Abstract
Current neurological hypotheses of paraphilia posit that sexual deviance is associated with frontal and/or temporal lobe damage. This broad conception is based on few investigations, however, and the first goal of this study was to review the existing data derived from neuropsychiatry, neuroimaging and neuropsychology. It is concluded that although fronto-temporal dysfunctions are sporadically reported among sexual offenders, the evidence is scarce and it might not be specific to this type of offending. The second objective of this investigation was to gather preliminary neuropsychological data with more homogeneous subgroups of sexual offenders. A profile of lower-order executive dysfunctions (e.g. sustained attention and inhibition) and verbal deficits with intact or good capacities for higher-order executive functioning (e.g. reasoning and cognitive flexibility) and visuo-spatial processing was preferentially found among sexual offenders, suggesting basal fronto-temporal anomalies. Importantly, pedophiles were more consistently and severely impaired than rapists of adults. However, this basal fronto-temporal profile is not characteristic of sexual deviance, as it is also found in association with delinquency and criminality in general. Future neuropsychological and brain imaging studies should consider subgroups of sexual offenders and recruit non-sexual violent persons and non-violent individuals in order to disentangle the complex relations between brain anomalies and sexual deviance.
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Absher, J. R., Vogt, B. A., Clark, D. G., Flowers, D. L., Gorman, D. G., Keyes, J. W., et al. (2000). Hypersexuality and hemiballism due to subthalamic infarction. Neuropsychiatry Neuropsychology and Behavioral Neurology, 13, 220–229.
Arnow, B. A., Desmond, J. E., Banner, L. L., Glover, G. H., Solomon, A., Polan, M. L., et al. (2002). Brain activation and sexual arousal in healthy, heterosexual males. Brain, 125, 1014–1023.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.
Bechara, A., Damasio, H., & Damasio, A. R. (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral Cortex, 10, 295–307.
Blanchard, R., Watson, M. S., Choy, A., Dickey, R., Klassen, P., Kuban, M., et al. (1999). Pedophiles: Mental retardation, maternal age, and sexual orientation. Archives of Sexual Behavior, 28, 111–127.
Block, J. (1995). On the relation between IQ, impulsivity, and delinquency: Remarks on the Lynam, Moffitt, and Southnamer-Loeber (1993) interpretation. Journal of Abnormal Psychology, 104, 395–398.
Blumer, D. (1970). Hypersexual episodes in temporal lobe epilepsy. American Journal of Psychiatry, 126, 1099–1106.
Bogaert, A. F. (2001). Handedness, criminality, and sexual offending. Neuropsychologia, 39, 465–469.
Boone, K. B., Ghaffarian, S., Lesser, I. M., Hill-Gutierrez, E., & Berman, N. G. (1993). Wisconsin Card Sorting Test performance in healthy, older adults: Relationship to age, sex, education, and IQ. Journal of Clinical Psychology, 49, 54–60.
Bornstein, R. A. (1985). Normative data on selected neuropsychological measures from a nonclinical sample. Journal of Clinical Psychology, 41, 651–658.
Burns, J. M., & Swerdlow, R. H. (2003). Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign. Archives of Neurology, 60, 437–440.
Cantor, J. M., Blanchard, R., Christensen, B. K., Dickey, R., Klassen, P. E., Beckstead, A. L., et al. (2004). Intelligence, memory, and handedness in pedophilia. Neuropsychology, 18, 3–14.
Cantor, J. M., Blanchard, R., Robichaud, L. K., & Christensen, B. K. (2005). Quantitative reanalysis of aggregate data on IQ in sexual offenders. Psychological Bulletin, 131, 555–568.
Cardebat, D., Doyon, B., Puel, M., Goulet, P., & Joanette, Y. (1990). Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level [in French]. Acta Neurologica Belgica, 90, 207–217.
Casanova, M. F., Mannheim, G., & Kruesi, M. (2002). Hippocampal pathology in two mentally ill paraphiliacs. Psychiatry Research: Neuroimaging, 115, 79–89.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.
