Pedophilia

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Pedophilia
Classification and external resources
ICD-10 F65.4
ICD-9 302.2
MeSH D010378

Pedophilia or paedophilia is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children, generally age 11 years or younger; as a medical diagnosis, specific criteria for the disorder extends the cut-off point for prepubescence to age 13.[1][2][3][4] A person who is diagnosed with pedophilia must be at least 16 years of age, but adolescents who are 16 years of age or older must be at least five years older than the prepubescent child before the attraction can be diagnosed as pedophilia.[1][2]

Pedophilia has a range of definitions, as found in psychiatry, psychology, the vernacular, and law enforcement. The International Classification of Diseases (ICD) defines it as a "disorder of adult personality and behaviour" in which there is a sexual preference for children of prepubertal or early pubertal age.[5] It is termed pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the manual defines it as a paraphilia in which adults or adolescents 16 years of age or older have intense and recurrent sexual urges towards and fantasies about prepubescent children that they have either acted on or which cause them distress or interpersonal difficulty.[1]

In popular usage, the word pedophilia is often incorrectly used to mean any sexual interest in children or the act of child sexual abuse.[3][6][7][8] For example, The American Heritage Stedman's Medical Dictionary states, "Pedophilia is the act or fantasy on the part of an adult of engaging in sexual activity with a child or children."[9] This common use sometimes conflates the sexual interest in and sexual contact with pubescent or post-pubescent minors.[10][11] Researchers recommend that these imprecise uses be avoided because although people who commit child sexual abuse sometimes exhibit the disorder,[6][12][13] many child sexual abuse offenders do not meet the clinical diagnosis standards for pedophilia and these standards pertain to prepubescents.[10][14][15]

Pedophilia was first formally recognized and named in the late 19th century. A significant amount of research in the area has taken place since the 1980s. Although mostly documented in men, there are also women who exhibit the disorder,[16][17] and researchers assume available estimates underrepresent the true number of female pedophiles.[18] No cure for pedophilia has been developed, but there are therapies that can reduce the incidence of a person committing child sexual abuse.[6][19] In the United States, following Kansas v. Hendricks, sex offenders who are diagnosed with certain mental disorders, particularly pedophilia, can be subject to indefinite civil commitment,[20] under various state laws (generically called SVP laws[21][22][23]) and the federal Adam Walsh Child Protection and Safety Act of 2006.[24] At present, the exact causes of pedophilia have not been conclusively established.[25] Research suggests that pedophilia may be correlated with several different neurological abnormalities, and often co-exists with other personality disorders and psychological pathologies. In the contexts of forensic psychology and law enforcement, a variety of typologies have been suggested to categorize pedophiles according to behavior and motivations.[11]

Etymology and definitions

The word comes from the Greek: παῖς (paîs), meaning "child", and φιλία (philía), "friendly love" or "friendship".[26] As pedophilia denotes sexual attraction, the term's Greek meaning is not employed by medical authorities; further, the terms child love and child lover are used by pedophiles who use symbols and codes to identify their sexual preference toward prepubescent children.[27][28]

Pedophilia is used for individuals with a primary or exclusive sexual interest in prepubescent children aged 13 or younger.[1][2] Nepiophilia (Infantophilia) is pedophilia,[13] but is used to refer to a sexual preference for infants and toddlers (ages 0–3 or those under age 5).[13][29] Hebephilia is defined as individuals with a primary or exclusive sexual interest in 11-14 year old pubescents.[30] The DSM-5 does not list hebephilia among the diagnoses; while evidence suggests that hebephilia is separate from pedophilia, the ICD-10 includes hebephilia in its pedophilia definition, covering the physical development overlap between the two philias.[4] In addition to hebephilia, some clinicians have proposed other categories that are somewhat or completely distinguished from pedophilia; these include pedohebephilia (a combination of pedophilia and hebephilia) and ephebophilia (though ephebophilia is not considered pathological).[31][32]

