Impairment in inhibition
With regard to inhibitory dysfunction, 3 areas to consider include impulsivity, cognitive distortions, and psychopathy. Impulsivity can impede inhibition via inadequate consideration of consequences, cognitive distortions through misunderstanding of the implications of the pedophilic behavior, and psychopathy through inadequate concern with the harm done to others, particularly young victims.
Considerable data point to high levels of impulsivity or impulse control disorders within pedophile samples.13,24 Nonetheless, these findings are not consistent and may reflect comorbid psychopathology in those pedophiles with the most severe psychopathology and/or those most likely to get caught. In addition, the findings may characterize pedophiles on the opportunistic side of the spectrum.
In the 1967 study by Gebhard,25 the majority of pedophilic crimes (70% to 85%) were premeditated rather than impulsive. Likewise, in our study, pedophiles displayed lower scores on an impulsivity scale than a group of opiate-addicted controls. Moreover, the pedophiles’ scores were virtually indistinguishable from those of healthy controls.14 The relatively high prevalence of pedophiles who maintain demanding jobs with high levels of responsibility, such as pedophile priests, also argues against a central role of impulsivity.26 Thus, impulsivity may characterize some pedophiles but not all.
One finding that has robust support is the tendency toward grossly distorted thinking.3,4,12 Pedophiles commonly experience their sexual urges as ego-syntonic. Presumably in an effort to justify behavior that is widely socially condemned, pedophiles frequently rationalize, minimize, and normalize their sexual interaction with children, sometimes to the point of delusional ideation. Relatedly, several studies have noted high levels of schizotypal and other cluster A personality traits in this population.12,27
Finally, engaging in sexual activity with children violates strongly held taboos as well as criminal law. Thus, we can predict that the participation in child sexual abuse may be associated with elevated psychopathic traits. Indeed, many studies have supported this finding.12-14 Nonetheless, the degree of psychopathic traits appears to vary across subgroups. A study of pedophilic priests found that this subgroup had lower levels of psychopathy than a sample of nonclerical pedophiles.26
In sum, research shows highly consistent evidence for cognitive distortions and sexual abuse histories, fairly consistent evidence for psychopathic traits, and mixed evidence for avoidant personality traits, impulsivity, and neurobiological or neuropsychological impairment. Future research is needed to address the extent to which:
• These traits pertain to either motivational or inhibitory dysfunction
• They are characteristic of true versus opportunistic pedophiles
Consequently, when evaluating a pedophilic patient, clinicians should consider the level of comorbid impulsivity, social inhibition, neurocognitive dysfunction, psychopathic traits, and cognitive distortions. These traits may give a fuller picture of motivating factors as well as impediments to the inhibition of pedophilic urges.
Because pedophiles are not always truthful, full assessment of pedophilia is best performed with multiple modalities and multiple sources of information. When the criminal justice system is involved, examination of court records is critical. Likewise, objective measures of sexual response styles are often necessary because pedophiles routinely minimize their pedophilic tendencies.
The most common objective methodology involves plethysmographic measures, in which erectile response to targets of different ages and genders is recorded.5 Measures of galvanic skin response and respiration rate can also accompany plethysmographic measures. The Abel Assessment for Sexual Interests (AASI) offers an alternative measure of observable behavior, recording visual reaction time to a range of images.28 The AASI also comes with a lengthy self-report questionnaire. Two other self-report instruments, the Clarke Sexual History Questionnaire–Revised and the Multiphasic Sex Inventory, contain validity scales to detect lying.5