Draft:Troubled Desire

Troubled Desire (troubled-desire.com) is an online platform launched by the Institute of Sexology and Sexual Medicine at Charité - University Medicine Berlin. Established in 2017, the platform provides free, anonymous support and self-management tools for who are concerned about their sexual attraction to children.

Background

Launched on October 25, 2017, the Troubled Desire was designed to address the need for accessible, anonymous support for individuals with sexual interests in pre-adolescent (Pedophilia) and early adolescent children (Hebephilia). The initiative emerged in response to the mandatory reporting requirements under the POCSO Act in India, which hindered individuals with a history of sexual offending from seeking treatment due to fear of legal repercussions. To overcome these barriers, Troubled Desire was conceived as a low-threshold, internet-based self-help tool available in multiple languages, including English, Hindi, and Marathi, among others.

The program aims to prevent child sexual abuse (CSA) and the use of child sexual exploitation material (CSEM) by alleviating the distress experienced by individuals with pedophilic and hebephilic inclinations. It provides a detailed sexual preference assessment, which eventually directs participants to extensive self-management modules based on cognitive-behavioral therapy principles. These modules help users discover their core values and lead their lives according to the Good Lives Model by Ward & Stewart. Non-offending participants can also access contact information for in-person treatment through the platform, linking them to healthcare professionals trained to offer preventive treatment locally. The service is designed to ensure complete confidentiality and anonymity, with no identifying information or IP addresses recorded.

Online self-help

Troubled Desire offers a holistic approach to self-management and psychoeducation, aiming to prevent child sexual abuse (CSA) and the use of child sexual exploitation material (CSEM). The platform is available in multiple languages.

Self-Assessment Module

The self-help process begins with a self-assessment module that gathers demographic information and explores the user's sexual preferences, behaviors, and fantasies. The assessment uses a sophisticated algorithm to eliminate several paraphilias listed in the Diagnostic and Statistical Manual (DSM-5). Participants answer a series of 100–280 questions, which typically take about 15–30 minutes to complete. The questions cover various dimensions such as gender, age, body type, and orgasmic fantasies, utilizing illustrations of Tanner stages to aid in recognizing the body type and age of the sexually fantasized partner. After completing the assessment, users receive personalized feedback on their sexual preferences and past problematic sexual behavior.

Self-Management Modules

Upon completing the assessment, users gain access to self-management modules designed to help them manage their sexual preferences and behaviors. These modules are based on the Berlin Dissexuality Therapy (BEDIT) program, which has been used to treat individuals with pedophilia and hebephilia since 2005. The self-management modules include:

1. Psychoeducation: Provides knowledge about sexuality, sexual preferences, problematic sexual behavior, consent, and risk factors for sexual offending behavior.
2. Acceptance: Supports participants in accepting their sexual preferences as a stable part of their personality while encouraging behavioral changes to avoid offenses.
3. Motivation: Helps users analyze their motivational state and develop motivation to change.
4. Perception: Promotes awareness of problematic perceptions, attitudes, and cognitive distortions related to interactions and sexual activities with children.
5. Emotions: Teaches strategies for identifying, expressing, and regulating emotions.
6. Sexual Fantasies and Behaviors: Helps users understand and manage their sexual fantasies and behaviors.
7. Empathy and Perspective-Taking: Enhances the ability to empathize with children and understand their perspective, as well as promoting self-empathy.
8. Curriculum and Schemas: Relates personal learning history, sexual development, and social interactions to sexual preferences.
9. Coping and Problem-Solving: Enhances functional coping skills and problem-solving strategies.
10. Social Relationships: Analyzes social interactions and provides solutions for problematic behaviors.
11. Intimacy and Trust: Teaches the concepts of intimacy and trust, addressing emotional loneliness and sexual function disorders.
12. Planning the Future: Helps users set new life goals and develop functional coping styles.
13. Protective Measures: Provides strategies for identifying and intervening in risk situations to prevent problematic behaviors.

The self-management modules aim to help users develop self-control strategies, achieve de-escalation, and refrain from offending behaviors.

Empirical evaluation

There have been no formal evaluations published regarding the effectiveness of Troubled Desire to date. The absence of such evaluations means that while the platform's theoretical framework and self-reported user characteristics are well-documented, the practical impact and long-term outcomes of the program remain largely unverified in peer-reviewed studies.

Internal Analysis and User Characteristics

An internal analysis conducted by Schuler et al. (2021) provided a detailed summary of user demographics and characteristics over a 30-month period. During this time, 7,496 users commenced the self-assessment module, with 4,161 users completing it. Among those who completed the module and self-reported a sexual interest in children, 72.8% admitted to accessing illegal child abuse material (I/CAM) at some point in their lives. This statistic underscores the significant potential for the platform to identify high-risk individuals and suggests a pressing need for effective intervention strategies.

Need for Comprehensive Evaluation

Experts have highlighted the urgent need for comprehensive evaluations to assess the efficacy of Troubled Desire's intervention modules. Garrington et al. (2023) emphasize that without robust data on user outcomes, it is challenging to gauge the program's success in preventing child sexual abuse (CSA) and the use of child sexual exploitation material (CSEM). Evaluations would ideally include both quantitative and qualitative measures, assessing changes in behavior, psychological well-being, and risk factors over time.

Challenges in Evaluation

One of the major challenges in evaluating Troubled Desire is the anonymity and confidentiality integral to its design. While these features are crucial for user privacy and security, they also complicate efforts to track long-term user outcomes and verify the self-reported data. As noted by Schröder et al. (2023), the anonymous nature of the platform makes it difficult to ensure the robustness of the data and to follow up with users for longitudinal studies.

Recent Developments

In October 2023, a Therapeutic Chat Service was added to the Troubled Desire platform. This service is made possible by funding from the European Commission's Internal Security Fund (ISF) as part of the “STOP-CSAM” project . The Therapeutic Chat Service is aimed specifically at people who use child sexual abuse images (CSAM; so-called “child pornography”) and want to stop doing so. The main aim of the Therapeutic Chat Service is to combat the sexual abuse and exploitation of children. The Therapeutic Chat Service is aimed at people who are about to engage in problematic online behavior or for those who are at risk of using abusive images. Participation in the Therapeutic Chat Service is voluntary, but specific criteria must be met in order to be included in the research study.

To address the gaps in evaluation, the program will be one of the seven programs selected for rigorous impact evaluation by Prevention Global. Prevention Global serves as a comprehensive resource hub for anyone involved in preventing child sexual abuse. This research initiative was launched by the Moore Center for the Prevention of Child Sexual Abuse at the Johns Hopkins Bloomberg School of Public Health and The Royal’s Institute of Mental Health Research.[1]