Daniel Turner | University Medical Center Hamburg-Eppendorf (original) (raw)
Papers by Daniel Turner
PLoS ONE, Jul 6, 2015
Although, much is currently known about hypersexuality (in form of excessive sexual behavior) amo... more Although, much is currently known about hypersexuality (in form of excessive sexual behavior) among sexual offenders, the degree to which hypersexual behavior is linked to paraphilic and especially pedophilic interests in non-forensic populations has not been established. The purpose of the present study was to elucidate the associations between total sexual outlets (TSO) and other sex drive indicators, antisocial behavior, pedophilic interests, and sexual offending behavior in a large population-based community sample of males. The sample included 8,718 German men who participated in an online study. Hypersexual behavior as measured by self-reported TSO, self-reported sex drive, criminal history, and pedophilic interests were assessed. In moderated hierarchical logistic regression analyses self-reported contact sexual offending against children was linked to sexual fantasizing about children and antisociality. There was no association between aggregated sex drive, and sexual abusive behaviour in the multivariate analyses. In contrast, self-reported child pornography consumption was associated with sex drive, sexual fantasies involving children, and antisociality. Nevertheless, in clinical practice an assessment of criminal history and pedophilic interests in hypersexual individuals and vice versa hypersexuality in antisocial or pedophilic men should be considered as particularly antisociality and pedophilic interest are important predictors of sexual offending against prepubescent children.
International journal of offender therapy and comparative criminology, Jan 6, 2014
The present study examines recidivism rates in sexual offenders using officially registered recon... more The present study examines recidivism rates in sexual offenders using officially registered reconvictions in a representative data set of N = 1,115 male sexual offenders from Austria. In general, results indicate that most sexual offenders do not reoffend sexually after release from prison. More detailed, within the first 5 years after release, the sexual recidivism rate was 6% for the total sample, 4% for the rapist subgroup, and 8% for the child molester subgroup. The findings confirmed previous studies about sex offender recidivism which have shown that first-time sexual offenders are significantly less likely to sexually reoffend than those with previous sexual convictions. With regard to the relationship between age and sexual recidivism, the results challenged the traditional assumption of a clear linear function between age and recidivism. Taken together, compared with previous studies, the recidivism rates found in the present investigation are substantially lower than previ...
The journal of sexual medicine, 2014
During the 1970s, a growing number of medical schools began to recognize the importance of medica... more During the 1970s, a growing number of medical schools began to recognize the importance of medical education concerning human sexuality. Currently, most medical schools provide at least some instruction in human sexuality. In light of this development, the present study aimed to compare the interest in and knowledge about human sexuality of medical students from two different time periods. The answers to a self-constructed questionnaire of 236 students in 1972 were compared with those of 259 students in 2012. Students were asked whether they were interested in education regarding human sexuality and which specific topics they felt should be included in the medical curriculum. The students' knowledge in the following domains was assessed: sexual development, sexual behavior, sexual physiology and psychology, and sexual medicine. The two cohorts were compared with regard to those specific sexuality-related topics in which the students were most and least interested in. Furthermore...
![Research paper thumbnail of ['How Much Sex do Medical Studies Need?' - A Survey of the Knowledge and Interest in Sexual Medicine of Medical Students.]](https://attachments.academia-assets.com/44092565/thumbnails/1.jpg)
](Psychotherapie, Psychosomatik, medizinische Psychologie, 2014
Background: Because of the increasing need for medical care of problems concerning human sexualit... more Background: Because of the increasing need for medical care of problems concerning human sexuality, the International Society for Sexual Medicine (ISSM) in 2010 suggested to include sexual medicine in the current curricula of medical studies. Based on the ISSM's suggestions sexual medicine should be taught on a multidisciplinary basis throughout the whole study process. Furthermore, health care providers have repeatedly indicated that they have lacking knowledge concerning sexual medicine and patients have criticized that their health care providers only infrequently address their sexuality. Methods: 404 medical students from 2 German university medical centers answered an online questionnaire assessing the quality of sexual medicine education. The students were asked about their interest in and their knowledge about different issues concerning human sexuality in the following 4 domains: Sexual development, Sexual behavior, Sexual physiology and psychology, Sexual medicine and t...
Sexual abuse : a journal of research and treatment, Jan 18, 2014
Child sexual abuse occurring in a child- or youth-serving institution or organization has attract... more Child sexual abuse occurring in a child- or youth-serving institution or organization has attracted great public and scientific attention. In light of the particular personal and offense-related characteristics of men who have abused children within such an institution or organization, it is of special importance to evaluate the predictive performance of currently applied risk assessment instruments in this offender population. Therefore, the present study assessed the risk ratings and predictive performance of four risk assessment instruments and one instrument assessing protective factors concerning any, violent and sexual recidivism in child sexual abusers working with children (CSA-W) in comparison with extra-familial child sexual abusers (CSA-E) and intra-familial child sexual abusers (CSA-I). The results indicate that CSA-W mostly recidivate with a sexual offense. Although all included risk measures seem to function with CSA-W, the Static-99 seems to be the instrument that per...
