Description, Causes and Risk Factors:
Pedophilia, the sexual attraction to children who have not yet reached puberty, remains a vexing challenge for Clinicians and public officials.
The understanding of pedophilia has evolved over time, so each successive edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has defined this disorder in a slightly different way. The current edition, DSM-IV, categorizes pedophilia as a disorder only if the sexual fantasies or urges involve prepubescent children (defined as 10 or younger), if they last at least six months, if the individual has acted on them, or if they cause marked distress (including legal problems). The DSM-IV also specifies that a person be at least 16 years old and at least five years older than the prepubescent child.
One challenge in the scientific literature is that most of the studies on pedophilia have involved men convicted of crimes against children, and experts estimate that only one in 50 cases of child sexual abuse is reported. It remains unclear how prevalent pedophilia is in the general population. Research on convicts may not apply to people with pedophilic tendencies who live without detection in the community or suffer silently while controlling their impulses.
Researchers also do not agree about what proportion of child sex abusers are pedophiles. Other types of offenders include sexually curious or abusive adolescents who molest younger children, hypersexual adults who opportunistically target children, and people who act impulsively (rather than in response to erotic attachment) under the influence of alcohol or drugs. Moreover, about half of all child sexual abuse victims are 12 to 17 years old (postpubescent), so their assailants do not meet the strict definition of pedophilia.
The prognosis of successfully ending pedophilic habits among persons who practice pedophilia is not favorable. Pedophiles have a high rate of recidivism; that is, they tend to repeat their acts often over time.
The rate of prosecution for pedophiles through the criminal justice system has increased in recent years. Pedophiles are at high risk of being beaten or killed by other prison inmates. For this reason, they must often be kept isolated from other members of a prison population.
Nearly all people with pedophilic tendencies are male. Co-occurring disorders, such as personality disorders or mood disorders, are common in people with pedophilic tendencies. And about 50% to 70% of people with pedophilic tendencies are also diagnosed with another paraphilia, such as exhibitionism, voyeurism, or sadism. They often have good interpersonal skills with children and can easily gain the children's trust.Some pedophiles offer rationalizations or excuses that enable them to avoid assuming responsibility for their actions. They may blame the children for being too attractive or sexually provocative. They may also maintain that they are "teaching" the child about "the facts of life" or "love;" this rationalization is frequently offered by pedophiles who have molested children related to them. All these rationalizations have been proven by Psychiatristsbased on Pornography with pedophilic themes.
The draft version of DSM-V, now undergoing review, proposes several changes to the diagnosis of pedophilia. One is to expand the definition of this disorder to include hebephilia, an attraction to children who are going through puberty. The hybrid category, pedohebephilia, would consist of the pedophilic type (attracted to prepubescent children, generally younger than 10), the hebephilic type (attracted to pubescent children, usually ages 10 through 14), and the pedohebephilic type (attracted to both). In another significant change, the draft suggests that the use of pornography depicting prepubescent or pubescent children for six months or longer should be considered a symptom of pedohebephilia.
Researchers have found no effective treatment. Like other sexual orientations, pedophilia is unlikely to change. The goal of treatment, therefore, is to prevent someone from acting on pedophile urges — either by decreasing sexual arousal around children or increasing the ability to manage that arousal. But neither is as effective for reducing harm as preventing access to children, or providing close supervision.
Treatment is effective only if a patient with pedophilia is motivated and committed to controlling his behavior — attributes that are difficult for mental health professionals to assess. Outcomes are better when treatment combines psychotherapy and medication.
Psychotherapy. Most psychotherapies used to treat pedophilia incorporate the principles and techniques of cognitive behavioral therapy (CBT). The focus of therapy is to enable the patient to recognize and overcome rationalizations about his behavior. In addition, therapy may involve empathy training and techniques in sexual impulse control.
The most common type of cognitive behavioral therapy used with sex offenders, known as relapse prevention, is based on addiction treatment. Relapse prevention is intended to help the patient anticipate situations that increase the risk of sexually abusing or assaulting a child, and to find ways to avoid or more productively respond to them. Reviews that have included uncontrolled and nonrandomized studies concluded that relapse prevention programs reduced recidivism. Only one randomized controlled trial has evaluated how effective a relapse prevention program was, however, and it included sex offenders who had assaulted adults as well as those who hurt children. After an average of eight years, there was no significant difference in recidivism between sex offenders who underwent relapse prevention therapy and controls who did not undergo treatment.
Drug treatment. Drugs that suppress production of the male hormone testosterone are used to reduce the frequency or intensity of sexual desire. Although physical castration is another option, testosterone suppression offers advantages such as the need for follow-up visits (which aids in monitoring behavior). It may take three to 10 months for testosterone suppression to reduce sexual desire.
Investigators were once optimistic about the potential of selective serotonin reuptake inhibitors (SSRIs) in treating pedophilia. But only case reports and open-label trials find that SSRIs are helpful; this has not been demonstrated in randomized, placebo-controlled trials. However, SSRIs may be a useful adjunct to other treatments, because they not only subdue sexual ruminations and urges but also help with impulse control.
Preventing child sexual abuse:
School- and community-based educational programs offer advice about how to identify situations that may endanger children, how to recognize behaviors such as inappropriate touching that may desensitize children so that they are more easily victimized, and how children can protect themselves.
Unfortunately, little evidence exists about how effective these efforts are. Most studies that have evaluated the efficacy of educational programs have examined specific components, such as whether young children understand the concepts being taught, rather than long-term outcomes. Only two observational studies have examined whether these educational programs actually prevent childhood sexual abuse; one concluded that it did, while the other found no benefit.
In an effort to better understand pedophilia and find ways to intervene before sexual crimes occur, researchers are now trying to broaden study populations to include people who voluntarily seek treatment in response to community outreach rather than a court order. There is some encouraging news. Sexual crimes against Indian and US children, as recorded by law enforcement agencies declined 53% between 1992 and 2006. A review identified four possible explanations for the decline: economic growth, increased numbers of police and child protection workers, greater efforts to identify and prosecute child sex offenders of all types, and increased treatment of aggressive behavior.
It is unclear whether these factors are reducing activity by people with pedophilia, because the original data and the review are not limited to individuals with the disorder. Until we know more, parents and others who want to protect children from pedophiles are best advised to watch for the subtle stalking behaviors that may precede physical contact — and to remember that most sex offenders of any type approach children they know.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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