Pedophilia

Pedophilia

Pedophilia (or paedophilia) is a psychological disorder in which an adult or older adolescent experiences a sexual preference for prepubescent children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), pedophilia is specified as a form of paraphilia in which a person either has intense sexual urges towards children, and experiences recurrent sexual urges towards and fantasies about children that they have either acted on, or cause distress or interpersonal difficulty. The diagnosis can be made under the DSM or ICD criteria for persons age 16 and older. The disorder is common among people who commit child sexual abuse; however, some offenders do not meet the clinical diagnosis standards for pedophilia.[8] In strictly behavioral contexts, the word “pedophilia” has been used to refer to child sexual abuse itself, also called “pedophilic behavior”.

In law enforcement, the term “pedophile” is loosely used without formal definition to describe those convicted of child sexual abuse or the sexual abuse of a minor, including both prepubescent children and pubescent or post-pubescent adolescents. An example of this use can be seen in various forensic training manuals. Researchers recommend that this imprecise use be avoided. In common usage, the term refers to any adult who is sexually attracted to young children or who sexually abuses a child or adolescent minor.

The causes of pedophilia are not known; research is ongoing.] Most pedophiles are men, though there are also women who are pedophiles. Due to the stereotype that pedophiles are always male, it has been difficult to determine the prevalence of female pedophiles; however, studies in the United Kingdom and United States suggest that a range of 5% to 20% of child sexual abuse offenses are perpetrated by women.

In forensic psychology and law enforcement, there have been a variety of typologies suggested to categorize pedophiles according to behavior and motivations. No significant curative treatment for pedophilia has yet been found. There are, however, certain therapies that can reduce the incidence of pedophilic behaviors that result in child sexual abuse.

Etymology and history

The word comes from the Greek: παιδοφιλία (paidophilia): παῖς (pais), “child” and φιλία (philia), “friendship”. Paidophilia was coined by Greek poets either as a substitute for “paiderastia” (pederasty),[22] or vice versa.

The term paedophilia erotica was coined in 1886 by the Viennese psychiatrist Richard von Krafft-Ebing in his writing Psychopathia Sexualis.[23] The term appears in a section titled “Violation of Individuals Under the Age of Fourteen,” which focuses on the forensic psychiatry aspect of Child Sexual Offenders in general. Krafft-Ebing describes several typologies of offender, dividing them into psychopathological and non-psychopathological origins, and hypothesizes several apparent causal factors that may lead to the sexual abuse of children.

After listing several typologies of sexual offender, Krafft-Ebing then mentioned one final typology, which he refers to as a “psycho-sexual perversion”: paedophilia erotica. He noted that he had only encountered it four times in his career and gave brief descriptions of each case, as well as noting they all have three traits in common:

Their attraction is persistent (Krafft-Ebing refers to this as being “tainted”)

The subject’s primary attraction is to children, rather than adults.

The acts committed by the subject are typically not intercourse, but rather involve inappropriate touching or manipulating the child into performing an act on the subject.

It is notable that this work also indicates several cases of pedophilia among adult women (provided by another physician), and also considered the abuse of boys by homosexual men to be extremely rare. Further clarifying this point, he indicated that cases of adult men who have some medical or neurological disorder and abuse a male child are not true pedophilia, and that in his observation victims of such men tended to be older and pubescent. He also lists “Pseudopaedophilia” as a related condition wherein “individuals who have lost libido for the adult through masturbation and subsequently turn to children for the gratification of their sexual appetite” and claimed this is much more common.

In 1908, Swiss neuroanatomist and psychiatrist Auguste Forel wrote of the phenomenon, proposing that it be referred to it as “Pederosis,” the “Sexual Appetite for Children.” Similar to Krafft-Ebing’s work, Forel made the distinction between incidental sexual abuse by person’s with dementia and other organic brain conditions, and the truly preferential and sometimes exclusive sexual desire for children. However, he disagreed with Krafft-Ebing in that he felt the condition of the latter was largely ingrained and unchangeable.

The term “Pedophilia” became the generally accepted term for the condition and saw widespread adoption in the early 20th century, appearing in many popular medical dictionaries such as the 5th Edition of Stedman’s. In 1952, it was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders This edition and the subsequent DSM-II listed the disorder as one subtype of the classification “Sexual Deviation,” but no diagnostic criteria were provided. The DSM-III, published in 1980, contained a full description of the disorder and provided a set of guidelines for diagnosis. The revision in 1987, the DSM-III-R, kept the description largely the same, but updated and expanded the diagnostic criteria.

Diagnosis

The ICD (International Statistical Classification of Diseases and Related Health Problems) (F65.4) defines pedophilia as “a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age.”[1] Under this system’s criteria, a person 16 years of age or older meets the definition if they have a persistent or predominant sexual preference for prepubescent children at least five years younger than them.

The Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV-TR) outlines specific criteria for use in the diagnosis of this disorder. These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child (often aged 13 or younger) for six months or more, and that the subject has acted on these urges or suffers from distress as a result of having these feelings. The criteria also indicate that the subject should be 16 or older and that child or children they fantasize about are at least five years younger than them, though ongoing sexual relationships between a 12-13 year old and a late adolescent are advised to be excluded. A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to incest, and if the attraction is “exclusive” or “nonexclusive”.

Exclusive pedophiles are attracted to children, and children only. They show little erotic interest in adults their own age and in some cases, can only become aroused while fantasizing or being in the presence of prepubescent children. Nonexclusive pedophiles are attracted to both children and adults, and can be sexually aroused by both. According to a U.S. study on 2429 adult male pedophile sex offenders, only 7% identified themselves as exclusive; indicating that many or most pedophiles fall into the nonexclusive category.[7] Some systems further differentiate types of offender in more specific categories (see Child Sexual Offender Types).

Neither the ICD nor the DSM diagnostic criteria require actual sexual activity with a prepubescent youth. The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. Acting on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposure, voyeuristic or frotteuristic behaviors, or masturbating to child pornography. Often these behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made. Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation.[29]

Nepiophilia, also called infantophilia, is used to refer to a sexual preference for toddlers and infants (usually ages 0–3).[30]

Ego-dystonic sexual orientation (F66.1) includes people who do not doubt that they have a prepubertal sexual preference, but wish it were different because of associated psychological and behavioral disorders. The WHO allows for the patient to seek treatment to change their sexual orientation.

Biological associations

Beginning in 2002, researchers began reporting a series of findings linking pedophilia with brain structure and function: Pedophilic (and hebephilic) men have lower IQs, poorer scores on memory tests, greater rates of non-right-handedness, greater rates of school grade failure over and above the IQ differences, lesser physical height, greater probability of having suffered childhood head injuries resulting in unconsciousness and several differences in MRI-detected brain structures. They report that their findings suggest that there are one or more neurological characteristics present at birth that cause or increase the likelihood of being pedophilic. Evidence of familial transmittability “suggests, but does not prove that genetic factors are responsible” for the development of pedophilia.

Another study, using structural MRI, shows that male pedophiles have a lower volume of white matter than a control group.

Functional magnetic resonance imaging (fMRI) has shown that child molesters diagnosed with pedophilia have reduced activation of the hypothalamus as compared with non-pedophilic persons when viewing sexually arousing pictures of adults.[43] A 2008 functional neuroimaging study notes that central processing of sexual stimuli in heterosexual “paedophile forensic inpatients” may be altered by a disturbance in the prefrontal networks, which “may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours.” The findings may also suggest “a dysfunction at the cognitive stage of sexual arousal processing.”

Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify hormonal aspects of pedophiles. They concluded that there is some evidence that pedophilic men have less testosterone than controls, but that the research is of poor quality and that it is difficult to draw any firm conclusion from it.

While not causes of pedophilia themselves, comorbid psychiatric illnesses — such as personality disorders and substance abuse — are risk factors for acting on pedophilic urges. Blanchard, Cantor, and Robichaud (2006) noted about comorbid psychiatric illnesses that, “The theoretical implications are not so clear. Do particular genes or noxious factors in the prenatal environment predispose a male to develop both affective disorders and pedophilia, or do the frustration, danger, and isolation engendered by unacceptable sexual desires—or their occasional furtive satisfaction—lead to anxiety and despair?”They indicated that, because they previously found mothers of pedophiles to be more likely to have undergone psychiatric treatment, the genetic possibility is more likely.

Psychopathology and personality traits

Several researchers have reported correlations between pedophilia and certain psychological characteristics, such as low self-esteem[46][47] and poor social skills.[48] Cohen et al. (2002), studying child sex offenders, states that pedophiles have impaired interpersonal functioning and elevated passive-aggressiveness, as well as impaired self-concept. Regarding disinhibitory traits, pedophiles demonstrate elevated sociopathy and propensity for cognitive distortions. According to the authors, pathologic personality traits in pedophiles lend support to a hypothesis that such pathology is related to both motivation for and failure to inhibit pedophilic behavior.

According to Wilson and Cox (1983), “The paedophiles emerge as significantly higher on Psychoticism, Introversion and Neurotocism than age-matched controls. [But] there is a difficulty in untangling cause and effect. We cannot tell whether paedophiles gravitate towards children because, being highly introverted, they find the company of children less threatening than that of adults, or whether the social withdrawal implied by their introversion is a result of the isloation engendered by their preference (i.e., awareness of the social approbation and hostility that it evokes”

Studying child sex offenders, a review of qualitative research studies published between 1982 and 2001 concluded that pedophiles use cognitive distortions to meet personal needs, justifying abuse by making excuses, redefining their actions as love and mutuality, and exploiting the power imbalance inherent in all adult-child relationships. Other cognitive distortions include the idea of “children as sexual beings,” “uncontrollability of sexuality,” and “sexual entitlement-bias.”

