Pedophilia Health Article

Demographics

Pedophilia is one of the more common paraphilias; the large worldwide market for child pornography suggests that it is more frequent in the general population than prison statistics would indicate. Together with voyeurismand exhibitionism, pedophilia is one of the three paraphilias most commonly leading to arrest by the police.

The onset of pedophilia usually occurs during adolescence. Occasional pedophiles begin their activities during middle age but this late onset is uncommon. In the United States, about 50% of men arrested for pedophilia are married.

The frequency of behavior associated with pedophilia varies with psychosocial stress. As the pedophile's stress levels increase, the frequency of his or her acting out generally rises also.

Pedophilia is more common among males than among females. In addition, the rate of recidivism for persons with a pedophilic preference for males is approximately twice that of pedophiles who prefer females.

Little is known about the incidence of pedophilia in different racial or ethnic groups.

Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders,fourth edition text revised, the following criteria must be met to establish a diagnosisof pedophilia.

• Over a period of at least six months, the affected person experiences recurrent, intense and sexually arousing fantasies, sexual urges or actual behaviors involving sexual activity with a prepubescent child or children aged 13 or younger.
• The fantasies, sexual urges or behaviors cause clinically significant distress or impairment in social, occupational or other important areas of daily functioning.
• The affected person must be at least age sixteen and be at least five years older than the child or children who are the objects or targets of attention or sexual activity.

A diagnosis of pedophilia cannot be assigned to an individual in late adolescence (age 17 to 19) who is involved in an ongoing sexual relationship with a 12- or 13-year-old person.

In establishing a diagnosis of pedophilia, it is important for a mental health professional to determine if the patient is attracted to males, females or both. It is also important to determine whether incest is a factor in the relationship. Finally, the doctor must determine whether the pedophilia is exclusive or nonexclusive; that is, whether the patient is attracted only to children (exclusive pedophilia) or to adults as well as to children (nonexclusive pedophilia).

One difficulty with the diagnosis of the disorder is that persons with pedophilia rarely seek help voluntarily from mental health professionals. Instead, counseling and treatment is often the result of a court order. An interview that establishes the criteria for diagnosis listed above may be enough to diagnose the condition, or surveillance or Internet records obtained through the criminal investigation may also be used.

An additional complication in diagnosis is that the paraphilias as a group have a high rate of comorbidity with one another and an equally high rate of comorbidity with major depression, anxiety disorders, and substance abuse disorders. A person diagnosed with pedophilia may also meet the criteria for exhibitionism or for a substance abuse or mood disorder.

Treatments

In the earliest stages of behavior modificationtherapy, pedophiles may be narrowly viewed as being attracted to inappropriate persons. Such aversive stimuli as electric shocks have been administered to persons undergoing therapy for pedophilia. This approach has not been very successful.

In 2002, the most common form of treatment for pedophilia is psychotherapy, often of many years' duration. It does not have a high rate of success in inducing pedophiles to change their behavior.

Pedophilia may also be treated with medications. The three classes of medications most often used to treat pedophilia (and other paraphilias) are: female hormones, particularly medroxyprogesterone acetate, or MPA; luteinizing hormone-releasing hormone (LHRH) agonists, which include such drugs as triptorelin (Trelstar), leuprolide acetate, and goserelin acetate; and anti-androgens, which block the uptake and metabolism of testosterone as well as reducing blood levels of this hormone. Most clinical studies of these drugs have been done in Germany, where the legal system has allowed their use in treating repeat sexual offenders since the 1970s. The anti-androgens in particular have been shown to be effective in reducing the rate of recidivism.

Surgical castration is sometimes offered as a treatment to pedophiles who are repeat offenders or who have pleaded guilty to violent rape.

Increasingly, pedophiles are being prosecuted under criminal statutes and being sentenced to prison terms. Imprisonment removes them from society for a period of time but does not usually remove their pedophilic tendencies. In 2002, many states have begun to publish the names of persons being released from prison after serving time for pedophilia. Legal challenges to this practice are pending in various jurisdictions.