Disease models

The term paedophilia erotica was coined in 1886 by the Viennese psychiatrist Richard von Krafft-Ebing in his writing Psychopathia Sexualis.[33] The term appears in a section titled "Violation of Individuals Under the Age of Fourteen", which focuses on the forensic psychiatry aspect of child sexual offenders in general. Krafft-Ebing describes several typologies of offender, dividing them into psychopathological and non-psychopathological origins, and hypothesizes several apparent causal factors that may lead to the sexual abuse of children.[33]

Krafft-Ebing mentioned paedophilia erotica in a typology of "psycho-sexual perversion". He wrote that he had only encountered it four times in his career and gave brief descriptions of each case, listing three common traits:

  1. The individual is tainted [by heredity] (hereditär belastete)[34]
  2. The subject's primary attraction is to children, rather than adults.
  3. The acts committed by the subject are typically not intercourse, but rather involve inappropriate touching or manipulating the child into performing an act on the subject.

He mentions several cases of pedophilia among adult women (provided by another physician), and also considered the abuse of boys by homosexual men to be extremely rare.[33] Further clarifying this point, he indicated that cases of adult men who have some medical or neurological disorder and abuse a male child are not true pedophilia and that, in his observation, victims of such men tended to be older and pubescent. He also lists pseudopaedophilia as a related condition wherein "individuals who have lost libido for the adult through masturbation and subsequently turn to children for the gratification of their sexual appetite" and claimed this is much more common.[33]

Austrian neurologist Sigmund Freud briefly wrote about the topic in his 1905 book Three Essays on the Theory of Sexuality in a section titled The Sexually immature and Animals as Sexual objects. He wrote that exclusive pedophilia was rare and only occasionally were prepubescent children exclusive objects. He wrote that they usually were the subject of desire when a weak person "makes use of such substitutes" or when an uncontrollable instinct which will not allow delay seeks immediate gratification and cannot find a more appropriate object.[35]

In 1908, Swiss neuroanatomist and psychiatrist Auguste Forel wrote of the phenomenon, proposing that it be referred to it as "Pederosis", the "Sexual Appetite for Children". Similar to Krafft-Ebing's work, Forel made the distinction between incidental sexual abuse by persons with dementia and other organic brain conditions, and the truly preferential and sometimes exclusive sexual desire for children. However, he disagreed with Krafft-Ebing in that he felt the condition of the latter was largely ingrained and unchangeable.[36]

The term pedophilia became the generally accepted term for the condition and saw widespread adoption in the early 20th century, appearing in many popular medical dictionaries such as the 5th Edition of Stedman's in 1918. In 1952, it was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders.[37] This edition and the subsequent DSM-II listed the disorder as one subtype of the classification "Sexual Deviation", but no diagnostic criteria were provided. The DSM-III, published in 1980, contained a full description of the disorder and provided a set of guidelines for diagnosis.[38] The revision in 1987, the DSM-III-R, kept the description largely the same, but updated and expanded the diagnostic criteria.[39]

Diagnostic criteria

ICD-10 and DSM

The ICD-10 defines pedophilia as "a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age".[5] Under this system's criteria, a person 16 years of age or older meets the definition if they have a persistent or predominant sexual preference for prepubescent children at least five years younger than them.[2]

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) has a significantly larger diagnostic features section for pedophilia than the previous DSM version, the DSM-IV-TR, and states, "The diagnostic criteria for pedophilic disorder are intended to apply both to individuals who freely disclose this paraphilia and to individuals who deny any sexual attraction to prepubertal children (generally age 13 years or younger), despite substantial objective evidence to the contrary."[1] Like the DSM-IV-TR, the manual outlines specific criteria for use in the diagnosis of this disorder. These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child (with the diagnostic criteria for the disorder extending the cut-off point for prepubescence to age 13) for six months or more, or that the subject has acted on these urges or suffers from distress as a result of having these feelings. The criteria also indicate that the subject should be 16 or older and that the child or children they fantasize about are at least five years younger than them, though ongoing sexual relationships between a 12–13 year old and a late adolescent are advised to be excluded. A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to incest, and if the attraction is "exclusive" or "nonexclusive".[1]