Current Opinion in Psychiatry, 2014
The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edi... more The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition introduced some important changes in the conceptualization of hypersexuality and paraphilic disorders. The destigmatization of nonnormative sexual behaviors could be viewed as positive, However, other changes are more controversial. In order to stimulate new research approaches and provide mental healthcare providers with appropriate treatment regimes, validated assessment and treatment methods are needed. The purpose of this article is to review the studies published between January 2013 and July 2014 that aimed at assessing the psychometric properties of the currently applied assessment instruments and treatment approaches for hypersexuality and hypersexual disorders or paraphilias and paraphilic disorder. Currently existing instruments can validly assess hypersexual behaviors in different populations (e.g. college students, gay and bisexual men, and patients with neurodegenerative disorders) and cultural backgrounds (e.g. Germany, Spain, and USA). Concerning the assessment of paraphilias, it was shown that combining different assessment methods show a better performance in distinguishing between patients with paraphilias and control groups. In addition to psychotherapeutic treatment, pharmacological agents aiming at a reduction of serum testosterone levels are used for hypersexual behaviors as well as paraphilic disorders. Although the currently applied assessment and treatment methods seem to perform quite well, more research about the assessment and evidence-based treatment is needed. This would help to overcome the existing unresolved issues concerning the conceptualization of hypersexual and paraphilic disorders.
Current Opinion in Psychiatry, 2015
Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults... more Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults and is frequently accompanied by changes in sexual behaviors. Satisfying sexuality is an important factor for overall quality of life in people with disabilities. The purpose of this article is to review the studies evaluating the assessment, correlates and management of sexuality following TBI. The Brain Injury Questionnaire of Sexuality is the first validated questionnaire specifically developed for adults with TBI. A considerable amount of individuals with TBI show inappropriate sexual behaviors and sexual dysfunctions. Whereas inappropriate sexual behaviors are related to younger age, less social participation and more severe injuries, sexual dysfunctions show an association with higher fatigue, higher depression scores, less self-esteem and female sex. Healthcare professionals have suggested that because of discomfort at the individual or institutional level, sexual problems are often not sufficiently addressed and have suggested that a specialist should treat sexual problems. Although some important correlates of sexual problems could be identified, methodological differences across studies limit their comparability. Furthermore, there is an absence of evidence-based treatment strategies for addressing sexual problems. Therapeutic efforts should take into account the identified correlates of sexual problems following TBI.
The World Journal of Biological Psychiatry, 2013
Objectives. Although testosterone-lowering medications (TLM) are a frequently used addition to ps... more Objectives. Although testosterone-lowering medications (TLM) are a frequently used addition to psychotherapy in sex offender treatment, discord still seems to exist amongst clinicians as to in which cases administering TLM is justifi ed. The depo-Provera scale (DPS), which was published by Maletzky and Field (Aggress Violent Behav 2003;8:391), assesses the appropriateness of TLM administration in sex offender treatment. Methods . The DPS was sent to all forensic psychiatric institutions in Germany. The clinical directors of these institutions were asked to rate the importance of each item of the DPS on a six-point Likert scale. Results. Twenty-nine clinicians participated. The most important reason selected for the prescription of TLM for sex offender treatment was a " history of sexual offender treatment failure " . The least important item was " deviant sexual interest, by plethysmograph or Abel Screen " (neither plethysmograph nor Abel Screen is used in Germany). Conclusions. Clinicians ' attitudes towards the DPS correspond to the suggestions made in the current WSFBF-guidelines for the pharmacological treatment of sex offenders World J Biol Psychiatry 11:604 -655). Use of the DPS could therefore contribute to a more structured approach towards helping clinicians come to a decision about whether or not to treat a sex offender with TLM. World J Biol Psychiatry Downloaded from informahealthcare.com by 2.203.94.95 on 11/13/13
The Journal of Sexual Medicine, 2013
Introduction. Different clinical guidelines suggest using testosterone-lowering medications (TLM)... more Introduction. Different clinical guidelines suggest using testosterone-lowering medications (TLM) in sex offender treatment in addition to psychotherapy. Within Germany, there are two officially approved agents. So far, no current data exist about the routine use of TLM in a clinical context. Aim. The present observational study evaluates the frequency of the prescription of TLM and other medications in sex offender treatment in German forensic-psychiatric institutions. Experts are asked about the observed effects and side effects of TLM. Method. The heads of all 69 German forensic-psychiatric hospitals and outpatient clinics were asked to fill out a questionnaire assessing offender characteristics and treatment methods in use.
