Journal Article Epublish
PubMed: 42602149 DOI: 10.3389/fpsyt.2026.1830667
Identity under threat: internal conflict and stigma in undetected child sexual abuse material users.
Front Psychiatry 17:1830667
Authors: Lucia Nemcová, Adam Schreier, Tereza Karousová, Lucie Kalenská, Gabriel Bianchi, Maria Breide, Stina Lindegren, Rafael Ballester-Arnal, Peer Briken, Michal Chovanec, Sophie Dixelius, Marcel Elipe-Miravet, Lisann Högström, Johan Holmberg, Tarik Korkutan, Jozef Metenko, Sabine Prantner, Ellen Zakreski, Christoffer Rahm, Kateřina Klapilová
Affiliations
- Faculty of Humanities, Charles University, Prague, Czechia.
- Centre for Sexual Health and Interventions, National Institute of Mental Health, Prague, Czechia.
- Faculty of Arts, Charles University, Prague, Czechia.
- Institute for Research in Social Communication, Slovak Academy of Sciences, Bratislava, Slovakia.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
- Department of Social Work, Uppsala University, Uppsala, Sweden.
- National Center for Knowledge on Men's Violence Against Women, Uppsala University, Uppsala, Sweden.
- Universitat Jaume I, Castellon, Spain.
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, Hamburg, Germany.
- Academy of the Police Force in Bratislava, Bratislava, Slovakia.
Abstract
INTRODUCTION
Individuals who use child sexual abuse material (CSAM) represent an under-researched population, particularly those who remain undetected by the legal system and outside formal treatment settings. Existing research is predominantly expert-driven and rarely captures users' subjective experiences or sociocultural contexts. This lack of perspective limits the development of patient-centered and culturally responsive prevention strategies.
METHODS
This study utilized a qualitative design to analyze anonymous, chat-based Cultural Formulation Interviews (CFI) conducted within the EU-funded Project Bridge. The sample consisted of 32 help-seeking CSAM users assessed as low-to-medium risk for hands-on offending, representing four language groups (English, Swedish, Czech, and Finnish). Data were analyzed using reflexive thematic analysis to capture the "user-only" perspective.
RESULTS
CSAM use emerged as a deeply distressing and heterogeneous experience shaped by a perceived loss of control, internal conflict, identity threat, and experienced stigma. Participants' explanations of causality (e.g., innate, learned, or addiction-like accounts) functioned as meaning-making strategies to negotiate shame, responsibility, and self-concept, which occasionally included denial of responsibility or socially desirable responding. While secrecy, social isolation, and limited access to support acted as major barriers to help-seeking; relational stability, emotional well-being, and structured life circumstances functioned as key facilitators that supported and regulated engagement with support services.
DISCUSSION
These findings demonstrate the critical value of informed, patient-centered qualitative approaches for understanding CSAM use beyond traditional diagnostic and risk-focused models. Methodologically, adapting the CFI to an anonymous, chat-based format represents a vital innovation for accessing hard-to-reach populations fearing social condemnation. Culturally sensitive, low-threshold interventions must be designed to address ambivalence, stigma, denial, and contextual life factors as core components of effective prevention and support.
MeSH
Pedophilia, Conflict, Psychological, Denial, Psychological, Child Abuse, Sexual, Research, Child, Compulsive Sexual Behavior Disorder