Pedophilia (302.2)

DSM-IV-TR criteria

• The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.
• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children (generally age 13 or younger)
• Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old
• The person must state whether they are:
  • Sexually attracted to males
  • Sexually attracted to females
  • Sexually attracted to both males and female
• Must specify if:
  • Limited to incest
• Must state whether:
  • Exclusive Type (aroused only by children)
  • Nonexclusive Type

Associated features

• Recurring sexual dreams, behaviors, or urges concerning children that are 13 years old or younger. These urges may be directed toward children of the same sex as the pedophiles, or the other sex. Some pedophiles are attracted to both boys and girls. Some are attracted to to only children, while others are attracted to children as well as adults. These issues must be persistent for at least 6 months and must cause impairment to everyday functioning to be considered symptoms. If an individuals is 16 years old and exhibits these behaviors with someone that is at least 5 years younger, he would be considered for this disorder.
• To be diagnosed as having Pedophilia, the individual must be at least 16 years of age. The disorder typically begins in adolescence, although some individuals with Pedophilia report that they did not become sexually aroused by children until middle adulthood.
• Pedophiles may limit their activity to exposing themselves to the child (sometimes known as flashing), touching and fondling the child gently, undressing the child and looking at him or her, or masturbating in front of the child.

Gender and cultural differences in presentation

• The word “Pedophilia” is derived from the Greek words “paidos” (child) and “philia” (love). Until recently, pedophilic individuals had found it relatively easy to gain access to unattended children. Awareness of Pedophilia has been raised in the past two decades, and it has become more difficult for these individuals to find children with whom to act out their fantasies. In response to the scarcity of vulnerable children, many pedophiles have turned to chatrooms and child pornography.
• Males are more often diagnosed with this disorder than women. Pedophilia is more prevalent among Caucasians than among other ethnicities. It is also known that if a male prefers males, it is more likely that he will repeat his pedophilic actions. This has led certain religious or otherwise radical activists to suggest that pedophilia and homosexuality are “one and the same,” resulting in further media attention to an already well-covered topic.
• One of the biggest issues in assessing behavior as pedophilic or normal is the criteria for Pedophilia; by Western standards, certain cultures (e.g. Islamic) would have higher prevalence of Pedophilia. Some cultures allow “child weddings,” or unions between mature males and prepubescent females. In some tribal societies in Africa, pedophilic behavior is considered perfectly normal; men often take “boy-wives” in addition to wives. The men engage in sexual activity with these boy-wives until it is deemed time for the young boy to choose a wife of his own. At this point, the boy’s “husband” will then aid him in choosing a wife, and the boy will be allowed to leave to start a family of his own. Clearly, it is important to note any religious or cultural backgrounds in individuals being examined as having Pedophilia. This is a very difficult situation, as some groups have voiced the concern that any pedophile can simply convert to a belief system that accommodates and excuses his behaviors
• Islamic Sharia law

Epidemiology

• There is very little known about the prevalence of Pedophilia at this time because, due to the severely negative stigma associated with having Pedophila, many people with Pedophilia rarely seek help from a mental health professional. The ratio of sex offenders against female children and sex offenders against male children is about 2:1. According to data in a (1987; 1988) study, sexual offenders against males have many more victims than those against females. Sexual offenses against female children have a rate of 19.8, while sexual offenses against male children are at a rate of 150.2. Since there is a higher rate of sexual offenders against male children, this may suggest that this group has a greater number of true pedophiles.
• Note: The large commercial market in pedophiliac pornography suggests a much higher prevalence than the limited medical data indicates

Etiology

Some researchers feel that it is due to biological factors, that one of the male sex hormones predisposes men to be more sexually deviant; however, according to a 2002 study there is no evidence of any link between genetics and Pedophilia. Others suggest that pedophilia results from certain psychosocial factors (e.g. being sexually abused as a child, or the nature of one’s familial interactions). Still others invoke factors such as the following: anomalies in psychological development, the desire to overpower sexual partners, and the belief that sex is a necessary requisite for affection.

Empirically supported treatment

• There are multiple treatment options for those individuals that are considered to have Pedophilia. The first one is cognitive behavioral therapy. This is a relapse prevention program that has been shown to reduce recidivism.
• Another option is behavioral interventions. This helps suppress sexual arousal of children and turn it more toward adult arousal. However, it is currently not known if the method changes sexual interest or if it just changes the ability to control erections during testing.
• Medication is also used in some cases. 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. These hormones are sometimes prescribed to divert intrusive sexual thoughts, urges, or abnormally frequent sexual behavior. Although medication may seem like a good option, it almost always must be long term to be fully and completely effective.
• Relapse- Pedophilia is typically chronic in nature, but the fantasies and behaviors associated with Pedophilia tend to decrease with age (as is the case with any sexual activity).
• Surgical castration is sometimes offered as a treatment to pedophiles who are repeat offenders or who have pleaded guilty to violent rape.

Prognosis

• The prognosis of successfully ending pedophilic habits among people 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.