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Minor physical anomalies (MPAs) are anatomical variations that are markers of aberrant early neurodevelopment. Schizophrenia is associated with increased MPA frequency, however, the frequency and distribution of MPAs exhibit substantial heterogeneity in schizophrenia and are not exclusive to this disorder. MPAs at different localizations might represent different developmental origins and might be related to latent genetic predisposition or vulnerability to develop full-blown psychosis. Therefore, we conducted a thorough review of minor physical anomalies (MPAs) in schizophrenia (Sch) and first-degree relatives (SchRel). Analyzing 52 studies published from January 1980 to October 2023, the meta-analysis compared MPA scores between 3780 schizophrenia patients and 3871 controls, as well as 1415 SchRel and 1569 controls. The total MPA score was significantly increased in schizophrenia compared to controls (g = 0.78 [0.63-0.93], p<0.001). In regional MPA meta-analyses, effect sizes ranged from 0.56 to 0.78. The difference between SchRel and controls was moderate (g = 0.44 [0.28-0.61], p<0.001). When individual MPA items were analyzed separately, fine electric hair, malformed ear, asymmetrical ear, curved 5th finger were anomalies that were shared between both schizophrenia and SchRel. Also, direct comparisons of the frequency of MPAs in schizophrenia and their relatives were conducted. Additionally, the early age of onset of schizophrenia was associated with mouth anomalies (Z=-2.13, p = 0.03), and ear anomalies were associated with a higher percentage of males in the schizophrenia group (Z = 2.64, p = 0.008). These findings support the notion that different MPAs might be associated with genetic susceptibility as well as vulnerability to developing full-blown psychosis. Studies investigating clinical and neurobiological correlates of MPAs in schizophrenia might be helpful in characterizing subtypes of psychoses that are associated with different developmental processes.

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BACKGROUND: Minor physical anomalies (MPAs) are congenital morphological abnormalities linked to disruptions of fetal development. MPAs are common in 22q11.2 deletion syndrome (22q11DS) and psychosis spectrum disorders (PS) and likely represent a disruption of early embryologic development that may help identify overlapping mechanisms linked to psychosis in these disorders. METHODS: Here, 2D digital photographs were collected from 22q11DS (n = 150), PS (n = 55), and typically developing (TD; n = 93) individuals. Photographs were analyzed using two computer-vision techniques: (1) DeepGestalt algorithm (Face2Gene (F2G)) technology to identify the presence of genetically mediated facial disorders, and (2) Emotrics-a semi-automated machine learning technique that localizes and measures facial features. RESULTS: F2G reliably identified patients with 22q11DS; faces of PS patients were matched to several genetic conditions including FragileX and 22q11DS. PCA-derived factor loadings of all F2G scores indicated unique and overlapping facial patterns that were related to both 22q11DS and PS. Regional facial measurements of the eyes and nose were smaller in 22q11DS as compared to TD, while PS showed intermediate measurements. CONCLUSIONS: The extent to which craniofacial dysmorphology 22q11DS and PS overlapping and evident before the impairment or distress of sub-psychotic symptoms may allow us to identify at-risk youths more reliably and at an earlier stage of development.

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In the neurodevelopmental model of schizophrenia, minor physical anomalies (MPAs) are considered neurodevelopmental markers of schizophrenia. To date, there has been no research to evaluate the interaction between MPAs. Our study built and used a machine learning model to predict the risk of schizophrenia based on measurements of MPA items and to investigate the potential primary and interaction effects of MPAs. The study included 470 patients with schizophrenia and 354 healthy controls. The models used are classical statistical model, Logistic Regression (LR), and machine leaning models, Decision Tree (DT) and Random Forest (RF). We also plotted two-dimensional scatter diagrams and three-dimensional linear/quadratic discriminant analysis (LDA/QDA) graphs for comparison with the DT dendritic structure. We found that RF had the highest predictive power for schizophrenia (Full-training AUC = 0.97 and 5-fold cross-validation AUC = 0.75). We identified several primary MPAs, such as the mouth region, high palate, furrowed tongue, skull height and mouth width. Quantitative MPA analysis indicated that the higher skull height and the narrower mouth width, the higher the risk of schizophrenia. In the interaction, we further identified that skull height and mouth width, furrowed tongue and skull height, high palate and skull height, and high palate and furrowed tongue, showed significant two-item interactions with schizophrenia. A weak three-item interaction was found between high palate, skull height, and mouth width. In conclusion, we found that the two machine learning methods showed good predictive ability in assessing the risk of schizophrenia using the primary and interaction effects of MPAs.

