impairment
during a 7-day period before the assessment in terms of nine symptom dimensions and three global
scores. The BSI was developed in order to reduce time exposure for administration; it constitutes a
shortened version of the SCL-90-R and was built by restraining to the 53 SCL-90 items with the stron-
gest factor loadings (Franke, 2000). The items are assigned to one of the nine scales, which are labeled
somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic
anxiety, paranoid ideation, and psychoticism. The global scores allow for an evaluation of overall
psychological impairment (Global Severity Index; GSI), the intensity of the answers (Positive
Symptom Distress Index; PSDI), and the quantity of symptoms with impairment (Positive Symptom
Total; PST). The GSI is a composite measure of psychological distress, and is “the single best indicator
of the respondent’s overall emotional adjustment and psychopathologic status”, with a Cronbach’s
coefficient alpha ranging between .92 and .96 (Derogatis & Melisaratos, 1983, p. 6). However, a
further examination of the nine subscales is warranted to understand the pattern of the patient’s
symptomatology (Derogatis & Melisaratos, 1983). The BSI is considered a reliable measure of psycho-
logical distress and has been administered in a variety of studies assessing overall psychological
impairment for different clinical samples. Based on the German standardisation sample of male
adults, a GSI of 0.62 (which corresponds to a raw score of 33 and a normalised t score of 63) has
been set as the cut-off for clinically significant global psychological distress (Derogatis, 1993). The
German manual (Franke, 2000) lists mean GSI for normal controls (N = 300, M = 0.28, SD = 0.23), psy-
chiatric male inpatients from the US (N = 158, M = 0.97, SD = 0.78), and psychiatric male outpatients
from the US (N = 425, M = 0.28, SD = 0.70).

Findings on psychopathological impairment and distress in paedophiles

The BSI was administered to two paedophilic samples (Beier et al., 2015; Jahnke, Schmidt, Geradt, &
Hoyer, 2015). Beier et al. (2015) assessed 245 paedophilic, hebephilic, and teleiophilic men with
several psychological measures, and found clinically significant averaged GSI scores between 0.80
and 1.06 for paedo-hebephilic individuals. These elevated GSI scores correspond to the findings of
Jahnke, Schmidt, et al. (2015) who assessed stigma-related stress in an online survey and adminis-
tered the BSI in a sample of N = 104 self-identified paedophiles (GSI: M = 0.90; SD = 0.70).
 JOURNAL OF SEXUAL AGGRESSION 3

Although previous research has suggested that paedophilic men display high levels of psycho-
pathological symptoms and overall psychological distress, less is known about factors that could
have an influence on levels of psychological distress. The present study therefore aims to examine
the level of overall psychological distress in self-identified paedophiles. Further, it explores
whether preference and offence-related aspects are related to the level of self-reported psychological
distress.
Based on the findings of previous studies, it was hypothesised that (1) paedophilic men would
exhibit elevated GSI scores when compared with normative controls and with teleiophilic controls
and (2) preference- and offence-related variables (exclusivity of sexual preference, sexual orientation,
other paraphilias, and sexual offending history) could be identified that predict the level of psycho-
logical distress expressed through the GSI.

Method
Downloaded by [University of Michigan] at 14:03 03 August 2017

Procedure
Data for the study were collected between 2005 and 2010 as part of the Prevention Project Dunkel-
feld (PPD) aimed at preventing child sexual abuse and child pornography offences by offering a 1-
year-long cognitive-behavioural treatment to help-seeking paedophiles at risk of (re-)offending
(Beier et al., 2009). The Institutional Review Board of the university clinic, where participants were
assessed and treated, approved the present study. After a complete description of the study to
the participants, written informed consent was obtained.
Respondents underwent a semi-structured clinical interview and completed a psychometric
assessment. The interview aimed at collecting information on inclusion and exclusion criteria by
assessing the participants’ sexual preference and sexual history, including past offending behaviours
(contact and/or child abusive image [CAI] offences). Since Germany does not have a mandatory
reporting law for therapists, participants were able to report past offences undetected by the criminal
justice system without having to fear legal consequences. Inclusion criteria for the study consisted of
a self-identified sexual interest in (pre- and/or early) pubescent children, a minimum age of 18, and
sufficient literacy in the German language. Developmental disabilities were defined as exclusion cri-
teria. Additionally, acute psychiatric conditions (e.g. psychosis and compulsive disorders) were
defined as exclusion criteria for an offer of treatment; these individuals were referred elsewhere.
DSM-5 diagnostic criteria for paedophilia were retroactively applied to the intake assessment data
(two independent clinically experienced raters; interrater reliability alpha = .908). Participants were
diagnosed as having a paedophilic disorder on the basis of their self-reported sexual fantasies invol-
ving children. Paedophilia was diagnosed according to the DSM-5 if the person reported recurrent
sexual thoughts, fantasies, or urges with prepubescent or early pubescent children over a period
of at least 6 months.1 A history of sexual interactions with children without admission of concomitant
sexual thoughts, fantasies, or urges was not considered to be sufficient for the diagnosis. Exclusivity
of sexual preference was coded if either prepubescent or early pubescent children were exclusively
present in sexual fantasies (exclusive paedophilia) or if adults were exclusively part of sexual fantasies
or urges (exclusive teleiophilia). Sexual gender orientation was coded according to the gender pre-
dominantly appearing in the participants’ fantasies during masturbation. Similarly, additional para-
philic interests were dichotomously coded (existing or non-existing) when participants reported
contents to be recurrently part of sexual thoughts, fantasies, or urges.

