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.
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.
Pedophilia 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.
Using cutoff values that produce high specificity among nonpedophilic men (e.g., community volunteers, offenders who have committed only nonsexual crimes), the sensitivity of phallometric testing among men who deny pedophilia is approximately 60% using optimal procedures and stimuli. The sensitivity is approximately 90% among men who admit pedophilia. Specificity refers to the proportion of nonpedophilic men identified as such by the phallometric test, while sensitivity refers to the proportion of sex offenders against children who are identified as pedophilic. Phallometrically assessed sexual arousal by children is one of the strongest single predictors of sexual recidivism in quantitative reviews of sex offender follow-up research.
Studies have also shown that pedophiles and sex offenders with child victims can be distinguished from other men in the unobtrusively recorded amount of time they look at pictures of children relative to pictures of adults. No studies have yet demonstrated, however, that viewing-time measures predict sexual recidivism.
There are challenges in making the diagnosis of pedophilia. The Diagnostic and Statistical Manual (fourth edition, text revision; DSM-IV-TR) diagnostic criteria have not been rigorously evaluated for interrater or test-retest reliability, and different assessment methods may identify overlapping but nonidentical groups of men as pedophiles. In addition, many phallometric laboratories do not use validated procedures and stimulus sets. Diagnosis is more likely to be reliable and more valid when assessment procedures are standardized. For example, sexual history variables that are associated with pedophilia can be combined to create a short, easy-to-score scale that organizes diagnostic decisions on the basis of these variables (Screening Scale for Pedophilic Interests).
Pedophilia can be described as a sexual preference that is phenomenologically similar to heterosexual or homosexual orientation, in that it emerges prior to or during puberty; is stable over time; and directs the person’s sexuality in terms of his thoughts, fantasies, urges, arousal, and behavior. Retrospective studies indicate that some adult sex offenders admit to pedophilia when they were adolescents, and the average age of onset of paraphilic behavior among adolescent sex offenders is around 11 or 12 years. Some pedophiles have reported being aware of their sexual interest in children from a very early age, just as other individuals report being aware of their opposite-sex or same-sex attractions early in life.
Pedophilia Risk Assessment
All other things being equal, pedophilic sex offenders are more likely to sexually re-offend than nonpedophilic sex offenders. There is an interaction between pedophilia and antisocial tendencies; offenders who score higher on measures of both factors are much more likely to sexually re-offend than others. Reflecting the importance of pedophilia in the prediction of sex offender recidivism, many of the actuarial risk scales developed for adult sex offenders include variables that pertain to pedophilia (e.g., phallometrically assessed sexual arousal by children, having boy victims). Examples of these scales include the Sex Offender Risk Appraisal Guide, STATIC-99, and Rapid Risk Assessment for Sexual Offense Recidivism.
A recent study found that child pornography offenders with no known history of sexual contacts with children are significantly more likely than men who have sexually offended against children to be identified as pedophilic on the basis of their phallometric responses. This suggests that pedophilia may not be a sufficient factor to explain the onset of sexual offending against children. Antisocial tendencies are also expected to play an important role, but research on the onset (vs. maintenance) of sexual offending is only just beginning.
There is accumulating evidence that pedophilia is a neurodevelopmental disorder. Recent studies have shown that pedophilic men score lower on measures of intelligence and other cognitive abilities than nonpedophilic men. In addition, pedophilic men are significantly more likely to have incurred head injuries before age 13 and differ by having less white-matter volume in two tracts that are thought to connect areas of the brain involved in the identification of visual stimuli as sexually relevant.
Other research has confirmed the common belief that many sex offenders against children have themselves been victims of sexual abuse as children. Meta-analytic reviews have found that adolescent sex offenders have almost five times the odds of having been sexually abused than other adolescent offenders, while adult sex offenders have almost three times the odds of having such a history. These significant differences are obtained whether the analysis is restricted to studies based on self-report or studies based on other sources of information. Moreover, sex offenders with child victims are more likely to have been sexually abused than offenders with peer or adult victims; adult sex offenders who report having been sexually abused are more likely to admit being sexually aroused by children; and adolescent sex offenders who were sexually abused showed relatively greater sexual arousal by children, when assessed phallometrically, than those who were not abused.
The mechanisms underlying this association between childhood sexual abuse and sexual offending against children are not known. Possibilities include imitation of the perpetrator’s behavior, disruption of emotional and sexual development, and familial transmission of predisposition(s) for sexual offending (because many incidents of child sexual abuse are committed by relatives). The large majority of sexually abused children do not go on to offend, so there must be individual differences in vulnerability. The most obvious candidate for a vulnerability factor is being male, because most sex offenders against children are male, yet the majority of child victims of sexual abuse are female. Other writers have suggested that other vulnerabilities include poor parent-child attachment, social skills deficits, and emotional regulation problems.
Pedophilia co-occurs with other paraphilias, such that the prevalence of paraphilias is higher in a sample of pedophiles than in the general population. Two studies suggest that approximately one in six pedophiles has engaged in exhibitionistic behavior, and approximately one in five pedophiles has engaged in voyeuristic behavior. Comorbidity of paraphilias has implications for risk assessment and intervention because evidence of any paraphilic behavior is significantly related to sexual recidivism, and treatment may need to target multiple paraphilias. This comorbidity also has implications for etiological theories because it suggests that the factors influencing the development of one para-philia may also influence the development of other paraphilias. One implication of the neurodevelopmental research mentioned earlier is that the nature, location, and timing of perturbations (e.g., maternal malnutrition, illness, exposure to toxins) might determine which paraphilias emerge.
The most common approaches to the treatment of pedophilia involve arousal conditioning, pharmacological sex drive reduction, or cognitive-behavioral treatments designed to teach pedophilic sex offenders how to identify risky situations and other situational triggers that they can avoid or cope with in order to avoid sexual contacts with children. The evidence regarding these approaches is not strong, however. Many clinicians and investigators assume that pedophilia is a sexual disorder that can be managed but not changed.
There is evidence that aversive conditioning is effective in reducing sexual arousal by children, but it is unclear how long such changes can be maintained once the conditioning sessions have stopped. It is likely that booster sessions are required to maintain any treatment gains. The changes in sexual arousal by children are unlikely to represent a change in pedophilia; instead, participants learn to voluntarily control their sexual arousal in the laboratory. The hope is that this voluntary control can generalize outside the laboratory.
Several randomized clinical trials suggest that some medications can reduce sex drive and subsequently reduce the frequency or intensity of sexual thoughts, fantasies, urges, arousal, and behavior. Surgical castration can also reduce sex drive. Treatment attrition and compliance are serious issues in the drug treatment of pedophilic sex offenders, however, and castration is controversial; it has not been demonstrated that reduced sex drive leads to reductions in recidivism.
There is much debate as well about the efficacy of cognitive-behavioral treatments for pedophilic sex offenders. A recent meta-analysis of sex offender treatment-outcome studies suggested that such treatments are indeed effective, because there was a significant difference between sex offenders in treatment versus those in comparison conditions; however, the methodologically strongest study, California’s Sex Offender Treatment and Evaluation Project (SOTEP), found no significant difference between sex offenders randomly assigned to treatment or to a control condition. There was a nonsignificant trend for those who victimized children to be more likely to re-offend after treatment (22% of treated offenders and 17% of controls). In light of these discouraging results, innovative treatment approaches and rigorous evaluations are needed if we are to make advances in the treatment of pedophilia.
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- Seto, M. C. (in press). Pedophilia and sexual offending against children: Theory, assessment, and intervention. Washington, DC: American Psychological Association.