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Pedophilia

Pedophilia, a sexual preference for prepubescent children, appears early in life, is stable over time, and directs the person's sexuality with regard to thoughts, fantasies, urges, arousal, and behavior. Pedophilia can be diagnosed on the basis of self-report, sexual history, and (among men) penile responses. These indicators of pedophilia predict sexual recidivism among male sex offenders. There is accumulating evidence that pedophilia is a neurodevelopmental disorder. Different treatment approaches for pedophilia have been evaluated but with only mixed success.

Definition

Pedophilia is defined as a sexual preference for prepubescent children, reflected in the person's sexual thoughts, fantasies, urges, arousal, and behavior. There are three key features in this definition: (1) the sexual interest is persistent, so individuals who have occasionally fantasized about sex with a prepubescent child or who have engaged in sexual contact with a child are not necessarily pedophiles; (2) the persons of interest are prepubescent and thus show few or no signs of secondary sexual development; and (3) the person would sexually choose children even when adult partners are available. Individuals who seek sexual contacts with sexually mature minors are unlikely to be pedophiles, though they may be engaging in illegal behavior given a jurisdiction's legally defined age of sexual consent.

Pedophilia is probably the best-understood paraphilia, given society's concerns about preventing children from becoming victims of sexual offenses. Pedophilia is an important motivation for sexual offending against children, but the two concepts are not synonymous: Some pedophiles have no known history of sexual contacts with children, and perhaps half the sex offenders against children are pedophiles.

Most of what we know about pedophilia is based on research on adult males and samples recruited in clinical or correctional settings. We know little about female pedophiles, though some women meet the diagnostic criteria, and we know relatively little about pedophiles who are not involved in clinical services or who have not been criminally charged for sexual offenses involving children. Pedophiles are much more likely to be male; otherwise, pedophiles are a heterogeneous group with regard to characteristics such as education level, occupation, and socioeconomic status. The prevalence of pedophilia in the general population is not known because epidemiological surveys of sexuality have not included the pertinent questions about the frequency and intensity of sexual thoughts, fantasies, urges, arousal, or behavior regarding prepubescent children.

Assessment and Diagnosis

Pedophilia can be diagnosed on the basis of self-report, sexual history, and penile responses. Self-report is the simplest and most direct source of information, but it is limited by individuals being reluctant to admit to pedophilia. Among sex offenders, pedophilia is positively associated with having boy victims, multiple child victims, younger child victims, or unrelated child victims and the possession of child pornography and is negatively associated with the number of adult sexual partners. One of the most consistent assessment research findings is that pedophilic men (such as sex offenders with many unrelated child victims) can be distinguished from other men in their penile responses when presented with sexual stimuli depicting children or adults during phallometric testing.

Phallometric testing involves the recording of changes in penile circumference or volume as men are presented with audiotaped or visual stimuli. Penile responses are more specific to sexual arousal than other psychophysiological parameters such as skin conductance, heart rate, and pupil dilation. For pedophilia, the measure of interest is how much a man responds to stimuli depicting children compared with stimuli depicting adults. Because the overall penile responsivity can vary for many reasons, including the man's age and health and the amount of time since he last ejaculated, an index of relative response is more informative than absolute responses. For example, interpreting the responses of an individual who exhibits a 10-mm increase in penile circumference in response to pictures of children is possible only when we know whether he exhibits a 5-or a 20-mm increase, for example, in response to pictures of adults. The first set of responses is from someone who is more sexually aroused by children than by adults, indicating a sexual preference for children; the second pattern of responses is from someone who is more sexually aroused by adults than by children, indicating a sexual preference for adults.

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