Measure
As a measure for psychological distress, the German version of the BSI (Derogatis, 1993) was applied
(Franke, 2000). The BSI measures self-reported current psychopathology as participants rate the
extent to which the described symptom has distressed them in the last 7 days. Respondents are
 4 A. KONRAD ET AL.

to rate their experienced distress for 53 items on a 5-point Likert scale ranging from 0 (not at all) to 4
(extremely). Based on these answers, a sum score (sum of all values for each scale) and mean score
(sum score divided by the number of items, range 0–4) can be determined for each of the nine
dimensions. The GSI allows for an evaluation of overall psychological impairment. The GSI can be
computed by adding the scores of all items and then dividing it by the number of responses, and
can thus range from 0 to 4 (Franke, 2000).

Statistical analysis
In the first step, three different sets of group comparisons were conducted. First, all participants were
grouped based on their sexual age preference (exclusive paedophiles, non-exclusive paedophiles,
and exclusive teleiophiles). Second, all paedophilic participants were grouped based on their lifetime
offending behaviour (non-offenders, CAI-only offenders, and hands-on offenders). Third, all offending
paedophilic participants were compared based on their detection status (paedophilic offenders who
Downloaded by [University of Michigan] at 14:03 03 August 2017

were never detected, paedophilic offenders who were detected). Lastly, the teleiophilic subgroup
was compared to all paedophilic offender groups. The groups were compared according to
sociodemographic variables as well as GSI scores and BSI subscales by using analyses of variance.
Holm-corrected post hoc comparisons were made to further analyse statistically significant effects.
For non-parametric post hoc comparisons, chi-square tests were calculated. Cohen’s d and the
respective 95% confidence intervals (CIs) were reported as a measure of effect size. According to
Cohen (1988), d = 0.2 can be considered a small, d = 0.5 a medium, and d = 0.8 a large effect.
To examine further variables that might be associated with clinically significant distress, a logistic
regression was carried out with the whole sample. Clinically significant distress was entered as a
dichotomous-dependent variable according to the proposed cut-off for the GSI raw score of 33
points (significant distress, no significant distress). Exclusivity of sexual preference (yes/no), gender
preference (hetero/homo/bi), existence of additional paraphilias (yes/no), lifetime offence history
(no offence, CAI-only offending, mixed offending), and lifetime detection status (detected/never
detected) were entered as covariates in the analysis. A final model was determined by selecting
the variables that were statistically significant in the full model.
The significance level was set at 0.05 for all analyses. The data were analysed with RStudio Version
0.99.484. In order to compare the data with the standardisation samples of the manual, Cohen’s d was
computed using an online calculation tool (https://www.psychometrica.de/effect_size.html).

Participants
The study sample composed of N = 455 male participants who provided full data on the measure of
psychological distress, sexual body age orientation (i.e. orientation to a specific pubertal status: exclu-
sive teleiophiles, exclusive paedophiles, or non-exclusive paedophiles with additional teleiophilic
interests), and offence history. The mean age of the sample was 38.9 (SD = 11.7, range = 17–81).
Forty-seven percent reported having had at least 11 years of school education, 64% were employed,
and 62% reported to be single. Half of the sample (56%) felt sexually attracted to females, 32% to
males, and 12% to both.
Approximately half of the sample (55%) was diagnosed with a paedophilic disorder, non-exclusive
type and 33% were diagnosed with a paedophilic disorder, exclusive type. Twelve percent did not
fulfil the criteria of a paedophilic disorder, but reported sexual fantasies and impulses exclusively
to adults and were thus coded as exclusive teleiophiles. These participants comprised a teleiophilic
clinical control group; they contacted the project for various reasons including past child abusive
behaviours on the background of other psychiatric problems. One-fourth (n = 13; 24.5%) contacted
the project because of child sexual offences against one or two victims within their family (i.e.
incest offenders), but did not report paedophilic fantasies and were considered non-paedophilic
offenders. One-fifth (n = 12; 22.6%) reported feeling sexually attracted to post-pubertal teens
 JOURNAL OF SEXUAL AGGRESSION 5

