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Pedophilia ( alternatively spelt paedophilia) is a
psychiatric disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...
in which an adult or older adolescent experiences a primary or exclusive
sexual attraction Sexual attraction is attraction on the basis of sexual desire or the quality of arousing such interest. Sexual attractiveness or sex appeal is an individual's ability to attract other people sexually, and is a factor in sexual selection or mat ...
to
prepubescent Preadolescence is a stage of human development following middle childhood and preceding adolescence.New Oxford American Dictionary. 2nd Edition. 2005. Oxford University Press. It commonly ends with the beginning of puberty. Preadolescence is c ...
children. Although girls typically begin the process of
puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy. ...
at age 10 or 11, and boys at age 11 or 12, criteria for pedophilia extend the cut-off point for prepubescence to age 13. According to DSM-5-TR, a person must be at least 16 years old, and at least five years older than the prepubescent child, for the attraction to be diagnosed as pedophilic disorder. Pedophilia is distinguished from pedophilic disorder in the current version of the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' (
DSM-5-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
) . The DSM-5-TR defines it as a
paraphilic disorder Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...
involving intense and recurrent sexual urges,
fantasies Fantasy is a genre of fiction. Fantasy, Fantasie, or Fantasies may also refer to: Arts and entertainment Music * Fantasia (music), a free-form musical composition * ''Fantasie'' (Widmann), a 1993 composition for solo clarinet by Jörg Widmann * ...
or behaviors about prepubescent children that have either been acted upon or which cause the person with the attraction distress or
interpersonal The concept of interpersonal relationship involves social associations, connections, or affiliations between two or more people. Interpersonal relationships vary in their degree of intimacy or self-disclosure, but also in their duration, in t ...
difficulty. Similar to DSM-5-TR, the ICD-11 defines it as a "sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children" and requires the individual to have acted their their urges or to be experiencing distress. In popular usage, the word ''pedophilia'' is often applied to any sexual interest in children or the act of
child sexual abuse Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child (whet ...
, including any sexual interest in minors below the local
age of consent The age of consent is the age at which a person is considered to be legally competent to consent to sexual acts. Consequently, an adult who engages in sexual activity with a person younger than the age of consent is unable to legally claim ...
, regardless of their level of physical or mental development. This use conflates the sexual attraction to prepubescent children with the act of child sexual abuse and fails to distinguish between attraction to prepubescent and pubescent or post-pubescent minors. Researchers recommend that these imprecise uses be avoided, because although some people who commit child sexual abuse are pedophiles, child sexual abuse offenders are not pedophiles unless they have a primary or exclusive sexual interest in prepubescent children, and some pedophiles do not molest children. 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, and researchers assume available estimates underrepresent the true number of female pedophiles. No cure for pedophilia has been developed, but there are therapies that can reduce the incidence of a person committing child sexual abuse. The exact causes of pedophilia have not been conclusively established.Seto, p. 101 Some studies of pedophilia in child sex offenders have correlated it with various neurological abnormalities and psychological pathologies. In the United States, following ''
Kansas v. Hendricks ''Kansas v. Hendricks'', 521 U.S. 346 (1997), was a Supreme Court of the United States, United States Supreme Court case in which the Court set forth procedures for the indefinite civil commitment of prisoners convicted of a sex offense whom the s ...
'' in 1997, sex offenders who are diagnosed with certain mental disorders, particularly pedophilia, can be subject to indefinite
involuntary commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
.Seto, p. 186


Definitions

The word ''pedophilia'' comes from the
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
παῖς, παιδός (''paîs, paidós''), meaning "child", and φιλία ('' philía''), "friendly love" or "friendship". ''Pedophilia'' is used for individuals with a primary or exclusive sexual interest in prepubescent children aged 13 or younger. ''Infantophilia'' is a sub-type of pedophilia; it is used to refer to a sexual preference for children under the age of 5 (especially
infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
s and
toddler A toddler is a child approximately 12 to 36 months old, though definitions vary. The toddler years are a time of great cognitive, emotional and social development. The word is derived from "to toddle", which means to walk unsteadily, like a child ...
s). This is sometimes referred to as ''nepiophilia'' (from the el , νήπιος (''népios'') meaning "infant" or "child," which in turn derives from "ne-" and "epos" meaning "not speaking"), though this term is rarely used in academic sources. ''
Hebephilia Hebephilia is the strong, persistent sexual interest by adults in puberty, pubescent children who are in early adolescence, typically ages 11–14 and showing Tanner stages 2 to 3 of physical development. It differs from pedophilia (the primary or ...
'' is defined as individuals with a primary or exclusive sexual interest in 11- to 14-year-old pubescents. The DSM-5 does not list hebephilia among the diagnoses. While evidence suggests that hebephilia is separate from pedophilia, the ICD-10 includes early pubertal age (an aspect of hebephilia) in its pedophilia definition, covering the physical development overlap between the two philias. 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 Ephebophilia is the primary sexual interest in mid-to-late adolescents, generally ages 15 to 19. The term was originally used in the late 19th to mid-20th century. It is one of a number of sexual preferences across age groups subsumed under the t ...
'' (though ephebophilia is not considered pathological).


