(564) Criminal Responsibility in Court-Ordered Assessments of Alleged Sexual Offences Against Minors: Clinical Determinants from a Tertiary Forensic Psychiatric Service

Abstract Introduction Forensic psychiatry opinions must clearly separate diagnostic formulation from criminal behavior and translate clinical findings into proportionate, court-useful recommendations. Misattribution of International Classification of Diseases, 10th Revision (ICD-10) disorders of sexual preference—especially F65.4 paedophilia—can bias opinions on responsibility and downstream measures. Objective To describe patterns across 15 consecutive court-ordered forensic psychiatric evaluations of alleged sexual offences against minors and identify clinical factors associated with diagnostic conclusions, opinions on criminal responsibility, security-measure recommendations, and fitness to stand trial. Methods Retrospective descriptive case series of N=15 expert opinions from a tertiary forensic service. Source materials included full file review, multiple psychiatric interviews, psychological testing, laboratory investigations and, when indicated, cognitive screening and neuroimaging. Extracted variables were offence context; presence of or cognitive impairment secondary to a physiological condition or early neurocognitive decline; personality disorder/traits; alcohol or other psychoactive substances; ICD-10 F65 disorders of sexual preference (e.g., F65.4 paedophilia); opinion on responsibility (full, diminished—non-substantial, substantially diminished); fitness to stand trial; and recommendations (e.g., addiction treatment, compulsory psychiatric treatment or other security measures). Data were summarized descriptively without inferential statistics. We are expanding the series; additional cases will be included in the final version. Results No case met ICD-10 criteria for paedophilia at the time of opinion. In several, a diagnosis within ICD-10 disorders of sexual preference was considered conditional on legal proof of the alleged acts, with some patterns more consistent with hebephilic interest than paedophilia. Personality pathology was documented in 7/15 cases (narcissistic, antisocial/dissocial or paranoid disorders), with additional narcissistic traits noted in others. Cognitive impairment secondary to a physiological condition or early neurocognitive decline was recorded in 9/15. Alcohol-related problems were present in 5/15 (dependence 3; harmful use 2) and were rarely decisive for responsibility. Responsibility was fully preserved in 10/15, diminished but not substantial in 4/15, and substantially diminished in 1/15 (severe intellectual disability with organic deficits). Security measures were recommended in 2/15 (addiction treatment; compulsory psychiatric treatment). Fitness to stand trial was preserved in 14/15; one defendant was unfit. Conclusions An ICD-10-anchored, measurement-informed framework improves the precision and utility of forensic opinions in alleged child sexual offences. Most defendants retain full or only mildly diminished responsibility with no indication for security measures; however, rare cases with severe intellectual disability may warrant substantially diminished responsibility and compulsory treatment. Clear separation of diagnostic formulation from responsibility analysis may help avoid over-diagnosing paedophilia when alternative explanations (e.g., hebephilia, personality pathology or organic deficits) better account for behavior, while focusing resources on modifiable risk factors. Disclosure No