Cohen, L. J., Nikiforov, K., Gans, S., Poznansky, O., McGeoch, P., Weaver, C., et al. (2002). Heterosexual male perpetrators of childhood sexual abuse: A preliminary neuropsychiatric model. Psychiatric Quaterly, 73, 313–336.
Cummings, J. L. (1985). Clinical neuropsychiatry. New York: Grune & Stratton.
Cummings, J. L., & Mendez, M. F. (1984). Secondary mania with focal cerebrovascular lesions. American Journal of Psychiatry, 141, 1084–1087.
Davies, B. M., & Morgenstern, F. S. (1960). A case of cysticercosis, temporal lobe epilepsy, and transvestism. Journal of Neurology, Neurosurgery & Psychiatry, 23, 247–249.
Delis, D. C., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan Executive Function System. San Antonio, TX: Psychological Corporation.
Dewhurst, K., Oliver, J. E., & McKnight, A. L. (1970). Socio-psychiatric consequence of Huntington’s disease. British Journal of Psychiatry, 111, 255–258.
Dolan, M., Millington, J., & Park, I. (2002). Personality and neuropsychological function in violent, sexual and arson offenders. Medicine, Science, and the Law, 42, 34–43.
Epstein, A. W. (1961). Relationship of fetishism and transvestism to brain and particularly to temporal lobe dysfunction. Journal of Nervous & Mental Disease, 133, 247–253.
Flor-Henry, P. (1987). Cerebral aspects of sexual deviation. In G. D.Wilson (Eds.), Variant sexuality: Research and theory. Baltimore, MD: John Hopkins University Press.
Flor-Henry, P., Lang, R. A., Koles, Z. J., & Frenzel, R. R. (1991). Quantitative EEG studies of pedophilia. International Journal of Psychophysiology, 10, 253–258.
Frohman, E. M., Frohman, T. C., & Moreault, A. M. (2002). Acquired sexual paraphilia in patients with multiple sclerosis. Archives of Neurology, 59, 1006–1010.
Galski, T., Thornton, K. E., & Shumsky, D. (1990). Brain dysfunction in sex offenders. Journal of Offender Rehabilitation, 16, 65–80.
Ghika-Schmid, F., Assal, G., De Tribolet, N., & Regli, F. (1995). Kluver–Bucy syndrome after left anterior temporal resection. Neuropsychologia, 33, 101–113.
Gillespie, N. K., & Mckenzie, K. (2000). An examination of the role of neuropsychological deficits in mentally disordered sex offenders. The Journal of Sexual Agression, 5, 21–29.
Gorman, D. G., & Cummings, J. L. (1992). Hypersexuality following septal injury. Archives of Neurology, 49, 308–310.
Goul, W. R., & Brown, M. (1970). Effects of age and intelligence on Trail Making Test performance and validity. Perceptual and Motor Skills, 30, 319–326.
Graber, B., Hartmann, K., Coffman, J. A., Huey, C. J., & Golden, C. J. (1982). Brain damage among mentally disordered sex offenders. Journal of Forensic Sciences, 27, 125–134.
Hartmann, M., & Potter, G. (1998). Sources of age differences on the Rey–Osterrieth Complex figure Test. Clinical Neuropsychologist, 12, 513–524.
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtis, G. (1993). Wisconsin Card Sorting Test manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources.
Heaton, R. K., Grant, I., & Matthews, C. G. (1986). Differences in neuropsychological test performance associated with age, education, and sex. In I. Grant, & K. Adhams (Eds.), Neuropsychological assessment of neuropsychiatric disorders. NewYork: Oxford University Press.
Hendricks, S. E., Fitzpatrick, D. F., Hartmann, K., Quaife, M. A., Stratbucker, R. A., & Graber, B. (1988). Brain structure and function in sexual molesters of children and adolescents. Journal of Clinical Psychiatry, 49, 108–112.