(Tanner stage 4), ten men (18.9%) contacted the project on the background of concerns about
another paraphilic disorder, eight men (15.1%) had an obsessive-compulsive disorder, six men
(11.3%) were sent by their partners who were concerned without explicable reasons, and four
men (7.5%) admitted using CAI among other illegal materials due to sensation seeking. Overall, 17
(32.08%) of these teleiophilic participants were considered lifetime non-offenders.
With respect to prior sexual offences, 36 men (8%) from the overall sample reported never having
committed sexual offences against children (non-offender), whereas 130 men (29%) reported CAI
offences while denying any hands-on offences (CAI-only offender), and 289 men reported hands-
on offences against children2 with or without additional CAI offending (referred to as hands-on offen-
ders in the following). Regarding additional paraphilic interests, 34% reported at least one additional
paraphilic content to be of interest concerning their sexuality, with sadism, urophilia, masochism,
fetishism, and voyeurism being the most common ones. This is in line with prevalence rates in the
general population (Joyal, 2015) and in samples of convicted sex offenders (Smallbone & Wortley,
2004).
Downloaded by [University of Michigan] at 14:03 03 August 2017

Results
The mean GSI for the sample was 0.93 (SD = 0.63), which corresponds to a sum of 49.07 (SD = 33.50)
for the GSI score. Fifty-nine percent of participants (n = 267) reported clinically significant levels of
global psychological distress (GSI ≥ 0.62). The mean GSI for the n = 402 paedophiles (exclusive and
non-exclusive) was 0.96 (SD = 0.63). When comparing the GSI of the paedophilic sample with the
GSI of the comparison groups listed in the manual, the paedophilic sample reported a significantly
higher GSI than normal controls (d = 1.36, 95% CI [1.20, 1.53]) and psychiatric male outpatients
(d = 1.02, 95% CI [0.86, 1.17]). No difference was found when comparing the GSI of the paedophilic
sample with the GSI of psychiatric male inpatients (d = 0.02, 95% CI [−0.17, 0.20]).

Group comparisons
The results of the group comparisons based on sexual age preference, exclusivity of sexual prefer-
ence, sexual offending history, and detection status are presented in Table 1 for sociodemographic
differences and Tables 2–4 for the BSI data.

Sexual age preference

As for differences in their self-reported psychological distress, groups categorised according to sexual
age preference showed a significant effect on the GSI score. Post hoc analyses showed that teleio-
philes showed significantly lower overall scores than exclusive paedophiles and non-exclusive pae-
dophiles (Table 2). Exclusivity of sexual preference did not have an impact on the level of reported
distress. Among both the exclusive paedophiles and the non-exclusive paedophiles, a higher ratio
of participants reached the cut-off of 33 for clinically significant psychological distress (62.5% and
60.8%) when compared with the teleiophilic group (37.7%, χ 2(2) = 10.97, p = .004). Compared with
the normative BSI samples, both the paedophilic samples and the teleiophilic sample showed
significantly higher GSIs than normal controls (d = 1.73, 95% CI [1.51, 1.97] for exclusive paedophiles;
d = 1.42, 95% CI [1.24, 1.61] for non-exclusive paedophiles; d = 1.20, 95% CI [0.90, 1.51] for
teleiophiles). When it comes to the subscales of the BSI, groups based on sexual preference
differed on six of the nine subscales (interpersonal sensitivity, depression, anxiety, hostility, paranoid
ideation, psychoticism), with teleiophiles showing significantly lower scores than both paedophilic
groups.

Sexual offending behaviour

The groups categorised according to their lifetime sexual offending behaviour did not show any
differences with respect to the GSI score (d = 0.08, 95% CI [−0.41, 0.59] for paedophilic non-offenders
 6
A. KONRAD ET AL.
Downloaded by [University of Michigan] at 14:03 03 August 2017