Signs and symptoms


Development

Pedophilia emerges before or during puberty, and is stable over time. It is self-discovered, not chosen. For these reasons, pedophilia has been described as a disorder of sexual preference, phenomenologically similar to a heterosexual or homosexual orientation. These observations, however, do not exclude pedophilia from being classified as a mental disorder since pedophilic acts cause harm, and mental health professionals can sometimes help pedophiles to refrain from harming children. In response to misinterpretations that the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
considers pedophilia a sexual orientation because of wording in its printed DSM-5 manual, which distinguishes between
paraphilia Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...
and what it calls "paraphilic disorder", subsequently forming a division of "pedophilia" and "pedophilic disorder", the association commented: "' xual orientation' is not a term used in the diagnostic criteria for pedophilic disorder and its use in the DSM-5 text discussion is an error and should read 'sexual interest.'" They added, "In fact, APA considers pedophilic disorder a 'paraphilia,' not a 'sexual orientation.' This error will be corrected in the electronic version of DSM-5 and the next printing of the manual." They said they strongly support efforts to criminally prosecute those who sexually abuse and exploit children and adolescents, and "also support continued efforts to develop treatments for those with pedophilic disorder with the goal of preventing future acts of abuse."


Comorbidity and personality traits

Studies of pedophilia in child sex offenders often report that it co-occurs with other
psychopathologies Psychopathology is the study of Abnormal psychology, abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biol ...
, such as low
self-esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
, depression, anxiety, and personality problems. It is not clear whether these are features of the disorder itself, artifacts of
sampling bias In statistics, sampling bias is a bias in which a sample is collected in such a way that some members of the intended population have a lower or higher sampling probability than others. It results in a biased sample of a population (or non-human fa ...
, or consequences of being identified as a sex offender. One review of the literature concluded that research on personality correlates and
psychopathology Psychopathology is the study of abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biological psychopatholo ...
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. 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. Impaired self-concept and interpersonal functioning were reported in a sample of child sex offenders who met the diagnostic criteria for pedophilia by Cohen et al. (2002), which the authors suggested could contribute to motivation for pedophilic acts. The pedophilic offenders in the study had elevated
psychopathy Psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent Anti-social behaviour, antisocial behavior, impaired empathy and remorse, and Boldness, bold, Disinhibition, disinhibited, and Egotism, egotistical B ...
and cognitive distortions compared to healthy community controls. This was interpreted as underlying their failure to inhibit their criminal behavior. Studies in 2009 and 2012 found that non-pedophilic child sex offenders exhibited psychopathy, but pedophiles did not. Wilson and Cox (1983) studied the characteristics of a group of pedophile club members. The most marked differences between pedophiles and controls were on the introversion scale, with pedophiles showing elevated shyness, sensitivity and depression. The pedophiles scored higher on
neuroticism In the study of psychology, neuroticism has been considered a fundamental personality trait. For example, in the Big Five approach to personality trait theory, individuals with high scores for neuroticism are more likely than average to be moody ...
and
psychoticism Psychoticism is one of the three traits used by the psychologist Hans Eysenck in his P–E–N model (psychoticism, extraversion and neuroticism) model of personality. Nature Psychoticism is conceptually similar to the ''constraint'' factor i ...
, but not enough to be considered pathological as a group. The authors caution that "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 ispprobation and hostility that it evokes" (p. 324). In a non-clinical survey, 46% of pedophiles reported that they had seriously considered suicide for reasons related to their sexual interest, 32% planned to carry it out, and 13% had already attempted it. A review of qualitative research studies published between 1982 and 2001 concluded that child sexual abusers use
cognitive distortion A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as depression and anxiety. Cognitive distortions are thoughts that cause individuals to perceive rea ...
s 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. Other cognitive distortions include the idea of "children as sexual beings", uncontrollability of sexual behavior, and "sexual entitlement-bias".


Child pornography

Consumption of
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography that unlawfully exploits children for sexual stimulation. It may be produced with the direct involvement or sexual assault of a chi ...
is a more reliable indicator of pedophilia than molesting a child, although some non-pedophiles also view child pornography. Child pornography may be used for a variety of purposes, ranging from private sexual gratification or trading with other collectors, to preparing children for sexual abuse as part of the
child grooming Child grooming is befriending and establishing an emotional connection with a minor under the age of consent, and sometimes the child's family, to lower the child's inhibitions with the objective of sexual abuse. Child grooming is also regularly ...
process. Pedophilic 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. 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". Lanning states that the collection is the single best indicator of what the offender wants to do, but not necessarily of what has been or will be done. Researchers Taylor and Quayle reported that pedophilic collectors of child pornography are often involved in anonymous internet communities dedicated to extending their collections.