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Background: Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy, which delays growth leading to an altered skeleton and craniofacial pattern. Palatal rugae patterning has been considered the regulator of the development of the palate. The purpose of the research work was to study the morphology of the palate, rugae pattern, and its dimensions in SCD children and compare them with healthy normal children, and to evaluate its role as minor physical anomalies (MPAs). Methods: A cross-sectional case-control study was designed as per STROBE guidelines. The sample comprised 50 children diagnosed with sickle cell disease (Group SCD) and 50 normal healthy children as control (Group C) belonging to the same age group (10-18 years). Dental impressions were made, followed by the pouring of dental casts. The length of the palatal rugae was measured and categorized into primary (>5 mm), secondary (3 mm-5 mm), and fragmentary rugae (<3 mm). The shape of each primary palatal rugae was identified and categorized as curved, wavy, straight, circular and non-specific. Linear and angular measurements of the palatal rugae patterns and palatal dimensions (width, height, area) were measured and recorded. Results: The total number of palatal rugae and fragmentary rugae was lesser in Group SCD than in Group C (p < 0.05). The depth of the palate was significantly increased, whereas the area of the palate significantly decreased in Group SCD. Conclusions: The children with SCD showed distinctive palatal rugae patterns and dimensions when compared with normal healthy children that can be attributed as potential MPAs for sickle cell disease. Children with SCD had an under-developed palatal rugae pattern with a deep, narrow and small palate when compared to healthy children.The dimensions of the palatal rugae pattern in SCD showed reduced distance between the incisive papilla and the first and last rugae, indicating a further decrease in the anteroposterior dimensions of the palate. These findings may aid in the early diagnosis and prevention of malocclusion in children with SCD by appropriate interceptive orthodontic treatment.

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This study investigates the relationship between minor physical anomalies (MPA) and treatment resistance in schizophrenia (TRS). We evaluated 137 patients and 100 healthy controls by using a modified Waldrup MPA scale. Thirteen MPA items were found more frequently in the schizophrenia group than in the controls. The total MPA score was higher in TRS, and MPAs in the eye and mouth regions were more frequent in TRS (n = 57) than in non-TRS. Total MPA score was correlated to Brief Psychiatric Rating Scale-Expanded (BPRS-E) total and BPRS-positive scores in TRS. Our findings suggest that MPA might contribute to treatment resistance in schizophrenia.

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Background: To investigate the frequency of left eye dominance and minor physical anomalies (MPAs) in schizophrenia patients and control subjects and determine the interrelations of these two biological markers of neuronal dysontogenesis in schizophrenia. Subjects and methods: Three tests for eye dominance were administered as performance tasks, not preference questionnaires. Seven MPAs were examined. The sample consisted of 180 (98 schizophrenia patients and 82 control subjects). Several statistical methods for examining the eye tests separately and together were used to assess the difference in left-eyedness between schizophrenia patients and control subjects. Results: Left eye dominance is significantly higher in schizophrenia subjects. Left-eyed subjects are more stigmatized with MPAs. There is a strong positive correlation between left-eyedness and stigmatization with MPAs in schizophrenia patients. Conclusion: As hand dominance is under cultural pressure, eye dominance is culturally independent and is useful and reliable indicator of altered hemispheric lateralization. The significant positive correlations between left-eyedness and MPAs and the high concurrence of these biological markers in schizophrenia patients are a potent indicator of underlying aberrant neurodevelopment.

