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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

Pedophilia Mike Edwards, MD Psychologist, Caner R Karaçay, Ph.D

Summary

This article is about the sexual interest. For the act itself, For the primary sexual interest in pubescent (generally 11-14 year old) children, see. adolescents. Pedophilia

(or paedophilia) is a

For mid-to-late

or late (persons age 16 and older)

characterized by a primary or exclusive sexual interest in prepubescent According to the (DSM), pedophilia is in which a person has intense and recurrent sexual urges towards and about children they have either acted on or cause distress or difficulty. The disorder is common among people who commit; however, some offenders do not meet the clinical diagnosis standards for pedophilia. In strictly behavioral contexts, the word "pedophilia" has been used to refer to child sexual abuse itself, also called "pedophilic behavior", and to the sexual abuse of

or post-pubescent. Researchers

recommend that this imprecise use be avoided. Pedophilia was first formally recognized and named in the late 19th century. A significant amount of research in the area has taken place since the 1980s. At present, the exact causes of pedophilia have not been conclusively established. Research suggests that pedophilia may be correlated with several different neurological abnormalities, and often co-exists with other personality disorders and psychological pathologies. In the contexts and law enforcement, a variety of typologies have been suggested to categorize pedophiles according to behavior and motivations. Most pedophiles are men, though there are also women who are pedophiles, and the issue of pedophilia has been the subject of a great deal of media attention and social activism.No significant curative treatment for pedophilia has been found yet. There are, however, certain therapies that can reduce the incidence of a person committing an abusive act on a child.

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1.

Etymology And History

The word comes from the παιδοφιλία (paidophilia): παῖς (pais), "child" and φιλία (philia), "friendship". Paidophilia was coined by Greek poets either as a substitute for "paiderastia" or vice versa.

The term paedophilia erotica was coined in 1886 by the psychiatrist in his writing the term appears in a section titled "Violation of Individuals Under the Age of Fourteen," which focuses on the aspect of in general. Krafft-Ebing describes several typologies of offender, dividing them into and non-psychopathological origins, and hypothesizes several apparent causal factors that may lead to the sexual abuse of children.

After listing several typologies of it four times in his career and gave brief descriptions of each case, as well as noting they all have three traits in common:

a. Their attraction is persistent (Krafft-Ebing refers to this as being "tainted")

b. The subject's primary attraction is to children, rather than adults.

c. The acts committed by the subject are typically not intercourse, but rather involve inappropriate touching or manipulating the child into performing an act on the subject.

It’s notable that this work also indicates several cases of pedophilia among adult women (provided by another physician), and also considered the abuse of boys men to be extremely rare. Further clarifying this point, he indicated that cases of adult men who have some medical or disorder and abuse a male child are not true pedophilia, and that in his observation victims of such men tended to be older and pubescent. He also lists "Pseudopaedophilia" as a related 16 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

condition wherein "individuals who have lost

for the adult through masturbation and

subsequently turn to children for the gratification of their sexual appetite" and claimed this is much more common.

In 1908, and psychiatrist wrote of the phenomenon, proposing that it be referred to it as "Pederosis," the "Sexual Appetite for Children." Similar to Krafft-Ebing's work, Forel made the distinction between incidental sexual abuse by person's and other organic brain conditions, and the truly preferential and sometimes exclusive sexual desire for children. However, he disagreed with Krafft-Ebing in that he felt the condition of the latter was largely ingrained and unchangeable.

The term "Pedophilia" became the generally accepted term for the condition and saw widespread adoption in the early 20th century, appearing in many popular

such as the

5th Edition of Stedman's. In 1952, it was included in the first edition of the. This edition and the subsequent DSM-II listed the disorder as one subtype of the classification "Sexual Deviation," but no diagnostic criteria were provided. The DSM-III, published in 1980, contained a full description of the disorder and provided a set of guidelines for diagnosis. The revision in 1987, the DSM-III-R, kept the description largely the same, but updated and expanded the diagnostic criteria. 2. Diagnosis

The ICD) (F65.4) defines pedophilia as "a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age." Under this system's criteria, a person 16 years of age or older meets the definition if they have a persistent or predominant sexual preference for prepubescent children at least five years younger than them. The 4th edition Text Revision (DSM-IV-TR) outlines specific criteria for use in the diagnosis of this disorder. These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child (age 13 or younger, though puberty can vary) for six months or more, and that the subject has acted on these urges or suffers from distress as a result of having these feelings. The criteria also indicate that the subject should be 16 or older 17 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

and that child or children they fantasize about are at least five years younger than them, though on going sexual relationships between a 12-13 year old and a late adolescent are advised to be excluded. A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to, and if the attraction is "exclusive" or "nonexclusive".

