Psychological Sexual Deviances: Pedophilia - Coursework Example

Pedophilia Pedophilia is a psychiatric disorder about which the public, the government and medical professionals are becoming increasingly aware. The increased awareness is partly due to increased information from the media and has led to increased investigation, detections and application of concerned laws. Since many pedophiles conceal their disorder, hence psychiatrists must apply their own techniques in identifying the disorder and treating it. My article aims to describe the various definitions, causes, clinical presentation and treatments for pedophilia Definitions Abnormal interest in children is known as pedophilia. The term comes from the Greek words pais which means boy and philia which means love. This psychological condition falls into the category of paraphilias. There are many definitions to pedophilia. Commonly pedophilia is described as "any adult who is sexually attracted to children or who sexually abuses a child" (American Heritage Dictionary). Medically, this condition is defined as "a psychological disorder in which an adult experiences a sexual preference for prepubescent children" (WHO, 2007). According to DSM-4-TR, "Pedophilia is a type of paraphilia in which a person recurrent, intense, sexually arousing fantasies, sexual urges or behaviors that generally involve nonhuman subjects, the suffering or humiliation of oneself or ones partner, or children or other non-consenting persons" (APA, 2006). Pedophilia is categorized in the DSM-IV as one of several paraphiliac mental disorders. In Law enforcement, the term pedophilia describes "those accused or convicted of the sexual abuse of a minor (including both prepubescent children and adolescent minors younger than the local age of consent)" (Ames & Douston, 1990). It is important to note that pedophilia is actually a clinical diagnosis made by a psychologist or psychiatrist and it is definitely not a criminal or legal term, nor is used in criminal statistics. To meet the criteria for pedophilia, "the individual must be atleast 16 years of age and atleast 5 years older than the juvenile of interest" (Hall & Hall, 2007). Diagnostic Criteria The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) criteria for Pedophilia (302.2) are: A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger); B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty; C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A. To arrive at a diagnosis of pedophilia, all the 3 criteria must be present. Also, if a diagnosis has to be made based on a specific act, intoxication and other causes like mania which affect judgment must be ruled out (Hall & Hall, 2007). Types of pedophilia There are 2 types of pedophiles: 1. Exclusive pedophiles- These are attracted to children only and show little erotic interest in adults. 2. Nonexclusive pedophiles- These are attracted to both children and adults. Most of the pedophiles fall into this category. Some individuals have special interest in toddlers and infants. They are known as nepiophilia or infantophilia (Laws & William, 2008). 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) (Hall & Hall, 2007). Prevalence of the disorder Pedophilia begins in adolescence, although in many cases the onset is noted in middle age. It is more commonly seen in men. Psychological and social stress may either increase or decrease pedophiliac behaviour. The details about incidence and prevalence of this condition are not much known because individuals with this disorder conceal their condition and seldom seek psychiatrist help. An estimated 1 in 20 cases of child sexual abuse is reported or identified (Hall & Hall, 2007). The activities of the pedophiles may limit to their own children or may be extended to other children at home or outside. Many of these individuals threaten the children to prevent them from telling others. The desire for these activities is so much that the individuals may develop complicated techniques for gaining access to children. They may even go to the extent of changing their job, create a hobby or even volunteer some work to keep in contact with children. These individuals win the trust of the childs mother or even marry a woman with attractive child. Many a times pedophilia is associated with sexual sadism, although the pedophile may appear kind and attentive to the childs needs. Pedophiles come under mental heath attention only when a child victim informs this to some one else and necessary action is taken. Behaviour of pedophiles These individuals exhibit various types of sexual behaviour with children. The activities include exhibitionism (exposing themselves to children), voyeurism (undressing a child or looking at naked children), frotteurism (masturbating in the presence of children to more intrusive physical contact, such as rubbing their genitalia against a c or fondling children, engaging in oral sex or other forms of sexual acts like penetration of the mouth, anus, and/or vagina (Hall & Hall, 2007). Pedophiles engage in fondling and genital manipulation more than intercourse (Hall & Hall, 2007). Most of the pedophiles do not force children into these acts unlike rapists. Instead, they actually manipulate the children psychologically. One such manipulation is desensitization. Here the pedophile progresses gradually from innocuous touching to inappropriate touching or even showing pornography to children. When by chance they are confronted about such acts, they justify themselves by stating casual comments like these are of educational value or I was just trying to console the crying child, etc. According to the US Department of Justice manual for law enforcement officers, there are 5 common psychological defense patterns in pedophiles (Hall & Hall, 2007): 1. Denial ("Is it wrong to hug a child?") 