One review of the literature concludes that research on personality correlates and psychopathology in pedophiles is rarely methodologically correct, in part owing to confusion between pedophiles and child sex offenders, as well as the difficulty of obtaining a representative, community sample of pedophiles.[53] Seto (2004) points out that pedophiles who are available from a clinical setting are likely there because of distress over their sexual preference or pressure from others. This increases the likelihood that they will show psychological problems. Similarly, pedophiles recruited from a correctional setting have been convicted of a crime, making it more likely that they will show anti-social characteristics.

Prevalence and child molestation

The prevalence of pedophilia in the general population is not known,[54] and research is highly variable owing to varying definitions and criteria. The term pedophile is commonly used to describe all child sexual abuse offenders, including those who do not meet the clinical diagnosis standards. This use is seen as problematic by some people.[8] Some researchers, such as Howard E. Barbaree,[55] have endorsed the use of actions as a sole criterion for the diagnosis of pedophilia as a means of taxonomic simplification, rebuking the American Psychiatric Association’s standards as “unsatisfactory”.

A perpetrator of child sexual abuse is commonly assumed to be and referred to as a pedophile; however, there may be other motivations for the crime[55] (such as stress, marital problems, or the unavailability of an adult partner).[56] Child sexual abuse may or may not be an indicator that its perpetrator is a pedophile. Many terms have been used to distinguish “true pedophiles” from nonpedophilic offenders, or to distinguish among types of offenders on a continuum according to strength and exclusivity of pedophilic interest, and motivation for the offense (see Child Sexual Offender Types).

Perpetrators who meet the diagnostic criteria for pedophilia offend more often than non-pedophile perpetrators, and with a greater number of victims. According to the Mayo Clinic, approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia.[7] A behavioral analysis report by the FBI states that a “high percentage of acquaintance child molesters are preferential sex offenders who have a true sexual preference for children (i.e., pedophiles).”

A review article in the British Journal of Psychiatry notes the overlap between extrafamilial and intrafamilial offenders. One study found that around half of the fathers and stepfathers in its sample who were referred for committing extrafamilial abuse had also been abusing their own children.

As noted by Abel, Mittleman, and Becker[58] (1985) and Ward et al. (1995), there are generally large distinctions between the two types of offenders’ characteristics. Situational offenders tend to offend at times of stress; have a later onset of offending; have fewer, often familial victims; and have a general preference for adult partners. Pedophilic offenders, however, often start offending at an early age; often have a large number of victims who are frequently extrafamilial; are more inwardly driven to offend; and have values or beliefs that strongly support an offense lifestyle. Research suggests that incest offenders recidivate at approximately half the rate of extrafamilial child molesters, and one study estimated that by the time of entry to treatment, nonincestuous pedophiles who molest boys had committed an average of 282 offenses against 150 victims.

Some child molesters — pedophilic or not — threaten their victims to stop them from reporting their actions.[3] Others, like those that often victimize children, can develop complex ways of getting access to children, like gaining the trust of a child’s parent, trading children with other pedophiles or, infrequently, get foster children from non-industrialized nations or abduct child victims from strangers.[3] Pedophiles may often act interested in the child, to gain the child’s interest, loyalty and affection to keep the child from letting others know about the abuse.

Treatment

Although pedophilia has yet no cure, various treatments are available that are aimed at reducing or preventing the expression of pedophilic behavior, reducing the prevalence of child sexual abuse. Treatment of pedophilia often requires collaboration between law enforcement and health care professionals. A number of proposed treatment techniques for pedophilia have been developed, though the success rate of these therapies has been very low.

Cognitive behavioral therapy (“relapse prevention”)

Cognitive behavioral therapy has been shown to reduce recidivism in contact sex offenders.

According to Canadian sexologist Michael Seto, cognitive-behavioral treatments target attitudes, beliefs, and behaviors that are believed to increase the likelihood of sexual offenses against children, and “relapse prevention” is the most common type of cognitive-behavioral treatment. The techniques of relapse prevention are based on principles used for treating addictions. Other scientists have also done some research that indicates that recidivism rates of pedophiles in therapy are lower than pedophiles who eschew therapy, says Dr. Zonana.

Behavioral interventions

Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and covert sensitization (or masturbatory reconditioning) to increase sexual arousal to adults.[63] Behavioral treatments appear to have an effect on sexual arousal patterns on phallometric testing, but it is not known whether the test changes represent changes in sexual interests or changes in the ability to control genital arousal during testing.

Applied behavior analysis has been applied with sex offenders with mental disabilities.

Pharmacological interventions

Medications are used to lower sex drive in pedophiles by interfering with the activity of testosterone, such as with Depo-Provera (medroxyprogesterone acetate), Androcur (cyproterone acetate), and Lupron (leuprolide acetate).

