For decades, researchers have documented how stereotyping and unfair treatment affect the lives of people with stigmatized characteristics. Pedophilic sexual interests, however, have received remarkably little academic attention. This research gap should be closed for two important reasons. First of all, people with pedophilia have a particularly high risk of experiencing negative stigma-related consequences as, arguably, one of the most feared and despised groups in Germany and many other Western countries. Secondly, vulnerability factors that are hypothesized to contribute to a higher risk of sexually abusive behavior towards children (e.g., low self-esteem, emotion regulation problems, and reduced motivation to seek mental health services) are likely to be enhanced by stigma-related stress. That means that stigmatization of people with pedophilia might not only have a negative effect on members of this group but may also compromise child sexual abuse prevention. This thesis aims at laying the much-needed groundwork for the scientific study of stigma against people with pedophilia by (1) conducting a systematic and comprehensive review of the literature on stigma against people with pedophilia, (2) assessing the prevalence and strength of public stigma against people with pedophilia compared to other despised groups, (3) developing and testing a theoretical framework for the study of stigma-related stress and associated problems among people with pedophilia, and (4) creating and evaluating an anti-stigma intervention program. (1) Our literature review documented a lack of research on this issue as well as the need for theoretical concepts and methodological designs conceptualized specifically for this field of study. (2) A scale to assess public stigma against people with pedophilia was designed and used to survey a sample of German pedestrians and US American workers from the Internet marketplace MTurk. A parallel set of items was employed to measure public stigma against other groups (people who abuse alcohol, sexual sadists, and people with antisocial tendencies). Results of these surveys documented people with pedophilia to be massively disadvantaged by stereotyping beliefs, negative affective reactions, and social distance, even compared to the three other stigmatized groups. (3) To reach the third sub-goal, the author of this thesis formulated the “Framework for the Effects of Stigma-related Stress among People with Pedophilia”. It contains a set of assumptions highlighting the relationship between the stigma-related stress and the risk of child sex offending, which is assumed to be mediated by impairments in emotional and social areas of functioning, as well as cognitive distortions, and the person’s motivation to seek mental health services. The model was tested in an online sample of men with a sexual interest in children. Overall, results provided preliminary evidence for the hypotheses previously laid out. (4) Finally, these ideas were put to practical use in the development of an anti-stigma program for psychotherapists in training that was experimentally validated online. Findings indicated that a number of stigma-related beliefs, affects, and behavioral intentions can be changed at a cost-effective level. Motivation to treat help-seeking patients with pedophilia, however, could not be increased within the sample. In summary, this thesis shows that stigma against pedophilia is a serious and widespread problem, and offers concrete propositions to promote a more realistic and empathetic view of this group. By approaching the emotionally charged concept of pedophilia from a stigma perspective, the research presented in this thesis challenges the way in which not only people from the general public, but also scientists and health care professionals think about pedophilia, and corroborates the importance of stigma reduction within the wider context of child sexual abuse prevention.