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Objective: To assess the frequency and type of minor physical anomalies (MPAs) in subjects with autism spectrum disorder (ASD). Methods: This descriptive cross-sectional study was conducted from September, 2016 to October, 2020. Using purposive sampling technique, 147 subjects with ASD were recruited from Children's Hospital and Institute of Child Health (CH & ICH) Lahore, with a confirmed clinical diagnosis by developmental pediatrician, using Diagnostic and Statistical Manual of Mental Disorders (DSM-V). For morphology assessment, 12 body regions of ASD subjects were examined using Autism Dysmorphology Measure (ADM) manual after taking informed consent. Physical measurements (height, weight, head circumference, ear length, philtrum, hand, finger and foot length) were also taken and were compared with the available standard charts. Results: A total of 381 dysmorphologies were identified in 131 (89.1%) ASD subjects whereas 16 subjects had no dysmorphology at all. Microcephaly was exhibited by 14 (9.5%) subjects, out of which 13 had variable number of dysmorphologies while one had no dysmorphology in other body regions. Out of 131 subjects exhibiting dysmorphologies, there were 108 male and 23 female subjects, with a M:F ratio 4.7:1 whereas microcephaly was observed in 12 male and two female subjects, with a M:F ratio 6:1. The highest number of dysmorphic features were noted in the ears, followed by feet and hair growth pattern. Conclusions: MPAs associated with ASD are frequently found in, but are clearly not limited to, the head or facial region.

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Minor physical anomalies (MPAs) are markers of abnormalities in early foetal development and are well established findings in schizophrenia. It has been suggested that neurodevelopmental abnormalities might play a role not only in schizophrenia but also in bipolar disorder (BD). Therefore, according to neurodevelopmental theory of BD, one might expect increased prevalence of MPAs in BD. A meta-analysis of 11 studies was conducted to quantitatively review MPAs in BD in comparison to schizophrenia and healthy controls. The current meta-analysis compared MPA scores of 584 BD patients and 723 healthy controls, and 401 BD and 612 schizophrenia patients. Patients with BD had significantly higher MPA scores than healthy controls (g=0.47, CI=0.28-0.67). This was true both for craniofacial (g=0.57, CI=0.34-0.79) and periphery (g=0.46, CI=0.18-0.73) MPAs. BD was associated with a less severe increase in MPA score compared to schizophrenia, however, between-group difference was small (g=0.19, CI=0.05-0.33). The outcome of this meta-analysis suggests that BD is associated with medium effect size increase in MPAs which is only minimally less severe than schizophrenia. This finding supports the hypothesis that early developmental insult in brain development plays a role not only in schizophrenia but also BD. Studies investigating clinical, neurocognitive, neuroanatomical and other biological correlates of MPAs in BD might helpful in characterizing subtype (s) of BD that is associated with pronounced deviations in brain development.

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Current research suggests that alterations in neurodevelopmental processes, involving gene X environment interactions during key stages of brain development (prenatal period and adolescence), are a major risk for schizophrenia. First, epidemiological studies supporting a genetic contribution to schizophrenia are presented in this article, including family, twin, and adoption studies. Then, an extensive literature review on genetic disorders associated with schizophrenia is reviewed. These epidemiological findings and clinical observations led researchers to conduct studies on genetic associations in schizophrenia, and more specifically on genomics (CNV: copy-number variant, and SNP: single nucleotide polymorphism). The main structural (CNV) and sequence (SNP) variants found in individuals with schizophrenia are reported here. Evidence of genetic contributions to schizophrenia and current knowledge on genetic syndromes associated with this psychiatric disorder highlight the importance of a clinical genetic examination to detect minor physical anomalies in individuals with ultra-high risk of schizophrenia. Several dysmorphic features have been described in schizophrenia, especially in early onset schizophrenia, and can be viewed as neurodevelopmental markers of vulnerability. Early detection of individuals with neurodevelopmental abnormalities is a fundamental issue to develop prevention and diagnostic strategies, therapeutic intervention and follow-up, and to ascertain better the underlying mechanisms involved in the pathophysiology of schizophrenia.

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Introduction: Minor physical anomalies (MPAs) may reflect basic neurobiological features underlying bipolar disorders (BPD), as they are sensitive physical indicators of morphogenetic failure of the brain. Despite several researches about the presence of MPAs in BPD, the results are still controversial. Objectives: The aim of the present meta-analysis was to assess the standardized weighted mean effect sizes of MPAs in BPD and to examine if MPAs may be found predominantly in the head and/or facial regions in BPD patients compared to controls (HC). Methods: Four studies, involving 155 patients with BPD, and 187 HC, were involved in the analysis after searching the literature. For the investigation of MPAs in the peripheral (MPA-P) and in the head and facial regions (MPA-CF), two studies involving 121 BPD patients, and 133 HC passed the inclusion criteria. Results: The number of the MPAs in the BPD group was significantly higher compared to HC. Another important finding of the present study is that BPD patients' MPA-P scores do not significantly differ from those of the HC. In contrast, BPD patients' MPA-CF scores were found to be significantly higher compared to HC subjects. It is important to note that there was a low number of eligible publications included, which caused higher heterogeneity. Conclusions: Low quality of evidence suggests that MPAs are more common in patients with BPD than in HC and the higher rate of MPAs is found predominantly in the head and facial regions.