Gonadotropin-releasing hormone analogues, which last longer and have fewer side-effects, are also effective in reducing libido and may be used.

These treatments, commonly referred to as “chemical castration”, are often used in conjunction with the non-medical approaches noted above. According the Association for the Treatment of Sexual Abusers, “Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan.”

In a controlled Depo-Provera treatment study of 40 sex offenders — including 23 pedophiles — who received Depo-Provera, and 21 sex offenders who received psychotherapy alone, the outcome follow-up of the treated group as compared to the untreated group demonstrated that the reoffense rate for the Depo-Provera-treated group was significantly lower. Eighteen percent reoffended while receiving medication; 35 percent reoffended after stopping medication. In contrast, 58 percent of the control patients, who received psychotherapy alone, reoffended. Patients defined as regressed were much more likely to reoffend off therapy than the patients defined as fixated.

Other therapies

Klaus M. Beier of the Institute of Sexology and Sexual Medicine at Charité, a university hospital in Berlin, reported success in a preliminary study using role-play therapy and “impulse-curbing drugs” to help pedophiles avoid sexually assaulting a child. According to researchers, contact child sex offenders were better able to control their urges once they understood the prepubescent youth’s view.

Limitations of treatment

Although these results are relevant to the prevention of reoffending in contact child sex offenders, there is no empirical suggestion that such therapy is a cure for pedophilia. Dr. Fred Berlin, founder of the Johns Hopkins Sexual Disorders Clinic, believes that pedophilia could be successfully treated if the medical community would give it more attention.

Legal and social issues

Misuse of terminology

The words “pedophile” and “pedophilia” are frequently misused to refer to situations in which an older person has sexual relations with a person who is below the legal age of consent, but is pubescent or post-pubescent . The terms “hebephilia” or “ephebophilia” may be more accurate in these cases,[16] but even then may be erroneously used to refer to the actus reus itself, rather than the correct meaning, which is a preference for that age group on the part of the older individual. Even more problematic are situations where the terms are misused to refer to relationships where the younger person is an adult of legal age, but is either perceived socially as being too young in comparison to their older partner, or the older partner occupies a position of authority over them.

Pedophile activism

During the late 1950s to early 1990s, several pedophile membership organizations advocated age of consent reform to lower or abolish age of consent laws, and for the acceptance of pedophilia as a sexual orientation rather than a psychological disorder,[80] and the legalization of child pornography. The efforts of pedophile advocacy groups did not gain any public support[76][79][81][82][83] and today those few groups that have not dissolved have only minimal membership and have ceased their activities other than through a few websites.

Anti-pedophile activism

Main article: Anti-pedophile activism

Anti-pedophile activism encompasses opposition against pedophiles, against pedophile advocacy groups, and against other phenomena that are seen as related to pedophilia, such as child pornography and child sexual abuse.[86] Much of the direct action classified as anti-pedophile involves demonstrations against sex offenders, groups advocating legalization of sexual activity between adults and children,[88] and internet users who solicit sex from teens.

Moral panic and vigilantism

In the 1990s and 2000s, there have been several moral panics related to misuse of the term “pedophile” with regards to unusual crimes of abuse such as high-profile cases of child abduction and murder,[89] and popular press reports of ideas such as stranger danger, satanic ritual abuse and the day care sex abuse hysteria. There has been vigilatism directed against convicted or publicly suspected child sex offenders such as the mob violence resulting from the News of the World “naming and shaming” campaign in the UK in the early 2000s.

TREATMENT : CHILD SEXUAL ABUSE

Medical Care



Medical treatment is guided by any conditions uncovered. The incidence of STDs in child sexual abuse (CSA) is low. In prepubertal children, asymptomatic vaginal infections are thought to be increasingly uncommon. Therefore, the Centers for Disease Control and Prevention (CDC) does not recommend prophylaxis for STDs in asymptomatic prepubertal children who are evaluated for possible CSA. In contrast, the CDC recommends that teenaged patients and adults who are sexually abused or assaulted should receive antibiotic prophylaxis for STDs. For more information, see MMWR Recommendation and Report Sexually Transmitted Diseases Treatment Guidelines.



  • Treat STDs with appropriate medications based on the infection and the child’s age and weight.

  • In postmenarcheal children, consider the possibility of pregnancy.

  • Recognize the overriding need for emotional support and attention to the psychosocial crisis in which the child and family now find themselves.

  • Health care providers are mandated reporters in all 50 states; once sexual abuse seriously is suspected or diagnosed, a report to the appropriate child protective services (CPS) agency is necessary. Attention to the safety of the child is essential. The AAP recommends reporting in the following situations:

    • When a child makes a clear disclosure of abusive sexual contact, with or without specific findings

    • When individuals present with STDs (see Workup section)

    • When physical examination findings are believed to be the result of abusive sexual contact

  • When sexual abuse is being considered, the AAP suggests the possibility of reporting, depending on the perceived risk to the child. In such cases, discussion with members of an interdisciplinary team may be helpful.

