Pedophilia

Introduction
Few psychological disorders are as stigmatized as pedophilia. From the Greek meaning “love of children,” pedophilia is defined in the Diagnostic and Statistical Manual as “recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children,” (Muller, 2016, p. 1). The media perpetuates stigma by semantically linking pedophilia with child sexual abuse or child molestation. In fact, pedophilia refers only to the desire or fantasy, but not to the behavior. Differentiating between pedophilia and child molestation is important both for dispelling myths and for promoting effective interventions for people with pedophilia.
What is Pedophilia?
Pedophilia literally meals love of children, but more specifically refers to having a sexual attracting to children. The Diagnostic and Statistical Manual describes pedophilia as “recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children,” (Muller, 2016, p. 1). For a brief time the American Psychiatric Association defined pedophilia as a “sexual orientation,” but quickly backpedaled due to public outcry (Whitney, 2015). As Berlin (2014) points out, the APA and other professional organizations that set standards for diagnosis, treatment, and public health policy should revert to a definition of pedophilia that does refer to sexual orientation. Doing so would reduce stigma, showing that having sexual urges or fantasies about children is something that is beyond the person’s control; essentially the pedophile was born that way. In fact, emerging evidence has been showing that pedophilia may be a “biologically based neurodevelopmental disorder,” (Fazio, Dyshniku, Lykins, et al, 2015, p. 1). Neurological tests also show that structural alterations in the brain “account for common affective and neurocognitive impairments in pedophilia,” (Poeppl, Eickhoff, Fox, et al, 2015, p. 2374). Therefore, it is reasonable to classify pedophilia as a sexual orientation.
By definition, pedophiliacs experience serious emotional and psychological distress. The DSM-V includes as part of its clinical definition the parameter that “to be diagnosed with pedophilia, the person must experience these symptoms for at least six months, and feel serious distress from the sexual urges and fantasies,” (Muller, 2016, p. 1). The distress pedophiles feel can be serious, making comorbidity with other psychological disorders, such as depression or anxiety disorders, a high likelihood. In fact, pedophilia has been associated with “agonizing self-hatred” and suicidal ideation (Muller, 2016). Treating pedophilia as a psychological disorder is an appropriate and sensible response.
Unfortunately, research on pedophilia is scant. Treatment interventions are also scarce, which increases the likelihood that some pedophiliacs might act on their urges, placing children in serious danger. It is crucial to remember that pedophiles are not inherently dangerous; their urges are not necessarily going to be translated into action. “The great majority of pedophiles may never offend against children, and choose to keep their attractions a secret,” (CBC Firsthand Productions, 2016). A pedophile is not a child molester; a child molester is also not necessarily a pedophile but just a sexual predator (CBC Firsthand Productions, 2016). Differentiating between pedophilia and child molestation is the most important first step towards improving prognosis for pedophiles, improving public health, and improving public safety and the welfare of children.
Prevalence
Because of measurement discrepancies and difficulties relying on self-reports, t is hard to know how many pedophiliacs there are in the general population or overall prevalence rates. Muller (2016) claims, “it is now believed that approximately 1 to 5 percent of men identify as a pedophile,” (p. 1). Population research substantiates the estimate of “0.5–1% lifetime prevalence in men,” (Poeppl, Eickhoff, Fox, et al, 2015, p. 2374). Research on the prevalence, types, and effects of stigmatization of people with pedophilia is in fact difficult to acquire in part because of stigma and reluctance to frankly address the taboo topic.
Support groups for pedophiles are mostly online affairs because of the shame, stigma and lack of established or formal social services. The online support group Virtuous Pedophile has over 1200 registered members (CBC Firsthand Productions, 2016). Both men and women can be pedophiles, but males are “far more likely than females to commit child sexual abuse,” (Pittaro, 2016, p. 301). Again due to stigma related to pedophilia, there are no precise numbers of the prevalence of pedophilia among adult women. As Pittaro (2016) points out, female pedophiles are “uncommon,” but being uncommon does not mean it is acceptable to ignore this small subset of the population and provide appropriate treatment intervention to reduce harm (p. 301).
Stigmatizing
Understandably, stigma about pedophilia arises because it is “closely associated with harm to children through child sexual abuse,” (Shetty, Nayak, Travers, et al, 2014, p. 1). Sexually molesting children is grossly unethical and illegal, and needs to remain a highly stigmatized behavior. However, pedophilia is not equal to child sexual abuse any more than suicidal ideation is the same thing as suicide. The whole point of trying to remove stigma about pedophilia is actually to prevent harm to children, not to normalize child sexual abuse.
