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Commentary on Kärgel and colleagues' study: diminished functional connectivity on the road to child sexual abuse in pedophilia.

Pedophilic sexual interest has always been viewed with fear but also with amazement. Scientists and clinicians have tried to enter the pedophile’s mind for many years. Insights on pedophilia have been collected by different means; some findings relay upon anecdotal evidence, and others result from well-established scientific protocols usually assuming a correlational nature. More recently, there’s been an attempt to look into the pedophile’s mind and motivations through a neurobiological perspective. Experimental designs aimed at mapping neural activity in pedophiles are certainty expected to add value information on the nature of this paraphilia offering professionals new targets for clinical and social interventions. Another topic of interest within pedophilia is the fact that not all pedophiles abuse children. Only some act upon their sexual interests and urges. The causes underpinning this distinction are far misunderstood. Yet this seems to be a major issue as the prevention of sexual victimization may somehow be improved by a better knowledge on these—apparently—distinct profiles. Nonetheless, this question has been neglected. Until now . . . The Journal of Sexual Medicine is publishing a ground-breaking study targeting this very issue. This study, conducted by C. Kärgel, C. Massau, S. Weiß, M. Walter, T.H.C. Kruger, and B. Schiffer, is aimed at deepening the knowledge on the neurobiology of pedophilia. A particular focus is given to the neurobiological underpinnings differentiating pedophilia with and without real child sexual abuse. The authors used functional magnetic resonance imaging (fMRI) to compare functional connectivity at rest (RSFC), both in the default mode and limbic networks. Three samples were used: pedophiles committing child sexual abuse (n = 12), pedophiles reporting no criminal record (n = 14), and normal controls (n = 14). Whereas a few studies using fMRI in pedophilia have been conducted recently, this is possibly the first one mapping brain activity while considering for the presence versus absence of child sexual abuse. The methodology (which in this case goes hand in hand with technology) and the level of specificity undertaken are, to my view, the strength of this study. Findings on the neurobiology of this paraphilia showed that pedophiles with a record of child sexual abuse presented diminished functional connectivity at rest in both networks in relation to the other groups; furthermore, these networks are known for their role in shaping how one perceives social and emotional awareness of others. This process of social/emotional cognition, known as theory of mind, has been adopted by some as a framework to conceptualize child sexual offending (cf. Keenan and Ward [1]). Kärgel and colleagues’ study provides new and solid answers to old questions. Further, and despite its experimental nature, the clinical implications of these findings are rich; for those working in the clinical and/or forensic settings, this study points value rehabilitation targets for individuals acting upon their pedophilic urges. Based on the present findings, interpersonal functioning seems a key target. One possible limitation of this study is the age difference between the groups. Those committing child sexual abuse were significantly older. In spite of this, the authors reported that RSFC was not related to age differences. After so many years digging into the pedophile’s mind, a little bit has been revealed. So, we will wait for the authors’ next chapter.