Hoenig, J., & Kenna, J. C. (1979). EEG abnormalities and transsexualism. British Journal of Psychiatry, 134, 293–300.
Hucker, S., Langevin, R., Dickey, R., Handy, L., Chambers, J., & Wright, S. (1988). Cerebral damage and dysfunction in sexually aggressive men. Annals of Sex Research, 1, 33–47.
Hucker, S., Langevin, R., Wortzman, G., Bain, J., Handy, L., Chambers, J., et al. (1986). Neuropsychological impairment in pedophiles. Canadian Journal of Behavioral Sciences, 18, 440–448.
Hunter, R., Logue, V., & McMenemy, W. H. (1963). Temporal lobe epilepsy supervening on longstanding transvestism and fetishism. Epilepsia, 4, 60–65.
Huws, R., Schubsachs, A. P. W., & Taylor, P. J. (1991). Hypersexuality, fetishism and multiple sclerosis. British Journal of Psychiatry, 158, 280–281.
Kelly, T., Richardson, G., Hunter, R., & Knapp, M. (2002). Attention and executive function deficits in adolescent sex offenders. Neuropsychological Development and Cognition, Section C. Child Neuropsychology, 8, 138–143.
King, M. C. (1981). Effects of non-focal brain dysfunction on visual memory. Journal of Clinical Psychology, 37, 638–643.
Kolarsky, A., Freund, K., Machek, J., & Polak, O. (1967). Male sexual deviation. Association with early temporal lobe damage. Archives of General Psychiatry, 17, 735–743.
Krafft-Ebing, R. V. (1886/1965). Psychopathia sexualis. (english translation). New York: Putnam.
Lang, R. A. (1993). Neuropsychological deficits in sexual offenders: Implications for treatment. Sexual and Marital Therapy, 8, 181–200.
Langevin, R. (1990). Sexual anomalies and the brain. In: W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assaults. New York: Plenum.
Langevin, R., Bain, J., Ben-Aron, M. H., Coulthard, R., Day, D., Handy, L., et al. (1985). Sexual aggression: Constructing a predictive equation. A controlled pilot study. In R. Langevin (Ed.), Erotic preference, gender identity, and aggression in men: New research studies. Hillsdale, NJ: Erlbaum.
Langevin, R., Ben-Aron, M. H., Wortzman, G., Dickey, R., & Handy, L. (1987). Brain damage, diagnosis, and substance abuse among violent offenders. Behavioral Sciences and the Law, 5, 77–94.
Langevin, R., Ben-Aron, M. H., Wright, P., Marchese, V., & Handy, L. (1988a). The sex killer. Annals of Sex Research, 1, 263–301.
Langevin, R., Lang, R. A., Wortzman, G., Frentzel, R. R., & Wright, P. (1989b). An examination of brain damage and dysfunction in genital exhibitionists. Annals of Sex Research, 2, 77–87.
Langevin, R., Wortzman, G., Dickey, R., Wright, P., & Handy, L. (1988b). Neuropsychological impairment in incest offenders. Annals of Sex Research, 1, 401–415.
Langevin, R., Wortzman, G., Wright, P., & Handy, L. (1989a). Studies of brain damage and dysfunction in sex offenders. Annals of Sex Research, 2, 163–179.
Lesniak, R., Szymusik, A., & Chrzanowski, R. (1972). Case report: Multidirectional disorders of sexual drive in a case of brain tumor. Forensic Science, 1, 333–338.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th Ed). New York: Oxford University Press.
Marlowe, W. B., Mancall, E. L., & Thomas, J. J. (1975). Complete Klüver–Bucy syndrome in man. Cortex, 11, 53–59.
Martin, J. E. (1999). Assessment of executive functions in sexual offenders. Dissertation Abstracts International: Section B: The Sciences & Engineering, 59 (10-B), 5580. US: University Microfilms International.