Causes

Although what causes pedophilia is not yet known, researchers began reporting a series of findings linking pedophilia with brain structure and function, beginning in 2002. Testing individuals from a variety of referral sources inside and outside the criminal justice system as well as controls, these studies found associations between pedophilia and lower IQs, poorer scores on memory tests, greater rates of non-right-handedness, greater rates of school grade failure over and above the IQ differences, being below average height, greater probability of having had childhood head injuries resulting in unconsciousness, and several differences in
MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
-detected brain structures. Such studies suggest that there are one or more neurological characteristics present at birth that cause or increase the likelihood of being pedophilic. Some studies have found that pedophiles are less cognitively impaired than non-pedophilic child molesters. A 2011 study reported that pedophilic child molesters had deficits in response inhibition, but no deficits in memory or cognitive flexibility. Evidence of familial transmittability "suggests, but does not prove that genetic factors are responsible" for the development of pedophilia. A 2015 study indicated that pedophilic offenders have a normal IQ. Another study, using structural
MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
, indicated that male pedophiles have a lower volume of
white matter White matter refers to areas of the central nervous system (CNS) that are mainly made up of myelinated axons, also called tracts. Long thought to be passive tissue, white matter affects learning and brain functions, modulating the distribution ...
than a
control group In the design of experiments, hypotheses are applied to experimental units in a treatment group. In comparative experiments, members of a control group receive a standard treatment, a placebo, or no treatment at all. There may be more than one tr ...
. Functional magnetic resonance imaging (
fMRI Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
) has indicated that child molesters diagnosed with pedophilia have reduced activation of the
hypothalamus The hypothalamus () is a part of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions is to link the nervous system to the endocrine system via the pituitary gland. The hypothalamu ...
as compared with non-pedophilic persons when viewing sexually arousing pictures of adults. A 2008 functional
neuroimaging Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Incre ...
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 Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
stage of
sexual arousal Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind as ...
processing". Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify
hormonal A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required fo ...
aspects of pedophiles. Blanchard, R., Cantor, J. M., & Robichaud, L. K. (2006). Biological factors in the development of sexual deviance and aggression in males. In They concluded that there is some evidence that pedophilic men have less
testosterone Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testes and prostate, as well as promoting secondar ...
than controls, but that the research is of poor quality and that it is difficult to draw any firm conclusion from it. While not causes of pedophilia themselves,
childhood abuse Child abuse (also called child endangerment or child maltreatment) is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to ac ...
by adults or
comorbid In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary c ...
psychiatric illnesses—such as
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
s and
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, ...
—are risk factors for acting on pedophilic urges. Blanchard, Cantor, and Robichaud addressed 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?" They indicated that, because they previously found mothers of pedophiles to be more likely to have undergone psychiatric treatment, the genetic possibility is more likely. 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 Paraphilia (previously known as sexual perversion and sexual deviation) is the experience of intense sexual arousal to atypical objects, situations, fantasies, behaviors, or individuals. It has also been defined as sexual interest in anything ot ...
interest (including pedophilia) had a greater number of older brothers, a high 2D:4D
digit ratio The digit ratio is the ratio of the lengths of different digits or fingers on a hand, the study of which has been considered pseudoscience. The 2D:4D ratio is the most studied digit ratio and is calculated by dividing the length of the index ...
(which would indicate low prenatal
androgen An androgen (from Greek ''andr-'', the stem of the word meaning "man") is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This inc ...
exposure), and an elevated probability of being
left-handed In human biology, handedness is an individual's preferential use of one hand, known as the dominant hand, due to it being stronger, faster or more dextrous. The other hand, comparatively often the weaker, less dextrous or simply less subjecti ...
, suggesting that disturbed hemispheric
brain lateralization A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a ve ...
may play a role in deviant attractions.


Diagnosis


DSM and ICD-11

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) 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." 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 is distressed 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- to 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 Incest ( ) is human sexual activity between family members or close relatives. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by affinity (marriage or stepfamily), adoption ...
, and if the attraction is "exclusive" or "nonexclusive". The
ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World He ...
defines pedophilic disorder as a "sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children." It also states that for a diagnosis of pedophilic disorder, "the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them. This diagnosis does not apply to sexual behaviours among pre- or post-pubertal children with peers who are close in age." Several 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 only prepubescent children. 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. 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. Neither the DSM nor the ICD-11 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 Indecent exposure is the deliberate public exposure by a person of a portion of their body in a manner contrary to local standards of appropriate behavior. Laws and social attitudes regarding indecent exposure vary significantly in different ...
,
voyeuristic Voyeurism is the sexual interest in or practice of watching other people engaged in intimate behaviors, such as undressing, sexual activity, or other actions of a private nature. The term comes from the French ''voir'' which means "to see". A ...
or frotteuristic behaviors. On the other hand, watching
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography that unlawfully exploits children for sexual stimulation. It may be produced with the direct involvement or sexual assault of a chi ...
is not recognized by DSM-5-TR as "acting on sexual urges", since it require the action must have a "sexual interactions with children". 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.''Pedophilia''
DSM at the Medem Online Medical Library


Debate regarding criteria

There was discussion on the DSM-IV-TR being overinclusive and underinclusive. Its criterion A concerns sexual fantasies or sexual urges regarding prepubescent children, and its criterion B concerns acting on those urges or the urges causing marked distress or interpersonal difficulty. Several researchers discussed whether or not a "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—met the DSM-IV-TR criteria for pedophilia since this person did not meet criterion B. Criticism also concerned someone who met criterion B, but did not meet criterion A. 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 underinclusiveness, as well as a lack of validity, reliability and clarity might have led to the rejection of the DSM classification.
Ray Blanchard Ray Milton Blanchard ( ; born October 9, 1945) is an American-Canadian sexologist, best known for his research studies on transsexualism, pedophilia and sexual orientation. He found that men with more older brothers are more likely to be gay tha ...
, an
American-Canadian American Canadians are Canadians of American descent. The term is most often used to refer to Canadians who migrated from or have ancestry from the United States. Demography According to the 2016 Census, 29,590 Canadians reported American as ...
sexologist Sexology is the scientific study of human sexuality, including human sexual interests, behaviors, and functions. The term ''sexology'' does not generally refer to the non-scientific study of sexuality, such as social criticism. Sexologists app ...
known for his research studies on pedophilia, addressed (in his literature review for the DSM-5) the objections to the overinclusiveness and under underinclusiveness of 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. 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. The proposal for hebephilia was rejected by the American Psychiatric Association, but the distinction between ''paraphilia'' and ''paraphilic disorder'' was implemented. The American Psychiatric Association stated that " 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 " ly the disorder name will be changed from pedophilia to pedophilic disorder to maintain consistency with the chapter's other listings." 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, 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). 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." Also arguing for behavioral criteria in defining pedophilia, Howard E. Barbaree and
Michael C. Seto Michael Chikong Seto (; born 1967) is a Canadian forensic psychologist, sexologist, and author. He is director of Forensic Rehabilitation Research at the Royal Ottawa Health Care Group, where his research focuses on pedophilia, sexual offenses com ...
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 Taxonomy is the practice and science of categorization or classification. A taxonomy (or taxonomical classification) is a scheme of classification, especially a hierarchical classification, in which things are organized into groups or types. ...
simplification.Barbaree, H. E., and Seto, M. C. (1997). Pedophilia: Assessment and Treatment. ''Sexual Deviance: Theory, Assessment, and Treatment''. 175–193.


