Pedophilia

Pedophilia (alternatively spelled as paedophilia) is a psychosexual disorder in which an adult or adolescent over the age of 16 is primarily or exclusively attracted to prepubescentPrepubescence (often referred to as one's "childhood") refers to the period of one's life before they have undergone puberty, the process in which their body develops secondary sex characteristics (such as breasts and body hair). Girls usually begin puberty at age 10 or 11, and boys at age 11 or 12. However, the diagnostic criteria for pedophilia states that age 13 is the end of prepubescence. children.
== History ==
The term pedophilia comes from the Greek παῖς, παιδός (paîs, paidós), meaning "child", and φιλία (philía), meaning "friendly love" or "friendship", and was first used among researchers in the 1830s. It was used further in the field of forensics after the 1890s, when Richard von Krafft-Ebing (a German psychiatrist whose work most often centered on pedophilia, homosexuality/bisexualityThough an obvious outlier among the others, homosexuality/bisexuality was, at the time, considered a sexual perversion. , masochism/sadism, necrophilia, etc.) used the term paedophilia erotica in his work. 
== In psychology==
===Development===
Pedophilia typically emerges (as in self-discovered, not chosen) before or during puberty and remains stable thereafter, similar to homosexuality/bisexuality.Cutler, Brian L., ed. (2008). "Pedophilia". Encyclopedia of Psychology and Law. Vol. 2. Thousand Oaks, California: SAGE Publishing. p. 549. ISBN 978-1-4129-5189-0. However, these observations do not exclude pedophilia from being classified as a psychological/psychosexual disorder. It is considered as such, rather than as a sexual preference, due to the fact that the disorder causes harm to others and can sometimes be treated by psychologists (though not cured).Berlin, Fred S. (May 2000). "Treatments to Change Sexual Orientation". Letter to the Editor. American Journal of Psychiatry. Philadelphia, Pennsylvania: American Psychiatric Association. 157 (5): 838. Retrieved on October 9, 2023. It is most often referred to as a "paraphilia", the sexual attraction to atypical objects, situations, fantasies, behaviors, and/or individuals. Paraphilia is sometimes referred to as "the attraction to any non-consenting human partner" as well.The Pedophilia and Orientation Debate and Its Implications for Forensic Psychiatry | Journal of the American Academy of Psychiatry and the Law (jaapl.org)
===Symptoms and comorbidity===
Studies of pedophilia in child sex offenders often report that it co-occurs with other psychopathologies, such as low self-esteemMarshall, William L. (1997). "The relationship between self-esteem and deviant sexual arousal in nonfamilial child molesters". Behavior Modification. Thousand Oaks, California: SAGE Publishing. 21 (1): 86–96. Retrieved on October 10, 2023., depression, anxiety, and personality problems. It is not clear, however, if these symptoms are features of the disorder itself, artifacts of sampling bias, or consequences of being identified as a sex offender.Seto, Michael (2008). "Pedophilia: Psychopathology and Theory". In Laws, D. Richard (ed.). Sexual Deviance: Theory, Assessment, and Treatment (2 ed.). New York City: Guilford Press. p. 168. ISBN 9781593856052. Such data is also considered unreliable because not all pedophiles act upon their actions and therefore are not registered sex offenders.Seto, Michael (2004). "Pedophilia and sexual offenses against children". Annu Rev Sex Res. 15: 321–61. PMID 16913283.
Impaired self-concept and interpersonal functioning, which the authors suggested could contribute to motivation for pedophilic acts, were reported in a sample of child sex offenders who met the diagnostic criteria for pedophilia. Subjects also had elevated psychopathy and cognitive distortions compared to healthy community controls.Cohen, L. J., et al. (October 2002). "Personality impairment in male pedophiles". Journal of Clinical Psychiatry. Memphis, Tennessee: Physicians Postgraduate Press. 63 (10): 912–9. Other studied observed that non-pedophilic child sex offenders exhibited psychopathy while pedophiles did not.Strassberg, D. S., et al. (April 2012). "Psychopathy among pedophilic and non-pedophilic child molesters". Child Abuse & Neglect. Amsterdam, Netherlands: Elsevier. 36 (4): 379–382. Suchy, Y., et al. (March 2009). "Facial and prosodic affect recognition among pedophilic and nonpedophilic criminal child molesters". Sexual Abuse: A Journal of Research and Treatment. Thousand Oaks, California: SAGE Publishing. 21 (1): 93–110.
According to one study in 1983, pedophiles displayed elevated shyness, sensitivity, and depression in comparison to the control groups (non-pedophiles). They also displayed more signs of neuroticism and psychoticism, though not enough to be considered pathological as a group. Regarding their findings, the authors stated: "there is a difficulty in untangling cause and effect. We cannot tell whether pedophiles gravitate towards children because, being highly introverted, they find the company of children less threatening than that of adults, or whether the social withdrawal implied by their introversion is a result of the isolation engendered by their preference i.e., awareness of the social [dis]approbation and hostility that it evokes."Wilson G. D.; Cox D. N. (1983). "Personality of paedophile club members". Personality and Individual Differences. Amsterdam, Netherlands: Elsevier. 4 (3): 323–329. In a non-clinical survey, 46% of pedophiles reported that they had seriously considered suicide for reasons related to their sexual interest, 32% had planned to commit the act, and 13% had previously attempted suicide.Jahnke, S.; Hoyer, J. (2013). "Stigma against people with pedophilia: A blind spot in stigma research?". International Journal of Sexual Health. 25 (3): 169–184.