Many terms have been used to distinguish "true pedophiles" from non-pedophilic and non-exclusive offenders, or to distinguish among types of offenders on a continuum according to strength and exclusivity of pedophilic interest, and motivation for the offense (see). Exclusive pedophiles are sometimes referred to as "true pedophiles." They are attracted to children, and children only. They show little erotic interest in adults their own age and in some cases, can only become aroused while fantasizing or being in the presence of prepubescent children. Non-exclusive pedophiles may at times be referred to as non-pedophilic offenders, but the two terms are not always synonymous. Non-exclusive pedophiles are attracted to both children and adults, and can be sexually aroused by both, though a sexual preference for one over the other in this case may also exist.

Neither the ICD nor the DSM diagnostic criteria require actual sexual activity with a prepubescent youth. The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. Acting on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposure, or behaviors, or masturbating to child pornography. Often these behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made. Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation. Nepiophilia, also called infantophilia, is used to refer to a sexual preference for (usually ages 0–3), includes people who do not doubt that they have a prepubertal sexual preference, but wish it were different because of associated psychological and behavioral disorders. 18 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

3.

Biological Associations

Beginning in 2002, researchers began reporting a series of findings linking pedophilia with brain structure and function: Pedophilic men have lower IQs, poorer scores on memory tests, greater rates of non-right-handedness, greater rates of school grade failure over and above the IQ differences, lesser physical height, greater probability of having suffered childhood head injuries resulting in unconsciousness, and several differences in-detected brain structures. They report that their findings suggest that there are one or more neurological characteristics present at birth that cause or increase the likelihood of being pedophilic. Evidence of familial transmittability suggests, but does not prove that genetic factors are responsible" for the development of pedophilia.

Another study, using structural, shows that male pedophiles have a lower volume of than a. Functional magnetic resonance imaging) has shown that child molesters diagnosed with pedophilia have reduced activation of the as compared with non-pedophilic persons when viewing sexually arousing pictures of adults. A 2008 functional processing of sexual stimuli in

study notes that central

"paedophile forensic inpatients" may be altered by a

disturbance in the prefrontal networks, which "may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours." The findings may also suggest "a dysfunction at the stage of sexual arousal processing."

Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify aspects of pedophiles. They concluded that there is some evidence that pedophilic men have less than controls, but that the research is of poor quality and that it is difficult to draw any firm conclusion from it. While not causes of pedophilia themselves, psychiatric illnesses — such as and— are risk factors for acting on pedophilic urges. Blanchard, Cantor, and Robichaud (2006) noted about comorbid psychiatric illnesses that, "The theoretical implications are not so clear. Do particular genes or noxious factors in the prenatal environment predispose a male to develop both affective disorders and pedophilia, or do the frustration, danger, and isolation engendered by unacceptable sexual desires—or their occasional furtive satisfaction—lead to 19 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

anxiety and despair?" They indicated that, because they previously found mothers of pedophiles to be more likely to have under gone psychiatric treatment, the genetic possibility is more likely.

4. Psychopathology And Personality Traits

Several researchers have reported correlations between pedophilia and certain psychological characteristics, such as low and poor social skills. Cohen et al. (2002), studying child sex offenders, states that pedophiles have impaired interpersonal functioning and elevated, as well as impaired. Regarding disinhibitory traits, pedophiles demonstrate elevated and propensity for cognitive distortions. According to the authors, pathologic personality traits in pedophiles lend support to a hypothesis that such pathology is related to both motivation for and failure to inhibit pedophilic behavior.

According to Wilson and Cox (1983), "The paedophiles emerge as significantly higher on Psychoticism, Introversion and Neurotocism than age-matched controls’’. [But] there is a difficulty in untangling cause and effect. We cannot tell whether paedophiles 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 isloation engendered by their preference. Studying child sex offenders, a review of qualitative research studies published between 1982 and 2001 concluded that pedophiles use to meet personal needs, justifying abuse by making excuses, redefining their actions as love and mutuality, and exploiting the power imbalance inherent in all adult-child relationships. Other cognitive distortions include the idea of "children as sexual beings," "uncontrollability of sexuality," and "sexual entitlement-bias."

