(868) Neurobiological Mechanisms Underlying Devoteism: A Narrative Review of Attraction Profiles and Psychological Correlates

Introduction Understanding the neurobiological underpinnings of complex sexual behaviors remains a critical challenge in contemporary sexology. Devoteism, defined as a persistent sexual or romantic attraction to individuals with physical disabilities, presents a unique paradigm for exploring disability-related attractions. Distinct from apotemnophilia (the desire for self-disability) and acrotomophilia (specific attraction to amputees), devoteism encompasses a broader spectrum of disability-centered desires. This phenomenon challenges conventional understanding of sexual arousal patterns through its unique combination of psychological mechanisms and embodied affective cognitions. The intersection between empathy and arousal represents an emerging area of investigation, particularly regarding the interplay among reward processing, affective responses, empathetic circuits, and body schema integration. Objective This narrative review aimed to delineate distinct neurobiological activation patterns, neural connectivity profiles, and psychological correlates underlying attraction profiles in devoteism, while systematically examining research paradigms and methodological challenges in this field. Methods A comprehensive narrative review was conducted using PubMed, Scopus, and PsycINFO databases, spanning 2005 to 2025. Search strategy employed MeSH terms and keywords including "devoteism," "disability sexuality," "paraphilic disorders," "neurophysiology of physical attraction," "psychology of attraction," and "body representation." Twenty-eight studies meeting inclusion criteria were selected based on methodological quality, clinical relevance, and contribution to understanding neurobiological and psychological mechanisms. Results Analysis identified two predominant attraction profiles. The first, characterized by exclusive sexual orientation (approximately 58%) and integrated affective-sexual orientation (approximately 42%). Functional neuroimaging studies demonstrate activation in the orbitofrontal cortex, amygdala, ventral striatum, insula, and anterior cingulate cortex, indicating involvement of reward, emotional, and empathy circuits. Psychologically, devoteism is associated with a fascination for bodily differences, protective or caregiving impulses, and empathic connection with vulnerability. Significant barriers included: participant recruitment challenges due to stigma, absence of validated assessment instruments, and ethical complexities in studying vulnerable populations. Conclusions These findings reveal distinct neurobiological signatures underlying devoteism attraction profiles, challenging conventional categorizations of sexual diversity. The identification of specific neural networks-encompassing reward, empathic, and body representation systems-provides biological evidence supporting the complexity of human sexual attraction beyond traditional frameworks. This neurobiological understanding has important clinical implications for developing tailored, interdisciplinary approaches to assessment and support, while reducing stigma through evidence-based recognition of biological and emotional foundations. Future research requires multidisciplinary collaboration integrating neuroscience, psychology, sexology, and clinical expertise to further elucidate these mechanisms and develop appropriate, destigmatizing interventions. Disclosure No