It was reported that child sex abusers use cognitive distortions to meet personal needs, as means for justifying their actions (and redefining them as love and mutuality), and exploiting the power imbalance present in all adult–child relationships.Lawson, L. (2003). "Isolation, gratification, justification: offenders' explanations of child molesting". Issues in Mental Health Nursing. Abingdon, England: Taylor & Francis. 24 (6–7): 695–705. Other cognitive distortions include the idea of "children as sexual beings", uncontrollability of sexual behavior, and "sexual entitlement-bias".Mihailides, Stephen; Devilly, Grant J.; Ward, Tony (October 2004). "Implicit cognitive distortions and sexual offending". Sexual Abuse: A Journal of Research and Treatment. Thousand Oaks, California: SAGE Publishing. 16 (4): 333–350. 
===Causes===
Although the direct causes of pedophilia are not yet known, researchers have found several links between pedophilia and brain structure/function, such as having lower IQsBlanchard, R., et al. (2007). "IQ, handedness, and pedophilia in adult male patients stratified by referral source". Sexual Abuse: A Journal of Research and Treatment. 19 (3): 285–309. Cantor, J. M., et al. (2004). "Intelligence, memory, and handedness in pedophilia". Neuropsychology. 18 (1): 3–14. Cantor, J. M., et al. (2005). "Quantitative reanalysis of aggregate data on IQ in sexual offenders". Psychological Bulletin. 131 (4): 555–568., poorer scores on memory tests, greater rates of non-right-handednessCantor, J. M., et al. (2005). "Handedness in pedophilia and hebephilia". Archives of Sexual Behavior. 34 (4): 447–459. Bogaert, A. F. (2001). "Handedness, criminality, and sexual offending". Neuropsychologia. 39 (5): 465–469. , greater rates of school grade failureCantor, J. M., et al. (2006). "Grade failure and special education placement in sexual offenders' educational histories". Archives of Sexual Behavior. 35 (6): 743–751. , being below average heightCantor, J. M., et al. (2007). "Physical height in pedophilic and hebephilic sexual offenders". Sex Abuse. 19 (4): 395–407. McPhail, I. V.; Cantor, J. M. (April 2015). "Pedophilia, Height, and the Magnitude of the Association: A Research Note". Deviant Behavior. 36 (4): 288–292., greater probability of having had severe head injuries during childhoodBlanchard, R., et al. (2002). "Retrospective self-reports of childhood accidents causing unconsciousness in phallometrically diagnosed pedophiles". Archives of Sexual Behavior. 31 (6): 511–526. Blanchard, R., et al. (2003). "Self-reported injuries before and after age 13 in pedophilic and non-pedophilic men referred for clinical assessment". Archives of Sexual Behavior. 32 (6): 573–581. , and several difference in MRI-detected brain structuresCantor, J. M., et al. (2008). "Cerebral white matter deficiencies in pedophilic men". Journal of Psychiatric Research. 42 (3): 167–183. Schiffer, B., et al. (2007). "Structural brain abnormalities in the frontostriatal system and cerebellum in pedophilia". Journal of Psychiatric Research. 41 (9): 753–62. Schiltz, K., et al. (2007). "Brain pathology in pedophilic offenders: Evidence of volume reduction in the right amygdala and related diencephalic structures". Archives of General Psychiatry. 64 (6): 737–746. (having a lower level of white matter). Another study suggested that central processing of sexual stimuli in pedophiles may have been altered by disturbance to the prefrontal cortex or "a dysfunction at the cognitive stage of sexual arousal processing."Schiffer, B., et al. (May 2008). "Functional brain correlates of heterosexual paedophilia". NeuroImage. 41 (1): 80–91. It has been suggested (but not proven) that genetic factors could contribute to the possibility of being pedophilic.Gaffney, G. R.; Lurie, S. F.; Berlin, F. S. (September 1984). "Is there familial transmission of pedophilia?". Journal of Nervous and Mental Disease. 172 (9): 546–8. 
Though not direct causes for the disorder, childhood abuse by adults or comorbid psychiatric illnesses—such as personality disorders and substance abuse—are risk factors for acting on pedophilic urges.
===Diagnosis===
====DSM-5 and ICD-11====
The fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) states that "the diagnostic criteria for pedophilic disorder are intended to apply both to individuals who freely disclose this paraphilia and to individuals who deny any sexual attraction to prepubertal children (generally age 13 years or younger), despite substantial objective evidence to the contrary." Its required symptoms include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child for six months or more, or that the subject has acted on these urges or is distressed as a result of having these feelings. It is also indicated that the subject be 16 years or older or that the child/targeted children be at least five years younger than them, though ongoing sexual relationships between a 12- to 13-year-old and a late adolescent are advised to be excluded..
