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Onset, Maintaining Risk Factors, and Treatment of Sexually Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment. Gerry D. Blasingame, MA Licensed Marriage & Family Therapist. How Do Problematic Sex Behaviors Develop?. Gerry D. Blasingame, MA

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Onset, Maintaining Risk Factors, and Treatment of Sexually Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

Gerry D. Blasingame, MA

Licensed Marriage & Family Therapist


How do problematic sex behaviors develop l.jpg

How Do Problematic Sex Behaviors Develop? Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

Gerry D. Blasingame, MA

Licensed Marriage & Family Therapist


How do problematic sex behaviors develop3 l.jpg
How Do Problematic Sex Behaviors Develop? Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Neuroanatomy

  • Reinforcement structures

  • Androgenization

  • Psychosocial enhancements

  • Psychosocial impairments


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Gerry D. Blasingame, MA, LMFT Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

http://www.childtrauma.org/images/neuroarcheology2.jpg


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Neuroanatomy & Development Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Human sex differences have varied origins.

  • Human fetus brains are bimorphic

  • Human fetus gonads are bimorphic

  • X and Y chromosomes carry different amounts of genetic materials and lead to different outcomes


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Neuroanatomy & Development Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Chromosomal errors have varied expressions

  • Adaptive differences can be traced to activation and/or levels of suppression of chromosomal expressions and genomic imprinting (Arnold, Xu, Grisham, Chen, Kim, & Itoh, 2004)


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Sex and Gender Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Sex

    • genetic sex - chromosomes

    • anatomical sex - internal and external genitalia

    • sexual identity - one’s identity as male or female

Gerry D. Blasingame, MA, LMFT


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Sex and Gender Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Gender

    • social meaning attached to being male or female

    • gender identity - sense of being male or female

    • gender role - expectations about how a male or female should behave

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: Genetics Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Chromosomes

    • each human cell contains 46 chromosomes, occurring in pairs

    • 23 pairs of chromosomes

      • 22 autosomes (determines e.g., hair color)

      • 23rd pair are the sex chromosomes

        • male: XY

        • female: XX

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: Genetics Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: Genetics Maladaptive Behaviors: Introduction to Sex Offender Assessment and Treatment

  • Gamete cells:

    • male: sperm - contains “X” or “Y”

    • female: ovum - contains an “X”

    • “Y” chromosome contains less genetic material than “X” chromosome

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: Maladaptive Behaviors: Introduction to Sex Offender Assessment and TreatmentInternal & External Genitalia

  • Undifferentiated stage:

    • 0-7 weeks gestation

    • male and female external genitals the same

      • urogenital fold

      • genital groove

      • genital tubercle

      • labioscrotal swelling

    • male and female internal genitalia the same - undifferentiated sex glands….dimorphic

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: Maladaptive Behaviors: Introduction to Sex Offender Assessment and TreatmentInternal & External Genitalia

  • Sexual differentiation: Gonadal development

    • 8 weeks gestation

    • Y chromosome synthesis of H-Y antigen

      • Male: H-Y antigen causes undifferentiated sex glands to develop into testes

      • Female: lack of H-Y antigen causes undifferentiated sex glands to develop into ovaries

Gerry D. Blasingame, MA, LMFT


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http://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htmhttp://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htm


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http://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htmhttp://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htm


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Normal Prenatal Development:http://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htmThe Brain

  • Sexual differentiation:

    • Male:

      • Testosterone secreted into the blood reaches the brain

      • testosterone converted to estradiol and dihydrotestosterone in the brain

      • estradiol masculinizes the brain, making permanent changes

    • Female:

      • alpha-fetoprotein binds to estradiol

      • prevents estradiol from entering the brain

      • protects female brains from being masculinized by estradiol

Gerry D. Blasingame, MA, LMFT


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Normal Prenatal Development: http://www.flyfishingdevon.co.uk/salmon/year1/psy128psychosexual_differentiation/sexdiff.htmThe Brain

  • Prenatal hormone exposure fundamentally organizes the brain:

    • Sexual/Reproductive Behaviors:

      • development of the hypothalamus (sexual orientation)

    • Problem Solving

    • Aggression

    • Rough-and-tumble play

  • Hormone exposure seems to involve a critical period - exposure outside the critical period does not have the same impact on brain organization

Gerry D. Blasingame, MA, LMFT


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  • Female brains not exposed to androgens prenatally typically leads to heterosexual female behavior in adulthood.

