Pedophilia
Definition
Pedophilia is a paraphilia that involves an abnormal interest in children. A paraphilia is a disorder that is characterized by recurrent intense sexual urges and sexually arousing fantasies generally involving: nonhuman objects; the suffering or humiliation of oneself or one's partner (not merely simulated); or animals, children, or other nonconsenting persons. Pedophilia is also a psychosexual disorder in which the fantasy or actual act of engaging in sexual activity with prepubertal children is the preferred or exclusive means of achieving sexual excitement and gratification. It may be directed toward children of the same sex or children of the other sex. Some pedophiles are attracted to both boys and girls. Some are attracted only to children, while others are attracted to adults as well as to children.
Pedophilia is defined by mental health professionals as a mental disorder, but the American legal system defines acting on a pedophilic urge as a criminal act.
Description
The focus of pedophilia is sexual activity with a child. Many courts interpret this reference to age to mean children under the age of 18. Most mental health professionals, however, confine the definition of pedophilia to sexual activity with prepubescent children, who are generally age 13 or younger. The term ephebophilia, derived from the Greek word for "youth," is sometimes used to describe sexual interest in young people in the first stages of puberty.
The sexual behaviors involved in pedophilia cover a range of activities and may or may not involve the use of force. Some pedophiles limit their behaviors to exposing themselves or masturbating in front of the child, or fondling or undressing the child, but without genital contact. Others, however, compel the child to participate in oral sex or full genital intercourse.
The most common overt aspect of pedophilia is an intense interest in children. There is no typical pedophile. Pedophiles may be young or old, male or female, although the great majority are males. Unfortunately, some pedophiles are professionals who are entrusted with educating or maintaining the health and well-being of young persons, while others are entrusted with children to whom they are related by blood or marriage.
Causes and symptoms
Causes
A variety of different theories exist as to the causes of pedophilia. A few researchers attribute pedophilia along with the other paraphilias to biology. They hold that testosterone, one of the male sex hormones, predisposes men to develop deviant sexual behaviors. As far as genetic factors are concerned, as of 2002 no researchers have claimed to have discovered or mapped a gene for pedophilia.
Most experts regard pedophilia as resulting from psychosocial factors rather than biological characteristics. Some think that pedophilia is the result of having been sexually abused as a child. Still others think that it derives from the person's interactions with parents during their early years of life. Some researchers attribute pedophilia to arrested emotional development; that is, the pedophile is attracted to children because he or she has never matured psychologically. Some regard pedophilia as the result of a distorted need to dominate a sexual partner. Since children are smaller and usually weaker than adults, they may be regarded as nonthreatening potential partners. This drive for domination is sometimes thought to explain why most pedophiles are males.
Symptoms
A pedophile is often very attractive to the children who are potential victims. Potential pedophiles may volunteer their services to athletic teams, Scout troops, or religious or civic organizations that serve youth. In some cases, pedophiles who are attracted to children within their extended family may offer to baby-sit for their relatives. They often have good interpersonal skills with children and can easily gain the children's trust.
Some pedophiles offer rationalizations or excuses that enable them to avoid assuming responsibility for their actions. They may blame the children for being too attractive or sexually provocative. They may also maintain that they are "teaching" the child about "the facts of life" or "love"; this rationalization is frequently offered by pedophiles who have molested children related to them. All these rationalizations may be found in pornography with pedophilic themes.
Demographics
Pedophilia is one of the more common paraphilias; the large worldwide market for child pornography suggests that it is more frequent in the general population than prison statistics would indicate. Together with voyeurism and exhibitionism , pedophilia is one of the three paraphilias most commonly leading to arrest by the police.
The onset of pedophilia usually occurs during adolescence. Occasional pedophiles begin their activities during middle age but this late onset is uncommon. In the United States, about 50% of men arrested for pedophilia are married.
The frequency of behavior associated with pedophilia varies with psychosocial stress . As the pedophile's stress levels increase, the frequency of his or her acting out generally rises also.
Pedophilia is more common among males than among females. In addition, the rate of recidivism for persons with a pedophilic preference for males is approximately twice that of pedophiles who prefer females.
Little is known about the incidence of pedophilia in different racial or ethnic groups.
Diagnosis
According to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition text revised, the following criteria must be met to establish a diagnosis of pedophilia.
- Over a period of at least six months, the affected person experiences recurrent, intense and sexually arousing fantasies, sexual urges or actual behaviors involving sexual activity with a prepubescent child or children aged 13 or younger.
- The fantasies, sexual urges or behaviors cause clinically significant distress or impairment in social, occupational or other important areas of daily functioning.
- The affected person must be at least age sixteen and be at least five years older than the child or children who are the objects or targets of attention or sexual activity.
A diagnosis of pedophilia cannot be assigned to an individual in late adolescence (age 17 to 19) who is involved in an ongoing sexual relationship with a 12- or 13-year-old person.
In establishing a diagnosis of pedophilia, it is important for a mental health professional to determine if the patient is attracted to males, females or both. It is also important to determine whether incest is a factor in the relationship. Finally, the doctor must determine whether the pedophilia is exclusive or nonexclusive; that is, whether the patient is attracted only to children (exclusive pedophilia) or to adults as well as to children (nonexclusive pedophilia).