Table 1. Group comparisons on sociodemographic data by sexual age preference, lifetime offending behaviour, and detection status.
Lifetime sexual offending behaviour in paedophilic
Sexual age preferencea participantsb Detection statusc
Exclusive Non-exclusive Exclusive CAI-only Hands-on
paedophilia paedophilia teleiophilia Non-offender offender offender Never detected Detected
(n = 152) (n = 250) (n = 53) (n = 19) (n = 115) (n = 268) (n = 244) (n = 139)
Ma (SD) M (SD) M (SD) F(2, 452) Ma (SD) M (SD) M (SD) F(2,399) M (SD) M (SD) t(381)
Age 38.01 (11.69) 38.38 (11.16) 43.57 (13.11) 5.01** 31.11 (10.09) 36.59 (10.79) 39.45 (11.43) 6.67*** 37.02 (11.04) 41.36 (11.28) -3.67***
n (%) n (%) n (%) χ 2 (2) n (%) n (%) n (%) χ 2 (2) n (%) n (%) χ 2 (1)
Years of 70 (46.1) 121 (48.4) 23 (0.43) 0.53 7 (36.8) 66 (57.4) 118 (44.0) 6.67* 124 (67.4) 60 (32.6) 2.08
education > 10
Employed 87 (57.2) 169 (67.6) 34(64.2) 4.4 13 (68.4) 89 (77.4) 154 (57.5) 14.01*** 162 (66.7) 81 (33.3) 2.52
Relationship 36 (23.7) 110 (44.0) 26 (49.1) 19.78*** 7 (36.8) 47 (40.9) 92 (34.3) 1.49 86 (61.9) 53 (38.1) 0.32
Has children 41 (27.0) 83 (33.2) 30 (56.6) 15.48*** 3 (15.8) 30 (26.1) 91 (34.0) 4.46 73 (60.3) 48 (39.7) 0.87
Note: Group allocation was based on asexual age preference (N = 455), bsexual offending history in paedophilic participants (n = 402), and cdetection status among offending paedophilic participants
(n = 383). Mean score differences between the groups are significant at *p < .05, **p < .01, or ***p < .005.
 JOURNAL OF SEXUAL AGGRESSION 7

Table 2. Means and standard deviations (SD) for BSI data for exclusive paedophiles (Pex), non-exclusive paedophiles (Pnex), and
exclusive teleiophiles (Tex).
Cohen’s d (95%
Pex (n = 152) Pnex (n = 250) Tex (n = 53) F(2, 452) Post hoc tests confidence interval)
GSI 0.99 (0.63) 0.94 (0.64) 0.64 (0.55) 6.39** Tex < Pex Tex < Pnex d = 0.57 (0.26–0.89)
d = 0.48 (0.18–0.78)
Somatisation 0.55 (0.59) 0.53 (0.62) 0.37 (0.50) 1.9
Obsessive-compulsive 1.16 (0.75) 1.13 (0.81) 0.88 (0.73) 2.69
Interpersonal sensitivity 1.18 (0.83) 1.15 (0.87) 0.74 (0.75) 5.79** Tex < Pex Tex < Pnex d = 0.54 (0.23–0.86)
d = 0.48 (0.18–0.78)
Depression 1.48 (0.97) 1.37 (1.02) 0.83 (0.81) 8.9*** Tex < Pex Tex < Pnex d = 0.70 (0.38–1.02)
d = 0.55 (0.25–0.85)
Anxiety 0.99 (0.78) 0.97 (0.80) 0.60 (0.63) 5.66** Tex < Pex Tex < Pnex d = 0.52 (0.21–0.84)
d = 0.48 (0.18–0.78)
Hostility 0.74 (0.73) 0.73 (0.60) 0.48 (0.47) 3.78* Tex < Pex Tex < Pnex d = 0.39 (0.07–0.70)
d = 0.43 (0.13–0.73)
Phobic anxiety 0.59 (0.72) 0.56 (0.72) 0.36 (0.66) 2.07
Paranoid ideation 0.99 (0.89) 0.81 (0.74) 0.63 (0.67) 4.83** Tex < Pex Tex < Pnex d = 0.43 (0.11–0.74)
Downloaded by [University of Michigan] at 14:03 03 August 2017

d = 0.25 (0.05–0.54)
Psychoticism 1.16 (0.86) 1.09 (0.83) 0.71 (0.62) 5.93** Tex < Pex Tex < Pnex d = 0.56 (0.24–0.88)
d = 0.48 (0.18–0.78)
Note: Mean score differences between the groups are significant at *p < .05, **p < .01, or ***p < .005.

Table 3. Means and standard deviations (SD) for BSI data for paedophilic non-offenders (PNO), paedophilic CAI-only offenders (PCAI)
and paedophilic hands-on offenders (PHO).
PNO (n = 19) PCAI (n = 115) PHO (n = 268) F(2, 452)
GSI 0.88 (0.58) 0.93 (0.65) 0.98 (0.63) 0.41
Somatisation 0.34 (0.38) 0.55 (0.59) 0.55 (0.62) 1.12
Obsessive-compulsive 1.04 (0.68) 1.10 (0.99) 1.17 (0.79) 0.54
Interpersonal sensitivity 1.30 (0.73) 1.12 (0.92) 1.17 (0.84) 0.43
Depression 1.26 (0.99) 1.46 (1.08) 1.40 (0.96) 0.38
Anxiety 0.74 (0.47) 0.97 (0.80) 1.00 (0.80) 0.95
Hostility 0.68 (0.68) 0.66 (0.57) 0.78 (0.68) 1.74
Phobic anxiety 0.52 (0.73) 0.59 (0.74) 0.57 (0.71) 0.09
Paranoid ideation 0.99 (0.89) 0.72 (0.71) 0.94 (0.83) 3.41*
Psychoticism 1.07 (0.93) 1.16 (0.86) 1.12 (0.83) 0.28
Note: Mean score differences between two groups are significant at *p < .05.