Stigma is systematic negative attribution, linked to labeling, and results in social isolation (Jahnke, Imhoff & Hoyer, 2015). Shaming excluding the person from mainstream society can exacerbate the original condition, leading to symptom deterioration or the emergence of comorbid disorders. A stigma can also be challenging to overcome, and takes a while to change the public perceptions of the problems. Taking a more balanced approach to pedophilia would be far more productive than stigmatizing, and yet stigmatizing persists due to prevailing misconceptions about pedophilia.
Misconceptions are perpetuated by the media and popular culture, and embedded in laws like Canada’s mandatory reporting laws (Muller, 2016). The media continues to equate pedophilia with child sexual abuse, calling abusers “pedophiles,” instead of calling abusers child molesters. Mandatory reporting laws can apply just as well to pedophiles who have never harmed a child as they do to child molesters. These types of laws and the social support of those laws underscore how deeply entrenched stigma against pedophilia is. The stigma leads to lack of treatment options, lack of research, and lack of policy that can keep children safe.
Research also shows how deeply negative the stigmas against pedophilia are. Jahnke, Imhoff & Hoyer (2015) conducted two separate surveys in two different populations and found “nearly all reactions to people with pedophilia were more negative than those to alcoholics, “sexual sadists,” or “people with antisocial tendencies,” (p. 21). Furthermore, as many as 28% percent of people surveyed expressed the belief that “people with pedophilia should better be dead, even if they never had committed criminal acts,” (Jahnke, Imhoff & Hoyer, 2015, p. 21). These are extremist views, views that leave no room for sensible dialogue about wht to do about pedophilia, how to prevent pedophilia from becoming child molestation, or how to help people with pedophilia to live healthy lives. People with “right-wing authoritarian” qualities were shown to be more likely to exhibit strong feelings of stigma against pedophilia (Jahnke, Imhoff & Hoyer, 2015, p. 21). However, stigmatization is pervasive.
Stigma About Female Pedophilia
Stigma against female pedophiles may in fact be worse than stigma against male pedophiles. Even though male pedophilia receives far more media attention, “it is just too heinous and counterintuitive an idea to contemplate that a female, whose traditional identity has included giving life, nurturing, and protecting the young, could molest a child,” but it does happen (Pittaro, 2016, p. 301). Female pedophiles may suffer even more stigma than males due to gender norms related to appropriate sexual urges; “pedophilia, especially female pedophilia, is improperly stigmatized by modern society,” (Carroll, 2015, p. 26). Henry James’s Turn of the Screw included a poignant theme related to female pedophilia, contributing to the “overall horror and dreadfulness” of the novel (Carroll, 2015, p. 28). Female pedophilia is perceived as being so demonic that it is considered almost supernaturally horrific; “most people in modernity consider female pedophilia to be the ‘most perverse act against nature’” (Carroll, 2015, p. 28).
Effects of Stigma
While norming is an important way to ensure important ethical boundaries are not crossed, stigmatizing psychological disorders like pedophilia can easily backfire. The most important problem with stigma is that it may prevent pedophiles from seeking help or support. Seeking help is the only way to prevent further harm, as the pedophile might be a potential harm to themselves or to children if the urges are acted upon. In fact, being stigmatized can potentially increase the likelihood of acting on impulse: “people with pedophilic sexual interests use societal thinking to self-stigmatize, which in turn may actually serve to increase their risk of committing a sexual offense,” (Harper, Bartels & Hogue, 2016, p. 1). Stigma causes social isolation, which can contribute to depression and suicidal thoughts or behaviors (Muller, 2016). A pedophile is unlikely to confide in even those closest to them, for fear of being forever socially scorned or worse, for fear of being arrested. In some jurisdictions, mandatory reporting laws are preventing pedophiles from being able to access mental health services.
Contributing to the problem are professional psychologists, psychiatrists, and social workers who have become unwilling to research or treat persons with pedophilia. Researchers have recorded instances of therapists turning down clients with pedophilia (Jahnke, Philipp & Hoyer, 2014, p. 93). Therapists may be reacting to the stigma themselves, fearful that working with pedophiles might hurt their career or reputation. Without adequate clinical attention, though, pedophilia will become more problematic than it already is. Professionals, and especially research psychologists and neuroscientists, need to do more research on the etiology of pedophilia and appropriate and effective interventions. Public health research can also illuminate best practices in social work and public policy. Stigmatizing impedes research, reducing funding and support for much-needed understanding of pedophilia. As a result, it is difficult if not impossible to know the exact causes, prevalence rates, or the pharmacological solutions that might be effective (Muller, 2016).
