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What is Pedophilic Disorder?
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People who have Pedophilic Disorder have a powerful sexual attraction to prepubescent children. Many will sexually molest children at some point in their lives, and those who don’t will probably view and share child pornography. As most people go through puberty and mature in adolescence, the age of the people they are attracted to rises appropriately with their age. However, for people with Pedophilic Disorder, this doesn’t happen. They notice usually by middle adolescence that they are still attracted to much younger people, those who are still children. In fact, about 40% of people with Pedophilic Disorder have sexually molested a prepubescent child by the time they are 15 years old.
There are two main categories of people with this disorder: those attracted to both children and adults and those who prefer only children. Surprisingly, over 90% of them are in the first group. Many of these people molest children simply because they have an opportunity to do so and because they are intoxicated, isolated, or under some other stress. Some prefer boys, some girls, and others both. Another group only abuses children within their own families. This attraction to children is powerful, as strong as other sexual orientations like heterosexuality or homosexuality. It appears to be life-long even with treatment, and many continue to commit sexual abuse into old age.
Most people with this disorder struggle in a number of ways to function among others their age. They often have very poor self-esteem, spend a lot of time by themselves, and compare themselves negatively to others. They feel very insecure in social situations because they struggle to read or relate to other’s emotions. Intimate relationships with other age-appropriate adults do not come easily. They struggle to communicate well and are often passive-aggressive.
Causes and Risk Factors
Rates and numbers
The true rates of Pedophilic Disorder are very hard to establish. Authorities believe only a small fraction of those who commit these crimes are ever caught or prosecuted, and people who fly under the radar are unlikely to look for treatment on their own. With this in mind, experts believe that Pedophilic Disorder may appear in up to 3% of the population, this being almost entirely men. A slightly more helpful metric is the numbers of victims. About one in three adult women and one in seven adult men report being subject to these types of sexual encounters as children or adolescents.
Brain abnormalities
Without a doubt, the brains of people with Pedophilic Disorder function differently from most people’s in numerous ways. People with this disorder have measurable differences in brain lobe structures that could explain aspects of their sexuality. There are a few reports of tumors or other diseases in these areas leading to pedophilic behaviors that then subside after the issue is treated. Traumatic brain injury may also play a role: A large percentage of these people report significantly higher numbers of head wounds prior to age 13. Lower IQ and lower levels of education are common additional factors, and many have a history of repeating grades in school or needing special education.
Maturity problems
One of the theories behind a potential cause for Pedophilic Disorder is that they may be emotionally “stuck” at a much younger age. This could explain why so many people with the disorder are not disturbed by it and feel that their relationships with kids are natural. Their thinking is so sick and distorted that they truly believe children like and benefit from sexual molestation. What causes this developmental arrest is even more of a mystery, but research suggests that traumatic events in childhood or altered brain development may play a role. A traditionally popular theory suggested that being the victim of molestation makes someone more likely to become a predator as they age. However, modern research tells us that is simply not true. Suffering sexual abuse as a child predicts later life struggles like depression and drug abuse, but not molesting children.
Co-existing disorders
Pedophilic Disorder rarely occurs alone. Personality Disorders are one of the more common types of illnesses, appearing in four out of five affected people. The Obessive-Compulsive, Antisocial, and Narcissistic Personality Disorders show up the most. Sixty percent have a Substance Use Disorder – largely Alcohol Use Disorder. A similar number have mood disorders like Major Depressive Disorder or Bipolar Disorder, and about half have Anxiety Disorders. Many of these people also have symptoms of other sexual disorders, such as Exhibitionistic Disorder (exposing themselves sexually to others) and Voyeuristic Disorder (spying on others who are undressed or having sex).
Diagnosing Pedophilic Disorder
The criteria
People with Pedophilic Disorder have a powerful sexual attraction to children who have not yet gone through puberty (generally, under age 13). These urges cause problems when they act on them, endangering children around them. Consequences from illegal sexual contact with kids is largely what brings these people to treatment. More rarely, people come to treatment because they are disturbed by these urges and want to avoid acting on them.
People need to be at least 16 years old before they can be diagnosed with Pedophilic Disorder. Adolescents with this disorder are attracted to others who are at least 5 years younger than themselves. The only times such large age gaps are not due to pedophilia is when the older individual has some sort of major developmental delay. However, in these cases, such a relationship is still problematic and dangerous for the child.