Mega, M. S., & Cummings, J. L. (1994). Frontal-subcortical circuits and neuropsychiatric disorders. The Journal of Neuropsychiatry and Clinical Neurosciences, 6, 358–370.
Mendez, M. F., Chow, T., Ringman, J., Twitchell, G., & Hinkin, C. H. (2000). Pedophilia and temporal lobe disturbances. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 71–76.
Mendez, M. F., O’Connor, S. M., & Lim, G. T. (2004). Hypersexuality after right pallidotomy for Parkinson’s disease. Journal of Neuropsychiatry and Clinical Neuroscience, 16, 37–40.
Miller, A. D. (1998). Executive function deficits in incarcerated adolescent sexual offenders as measured by the Wisconsin Card Sorting Test. Dissertation Abstracts International: Section B: The Sciences & Engineering, 58 (12-B), 6817. US: University Microfilms International.
Miller, B. L., Cummings, J. L., McIntyre, H., Ebers, G., & Grode, M. (1986). Hypersexuality or altered sexual preference following brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 49, 867–873.
Milner, B. (1963). Effects of different brain lesions on card sorting: The role of the frontal lobes. Archives of Neurology, 9, 90–100.
Mitchell, W., Falconer, M. A., & Hill, D. (1954). Epilepsy with fetishism relieved by temporal lobectomy. Lancet, 267, 626–630.
Mitrushina, M., Boone, K. B., & D’Elia, L. F. (2005). Handbook of Normative Data for Neuropsychological Assessment (2nd Ed). New York: Oxford University Press.
Monga, T. N., Monga, M., Raina, M. S., & Hardjasudarma, M. (1986). Hypersexuality in stroke. Archives of Physical Medicine and Rehabilation, 67, 415–417.
O’Carroll, R. (1989). A neuropsychological study of sexual deviation. Sexual and Marital Therapy, 4, 59–63.
Ortego, N., Miller, B. L., Itabashi, H., & Cummings, J. L. (1993). Altered sexual behavior with multiple sclerosis: A case report. Neuropsychiatry Neuropsychology, and Behavioral Neurology, 6, 260–264.
Raine, A. (1993). The psychopathology of crime. Criminal Behavior as a Clinical Disorder. New York: Academic Press.
Raine, A., & Buchsbaum, M. S. (1996). Violence, brain imaging, and neuropsychology. In D. Stoff, & R. B. Cairns (Eds.), Aggression and violence: Genetic, neurobiological, and biosocial perspectives. New York: Erlbaum.
Redouté, J., Stoleru, S., Gregoire, M. C., Costes, N., Cinotti, L., Lavenne, F., et al. (2000). Brain processing of visual sexual stimuli in human males. Human Brain Mapping, 11, 162–177.
Regestein, Q. R., & Reich, P. (1978). Pedophilia occurring after onset of cognitive impairment. Journal of Nervous and Mental Disease, 166, 794–798.
Rubenstein, J. A. (1992). Neuropsychological and personality differences between controls and pedophiles. Dissertation Abstracts International, Section B—The Science and Engineering, 53 (5-B), 2553. US: University Microfilms International.
Ruffolo, L. F., Guilmette, T. J., & Willis, W. G. (2000). Comparison of time and error rates on the Trail Making Test among patients with head injuries, experimental malingerers, patients with suspect effort testing, and normal controls. Clinical Neuropsychologist, 14, 223–230.
Ryan, J. J., Paolo, A. M., & Findley, G. (1991). Percentile rank conversion tables for WAIS-R IQs at six educational levels. Journal of Clinical Psychology, 47, 104–107.
Schreiber, H. E., Javorsky, D. J., Robinson, J. E., & Stern, R. A. (1999). Rey-Osterrieth Complex Figure performance in adults with attention deficit hyperactivity disorder: A validation study of Boston Qualitative Scoring System. Clinical Neuropsychologist, 13, 509–520.