Treatment


General

There is no evidence that pedophilia can be cured. Instead, most therapies focus on helping pedophiles refrain from acting on their desires. Some therapies do attempt to cure pedophilia, but there are no studies showing that they result in a long-term change in sexual preference.
Michael Seto Michael Chikong Seto (; born 1967) is a Canadian forensic psychologist, sexologist, and author. He is director of Forensic Rehabilitation Research at the Royal Ottawa Health Care Group, where his research focuses on pedophilia, sexual offenses com ...
suggests that attempts to cure pedophilia in adulthood are unlikely to succeed because its development is influenced by prenatal factors. Pedophilia appears to be difficult to alter but pedophiles can be helped to control their behavior, and future research could develop a method of prevention. There are several common limitations to studies of treatment effectiveness. Most categorize their participants by behavior rather than erotic age preference, which makes it difficult to know the specific treatment outcome for pedophiles. Many do not select their treatment and control groups
randomly In common usage, randomness is the apparent or actual lack of pattern or predictability in events. A random sequence of events, symbols or steps often has no :wikt:order, order and does not follow an intelligible pattern or combination. Ind ...
. Offenders who refuse or quit treatment are at higher risk of offending, so excluding them from the treated group, while not excluding those who would have refused or quit from the control group, can bias the treated group in favor of those with lower recidivism. The effectiveness of treatment for non-offending pedophiles has not been studied.


Cognitive behavioral therapy

Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT) aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use
cognitive restructuring Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions,Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Educatio ...
to change views on sex with children. The most common form of this therapy is
relapse prevention Relapse prevention (RP) is a cognitive-behavioral approach to relapse with the goal of identifying and preventing high-risk situations such as unhealthy substance use, obsessive-compulsive behavior, sexual offending, obesity, and depression.Witki ...
, where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions. The evidence for cognitive behavioral therapy is mixed. A 2012
Cochrane Review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professi ...
of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders. Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism. There is debate over whether non-randomized studies should be considered informative. More research is needed.


Behavioral interventions

Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and
covert sensitization Covert conditioning is an approach to mental health treatment that uses the principles of applied behavior analysis, or cognitive-behavior therapies (CBTs) to assist people in making improvements in their behavior or inner experience. The method r ...
(or
masturbatory Masturbation is the sexual stimulation of one's own Sex organ, genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrator (sex t ...
reconditioning) to increase sexual arousal to adults. Behavioral treatments appear to have an effect on sexual arousal patterns during phallometric testing, but it is not known whether the effect represents changes in sexual interests or changes in the ability to control genital arousal during testing, nor whether the effect persists in the long term. For sex offenders with mental disabilities,
applied behavior analysis Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. ...
has been used.


Sex drive reduction

Pharmacological interventions are used to lower the sex drive in general, which can ease the management of pedophilic feelings, but does not change sexual preference.
Antiandrogens Antiandrogens, also known as androgen antagonists or testosterone blockers, are a class of drugs that prevent androgens like testosterone and dihydrotestosterone (DHT) from mediating their biological effects in the body. They act by blocking the ...
work by interfering with the activity of testosterone.
Cyproterone acetate Cyproterone acetate (CPA), sold alone under the brand name Androcur or Ethinylestradiol/cyproterone acetate, with ethinylestradiol under the brand names Diane or Diane-35 among others, is an antiandrogen and progestin medication used in the treat ...
(Androcur) and
medroxyprogesterone acetate Medroxyprogesterone acetate (MPA), also known as depot medroxyprogesterone acetate (DMPA) in injectable form and sold under the brand name Depo-Provera among others, is a hormonal medication of the progestin type. It is used as a method of bi ...
(Depo-Provera) are the most commonly used. The efficacy of antiandrogens has some support, but few high-quality studies exist. Cyproterone acetate has the strongest evidence for reducing sexual arousal, while findings on medroxyprogesterone acetate have been mixed.
Gonadotropin-releasing hormone analogue A GnRH modulator, or GnRH receptor modulator, also known as an LHRH modulator or LHRH receptor modulator, is a type of medication which modulates the GnRH receptor, the biological target of the hypothalamic hormone gonadotropin-releasing hormone ...
s such as
leuprorelin Leuprorelin, also known as leuprolide, is a manufactured version of a hormone used to treat prostate cancer, breast cancer, endometriosis, uterine fibroids, as part of transgender hormone therapy, for early puberty, or to perform chemical castra ...
(Lupron), which last longer and have fewer side-effects, are also used to reduce libido, as are
selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs increase the extracell ...
s. The evidence for these alternatives is more limited and mostly based on open trials and case studies. All of these treatments, commonly referred to as "
chemical castration Chemical castration is castration via anaphrodisiac drugs, whether to reduce libido and sexual activity, to treat cancer, or otherwise. Unlike surgical castration, where the gonads are removed through an incision in the body, ...
", are often used in conjunction with cognitive behavioral therapy. According to the
Association for the Treatment of Sexual Abusers The Association for the Treatment and Prevention of Sexual Abuse (ATSA) is an international, multi-disciplinary, non-profit organization with a stated goal of making society safer by preventing sexual abuse. ATSA promotes sound research, evidence- ...
, when treating child molesters, "anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan." These drugs may have side-effects, such as weight gain, breast development, liver damage and osteoporosis. Historically, surgical
castration Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...
was used to lower sex drive by reducing testosterone. The emergence of pharmacological methods of adjusting testosterone has made it largely obsolete, because they are similarly effective and less invasive. It is still occasionally performed in Germany, the Czech Republic, Switzerland, and a few U.S. states. Non-randomized studies have reported that surgical castration reduces recidivism in contact sex offenders. The Association for the Treatment of Sexual Abusers opposes surgical castration and the
Council of Europe The Council of Europe (CoE; french: Conseil de l'Europe, ) is an international organisation founded in the wake of World War II to uphold European Convention on Human Rights, human rights, democracy and the Law in Europe, rule of law in Europe. ...
works to bring the practice to an end in Eastern European countries where it is still applied through the courts.