  • Genetic females with a condition known as Congenital Adrenal Hyperplasia are exposed to high amounts of androgens pre and post- natally, and often develop bi-sexual or homosexual behaviors in adulthood. (Carlson, 2007)

  • Women with CAH may have enlarged clitorises, to the extent that some parents have been recommended to raise them as males or surgically alter them.


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  • In genetic males with a condition known as Androgen Insensitivity Syndrome, the person will also develop as a female with a shallow vagina. (Carlson, 2007)

  • These males do not develop homosexual or bisexual orientations, suggesting the absence of androgen receptors prevents the masculinizing and defeminizing effects of androgens on a persons’ sexual interests.


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  • Additional studies have identified that high stress mothers, during pregnancy, are more likely to procreate homosexual males.

  • The high stress levels would interfere with the androgenization processes and may contribute to development of a smaller sexually dimorphic nucleus of the preoptic area. (the latter is typically larger in males than females but is reduced in homosexual males) (Carlson, 2007)


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How do problematic sex behaviors develop? during pregnancy, are more likely to procreate homosexual males.

  • Reinforcement structures within the brain


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Reinforcement Structures during pregnancy, are more likely to procreate homosexual males.

  • Puberty has its onset when the hypothalamus secretes gonadatropin-releasing hormones that then stimulate the production and release of two gonadotropic hormones by the anterior pituitary gland. (Carlson, 2007)

  • Hypothalamic changes have typical onset at age ten with gradual changes as the person moves towards puberty.

  • These promote sexual maturation


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Reinforcement Structures during pregnancy, are more likely to procreate homosexual males.

  • Puberty has its onset when the hypothalamus secretes gonadatropin-releasing hormones that then stimulate the production and release of two gonadotropic hormones by the anterior pituitary gland. (Carlson, 2007)

  • Hypothalamic changes have typical onset at age ten with gradual changes as the person moves towards puberty.

  • These promote sexual maturation


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  • A number of brain structures are responsible for sexual behaviors. Androgens are responsible for dimorphisms in the brain.

  • In males, sexual behavior is significantly managed by the medial pre-optic area (MPA), located next to the hypothalamus.

  • The sexually dimorphic nucleus of the MPA is several times larger in males than females, influenced by the amount of androgen exposure prenatally.


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http://www.niaaa.nih.gov/NR/rdonlyres/01DAE108-9B80-4672-A497-1E53A7ED5EF4/0/211p67.gifhttp://www.niaaa.nih.gov/NR/rdonlyres/01DAE108-9B80-4672-A497-1E53A7ED5EF4/0/211p67.gif

Gerry D. Blasingame, MA, LMFT


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http://www.becomehealthynow.com/popups/pit_hypothalamus.htm makes certain brain sections very happy…

Gerry D. Blasingame, MA, LMFT


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http://www.scholarpedia.org/wiki/images/9/9d/Hypo_pit.jpg makes certain brain sections very happy…

Gerry D. Blasingame, MA, LMFT


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  • The hypothalamic-pituitary-gonadal axis. The hypothalamus produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • http://pubs.niaaa.nih.gov/publications/arh25-4/254images/283Fig1.gif

Gerry D. Blasingame, MA, LMFT


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Other Brain Regions produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • The ventral tegmentum and sublenticular extended amygdala of the basal forebrain are involved in the appraisal of beautiful faces. (Senior, 2003)

  • Facial features signal sexual fertility and readiness for reproductive activity; facial features indicate levels of psychosexual and psychosocial maturity.


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Other Brain Regions produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • Responses to facial attractiveness is also associated with the brain regions involved with reinforcement and pleasure, e.g. the hypothalamus and amygdala.


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Other Brain Regions produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • Pleasure and reinforcement from orgasm are likely generated from several locations in the brain.

  • These include the ventral tegmental area, areas of the midbrain, several thalamic nuclei, the lateral putamen and the cerebellum.


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Other Brain Regions produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • Orgasm leads to decreased activity in the amygdala, which is involved in defensive behavior and negative emotions such as fear and anxiety. (could this contribute to sexual behavior as a coping mechanism?)

