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Open Access Case report

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

Kirsten Jordan1*, Peter Fromberger1, Helge Laubinger2, Peter Dechent3 and Jürgen L Müller12

Author Affiliations

1 Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany

2 Asklepios Forensic Psychiatric Hospital of Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany

3 Department of Cognitive Neurology, Georg-August-University Göttingen, Robert-Koch-St. 40, Göttingen 37075, Germany

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BMC Psychiatry 2014, 14:142  doi:10.1186/1471-244X-14-142

Published: 17 May 2014

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.

Keywords:
Pedophilia; Eye movements; Functional magnetic resonance imaging (fMRI); Subliminal; Antiandrogen therapy (ADT)