Epidemiology


Pedophilia and child molestation

The prevalence of pedophilia in the general population is not known, but is estimated to be lower than 5% among adult men. Less is known about the prevalence of pedophilia in women, but there are case reports of women with strong sexual fantasies and urges towards children. Male perpetrators account for the vast majority of sexual crimes committed against children. Among convicted offenders, 0.4% to 4% are female, and one literature review estimates that the ratio of male-to-female child molesters is 10 to 1. The true number of female child molesters may be underrepresented by available estimates, for reasons including 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. The term ''pedophile'' is commonly used by the public to describe all child sexual abuse offenders. This usage is considered problematic by researchers, because many child molesters do not have a strong sexual interest in prepubescent children, and are consequently not pedophiles. There are motives for child sexual abuse that are unrelated to pedophilia, such as stress, marital problems, the unavailability of an adult partner, general anti-social tendencies, high sex drive or alcohol use. As child sexual abuse is not automatically an indicator that its perpetrator is a pedophile, offenders can be separated into two types: pedophilic and non-pedophilic (or preferential and situational). Estimates for the rate of pedophilia in detected child molesters generally range between 25% and 50%. A 2006 study found that 35% of its sample of child molesters were pedophilic. Pedophilia appears to be less common in
incest Incest ( ) is human sexual activity between family members or close relatives. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by affinity (marriage or stepfamily), adoption ...
offenders, especially fathers and step-fathers. 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. Some pedophiles do not molest children. Little is known about this population because most studies of pedophilia use criminal or clinical samples, which may not be representative of pedophiles in general. Researcher Michael Seto suggests that pedophiles who commit child sexual abuse do so because of other anti-social traits in addition to their sexual attraction. He states that pedophiles who are "reflective, sensitive to the feelings of others, averse to risk, abstain from alcohol or drug use, and endorse attitudes and beliefs supportive of norms and the laws" may be unlikely to abuse children. A 2015 study indicates that pedophiles who molested children are neurologically distinct from non-offending pedophiles. The pedophilic molesters had neurological deficits suggestive of disruptions in inhibitory regions of the brain, while non-offending pedophiles had no such deficits. According to Abel, Mittleman, and Becker (1985) and Ward ''et al.'' (1995), there are generally large distinctions between the characteristics of pedophilic and non-pedophilic molesters. They state that non-pedophilic offenders tend to offend at times of stress; have a later onset of offending; and have fewer, often familial, victims, while pedophilic offenders often start offending at an early age; often have a larger number of victims who are frequently extrafamilial; are more inwardly driven to offend; and have values or beliefs that strongly support an offense lifestyle. One study found that pedophilic molesters had a median of 1.3 victims for those with girl victims and 4.4 for those with boy victims. Child molesters, pedophilic or not, employ a variety of methods to gain sexual access to children. Some groom their victims into compliance with attention and gifts, while others use threats, alcohol or drugs, or physical force.