  • The amygdala is loaded with testosterone receptors.

  • The hippocampus is loaded with estrogen receptors


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Development produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • The process of sexual discovery begins prior to the obvious signs of puberty.

  • The increases in secretion of sex related hormones at sensitive periods of development facilitate the sexual discovery process. (Quinsey, 2003)

  • Errors during this periods could lead to reinforcement of maladaptive behaviors.


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development produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • Adolescents process more information through the amygdala and limbic system while adults process more information through the prefrontal cortex and upper brain.

  • This may explain the adolescents higher level of novelty seeking associated with puberty, i.e. risk taking and increased priority for social interaction.


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development produces luteinizing hormone releasing hormone (LHRH), which is released to the pituitary gland. In response to the LHRH signal, the pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. Testosterone circulates in the blood back to the hypothalamic-pituitary unit and regulates the further production and secretion of LHRH and LH.

  • The transition to adulthood involves increased use of the frontal lobes with its increased integration of the widely distributed brain circuitry.

    • Faster connections for top down modulation

    • More efficient neural processing

    • The connections between brain regions appear to be as critical as the regions themselves.


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  • A number of brain regions are involved in perception and response to sexual stimuli in normal, non-pedophilic males. (Arnow, Desmond, Banner, Glover, Solomon, Polan, Lue, & Atlas, 2002)

  • These include the left caudate and putamen, right middle occipital/middle temporal gyri, bilateral cingulated gyrus, and right sensorimotor and premotor regions, when subjects were watching video clips of adult erotic stimuli.


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  • In an fMRI study, the paralimbic and limbic areas are found to differentially participate in managing sexual responses in different phases of the sexual arousal cycle. (Miyagawa, Tsujimuar, Fujita, Matsuoka, Takahashi, Takao, Takade, Matsumiya, Osaki, Takasawa, Oku, Hatazawa, Kaneko, & Okuyama, 2007)

  • During the plateau phase subcortical activation was recorded in the right ventral putamen, as well as significant increase in cerebral blood flow to the left hypothalamus. The right anterior cingulate and left insula were activated during the excitation phase, but not during plateau.


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  • The onset of paraphilic interest in children appears to be in childhood for many men. (Freund & Kuban, 1993) In a retrospective study, males with pedophilia were more likely to recall early sexual interest in seeing children nude but not adults.

  • Most males interested in same-age adult females outgrew any such child-oriented sexual interests by adolescence, suggesting that to be a time when normal-interested males would self-terminate sexual interest in some categories, establishing sexual preferences at puberty.


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  • There is a growing body of research findings that strongly suggest a neurogenesis of the paraphilic tendencies that unfold over time. (Rahman & Symeonides, 2008)

  • It is suggested that developmental instabilities and maternal immunity may play a role in sexual deviation.

  • Having failed a grade in school or being enrolled in special education were found to be common among pedophilic and hebephilic offenders compared to offenders who sexually abused adults. (Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard, 2006)


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  • These concepts imply there may be an interface of psychosocial factors with neuroanatomical and/or neurodevelopmental sensitive periods causing differential responses to either or both factors presumed to contribute to developing sexual deviance.


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  • Another study found that lower intellectual functioning was correlated with a diagnosis of pedophilia. Blanchard et al (1999) found that the presence of lowered intellectual capacities decreased the likelihood of exclusive sexual interest in girls.

  • They also found that maternal age at birth of the child increased the likelihood of exclusive sexual interest in boys.

  • When both of these characteristics were present there was a greater likelihood of sexual interest in boys; when only one was present that likelihood decreased.


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  • Males with pedophilia were measured with correlated with a diagnosis of pedophilia. Blanchard et al (1999) found that the presence of lowered intellectual capacities decreased the likelihood of exclusive sexual interest in girls. reduced activation of the hypothalamus, periaqueductal gray matter, and dorsolateral prefrontal cortex while viewing erotic stimuli.

  • These were different results than their non-pedophilic male counterparts. There was also alteration of emotional processing associated with the amygdala-hippocampal formation and dorsomedial prefrontal cortex.


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  • These data suggest that males with pedophilia lack sufficient connections between these brain regions that play critical parts in sexual arousal and activity.