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BACKGROUND: Minor physical anomalies (MPA) are markers of impaired neurodevelopment during the prenatal stage. Assessing MPA across psychiatric disorders may help understand their shared nature. In addition, MPA in family members would indicate a shared liability and endophenotype potential. We examined familial aggregation of MPA and their role as transdiagnostic and disorder-specific markers of 5 major psychiatric/neuropsychiatric conditions (schizophrenia, bipolar disorder, substance dependence, obsessive-compulsive disorder, and Alzheimer's dementia). METHODS: Modified Waldrop's MPA scale was applied on 1321 individuals from 439 transdiagnostic multiplex families and 125 healthy population controls (HC). Stage of fetal development (morphogenetic/phenogenetic)- and anatomical location (craniofacial/peripheral)-based sub-scores were calculated. Familiality and endophenotypic potential of MPA were analyzed with serial negative binomial mixed-effect regression. Cross-diagnostic differences and the effect of family history density (FHD) of each diagnosis on MPA were assessed. Mixed-effects Cox models estimated the influence of MPA on age-at-onset of illness (AAO). RESULTS: MPA were found to be heritable in families with psychiatric disorders, with a familiality of 0.52. MPA were higher in psychotic disorders after controlling for effects of sex and intrafamilial correlation. Morphogenetic variant MPA was noted to be lower in dementia in comparison to HC. FHD of schizophrenia and bipolar disorder predicted higher, and that of dementia and substance dependence predicted lower MPA. MPA brought forward the AAO [HR:1.07 (1.03-1.11)], and this was more apparent in psychotic disorders. CONCLUSION: MPA are transmissible in families, are specifically related to the risk of developing psychoses, and predict an earlier age at onset. Neurodevelopmentally informed classification of MPA has the potential to enhance the etiopathogenic and translational understanding of psychiatric disorders.

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PURPOSE: Although there are highly precise and advanced diagnostic methods, the etiology and pathophysiology of schizophrenia remain poorly understood. There are several theories about schizophrenia origin, among which the neurodevelopmental theory is widely accepted. Our study aimed to assess minor physical anomalies among schizophrenic patients as putative indices of its developmental origin in North West Ethiopia 2018-2019. PATIENTS AND METHODS: Institutional-based comparative cross-sectional study design was conducted in Debre Markos comprehensive, specialized hospitals in 190 schizophrenic patients, 190 healthy controls, and 190 1st-degree relatives. Data were collected using standard methods, entered into EpiData version 3.1, and exported to SPSS version 24 for analysis. Descriptive data were analyzed using descriptive statistics, and discriminant function analysis was conducted and a value of 0.03 was taken as the cutoff point for prediction of group status of the study samples. RESULTS: Five hundred seventy study samples, male 375 (65.8%), and female 195 (34.2%), were included in this study. The discriminate function 1 and 2 revealed a significant association between groups and all predictors, accounting for 83.5% and 16.5% of between-group variability, respectively. However, closer analysis of the structure matrix revealed longitudinally furrowed tongue, ≥Five palate ridges, high steeples palate, transversely and randomly furrowed tongue, protruding supraorbital ridge as significant predictors. CONCLUSION: Depending on predictor variables in this study, minor physical anomalies can serve as a biomarker for early screening of schizophrenic patients and clue for its developmental origin.

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A number of biomarkers were assessed in photos and prints of the hands of 95 patients with a variety of mental disorders to determine whether patients with schizophrenia could be distinguished from the others. Patients were recruited as consecutive admissions from an outpatient psychiatric day hospital population. Fourteen patients were diagnosed with schizophrenia/schizoaffective disorder and 81 were diagnosed with other mental disorders. A discriminant analysis yielded an overall 80% correct classification, with a sensitivity (schizophrenia patients identified correctly) of 78.6% and a specificity (non-schizophrenia patients identified correctly) of 80.2%. Significant differences were noted in the proximal interphalangeal joint, eponychium of the middle digit and fingernails. To determine biomarker frequency distribution patients with bipolar disorder were then compared to those with schizophrenia/schizoaffective disorder and then to patients with PTSD. The former yielded an overall 78.6% correct classification, with a sensitivity of 71.4% and a specificity of 85.7% and with similar biomarker frequency distribution for bipolar disorder as for the entire non schizophrenia group. The latter comparison yielded an overall 58.6% correct classification, with no significant differences between the features. The application of these biomarkers in clinical practice could constitute an additional tool for the psychiatrist in cases lacking diagnostic clarity.