  • Cases of sexual abuse may result in law enforcement action against the alleged perpetrator and possible criminal court proceedings. Well-documented medical records are essential, since legal proceedings may occur over long periods of time. The health care provider cannot rely solely on recollection of the case.

 



Consultations




  • Mental health consultation is warranted to evaluate and treat acute stress reaction and, later, posttraumatic stress disorder (PTSD).

  • Expert mental health management of stress disorders is warranted because of the burgeoning evidence that psychic trauma in young children has a significant effect.

 


Provided by
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA


Yudhasmara Foundation


Address : JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210


Phone : 62(021) 70081995 – 5703646


email : judarwanto@gmail.com, 


https://pedophiliasexabuse.wordpress.com/


 


Foundation and Editor in Chief


Dr Widodo Judarwanto


 


Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved.

TREATMENT AND MANAGEMENT : PARAPHILIA-PEDOPHILIA

Treatment

Medical Care

  • Inpatient treatment indications
    • Patients are suicidal, homicidal, or gravely disabled (Suicide risk is high if they feel exposed or confronted.)
    • Patients are dangerous to themselves, others, or cannot take care of themselves
  • Psychotherapy
    • Cognitive-behavioral therapy: This type of therapy involves applying behavioral therapy techniques to modify the patient’s sexual deviations by altering distorted thinking patterns and making patients cognizant of the irrational justifications that lead to their sexual variations. This therapy also incorporates relapse prevention techniques, helping the patient to control the undesirable behaviors by avoiding situations that may generate initial desires. Many times, therapists apply the technique of “covert sensitization,” in which patients’ harmful sexual variation is paired with an unpleasant stimulus, such as that of a person with alcoholism who is administered Antabuse, in order to deter them from repeating the act. This approach has been proven effective in cases of pedophilia and sadism.
    • Another technique employed by therapists is that of orgasmic reconditioning. In this approach, a patient is reconditioned to a more appropriate stimulus by masturbating to his or her typical, less socially acceptable stimulus. Then, just before orgasm, the patient is told to concentrate on a more acceptable fantasy. This is repeated at earlier times before orgasm until, soon, the patient begins his masturbation fantasies with an appropriate stimulus.
    • Social skills training: Because many believe that paraphilias develop in patients who lack the ability to develop relationships, many therapists and physicians use social skills training to treat patients with these types of disorders. They may work on such issues as developing intimacy, carrying on conversations with others, and assertive skills training. Many social skills training groups also teach basic sexual education, which is very helpful to this patient population.
    • Twelve-step programs: Many physicians and therapists refer patients with paraphilias to 12-step programs designed for sexual addicts. Similar to alcoholics anonymous, these programs are designed to give control to group members, who lead most of the sessions. The program incorporates cognitive restructuring with social support to increase awareness of the problem. The group also focuses on the sense of a “higher power” and each individual’s reliance upon his or her spirituality.
    • Group therapy: This mode of therapy involves breaking through the denial so commonly found in people with paraphilias by surrounding them with other patients who share their illness. Once they begin to admit that they have a sexual divergence, the therapist begins to address individual issues such as past sexual abuse or other problems that may have led to the sexual disorder. When these issues have been identified, beginning Gestalt-type therapy (with the victim, if any) may be desirable to help patients get past the guilt and shame associated with their particular paraphilia. The goal of this type of therapy is to lead the patient to a “healthy remorse.” These patients require lifetime therapy in order to reduce the likelihood of relapse.
    • Individual expressive-supportive psychotherapy: This type of therapy requires a psychologically minded patient willing to focus on the paraphilia. The therapist should not set high goals but needs to break through the denial. Countertransfence and avoidance of the patient can be a problem with this form of therapy. If the patients can break through the denial, then the patient can work on the unconscious meaning behind the paticular paraphila.
  • Medications
    • Antidepressants
    • Long-acting gonadotropin-releasing hormones (GnRH, ie, medical castration)
    • Antiandrogens
    • Phenothiazine
    • Mood stabilizers
  • Sex education and therapy
  • Social skills and training

Surgical Care

Surgical castration

Consultations

  • Neurologist, if neurological signs are present
  • Attorney
  • Pastor

Activity

Restrict activity if patients represent a danger to themselves, to others, or if they are gravely disabled.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Antidepressants

May be used to decrease aggression and treat underlying illness.

 

Fluoxetine (Prozac)

Antidepressant (SSRI) used to treat impulse control problems or underlying illness. Selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine.