  • This may explain some aspects of their inability to become aroused when viewing adult appropriate stimuli. (Walter, Witzel, Wiebking, Gubka, Rotte, Schiltz, Bermpohl, Templemann, Bogerts, Heinze, & Northhoff, 2007)


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  • These data indicate that males with pedophilia do not have significant activation of the hypothalamus when viewing adult stimuli and suggests an inaccurate pairing of age-appropriate stimuli with the normal reinforcement mechanisms.

  • This is further supported by data regarding measured sexual arousal while viewing child-focused stimuli, via penile plethysmography or viewing time measures. (Abel, Huffman, Warberg, & Holland, 1998)


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  • Insufficient self-control of sexual interest and arousal appears to be an outcome of inadequate activation of the prefrontal cortex, along with dyscontrol of other impulses.

  • Further, under-activation of the hippocampal-amygdala complex indicates that persons with pedophilia are less in tune with the emotional aspects of sexuality and social relationships and assertiveness. (Walter et al, 2007)


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  • Transcortical connections, along with the hippocampal formation, are involved with acquiring episodic memories, i.e. complex perceptual memories of sequences of events that are either seen or described to a person.

  • While the transcortical circuitry is mastering a new behavior sequence, the basal ganglia is “observing” and learning the sequence as well. Once the initial learning is accomplished through the transcortical circuits, the basal ganglia takes on managing the task(s), freeing the other circuitry to do other things and learn different behaviors.(Carlson, 2007)


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  • However, the brains of males with pedophilia appear to have inadequate amounts of cerebral white matter in the fronto-occipital fasciculus and right arcuate fasciculus, causing disconnection within the regions that respond to sexual cues. (Cantor, Kabani, Christensen, Zipursky, Barbaree, Dickey, Klassen, Mikulis, Kuban, Blak, Richards, Hanratty, & Blanchard, 2007)

  • This can cause inadequate information to be passed along to the brain regions involved in learning and sexual self-regulation.


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  • Repeated sexual fantasy or behavior involving children may train the brain’s neurological pathways to ignore the lack of connection to other possible sources of information that might guide one’s behavior more appropriately; the frontal cortex may be bypassed; orgasm and its dopaminergic outcome reinforces the inappropriate behavior and call for its repetition.

  • At this point behavior appears to become habituated and no longer requires conscious thinking about what one is doing. If the person has not learned to be aroused to adults and not to children, habituation can lead the individual to pedophilic behaviors with and/or without a conscious thoughtful decision.


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Psychosocial enhancements to the sexual development process train the brain’s neurological pathways to ignore the lack of connection to other possible sources of information that might guide one’s behavior more appropriately; the frontal cortex may be bypassed; orgasm and its dopaminergic outcome reinforces the inappropriate behavior and call for its repetition.

How do problematic sex behaviors develop?


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  • Role models and development processes.

  • Non-interference with normal developmental sequences

  • Normal opportunities for experimentation without shame or distress

  • Formation of sexual scripts and values


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Psychosocial impairments to the sexual development process and development processes.

How do problematic sex behaviors develop?


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  • Exposure to various forms of child abuse and neglect are known to cause neurological adaptations in the growing brain. (Perry, 2004; Hall & Hall, 2007)

  • Children adapting to ongoing threat are more vulnerable at some phases of development than others, i.e. during sensitive periods or neurological transition periods.


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  • Stress responses to abuse can cause undesirable variances in neurogenesis, neuronal migration, synaptogenesis, and neurochemical differentiation. (Perry, 2004)

  • Brains of children who have been traumatized make adaptations for survival so as to be prepared for the unpredictable traumatic insults that may come their way.

  • How they cope with these challenges and how they behaved in response to them become stored in memory.

  • As memories are established at the neurological level, neurological scripting appears to embed the memories and their associated cues.


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  • While some children benefit from social and cognitive experiences, those children traumatized by abuse or neglect may not be capable of such benefits. As the brain becomes habituated to certain neurological pathways being activated it tends to ignore other pathways due to non-use. This in turn changes the learning process as well as emotional functioning. (Perry, 2004)


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  • This interruption in the learning process often impairs abused children from integrating new academic and social information while reinforcing otherwise faulty information being stored.

