User:KimvdLinde/Pedophilia sandbox


 * This article is about the sexual interest in prepubescent children. For the act itself, see child sexual abuse. The primary sexual interest in 11-14 year old pubescents is sometimes referred to as hebephilia. For mid-to-late adolescents (15-19), see ephebophilia.

Pedophilia (American English) or paedophilia (British English) is generally defined as the sexual attraction by adults to children. In general usage, this sometimes includes all minors, but appropriately includes only pre-pubescent and/or early pubescent children. The International Classification of Diseases (ICD) defines pedophilia as a sexual preference for children of prepubertal or early pubertal age, while the American DSM IV limits it to sexual preference of prepubescent children.

--- encompasses a range of adult sexual interest in prepubertal children. As a medical diagnosis, it is defined as a psychiatric disorder in adults or late adolescents (persons age 16 and older) characterized by a primary or exclusive sexual interest in prepubescent children (generally age 13 years or younger, though onset of puberty may vary). The child must be at least five years younger in the case of adolescent pedophiles. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), pedophilia is a paraphilia in which a person has intense and recurrent sexual urges towards and fantasies about prepubescent children and on which feelings they have either acted or which cause distress or interpersonal difficulty.

In common usage, pedophilia means any sexual interest in children or the act of child sexual abuse, often termed "pedophilic behavior". For example, The American Heritage Stedman's Medical Dictionary states, "Pedophilia is the act or fantasy on the part of an adult of engaging in sexual activity with a child or children." This common use application also extends to the sexual interest and abuse of pubescent or post-pubescent minors. Researchers recommend that these imprecise uses be avoided, as people who commit child sexual abuse commonly exhibit the disorder, but some offenders do not meet the clinical diagnosis standards for pedophilia, and the clinical diagnosis for pedophilia pertains to prepubescents. Additionally, not all pedophiles actually commit such abuse.

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 of forensic psychology and law enforcement, a variety of typologies have been suggested to categorize pedophiles according to behavior and motivations. Most pedophiles are men, although there are also women who exhibit the disorder, and the issue of pedophilia has been the subject of a great deal of media attention and social activism as it is stigmatized in much of the world.

No significant curative treatment for pedophilia has yet been developed. There are, however, certain therapies that can reduce the incidence of a person committing an abusive act on a child.

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

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 "hebephilia" or "ephebophilia" may be more accurate in these cases. Another erroneous but unfortunately common usage of "pedophilia" is to refer to the actus reus itself (that is, interchangeably with "sexual abuse")  rather than the medical 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 these incorrect uses be avoided.

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

Krafft-Ebing mentioned paedophilia erotica in a typology of "psycho-sexual perversion." He wrote that he had only encountered it four times in his career and gave brief descriptions of each case, listing three common traits:
 * 1) The individual is tainted [by heredity] (hereditär belastate)
 * 2) The subject's primary attraction is to children, rather than adults.
 * 3) 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.

He mentions several cases of pedophilia among adult women (provided by another physician), and also considered the abuse of boys by homosexual men to be extremely rare. Further clarifying this point, he indicated that cases of adult men who have some medical or neurological 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 condition wherein "individuals who have lost libido 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, Swiss neuroanatomist and psychiatrist Auguste Forel 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 with dementia 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 medical dictionaries such as the 5th Edition of Stedman's. In 1952, it was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders. 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. Some clinicians have proposed further cateogories, somewhat or completely distinguished from pedophilia, including "pedohebephilia," "hebephilia," and "ephebophilia." Other experts such as Karen Franklin consider classifications like hebephilia to be "pretextual" diagnoses which should not be considered disorders.

Diagnosis
Several diagnostic methods are used to diagnose pedophiles. Among these methods are the international ICD 10, the American DSM IV, phallometric assessment and the Screening Scale for Pedophilic Interest (SSPI).

ICD 10 & DSM IV
The ICD (International Statistical Classification of Diseases and Related Health Problems) 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 American Diagnostic and Statistical Manual of Mental Disorders 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 may 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 and that child or children they fantasize about are at least five years younger than them, though ongoing 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 incest, and if the attraction is "exclusive" or "nonexclusive".

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, voyeuristic or frotteuristic 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.

