Pedophilic Disorder DSM-5 302.2 (F65.4)
This Article Is Part of A Series For Paraphilic Disorders
DSM-5 Category: Paraphilic Disorders
Introduction
Pedophilic Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to adults ( defined as age 16 and up) who have sexual desire for prepubescent children (American Psychiatric Association, 2013a).Any behavioral expression of Pedophilic Disorder is a criminal offense in the United States, Canada, and Europe, as well as most other places in the world. Some authors differentiate between having deviant desires for children which are ego-dystonic and resisted, causing guilt, shame, and distress, vs. desires which are indulged through fantasy, associating with other pedophiles, possession and trading of pornographic images, or direct observation, self-exposure, or physical contact with a victim (Harvard University, 2010; Vachss, 2013). Pedophilic Disorder is highly treatment resistant and rates of recidivism have been estimated to be 25% -50%, (Harvard University, 2010) This is inconclusive however, as this figure is more accurately described as 25 % to 50% are arrested for child sexual abuse, and an unknown number re-offend but do not come to the attention of law enforcement. For the victim of the offense, it tends to be very psychologically damaging, and can produce long term psychosexual problems, and PTSD (Post- traumatic Stress Disorder).
The DSM-5 initially described Pedophilic Disorder as a sexual orientation, which caused some members of the public to take offense, and express concern that this would pave the way for reduced criminal culpability (American Psychiatric Association, 2013a).The American Psychiatric Association later indicated the word “ preference” was a typographical error, and should have read “ interest” (American Psychiatric Association, 2013b). The APA (American Psychological Association) clarified their position on Pedophilic Disorder in response to a statement released by the American Family Association. The APA indicated that they do not “classify Mental Disorders or publish the Diagnostic and Statistical Manual as the the release incorrectly stated”, the APA holds the position that acting on pedophilic desires is a crime, and adult -child sexually contact is always wrong (American Psychological Association. 2013). However other sources concur that Pedophilic Disorder is a sexual preference, (Harvard University, 2010), and differentiate between deviant desires, and acting them out cognitively or behaviorally. In the latter case, the term Predatory Pedophile may used to discriminate between one who has desires but resists them vs. one who indulges the desires. The desires can be viewed as a illness, disease, disorder, or sickness. The desires may be buried, resisted, and never acted on due to shame, guilt, conscience, sense of morality, horror, or fear of consequences. This may be a repressed sexual orientation, and is sickness, which may be amenable to treatment. However, acting on these desires is an act of evil, a choice, and a crime. (Vachss, 2013) The lay public’s fear that the use of the phrase sexual preference will lead to reduced criminal culpability may be unfounded, as this does not consider that it is established that sexual orientation cannot be altered through psychotherapy. This implies that Pedophilic Disorder cannot be fundamentally altered, or as the lay public may use the term, “ cured” and this implies even greater criminal culpability, rather than diminished responsibility. The implication is that recidivism is almost certain, and that only incapacitation and supervision will prevent Pedophiles from acting out their desires. The individual who is predatory ( Pedophilic Disordered) will not be safe around children at any point in their lives, and must therefore be contained and monitored indefinitely. There is also a misunderstanding of the law, While sexual orientation is a status generally protected by law, coerced sexual behavior, or sexual behavior with someone under the age of consent is a criminal offense, regardless of sexual preference.
Symptoms of Pedophilic Disorder
According to the DSM-5, there are three criterion, with six specifiers:
- An individual who has had arousing fantasies about, urges for, or behaviors with a prepubescent child or children.
- The individual has acted out these sexual desires, or is experiencing significant distress or difficulty as a result of these desires.
- The Individual is 16 years of age, and at least five years older than the child or children noted in Criterion A.
The Specifiers are:
- Exclusive type- sexual attraction to children only.
- Non-exclusive type- sexual attraction to adults and children.
- Attraction to boys.
- Attraction to girls.
- Incestuous only. (American Psychiatric Association, 2013a).
Onset
The DSM-5 notes that males with Pedophilic Disorder begin to feel sexual attraction toward children about the time of puberty (American Psychiatric Association, 2013a).
Prevalence
According to the DSM-5, the actual prevalence of Pedophilic Disorder is unknown, with an estimate of 3% to 5% (American Psychiatric Association, 2013a).
Risk Factors
The DSM-5 indicates that there is a correlation between Antisocial Personality Disorder and Pedophilic Disorder. Also, many adults involved with the criminal justice system will report they were molested as children (American Psychiatric Association, 2013a).It may be tempting for some to look on Pedophilic Disorder as a learned behavior, or the result of sexual trauma in which an individual is acting out the Repetition Compulsion ( a drive to re-live trauma) in accordance with Freudian theory. There are an unknown number of individuals who were molested, and may have other psychological problems, but do not act out in a sexually predatory manner. Reaction formation is another Freudian concept, which when applied in this context, could mean an individual will become asexual, which would preclude the possibility of sexually acting out.
Comorbidity
The DSM-5 indicates that Pedophilic Disorder may be comorbid with substance abuse disorder, bipolar disorder, Depressive disorder, anxiety disorders, and other paraphilias (American Psychiatric Association, 2013a).
