Paul Fedoroff

University of Ottawa · Department of Psychiatry

Decisions to engage in child sexual abuse (CSA) are not motivated solely by sexual/romantic interest in children. Given the complex interplay of personal, relational, and societal factors involved, we explored the narratives men constructed around their subjective motivations for offending, situated within the post-structuralist constructs of desir...

Decisions to engage in child sexual abuse (CSA) are not motivated solely by sexual interest in children. Given the complex interplay of personal, relational, and societal factors involved, we explored the narratives men constructed around their subjective motivations for offending, situated within the post-structuralist constructs of desire, power,...

Objective We explored men’s subjective experiences of hypersexuality, including the underlying factors they believed contributed to their sexuality. Methods: We interviewed 32 Canadian men with self-reported concerns related to hypersexuality. Interviews were analyzed using Interpretative Phenomenological Analysis and narrative analysis. Results: P...

This study reviews sentencing decisions of people diagnosed with intellectual disabilities who have been convicted of sexual offences by judges in Canada. Given the prevalence of people with intellectual disabilities managed within the criminal justice system (CJS), courts have increasingly been faced with issues concerning appropriate sentencing....

Community-based risk management strategies for people convicted of sexual off ences (PCSO) can hinder successful reintegration, which plays an important role in reducing sexual recidivism. Section 161 of the Criminal Code is a Canadian risk management strategy, which aims to protect children by prohibiting people convicted of sexual offences agains...

Pramipexole is a dopaminergic pharmacologic agent with reported adverse effects that include hypersexuality, shift in sexual interests, pathological gambling, compulsive shopping, and binge eating. Pramipexole is indicated in the treatment of Parkinson’s disease and restless leg syndrome and has been used as adjunctive or add-on treatment in major...

The terms sadism and masochism were coined by German psychiatrist Richard von Krafft‐Ebing in his book Psychopathia Sexualis. He described sadism as deriving sexual pleasure from inflicting pain on another person and masochism as obtaining sexual pleasure from receiving pain and cruelty inflicted by another person. British psychologist Havelock Ell...

A brief overview of consensual and non-consensual sadism and masochism.

This chapter focuses on the laboratory measurement of penile response in the assessment of sexual arousal. Changes in penile tumescence, as measured by penile plethysmography (PPG), is a widely recognized means of measuring male sexual arousal in response to the presentation of various stimuli. Although not part of the Diagnostic and Statistical Ma...

This chapter analyzes the biological underpinnings of male sexual behavior. Research in human sexual behavior has been primarily focused on the effects of pharmacological agents, especially those acting on the serotonergic system and agents that affect the production and action of sex hormones. More recently, brain-imaging studies have increased th...

The terms sadism and masochism were coined by German psychiatrist Richard von Krafft‐Ebing in his book Psychopathia Sexualis. He described sadism as deriving sexual pleasure from inflicting pain on another person and masochism as obtaining sexual pleasure from receiving pain and cruelty inflicted by another person. British psychologist Havelock Ell...

Objectives: Individuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic a...

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. T...

Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribut...

The staggering rate at which incidents of child pornography (CP) are increasing highlights the need for proactive approaches to this problem. Improving the efficacy and accessibility of interventions designed for individuals who view CP provides one means of addressing this growing concern. This article explores the self-identified motivations unde...

At various points in the trajectory through the criminal justice system, a person may be encouraged by the hope of legal benefit to consent to medical treatment. This benefit may consist of diversion from prosecution, a favorable sentence, or parole. This form of legal encouragement has been referred to as legal leverage, quasi‐coercive, or quasi‐c...

Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010–2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medli...

Individuals with intellectual disabilities (IDs) - and specifically those with genetic disorders - are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and...

Introduction: Pedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of establis...

Objectives: Individuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic at...

Sexual sadism and masochism encompass a wide range of sexual interests. The words “sadism” and “masochism” are also used to describe nonsexual situations. In this chapter, the concepts of sadism and masochism are discussed as they relate both to sexual sadism disorder and sexual masochism disorder and also to bondage and discipline, dominance and s...

The Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has a category of disorders termed “other specified paraphilic disorders” (OSPD). The DSM-5 diagnostic criteria for these disorders are contradictory, on the one hand referring to symptoms characteristic of a paraphilic disorder and, on the other hand, referring...

This book examines current and past perspectives concerning unconventional sexual interests. Extensively referenced, it challenges the dogma that sexual interests are immutably determined during a single critical period and are thereafter unchangeable. It critically reviews the fifth edition of the Diagnostic and Statistical Manual of Mental Disord...

Frotteuristic disorder is a condition defined as recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors, or by rubbing against non-consenting people for sexual stimulation. It has been reported that up to 30% of adult males in the general population may have comm...

Unconventional sexual interests and behaviors can be classified in four ways. The system that appeals most to each person depends on the person’s background and preferred working paradigm. Those who think of paraphilias from a medical perspective will tend to think of possible anatomic or physiologic pathologies. Those who think of paraphilias from...

Paraphilias are sexual interests that differ from “normal.” There is a widespread belief that paraphilias cannot be changed and therefore can be at best, managed, with no hope of successfully treatment. This chapter reviews how problematic sexual interests have been dealt with by clinicians and the courts. It introduces the concepts of genes, gende...