vs. paedophilic CAI-only offenders; d = 0.16, 95% CI [−0.31, 0.63] for paedophilic non-offenders vs.
paedophilic hands-on offenders; d = 0.08, 95% CI [−0.14, 0.30] for paedophilic CAI-only offenders
vs. paedophilic hands-on offenders). Accordingly, the subgroups differed only with respect to the
subscale paranoid ideation, with CAI-only offenders being less paranoid than non-offenders (d =
0.37, 95% CI [0.11, 0.86]) and hands-on offenders (d = 0.37, 95% CI [0.06, 0.50]; Table 3). Compared
with the normative BSI samples, all three offender groups showed significantly higher GSIs than
normal controls (d = 2.28, 95% CI [1.79, 2.78] for non-offenders; d = 1.65, 95% CI [1.41, 1.89] for
CAI-only offenders; d = 1.51, 95% CI [1.32, 1.70] for hands-on offenders).

Detection status
When comparing groups based on their detection status, detected offenders reported a higher level
of distress when compared with those who had never been detected. Moreover, six of the nine sub-
scales (interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideations, psychoticism)
displayed significant differences with respect to detection status, with those who had been detected
showing significantly higher scores when compared to those who had never been detected (Table 4).
Compared with the normative BSI samples, normative controls showed less overall psychological dis-
tress than both the never-detected (d = 1.44, 95% CI [1.25, 1.63]) and the detected (d = 1.85, 95% CI
[1.62, 2.09]) groups.
 8 A. KONRAD ET AL.

Table 4. Means and standard deviations (SD) for BSI data for paedophilic offenders who have never been detected (Pnd) and
paedophilic offenders who have been detected (Pd).
Pnd (n = 244) Pd (n = 139) t(381) Cohen’s d (95% confidence interval)
GSI 0.90 (0.59) 1.09 (0.70) 2.77** d = 0.30 (0.09–0.51)
Somatisation 0.48 (0.58) 0.61 (0.66) 1.36
Obsessive-compulsive 1.11 (0.75) 1.22 (0.86) 1.35
Interpersonal sensitivity 1.07 (0.79) 1.30 (0.97) 2.48** d = 0.27 (0.06–0.48)
Depression 1.33 (0.96) 1.58 (1.05) 2.26* d = 0.25 (0.04–0.46)
Anxiety 0.93 (0.79) 1.10 (0.82) 2.01* d = 0.21 (0.00–0.42)
Hostility 0.69 (0.62) 0.82 (0.70) 1.88
Phobic anxiety 0.51 (0.66) 0.69 (0.79) 2.38* d = 0.25 (0.05–0.46)
Paranoid ideation 0.77 (0.75) 1.07 (0.85) 3.60*** d = 0.38 (0.17–0.59)
Psychoticism 1.03 (0.80) 1.24 (0.92) 2.39* d = 0.25 (0.04–0.46)
Note: Mean score differences between the groups are significant at *p < .05, **p < .01, or ***p < .005.

Table 5. Results of the logistic regression analysis for N = 455.

Downloaded by [University of Michigan] at 14:03 03 August 2017

95% CI for Odds ratio

B (SE) Lower Odds ratio Upper
Step 1
Constant −0.63 (0.29)
Detected 0.45* (0.21) 1.04 1.58 2.38
Exclusive paedophilic preference 1.02** (0.33) 1.45 2.78 5.32
Non-exclusive paedophilic preference 0.89** (0.31) 1.32 2.44 4.50
Note: R 2 = .03 (Cox & Snell), .05 (Nagelkerke). Model χ 2 (3) = 15.54, p = .001. *p < .05; **p < .01.

Comparison of the teleiophilic subgroup with all paedophilic offender groups

When comparing the teleiophilic participants with the paedophilic offender groups based on the GSI,
teleiophilic participants reported significantly less distress when compared to paedophilic CAI offen-
ders (d = 0.47, 95% CI [0.14, 0.80]) and paedophilic hands-on offenders (d = 0.55, 95% CI [0.25, 0.85]).
No differences were found when comparing the teleiophilic participants and paedophilic non-offen-
ders (d = 0.43, 95% CI [−0.10, 0.96]). Also, no differences were found when comparing the non-offend-
ing teleiophilic individuals to non-offending paedophilic individuals (d = 0.49, 95% CI [−0.18, 1.15]).

Logistic regression
The results of the logistic regression analysis are represented in Table 5. The final model accounted
for 5% of the variance in global psychological distress (p = .001). Significant predictors were an exclu-
sive paedophilic sexual preference (p < .01), a non-exclusive paedophilic sexual preference (p < .01),
and previous judicial detection (p < .05). Sexual orientation, additional paraphilic interests, and life-
time offending history were not included in the final model because they had no predictive value
on the presence of clinically significant distress.