Treatment for Pedophilic Disorder
The DSM-5 does not specify treatment options for (American Psychiatric Association, 2013a). As noted in the Introduction, generally speaking, Pedophilic Disorder is not amenable to Psychotherapy, although many methods have been tried, including a Relapse-Prevention model, and CBT ( Cognitive Behavioral Therapy). Pharmacotherapy using estrogens or SSRI''s (Selective Serotonin Re-uptake Inhibitors) to suppress sexual desire, and castration. Studies have shown that long terms outcomes in terms of recidivism are worse for offenders who receive Relapse Prevention therapy (Harvard University, 2010). Pharmacotherapy involves compliance with taking medications, and monitoring and supervision of compliance, tasks which Departments of Corrections may not have sufficient staff to conduct. Physical castration of sex offenders was practiced in the United States through 1975 (Scharf,1989), and as of 2012, in nine states, chemical castration through the use of synthetic estrogen can be used, in some states as a condition of attaining parole status. However, even castration may not dissuade a determined and predatory offender, as they will resort to using foreign objects for penetration, watch other individuals perpetrate on a victim, or watch pornographic videos or images. The distinction is that the deviant desires are in the offenders mind, not body. The most viable option at this time is long term incarceration, and post release monitoring and supervision (Harvard University, 2010) through parole or House arrest (if applicable as this is not available in all jurisdictions). Designation as an MDSO (Mentally Disordered Sex offender) under SVP (Sexually Violent Predator) laws is another option for long term incapacitation of the offender, and is practiced in 20 states as of 2011 (Minnesota Office of the State Auditor, 2011). MDSO involves post release civil commitment of the offender if a comorbid mental illness is present and the offender is deemed at high risk of recidivism (The California Coalition on Sexual Offending, 2009). Pedophilic Disorder offenders are often not successfully prosecuted, and there is gross under reporting by their victims (Harvard University, 2010).
Impact on Functioning
Pedophilic Disorder has the potential to impact many areas of functioning. Those with Pedophilic Disorder typically lead dual lives. They maintain secrecy, presenting a picture of normalcy, respectability, responsibility, and adult sexual functioning. Some are married and have families, and even their spouses are not aware of their aberrant desires and activities. (Salter, 2003).
Once apprehended, they may experience incarceration or other involvement with the criminal justice system, and public shame and humiliation. Typically, not even other violent offenders will tolerate an inmate with Pedophile Disorder in their midst. Incarcerated individuals with Pedophilic disorder will typically have to be segregated in their own unit or pod within a correctional facility for their own safety, as they will be subject to acts of violence by other inmates.
Differential Diagnosis
There are diagnostic rule-outs for the clinician to consider for Pedophilic Disorder. In the DSM -5, it is noted that OCD (Obsessive Compulsive Disorder ) may cause intrusive, involuntary, ego-dystonic sexual thoughts of children, but someone with OCD considers these thoughts and images abhorrent, and according to the DSM-5 diagnostic criteria for OCD, makes efforts to resist or ignore them The DSM 5 states that someone who prefers adults sexually, may engage in sexual behavior with a child while under the influence of drugs or alcohol (American Psychiatric Association, 2013a). While the DSM-5 differentiates this behavior from Pedophilic Disorder, it could be argued that the disinhibitive effects of a substance would free the deviant desires the individual suppresses while sober- In Vino Veritas (In Wine is Truth) may apply here.
References
American Psychiatric Association. (2013a). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.
American Psychiatric Association. (2013b). APA Statement on DSM - 5 Text Error: Pedophilic disorder text error to be corrected . Press Release. American Psychiatric Association. Retrieved March 14, 2014, from http://www.dsm5.org/Documents/13-67-DSM-Correction-103113.pdf
American Psychological Association. (2013). Statement of the American Psychological Association Regarding Pedophilia and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychological Association. Retrieved March 12, 2014, from http://www.apa.org/news/press/releases/2013/10/pedophilia mental.aspx
California Department of State Hospitals. (2012). Forensics: Sex Offender Commitment Program (SCOP). Retrieved March 14, 2014, from http://www.dsh.ca.gov/forensics/SOCP.aspMDSO
Harvard University. (2010). Pessimism about Pedophilia. Harvard Health Publications .Retrieved March 12, 2014, from http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/July/p ssimism-about pedophilia
Minnesota Office of the State Auditor. (2011). Civil Commitment of Sex offenders. Minnesota Office of the State Auditor. Program Evaluation Division, Retrieved March 14, 2014, from
http://www.auditor.leg.state.mn.us/ped/2011/ccsosum.htm
Salter, A. (2003). Predators: Rapists, Pedophiles, and other Sex Offenders. Chapter Four. Basic
Books: NY.
Scharf, T.L. (1989). The Most Critical Option: Sex Offenses and Castration in San Diego, 1938 1975 . San Diego Historical Society Quarterly. (35). 4, Retrieved March 14, 2014, from
http://www.sandiegohistory.org/journal/89fall/most.htm
The California Coalition on Sexual Offending. (2009). THE CALIFORNIA SEXUALLY VIOLENT PREDATOR STATUTE: HISTORY, DESCRIPTION & AREAS FOR IMPROVEMENT. Retrieved March 14, 2014, from http://ccoso.org/papers/CCOSO%20SVP%20Paper.pdf
Vachss, A. (2013). Confusing Ideation with Criminal Action: The difference between a pedophile and a predatory pedophile is a criminal act. The Zero. Retrieved March 13, 2014 from Retrieved March 12, 2014 from http://www.vachss.com/av_dispatches/predatory.html
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