Many terms have been used to distinguish "true pedophiles" from non-pedophilic and non-exclusive offenders, or to distinguish among types of offenders on a continuum according to strength and exclusivity of pedophilic interest, and motivation for the offense (see child sexual offender types). Exclusive pedophiles are sometimes referred to as true pedophiles. They are sexually attracted to prepubescent children, and prepubescent children only. Showing no erotic interest in adults, they can only become sexually aroused while fantasizing about or being in the presence of prepubescent children, or both.[18] Non-exclusive offenders—or "non-exclusive pedophiles"—may at times be referred to as non-pedophilic offenders, but the two terms are not always synonymous. Non-exclusive offenders are sexually attracted to both children and adults, and can be sexually aroused by both, though a sexual preference for one over the other in this case may also exist. If the attraction is a sexual preference for prepubescent children, such offenders are considered pedophiles in the same vein as exclusive offenders.[5][18]

Neither the ICD nor the DSM diagnostic criteria require actual sexual activity with a prepubescent youth. The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. Acting on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposure, voyeuristic or frotteuristic behaviors,[1] or masturbating to child pornography.[40] Often, these behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made. Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation.[41]

Ego-dystonic sexual orientation (F66.1) includes people who acknowledge that they have a sexual preference for prepubertal children, but wish to change it due to the associated psychological or behavioral problems (or both).

Debate regarding the DSM criteria

The DSM-IV-TR criteria was criticized simultaneously for being over-inclusive, as well as under-inclusive.[42] Though most researchers distinguish between child molesters and pedophiles,[4][14][15][42] Studer and Aylwin argue that the DSM criteria are over-inclusive because all acts of child molestation warrant the diagnosis. A child molester satisfies criteria A because of the behavior involving sexual activity with prepubescent children and criteria B because the individual has acted on those urges.[42] Furthermore, they argue that it also is under-inclusive in the case of individuals who do not act upon it and are not distressed by it.[42] The latter point has also been made by several other researchers who have remarked that a so-called "contented pedophile"—an individual who fantasizes about having sex with a child and masturbates to these fantasies, but does not commit child sexual abuse, and who does not feel subjectively distressed afterward—does not meet the DSM-IV-TR criteria for pedophilia, because this person does not meet Criterion B.[4][43][44][45] A large-scale survey about usage of different classification systems showed that the DSM classification is only rarely used. As an explanation, it was suggested that the under-inclusiveness, as well as a lack of validity, reliability and clarity might have led to the rejection of the DSM classification.[46]

Ray Blanchard, an American-Canadian sexologist known for his research studies on pedophilia, addressed (in his literature review for the DSM-5) the aforementioned objections to the DSM-IV-TR, and proposed a general solution applicable to all paraphilias. This meant namely a distinction between paraphilia and paraphilic disorder. The latter term is proposed to identify the diagnosable mental disorder which meets Criterion A and B, whereas an individual who does not meet Criterion B can be ascertained but not diagnosed as having a paraphilia.[47] Blanchard and a number of his colleagues also proposed that hebephilia become a diagnosable mental disorder under the DSM-5 to resolve the physical development overlap between pedophilia and hebephilia by combining the categories under pedophilic disorder, but with specifiers on which age range (or both) is the primary interest.[31][48] The proposal for hebephilia was rejected by the American Psychiatric Association,[49] but the distinction between paraphilia and paraphilic disorder was implemented.[1][50]