History

Pedophilia is believed to have occurred in humans throughout history, but was not formally named, defined or studied until the late 19th century. The term ''paedophilia erotica'' was coined in an 1886 article by the
Viennese Viennese may refer to: * Vienna, the capital of Austria * Viennese people, List of people from Vienna * Viennese German, the German dialect spoken in Vienna * Music of Vienna, musical styles in the city * Viennese Waltz, genre of ballroom dance * V ...
psychiatrist
Richard von Krafft-Ebing Richard Freiherr von Krafft-Ebing (full name Richard Fridolin Joseph Freiherr Krafft von Festenberg auf Frohnberg, genannt von Ebing; 14 August 1840 – 22 December 1902) was a German psychiatrist and author of the foundational work ''Psychopathi ...
but does not enter the author's ''
Psychopathia Sexualis ''Psychopathia Sexualis: eine Klinisch-Forensische Studie'' (''Sexual Psychopathy: A Clinical-Forensic Study'', also known as ''Psychopathia Sexualis, with Especial Reference to the Antipathetic Sexual Instinct: A Medico-forensic Study'') is an ...
'' until the 10th German edition. A number of authors anticipated Krafft-Ebing's diagnostic gesture. In ''Psychopathia Sexualis'', the term appears in a section titled "Violation of Individuals Under the Age of Fourteen", which focuses on the
forensic psychiatry Forensic psychiatry is a subspeciality of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiat ...
aspect of child sexual offenders in general. Krafft-Ebing describes several typologies of offender, dividing them into
psychopathological Psychopathology is the study of Abnormal psychology, abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biol ...
and non-psychopathological origins, and hypothesizes several apparent causal factors that may lead to the sexual abuse of children. 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: # The individual is tainted
y heredity Y, or y, is the twenty-fifth and penultimate letter of the Latin alphabet, used in the modern English alphabet, the alphabets of other western European languages and others worldwide. According to some authorities, it is the sixth (or seventh ...
(''hereditär belastete'')Roudinesco, Élisabeth (2009). ''Our dark side: a history of perversion,'
p. 144.
Polity,
# The subject's primary attraction is to children, rather than adults. # 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. Further clarifying this point, he indicated that cases of adult men who have some medical or
neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
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 Libido (; colloquial: sex drive) is a person's overall sexual drive or desire for sexual activity. Libido is influenced by biological, psychological, and social factors. Biologically, the sex hormones and associated neurotransmitters that act up ...
for the adult through masturbation and subsequently turn to children for the gratification of their sexual appetite" and claimed this is much more common. Austrian neurologist
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
briefly wrote about the topic in his 1905 book ''
Three Essays on the Theory of Sexuality ''Three Essays on the Theory of Sexuality'' (german: Drei Abhandlungen zur Sexualtheorie), sometimes titled ''Three Contributions to the Theory of Sex'', is a 1905 work by Sigmund Freud, the founder of psychoanalysis, in which the author advance ...
'' 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. In 1908,
Swiss Swiss may refer to: * the adjectival form of Switzerland * Swiss people Places * Swiss, Missouri * Swiss, North Carolina *Swiss, West Virginia * Swiss, Wisconsin Other uses *Swiss-system tournament, in various games and sports *Swiss Internation ...
neuroanatomist Neuroanatomy is the study of the structure and organization of the nervous system. In contrast to animals with radial symmetry, whose nervous system consists of a distributed network of cells, animals with bilateral symmetry have segregated, defin ...
and psychiatrist
Auguste Forel Auguste-Henri Forel (1 September 1848 – 27 July 1931) was a Swiss myrmecologist, neuroanatomist, psychiatrist and eugenicist, notable for his investigations into the structure of the human brain and that of ants. For example, he is considered a ...
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 Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
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. 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 A medical dictionary is a lexicon for words used in medicine. The three major medical dictionaries in the United States are ''Stedman's'', ''Taber's'', and ''Dorland's''. Other significant medical dictionaries are distributed by Elsevier. Dicti ...
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 The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
''. 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. The revision in 1987, the DSM-III-R, kept the description largely the same, but updated and expanded the diagnostic criteria.


Law and forensic psychology


Definitions

''Pedophilia'' is not a legal term, and having a sexual attraction to children is not illegal. In law enforcement circles, the term ''pedophile'' is sometimes used informally to refer to any person who commits one or more sexually-based crimes that relate to legally underage victims. These crimes may include
child sexual abuse Child sexual abuse (CSA), also called child molestation, is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include engaging in sexual activities with a child (whet ...
,
statutory rape In common law jurisdictions, statutory rape is nonforcible sexual activity in which one of the individuals is below the age of consent (the age required to legally consent to the behavior). Although it usually refers to adults engaging in sexual ...
, offenses involving
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography that unlawfully exploits children for sexual stimulation. It may be produced with the direct involvement or sexual assault of a chi ...
,
child grooming Child grooming is befriending and establishing an emotional connection with a minor under the age of consent, and sometimes the child's family, to lower the child's inhibitions with the objective of sexual abuse. Child grooming is also regularly ...
,
stalking Stalking is unwanted and/or repeated surveillance by an individual or group toward another person. Stalking behaviors are interrelated to harassment and intimidation and may include following the victim in person or monitoring them. The ter ...
, and
indecent exposure Indecent exposure is the deliberate public exposure by a person of a portion of their body in a manner contrary to local standards of appropriate behavior. Laws and social attitudes regarding indecent exposure vary significantly in different ...
. One unit of the United Kingdom's
Child Abuse Investigation Command A child (plural, : children) is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The legal definition of ''child'' generally refers ...
is known as the "
Paedophile Unit The Paedophile Unit is a branch of the Metropolitan Police Service's Child Abuse Investigation Command, based at Scotland Yard in London, England. It operates against the manufacture and distribution of child pornography, online child grooming, an ...
" and specializes in online investigations and enforcement work. Some forensic science texts, such as Holmes (2008), use the term to refer to offenders who target child victims, even when such children are not the primary sexual interest of the offender.
FBI The Federal Bureau of Investigation (FBI) is the domestic Intelligence agency, intelligence and Security agency, security service of the United States and its principal Federal law enforcement in the United States, federal law enforcement age ...
agent Kenneth Lanning, however, makes a point of distinguishing between pedophiles and child molesters.