  • As this response to abuse process unfolds, less and less cortical regulation occurs. Brain development is influenced by the presence of stressful, traumatic events making some children highly prone to aggressive behaviors. (Perry, 2004)


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  • Conversely, structured, nurturing experiences do not interfere with cortical regulation.

  • Cortical modulation is critical in self-regulation; if the brains’ functioning becomes habituated to bypass such modulating processes, it can lead to impulsive, thoughtless, maladaptive behaviors.


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  • Developmental sensitive periods allow abuse victims to be impacted in different ways dependent on the child’s age at the time of the trauma.

  • Perry (2004) indicates that in utero or perinatal traumagenic experiences will most impact the development of the brain stem. In the perinatal to early childhood years such experiences will impact the developing midbrain resulting in more impulsive and aggressive behaviors.


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  • Subcortical and limbic impairments are caused by neglect and trauma in infancy and early childhood undermining the ability to attach and manage affect.

  • Further, Perry indicates that traumagenic experiences in childhood cause impairment in developing problem solving skills which undermines self-regulation and increases the likelihood of aggressive behaviors.


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  • Early childhood abuses have long been considered contributory factors in the onset of pedophilic or sexually abusive behaviors. (Cohen, Nikiforov, Gans, Poznansky, McGeoch, Weaver, King, Cullen, & Galynker, 2002)

  • It is hypothesized that early neurodevelopmental abnormalities in the temporal regions of the brain and the presence of sexual abuse experiences may contribute to problems with regulating sexual arousal and erotic discrimination.


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  • Impairment in the temporal lobes may contribute to under-regulation of these pedophilic interests, undermining individuals’ abilities to self-regulate their behaviors, develop maladaptive sexual patterns, and impair their ability to self-terminate such sexual interests as they enter puberty.


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  • Other personality impairments are also common among pedophiles.

  • These include social immaturity, poor interpersonal skills, diminished assertiveness skills, passive-aggressiveness, poor self-concepts, and poor coping skills. (Cohen, McGeoch, Watras-Gans, Acker, Poznansky, Cullen, Itskovich, & Galynker, 2002)


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  • Additionally, pedophiles and other paraphilics are found to frequently experience comorbid conditions such as attention-deficit hyperactivity disorder, conduct disorder, and mood disorders. (Kafka & Hennen, 2002)

  • These impairments can both contribute to and cause under-regulation of maladaptive sexual interests and behaviors.


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  • Emotional immaturity has been proposed as a contributing factor in pedophilia and sexual abuse of children.

  • Wilson (1999) found that male-preference pedophiles were most interested in interacting with children at the child level when compared to other types of pedophiles and non-sex offenders. Incest offenders were found to prefer to elevate, in their fantasies, their victims to adults; heterosexual pedophiles were found to be more motivated by seeking sexual gratification rather than by emotional or relational interests.


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  • Some have proposed that a genomic contribution may exist; that a particular gene encoding neurotransmitter-metabolizing enzyme, monoamine oxidase A (MAOA) may moderate the neuroanatomical effects of abuse.

  • Those with high levels of MAOA were found to be less likely to develop antisocial characteristics. These data may explain why many who are abuse victims do not grow up to become perpetrators of abuse while others do. (Caspi, McClay, Moffitt, Mill, Martin, Craig, Taylor, & Poulton, 2002)


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  • There is also an interface of the child-victims’ age and gender; males who are traumatized in childhood or early adolescence are effected differently than girls.

  • Males in that condition are more likely to develop impulsivity and sensitization to abuse behaviors. (Huang, Cate, Battistuzzi, Oquendo, Brent, & Mann, 2004)


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  • It has been suggested that MAOA related factors may contribute to individual differences in serotonergic responsivity and personality traits related to impulse control, antagonist behavior and stress regulation. (Manuck, Flory, Ferrell, Mann, & Muldoon, 2000; Jabbi, Korf, Kema, Hartman, van der Pompe, Minderaa, Ormel, & den Boer, 2007)


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  • There is not a question as to the contribution of adverse childhood experiences to the development of psychological problems

  • The question is how these psychosocial experiences interface with the brain’s neurodevelopmental sensitive periods so that some who are exposed to such trauma develop maladaptive sexual behaviors, and some do not.


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  • Contact information childhood experiences to the development of psychological problems

    Gerry D. Blasingame, MA

    gerryblasingame@aol.com