The American Psychiatric Association stated that "[i]n the case of pedophilic disorder, the notable detail is what wasn’t revised in the new manual. Although proposals were discussed throughout the DSM-5 development process, diagnostic criteria ultimately remained the same as in DSM-IV TR" and that "[o]nly the disorder name will be changed from pedophilia to pedophilic disorder to maintain consistency with the chapter’s other listings."[50] If hebephilia had been accepted as a DSM-5 diagnosable disorder, it would have been similar to the ICD-10 definition of pedophilia that already includes early pubescents,[4] and would have raised the minimum age required for a person to be able to be diagnosed with pedophilia from 16 years to 18 years (with the individual needing to be at least 5 years older than the minor).[31]

O'Donohue, however, suggests that the diagnostic criteria for pedophilia be simplified to the attraction to children alone if ascertained by self-report, laboratory findings, or past behavior. He states that any sexual attraction to children is pathological and that distress is irrelevant, noting "this sexual attraction has the potential to cause significant harm to others and is also not in the best interests of the individual."[51] Also arguing for behavioral criteria in defining pedophilia, Howard E. Barbaree and Michael C. Seto disagreed with the American Psychiatric Association's approach in 1997 and instead recommended the use of actions as the sole criterion for the diagnosis of pedophilia, as a means of taxonomic simplification.[52]

Other uses

In a 1993 review of research on child sexual abuse, Sharon Araji and David Finkelhor stated that because this field of research was underdeveloped at that time, there are "definitional problems" resulting from lack of standardization among researchers in their use of the term "pedophilia". They described two definitions, a "restrictive" form referring to individuals with strong and exclusive sexual interest in children, and an "inclusive" definition, expanding the term to include offenders who engaged in sexual contact with a child, including incest. They stated that they used the wider definition in their review paper because behavioral criteria are easier to identify and do not require complex analysis of an individual's motivations.[12]

Development and sexual orientation

Pedophilia has been described as a disorder of sexual preference, phenomenologically similar to a heterosexual or homosexual sexual orientation because it emerges before or during puberty, and because it is stable over time.[53] These observations, however, do not exclude pedophilia from the group of mental disorders because pedophilic acts cause harm, and pedophiles can sometimes be helped by mental health professionals to refrain from acting on their impulses.[54]

Psychopathology and personality traits

Several researchers have reported correlations between pedophilia and certain psychological characteristics, such as low self-esteem[55][56] and poor social skills.[57] Cohen et al. (2002), studying child sex offenders, states that pedophiles have impaired interpersonal functioning and elevated passive-aggressiveness, as well as impaired self-concept. Regarding disinhibitory traits, pedophiles demonstrate elevated psychopathy and propensity for cognitive distortions. According to the authors, pathologic personality traits in pedophiles lend support to a hypothesis that such pathology is related to both motivation for and failure to inhibit pedophilic behavior.[58]

According to Wilson and Cox (1983), "The paedophiles emerge as significantly higher on Psychoticism, Introversion and Neurotocism than age-matched controls. [But] there is a difficulty in untangling cause and effect. We cannot tell whether paedophiles gravitate towards children because, being highly introverted, they find the company of children less threatening than that of adults, or whether the social withdrawal implied by their introversion is a result of the isolation engendered by their preference i.e., awareness of the social approbation and hostility that it evokes" (p. 324).[59]

Studying child sex offenders, a review of qualitative research studies published between 1982 and 2001 concluded that pedophiles use cognitive distortions to meet personal needs, justifying abuse by making excuses, redefining their actions as love and mutuality, and exploiting the power imbalance inherent in all adult–child relationships.[60] Other cognitive distortions include the idea of "children as sexual beings", "uncontrollability of sexuality", and "sexual entitlement-bias".[61]

One review of the literature concludes that research on personality correlates and psychopathology in pedophiles is rarely methodologically correct, in part owing to confusion between pedophiles and child sex offenders, as well as the difficulty of obtaining a representative, community sample of pedophiles.[62] Seto (2004) points out that pedophiles who are available from a clinical setting are likely there because of distress over their sexual preference or pressure from others. This increases the likelihood that they will show psychological problems. Similarly, pedophiles recruited from a correctional setting have been convicted of a crime, making it more likely that they will show anti-social characteristics.[63]

