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.

Personality Traits of the Pedophile
It is difficult to present a classic personality pattern for pedophilia because of the various subgroups that exist. Some individuals who have pedophilia are able to present themselves as psychologically normal during examination or superficial encounters, even though they have severe underlying personality disorders. Studies have shown that people with pedophilia generally experience feelings of inferiority, isolation or loneliness, low self-esteem, internal dysphoria, and emotional immaturity. They have difficulty with mature age-appropriate interpersonal interactions, particularly because of their reduced assertiveness, elevated levels of passive-aggressivity, and increased anger or hostility. These traits lead to difficulty dealing with painful affect, which results in the excessive use of the major defense mechanisms of intellectualization, denial, cognitive distortion (eg, manipulation of fact), and rationalization. Even though pedophiles often have difficulty with interpersonal relationships, 50% or more will marry at some point in their lives.

It is common for people who are diagnosed as having pedophilia to also experience another major psychiatric disorder (affective illness in 60%–80%, anxiety disorder in 50%–60%) and/or a diagnosable personality disorder (70%–80%) at some time in their life. An estimated 43% of pedophiles have cluster C personality disorders, 33% have cluster B personality disorders, and 18% have cluster A personality disorders (Table 3). A study by Curnoe and Langevin, using the Minnesota Multiphasic Personality Inventory with pedophiles and other “deviant fantasizers” (n=186), showed significantly increased scores on the infrequency scale, the psychopathic deviance scale, the masculinity-femininity scale, the paranoia scale, and the schizophrenia scale. These results suggest that pedophiles are more socially alienated and less emotionally stable than most other people, traits commonly seen in patients with cluster A and B personality disorders. Many pedophiles also demonstrate narcissistic, sociopathic, and antisocial personality traits. They lack remorse and an understanding of the harm their actions cause.

The notion of impulsivity as a personality factor in pedophiles is often debated. Pedophiles frequently report trouble controlling their behavior, although it is rare for them to spontaneously molest a child. The fact that 70% to 85% of offenses against children are premeditated speaks against a lack of perpetrator control. Cohen et al compared 20 heterosexual pedophiles to a control group and found that pedophiles demonstrated elevated scores for harm avoidance, with no elevation for novelty seeking on the Temperament and Character Inventory. Cohen et al suggest that, instead of viewing pedophilia as the result of an impulse-aggressive trait (eg, unplanned with no consideration for consequences), it should be viewed as the result of a compulsive-aggressive trait (planned with the intention of relieving internal pressures or urges).

What Makes a Pedophile?
A substantial amount of research has been performed on what leads one to be attracted to children. Pedophilia, especially the exclusive type, may be best thought of as its own category of sexual orientation, not something that is superimposed on an existing heterosexual or homosexual identity. This theory then raises the questions, “Do people choose to be pedophiles or are they born that way? If they are born that way, can any type of treatment convert them into a normal adult sexual orientation?” These questions remain an area of medical controversy. The information that follows is a sample of some of the theories that have been proposed and studied.

Neuropsychiatric Differences
Research that seeks neuropsychiatric differences between pedophiles and the general population, the prison population, and other sexual offenders has been undertaken.

The reported differences include lower intelligence (an area of controversy), a slight increase in the prominence of left-handed individuals, impaired cognitive abilities, neuroendocrine differences, and brain abnormalities, particularly frontocortical irregularities and/or differences. A high comorbidity of impulse control disorders (eg, explosive personality disorder, kleptomania, pyromania, pathological gambling) has been noted in pedophiles (30%–55%). These factors have been postulated to indicate that pedophiles may have neurodevelopmental perturbations.

A study by Schiffer et al, using voxel-based morphometry magnetic resonance imaging techniques on 18 individuals with pedophilia from a maximum-security prison (9 homosexual and 9 heterosexual pedophiles) vs 24 controls (12 heterosexual and 12 homosexual males), found decreased gray matter volume bilaterally in the ventral striatum, insula, orbitofrontal cortex, and cerebellum of the pedophiles. These findings are similar to other imaging studies that found unilateral and bilateral frontal lobe, temporal lobe, and cerebellar changes in pedophiles. Schiffer et al postulated that these changes may imply the existence of disrupted neurophysiologic attributes. Similar changes have been reported in patients with impulse control disorders, such as addiction, obsessive-compulsive disorder (OCD), and antisocial personality disorder.

The temporal lobe findings deserve special attention. It has long been known that certain medical conditions, such as temporal lobe epilepsy and Kluver-Bucy syndrome (bilateral lesions in the temporal lobes), can lead to hypersexual or hyposexual behavior. Several studies indicate that the temporal lobe is involved in erotic discrimination and arousal thresholds. Many computed tomography studies have demonstrated abnormalities of the temporal lobes in pedophiles vs controls. Positron emission tomography studies by Cohen et al found decreased glucose metabolism in the right inferior temporal cortex (P=.04) and the superior ventral frontal gyrus (P=.03) of 7 heterosexual, nonexclusive, nonincest pedophiles vs 7 controls.

