{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:00:41Z","timestamp":1785477641528,"version":"3.56.0"},"reference-count":102,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["ISF-2021-TF1-AG-CYBER"],"award-info":[{"award-number":["ISF-2021-TF1-AG-CYBER"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Individuals who use child sexual abuse material (CSAM) represent an under-researched population, particularly those who remain undetected by the legal system and outside formal treatment settings. Existing research is predominantly expert-driven and rarely captures users\u2019 subjective experiences or sociocultural contexts. This lack of perspective limits the development of patient-centered and culturally responsive prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized a qualitative design to analyze anonymous, chat-based Cultural Formulation Interviews (CFI) conducted within the EU-funded Project Bridge. The sample consisted of 32 help-seeking CSAM users assessed as low-to-medium risk for hands-on offending, representing four language groups (English, Swedish, Czech, and Finnish). Data were analyzed using reflexive thematic analysis to capture the \"user-only\" perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CSAM use emerged as a deeply distressing and heterogeneous experience shaped by a perceived loss of control, internal conflict, identity threat, and experienced stigma. Participants\u2019 explanations of causality (e.g., innate, learned, or addiction-like accounts) functioned as meaning-making strategies to negotiate shame, responsibility, and self-concept, which occasionally included denial of responsibility or socially desirable responding. While secrecy, social isolation, and limited access to support acted as major barriers to help-seeking; relational stability, emotional well-being, and     structured life circumstances functioned as key facilitators that supported and regulated engagement with support services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings demonstrate the critical value of informed, patient-centered qualitative approaches for understanding CSAM use beyond traditional diagnostic and risk-focused models. Methodologically, adapting the CFI to an anonymous, chat-based format represents a vital innovation for accessing hard-to-reach populations fearing social condemnation. Culturally sensitive, low-threshold interventions must be designed to address ambivalence, stigma, denial, and contextual life factors as core components of effective prevention and support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1830667","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:38:20Z","timestamp":1785476300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identity under threat: internal conflict and stigma in undetected child sexual abuse material users"],"prefix":"10.3389","volume":"17","author":[{"given":"Lucia","family":"Nemcov\u00e1","sequence":"first","affiliation":[{"name":"Faculty of Humanities, Charles University","place":["Prague, Czechia"]},{"name":"Centre for Sexual Health and Interventions, National Institute of Mental Health","place":["Prague, 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