Treatment options in sexually transgressive behaviors in adolescence: Review and presentation of a novel prevention program 180Grad

Sexually transgressive behavior in adolescents without prior justice system contact remains underrecognized in prevention and clinical care. Specialized services for youth with sexually deviant fantasies or problematic sexual behavior are scarce in Germany and internationally. This study introduces 180Grad [180Degree], a German prevention program for adolescents aged 14–21 exhibiting sexually problematic behavior or deviant sexual fantasies, and provides an exploratory characterization of its initial help-seekers. Forty-seven adolescents aged 14–21 years contacted 180Grad between October 2022 and August 2024. A subsample completed comprehensive diagnostic assessments including cognitive testing, risk assessments and standardized self-report questionnaires assessing emotional and behavioral functioning, emotion regulation, personality, trauma symptoms, and sexual risk factors. Most participants (76.2%) reported at least one sexual offense, with 75% of these remaining unknown to authorities. Participants showed pronounced psychological difficulties, including elevated emotional and behavioral problems, impaired self-regulation, low self-esteem, and depressive symptoms. Risk assessments indicated frequent deviant sexual interests (57%) and attitudes supporting sexual violence (43%). These preliminary findings underscore a marked need for therapeutic intervention among the adolescents examined. Future research should rigorously examine the effectiveness of 180Grad and similar dark-field interventions in reducing dynamic risk factors and preventing recidivism. • Dark-field prevention sample of adolescents with sexually intrusive behavior. • Most had committed hands-on offenses; three quarters remained unknown to justice system. • Heightened rates of internalizing problems, low self-esteem, and adverse life events identified. • Marked self-control and emotion regulation difficulties consistent with ITSO vulnerability clusters. • Findings indicate high treatment need and support feasibility of an anonymous prevention service.