2. Minimization (“It only happened once”) 3. Justification (“I am a boy lover, not a child molester”) 4. Fabrication (activities were research for a scholarly project) 5. Attack (character attacks on child, prosecutors, or police, as well as potential for physical violence) Causes The causes of pedophilia are not known. Previously, it was thought that child sexual abuse leads to this condition. But studies have disproved this fact because sexually abused children do not become pedophiles, nor do adult pedophiles complain of abuse in early childhood. Pedophilia has been correlated to low self- esteem and poor social skills. Cantor and his colleagues reported that there exists a link between pedophilia and brain structure and function. They reported that men who are pedophiles have lower intelligent quotients, increased non- right handedness, increased school drop outs and lesser physical height. They also reported that head trauma in childhood increased the risk of pedophilia in adult hood. While a study of structural MRI in pedophile men reported lower volume of white matter than non-sexual criminals (Cantor et al, 2007), another study of functional MRI showed that pedophiles have reduced activation of the hypothalamus as compared with non-pedophile individuals when viewing sexually arousing pictures of adults (Walter et al, 2007). Thus it can be said that in pedophiles there probably exists "a dysfunction at the cognitive stage of sexual arousal processing." Also, various studies have also shown that there exists a high comorbidity of impulse control disorders like explosive personality disorder, kleptomania, pyromania and pathological gambling amongst 30- 55% of pedophiles (Hall & Hall, 2007). Environmental and social risk factors Many pedophiles report that certain environmental stress factors precipitate sexual urge and abnormal behaviour in them. Child abuse has been an important risk factor where in the victim in childhood turns abuser later in life. This is known as “victim-to-abuser cycle” or “abused-abusers phenomena" (Hall & Hall, 2007). However, this is still a debated topic and many researchers argue that their studies dont prove this. Those who are in favour of this theory argue that "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 form of social learning took place" 50- 60% of pedophiles also have substance abuse or dependence and attraction to children is present in both intoxicated and non-intoxicated states. 50- 70% of pedophiles also have another paraphilia such as frotteurism, exhibitionism, voyeurism, or sadism (Hall & Hall, 2007). Treatment There is no significant curative treatment for pedophilia. The main treatment instituted is cognitive- behavioural therapy. This treatment is given alone or with some medication. Cognitive- behavioural therapy is also combined with empathy training, sexual impulse control training, relapse prevention, and biofeedback (Hall & Hall, 2007). The most commonly used drugs are anti-androgens and selective serotonin reuptake inhibitors (SSRI). Anti- androgens cause testosterone suppression and chemical castration. Similar effects can be brought about by surgical castration. SSRI lessen the sexual ruminations and increased sexual urges that pedophiles report related to situational stress and internal discord. These treatments can only reduce the incidence of pedophilic behaviors that result in child sexual abuse. The model adapted for treatment is relapse- prevention model because rehabilitation is difficult in these patients (Hall & Hall, 2007). Course of the disease and prognosis The course of the disorder is chronic and lifelong in most of the patients. Successful treatment outcomes and rehabilitation for those with pedophilia is gaurded. Law enforcement Any physician who comes across pedophile in his clinic must report to the law about the case. There is also a mandatory sexual offender registration of the pedophile with local law enforcement. Some of the articles which deal with pedophiles and their laws are article by Kellogg from the American Academy of Pediatrics Committee on Child Abuse and Neglect,112 the Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws,113 and the Web site www.childwelfare.gov (Hall & Hall, 2007). Some states may have Megans laws which are actually public disclosure laws (Hall & Hall, 2007). Research Since it is not possible to alter the pedophiles sexual orientation towards children, currently most of the focus on pedophilic treatment is to stop further offenses against children. Currently topiramate and other medications that modulate the voltage-dependent sodium or calcium channel potentiation of γ-aminobutyric acid neurotransmission and/or block kainite/α-amino-3-hydroxy-5-methyl-4-isoxazole propionate glutamate receptors are under research for being used in pedophilia (Hall & Hall, 2007). Currently topiramate is useful in treating addictions such as gambling, kleptomania, binge eating, and substance use. Its use for pedophiles is yet to be documented (Hall & Hall, 2007). Conclusion Pedophilia is a type of paraphilia where in the individual is attracted towards children. Though many definitions exist for this term, clinical diagnosis is based on DSM-4- TR. Most pedophiles conceal this disorder and hence many of them do not seek medical help. There is no proper treatment for this condition. Presently, the main stay of treatment is cognitive- behavioural therapy along with chemical or surgical castration and SSRIs. The treatment only decreases acute urge tendencies and not the philia for children. Search is still on for specific treatment. References Ames, M.A., Houston, D.A. (1990). Legal, social, and biological definitions of pedophilia. Archives of Sexual Behavior., 19 (4): 333–42. Cantor, J. M., Kuban, M. E., Blak, T., Klassen, P. E., Dickey, R., & Blanchard, R. (2006). Grade failure and special education placement in sexual offenders’ educational histories. Archives of Sexual Behavior, 35, 743–751. Cantor, J. M., Kabani, N., Christensen, B. K., Zipursky, R. B., Barbaree & H. E., Dickey et al (2008). Cerebral white matter deficiencies in pedophilic men. Journal of Psychiatric Research, 42, 167–183. Hall, R.C.W., & Hall, R. C.W. (2007). Definition, Characteristics of Offenders, Recidivism, Treatment Outcomes, and Forensic Issues. Mayo Clin Proc., 82(4): 457- 471. Laws, D. R., & William, T. (2008). Sexual Deviance: Theory, Assessment, and Treatment. Guilford Press, p.176. Pedophile" (n.d.)". The American Heritage® Dictionary of the English Language, Fourth Edition. Psychiatric Association (2000-06). Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc., 943 Walter et al. (2007). Pedophilia Is Linked to Reduced Activation in Hypothalamus and Lateral Prefrontal Cortex During Visual Erotic Stimulation. Biological Psychiatry, 62. World Health Organization, International Statistical Classification of Diseases and Related Health Problems: ICD-10 Section F65.4: Paedophilia 2007 Read More