One difficulty with the diagnosis of the disorder is that persons with pedophilia rarely seek help voluntarily from mental health professionals. Instead, counseling and treatment is often the result of a court order. An interview that establishes the criteria for diagnosis listed above may be enough to diagnose the condition, or surveillance or Internet records obtained through the criminal investigation may also be used.
An additional complication in diagnosis is that the paraphilias as a group have a high rate of comorbidity with one another and an equally high rate of comorbidity with major depression, anxiety disorders, and substance abuse disorders. A person diagnosed with pedophilia may also meet the criteria for exhibitionism or for a substance abuse or mood disorder.
Treatments
In the earliest stages of behavior modification therapy, pedophiles may be narrowly viewed as being attracted to inappropriate persons. Such aversive stimuli as electric shocks have been administered to persons undergoing therapy for pedophilia. This approach has not been very successful.
In 2002, the most common form of treatment for pedophilia is psychotherapy , often of many years' duration. It does not have a high rate of success in inducing pedophiles to change their behavior.
Pedophilia may also be treated with medications. The three classes of medications most often used to treat pedophilia (and other paraphilias) are: female hormones, particularly medroxyprogesterone acetate, or MPA; luteinizing hormone-releasing hormone (LHRH) agonists, which include such drugs as triptorelin (Trelstar), leuprolide acetate, and goserelin acetate; and anti-androgens, which block the uptake and metabolism of testosterone as well as reducing blood levels of this hormone. Most clinical studies of these drugs have been done in Germany, where the legal system has allowed their use in treating repeat sexual offenders since the 1970s. The anti-androgens in particular have been shown to be effective in reducing the rate of recidivism.
Surgical castration is sometimes offered as a treatment to pedophiles who are repeat offenders or who have pleaded guilty to violent rape.
Increasingly, pedophiles are being prosecuted under criminal statutes and being sentenced to prison terms. Imprisonment removes them from society for a period of time but does not usually remove their pedophilic tendencies. In 2002, many states have begun to publish the names of persons being released from prison after serving time for pedophilia. Legal challenges to this practice are pending in various jurisdictions.
Prognosis
The prognosis of successfully ending pedophilic habits among persons who practice pedophilia is not favorable. Pedophiles have a high rate of recidivism; that is, they tend to repeat their acts often over time.
The rate of prosecution for pedophiles through the criminal justice system has increased in recent years. Pedophiles are at high risk of being beaten or killed by other prison inmates. For this reason, they must often be kept isolated from other members of a prison population. Knowledge of the likelihood of abuse by prison personnel and inmates is not, however, an effective deterrent for most pedophiles.
Prevention
The main method for preventing pedophilia is avoiding situations that may promote pedophilic acts. Children should never be allowed to in one-on-one situations with any adult other than their parents or trustworthy family members. Having another youth or adult as an observer provides some security for all concerned. Conferences and other activities can be conducted so as to provide privacy while still within sight of others.
Children should be taught to yell or run if they are faced with an uncomfortable situation. They should also be taught that it is acceptable to scream or call for help in such situations.
Another basis of preventing pedophilia is education. Children must be taught to avoid situations that make them vulnerable to pedophiles. Adults who work with youth must be taught to avoid situations that may be construed as promoting pedophilia.
Many states have adopted legislation that requires periodic background investigations of any adult who works with children. These persons may be paid, such as teachers, or they may be volunteers in a youth-serving organization.
The Boy Scouts of America has tried to address the problem of pedophilia by creating a training program that is required for all adults in the organization. All applications for volunteers are reviewed and approved by several persons. Adults and youth are required to use separate facilities on all activities. Secret meetings and one-on-one interactions between adults and youth are prohibited. This program has received several national awards.
See also Abuse; Aversion therapy
Resources
BOOKS
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.
Gelder, Michael, Richard Mayou, and Philip Cowen. Shorter Oxford Textbook of Psychiatry. 4th ed. New York: Oxford University Press, 2001.
Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.
PERIODICALS
Berlin, F. S. "Treatments to change sexual orientation." American Journal of Psychiatry 157, no. 5 (2000): 838-839.
Cohen, L. J., and others. "Impulsive personality traits in male pedophiles versus healthy controls: Is pedophilia an impulsive-aggressive disorder?" Comprehensive Psychiatry 43, no. 2 (2002): 127-134.
Hill, S. A. "The man who claimed to be a paedophile." Journal of Medical Ethics 26, no. 2 (2000): 137-138.
O'Donohue, W., L. G. Regev, and A. Hagstrom. "Problems with the DSM-IV diagnosis of pedophilia. " Sexual Abuse 12, no. 2 (2000): 95-105.
ORGANIZATIONS
American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. Phone: (913) 906-6000. Web site: <http://www.aafp.org>.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Telephone: (847) 434-4000. Fax: (847) 434-8000. Web site: <http://www.aap.org/default.htm>.
American Medical Association. 515 N. State Street, Chicago, IL 60610. Telephone: (312) 464-5000. Web site: <http://www.ama-assn.org>.
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Telephone: (888) 357-7924. Fax:(202) 682-6850.
American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. Phone: (800) 374-2721 or(202) 336-5500. Web site: <http://www.apa.org>.
L. Fleming Fallon, Jr., M.D., Dr.P.H.
