Pedophilic Disorder

What is Pedophilic Disorder?

Pedophilic Disorder is classified in the DSM-5 as a Paraphilic Disorder, which requires the presence of a paraphilia that is causing significant distress or impairment, or involve personal harm or risk of harm to others.

A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.

In order to be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

Symptoms of Pedophilic Disorder include:

• over a period of at least 6 months, a person has had recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child (a child who has not yet gone through puberty) or children. Typically, the child or children are age 13 years or younger.
• the individual has acted on these sexual urges, or the fantasies and sexual urges are causing marked distress or interpersonal difficulties.
• The individual is at least 16 years old and at least 5 years older than the child or children involved.

This diagnosis does not apply if the person is in late adolescence and is involved in an ongoing sexual relationship with a 12- or 13-year old.

Clinicians can also specify if the disorder is:

• Exclusive type (attracted only to children)
• Nonexclusive (attracted to both children and adults)
• Sexually attracted to males
• Sexually attracted to females
• Sexually attracted to both
• Limited to incest

If someone feels no guilt, shame or anxiety about their sexual urges, does not have any limitations in daily functioning because of the fantasies or urges, and has never actually acted on the urges, they are said to have a pedophilic sexual orientation, but would not be diagnosed with Pedophilic Disorder.

How common is Pedophilic Disorder?

The prevalence for Pedophilic Disorder in the general population is unknown. Estimates for the highest percentage in males is thought to be 3-5% and in females is thought to be a small fraction of the rate in males.

What are the risk factors for Pedophilic Disorder?

There are temperamental, environmental and genetic/physiological risk factors for this disorder. With temperament, there appears to be a relationship between males with antisocial personality disorder and pedophilic disorder where the acting out behavior from the personality disorder involves sexual urges, fantasies or behaviors with children.

Adult males with pedophilic disorder often report having been sexually abused as children, but a cause and effect relationship between the two have not been proven at this time.

There is some evidence that abnormal neurodevelopmental issues during fetal development may lead to an increased probability of developing the disorder.

What other disorders or conditions often occur with Pedophilic Disorder?

Research in this area has focused on people (mostly males) who have been convicted of sexual offenses involving children. This means that the co-occurring conditions found in this population might not be the same as in the general population. They typically include substance use disorders, depression and bipolar disorder, anxiety disorders, antisocial personality disorder, and other paraphilic disorders.

How is Pedophilic Disorder treated?

Common treatments include psychotherapy and medication. Cognitive-behavioral therapy can be used where the therapist helps the person discover the underlying cause of the behavior and then works with the person to teach skills to manage the sexual urges in more health ways. This may include the use of aversion therapy and different types of imagery/desensitization in which the person imagines themselves in the situation and then experiencing a negative event, such as being arrested, to reduce future interest in participating in the sadistic activities. Cognitive restructuring (identifying and changing the thoughts that drive the behavior) and empathy training may also be used.

Various medications can be used to decrease the level of circulating testosterone in order to reduce the frequency of sexual fantasies and erections. Antidepressant medications may also be used to reduce sexual desire.