Child Abuse & Neglect, 2014
PLoS ONE, Jul 6, 2015
Although, much is currently known about hypersexuality (in form of excessive sexual behavior) amo... more Although, much is currently known about hypersexuality (in form of excessive sexual behavior) among sexual offenders, the degree to which hypersexual behavior is linked to paraphilic and especially pedophilic interests in non-forensic populations has not been established. The purpose of the present study was to elucidate the associations between total sexual outlets (TSO) and other sex drive indicators, antisocial behavior, pedophilic interests, and sexual offending behavior in a large population-based community sample of males. The sample included 8,718 German men who participated in an online study. Hypersexual behavior as measured by self-reported TSO, self-reported sex drive, criminal history, and pedophilic interests were assessed. In moderated hierarchical logistic regression analyses self-reported contact sexual offending against children was linked to sexual fantasizing about children and antisociality. There was no association between aggregated sex drive, and sexual abusive behaviour in the multivariate analyses. In contrast, self-reported child pornography consumption was associated with sex drive, sexual fantasies involving children, and antisociality. Nevertheless, in clinical practice an assessment of criminal history and pedophilic interests in hypersexual individuals and vice versa hypersexuality in antisocial or pedophilic men should be considered as particularly antisociality and pedophilic interest are important predictors of sexual offending against prepubescent children.
International journal of offender therapy and comparative criminology, Jan 6, 2014
The present study examines recidivism rates in sexual offenders using officially registered recon... more The present study examines recidivism rates in sexual offenders using officially registered reconvictions in a representative data set of N = 1,115 male sexual offenders from Austria. In general, results indicate that most sexual offenders do not reoffend sexually after release from prison. More detailed, within the first 5 years after release, the sexual recidivism rate was 6% for the total sample, 4% for the rapist subgroup, and 8% for the child molester subgroup. The findings confirmed previous studies about sex offender recidivism which have shown that first-time sexual offenders are significantly less likely to sexually reoffend than those with previous sexual convictions. With regard to the relationship between age and sexual recidivism, the results challenged the traditional assumption of a clear linear function between age and recidivism. Taken together, compared with previous studies, the recidivism rates found in the present investigation are substantially lower than previ...
The journal of sexual medicine, 2014
During the 1970s, a growing number of medical schools began to recognize the importance of medica... more During the 1970s, a growing number of medical schools began to recognize the importance of medical education concerning human sexuality. Currently, most medical schools provide at least some instruction in human sexuality. In light of this development, the present study aimed to compare the interest in and knowledge about human sexuality of medical students from two different time periods. The answers to a self-constructed questionnaire of 236 students in 1972 were compared with those of 259 students in 2012. Students were asked whether they were interested in education regarding human sexuality and which specific topics they felt should be included in the medical curriculum. The students' knowledge in the following domains was assessed: sexual development, sexual behavior, sexual physiology and psychology, and sexual medicine. The two cohorts were compared with regard to those specific sexuality-related topics in which the students were most and least interested in. Furthermore...
Psychotherapie, Psychosomatik, medizinische Psychologie, 2014
Background: Because of the increasing need for medical care of problems concerning human sexualit... more Background: Because of the increasing need for medical care of problems concerning human sexuality, the International Society for Sexual Medicine (ISSM) in 2010 suggested to include sexual medicine in the current curricula of medical studies. Based on the ISSM's suggestions sexual medicine should be taught on a multidisciplinary basis throughout the whole study process. Furthermore, health care providers have repeatedly indicated that they have lacking knowledge concerning sexual medicine and patients have criticized that their health care providers only infrequently address their sexuality. Methods: 404 medical students from 2 German university medical centers answered an online questionnaire assessing the quality of sexual medicine education. The students were asked about their interest in and their knowledge about different issues concerning human sexuality in the following 4 domains: Sexual development, Sexual behavior, Sexual physiology and psychology, Sexual medicine and t...
Sexual abuse : a journal of research and treatment, Jan 18, 2014
Child sexual abuse occurring in a child- or youth-serving institution or organization has attract... more Child sexual abuse occurring in a child- or youth-serving institution or organization has attracted great public and scientific attention. In light of the particular personal and offense-related characteristics of men who have abused children within such an institution or organization, it is of special importance to evaluate the predictive performance of currently applied risk assessment instruments in this offender population. Therefore, the present study assessed the risk ratings and predictive performance of four risk assessment instruments and one instrument assessing protective factors concerning any, violent and sexual recidivism in child sexual abusers working with children (CSA-W) in comparison with extra-familial child sexual abusers (CSA-E) and intra-familial child sexual abusers (CSA-I). The results indicate that CSA-W mostly recidivate with a sexual offense. Although all included risk measures seem to function with CSA-W, the Static-99 seems to be the instrument that per...