Additional details
Most people think that molestation is entirely confined to sex (be it oral, vaginal, or anal). However, sexual contact with children has many forms beyond these. Some expose themselves to children or undress children in their presence. Others masturbate in front of children and touch or rub against them for sexual gratification. Most of the time, the perpetrators are not physically forcing children into these acts. Instead. they are able to psychologically manipulate them into participating.
A large percentage of people with Pedophilic Disorder also use the internet to act on their urges. Most view child pornography, which they trade with others on dark web forums. They exchange tips, such as how to skirt the law or manipulate children. Chat rooms, forums, and social media provide arenas for them to find children. They have sexual contact with kids in the virtual world (exchanging pictures or in video chat) and may meet up with them in person.
Treating Pedophilic Disorder
Relapse Prevention and Cognitive Behavioral Therapy
Treatment for people with Pedophilic Disorder is only a realistic option if they are willing and invested in the process, and Relapse Prevention is the best option. This treatment is a modified version of Cognitive Behavioral Therapy (CBT) that people with Substance Use Disorders use as a tool to help maintain sobriety. It treats the urges that people with Pedophilic Disorder feel towards children similarly to drug or alcohol cravings. People learn strategies to avoid tempting situations and how to manage them when they do happen. Many people also use standard CBT to tackle the dysfunctional thinking that is part of the disorder. This includes helping them empathize with their victims and break through their own denial.
Castration
Although the word “castration” brings to mind a barbaric, medieval procedure, it is actually a variety of hormonal treatments that reduce sexual drive and functioning in men with Pedophilic Disorder. Medications like medroxyprogresterone (the cheaper and more common option) and leuprolide slow the production of testosterone while cyproterone (used in Europe) blocks the effects of testosterone. With the first two medications, the managing physicians will modify doses to keep testosterone levels in the range typical for a healthy woman, which, for these men, will significantly curb their libidos. Unfortunately, these resources are not useful in the few women with the disorder.
Physical castration (by surgical removal of the testes) has been used in the past, but it is not nearly as effective in the long term as castration by medication. There are two reasons for this. The first is that men who have had their testes removed can (and have) taken supplemental testosterone to regain their sexual abilities and then returned to molesting children. The second issue is that using medications for castration requires regular follow-up visits that include psychiatric evaluations. This additional face time with treatment providers reduces the risk of relapse and makes monitoring easier for the long term.
SSRIs
Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac (fluoxetine) may also be helpful, though not as much so as previously thought. They are most useful in helping treat other mood disorders that co-occur with Pedophilic Disorder, and moderately suppress sexual drive.
Managing Pedophilic Disorder
Anatomy of denial
People with Pedophilic Disorder usually attempt to justify or somehow explain their actions in a variety of bizarre ways. When confronted about their behavior by parents, other adults, police, or medical professionals, many will flat out deny their actions or try to spin them in a way that sounds less threatening. They will minimize how far things went and how many encounters occurred. Most believe (or want to believe) that they are not predators, that they are misjudged by others, and that their relationships with children are legitimate and not harmful.
They make up wild stories to try to explain what happened. Some claim it is art, others insist it is research, and many assert that it is part of sexual education. Probably the most common lie pedophiles tell is that it was the victim’s fault. They often claim that the child is very sexual and began the encounters. This is just a distraction, though, because children are not legally capable of giving consent. The law is there to protect them from this kind of disordered thinking.
Prevention programs
Numerous programs targeted at children, potential child molesters, and other adults aim to prevent child sexual abuse by educational campaigns. Similar to many drug and crime avoidance initiatives in schools, these ones teach children about sexual predators. Kids learn what kinds of contact are inappropriate and when and how to report them. They also discover how to recognize dangerous situations for themselves and others and ways to avoid them.
Another program, termed “Stop It Now!”, targets both predators and other adults, such as teachers, parents, and anyone who has a lot of contact with kids. This organization believes that all adults who spend time with children can help prevent child sexual abuse. It teaches people how to recognize potential victims and predators and what steps to take to stop abuse. Their media drives even reach out to potential abusers, reminding them of the consequences of their actions and pushing them to seek treatment.