While not causes of pedophilia themselves, childhood abuse by adults or comorbid psychiatric illnesses—such as personality disorders and substance abuse—are risk factors for acting on pedophilic urges.[6] Blanchard, Cantor, and Robichaud (2006) noted about comorbid psychiatric illnesses that, "The theoretical implications are not so clear. Do particular genes or noxious factors in the prenatal environment predispose a male to develop both affective disorders and pedophilia, or do the frustration, danger, and isolation engendered by unacceptable sexual desires—or their occasional furtive satisfaction—lead to anxiety and despair?"[64] They indicated that, because they previously found mothers of pedophiles to be more likely to have undergone psychiatric treatment,[65] the genetic possibility is more likely.

Prevalence and child molestation

The prevalence of pedophilia in the general population is not known,[4][63] but is estimated to be lower than 5% among adult men.[4] "Most sexual offenders against children are male, although female offenders may account for 0.4% to 4% of convicted sexual offenders. On the basis of a range of published reports, McConaghy estimates a 10 to 1 ratio of male-to-female child molesters."[18] It is believed that the true number of female pedophiles is underrepresented by available estimates, and that reasons for this may include a "societal tendency to dismiss the negative impact of sexual relationships between young boys and adult women, as well as women’s greater access to very young children who cannot report their abuse", among other explanations.[18]

The term pedophile is commonly used in the mainstream to describe all child sexual abuse offenders, including those who do not meet the clinical diagnosis standards, which is seen as problematic by researchers,[10][15] as most of them distinguish between child molesters and pedophiles.[4][14][15][42] There are motives for child sexual abuse that are unrelated to pedophilia[52] (such as stress, marital problems, or the unavailability of an adult partner).[66] As child sexual abuse is not automatically an indicator that its perpetrator is a pedophile, offenders might be separated into two types: Exclusive (i.e., "true pedophiles") and non-exclusive (or, in some cases, "non-pedophilic").[13][18] According to a U.S. study on 2429 adult male sex offenders who were categorized as "pedophiles", only 7% identified themselves as exclusive; indicating that many or most child sexual abusers may fall into the non-exclusive category.[13] However, the Mayo Clinic reports perpetrators who meet the diagnostic criteria for pedophilia offend more often than non-pedophile perpetrators, and with a greater number of victims. They state that approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia.[13] A behavioral analysis report by the FBI states that a "high percentage of acquaintance child molesters are preferential sex offenders who have a true sexual preference for [prepubescent] children (i.e., true pedophiles)".[11]

A review article in the British Journal of Psychiatry notes the overlap between extrafamilial and intrafamilial offenders. One study found that around half of the fathers and stepfathers in its sample who were referred for committing extrafamilial abuse had also been abusing their own children.[67]

As stated by Abel, Mittleman, and Becker[68] (1985) and Ward et al. (1995), there are generally large distinctions between the two types of offenders' characteristics. Situational offenders tend to offend at times of stress; have a later onset of offending; have fewer, often familial victims; and have a general preference for adult partners. Pedophilic offenders, however, often start offending at an early age; often have a large number of victims who are frequently extrafamilial; are more inwardly driven to offend; and have values or beliefs that strongly support an offense lifestyle. Research suggests that incest offenders recidivate at approximately half the rate of extrafamilial child molesters, and one study estimated that by the time of entry to treatment, nonincestuous pedophiles who molest boys had committed an average of 282 offenses against 150 victims.[69]

Some child molesters—pedophiles or not—threaten their victims to stop them from reporting their actions.[1] Others, like those that often victimize children, can develop complex ways of getting access to children, like gaining the trust of a child's parent, trading children with other pedophiles or, infrequently, get foster children from non-industrialized nations or abduct child victims from strangers.[1] Offending pedophiles may often act interested in the child, to gain the child's interest, loyalty and affection to keep the child from letting others know about the abuse.[1]

