The following excerpt is taken from “A Profile of Pedophilia: Definition, Characteristics of Offenders, Recidivism, Treatment Outcomes, and Forensic Issues” by Ryan C. W. Hall, MD, & Richard C.W. Hall, MD. Originally published by MAYO CLINIC PROCEEDINGS.

What Is Pedophilia?
Pedophilia is a clinical diagnosis usually made by a psychiatrist or psychologist. It is not a criminal or legal term, such as forcible sexual offense, which is a legal term often used in criminal statistics. The Federal Bureau of Investigation’s National Incident-Based Reporting System’s (NIBRS) definition of forcible sexual offenses includes any sexual act directed against another person forcibly and/or against that person’s will or not forcibly or against the person’s will in which the injured party is incapable of giving consent. By diagnostic criteria of 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 <13 years) for a period of at least 6 months. Pedophiles are either severely distressed by these sexual urges, experience interpersonal difficulties because of them, or act on them. Pedophiles usually come to medical or legal attention by committing an act against a child because most do not find their sexual fantasies distressing or ego-dystonic enough to voluntarily seek treatment.

Generally, the individual must be at least 16 years of age and at least 5 years older than the juvenile of interest to meet criteria for pedophilia. In cases that involve adolescent offenders, factors such as emotional and sexual maturity may be taken into account before a diagnosis of pedophilia is made. Pedophiles usually report that their attraction to children begins around the time of their puberty or adolescence, but this sexual attraction to children can also develop later in life. If the clinical diagnosis of pedophilia is based on a specific act, it usually is not solely the result of intoxication or caused by another state or condition that may affect judgment, such as mania. These cases are distinguished from pedophilia by the act being contrary to the individual’s usual sexual behaviors and fantasies. Some studies have found that as many as 50% to 60% of pedophiles also have a substance abuse or dependence diagnosis, but what is important is that their attraction to children is present in both the sober and the intoxicated state.

The course of pedophilia is usually long term. In a study that examined the relationship between age and types of sexual crimes, Dickey et al found that up to 44% of pedophiles in their sample of 168 sex offenders were in the older adult age range (age, 40–70 years). When compared with rapists and sexual sadists, pedophiles comprise 60% of all older offenders, indicating that pedophiles offend in their later years at a greater rate than other sexual offenders.

Technically, individuals who engage in sexual activities with pubescent teenagers under the legal age of consent (ages 13–16 years) are known as hebophiles (attracted to females) or ephebophiles (attracted to males). The term hebophilia (also spelled as hebephilia) is becoming a generic term to describe sexual interest in either male or female pubescent children. Distinctions noted in the literature between hebophiles and pedophiles are that hebophiles tend to be more interested in having reciprocal sexual affairs or relationships with children, are more opportunistic when engaging in sexual acts, have better social functioning, and have a better posttreatment prognosis than pedophiles. The term teleiophile applies to an adult who prefers physically mature partners. There is also a subclassification of pedophilia known as infantophilia, which describes individuals interested in children younger than 5 years. These distinctions are important in understanding current research about paraphilias, selection criteria for studies of sexual behavior, and tests that gauge sexual interest (eg, plethysmography).

Pedophiles may engage in a wide range of sexual acts with children. These activities range from exposing themselves to children (exhibitionism), undressing a child, looking at naked children (voyeurism), or masturbating in the presence of children to more intrusive physical contact, such as rubbing their genitalia against a child (frotteurism), fondling a child, engaging in oral sex, or penetration of the mouth, anus, and/or vagina. Generally, pedophiles do not use force to have children engage in these activities but instead rely on various forms of psychic manipulation and desensitization (eg, progression from innocuous touching to inappropriate touching, showing pornography to children). When confronted about engaging in such activities, pedophiles commonly justify and minimize their actions by stating that the acts “had educational value,” that the child derived pleasure from the acts or attention, or that the child was provocative and encouraged the acts in some way. A US Department of Justice manual for law enforcement officers identifies 5 common psychological defense patterns in pedophiles: (1) denial (eg, “Is it wrong to give a child a hug?”), (2) minimization (“It only happened once”), (3) justification (eg, “I am a boy lover, not a child molester”), (4) fabrication (activities were research for a scholarly project), and (5) attack (character attacks on child, prosecutors, or police, as well as potential for physical violence).

Fifty percent to 70% of pedophiles can be diagnosed as having another paraphilia, such as frotteurism, exhibitionism, voyeurism, or sadism. Pedophiles are approximately 2.5 times more likely to engage in physical contact with a child than simply voyeuristic or exhibitionistic activities. Typically, pedophiles engage in fondling and genital manipulation more than intercourse, with the exceptions occurring in cases of incest, of pedophiles with a preference for older children or adolescents, and when children are physically coerced.

Child molestation is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. A child molester is loosely defined as any individual who touches a child to obtain sexual gratification with the specifier that the offender is at least 4 to 5 years older than the child. The age qualifier is added to eliminate developmentally normal childhood sex play (eg, two 8-year-olds “playing doctor”). By this definition, a 13-year-old who touches an 8-year-old would be considered a child molester but would not meet criteria to be a pedophile. The NIBRS data on juvenile sexual assaults found that 40% of assaults against children younger than 12 years were committed by juveniles, with the most frequent age of the offenders being 14 years old. Data from the study by Abel and Harlow showed that 40% of child molesters, who were later diagnosed as having pedophilia, had molested a child by the time they were 15 years old. An estimated 88% of child molesters and 95% of molestations (one person, multiple acts) are committed by individuals who now or in the future will also meet criteria for pedophilia. Pedophilic child molesters on average commit 10 times more sexual acts against children than nonpedophilic child molesters.

In general, most individuals who engage in pedophilia or paraphilias are male. . . . Continue Reading →