Discussion
The present study aimed to assess the level of global psychological distress in self-identified paedo-
philes and to explore whether preference and offence-related aspects are associated with the extent
of the distress. Results found that the included sample self-reported more psychological distress than
normal controls with approximately two-thirds of the sample scoring beyond the cut-off for clinical
significance. With respect to the group comparisons, both paedophilic preference and having been
detected for child sexual or CAI offences were associated with higher levels of overall distress. In
accordance, the regression analysis found paedophilic preference as well as detection status to be
predictive for psychological distress. However, the final model only accounted for a small percentage
of variance.
 JOURNAL OF SEXUAL AGGRESSION 9

These results have to be interpreted on the background of the strengths and limitations of the study
(Docherty & Smith, 1999). The included sample allowed for the assessment of overall psychological dis-
tress in self-identified paedophilic men who were not formally involved with the criminal justice system,
but sought support on their own. As a result, circumstantial factors of imprisonment or criminal prose-
cution that could have an impact on the level of psychological distress in paedophilic individuals can be
excluded, and distress and its relationship to aspects of a paedophilic disorder can be examined.
However, the study suffered from several limitations. First, the present sample is not representative
of all paedophiles, since it included only those seeking help. Men feeling sexually attracted to children
without any feelings of distress might not have contacted the project and therefore would not be
included. This selectivity of the sample considerably limits the interpretability. Second, the procedure
does not allow for causal interpretations due to the correlative character of the data. Thus, we
cannot draw conclusions on the causes of self-reported distress—only on associated factors. Further-
more, teleiophiles included in the study did not consist of normal controls, but of clinical controls
because they contacted a project for the purpose of preventing themselves from engaging in child
Downloaded by [University of Michigan] at 14:03 03 August 2017

sexual abuse, although a sexual interest in children could not be confirmed. While this limits the gen-
eralisability of the study’s results, the choice of this clinical comparison group enabled us to control for
the potential confound of choosing help-seeking paedophiles as the experimental group. A replication
of our results in non-clinical samples of both paedophiles and teleiophiles would allow for a more
general picture. Also, relying on self-reported data for sexual preference, sexual offence history,
and psychological distress limits the comparability to previous research using external assessments.
Finally, comorbid disorders of participants were not systematically assessed, thus preventing
the exploration of their potential impact on distress in this sample. Future studies should therefore
aim to assess psychopathology more specifically to add to these data.

Findings on self-reported distress dependent on sexual preference and offence history

With regard to the intensity of self-reported distress in paedophiles, the results indicate that a large
proportion of self-referring, help-seeking paedophiles report psychological impairment that exceeds
levels deemed clinically significant and are thus comparable to forensic samples (Seto, 2008). When
compared with normal controls and psychiatric outpatients, the paedophilic sample showed an
increased GSI comparable to those of psychiatric inpatients from the US (Derogatis, 1993). Thus,
men with a paedophilic preference seem to bear similar psychological impairment when compared
with other psychiatric disorders and might present with this symptomatology to the healthcare
system. The extent of self-reported distress in the present study corresponds with the results of pre-
vious research on distress in paedophiles (Beier et al., 2015; Jahnke, Schmidt, et al., 2015).
When comparing paedophilic with teleiophilic individuals who contacted the prevention project,
paedophilic men were significantly more distressed than men with an exclusive teleiophilic prefer-
ence. Bearing in mind that these teleiophilic men were also voluntarily contacting a therapy
project to prevent child sexual abuse, the difference in psychopathological impairment appears to
be related to the difference in sexual preference.
The seemingly contradictory non-significant difference between non-offending paedophilic par-
ticipants and teleiophilic participants might be due to the small samples available for the study as
is indicated by the rather large effect sizes of the comparisons. Still, the data suggest that the pae-
dophilic participants are distressed because they have sexually offended against children or have
been detected for their respective offending. Although subgroups based on lifetime offending beha-
viours did not differ with respect to their overall psychological distress, comparisons between tele-
iophilic participants and paedophilic CAI and mixed offenders found the latter groups to report
more distress. Accordingly, the regression analysis showed paedophilic sexual preference and detec-
tion status to be significantly associated with psychological distress.
Overall, the findings of the present study suggest that paedophiles are at greater risk of psycho-
logical distress when compared to normal controls, but the extent of the distress is determined by
 10 A. KONRAD ET AL.