DSM IV Criticism
The DSM criteria for paraphilias has not been without controversy, and, pedophilia, one of its most socially objectionable paraphilias, has been criticized for its criteria for various reasons. 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 taxonomic simplification, rebuking the American Psychiatric Association's standards back in 1997 as "unsatisfactory". With regard to the diagnostic criteria used in the DSM-IV-TR, both Richard Green and William O'Donohue remarked that a so-called "contended pedophile"&mdash;an individual who fantasizes about having sex with a child and masturbates to these fantasies, but does not commit child sexual abuse, and who does not feel subjectively distressed afterward&mdash;does not meet the DSM-IV-TR criteria for pedophilia, because this person does not meet Criterion B. Ray Blanchard, in his literature review for the DSM-5, noted the objections and proposed a general solution applicable to all paraphilias, namely a distinction between paraphilia and paraphilic disorder. The latter term is proposed to identify the diagnosable condition, which meets both Criterion A and B, whereas an individual who does not meet Criterion B, can be ascertained, but not diagnosed, as having a paraphilia. (Blanchard acknowledges Kenneth Zucker and James Cantor for discussions about this distinction.) O'Donohue, however, took the issue in a different direction, suggesting instead that the diagnostic criteria be simplified to the attraction to children alone if ascertained by self-report, laboratory findings, or past behavior. He states that any sexual attraction to children is pathological and that distress is irrelevant, noting "this sexual attraction has the potential to cause significant harm to others and is also not in the best interests of the individual."

Qualifiers
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 child sexual offender types). 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.

Related disorders
Nepiophilia, also called infantophilia, is used to refer to a sexual preference for toddlers and infants (usually ages 0–3).

Ego-dystonic sexual orientation 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. The WHO allows for the patient to seek treatment to change their sexual orientation.

Other uses
Sociologist David Finkelhor writes that "the meaning of pedophilia itself is a matter of some controversy, with different theorists and investigators defining it in different ways." He uses the inclusive definition of pedophilia "as occurring when an adult has a conscious sexual interest in prepubertal children." He contrasts this with definitions which specify enduring and exclusive interest or preference, such as the DSM definition.

Biological associations
Beginning in 2002, researchers began reporting a series of findings linking pedophilia with brain structure and function: Pedophilic (and hebephilic) 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 MRI-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 MRI, shows that male pedophiles have a lower volume of white matter than a control group.

Functional magnetic resonance imaging (fMRI) has shown that child molesters diagnosed with pedophilia have reduced activation of the hypothalamus as compared with non-pedophilic persons when viewing sexually arousing pictures of adults. A 2008 functional neuroimaging study notes that central processing of sexual stimuli in heterosexual "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 cognitive stage of sexual arousal processing."

Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify hormonal aspects of pedophiles. They concluded that there is some evidence that pedophilic men have less testosterone 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, comorbid psychiatric illnesses &mdash; such as personality disorders and substance abuse &mdash; 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 &mdash; or their occasional furtive satisfaction &mdash; lead to anxiety and despair?" They indicated that, because they previously found mothers of pedophiles to be more likely to have undergone psychiatric treatment, the genetic possibility is more likely.

Psychopathology and personality traits
Several researchers have reported correlations between pedophilia and certain psychological characteristics, such as low self-esteem and poor social skills. Cohen et al. (2002), studying child sex offenders, states that pedophiles have impaired interpersonal functioning and elevated passive-aggressiveness, as well as impaired self-concept. Regarding disinhibitory traits, pedophiles demonstrate elevated sociopathy 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 i.e., awareness of the social approbation and hostility that it evokes" (p. 324).

Studying child sex offenders, a review of qualitative research studies published between 1982 and 2001 concluded that pedophiles use cognitive distortions 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 psychopathology 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. 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.

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 child sexual abuse offenders, including those who do not meet the clinical diagnosis standards, which is seen as problematic by some researchers.

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 of child sexual abuse. 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.

Cognitive behavioral therapy ("relapse prevention")
Cognitive behavioral therapy has been shown to reduce recidivism in contact sex offenders.

According to Canadian sexologist 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 cognitive behavioral treatment. The techniques of relapse prevention are based on principles used for treating addictions. Other scientists have also done some research that indicates that recidivism rates of pedophiles in therapy are lower than pedophiles who eschew therapy.

