Definition
Pedophilia fall under the general category of paraphilias, "abnormal or unnatural attraction." Pedophilia is defined as the act or fantasy of engaging in sexual activity with prepubertal children as the preferred or exclusive method of achieving sexual excitement. However, pedophiles vary as to how well they can relate to adults of the opposite sex (usually pedophiles are males, who may be attracted to males, females or both).
While pedophilia is illegal and harmful to the victims, the offenders are apt to delude themselves into viewing their actions are beneficial to the children, i.e., they are contributing to the children's development or the children are enjoying the acts; however, they will be sure to tell the children not to alert their parents or authorities to the activities.
Pedophilia is the most commonly occurring form of paraphilia with an estimated 20% of American children having been sexually molested. Often, offenders are known to the children rather than being strangers, i.e., they are usually family friends or relatives. Types of activities vary and may include only looking at a child or undressing and touching a child; however, usually acts involve oral sex or touching of genitals of the child or offender. Studies suggest that children who are lonely or uncared for may be at higher risk for becoming victims of pedophilia (Morrison, 1995).
Symptoms
Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The person is at least age 16 years and at least 5 years older than the child or children in the first category.
Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.
Causes
The precise cause or causes of pedophilia (and other paraphilias) are not known. There is some evidence that pedophilia may run in families, but this could suggest either a genetic or a learned behavior effect.
Other factors, such as abnormalities in male sexual hormones or the brain chemical serotonin, have been hypothesized but never proved as factors in the development of paraphilias or pedophilia. A history of childhood sexual abuse has also been put forth as a factor in the development of pedophilias but this, too, has not been proved.
Nathan, Gorman and Salkind (1999) provide the following survey of current theories regarding the etiology of paraphilias. Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors learn to imitate and is later reinforced for the behavior. Compensation models suggest that these individuals are deprived of normal social sexual contacts and thus seek gratification through less socially acceptable means. Physiological models focus on the relationship between hormones, behavior and the central nervous systems with a particular interest in the role of aggression and male sexual hormones.
Treatment
Conditioning plays an important role in the treatment of paraphilias in general and pedophilia in particular. In olfactory aversion therapy, for example, the pedophile is trained to pair and associate the chain of events preceding pedophilic acts with the odor of ammonia, supplied by smelling salt capsules. In covert desensitization, the pedophile practices imagining the chain of events leading to pedophilic acts, and then inserts imagined negative consequences into the chain.
Antiandrogens (which reduce male sex hormone levels) and medications that increase serotonin (such as Prozac) are being investigated for treatment of the paraphilias and both have met with some success.
Nathan et al. (1999) describe these treatment approaches further here. First, they provide the following explanations regarding medication as treatment for paraphilias. They point out that level of sex drive is not consistently related to the behavior of paraphiliacs and also high levels of circulating testosterone do not predispose a male to paraphilias. That said, hormones such as medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate decrease the level of circulating testosterone thus reducing sex drive and aggression. These hormones result in reduction of frequency of erections, sexual fantasies and initiations of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine (Prozac) have also successfully decreased the sex drive but have not effectively targeted sexual fantasies.
Nathan et al. (1999) also note that research suggests that cognitive-behavioral models are effective in treating paraphiliacs. Aversive conditioning involves using negative stimuli to reduce or eliminate a behavior. Covert sensitization entails the patient relaxing, visualizing scenes of deviant behavior followed by a negative event such as getting his penis stuck in the zipper of his pants. Assisted aversive conditioning is similar to covert sensitization except the negative event is made real most likely in the form of a foul odor pumped in the air by the therapist. The goal is for the patient to associate the deviant behavior with the foul odor and take measures to avoid the odor by avoiding said behavior. Aversive behavioral reversal is commonly known as "shame therapy" as the goal is to shame the offender into stopping the deviant behavior. For example, the offender might be made to watch videotapes of their crime with the goal that the experience will be distasteful and offensive to the offender. Vicarious sensitization entails showing videotapes of deviant behaviors and their consequences such as victims describing desired revenge or perhaps even watching surgical castrations.
Nathan et al. (1999) also describe positive conditioning approaches which might center around social skills training and alternate behaviors the patient might take that are more appropriate. Reconditioning techniques center around providing immediate feedback to the patient so behavior will be changed right away. For example, a person might be connected to a plethysmographic biofeedback machine that is connected to a light and taught to keep the light within a specific range of color while the person is exposed to sexually stimulating material. Or masturbation training might focus on separating pleasure in masturbation and climax with the deviant behavior.
Cognitive therapies described by Nathan et al. (1999) include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting erroneous beliefs by the patient which may lead to errors in behavior such as seeing a victim and constructing erroneous logic that the victim deserves to be party to the deviant act. A pedophile observing a young girl wearing shorts may erroneously think, "she wants me." This line of thinking is targeted for reconstructuring. Empathy training involves helping the offender take on the perspective of the victim and in identification with the victim, understand the harm that has been done.
Use of alcohol and difficulty forming intimate relationships with adult women increase the chance of recidivism in men convicted of pedophilia and later released. Also, men who prefer boys are approximately twice as likely to reoffend as those who prefer girls (Morrison, 1995).