This chapter examines pedophilic disorder, which is defined as a condition lasting at least 6 months consisting of recurrent, intense sexual arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally aged 13 years or younger) or simply as a sexual preference for boys or girls or both, u...

Transvestic disorder is defined as a condition in which there is persistent (at least 6 months), recurrent, and intense sexual arousal from wearing clothes associated with the opposite gender as evidenced by fantasies, urges, or behaviors. The condition causes clinically significant distress or impairment in social, occupational, or other important...

The term fetish was originally used to describe inanimate objects that had religious or spiritual significance. By the early 20th century, the term was also used to describe the condition of being sexually aroused by a specific inanimate object or class of objects. Since then, fetishism has expanded to include reference to a sexual interest in anim...

This chapter provides a brief description of the key diagnostic features of exhibitionistic disorder in addition to a historic review of changes in the criteria in the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases . This is followed by a review of the differential diagnos...

Voyeuristic disorder is defined as a condition in which a person experiences persistent (at least 6 months), recurrent, and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors. The prevalence of true voyeuristic disorder is estimated to...

Many books, chapters, and articles concerning the assessment and treatment of the paraphilias have been published. Most are limited due to a lack of clarity about what is being treated and a failure to fully recognize the heterogeneity of the treatment population(s). This chapter provides a review of the assessment methods and treatments that have...

This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compa...

Circles of Support and Accountability (CoSA) was initially developed in Canada as a community-based programme designed to assist in the community reintegration of individuals who are deemed at high or very high risk of sexual recidivism. This article outlines the historical foundations and frameworks of the CoSA model, and examines the recruitment...

This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, th...

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral...

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre’s Sexual Behaviours Clinic in Canada;...

The high prevalence rates and numerous consequences associated with child sexual abuse makes preventing these offences a societal priority. Prevention strategies have traditionally involved only tertiary interventions, implemented by the criminal justice system after an offence has occurred. More recently, some have argued for a public health appro...

The role of the facial images in arousal and attraction has been examined before but never via penile plethysmography (PPG). This retrospective chart review aimed to determine the significance and magnitude of differences in arousal measured by PPG in 1,000 men exposed to slide stimuli with or without facial blurring in subjects of various ages. Ar...

Purpose of Review This review is written in response to an invitation to explain why clinicians should reconsider the statement: “Once a pedophile always a pedophile”. Recent Findings Reviewed in this paper are challenges to the concept that pedophilia is “hard-wired” during a “critical period”, the idea that all people with pedophilia reoffend, t...

In the recently published paper, “Can Pedophiles Change? Response to Opening Arguments and Conclusions”, the majority of the article content was missing along with a Table and Figure being out of place.

This invited commentary addresses an article by Joy and Weiss and their views on the potential use of sexual advanced directives "… as a theoretical mechanism to assert sexual desire past incapacity …." Their article focuses on the importance of the sexual rights of individuals with neurocognitive disorders, principally dementia, in which there is...

The study of Klinefelter's syndrome (XXY chromosome) in relation to sexual disorders is particularly relevant to forensic psychiatrists since various reports have suggested an association between these conditions [1-8]. However, the prevalence of sexual deviations or paraphilias in these men is not precisely known and may only be sporadic [2,4,9]....

In the realm of sexual offenses, there has been a decrease in hands‐on offenses, but an increase in online offenses against children. The current issue is whether online and offline sexual offenders are alike or differ. This literature review investigates the differences among individuals who have committed child pornography offenses, individuals w...

The current study examined the extent to which 1136 men were able to inhibit their sexual arousal on a phallometric assessment, when instructed to do so. Although the observed changes between the two conditions (i.e., Normal and Suppression) were small to moderate in magnitude, the change was not more than what would be expected by measurement erro...

Oral presentation at the Food for Thought Seminar Series hosted by The Royal’s Institute of Mental Health Research. Ottawa, ON.

With increasing criminalization of the mentally ill, individuals with mental disorders more frequently come into contact with the legal system. Psychiatrists may find themselves evaluating these individuals in a forensic context or treating them. Unfortunately, resident trainees and psychiatrists may be uncomfortable with forensic matters and treat...

We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in chil...

In the past three decades, there has been an exponential increase in the worldwide availability of Internet access and devices that are able to access online materials. This literature review investigated whether increased accessibility of Internet child pornography (CP) increases the risk of in-person child sexual exploitation. The current review...

Panel presentation for Conversations at The Royal. Ottawa, ON.

Cognitive mechanisms associated with the relative lack of sexual interest in adults by pedophiles are poorly understood and may benefit from investigations examining how the brain processes adult erotic stimuli. The current study used event-related brain potentials (ERP) to investigate the time course of the explicit processing of erotic, emotional...

Murphy L, Ranger R, Fedoroff JP, Stewart H, Dwyer RG, and Burke W. Standardization of penile plethysmography testing in assessment of problematic sexual interests. J Sex Med 2015;12:1853–1861 Penile plethysmography (PPG) is an objective measure of sexual arousal for men, commonly used to assess sexual arousal to both abnormal (i.e., paraphilic) and...

No abstract is available for this article.

The neuroanatomical correlates of human sexual desire, arousal, and behavior have been characterized in recent years with functional brain imaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Here, we briefly review the results of functional neuroimaging studies in humans, whether healthy or suffering...