Introduction
Over the past several years there have been numerous cases involving child molestation and the Catholic Church. This has put not only a spotlight on Priests but also on sexual abuse particularly involving children. The most recent case of Jerry Sandusky has created a great amount of interest in the psychology field. Some argue that loving a child is not wrong and not a mental illness, but our society views this in a very different way. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition a Pedophile is “an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally less than 13 years of age) for a period of at least six months” (Association, 2000).
This paper will discuss the Historical Content, a Diagnostic Description, the Etiology, Treatment, and a Summary/Discussion of pedophilia. This will be done through conducting research numerous studies found in well-respected Journal Articles and statistics found through FBI and National Crime Statistics.
Historical Context
Pedophilia dates back to ancient Greece when their warriors took young males as their sexual prize. The word pedophilia comes from the Greek work Pedo meaning young and philia meaning love. In 1984 the American Psychiatric Association removed homosexuality from the list of mental disorders. Many argued to have all sexual deviations removed which caused a huge debate when pedophilia was one of those up for debate (Hughes, 2007).
In the DSM-I, pedophilia was listed as a “sexual deviation” and labeled as “sociopathic”. However this changed in DSM-II (1968) to “sexual deviation” without “sociopathy” to become a “nonpsychotic mental disorder”. In DSM-III it was finally included as a paraphilia. This diagnosis left out “isolated sexual acts with children” so if only one sexual act occurred, they were not considered a pedophile. In DSM-IV the criteria changed again. Paragraph B states, “The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Hughes, 2007). If an individual acts on their sexual urges but is not distressed about it or suffers from a social impairment due to their actions, they are not considered a pedophile according the DSM-IV. The DSM-V will address this issue with yet more revisions (Hughes, 2007).
The Netherlands and philosopher Erasmus played a significant role in the history of pedophilia in the 1980s. Erasmus and William of Orange were major supporters in broadmindedness and individual rights. An article was published to accept the homosexual and pedophilia lifestyle. The Dutch Cultural and Recreational Center accepted pedophilia and pushed to have a more accepting view of gay identity. They even wanted to change the name to “intergenerational intimacy” and viewed it as a sexual choice (Hughes, 2007).
During the 1990s the Dutch influence spread over to the United States and influenced a group to form called the North American Man-Boy Love Association (NAMBLA). They fought to have pedophilia redefined and not a criminal offence. A major change in the view of pedophilia came in 2002 with the Catholic Priest Scandal. Thousands of priests had been indicted and cost the Catholic Church millions of dollars in compensation to the victims (Hall, 2007).
Diagnostic Description
As demonstrated in the history section, criterion for pedophilia has undergone numerous changes. According the DSM-IV there are 3 criteria for pedophilia.
Pedophilia 302.2
1. The patient must have intense sexual desires, fantasies, or behaviors regarding sexual activity with a child typically under the age of 13.
2. These must cause distress or impairs work, social, or personal functioning, or the patient has acted on the desires.
3. The patient must be 16 years of age or older and they must be 5 years older than the child (Beech & Harkins, 2012).
Perpetrators
Pedophiles vary from being attracted to males, females, both, incest, only by children, or by children and adults. It is the most common of the paraphilias that involve contact and around 20% of American children have experienced some form of sexual molestation before they are 18 (Morrison, 2006). Typically they are male and usually a relative, friend, or neighbor of the victim. Studies have shown that 50-60% of pedophiles also suffer from a substance abuse or dependence disorder but the attraction to children is present when they are sober. They are typically ages 40-70, with a 15-25% recidivism rate, and the behavior begins in their later teen years. Many were themselves abused as children and it seems to have a chronic course (Hall, 2007).
Victims
Studies have shown that the majority of victims are female with a mean age of 10.7. These statistics were received from data gathered in 1975. The attacks typically happened during the summer between the time of 2 and 6PM. During 1995 the ages of the victims were grouped into 2 groups: less than 5 and between the ages of 6 to 12 (Hall, 2007).
Etiology
Are pedophiles born with an attraction to children or they choose to be this way? Many have argued for both sides and several theories have been formed.
Neuropsychiatric Differences
Numerous studies have been run comparing the brains and other neurological characteristics of criminals, civilians, sexual offenders, and diagnosed pedophiles. There were slightly lower signs of intelligence, an increase in the prominence of left-handed individuals, impaired cognitive abilities, neuroendocrine differences, and frontocortical irregularities. 55% of known pedophiles suffer from impulse control disorders. There was also a decreased gray matter volume which may imply a disrupted neurophysiologic attribute (Hall, 2007).
The findings in the temporal lobe are very significant due to the function of the frontal lobe. Many studies have shown that the temporal lobe is responsible for erotic discrimination and arousal thresholds (Cohen et. al, 2002). The main question regarding these findings is if the problems with the brain development are due to biological conditions or are a result of life experiences such as molestation when they were children. The studies that were conducted also showed that pedophiles had a greater magnitude of cortisol and prolactin changes when exposed to metachlorophenylpiperazine (a serotonin agonist). The pedophiles also showed more pronounced symptoms (dizziness, change in appetite, etc.) compared to the control group. There were also statistics showing that the lower the intelligence of the offender, the younger the age of the abused child (Blanchard, 2002).