Civil and legal commitment

In the United States, following ''
Kansas v. Hendricks ''Kansas v. Hendricks'', 521 U.S. 346 (1997), was a Supreme Court of the United States, United States Supreme Court case in which the Court set forth procedures for the indefinite civil commitment of prisoners convicted of a sex offense whom the s ...
'', sex offenders who have certain mental disorders, including pedophilia, can be subject to indefinite
civil commitment Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
under various state laws (generically called SVP laws) and the federal
Adam Walsh Child Protection and Safety Act The Adam Walsh Child Protection and Safety Act is a federal statute that was signed into law by U.S. President George W. Bush on July 27, 2006. The Walsh Act organizes sex offenders into three tiers according to the crime committed, and mand ...
of 2006. Similar legislation exists in Canada. In ''Kansas v. Hendricks'', the
US Supreme Court The Supreme Court of the United States (SCOTUS) is the highest court in the federal judiciary of the United States. It has ultimate appellate jurisdiction over all U.S. federal court cases, and over state court cases that involve a point of ...
upheld as constitutional a Kansas law, the
Sexually Violent Predator Act Some jurisdictions may commit certain types of dangerous sex offenders to state-run detention facilities following the completion of their sentence if that person has a "mental abnormality" or personality disorder that makes the person likely to ...
, 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 him. In ''
United States v. Comstock United may refer to: Places * United, Pennsylvania, an unincorporated community * United, West Virginia, an unincorporated community Arts and entertainment Films * United (2003 film), ''United'' (2003 film), a Norwegian film * United (2011 film) ...
'', 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. 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". In the US, offenders with pedophilia are more likely to be recommended for civil commitment than non-pedophilic offenders. About half of committed offenders have a diagnosis of pedophilia. Psychiatrist
Michael First Michael B. First (born 1956) is an American psychiatrist who focuses on diagnostic criteria for mental disorders. He is Professor of Clinical Psychiatry at Columbia University. First was one of the editors of DSM-IV-TR, the Editor of Text and Criter ...
writes that, since not all people with a paraphilia have difficulty controlling their behavior, the evaluating clinician must present additional evidence of volitional impairment instead of recommending commitment based on pedophilia alone.


Society and culture


General

Pedophilia is one of the most stigmatized mental disorders. One study reported high levels of anger, fear and social rejection towards pedophiles who have not committed a crime. The authors suggested such attitudes could negatively impact child sexual abuse prevention by reducing pedophiles' mental stability and discouraging them from seeking help. According to sociologists Melanie-Angela Neuilly and Kristen Zgoba, social concern over pedophilia intensified greatly in the 1990s, coinciding with several sensational sex crimes (but a general decline in child sexual abuse rates). They found that the word ''pedophile'' appeared only rarely in ''
The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...
'' and ''
Le Monde ''Le Monde'' (; ) is a French daily afternoon newspaper. It is the main publication of Le Monde Group and reported an average circulation of 323,039 copies per issue in 2009, about 40,000 of which were sold abroad. It has had its own website si ...
'' before 1996, with zero mentions in 1991. Social attitudes towards child sexual abuse are extremely negative, with some surveys ranking it as morally worse than murder. Early research showed that there was a great deal of misunderstanding and unrealistic perceptions in the general public about child sexual abuse and pedophiles. However, a 2004 study concluded that the public was well-informed on some aspects of these subjects.


Misuse of medical terminology

The words ''pedophile'' and ''pedophilia'' are commonly used informally to describe an adult's sexual interest in pubescent or post-pubescent persons under the age of consent. The terms ''
hebephilia Hebephilia is the strong, persistent sexual interest by adults in puberty, pubescent children who are in early adolescence, typically ages 11–14 and showing Tanner stages 2 to 3 of physical development. It differs from pedophilia (the primary or ...
'' or ''
ephebophilia Ephebophilia is the primary sexual interest in mid-to-late adolescents, generally ages 15 to 19. The term was originally used in the late 19th to mid-20th century. It is one of a number of sexual preferences across age groups subsumed under the t ...
'' may be more accurate in these cases. Another common usage of ''pedophilia'' is to refer to the act of sexual abuse itself, rather than the medical meaning, which is a ''preference'' for prepubescents on the part of the older individual ( see above for an explanation of the distinction). 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 considered too young in comparison to their older partner, or the older partner occupies a position of authority over them. Researchers state that the above uses of the term ''pedophilia'' are imprecise or suggest that they are best avoided. The
Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...
states that ''pedophilia'' "is not a criminal or legal term".


Pedophile advocacy groups

From the late 1950s to early 1990s, several pedophile membership organizations advocated
age of consent reform Age of consent reform is an effort to change age of consent laws. Proposed reforms typically include raising, lowering, or abolishing the age of consent, applying (or not applying) close-in-age exemptions, changing penalties, or changing how ca ...
to lower or abolish
age of consent The age of consent is the age at which a person is considered to be legally competent to consent to sexual acts. Consequently, an adult who engages in sexual activity with a person younger than the age of consent is unable to legally claim ...
laws, as well as for the acceptance of pedophilia as a
sexual orientation Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. These attractions are generall ...
rather than a
psychological disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
, and for the legalization of child pornography. The efforts of pedophile advocacy groups did not gain mainstream acceptance, and today those few groups that have not dissolved have only minimal membership and have ceased their activities other than through a few websites. In contrast to these organizations, members of the support group
Virtuous Pedophiles Virtuous Pedophiles is an Internet-based mutual support group for pedophiles who acknowledge having a sexual interest in children and do not act on their attraction. Members support each other in trying to lead normal lives without committing chi ...
believe that child sexual abuse is wrong and seek to raise awareness that some pedophiles do not offend; this is generally not considered pedophile advocacy, as the Virtuous Pedophiles organization does not approve of the legalization of child pornography and does not support
age of consent reform Age of consent reform is an effort to change age of consent laws. Proposed reforms typically include raising, lowering, or abolishing the age of consent, applying (or not applying) close-in-age exemptions, changing penalties, or changing how ca ...
.