Another potential explanation for the neuroradiological findings, besides disturbances in early brain development, is that these findings are more a marker for comorbid psychiatric diseases than pedophilia itself. As previously mentioned, these changes commonly occur with other conditions, such as certain personality disorders, which are also found in a large number of pedophiles. Posttraumatic stress disorder in particular is known to cause changes on functional neuroimaging in areas similar to those found in pedophiles, such as the prefrontal cortex, orbitofrontal cortex, and the insula. A question this raises is whether some of the changes noted in pedophiles are related to problems of brain development and maturation or represent brain changes that have resulted from life experiences, such as being physically abused and sexual victimized themselves as children.

Studies of neurochemical differences in pedophiles vs controls have also been performed. A particular area of interest is serotonin function and metabolism. Serotonin has long been known to play a role in impulse control disorders such as OCD and is theorized to have significance in the paraphilias. A study by Maes et al showed that pedophiles (n=9) had differing hormonal responses (eg, greater magnitude of cortisol and prolactin level changes) to metachlorophenylpiperazine, a serotonin agonist, compared with controls (n=11). Pedophiles also had a greater frequency of physical symptoms (eg, dizziness, restlessness, change in appetite, lack of change in core body temperature) when exposed to metachlorophenylpiperazine vs controls. Maes et al interpreted these findings to indicate that pedophiles had a serotonergic disturbance, most likely caused by the decreased activity of the presynaptic serotonergic neuron and hypersensitivity of the serotonin 2 postsynaptic receptor.

A study by Blanchard et al evaluated the intelligence of 679 pedophilic subjects and found that the mean intelligence rating of bisexual and homosexual pedophiles was significantly lower than heterosexual offenders (either pedophile or teleiophile). The main factor for this difference in intellectual functioning was a higher percentage of subjects with borderline and full cognitive impairment in the bisexual and homosexual populations. The study by Beier reported opposite findings, noting that more heterosexual offenders were cognitively impaired than homosexual offenders. The study by Blanchard et al also indicated that the lower the intelligence of the offender, the younger the age of the abused child.

Another study by Blanchard et al of a population of 1206 individuals evaluated self-reported head trauma as a predisposing risk factor for being diagnosed as having pedophilia. This study found an increased rate of pedophilia, lower levels of education, and lower intelligence in individuals who had sustained head trauma, resulting in a loss of consciousness before the age of 6 years. Blanchard et al interpreted these results to confirm the hypothesis that neurodevelopmental differences or injuries in early childhood may result in one being sexually oriented toward children. A secondary finding of the study was that individuals who were pedophiles were more likely to have mothers who received psychiatric treatment than controls. The authors postulated that this finding might indicate a genetic linkage or predisposition to pedophilia but associated environmental factors could not be ruled out.

Environmental or Social Factors
Environmental factors may predispose individuals to become pedophiles. Pedophiles often report environmental stress as a factor that increases their urges or desire to offend against children.

One of the most obvious examples of an environmental factor that increases the chances of an individual becoming an offender is if he or she were sexually abused as a child. This relationship is known as the “victim-to-abuser cycle” or “abused-abusers phenomena.” The frequency of occurrence of this phenomenon varies widely on the basis of study selection criteria and the populations studied. The numbers reported for pedophiles who were abused as children range from 28% to 93% vs approximately 15% for random controls. Studies that examined females who committed sexual acts against children reported that 47% to 100% of them had experienced sexual assault as children. Individuals who engage in homosexual pedophilia were more likely to have been abused than individuals who engage in heterosexual pedophilia. Some studies have also found that pedophiles and hebophiles who were abused tend to have an age preference for children that is similar to the age at which they were abused.

Many theories have speculated on why the “abused-abusers phenomena” occurs: identification with the aggressor, in which the abused child is trying to gain a new identity by becoming the abuser; an imprinted sexual arousal pattern established by early abuse; early abuse leading to hypersexual behavior; or a forms of social learning took place. Of note, although abused individuals are more likely to abuse others, most individuals who are abused do not perpetuate the cycle. There is also legitimate concern regarding the validity of many of the self-reports of pedophiles who claim to have been abused as children themselves. These statements are often made in a legal or group treatment setting, in which pedophiles may be trying to mitigate their sentence or gain sympathy for their behavior.

Historically, pedophiles are likely to have repeated a grade in school (approximately 61%) or required special education classes. Academic difficulties occur in both pedophiles and hebophiles at twice the odds ratio seen for perpetrators of sexual offenses against adults. Some studies have also found that pedophiles have lower levels of education and employment than the general population, but this may be a prison sampling artifact. Studies by Abel et al, Gacono et al, and Huprich et al found that nonviolent pedophiles were educationally similar to, or better educated than, samples of sociopaths, sexual murderers, and controls, but these studies excluded cognitively impaired individuals.

A study by Blanchard et al that compared 260 pedophiles with 260 matched controls found a correlation between fraternal birth order (having more older male siblings) and the pedophile having a homosexual orientation. Similar findings exist linking birth order and adult homosexuality. Other studies have found correlations for older maternal age and pedophilia, which may also be a marker for birth order. Whether these correlations are due to social or biologic factors is unclear. One theory to explain how male birth order affects sexual orientation is the presence of antimale maternal antibodies in multiparous women, which affect neuropathway development in the fetus. . . . Continue Reading →