Child pornography

Child pornography is commonly collected by pedophiles who use the images for a variety of purposes, ranging from private sexual uses, trading with other pedophiles, preparing children for sexual abuse as part of the child grooming process, or enticement leading to entrapment for sexual exploitation such as production of new child pornography or child prostitution.[70][71][72]

Pedophile viewers of child pornography are often obsessive about collecting, organizing, categorizing, and labeling their child pornography collection according to age, gender, sex act and fantasy.[73][74] According to FBI agent Ken Lanning, "collecting" pornography does not mean that they merely view pornography, but that they save it, and "it comes to define, fuel, and validate their most cherished sexual fantasies". An extensive collection indicates a strong sexual preference for children and the owned collection is the single best indicator of what he or she wants to do.[74] Researchers Taylor and Quayle reported that pedophile collectors of child pornography are often involved in anonymous internet communities dedicated to extending their collections.[75] Pedophile online community bulletin boards (such as the defunct Dreamboard, taken down in Operation Delego), often include technical advice regarding encryption and other measures from experienced child pornographers to assist new perpetrators from detection from law enforcement.[74]

Causes and biological associations

Although what causes pedophilia is not yet known, beginning in 2002, researchers began reporting a series of findings linking pedophilia with brain structure and function: Pedophilic men have lower IQs,[76][77][78] poorer scores on memory tests,[77] greater rates of non-right-handedness,[76][77][79][80] greater rates of school grade failure over and above the IQ differences,[81] lesser physical height,[82] greater probability of having suffered childhood head injuries resulting in unconsciousness,[65][83] and several differences in MRI-detected brain structures.[84][85][86] They report that their findings suggest that there are one or more neurological characteristics present at birth that cause or increase the likelihood of being pedophilic. Evidence of familial transmittability "suggests, but does not prove that genetic factors are responsible" for the development of pedophilia.[87]

Another study, using structural MRI, shows that male pedophiles have a lower volume of white matter than a control group.[84]

Functional magnetic resonance imaging (fMRI) has shown that child molesters diagnosed with pedophilia have reduced activation of the hypothalamus as compared with non-pedophilic persons when viewing sexually arousing pictures of adults.[88] A 2008 functional neuroimaging study notes that central processing of sexual stimuli in heterosexual "paedophile forensic inpatients" may be altered by a disturbance in the prefrontal networks, which "may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours". The findings may also suggest "a dysfunction at the cognitive stage of sexual arousal processing".[89]

Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify hormonal aspects of pedophiles.[64] They concluded that there is some evidence that pedophilic men have less testosterone than controls, but that the research is of poor quality and that it is difficult to draw any firm conclusion from it.

A study analyzing the sexual fantasies of 200 heterosexual men by using the Wilson Sex Fantasy Questionnaire exam determined that males with a pronounced degree of paraphilic interest (including pedophilia) had a greater number of older brothers, a high 2D:4D digit ratio (which would indicate excessive prenatal estrogen exposure), and an elevated probability of being left-handed, suggesting that disturbed hemispheric brain lateralization may play a role in deviant attractions.[90]

Treatment

Although no cure has been found for pedophilia, various treatments are available that are aimed at reducing or preventing the expression of pedophilic behavior, reducing the prevalence of child sexual abuse.[19][91] Treatment of pedophilia often requires collaboration between law enforcement and health care professionals.[6][19] A number of proposed treatment techniques for pedophilia have been developed, though the success rate of these therapies has been very low.[92]

Cognitive behavioral therapy

Cognitive behavioral therapy, also known as relapse prevention, has been shown to reduce recidivism in contact sex offenders.[93]