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. 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.Families flee paedophile protests
August 9, 2000. Retrieved January 24, 2008.
High-profile media attention to pedophilia has led to incidents of
moral panic A moral panic is a widespread feeling of fear, often an irrational one, that some evil person or thing threatens the values, interests, or well-being of a community or society. It is "the process of arousing social concern over an issue", usua ...
, particularly following reports of pedophilia associated with
Satanic ritual abuse The Satanic panic is a moral panic consisting of over 12,000 unsubstantiated cases of Satanic ritual abuse (SRA, sometimes known as ritual abuse, ritualistic abuse, organized abuse, or sadistic ritual abuse) starting in the United States in th ...
and day care sex abuse. Instances of
vigilantism Vigilantism () is the act of preventing, investigating and punishing perceived offenses and crimes without Right, legal authority. A vigilante (from Spanish, Italian and Portuguese “vigilante”, which means "sentinel" or "watcher") is a pers ...
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.


See also

*
Age disparity in sexual relationships Concepts of age disparity in sexual relationships, including what defines an age disparity, have developed over time and vary among societies. Differences in age preferences for mates can stem from partner availability, gender roles, and evoluti ...
*
Age of consent The age of consent is the age at which a person is considered to be legally competent to consent to sexual acts. Consequently, an adult who engages in sexual activity with a person younger than the age of consent is unable to legally claim ...
*
Child marriage Child marriage is a marriage or similar union, formal or informal, between a child under a certain age – typically 18 years – and an adult or another child. * * * * The vast majority of child marriages are between a female child and a ma ...
*
Child sexuality Development of sexuality is an integral part of the development and maturation of children. It includes a range of sensory, emotional, and consequent sexual activities that may occur before or during early puberty, but before full sexual maturity i ...
*
Circles of Support and Accountability Circles of Support and Accountability (CoSA) are groups of volunteers with professional supervision to support sex offenders as they reintegrate into society after their release from incarceration. Evaluations of CoSA indicate that participation in ...
*
Gerontophilia Gerontophilia is the primary sexual attraction to the elderly. A person with such a sexual preference is a gerontophile or gerontosexual. The word ''gerontophilia'' was coined in 1901 by psychiatrist Richard von Krafft-Ebing. It derives from Gree ...
*
List of paraphilias Paraphilias are sexual interests in objects, situations, or individuals that are atypical. The American Psychiatric Association, in its ''Diagnostic and Statistical Manual, Fifth Edition'' (DSM), draws a distinction between paraphilias (which i ...
*
Pedobear Pedobear is an Internet meme that became popular through the imageboard 4chan. As the name suggests ("pedo" being short for "pedophile"), it is portrayed as a pedophilic cartoon bear. It is a concept used to mock child sex offenders or people ...
*
Prevention Project Dunkelfeld The Prevention Project Dunkelfeld (PPD) is an effort founded in Germany to provide clinical and support services to individuals who are sexually attracted to children ( pedophiles and hebephiles) and want help controlling their sexual urges, but a ...
*
Trafficking of children Trafficking of children is a form of human trafficking and is defined by the United Nations as the "recruitment, transportation, transfer, harboring, and/or receipt" kidnapping of a child for the purpose of slavery, forced labour and exploitation. ...


References


Further reading

* Gladwell, Malcolm.
In Plain View
" ("
Jerry Sandusky Gerald Arthur Sandusky (born January 26, 1944) is an American retired college football coach and convicted serial child molester. Sandusky served as an assistant coach for his entire career, mostly at Pennsylvania State University under Joe Pa ...
and the Mind of a Pedophile") ''
The New Yorker ''The New Yorker'' is an American weekly magazine featuring journalism, commentary, criticism, essays, fiction, satire, cartoons, and poetry. Founded as a weekly in 1925, the magazine is published 47 times annually, with five of these issues ...
''. September 24, 2012. *Philby, Charlotte.
Female sexual abuse: The untold story of society's last taboo
" ''
The Independent ''The Independent'' is a British online newspaper. It was established in 1986 as a national morning printed paper. Nicknamed the ''Indy'', it began as a broadsheet and changed to tabloid format in 2003. The last printed edition was publis ...
''. Saturday August 8, 2009. *Bleyer, Jennifer.
How Can We Stop Pedophiles? Stop treating them like monsters.
''
Slate Slate is a fine-grained, foliated, homogeneous metamorphic rock derived from an original shale-type sedimentary rock composed of clay or volcanic ash through low-grade regional metamorphism. It is the finest grained foliated metamorphic rock. ...
''. Monday September 24, 2012. *Fong, Diana. Editor: Nancy Isenson.
'If I'm attracted to children, I must be a monster'
" ''
Die Welt ''Die Welt'' ("The World") is a German national daily newspaper, published as a broadsheet by Axel Springer SE. ''Die Welt'' is the flagship newspaper of the Axel Springer publishing group. Its leading competitors are the ''Frankfurter Allg ...
''. May 29, 2013.


External links


Understanding MRI research on pedophilia

''Indictment from Operation Delego''
(PDF)
Archive

''Virtuous Pedophiles,'' online support for non-offending pedophiles working to remain offence-free.

HelpWantedPrevention.org, an online self-help course from Johns Hopkins University for managing attraction to children
{{Authority control Paraphilias