Stigma is used to send strong messages of intolerance against child abuse. Child abuse should never be tolerated. Yet stigmatizing pedophilia leads to “indirect negative consequences for child abuse prevention,” (Jahnke, Imhoff & Hoyer, 2015, p. 21). It is critical to base public policy not on fear mongering but on evidence and empirical research. For example, brain and neuroimaging studies are proving fruitful in showing that there are “differences in the functional connectivity between pedophiles who commit acts of child molestation versus those who do not carry out their desires,” (Kargel, Massau, Weiss, et al, 2015, p. 783). These types of studies need to inform public policy, showing that pedophilia is not the same thing as child molestation. Understanding the difference between pedophilia and child molestation will help reduce unnecessary stigma, and help pedophiles seek help as they would for any other mental health issue.
How to Remove Stigma
Removing stigma requires public education, changes to legislation and public policy, and collaboration among researchers and scholars. Researchers need to devote more resources towards the study of pedophilia. Similarly, more psychologists and psychiatrists need to treat clients with pedophilia in ways that helps reduce stigma and promote harm reduction. Family therapy and group therapy may be especially helpful, especially as “many pedophiles are fortunate to have some attraction to men or women their own age,” and many are also married (CBC Firsthand Productions, 2016). Pedophiles need to have safe and confidential places they can go for help and support, and often those places are online.
Online support groups “play a big role in reducing the instances of child molestation providing support to people who can’t seek help through traditional means for fear of being demonized — and reported to the police,” (CBC Firsthand Productions, 2016, p. 1). Virtuous Pedophiles and other online support groups create the right kind of normative yet supportive environment for pedophiles, offering a safe space while also establishing boundaries. For example, Virtuous Pedophiles firmly believe that acting on the pedophiliac impulse is “wrong” and have rules for joining that include strict stipulations against child pornography (CBC Firsthand Productions, 2016, p. 1). Most online support groups also require that their members have “no history of offending,” (CBC Firsthand Productions, 2016, p. 1).
Raising awareness about the harm of stigmatizing is also important. Public education can focus on messages showing how stigma does more harm than good, and that pedophiles need support groups, not shaming. The CBC Firsthand documentary I, Pedophile is a good example of how the media is participating in harm reduction campaigns dedicated to removing stigma. The use of first person narratives is becoming a good way to remove stigma, based on the principle of ““narrative humanization,” (Harper, Bartels, & Hogue, 2016, p. 1). Narrative humanization refers to the way that hearing first-person accounts breeds empathy and understanding, humanizing pedophiles instead of demonizing them.
Public policy also needs to be more sensible and less reactive to public whims. Mandatory reporting laws are based on misconceptions about pedophilia, not on empirical evidence. Muller (2016) mentions the German Prevention Project, which is a successful campaign to provide preventative treatment interventions to pedophiles. Treatment options range from cognitive-behavioral therapy to the use of medications that reduce libido (Muller, 2016).
Another important way of reducing stigma is to offer improved training to psychologists, social workers, and clinicians. Low-cost interventions with psychologists will be helpful, such as training programs that help the professional community shed their own misconceptions and remove biases. A pilot intervention was shown to reduce stigma among psychotherapists (Jahnke, Philipp & Hoyer, 2014).
Labeling theory can be used to show why the word “pedophilia” might have become overused, and have too much baggage. Research shows ““negative attitudes are even more pronounced when such sexual interest is labeled as pedophilia,” (Imhoff & Jahnke, 2017). The label can prevent the pedophile from being received at a mental health center, and especially prevents the person from being able to talk to friends and family.
Likewise, changing the DSM definitions may also be helpful, if not necessary, for reducing stigma. The focus in the DSM on “behaviors” effectively lumps the “innocent” pedophiles with the child molesters (Muller, 2016). Berlin (2014) agrees, noting that the DSM and the American Psychiatric Association may be contributing inadvertently to the misconception that [pedophilia and child molestation] are the same,” (p. 404). As it is, most mainstream media sources seem to conflate pedophilia and child molestation. The problem can be traced in part to the authoritative nature of the DSM. “The current criteria for diagnosing a Pedophilic Disorder place some persons who have never molested a child into the same diagnostic category as those who have done so,” (Berlin, 2014, p. 404). Child molestation is a deviant and criminal behavior that causes harm; pedophilia is a paraphilia; uncommon sexual urges towards prepubescent youth.
Pedophilia should be classified as an Axis I disorder, possibly framed again as a sexual orientation issue. “Experiencing ongoing sexual attractions to prepubescent children is, in essence, a form of sexual orientation, and acknowledging that reality can help to distinguish the mental makeup that is inherent to Pedophilia, from acts of child sexual abuse,” (Berlin, 2014, p. 404). At the very least, it is important to promote awareness that the condition of pedophilia is “unintentional,” (Imhoff & Jahnke, 2017, p. 1). The reason why lack of control and possible biological precursors must be discussed in public education and awareness programs is because research shows negative attitudes can be “attenuated to the extent that such sexual interest is perceived as beyond one’s own control,” framed as a mental health issue (Imhoff & Jahnke, 2017). When problems like addiction are framed as “diseases,” they are more likely to receive funding for research and treatment intervention, and less likely to be stigmatized.