For decades, researchers have documented how stereotyping and unfair treatment affect the lives of people with stigmatized characteristics. Pedophilic sexual interests, however, have received remarkably little academic attention. This research gap should be closed for two important reasons. First of all, people with pedophilia have a particularly high risk of experiencing negative stigma-related consequences as, arguably, one of the most feared and despised groups in Germany and many other Western countries. Secondly, vulnerability factors that are hypothesized to contribute to a higher risk of sexually abusive behavior towards children (e.g., low self-esteem, emotion regulation problems, and reduced motivation to seek mental health services) are likely to be enhanced by stigma-related stress. That means that stigmatization of people with pedophilia might not only have a negative effect on members of this group but may also compromise child sexual abuse prevention. This thesis aims at laying the much-needed groundwork for the scientific study of stigma against people with pedophilia by (1) conducting a systematic and comprehensive review of the literature on stigma against people with pedophilia, (2) assessing the prevalence and strength of public stigma against people with pedophilia compared to other despised groups, (3) developing and testing a theoretical framework for the study of stigma-related stress and associated problems among people with pedophilia, and (4) creating and evaluating an anti-stigma intervention program. (1) Our literature review documented a lack of research on this issue as well as the need for theoretical concepts and methodological designs conceptualized specifically for this field of study. (2) A scale to assess public stigma against people with pedophilia was designed and used to survey a sample of German pedestrians and US American workers from the Internet marketplace MTurk. A parallel set of items was employed to measure public stigma against other groups (people who abuse alcohol, sexual sadists, and people with antisocial tendencies). Results of these surveys documented people with pedophilia to be massively disadvantaged by stereotyping beliefs, negative affective reactions, and social distance, even compared to the three other stigmatized groups. (3) To reach the third sub-goal, the author of this thesis formulated the “Framework for the Effects of Stigma-related Stress among People with Pedophilia”. It contains a set of assumptions highlighting the relationship between the stigma-related stress and the risk of child sex offending, which is assumed to be mediated by impairments in emotional and social areas of functioning, as well as cognitive distortions, and the person’s motivation to seek mental health services. The model was tested in an online sample of men with a sexual interest in children. Overall, results provided preliminary evidence for the hypotheses previously laid out. (4) Finally, these ideas were put to practical use in the development of an anti-stigma program for psychotherapists in training that was experimentally validated online. Findings indicated that a number of stigma-related beliefs, affects, and behavioral intentions can be changed at a cost-effective level. Motivation to treat help-seeking patients with pedophilia, however, could not be increased within the sample. In summary, this thesis shows that stigma against pedophilia is a serious and widespread problem, and offers concrete propositions to promote a more realistic and empathetic view of this group. By approaching the emotionally charged concept of pedophilia from a stigma perspective, the research presented in this thesis challenges the way in which not only people from the general public, but also scientists and health care professionals think about pedophilia, and corroborates the importance of stigma reduction within the wider context of child sexual abuse prevention.

Hintergrund: Systematische Darstellungen zur Diagnostik und Verhaltenstherapie von sexuellen Gewalttätern mit psychischen Störungen fehlen im deutschen Sprachraum fast völlig. In der vorliegenden Arbeit werden deshalb für diese kleine, aber besonders gefährliche Tätergruppe die auf der Basis des DSM IV hauptsächlich relevanten Diagnosen (Paraphilie und Störung der Impulskontrolle) und für diese Störungen geeignete Behandlungsmethoden vorgestellt. Methoden: Merkmale, die Paraphile und Impulskontrollgestörte im Hinblick auf Lerngeschichte, sexuelle Präferenz und tatauslösende Bedingungen differenzieren, werden dabei hervorgehoben. Weiterhin wird eine erste Validierungsstudie vorgestellt, in der untersucht wurde, inwieweit sich beide Störungsgruppen hinsichtlich Impulsivität, sozialer Angst, Konfliktvermeidung und dysfunktionaler Selbstaufmerksamkeit unterscheiden. Ergebnisse: Die Ergebnisse verdeutlichen, dass die vorgeschlagene Kategorisierung valide ist und dass sich Paraphile und Impulskontrollgestörte psychologisch bedeutsam voneinander differenzieren lassen. Schlussfolgerungen: Auf dieser Basis lassen sich Aussagen über