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BACKGROUND: Minor physical anomalies (MPAs) are subtle anatomical deviations in one's appearance and may suggest altered embryogenesis. MPAs have been shown to be more common in neurodevelopmental disorders (NDDs) compared with typical development. Still, further studies are needed on MPAs in NDDs, especially using twins to adjust for confounding familial factors. METHODS: Clinical assessments were conducted on 116 twins (61 NDD, 55 controls) from 51 monozygotic and 7 dizygotic pairs to examine MPAs and their association with DSM-5 defined NDDs. Additionally, the relationship between the number of MPAs within twins by zygosity was investigated. RESULTS: Within the cohort sample, a specific association was found between MPAs and autism spectrum disorder (ASD) diagnosis (crude odds ratio = 1.29, p = .047; adjusted odds ratios = 1.26-1.33, adjusted p values = .032-.073) and autistic traits (crude ß = 3.02, p = .002; adjusted ß = 2.28, p = .019), but not NDDs in general or ADHD, nor within-pairs. Identified MPAs in ASD included overweight, hypermobility, pes planus, straight eyebrows, vision impairment, arachnodactyly/long toes, long eyelashes, and microtia. The number of MPAs within all monozygotic pairs was highly correlated (r = .88, p < .001). CONCLUSION: MPAs are more frequent in participants with ASD and may be influenced by genetics. The value of MPAs for (early) detection should be further explored, as they might index individuals at increased risk for ASD in particular.

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This study compared five human iris characteristics and minor physical anomalies (MPAs) between patients with schizophrenia (n = 32) and controls (n = 31). Correlations between iris characteristics and MPAs were expected, due to their same ectodermic origin. Iris macro photos were taken and quantified in five categories mentioned before. MPAs were also examined in both groups. Our results show significant differences in the frequency of pigment dots of the iris and total number of MPAs between groups. Other significant differences were found in the extension of concentric furrows, as they were more common in healthy subjects, while Wolfflin nodules occurred significantly more often in patients with schizophrenia. Expected difference in Fuch's crypts could not be observed between groups. Light eye color was positively correlated to pigment dots and Wolfflin nodules, and negatively correlated with concentric furrows. Dark eye color showed positive correlation with concentric furrows, and negative correlation with pigment dots and concentric furrows. A gender effect could also been observed: male individuals showed moderate positive correlations between pigment dots and total MPAs frequency, while this couldn't be observed in the female group. Our findings suggest possible connections between iris characteristics and MPAs, where males are more prone to deviations.

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Minor physical anomalies (MPAs) are subtle signs of fetal developmental abnormalities that have been considered to be among the most replicated risk markers for schizophrenia-spectrum disorders. However, quantitative approaches are needed to measure craniofacial MPAs. The present study adopted an imaging-based quantitative approach to examine craniofacial MPAs across the spectrum of schizophrenia and affective disorders, to address their sensitivity and specificity. We sampled 31 patients with schizophrenia, 30 of their unaffected relatives, and 30 individuals with schizotypal personality traits, as well as 37 non-schizotypal controls. We also examined 17 patients with bipolar disorder and 19 patients with major depressive disorder. Five craniofacial MPAs were measured on anterior-posterior commissure-aligned T1-weighted images of an individual's native brain space: medial-ocular distance, lateral-ocular distance, optical angle, maximum skull length, and skull-base width. Compared to non-schizotypal controls, patients with schizophrenia and their relatives showed a trend toward having smaller optical angles and medial-ocular distance, while no difference was found in patients with bipolar or major depressive disorders, suggesting some degree of specificity to schizophrenia. Our approach may benefit future research on craniofacial MPAs as risk markers for schizophrenia-spectrum disorders, and may eventually be useful in strategies to enhance risk stratification using multiple risk markers.

