Pedophilia

Pedophilia is a disorder in which an adult shows a strong and consistent preference to engage in sexual relationships with a prepubescent child younger than 13 years of age. The person with pedophilia must be at least 16 years of age and at least five years older than the child (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], 1994). Persons with pedophilia may be exclusive, that is only sexually attracted to children, or nonexclusive, where they are sometimes attracted to adults. Some restrict their interactions to children of their own gender, while others are attracted to children of both genders. Incidence reports about the disorder vary widely across studies and reflect a number of differences in its operational definition. Approximately 0.1% of men are believed to be pedophiles; data on the prevalence rate among females are not available. The statistic for male perpetrators is probably underestimated because so many cases go unreported. Approximately 35% of pedophiles are homosexual. Male-on-male pedophiles are far more numerous than heterosexual pedophiles. It is estimated that approximately 80% of pedophilic victims are boys molested by adult males. The most preferred age of female victims is 8 to 10 years, while male victims tend to be slightly older. The range of sexual behaviors in pedophilia extend from gentle fondling, self-masturbation, or actual genital and/or oral penetration of the child involving either the penis, fingers, or objects with varying degrees of force. It is not unusual for the adult to develop some kind of emotional bond with the child and try to meet the child's physical and material needs to encourage the child's loyalty and commitment.

Although it is difficult to develop a precise profile of a pedophile, some generalizations exist. Most pedophiles are adult males who rationalize these behaviors, devote a good deal of time to sexually fantasizing about children, often view various forms of child pornography, and typically engage in other kinds of socially approved behaviors to compensate for this behavior. Many pedophiles have childhood histories of being sexually abused.

A number of treatment approaches have been used with pedophiles, although this disorder is generally highly resistant to psychological intervention. Therapeutic strategies include treating the pedophilia as symptomatic of the person's own posttraumatic stress disorder or viewing the behavior as an addiction and using 12-step support groups to deliver treatment. Some promising approaches are behavior therapy using aversion techniques, where the pedophilic actions become associated mentally with unpleasant thoughts developed during visual imagery, desensitization, covert sensitization, and/or cognitive restructuring. Victim empathy and relapse prevention training programs often are used as adjuncts to the behavior therapy. Several antiandrogen medications have also been found to be effective in controlling this disorder but remain controversial control mechanisms (Crawford, 1981).