According to Canadian sexologist Michael C. Seto, cognitive-behavioral treatments target attitudes, beliefs, and behaviors that are believed to increase the likelihood of sexual offenses against children, and "relapse prevention" is the most common type of cognitive behavioral treatment.[94] The techniques of relapse prevention are based on principles used for treating addictions.[95] Other scientists have also done some research that indicates that recidivism rates of pedophiles in therapy are lower than pedophiles who eschew therapy.[95]

Behavioral interventions

Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and covert sensitization (or masturbatory reconditioning) to increase sexual arousal to adults.[94] Behavioral treatments appear to have an effect on sexual arousal patterns on phallometric testing, but it is not known whether the test changes represent changes in sexual interests or changes in the ability to control genital arousal during testing.[96][97] For sex offenders with mental disabilities, applied behavior analysis has been used.[98]

Pharmacological interventions

Medications are used to lower sex drive in pedophiles by interfering with the activity of testosterone, such as with Depo-Provera (medroxyprogesterone acetate), Androcur (cyproterone acetate), and Lupron (leuprolide acetate).

Gonadotropin-releasing hormone analogues, which last longer and have fewer side-effects, are also effective in reducing libido and may be used.[99]

These treatments, commonly referred to as "chemical castration", are often used in conjunction with the non-medical approaches noted above. According the Association for the Treatment of Sexual Abusers, "Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan."[100]

Limitations of treatment

Although these results are relevant to the prevention of reoffending in contact child sex offenders, there is no empirical suggestion that such therapy is a cure for pedophilia. Dr. Fred Berlin, founder of the Johns Hopkins Sexual Disorders Clinic, believes that pedophilia could be successfully treated if the medical community would give it more attention.[101] Castration, either physical or chemical, appears to be highly effective in removing such sexual impulses when offending is driven by the libido, but this method is not recommended when the drive is an expression of anger or the need for power and control (e.g., violent/sadistic offenders).[102] Chemical and surgical castration has been used in several European countries since World War II, although not to the extent it was employed in Nazi Germany. The program in Hamburg was terminated after 2000, while Poland is now seeking to introduce chemical castration.[103] The Council of Europe works to bring the practice to an end in Eastern European countries where it is still applied through the courts.[104]

In law and forensic psychology

Definitions

In law enforcement circles, the term pedophile is sometimes used in a broad manner to encompass a person who commits one or more sexually-based crimes that relate to legally underage victims. These crimes may include child sexual abuse, statutory rape, offenses involving child pornography, child grooming, stalking, and indecent exposure. One unit of the United Kingdom's Child Abuse Investigation Command is known as the "Paedophile Unit" and specializes in online investigations and enforcement work.[105] Some forensic science texts, such as Holmes (2008) use the term to refer to a class of psychological offender typologies that target child victims, even when such children are not the primary sexual interest of the offender.[106] The FBI, however, makes a point of acknowledging preferential sex offenders who have a true sexual preference for prepubescent children.[11]

Civil and legal commitment

In the United States, following Kansas v. Hendricks, sex offenders that can be diagnosed with certain mental disorders, including pedophilia, can be subject to indefinite civil commitment.[20] In Kansas v. Hendricks, the US Supreme Court upheld as constitutional a Kansas law, the Sexually Violent Predator Act (SVPA), under which Hendricks, a pedophile, was found to have a "mental abnormality" defined as a "congenital or acquired condition affecting the emotional or volitional capacity which predisposes the person to commit sexually violent offenses to the degree that such person is a menace to the health and safety of others", which allowed the State to confine Hendricks indefinitely irrespective of whether the State provided any treatment to Hendricks.[107][108][109] In United States v. Comstock, this type of indefinite confinement was upheld for someone previously convicted on child pornography charges; this time a federal law was involved—the Adam Walsh Child Protection and Safety Act.[24][110] The Walsh Act does not require a conviction on a sex offense charge, but only that the person be a federal prisoner, and one who "has engaged or attempted to engage in sexually violent conduct or child molestation and who is sexually dangerous to others", and who "would have serious difficulty in refraining from sexually violent conduct or child molestation if released". Neither sexually violent conduct nor child molestation is defined by the Act.[111]

