Background. Despite an abundance of clinical research on premenstrual and menstrual symptoms, few epidemiological data provide estimates of the prevalence, incidence, co-morbidity, stability and correlates of premenstrual dysphoric disorder (PMDD) in the community. Aims. To describe the prevalence, incidence, 12 co-morbidity factors and correlates of threshold and subthreshold PMDD in a community sample of young women. Methods. Findings are based on prospective–longitudinal community survey of 1488 women aged 14–24, who were followed-up over a period of 48 months (follow-up, N = 1251) as part of the EDSP sample. Diagnostic assessments were based on the Composite International Diagnostic Interview (CIDI) and its 12-month PMDD diagnostic module administered by clinical interviewers. Diagnoses were calculated using DSM-IV algorithms, but daily ratings of symptoms, as required, were not available. Results. The baseline 12-month prevalence of DSM-IV PMDD was 5·8%. Application of the diagnostic exclusion rules with regard to concurrent major depression and dysthymia decreased the rate only slightly (5·3%). An additional 18·6% were ‘near-threshold’ cases, mostly because they failed to meet the mandatory impairment criterion. Over the follow-up period only few new PMDD cases were observed: cumulative lifetime incidence was 7·4%. PMDD syndrome was stable across 48 months with <10% complete remissions among baseline PMDD cases. The 12-month and lifetime co-morbidity rates were high (anxiety disorders 47·4%, mood disorders 22·9%; somatoform 28·4%), only 26·5% had no other mental disorder. Particularly high odds ratios were found with nicotine dependence and PTSD. In terms of correlates increased rates of 4-weeks impairment days, high use of general health and mental health services, and increased rates of suicide attempts were found. Conclusion. In this sample of adolescents and young adults, premenstrual symptoms were widespread. However, DSM-IV PMDD was considerably less prevalent. PMDD is a relatively stable and impairing condition, with high rates of health service utilization, increased suicidality and substantial co-morbidity.

Background: Schizophrenia first appears in adolescence, in boys at an earlier age than girls. The interpretation of this key epidemiological finding crucially depends on whether similar age-related sex differences exist in the expression of associated, subclinical psychosis-like experiences. Methods: Findings are based on a population sample of 2548 adolescents and young adults aged 17–28. Subjects were assessed with the core psychosis sections on delusions and hallucinations of the Munich- Composite International Diagnostic Interview. Results: The risk of subclinical psychotic experiences was significantly higher for males in the younger half of the cohort (17–21 years), but similar in the older half (22–28 years). Conclusions: These findings suggest that normal maturational changes in adolescence with differential age of onset in boys and girls cause the expression of psychosis, the extreme of which is schizophrenia.

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.