One review of the literature concludes that research on personality correlates and in pedophiles is rarely methodologically correct, in part owing to confusion between pedophiles and child sex offenders, as well as the difficulty of obtaining a representative, community sample of pedophiles. Seto (2004) points out that pedophiles who are available from a clinical setting are likely there because of distress over their sexual preference or pressure from others. 20 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

This increases the likelihood that they will show psychological problems. Similarly, pedophiles recruited from a correctional setting have been convicted of a crime, making it more likely that they will show anti-social characteristics.

5.

Prevalence And Child Molestation

The prevalence of pedophilia in the general population is not known, and research is highly variable owing to varying definitions and criteria. The term pedophile is commonly used to describe all offenders, including those who do not meet the clinical diagnosis standards. This use is seen as problematic by some people. Some researchers, such as Howard E. Barbaree, have endorsed the use of actions as a sole criterion for the diagnosis of pedophilia as a means of simplification, rebuking theis standards as "unsatisfactory".

A perpetrator of child sexual abuse is commonly assumed to be and referred to as a pedophile; however, there may be other motivations for the crime (such as stress, marital problems, or the unavailability of an adult partner). Child sexual abuse may or may not be an indicator that its perpetrator is a pedophile. Offenders may be separated into two types: Exclusive (i.e., "true pedophiles") and non-exclusive (or, in some cases, "non-pedophilic").

According to a U.S. study on 2429 adult male pedophile sex offenders, only 7% identified themselves as exclusive; indicating that many or most offenders fall into the non-exclusive category. However, the reports perpetrators who meet the diagnostic criteria for pedophilia offend more often than non-pedophile perpetrators, and with a greater number of victims. They state that approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia. A behavioral analysis report by states that a "high percentage of acquaintance child molesters are preferential sex offenders who have a true sexual preference for children (i.e., pedophiles)."

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A review article in the notes the overlap between extrafamilial and intrafamilial offenders. One study found that around half of the fathers and stepfathers in its sample who were referred for committing extrafamilial abuse had also been abusing their own children.

As noted by Abel, Mittleman, and Becker (1985) and Ward et al. (1995), there are generally large distinctions between the two types of offenders' characteristics. Situational offenders tend to offend at times of stress; have a later onset of offending; have fewer, often familial victims; and have a general preference for adult partners. Pedophilic offenders, however, often start offending at an early age; often have a large number of victims who are frequently extrafamilial; are more inwardly driven to offend; and have values or beliefs that strongly support an offense lifestyle. Research suggests that incest offenders recidivate at approximately half the rate of extrafamilial child molesters, and one study estimated that by the time of entry to treatment, nonincestuous pedophiles who molest boys had committed an average of 282 offenses against 150 victims.

Some child molesters — pedophiles or not — threaten their victims to stop them from reporting their actions. Others, like those that often victimize children, can develop complex ways of getting access to children, like gaining the trust of a child's parent, trading children with other pedophiles or, infrequently, get foster children from non-industrialized nations or abduct child victims from strangers. Pedophiles may often act interested in the child, to gain the child's interest, loyalty and affection to keep the child from letting others know about the abuse.

6. Treatment

Although pedophilia has yet no cure, various treatments are available that are aimed at reducing or preventing the expression of pedophilic behavior, reducing the prevalence. Treatment of pedophilia often requires collaboration between law enforcement and health care professionals. A number of proposed treatment techniques for pedophilia have been developed, though the success rate of these therapies has been very low. 22 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

Cognitive behavioral therapy ("relapse prevention")has been shown to reduce recidivism in contact sex offenders. According to Michael Seto, cognitive-behavioral treatments target attitudes, beliefs, and behaviors that are believed to increase the likelihood of sexual offenses against children, and "relapse prevention" is the most common type of cognitivebehavioral treatment. The techniques of relapse prevention are based on principles used for treating addictions. Other scientists have also done some research that indicates hat recidivism rates of pedophiles in therapy are lower than pedophiles who eschew therapy, says Dr. Zonana.

7.