störungsspezifisch relevante Behandlungselemente ableiten. Unterschiedliche Vorgehensweisen bei Paraphilen bzw. Impulskontrollgestörten werden für folgende Bereiche skizziert: Aufbau einer therapeutischen Beziehung, Änderung der sexuellen Präferenzen, Training sozialer Fertigkeiten und der Konfliktbewältigung, Modifikation dysfunktionaler Kognitionen und Rückfallprävention. / Background: Systematic work regarding the diagnostics and behavior therapy of violent sex offenders with mental disorders is mostly lacking in German publications. Therefore, this study presents the diagnoses which are mainly relevant for this small but particularly dangerous group of offenders on the basis of DSM IV (paraphilia and impulse control disorders) and describes specifically indicated interventions. Methods: Characteristic features are emphasized which differentiate paraphiliacs and offenders with an impulse control disorder with regard to learning history, sexual preferences, and the stimulus conditions which triggered the offense. Further, a validation study is presented which examined the differences between both disorders concerning impulsivity, social anxiety, avoidance of interpersonal conflicts, and dysfunctional self-consciousness. Results: Results showed that the proposed categorization is valid and that paraphiliacs and offenders with an impulse control disorder can be psychologically useful differentiated. Conclusions: In this framework, first conclusions can be drawn regarding the treatment elements which are considered to be relevant for disorder-specific therapy. Different procedures for the treatment of paraphiliacs and offenders with an impulse control disorder are described for the following areas: establishment of a therapeutic relationship, modification of sexual preferences, training of social and coping skills, conflict management, modification of cognitive distortions, and relapse prevention. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Hintergrund: Systematische Darstellungen zur Diagnostik und Verhaltenstherapie von sexuellen Gewalttätern mit psychischen Störungen fehlen im deutschen Sprachraum fast völlig. In der vorliegenden Arbeit werden deshalb für diese kleine, aber besonders gefährliche Tätergruppe die auf der Basis des DSM IV hauptsächlich relevanten Diagnosen (Paraphilie und Störung der Impulskontrolle) und für diese Störungen geeignete Behandlungsmethoden vorgestellt. Methoden: Merkmale, die Paraphile und Impulskontrollgestörte im Hinblick auf Lerngeschichte, sexuelle Präferenz und tatauslösende Bedingungen differenzieren, werden dabei hervorgehoben. Weiterhin wird eine erste Validierungsstudie vorgestellt, in der untersucht wurde, inwieweit sich beide Störungsgruppen hinsichtlich Impulsivität, sozialer Angst, Konfliktvermeidung und dysfunktionaler Selbstaufmerksamkeit unterscheiden. Ergebnisse: Die Ergebnisse verdeutlichen, dass die vorgeschlagene Kategorisierung valide ist und dass sich Paraphile und Impulskontrollgestörte psychologisch bedeutsam voneinander differenzieren lassen. Schlussfolgerungen: Auf dieser Basis lassen sich Aussagen über störungsspezifisch relevante Behandlungselemente ableiten. Unterschiedliche Vorgehensweisen bei Paraphilen bzw. Impulskontrollgestörten werden für folgende Bereiche skizziert: Aufbau einer therapeutischen Beziehung, Änderung der sexuellen Präferenzen, Training sozialer Fertigkeiten und der Konfliktbewältigung, Modifikation dysfunktionaler Kognitionen und Rückfallprävention. / Background: Systematic work regarding the diagnostics and behavior therapy of violent sex offenders with mental disorders is mostly lacking in German publications. Therefore, this study presents the diagnoses which are mainly relevant for this small but particularly dangerous group of offenders on the basis of DSM IV (paraphilia and impulse control disorders) and describes specifically indicated interventions. Methods: Characteristic features are emphasized which differentiate paraphiliacs and offenders with an impulse control disorder with regard to learning history, sexual preferences, and the stimulus conditions which triggered the offense. Further, a validation study is presented which examined the differences between both disorders concerning impulsivity, social anxiety, avoidance of interpersonal conflicts, and dysfunctional self-consciousness. Results: Results showed that the proposed categorization is valid and that paraphiliacs and offenders with an impulse control disorder can be psychologically useful differentiated. Conclusions: In this framework, first conclusions can be drawn regarding the treatment elements which are considered to be relevant for disorder-specific therapy. Different procedures for the treatment of paraphiliacs and offenders with an impulse control disorder are described for the following areas: establishment of a therapeutic relationship, modification of sexual preferences, training of social and coping skills, conflict management, modification of cognitive distortions, and relapse prevention. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.