variables additional to the presence of paedophilic sexual preference and prior judicial detection for
sexual offences.
There is an ongoing discussion as to whether paedophilia actually is a mental disorder, since this
would require the preference-related distress to be endogenous and inherently linked to the prefer-
ence disorder instead of exogenous factors (Gert & Culver, 2009; Malón, 2012; Soble, 2004). The pre-
sented data do not allow for interpretations on the existence of a paedophilia-related distress.
However, the results suggest that paedophilic sexual preference does not automatically come
along with psychopathological impairment, but other underlying mechanisms or variables contribute
to distress in paedophilic men. For example, it has been suggested that distress results from the stig-
matisation accompanying this condition (Jahnke, Imhoff, & Hoyer, 2015; Jahnke, Schmidt, et al., 2015),
or the impossibility of experiencing equal and (sexually) fulfilling relationships (Beier & Neutze, 2012;
Faistbauer, 2011). Further, it could be argued that distress differs between offender types. For
example, feelings of shame and guilt could be enhanced in offenders who have had direct sexual
contact with a child, while CAI offenders might instead struggle with addictive behaviours and exces-
Downloaded by [University of Michigan] at 14:03 03 August 2017

sive preoccupations that restrict daily routine and lead to relationship or work-related problems, and
thus to subsequent distress. In a recent study on Internet pornography use in non-clinical samples,
the perceived addiction to pornography was found to be related to various measures of psychologi-
cal distress (Grubbs, Volk, Exline, & Pargament, 2015). However, the global assessment of distress in
the present study does not allow for such differentiated considerations on the quality of reported
distress, and further research is needed to examine the causes of experienced distress in paedophiles.

Conclusion
So far, little is known about the overall psychopathology or psychological distress of paedophiles who
are not formally involved with the criminal justice system. The results of this study suggest that a pae-
dophilic preference is indeed associated with distress in help-seeking paedophiles outside the judi-
cial system, but paedophilia is not sufficient for explaining the intensity of this distress. Besides
previous judicial detection in paedophilic offenders, other factors seem to influence whether a pae-
dophilic man is distressed on a clinically significant level. As therapy programs that aim to stabilise
the social functioning of sexual offenders continue to gain importance, further research is warranted
into exploring factors leading to distress in paedophilic men on the one hand, and preventing feel-
ings of distress on the other.

Notes
1. Note that some of the participants felt attracted to early pubertal rather than prepubescent children, and would
therefore fulfil the criteria for hebephilia as proposed by Blanchard et al. (2009) according to the DSM-5. The DSM-
5 and ICD-10 (World Health Organization [WHO], 1992) differ in diagnostic criteria for paedophilia (DSM-5 refers to
prepubertal children [generally age 13 years or younger], whereas ICD-10 refers to prepubertal or early pubertal
children). Hence, all participants who described sexual interest in children with a bodily development from Tanner
stages 1–3 (prepubertal and early pubertal stage) were diagnosed as paedophiles.
2. Note that according to German law, all minors up to the age of 14 are considered children.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This work was supported by the Volkswagen Foundation [Grant I/79763], the Federal Ministry of Justice and Consumer
Protection [Grant IIA6-2512BMJ009], and the Federal Ministry of Family Affairs, Senior Citizens, Women, and Youth [Grant
IIA6-2509091003].
 JOURNAL OF SEXUAL AGGRESSION 11

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:
Author.
Beier, K. M., Ahlers, C. J., Goecker, D., Neutze, J., Mundt, I. A., Hupp, E., & Schaefer, G. A. (2009). Can pedophiles be reached
for primary prevention of child sexual abuse? First results of the Berlin Prevention Project Dunkelfeld (PPD). The
Journal of Forensic Psychiatry & Psychology, 20(6), 851–867. doi:10.1080/14789940903174188
Beier, K. M., Amelung, T., Kuhle, L., Grundmann, D., Scherner, G., & Neutze, J. (2015). Hebephilia as a sexual disorder.
Fortschritte der Neurologie· Psychiatrie, 83(2), e1–e9.
Beier, K. M., & Neutze, J. (2012). Proactive strategies to prevent the use of child abusive images. In E. Quayle & K. M. Ribisl
(Eds.), Understanding and preventing online sexual exploitation of children (pp. 204–227). New York, NY: Routledge.
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M., Blak, T., … Klassen, P. E. (2009). Pedophilia, hebephilia,
and the DSM-V. Archives of Sexual Behavior, 38(3), 335–350.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Derogatis, L. R. (1977). SCL-90-R, administration, scoring & procedures manual-I for the R(evised) version. Eigendruck: John
Hopkins University School of Medicine.
Derogatis, L. R. (1993). Brief symptom inventory: Administration scoring and procedures manual (3rd ed.). Minneapolis, MN:
Downloaded by [University of Michigan] at 14:03 03 August 2017

National Computer Systems.

Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13,
595–605.
Docherty, M., & Smith, R. (1999). The case for structuring the discussion of scientific papers. BMJ, 318, 1224–1225.
Dunsieth, N. W., Nelson, E. B., Brusman-Lovins, L. A., Holcomb, J. L., Beckman, D., Welge, J. A., … McElroy, S. L.
(2004). Psychiatric and legal features of 113 men convicted of sexual offenses. Journal of Clinical Psychiatry, 65(3),
293–300.
Faistbauer, S. (2011). Dissexualitätsbehandlung im einzeltherapeutischen Setting zur Prävention sexueller Übergriffe auf
Kinder [Dissexuality therapy in a single setting to prevent child sexual abuse] (Unpublished doctoral dissertation).
Charité - Universitätsmedizin Berlin, Germany.
Fisher, D., Beech, A., & Browne, K. (1999). Comparison of sex offenders to nonoffenders on selected psychological
measures. International Journal of Offender Therapy and Comparative Criminology, 43(4), 473–491. doi:10.1177/
0306624X99434006
Franke, G. H. (2000). BSI: Brief symptom inventory von LR Derogati; (Kurzform der SCL-90-R). Göttingen: Beltz Test.
Galli, V., McElroy, S. L., Soutullo, C. A., Kizer, D., Raute, N., Keck, P. E., & McConville, B. J. (1999). The psychiatric diagnoses of
twenty-two adolescents who have sexually molested other children. Comprehensive Psychiatry, 40(2), 85–88.
Gert, B., & Culver, C. M. (2009). Sex, immorality, and mental disorders. Journal of Medicine and Philosophy, 34(5), 487–495.
doi:10.1093/jmp/jhp037
Green, R. (2002). Is pedophilia a mental disorder? Archives of Sexual Behaviour, 32(6), 467–471.
Grubbs, J. B., Volk, F., Exline, J. J., & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological
distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41(1), 83–106. doi:10.1080/0092623X.
2013.842192
Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual offenders: A meta-analysis of reci-
divism studies. Journal of Consulting and Clinical Psychology, 73(6), 1154–1163. doi:10.1037/0022-006X.73.6.1154
Jahnke, S., Imhoff, R., & Hoyer, J. (2015). Stigmatization of people with pedophilia: Two comparatative surveys. Archives of
Sexual Behavior, 44(1), 21–34. doi:10.1007/s10508-014-0312-4
Jahnke, S., Schmidt, A. F., Geradt, M., & Hoyer, J. (2015). Stigma-related stress and its correlates among men with pedo-
philic sexual interests. Archives of Sexual Behavior, 44(8), 2173–2187. doi:10.1007/s10508-015-0503-7
Joyal, C. C. (2015). Defining “normophilic” and “paraphilic” sexual fantasies in a population-based sample: On the impor-
tance of considering subgroups. Sexual Medicine, 3(4), 321–330.
Kafka, M. P., & Hennen, J. (2002). A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-
related disorders. Sexual Abuse, 14(4), 349–366.
Leue, A., Borchardt, B., & Hoyer, J. (2004). Mental disorders in a forensic sample of sexual offenders. European Psychiatry,
19(3), 123–130.
Malón, A. (2012). Pedophilia: A diagnosis in search of a disorder. Archives of Sexual Behavior, 41(5), 1083–1097. doi:10.
1007/s10508-012-9919-5
Mann, R. E., Hanson, R. K., & Thornton, D. (2010). Assessing risk for sexual recidivism: Some proposals on the nature of
psychologically meaningful risk factors. Sexual Abuse, 22(2), 191–217. doi:10.1177/1079063210366039
Marshall, W. L., Marshall, L. E., Serran, G. A., & O’Brien, M. D. (2011). Rehabilitating sexual offenders: A strengths based
approach. Washington, DC: American Psychological Association.
Raymond, N. C., Coleman, E., Ohlerking, R., Christensen, G. A., & Miner, M. (1999). Psychiatric comorbidity in pedophilic sex
offenders. American Journal of Psychiatry, 156(5), 786–788. Retrieved from http://ajp.psychiatryonline.org/doi/pdf/10.
1176/ajp.156.5.786
 12 A. KONRAD ET AL.

Seto, M. (2008). Pedophilia and sexual offending against children: Theory, assessment and intervention. Washington, DC:
American Psychological Association.
Smallbone, S. W., & Wortley, R. K. (2004). Criminal diversity and paraphilic interests among adult males convicted of sexual
offenses against children. International Journal of Offender Therapy and Comparative Criminology, 48, 175–188.
Soble, A. (2004). Paraphilia and distress in DSM-IV. In J. E. Radden (Ed.), The philosophy of psychiatry: A companion (pp. 54–
63). New York: Oxford University Press.
Wakefield, J. C. (2011). DSM-5 proposed diagnostic criteria for sexual paraphilias: Tensions between diagnostic validity
and forensic utility. International Journal of Law and Psychiatry, 34(3), 195–209. doi:10.1016/j.ijlp.2011.04.012
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and
diagnostic guidelines. Geneva: Author.
Downloaded by [University of Michigan] at 14:03 03 August 2017