Behavioral İnterventions

Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and (or reconditioning) to increase sexual arousal to adults. Behavioral treatments appear to have an effect on sexual arousal patterns on phallometric testing, but it is not known whether the test changes represent changes in sexual interests or changes in the ability to control genital arousalduring testing has been applied with sex offenders with mental disabilities.

8. Pharmacological İnterventions

Medications are used to lower sex drive in pedophiles by interfering with the activity of testosterone, such as with (medroxyprogesterone acetate), Androcur (cyproterone acetate), and Lupron (leuprolide acetate) which last longer and have fewer side-effects, are also effective in reducing libido and may be used. These treatments, commonly referred to as are often used in conjunction with the non-medical approaches noted above. According the, "Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan."

İn a controlled Depo-Provera treatment study of 40 sex

offenders — including 23 pedophiles — who received Depo-Provera, and 21 sex offenders who received alone, the outcome follow-up of the treated group as compared to the untreated group demonstrated that the reoffense rate for the Depo-Provera-treated group was significantly lower. Eighteen percent reoffended while receiving medication; 35 percent reoffended after stopping 23 canerkaracay@windowslive.com


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Toronto University, Department Of Psychology, Diarly Psychological Bulletin, 20 Apr. 2009

medication. In contrast, 58 percent of the control patients, who received alone, reoffended. Patients defined as regressed were much more likely to reoffend off therapy than the patients defined as fixated.

9. Other Therapies

Klaus M. Beier of the Institute of Sexology and Sexual Medicine at, a university hospital in, reported success in a preliminary study using therapy and "impulse-curbing drugs" to help pedophiles avoid a child. According to researchers, contact child sex offenders were better able to control their urges once they understood the prepubescent youth's view.

10. Limitations Of Treatment

Although these results are relevant to the prevention of reoffending in contact child sex offenders, there is no suggestion that such therapy is a cure for pedophilia. Dr. Fred Berlin, founder of the Sexual Disorders Clinic, believes that pedophilia could be successfully treated if the medical community would give it more attention. Castration, either physical or chemical, appears to be highly effective in removing such sexual impulses when offending is driven by the libido, but this method is not recommended when the drive is an expression of anger or the need for power and control (e.g. violent/sadistic offenders). Chemical and surgical castration has been used in several European countries since the second world war, although not to the extent it was employed under National Socialism.

The program in Hamburg was terminated after 2000, while Poland is now seeking to introduce chemical castration. The Council of Europe works to bring the practice to an end in Eastern European countries where it is still applied through the courts.

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11. Legal And Social İssues Misuse Of Terminology

The words "pedophile" and "pedophilia" are sometimes used informally to describe an adult's sexual interest or attraction to pubescent or post-pubescent teenagers and to other situations that do not fit within the clinical definitions. The terms or may be more accurate in these cases Another erroneous but unfortunately common usage of "pedophilia" is to refer to the itself (that is, interchangeably with "sexual abuse") rather than the correct meaning, which is a preference for that age group on the part of the older individual. Even more problematic are situations where the terms are misused to refer to relationships where the younger person is an adult of legal age, but is either perceived socially as being too young in comparison to their older partner, or the older partner occupies a position of authority over them. Researchers recommend that this incorrect use be avoided.

12. Pedophile Activism

During the late 1950s to early 1990s, several pedophile membership organizations advocated to lower or abolish laws, and for the acceptance of pedophilia as rather than a, and the legalization of. The efforts of pedophile advocacy groups did not gain any public support and today those few groups that have not dissolved have only minimal membership and have ceased their activities other than through a few websites.

13. Anti-Pedophile Activism Main Article

Anti-pedophile activism encompasses opposition against pedophiles, against pedophile advocacy groups, and against other phenomena that are seen as related to pedophilia, such as and. Much of the direct action classified as anti-pedophile involves demonstrations against sex offenders, groups advocating legalization of sexual activity between adults and children, and Internet users who solicit sex from minors. High-profile media attention to pedophilia has led to incidents of particularly following reports of associated pedophilia associated with and. Instances of have also been reported in response to public attention on convicted or suspected 25 canerkaracay@windowslive.com


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child sex offenders. In 2000, following a media campaign of "naming and shaming" suspected pedophiles in the UK, hundreds of residents took to the streets in protest against suspected pedophiles, eventually escalating to violent conduct requiring police intervention.

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Pedophilia