In 2012, Moldova reacted to an increase of Western European and United States citizens traveling to the country for the purpose of sex tourism with minors.[112] The parliament of Moldova enacted law that would mandate chemical castration for those who have sex with persons under the age of 15. Additionally, rapists would face castration on a case-by-case basis. The Associated Press also reported that Moldovans had a perception that their country had become a sex tourism destination and that every five of the nine convicted child sex offenders in the country over the past two years were foreigners.[113]

In Egypt, child marriages are forbidden by law, but the government does little to enforce the ban. Meanwhile, the United Nations estimates some two million children are trafficked each year.[114]

Societal views

General

Pedophilia and child sexual abuse are generally seen as morally wrong and abnormal by society.[28][115][116] Research at the close of the 1980s showed that there was a great deal of misunderstanding and unrealistic perceptions in the general public about pedophilia (La Fontaine, 1990; Leberg, 1997). However, a more recent study showed that the public's perception has gradually become more well-informed on the subject.[117]

Misuse of medical terminology

The words pedophile and pedophilia are sometimes used informally to describe an adult's sexual interest or attraction to pubescent or post-pubescent teenagers and to other situations that do not fit within the clinical definitions. The terms hebephilia or ephebophilia may be more accurate in these cases.[3][13][32] This was especially seen in the case of Mark Foley during the congressional page incident. Most of the media labeled Foley a pedophile, which led David Tuller of Slate magazine to state that Foley was not a pedophile but rather an ephebophile.[118]

Another common usage of pedophilia is to refer to the actus reus itself (that is, interchangeably with "sexual abuse")[3][7][8][9] rather than the medical meaning, which is a preference for that age group on the part of the older individual.[10][11] There are also situations where the terms are misused to refer to relationships where the younger person is an adult of legal age, but is either perceived socially as being too young in comparison to their older partner, or the older partner occupies a position of authority over them.[119][120] Researchers recommend that the above imprecise uses be avoided.[10][32] The Mayo Clinic states that pedophilia "is not a criminal or legal term".[13]

Pedophile advocacy groups

See also category: Pedophile activism

From the late 1950s to early 1990s, several pedophile membership organizations advocated age of consent reform to lower or abolish age of consent laws,[121][122][123] and for the acceptance of pedophilia as a sexual orientation rather than a psychological disorder,[124] and the legalization of child pornography.[123] The efforts of pedophile advocacy groups did not gain any public support[121][123][125][126][127] and today those few groups that have not dissolved have only minimal membership and have ceased their activities other than through a few websites.[123][127][128][129]

Anti-pedophile activism

Main article: Anti-pedophile activism

Anti-pedophile activism encompasses opposition against pedophiles, against pedophile advocacy groups, and against other phenomena that are seen as related to pedophilia, such as child pornography and child sexual abuse.[130] Much of the direct action classified as anti-pedophile involves demonstrations against sex offenders, against pedophiles advocating for the legalization of sexual activity between adults and children, and against Internet users who solicit sex from minors.[131][132][133][134]

High-profile media attention to pedophilia has led to incidents of moral panic, particularly following reports of associated pedophilia associated with satanic ritual abuse and day care sex abuse.[135] Instances of vigilantism have also been reported in response to public attention on convicted or suspected child sex offenders. In 2000, following a media campaign of "naming and shaming" suspected pedophiles in the UK, hundreds of residents took to the streets in protest against suspected pedophiles, eventually escalating to violent conduct requiring police intervention.[131]

In culture

See also

References

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Further reading

External links

Look up pedophilia in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Pedophilia.
See also
Forms
Sociological
theories
Laws
Related/See also
Pedophilia
Associated chronophilias
Behavior and legal aspects
Treatment methods
Research and support groups
Prevention organizations
Social views
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