Scott, M. L., Cole, J. K., McKay, S. E., Golden, C. J., & Liggett, K. R. (1984). Neuropsychological performance of sexual assaulters and pedophiles. Journal of Forensic Sciences, 29, 1114–1118.
Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests (2nd edn.). New York: Oxford University Press.
Starkstein, S. E., & Kremer, J. (2001). The disinhibition syndrome and frontal-subcortical circuits. In D. G. Lichter & J. L. Cummings (Eds.), Frontal-subcortical circuits in psychiatric and neurological disorders (pp. 163–176). New York: The Guilford Press.
Stein, D. J., Black, D. W., & Pienaar, W. (2000a). Sexual disorders not otherwise specified: Compulsive, addictive or impulsivity? CNS Spectrum, 5, 60–64.
Stein, D. J., Hugo, F., Oosthuizen, P., Hawkridge, S. M., & Van Heerden, B. (2000b). Neuropsychiatry of hypersexuality. CNS Spectrums, 5, 36–46.
Stoleru, S., Redouté, J., Costes, N., Lavenne, F., Bars, D.L., Dechaud, H., et al. (2003). Brain processing of visual sexual stimuli in men with hypoactive sexual desire disorder. Psychiatry Research: Neuroimaging, 124, 67–86.
Stone, M. H., & Thompson, E. H. (2001). Executive function impairment in sexual offenders. The Journal of Individual Psychology, 57, 51–59.
Stratta, P., Rossi, A., Mancini, F., Cupillari, M., Mattei, P., & Casacchia, M. (1993). Wisconsin Card Sorting Test performance and educational level in schizophrenic and control samples. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 6(3), 149–153.
Stuss, D. T., & Knight, R. T. (Eds.) (2002). Principles of frontal lobe function. New York: Oxford Press.
Toone, B. K., Edeh, J., Nanjee, M. N., & Wheeler, M. (1989). Hyposexuality and epilepsy: A community survey of hormonal and behavioural changes in male epileptics. Psychological Medicine, 19, 937–943.
Volavka, J. (2002). Neurobiology of violence. (2nd ed.). Washington: American Psychiatric Publishing.
Waismann, R., Fenwick, P. B., Wilson, G. D., Hewett, T. D., & Lumsden, J. (2003). EEG responses to visual erotic stimuli in men with normal and paraphilic interests. Archives of Sexual Behavior, 32, 135–144.
Walinder, J. (1965). Transvestism, definition and evidence in favor or occasional deviation from cerebral dysfunction. International Journal of neuropsychiatry, 1, 567–573.
Ward, T., & Beech, A. (2006). An integrated theory of sexual offending. Aggression and Violent Behavior, 11, 44–63.
Wiens, A. N., Tindall, A. G., & Crossen, J. R. (1994). California verbal learning test: A normative data study. The Clinical Neuropsychologist, 8, 75–90.
Wright, P., Nobrega, J., Langevin, R., & Wortzaman, G. (1990). Brain density and symmetry in pedophilic and sexually aggressive offenders. Annals of Sex Research, 3, 319–328.
Yeudall, L. T., & Fromm-Auch, D. (1979). Neuropsychological impairments in various psychopathological populations. In J. Gruzelier, & P. Flor-Henry (Eds.), Hemisphere asymmetries of function in psychopathology. New York: Elsevier.
Zasler, N. D. (1994). Sexual dysfunction. In J. M. Silver, S. C. Yudofsky, & R. E. Hales (Eds.), Neuropsychiatry of traumatic brain injury. Washington: American Psychiatric Press.
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The authors express their gratitude to Carine Doucet, M.Ps. for her assistance with the neuropsychological assessments.
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Joyal, C.C., Black, D.N. & Dassylva, B. The Neuropsychology and Neurology of Sexual Deviance: A Review and Pilot Study. Sex Abuse 19, 155–173 (2007). https://doi.org/10.1007/s11194-007-9045-4
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DOI: https://doi.org/10.1007/s11194-007-9045-4