Environmental/Social Factors
Many experts believe that there are numerous environmental factors that predispose people to become pedophiles. Often it is an environmental stressor that triggers their urges. The main factor is believed to be that the offender themselves were victims of sexual child abuse. Statistics show that pedophiles that were abused as children range from 28% to 90% compared to the control group which were 15% (Greenberg, 1993). These tests also showed that pedophiles tend to abuse children around the same age they had been abused. Low levels of education, repeated grades, low employment status, and birth order are also linked to pedophilia. They theorize that there is a presence of antimale maternal antibodies in multiparous women, which creates problems in their neuropathway as a fetus (Blanchard, 2002).
Treatment
As with most if not all disorders treatment will not help unless the patient is willing to participate in the treatment. There are multiple treatment methods ranging from behavioral therapy to surgery.
Surgery
Surgery was the first treatment for pedophiles starting in 1975. They started with a unilateral hypothalamotomy (type of brain surgery) and moved to orchidectomy (removal of testicles) in 1980. Even though there was a decrease in sexual thoughts and frequency 31% still were able to engage in sexual activity. There were no more reports of surgeries on pedophiles after 1981 (Hughes, 2007).
Drugs
Many different drugs have been used to decrease sexual fantasies in pedophiles. Medroxyprogesterone acetate was first used in 1978 and the patients taking this drug for 2 months reported lower levels of anxiety and sexual fantasies. In 2001 patients demonstrated a significant decrease in testosterone production but an increased drop-out rate from the program. Cyproterone acetate was used in 1991 but needed continuous treatment for 5 years to be effective. In 2004 this drug became a requirement for all criminals with paraphilic behavior. Triptorelin and Leuprolide acetate are also two drugs being used with similar results to the others (Briken & Kafka, 2007).
Behavioral Therapy
Results for this vary. Some studies show that there was a lower reoffending rate within one year while others showed that it did not benefit the patients at all. Some of the main reasons this treatment failed were the patient had to admit their guilt, medias view of pedophiles and their therapists, and the overall lack of confidence in the patients to ever recover (Eisenman, 1992).
Masturbation Therapy
This therapy involved an hour of masturbation while verbalizing their fantasies. It was also known as sanitation therapy and started in 1983. Overall the studies have demonstrated that drugs or therapy alone were not beneficial, but combining both medication and therapy was the most effective treatment for the pedophile (Hudson & Marshall, 1992).
Summary/Discussion
Since the Catholic Priest scandals and the numerous cases brought up against coaches, a spotlight has been put on pedophilia. Over the years the definition and diagnostic criteria in the DSM of pedophilia has changed. Some compare this to the struggle homosexuals went through before removing homosexuality from the DSM. On one side there are members of the NAMBLA organization who try and defend their claims that loving young children is their sexual freedom rights and is perfectly healthy and natural. On the other side you have adults speaking out against their abusers that are speaking of abuse and trauma that has caused years of emotional damage. The age of consent is 18 throughout most of the United States. This age was set for a specific reason and is there to protect our youth from those that would take advantage of their own naivety.
Those that have been diagnosed with pedophilia are extremely challenging to treat. Treatment, similar to diagnostic criteria, has undergone multiple changes. Starting from actual surgery to behavior therapy, the most effective has been a combination of medicine and talk therapy. Those that were only receiving one type of treatment lead to members refusing treatment or a high recidivism rate.
On a personal note and to me the most important information I learned from this topic; those pedophiles coming for treatment are sick. They realize that what they could or have done already is wrong and they need your help. Many of these individuals have themselves been victims of severe child molestation and are in need of help to end this twisted cycle of abuse. I could not imagine a more terrible disorder to have and I realize that they need help just as the victims of the abuse need help also. So as a therapist the most important thing is to look at yourself and if you can’t put your own feelings of disgust or hatred, then do not work with these clients.
References
Beech, A. R., & Harkins, L. (2012). DSM-IV paraphilia: Descriptions, demographics and treatment interventions. Aggression and Violent Behavior, 17(6), 527-539.
Briken, P., & Kafka, M. P. (2007). Pharmacological treatments for paraphilic patients and sexual offenders. Current Opinion in Psychiatry, 20(6), 609-613.
Cohen, I., Navarro, V., Clemenceau, S., Baulac, M., & Miles, R. (2002). On the origin of interictal activity in human temporal lobe epilepsy in vitro. Science, 298(5597), 1418-1421.
Chicago
Eisenman, R. (1992). Using humor in psychotherapy with a sex offender. Psychological reports, 71(3), 994-994.
Hall, R. C., & Hall, R. C. (2007, April). A profile of pedophilia: definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues. In Mayo Clinic Proceedings(Vol. 82, No. 4, pp. 457-471). Elsevier.
Johnston, P., Hudson, S. M., & Marshall, W. L. (1992). The effects of masturbatory reconditioning with nonfamilial child molesters. Behaviour research and therapy, 30(5), 559-561.
Hughes, J. R. (2007). Review of medical reports on pedophilia. Clinical pediatrics, 46(8), 667-682.