Pedophilia is a type of paraphilia—a category of recognized mental disorders defined by unusual fantasies, urges, or behaviours that are recurrent and sexually arousing. In order for pedophilia to be diagnosed clinically these thoughts or behaviours must be present for at least six months and must cause distress to the affected individual or impairment of the individual’s ability to function socially or occupationally. A clinical diagnosis of pedophilia also requires that the affected individual be at least 16 years of age and at least 5 years older than the child (or children) at the centre of the individual’s sexual fantasies. Pedophilia is distinguished from hebephilia and ephebophilia, which involve sexual obsessions of postpubescent children or late-stage adolescents, respectively. In many countries an individual who is convicted in a court of law for child sexual abuse, which involves sexual abuse of a prepubescent or postpubescent individual up to age 18, is known as a sex offender; some of these individuals also are later clinically diagnosed with pedophilia.
The typical pedophile is unable to find satisfaction in an adult sexual relationship and may have low self-esteem, seeing sexual activity with a child as less threatening than that with an adult. Most pedophiles are men; the condition is rare in women. Frequently the sexual encounter stops short of intercourse, with the pedophile obtaining sexual gratification through fondling the child and sometimes through genital display alone. Reactions of the child victim can range from fright, particularly if force or violence is involved, to bewilderment or passive enjoyment. Although some children seem more upset by previous parental warnings than by an actual encounter, the sexual encounter can often be quite traumatic to them, especially if there is associated violence. There is also evidence that children who have been sexually victimized are more likely to be troubled adults.
The underlying cause of pedophilia is unclear. Although biological abnormalities such as hormone imbalance may contribute to the disorder in some individuals, biological factors have not been proved as causes. In many cases pedophilic behaviour appears to be associated with sexual abuse or neglect experienced during childhood and with stunted emotional or psychological development. Research also has indicated that boys who were sexually abused are more likely to become pedophiles or sex offenders. Girls who were sexually abused more frequently respond by engaging in self-destructive behaviours, such as substance abuse or prostitution.
Because pedophilia is considered a serious sexual offense, patients diagnosed with the disorder are expected to participate in treatment programs. Among effective forms of treatment for pedophilia are cognitive and behavioral therapies that employ empathy training and restructuring of distorted and deviant thought patterns. Empathy training teaches the patient to view his or her behaviour from the perspective of the victim. Cognitive distortion therapy attempts to restructure a patient’s deviant notions—for example, by reinforcing the fact that coercion of children into sexual activities is an inappropriate behaviour. In some cases medications such as cyproterone that suppress the activity of testosterone in men can be effective in reducing aggressive behaviour and sex drive.
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