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The palate is considered typical of the structures in which schizophrenia-related minor physical anomalies may occur. In this study, we aimed to compare the dimensions and form of palate in patients with schizophrenia with nonpsychiatric controls in a blinded manner. Dental stone casts of 127 patients with schizophrenia and 127 controls were prepared from impressions of the maxillary dental arch. Palate dimensions were measured on the stone casts using a digital caliper and palatometer. Palate length did not differ significantly between the groups, but there was a significant difference in palate width and depth, which were significantly higher in the schizophrenia group. As a result of using multivariate analysis for assessing independent risk factors affecting patients with schizophrenia, furrowed palate shape, palate width, and ellipsoid maxillary dental arch shape were found to be significant. This study also revealed that patients with schizophrenia demonstrate certain gender-related predilections in the differences of palate parameters compared to same-sex controls. As the palate develops in conjunction with both the face and brain, our study findings can significantly contribute to the assumption that there might be structural abnormalities of the palate that could represent specific markers of embryological dysmorphogenesis underlying schizophrenia.

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Objective: To evaluate the presence of symptoms of attention deficit and hyperactivity disorder (ADHD) in intellectually gifted adults and children. Methods: Two cross-sectional studies were performed in children and adults whose intelligence quotient (IQ) had been previously evaluated using Raven’s Progressive Matrices (RPM) test. Seventy-seven adults displaying IQ scores above the 98th percentile were assessed using the Adult Self-Report Scale (ASRS-18) for signs of ADHD and a modified Waldrop scale for minor physical anomalies (MPAs). Thirty-nine children (grades 1-5) exhibiting IQ scores above the 99th percentile, as well as an equally matched control group, were assessed for ADHD by teachers using the Swanson, Nolan and Pelham IV Rating Scale (SNAP-IV) as used in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA-SNAP-IV). Results: In gifted adults, the frequency of ADHD-positive cases was 37.8%, and the total MPA score was significantly associated with ADHD (p < 0.001). In children, the ADHD-positive case frequency was 15.38% in the gifted group and 7.69% in the control group (odds ratio [OR] = 2.18, p = 0.288). Conclusions: The high frequency of ADHD symptoms observed, both in gifted adults and in gifted (and non-gifted) children, further supports the validity of this diagnosis in this population. Furthermore, the significant association between MPAs and ADHD suggests that a neurodevelopmental condition underlies these symptoms.

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The link between schizophrenia and anomalies in the distal upper limb is well documented. Preliminary studies have identified a number of biometric parameters of the hand by which schizophrenics can be distinguished from matched controls. The current study seeks to determine whether patients with schizophrenia can be singled out from a disparate group of other mental disorders by using the same parameters. We studied three groups, totaling 134 men: 51 diagnosed with schizophrenia, 29 with anxiety and mood disorders, and 54 comprising a control group. Seven parameters were studied: the proximal interphalangeal joint, the eponychia of the middle and ring digits, two dermatoglyphic features, and two constitutional factors. Examiners evaluated the parameters based on photographs and prints. An initial Mann Whitney comparison showed no significant difference between the control group and those identified with anxiety and mood disorders. We therefore accounted for them as a single group. In a discriminant analysis, an overall accuracy of 78.4% was established with a sensitivity of 80.4% (schizophrenics identified correctly) and a specificity of 77.1% (controls identified correctly). These results suggest that the biometric parameters employed may be useful in identifying patients with schizophrenia from a disparate group of other mental disorders.

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Evidence is steadily accumulating to support a neurodevelopmental basis for pedophilia. This includes increased incidence of non-right-handedness, which is a result primarily of prenatal neural development and solidified very early in life. Minor physical anomalies (MPAs; superficial deviations from typical morphological development, such as un-detached earlobes) also develop only prenatally, suggesting them as another potential marker of atypical physiological development during the prenatal period among pedophiles. This study administered the Waldrop Physical Anomaly Scale to assess the prevalence of MPAs in a clinical sample of men referred for assessment following a sexual assault, or another illegal or clinically significant sexual behavior. Significant associations emerged between MPA indices and indicators of pedophilia, including penile responses to depictions of children, number of child victims, and possession of child pornography. Moreover, greater sexual attraction to children was associated with an elevated craniofacial-to-peripheral anomalies ratio. The overall sample demonstrated a greater number of MPAs relative to prior samples of individuals with schizophrenia as well as to healthy controls.

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