Behavioral interventions
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. 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 arousal during testing.

Applied behavior analysis has been applied with sex offenders with mental disabilities.

Pharmacological interventions
Medications are used to lower sex drive in pedophiles by interfering with the activity of testosterone, such as with Depo-Provera (medroxyprogesterone acetate), Androcur (cyproterone acetate), and Lupron (leuprolide acetate).

Gonadotropin-releasing hormone analogues, which last longer and have fewer side-effects, are also effective in reducing libido and may be used.

These treatments, commonly referred to as "chemical castration", are often used in conjunction with the non-medical approaches noted above. According the Association for the Treatment of Sexual Abusers, "Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan."

In a controlled Depo-Provera treatment study of 40 sex offenders &mdash; including 23 pedophiles &mdash; who received Depo-Provera, and 21 sex offenders who received psychotherapy 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 medication. In contrast, 58 percent of the control patients, who received psychotherapy alone, reoffended. Patients defined as regressed were much more likely to reoffend off therapy than the patients defined as fixated.

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

Limitations of treatment
Although these results are relevant to the prevention of reoffending in contact child sex offenders, there is no empirical suggestion that such therapy is a cure for pedophilia. Dr. Fred Berlin, founder of the Johns Hopkins 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 World War II, although not to the extent it was employed in Nazi Germany. 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.

Legal and social issues
Legal conceptualizations are usually concerned with child sexual abuse and not the sexual interest itself.

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 Mayo Clinic 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 the FBI states that a "high percentage of acquaintance child molesters are preferential sex offenders who have a true sexual preference for children (i.e., true pedophiles)."

A review article in the British Journal of Psychiatry 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 &mdash; pedophiles or not &mdash; 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.

Pedophile advocacy groups
During the late 1950s to early 1990s, several pedophile membership organizations advocated age of consent reform to lower or abolish age of consent laws,  and for the acceptance of pedophilia as a sexual orientation rather than a psychological disorder, and the legalization of child pornography. 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.

Anti-pedophile activism
Anti-pedophile activism encompasses opposition against pedophiles, against pedophile advocacy groups, and against other phenomena that are seen as related to pedophilia, such as child pornography and child sexual abuse. 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 moral panic, particularly following reports of associated pedophilia associated with satanic ritual abuse and day care sex abuse. Instances of vigilantism have also been reported in response to public attention on convicted or suspected 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.

Catholic sex abuse cases
Since the mid-1980s, the Catholic Church has been involved in an ongoing series of scandals related to sex crimes committed by Catholic priests and members of religious orders, while under diocesan control or in orders that care for the sick or teach children. These cases began receiving public attention beginning in the mid-1980s. The attention led to criminal prosecutions of the abusers and to civil lawsuits against the church's dioceses and parishes where abuse was alleged to have occurred. Sexual abuse of minors by members of the priesthood has received significant media attention in Canada, Ireland, the United States, the United Kingdom, Mexico, Belgium, France, and Germany, while cases have been reported throughout the world.

In addition to cases of actual abuse, much of the scandal has focused around members of the Catholic hierarchy who did not report abuse allegations to the civil authorities and who, in many cases, reassigned the offenders to other locations where the alleged predators continued to have contact with minors and had opportunities to continue to sexually abuse children. In defending their actions, some bishops and psychiatrists contended that the prevailing psychology of the times suggested that people could be cured of such behavior through counseling.[citation needed] Members of the church hierarchy have argued that media coverage has been excessive.

Homosexuality and pedophilia
Homosexuality and pedophilia have both been classified as paraphilias and as related sexual deviance by clinicians in the past. Some clinicians now assert that there is no link whatsoever between homosexuality and pedophilia, citing various anthropometric tests. Many religious leaders have asserted that homosexuality and pedophilia are related sins, and that gay people are more likely to commit sex crimes against children. The gay rights movement has a conflicted relationship with pedophilia; the trend has been toward distancing gay rights from the rights of other sexual minorities in many parts of the world, including people with sexual interest in children. Groups that advocate same-sex adult/child relationships are condemned by most mainstream LGBT groups in North America. In some countries such as The Netherlands, groups like COC Nederland have advocated separation between the pedophile and homosexual identities, yet work toward an abolishment of oppression towards pedophilia.