Current Opinion in Psychiatry, 2014
The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edi... more The recent implementation of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition introduced some important changes in the conceptualization of hypersexuality and paraphilic disorders. The destigmatization of nonnormative sexual behaviors could be viewed as positive, However, other changes are more controversial. In order to stimulate new research approaches and provide mental healthcare providers with appropriate treatment regimes, validated assessment and treatment methods are needed. The purpose of this article is to review the studies published between January 2013 and July 2014 that aimed at assessing the psychometric properties of the currently applied assessment instruments and treatment approaches for hypersexuality and hypersexual disorders or paraphilias and paraphilic disorder. Currently existing instruments can validly assess hypersexual behaviors in different populations (e.g. college students, gay and bisexual men, and patients with neurodegenerative disorders) and cultural backgrounds (e.g. Germany, Spain, and USA). Concerning the assessment of paraphilias, it was shown that combining different assessment methods show a better performance in distinguishing between patients with paraphilias and control groups. In addition to psychotherapeutic treatment, pharmacological agents aiming at a reduction of serum testosterone levels are used for hypersexual behaviors as well as paraphilic disorders. Although the currently applied assessment and treatment methods seem to perform quite well, more research about the assessment and evidence-based treatment is needed. This would help to overcome the existing unresolved issues concerning the conceptualization of hypersexual and paraphilic disorders.
Current Opinion in Psychiatry, 2015
Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults... more Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults and is frequently accompanied by changes in sexual behaviors. Satisfying sexuality is an important factor for overall quality of life in people with disabilities. The purpose of this article is to review the studies evaluating the assessment, correlates and management of sexuality following TBI. The Brain Injury Questionnaire of Sexuality is the first validated questionnaire specifically developed for adults with TBI. A considerable amount of individuals with TBI show inappropriate sexual behaviors and sexual dysfunctions. Whereas inappropriate sexual behaviors are related to younger age, less social participation and more severe injuries, sexual dysfunctions show an association with higher fatigue, higher depression scores, less self-esteem and female sex. Healthcare professionals have suggested that because of discomfort at the individual or institutional level, sexual problems are often not sufficiently addressed and have suggested that a specialist should treat sexual problems. Although some important correlates of sexual problems could be identified, methodological differences across studies limit their comparability. Furthermore, there is an absence of evidence-based treatment strategies for addressing sexual problems. Therapeutic efforts should take into account the identified correlates of sexual problems following TBI.
The World Journal of Biological Psychiatry, 2013
Objectives. Although testosterone-lowering medications (TLM) are a frequently used addition to ps... more Objectives. Although testosterone-lowering medications (TLM) are a frequently used addition to psychotherapy in sex offender treatment, discord still seems to exist amongst clinicians as to in which cases administering TLM is justifi ed. The depo-Provera scale (DPS), which was published by Maletzky and Field (Aggress Violent Behav 2003;8:391), assesses the appropriateness of TLM administration in sex offender treatment. Methods . The DPS was sent to all forensic psychiatric institutions in Germany. The clinical directors of these institutions were asked to rate the importance of each item of the DPS on a six-point Likert scale. Results. Twenty-nine clinicians participated. The most important reason selected for the prescription of TLM for sex offender treatment was a " history of sexual offender treatment failure " . The least important item was " deviant sexual interest, by plethysmograph or Abel Screen " (neither plethysmograph nor Abel Screen is used in Germany). Conclusions. Clinicians ' attitudes towards the DPS correspond to the suggestions made in the current WSFBF-guidelines for the pharmacological treatment of sex offenders World J Biol Psychiatry 11:604 -655). Use of the DPS could therefore contribute to a more structured approach towards helping clinicians come to a decision about whether or not to treat a sex offender with TLM. World J Biol Psychiatry Downloaded from informahealthcare.com by 2.203.94.95 on 11/13/13
The Journal of Sexual Medicine, 2013
Introduction. Different clinical guidelines suggest using testosterone-lowering medications (TLM)... more Introduction. Different clinical guidelines suggest using testosterone-lowering medications (TLM) in sex offender treatment in addition to psychotherapy. Within Germany, there are two officially approved agents. So far, no current data exist about the routine use of TLM in a clinical context. Aim. The present observational study evaluates the frequency of the prescription of TLM and other medications in sex offender treatment in German forensic-psychiatric institutions. Experts are asked about the observed effects and side effects of TLM. Method. The heads of all 69 German forensic-psychiatric hospitals and outpatient clinics were asked to fill out a questionnaire assessing offender characteristics and treatment methods in use.
Child Abuse & Neglect, 2014