Zusammenfassung
Neurobiologische Befunde bei Patienten mit der Diagnose einer Pädophilie liegen kaum vor. Wir berichten über erste Befunde unter Einsatz der funktionellen Kernspintomographie (fMRI) bei einem sich im Maßregelvollzug befindenden psychisch kranken Straftäter mit der Diagnose einer homosexuellen Pädophilie. Die funktionelle Kernspintomographie ermöglicht nichtinvasiv die Darstellung zerebraler Aktivierungsmuster bei der Präsentation definierter Stimuli. Obwohl der Patient in der Selbsteinschätzung die gezeigten Bilder als sexuell nicht stimulierend einschätzte, ergab sich bei der Präsentation des Bildmaterials mit individuell bedeutsamen Stimuli (mit Unterwäsche bekleidete Jungen) eine starke Aktivierung in neuronalen Netzwerken, die für Aufmerksamkeit sowie affektive Erregung bedeutsam sind. Im Gegensatz zu gesunden Kontrollpersonen zeigte sich gleichzeitig dabei keine Aktivierung in sprachrelevanten Hirnregionen. Die Ergebnisse werden im Kontext der bei dem Patienten auch umfangreich erhobenen neuropsychologischen Testergebnisse und der verfügbaren Literatur diskutiert.
Abstract
Pedophilia is a complex bio-psycho-social disorder often associated with serious offending. Knowledge about neurobiological correlates that could serve as diagnostic and maybe even as prognostic markers is limited. FMRI examination, which shows neuronal activation in vivo and therefore represents a neurobiological correlate, was not done in pedophilia so far. We report on results of an fMRI examination in a homosexual pedophilic sex offender who differed significantly in neuronal activation during exposure to arousing visual material (young boys in underwear) from normal controls. In self assessment on a visual analogous scale the pedophilic offender scored the pictures of the boys as not being interesting and sexually not stimulating. Nevertheless presentation of the pictures of the boys resulted in the pedophilic offender in a significant activation of the attention network and the right orbitofrontal cortex. In contrast to the controls there was no activation of left hemispheric areas relevant for speech. The study design will be continued in a larger sample to examine whether there is a possible neurobiological correlate of pedophilia which can be changed by therapeutic interventions.
Literatur
1
Ames M A, Houston D A.
Legal, social, and biological definitions of pedophilia.
Arch Sex Behav.
1990;
19
333-342
2 Pfäfflin F. Sexualstraftaten. In: Venzlaff U, Foerster K (Hrsg.). Psychiatrische Begutachtung München: Urban und Fischer 2000: 241-267
3
Abel G G, Becker J V, Cunningham-Rathner J, Mittelman M, Rouleau J L.
Multiple paraphilic diagnoses among sex offenders.
Bull Am Acad Psychiatry Law.
1988;
16
153-168
4 Schorsch E. Sexualstraftäter. Stuttgart: Enke 1971
5 Giese H. Psychopathologie der Sexualität. Stuttgart: Enke 1962
6 Money J. Lovemaps. New York: Buffalo 1986
7
Gaffney G R, Lurie S F, Berlin F S.
Is there familial transmission of pedophilia?.
J Nerv Ment Dis.
1984;
172
546-548
8
Comings D E.
Role of genetic factors in human sexual behavior based on studies of Tourette syndrome and ADHD probands and their relatives.
Am J Med Genet.
1994;
54
227-241
9
Perilstein R D, Lipper S, Friedman L J.
Three cases of paraphilias responsive to fluoxetine treatment.
J Clin Psychiatry.
1991;
52
169-170
10
Kafka M P.
A monoamine hypothesis for the pathophysiology of paraphilic disorders.
Arch Sex Behav.
1997;
26
343-358
11
Gaffney G R, Berlin F S.
Is there hypothalamic-pituitary-gonadal dysfunction in paedophilia? A pilot study.
Br J Psychiatry.
1984;
145
657-660
12
Rösler A, Witzum E.
Treatment of men with paraphilia with a long-acting analogue of gonadotropin releasing hormone.
New England Journal of Medicine.
1998;
338
416-422
13
Briken P, Berner W, Noldus J, Nika E, Michl U.
Leuprorelinacetat bei Paraphilien und sexuell aggressiven Impulshandlungen.
Nervenarzt.
2000;
71
380-385
14
Mendez M F, Chow T, Ringman J, Twitchell G, Hinkin C H.
Pedophilia and temporal lobe disturbances.
J Neuropsychiatry Clin Neurosci.
2000;
12
71-76
15
Flor-Henry P, Lang R A, Koles Z J, Frenzel R R.
Quantitative EEG-studies of pedophilia.
Int J Psychophysiol.
1991;
10
253-258
16
Hall G C.
Sexual arousal as a function of physiological and cognitive variables in a sexual offender population.
Arch Sex Behav.
1991;
20
359-369
17
Braus D F, Ende G, Tost H, Weber-Fahr W, Jatzko A, Schmitt A, Demirakca T, Ruf M.
Funktionelle Kernspintomographie und Schizophrenie: Medikamenteneffekte, methodische Grenzen und Perspektiven.
Nervenheilkunde.
2000;
3
121-128
18
Howitt D.
Pornography and the paedophile: is it criminogenic?.
Br J Med Psychol.
1995;
68
15-27
19
Mesulam M M.
A cortical network for directed attention and unilateral neglect.
Ann Neurol.
1981;
10
309-325
20 Toga A W, Mazziotta J C. Brain mapping. The systems. San Diego: Academic Press 2000
21
Baker S C, Frith C D, Dolan R J.
The interaction between mood and cognitive function studied with PET.
Psychol Med.
1997;
27
565-578
22
Lang P J, Bradley M M, Fitzsimmons J R, Cuthbert B N, Scott J D, Moulder B, Nangia V.
Emotional arousal and activation of the visual cortex: an fMRI analysis.
Psychophysiology.
1998;
35
199-210
23
Schneider F, Habel U, Kessler C, Salloum J B, Posse S.
Gender differences in regional cerebral activity during sadness.
Hum Brain Mapp.
2000;
9
226-238
24
Corbetta M, Miezin F M, Dobmeyer S, Shulman G L, Petersen S E.
Selective and divided attention during visual discriminations of shape, color, and speed: functional anatomy by positron emission tomography.
J Neurosci.
1991;
11
2383-2402
25
Kastner S, Pinsk M A, De Weerd P, Desimone R, Ungerleider L G.
Increased activity in human visual cortex during directed attention in the absence of visual stimulation.
Neuron.
1999;
22
751-761
26
Georgiewa P, Rzanny R, Hopf J M, Knab R, Glauche V, Kaiser W A, Blanz B.
fMRI during word processing in dyslexic and normal reading children.
Neuroreport.
1999;
10
3459-3465
27
Abel G, Blachard E, Barlow D.
Measurement of sexual arousal in several paraphilias: The effects of stimulus modality, instructional set and stimulus content on the objective.
Behav Res and Therapy.
1980;
19
25-33
Priv.-Doz. Dr. D. F. Braus
NMR-Forschung · Zentralinstitut für Seelische Gesundheit
J5
68159 Mannheim