Adult

10-80 mg PO qd

Pediatric

<18 years: Not established; initial dose of 20 mg/d in children aged 6-14 y has been used
>18 years: Administer as in adults

Increases toxicity of diazepam and trazodone by decreasing clearance; also increases toxicity of MAOIs and highly protein-bound drugs

Documented hypersensitivity; concurrently taking MAOIs or having taken them in the last 2 wk

Pregnancy

B – Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hepatic impairment and history of seizures; discontinue MAOIs at least 14 d before initiating fluoxetine therapy

 

Lithium (Eskalith)

Indicated for treating bipolar disorder. Influences reuptake of serotonin and/or norepinephrine at cell membrane.

Adult

300 PO tid/qid

Pediatric

<6 years: Not established
6-12 years: 15-60 mg/kg/d PO tid/qid; not to exceed usual adult dose
>12 years: Administer as in adults

Lithium increases toxicity of thiazide diuretics, haloperidol, phenothiazines, neuromuscular blockers, carbamazepine, fluoxetine, and ACE inhibitors

Documented hypersensitivity; severe cardiovascular disease

Pregnancy

D – Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Lithium toxicity (ie, diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness); lithium toxicity is closely related to serum levels and can occur at therapeutic doses; serum lithium determinations are required to monitor therapy

Antiandrogens

Used to reduce androgen serum levels.

 

Medroxyprogesterone (Depo-Provera)

Derivative of progesterone. Used for breast cancer, contraception, secondary amenorrhea, and abnormal uterine bleeding. May be used to reduce sex drive.

Adult

150 mg IM qd/qwk/qmo usually adjusted based on patient response, tolerance, and/or plasma testosterone

Pediatric

Not recommended

May decrease effects of aminoglutethimide

Documented hypersensitivity; cerebral apoplexy; undiagnosed vaginal bleeding; thrombophlebitis; liver dysfunction

Pregnancy

X – Contraindicated; benefit does not outweigh risk

Precautions

Caution in asthma, depression, renal or cardiac dysfunction, or thromboembolic disorders

Phenothiazines

Are effective in treating emesis possibly due to their effects in the dopaminergic mesolimbic system.

 

Fluphenazine (Prolixin)

Antipsychotic used to treat underlying illness or decrease aggression.

Adult

1-10 mg PO qd

Pediatric

Administer as in adults

Potentiates CNS depressant effects of benzodiazepines; dronabinol and THC; entacapone; ethanol; general anesthetics; skeletal muscle relaxants; opiate agonists; zaleplon and zolpidem; anxiolytics, sedatives, and hypnotics; potentiates anticholinergic effects of amantadine, benztropine, clozapine, cyclobenzaprine, dicyclomine, diphenoxylate, disopyramide, hyoscyamine, maprotiline, meclizine, molindone, orphenadrine, oxybutynin, propantheline, tolterodine, and trihexyphenidyl

Documented hypersensitivity; narrow-angle glaucoma

Pregnancy

C – Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Drowsiness, headache, insomnia, hypertension, blurred vision, dry mouth, and weight gain; endocrine changes (eg, amenorrhea, menstrual irregularity, breast enlargement or mastalgia, libido decrease, impotence, ejaculation dysfunction, priapism) have occurred

Anxiolytics

These agents help induce impulse control.

 

Buspirone (BuSpar)

Unique anxiolytic that differs from benzodiazepines in that it does not exert anticonvulsant or muscle relaxer for GAD. A 5-HT1 agonist with serotonergic neurotransmission and some dopaminergic effects in CNS. Has anxiolytic effect but may take as long as 2-3 wk for full efficacy.

Adult

15 mg/d PO divided tid and increase by 5 mg/d q2-4d; titrate to 20-60 mg/d; not to exceed 60 mg/d

Pediatric

Not established

Toxicity is increased with MAOIs, phenothiazines, and CNS depressants; increases toxicity of digoxin and haloperidol

Documented hypersensitivity

Pregnancy

B – Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Interference with motor performance, binds to dopamine receptor (some concern with dystonia, TD, and akathisia); caution in hepatic or renal impairment

Long-acting gonadotropin-releasing hormones

These agents are used to reduce release of gonadotropin hormones.

 

Triptorelin (Trelstar)

Synthetic decapeptide agonist analog of GnRH also known as luteinizing hormone–releasing hormone (LHRH). Reduces LH, FSH, and testosterone, which may lead to reduced sex drive.

Adult

3.75 mg IM qmo

Pediatric

Not established

Drugs that increase prolactin (eg, antipsychotics, cimetidine, methyldopa, metoclopramide, reserpine) down-regulate number of pituitary GnRH receptors

Documented hypersensitivity; pregnancy; spinal cord compression; spinal metastases; prostate cancer

Pregnancy

X – Contraindicated; benefit does not outweigh risk

Precautions

Tumor flare, hot flushes, loss of libido, breast tenderness or fullness, nausea, diarrhea, bone demineralization

Mood stabilizer

These agents are used to treat bipolar disorders.

 

Divalproex sodium (Depakote)

Indicated for manic episodes associated with bipolar disorder. Recommended plasma concentration is 50-125 µg/mL.