Similarly, the eleventh edition of the ICD (International Classification of Diseases) defines pedophilic disorder as a "sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviors—involving pre-pubertal children." It also states that, in order to be diagnosed, "the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them. This diagnosis does not apply to sexual behaviors among pre- or post-pubertal children with peers who are close in age.""ICD-11 for Mortality and Morbidity Statistics". World Health Organization/ICD-11. 2018. See section 6D32 Pedophilic disorder. Retrieved November 30, 2022. 
Neither the DSM-5 or ICD-11 require that the subject have had sexual activity with a prepubescent child in order to be diagnosed; therefore, a diagnosis can be made on fantasies or sexual urges alone. Alternatively, a person who acts upon these urges (not limited to overt sexual acts and includes indecent exposure, voyeuristic behavior, and groping) yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. Unlike the DSM-5 (controversially changed from its previous edition for legal reasons), the ICD-11 states that viewing/distributing child pornography alone may qualify for the diagnosis. In practice, the patient's behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made (such as their age, preferred sex, whether or not incest is involved, whether the subject is "exclusive" or "nonexclusive", etc.)."Non-exclusive pedophiles" are attracted to both children and adults, while "exclusive pedophiles" are attracted only to children. 
==== Debate ====
===Treatment===
There is no evidence that pedophilia can be curedSeto, M. C. (2009). "Pedophilia". Annual Review of Clinical Psychology. 5: 391–407. ; however, pedophiles can learn to refrain from acting on their desires.Seto, M. C.; Ahmed, A. G. (2014). "Treatment and management of child pornography use". Psychiatric Clinics of North America. 37 (2): 207–214. Michael Seto, renowned forensic psychologist and sexologist, argued that attempts to treat pedophilia in adulthood are often unsuccessful, due to the disorder being influenced by prenatal factors.
Most often used is cognitive behavioral therapy (CBT), which encourages self-control, social competence, and empathy in pedophilic subjects, reconstructing their view on harming children. CBT also utilizes relapse prevention, which teaches patients to identify and respond to potentially risky situations with rationality. It is not, however, guaranteed to treat such disorders.Dennis, J. A. (2012). "Psychological interventions for adults who have sexually offended or are at risk of offending". Cochrane Database of Systematic Reviews. 12 (12): CD007507. Lösel F, S. M. (2005). "The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis". Journal of Experimental Criminology. 1 (1): 117–46.Hanson, R. K.; Gordon, A.; Harris, A. J.; Marques, J. K.; Murphy, W.; et al. (2002). "First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders". Sexual Abuse. 14 (2): 169–94.Rice, M. E.; Harris, G. T. (2012). "Treatment for adult sex offenders: may we reject the null hypothesis?". In Harrison K, Rainey B (eds.). Handbook of Legal & Ethical Aspects of Sex Offender Treatment & Management. London, England: Wiley-Blackwell.
Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and covert sensitization (or masturbatory reconditioning) to increase sexual arousal to adults. These treatments appear to have an effect on sexual arousal patterns during phallometric testing, but is not known whether this represents deep-rooted internal changes or long-term effects.Barbaree, H. E., Bogaert, A. F., & Seto, M. C. (1995). Sexual reorientation therapy for pedophiles: Practices and controversies. In L. Diamant & R. D. McAnulty (Eds.), The psychology of sexual orientation, behavior, and identity: A handbook (pp. 357–383). Westport, CT: Greenwood Press.Barbaree, H. C., & Seto, M. C. (1997). Pedophilia: Assessment and treatment. In D. R. Laws & W. T. O'Donohue (eds.), Sexual deviance: Theory, assessment and treatment (pp. 175–193). New York: Guildford Press. Pharmacological interventions (such as by using antiandrogens) are sometimes used to lower the sex drive, thus repressing pedophilic feelings, though the sexual preference remains. More often used as means of rehabilitation in other countries than the U.S. is surgical castration.Camilleri, J. A.; Quinsey, V. L. (2008). "Pedophilia: Assessment and Treatment". In Laws, D. Richard (ed.). Sexual Deviance: Theory, Assessment, and Treatment, 2nd edition. The Guilford Press. pp. 199–200. ISBN 9781593856052. 
== In law and forensics==
==In society==
===Epidemiology===
==Subtypes and other terms ==
*Infantophilia: sexual attraction to/preference for children under the age of five (infants and/or toddlers).
*Hebephilia: sexual attraction to pubescent children, typically between the ages of 11 and 14.
*Ephebophilia: sexual attraction to minors, typically between the ages of 15 and 18, in the later stages of adolescence.
*Child sex abuse: a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation, rather by force or coercion.
*MAP: an acronym for "minor attracted person," used most often in online communities.B4U-ACT’s Summary of MAP Research (b4uact.org)
==Notes==
==References==
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