Conclusion
The complexities of human sexuality are further complicated by social norms and stigma. A society with rigid norms regarding what constitutes acceptable sexual urges or fantasies is one that is most prone to developing harsh sanctions for pedophiles. Instead of addressing the urges for what they are, the society equates them with the intent to act.
Paying greater attention to research, and funding more research to better inform and educate the public, it will be possible to help pedophiles instead of punishing them for having deviant thoughts. Research can be used to promote evidence-based practices both in therapeutic interventions, in early detection, and in prevention programs. Moreover, research can be used to create evidence-based public policies and practices. With research, it becomes possible to dispel myths about pedophilia and dissolve misconceptions.
Child sexual abuse and child abuse more broadly are major problems that need to be resolved. However, child sexual abuse and child abuse occur in the absence of pedophilia. Pedophilia needs to be reclassified and understood more as a mental health issue, as persistent thoughts and fantasies that are not necessarily acted upon but which need to be understood rationally and with compassion.

References

Berlin, F.S. (2014). Pedophilia and DSM-V. J Am Acad Psychiatry Law 42:404 –7, 2014. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.881.9053&rep=rep1&type=pdf
Carroll, J. (2015). Screw-turnizing the Governess’s touching story. Sigma Tau Delta Review 12(2015): 16-29. https://s3.amazonaws.com/academia.edu.documents/36879703/review.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1519442786&Signature=4O3HxQm%2BiSNZrbwU90A1BrKxEzA%3D&response-content-disposition=inline%3B%20filename%3DThe_Horror_of_My_Other_Self_Transformat.pdf#page=16
Fazio, R.L., Dyshniku, F., Lykins, A.D., et al (2015). Leg length versus torso length in pedophilia. Sexual Abuse 29(5): 500-514.
Firsthand Productions (2016). I, Pedophile. CBC. http://www.cbc.ca/firsthand/features/four-misconceptions-about-pedophiles
Hall, R.C.W. & Hall, R.C.W. (2007). A profile of pedophilia. Mayo Clinical Proceedings 82(4): 457-471.
Harper, C.A., Bartels, R.M. & Hogue, T.E. (2016). Reducing stigma and punitive attitudes toward pedophiles through narrative humanization. Sexual Abuse, https://doi.org/10.1177/1079063216681561
Imhoff, R. & Jahnke, S. (2017). Determinants of Punitive Attitudes Toward People with Pedophilia: Dissecting Effects of the Label and Intentionality Ascriptions. Archieves of Sexual Behavior 47(2): 353-361.
Jahnke, S., Imhoff, R. & Hoyer, J. (2015). Stigmatization of people with pedophilia. Archives of Sexual Behavior 44(1): 21-34.
Jahnke, S., Philipp, K. & Hoyer, J. (2014). Stigmatizing attitudes towards people with pedophilia and their malleability among psychotherapists in training. Child Abuse and Neglect 40(2015): 93-102.
Kargel, C., Massau, C., Weiss, S., et al (2015). Diminished Functional Connectivity on the Road to Child Sexual Abuse in Pedophilia. The Journal of Sexual Medicine 12(3): 783-795.
Lamy, S., Delavenne, H. & Thibaut, F. (2015). A case of female hypersexuality and child abuse and a review. Archives of Women’s Mental Health 19(2016): 701-703.
Muller, R.T. (2016). Non-offending pedophiles suffer from isolation. Psychology Today. https://www.psychologytoday.com/blog/talking-about-trauma/201603/non-offending-pedophiles-suffer-isolation
Pittaro, M. (2016). Demystifying female perpetrated sex crimes against children. Family & Intimate Partner Violence Quarterly 8(4): 301-309.
Poeppl, T.B., Eickhoff, S.B., Fox, P.T., et al (2015). Connectivity and functional profiling of abnormal brain structures in pedophilia. Human Brain Mapping 36(6): 2374-2386.
Shetty, A., Nayak, A., Travers, R., et al (2014). Pedophilia. In: Corona G., Jannini E., Maggi M. (eds) Emotional, Physical, and Sexual Abuse, Springer.
Stephens, S., Leroux, E., Skilling, T., et al (2017). Taxometric analyses of pedophilia utilizing self-report, behavioral, and sexual arousal indicators. Journal of Abnormal Psychology, 126(8), 1114-1119.
Whitney, B. (2015). Facing disturbing truths about pedophilia could help us keep kids safer. Pacific Standard https://psmag.com/social-justice/facing-disturbing-truths-about-pedophilia-could-help-us-keep-kids-safer