 

 

 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA 

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com, 

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com,

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved

Mental health’s cold shoulder treatment of pedophilia: experts urge professionals to overcome the disorder’s stigma to help reduce future victimization.

 

Emotions run high when discussing pedophilia. The behavior is so disturbing that it’s often attributed to a moral flaw that must be punished. Although the victim’s perspective cannot be dismissed when examining this psychiatric disorder, is there no hope for helping people who struggle with–and even act on–their desires?

Noted pedophilia expert Fred S. Berlin, MD, PhD, PA, of Johns Hopkins’ Department of Psychiatry and Behavioral Sciences, believes that many people with pedophilia can indeed be successfully treated. Yet he says the mental health community’s interest in this area has been limited because of the intense stigma attached to pedophilia. “Unfortunately, there are many within mental health who feel that the ‘real’ mental illnesses are the ones that ought to be treated and that somehow pedophilia, the paraphilias, and the other sexual disorders aren’t as deserving” explains Dr. Berlin, who is also the director of the National Institute for the Study, Prevention and Treatment of Sexual Trauma.

Such attitudes–both among mental health professionals and members of society–have led to many common misperceptions about people with pedophilia (“pedophile” itself is a stigmatizing term akin to using “schizophrenic” to describe a person with schizophrenia, Dr. Berlin believes, and for this article the author has avoided using it). Dr. Berlin discounts the common view that pedophilia is a conscious choice. He regards pedophilia as a lifelong sexual orientation, just as hetero- an d homosexuality, and he says patients can be terrified by the discovery of pedophilic cravings: “In growing up we discover the kinds of partners to whom we are attracted, and someone’s discovering that he is sexually attracted to children is one of the most disturbing and troubling self-revelations that one can come up with.”

Pedophilic feelings also have been observed to develop in individuals that previously did not have them, Dr. Berlin notes. For example, some people have developed such cravings after a traumatic brain injury, yet denied having them before.

Although most cases of pedophilia involve men, people with pedophilia are hardly a homogeneous group; all they share is an attraction to children, explains Dr. Berlin, adding that some are attracted to children of the same sex (homosexual pedophilia), the opposite sex (heterosexual pedophilia), or both sexes (bisexual pedophilia). Their sexual interests might only involve children (exclusive pedophilia) or could involve adults (men, women, or both), as well (nonexclusive pedophilia). People with pedophilia have varying personality types and character traits, he adds.

People with pedophilia, therefore, come from many different life situations–and some are mental health professionals themselves. Take the case of Eugene Hepola, a 72-year-old retired forensic psychologist from Findlay, Ohio. After chatting online for nine months with an FBI agent posing as a 12-year-old girl, Hepola was arrested as he waited for “her” in a Cleveland suburb, reported Cleveland’s daily newspaper, The Plain Dealer. (1) Eleven times he sent the “girl” pornography, including video clips of minors having sex. He is now serving three years in prison.

We know so lit fie about this disorder and the people it afflicts because of the paucity of research in this area, says Dr. Berlin. He says factors hindering investigations include stigma (one researcher wouldn’t comment for this article because of past negative experiences with the media), challenges in fundraising, and the inability to conduct double-blind studies (researchers can’t justify giving a placebo to someone with pedophilic tendencies). Compared to studies of other mental health disorders, studies on pedophilia are few and far between in the medical literature. A recent MEDLINE search for “pedophilia” yielded fewer than 20 results since 2003, compared with hundreds of reports on schizophrenia and depression within that time frame.

David A. D’Amora, MS, LPC, CFC, chair of the Association for the Treatment of Sexual Abusers’ Public Policy Committee, says researching topics such as pedophilia can be hampered by basing investigations on approved diagnostic criteria and definitions: “There is, in fact, a significant amount of research on assessment and treatment of folks convicted of sexual offenses. One of the issues is whether one limits oneself to the diagnostic category of pedophilia. The DSM diagnoses are not always fully helpful in understanding the issues of sexual violence.” For example, a man who molests his son might not meet the criteria for a diagnosis of pedophilia, but he would still be considered a threat to his child. D’Amora adds that much of the current research comes from countries other than the United States, such as Canada, largely because U.S. government funding for studies of sexual offenses and disorders has been limited. The U.S. Department of Justice, however, does sponsor the Center for Sex Offender Management, which offers many resources on the topic.

Although awash with information on other mental health disorders, the Internet offers little for people suffering with pedophilia who are looking for help (the Web, of course, is also a tempting source of illegal child pornography). The first ten results from a recent Google search for “pedophilia” offered little for someone looking for assistance, but searches for “depression” and “schizophrenia” turned up many resources.

