Brain processing of pictures of children in men with pedophilic disorder: A positron emission tomography study

Abstract Although structural and functional neuroimagingtechniques have recently been used to investigate the mechanisms of sexual attractionto children, a hallmark of pedophilic disorder, the differences in the processing of child sexualstimuli between men attracted to children and those attracted to adults remain unclear. Here, our purpose was to identify through positron emission tomography the brain responses of 15 male outpatients with pedophilic disorderto validated visual sexual stimuli depicting children (VSSc) and to compare them with 15 male healthy controls matched for sexual orientation(to female or male adults), age, and handedness. The patients' sample comprised both offenders and non-offenders. In response to VSSc, the between- groups analysisshowed that activation in the right inferior temporal cortex [ Brodmann area(BA) 20] was lower in patients than in controls. Moreover, in patients but not in controls, the presentation of VSSc induced an activation in a more caudal region of the right inferior temporal gyrus(BA 37) and in the left middle occipital gyrus(BA 19). In addition, in patients the level of activation in the caudal right inferior temporal gyruswas positively correlated with ratings of sexual arousalelicited by VSSc, whereas this correlation was negative in BA 20. These results implicate the right inferior temporal gyrusas a possible candidate area mediating sexual arousalin patients with pedophilic disorderand suggest that two of its areas play opposite, i.e., activating and inhibitory, roles.