Because of recent scandals, pedophilia is one of the few psychiatric disorders widely known to the general public. Classified in DSM-IV and DSM-IV-TR as a paraphilia, pedophilia is characterized by persistent sexual attraction to prepubescent children. Although patients with pedophilic tendencies are generally seen by specialists in sexual disorders, many other clinicians are likely to encounter such patients as well. This article provides a general overview of the current literature on the psychology and psychopathology of pedophilia so that clinicians who encounter pedophilic patients will be better prepared to make an assessment and decide on the appropriate course of treatment. Moreover, a better understanding of people who are sexually attracted to children is critically important to protect against the severely destructive effects of childhood sexual abuse.1,2
Diagnosis
DSM-IV and DSM-IV-TR define pedophilia as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving activity with a prepubescent child or children (generally 13 years or younger).” These feelings, urges, or behaviors must persist for at least 6 months. The DSM-IV criterion that such urges must cause clinically significant distress or functional impairment was amended in DSM-IV-TR, such that recurrent pedophilic fantasies or arousal need not be experienced as distressing. This correction reflects the ego-syntonic nature of many pedophiles’ sexual desires and/or behavior.3,4
According to DSM-IV, pedophilia can be diagnosed in the absence of any pedophilic behavior. Nonetheless, because of the potential legal risks of self-reporting pedophilic inclinations, the majority of pedophile research is conducted with participants who are identified by their behavior, most often via their contact with the criminal justice system.
There are 2 problems inherent with this research pool. For one, convicted or arrested sex offenders might differ considerably from pedophilic individuals who have not acted on their urges or who have acted on them but have not been caught. Second, not everyone who sexually molests a child is actually a pedophile; that is, such a person may not have a persistent sexual attraction to prepubescent children.5 Despite these difficulties, current research does reveal sufficiently consistent patterns to provide a basic overview of common psychological features associated with pedophilia.
Male and female pedophiles
Most sexual offenders against children are male, although female offenders may account for 0.4% to 4% of convicted sexual offenders.6,7 On the basis of a range of published reports, McConaghy8 estimates a 10 to 1 ratio of male-to-female child molesters. However, most researchers assume available estimates underrepresent the true number of female pedophiles.9 Several reasons for this have been proposed, including a societal tendency to dismiss the negative impact of sexual relationships between young boys and adult women as well as women’s greater access to very young children who cannot report their abuse.9 Because of the low number of females in pedophile samples, most of the studies discussed below will be drawn from exclusively male samples.
