Understanding Mental Health and Childhood Adversity in Technology-Facilitated Child Sexual Exploitation Perpetrators: A Systematic Review of the Evidence

This systematic review examined the mental health conditions, emotional characteristics, and adverse childhood experiences (ACEs) documented among individuals who perpetrate technology-facilitated child sexual exploitation and abuse (TF-CSEA). Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 10 databases and grey literature sources were searched for studies published from 1989 to March 2024. A narrative synthesis of 22 studies, comprising justice-involved, self-referred, and anonymous online samples from predominantly Western, high-income countries ( n = 8 to 3,500), revealed that TF-CSEA perpetrators are heterogeneous. Depression (29%–60%), anxiety (28%–52%), antisocial personality disorder (~42%), and compulsive sexual behaviour (42%) were prevalent across identification methods. Emotional dysregulation was pervasive, with shame, guilt, chronic loneliness, social avoidance, and emotional detachment consistently reported as both antecedents to and consequences of offending. ACEs were widely documented, including childhood sexual abuse (17%–45%), emotional abuse (27%–31%), and physical neglect, with higher cumulative ACE burden associated with more compulsive offending patterns. Subgroup analyses identified two potentially distinct profiles: justice-identified individuals exhibited more entrenched antisocial and externalising traits, whilst self-referred or anonymously identified individuals more commonly reported internalising symptoms, emotional conflict, and desire to desist. These findings are contextualised within established multi-factor models of sexual offending, acknowledging that ACEs and mental health represent only a subset of relevant factors alongside sexual deviance, antisocial cognition, and opportunity structures. Given the predominance of cross-sectional designs, convenience samples, and the absence of direct comparison with contact-only offenders, these associations are hypothesis-generating. Future research priorities include prospective longitudinal designs, standardised measurement, comparison groups, and greater demographic diversity.