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Pedophilia ˌpēd-ə-ˈfil-ē-ə, ˌped-

(Pedophilic Disorder)

By George R. Brown, MD, Chief of Psychiatry;Professor and Associate Chairman, Department of Psychiatry, Mountain home VAMC, Johnson City, TN;East Tennessee State University

Pedophilic disorder is characterized by recurring, intense sexually arousing fantasies, urges, or behavior involving children (usually 13 years old or younger).

  • Pedophiles may be attracted to young boys, young girls, or both, and they may be attracted only to children or to children and adults.

  • Doctors diagnose pedophilia when people feel greatly distressed or become less able to function well because of their attraction to children or when they have acted on their urges.

  • Treatment involves long-term psychotherapy and drugs that alter the sex drive and reduce testosterone levels.

Pedophilia is form of paraphilia. Because it causes harm to others, it is considered a disorder.

Whether sexual interest or involvement between two people is considered pedophilic disorder depends on the age of the people involved. In Western societies, a diagnosis of a pedophilic disorder requires that the person be 16 years old or older and at least 5 years older than the child who is the object of the sexual fantasies or activity. However, sexual involvement of an older adolescent (aged 17 to 18) with a 12- or 13-year-old may not be considered a disorder. The age criteria used to identify when such activity is considered a crime may differ.

Although state laws vary in the United States, the law generally considers a person older than 18 to be committing statutory rape if the victim is 16 or younger. Statutory rape cases often do not meet the definition of pedophilia, highlighting the somewhat arbitrary nature of selecting a specific age cutoff point in a medical or legal definition. In many other countries and cultures, children as young as 12 can legally marry, further complicating the definition of pedophilia and statutory rape.

Pedophilia is much more common among men than among women.

Pedophiles may be attracted to young boys, young girls, or both. Whether girls or boys are more likely to be the victims of pedophiles is unclear, although girls seem much more likely to be the victims of sexual abuse in general.

Usually, the adult is known to the child and may be a family member, stepparent, or a person with authority (such as a teacher or coach). Some are attracted only to children within their own family (incest). Some pedophiles are attracted only to children, often of a specific age range or developmental stage. Others are attracted to both children and adults.

Looking or general touching seems more common than touching the genitals or having sexual intercourse.

Predatory pedophiles may use force or coercion to engage children sexually and may threaten to harm the child or the child's pets if the child tells anyone. Many of these pedophiles have antisocial personality disorder.

Many pedophiles have or develop substance abuse or dependence and depression. They often come from dysfunctional families, and marital conflict is common. Many have been sexually abused as children.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors diagnose pedophilia when

  • People have had repeated, intense sexually arousing fantasies, urges, or behaviors involving a child or children (usually aged 13 years or under).

  • People feel greatly distressed or become less able to function well (at work, in their family, or in interactions with friends), or they have acted on their urges.

  • People are aged 16 years old or older and are 5 or more years older than the child who is the object of the fantasies or behaviors. (An exception is an older adolescent who has an ongoing relationship with a 12- or 13-year-old.)

  • They have had the condition for 6 months or more.

Treatment

  • Psychotherapy

  • Drugs

Pedophilia can be treated with long-term individual or group psychotherapy and drugs that alter the sex drive and reduce testosterone levels.

Results of treatment vary. Outcome is best when participation is voluntary and the person receives training in social skills and treatment of other problems, such as drug abuse or depression. Treatment that is sought only after criminal apprehension and legal action may be less effective.

Simply putting pedophiles in prison or another institution, even for a long time, does not change pedophilic desires or fantasies. However, some imprisoned pedophiles who are committed to long-term, monitored treatment (usually including drugs) can refrain from pedophilic activity and be reintegrated into society.

Drugs

Doctors in the United States usually use the following drug:

  • Medroxyprogesterone acetate, which is injected into a muscle

Medroxyprogesterone (a progestin) is similar to the female hormone progesterone.

An alternative is leuprolide.

Medroxyprogesterone and leuprolide stop the pituitary gland from signaling the testicles to produce testosterone. They thus reduce testosterone levels and the sex drive. Doctors periodically do blood tests to monitor the effects of these drugs on liver function, as well as other tests (including bone density tests and blood tests to measure testosterone levels). It is not clear how useful these drugs are in women who are pedophiles.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may also be helpful. They may help control sexual urges and fantasies. They also decrease the sex drive and may cause erectile dysfunction.

Drug treatment is more effective when it is combined with psychotherapy and training in social skills.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • LUPRON
  • CRINONE
  • DELATESTRYL
  • PROVERA