John Grohol, PsyD, publisher of PsychCentral.com, says the lack of information on the Web can be tied to the stigma surrounding pedophilia: “I’ve come across a real bias against people with this problem, both from other mental health professionals and from others looking for mental health support online for other diagnoses. Most folks just don’t understand or appreciate the mental health aspect of pedophilia–that the behavioral health field has recognized this as a real disorder in need of real treatment.” He adds, “Education can go a long way to helping both professionals and individuals understand that people diagnosed with this disorder need treatment, too. I’m not sure the Internet is helping in that respect right now, given the paucity of unbiased, legitimate information available. Hopefully that will change in the future.”

Despite this knowledge gap, Dr. Berlin suggests that effective treatments for pedophilia do exist, although he acknowledges these are not cures: “[Pedophilia] can’t be cured any more than alcoholism can be cured, but that doesn’t mean either one of those can’t be successfully treated.” He believes the psychological approach to pedophilia should be similar to the way in which therapists help patients resist cravings for alcohol, heroin, or cocaine. “Part of the successful treatment for both alcoholism and pedophilia is for individuals to recognize that they have an enduring vulnerability and that they must exercise daily vigilance against giving in to unacceptable temptations and falling into unacceptable behavioral patterns,” he explains.

Following this logic, Dr. Berlin finds group therapy–often used for substance abuse patients–to be particularly helpful. He says this setting allows participants to share concerns in a safe environment and to discuss strategies for managing their condition, such as not moving into a neighborhood with a high concentration of children and recognizing that sexual temptations will develop if relationships with children become emotionally involved.

Dr. Berlin doesn’t put too much stock in aversion therapies designed to alter sexual interests because, he says, evidence supporting their long-term effectiveness is poor. Others do support using such therapies, however.

On the pharmacologic treatment side, the biologic basis of pedophilia remains elusive, admits Dr. Berlin, but he notes that testosterone-lowering medications can be used to reduce males’ sexual appetites.  source : http://goliath.ecnext.com/

 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA 

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com, 

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com,

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved

A Case of Late-Onset Pedophilia and Response to Sertraline

Prim Care Companion J Clin Psychiatry. 2007; 9(3): 235–236.

Naren Prahlada Rao, M.B.B.S.,1 Prabhat K. Chand, M.D., D.N.B.,2 and Pratima Murthy, D.P.M., M.D.3

1National Institute of Mental Health and Neurosciences, Bangalore, India2Department of Psychiatry Kasturba Medical College, Manipal, India3National Institute of Mental Health and Neurosciences, Bangalore, India

Top
References
 
Sir: Pedophilia is a psychiatric disorder in a person at least 16 year old that is characterized by sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a pre-pubescent child (aged 13 years or younger).1 These fantasies are acted out and cause marked distress or interpersonal difficulties. Pedophilia is a common and often overlooked syndrome that risks the child victim’s well-being and further psychosocial development and adaptive functioning. While a majority of cases of pedophilia begin among adolescents,2 in the elderly it is relatively rare and confined to a few case reports.3–5 In the present report, we describe a patient with emergence of pedophilia in late life, the assessment, and response to treatment with sertraline.
Case report. Mr. A, a 70-year-old man, was hospitalized in 2005 with a history of engaging in sexual behavior with female children 6 to 7 years old. The history was obtained from Mr. A’s adult son, as the patient initially denied any problem. During the last 13 years, Mr. A had been giving young girls money, later taking them to remote places and undressing them and fondling their genitals. On 1 or 2 occasions, he had apparently attempted intercourse (based on reports from the victims’ families of vaginal bleeding). No legal complaint had been filed by the victims’ families. However, Mr. A’s family was concerned that he may molest these children and get arrested and thus locked him in the house often. He is married and heterosexually oriented and was living with his wife and children. The patient reported no recent change in the sexual relationship with the wife, which was corroborated by her. Mr. A’s medical history was notable for a cataract surgery in the left eye 3 months before admission. He had no history of psychiatric or developmental problems and had exhibited no prior deviant sexual behavior. There was no history suggestive of cerebrovascular disease or dementia.
On examination, Mr. A was cooperative and had good eye-to-eye contact. His thought processes were logical and clear. He denied any hallucinations or delusions and appeared to be euthymic. He was alert and attentive and scored 29 of 30 on the modified Mini-Mental State Examination,6 missing an item in attention and concentration. Results of repetition, naming, memory, and constructional tasks were within normal limits. His ability to perform simple constructions was also within normal limits, and he had no difficulty with an alternating motor patterns test. Mr. A’s neuropsychological assessment showed deficits in focused attention, design fluency, and visual working memory. His abstract ability was within normal limits. Physical examination, including detailed neurologic examination, found no abnormalities. Results of laboratory tests, including liver, thyroid, and renal function; hemogram; electrocardiogram; serum Veneral Disease Research Laboratory test; ELISA for human immunodeficiency virus; and serum testosterone levels (measured by chemiluminescent immunoassay), were all in the normal range. Structural magnetic resonance imaging of the brain showed findings within normal limits.
After a couple of weeks of inpatient stay, Mr. A corroborated his sexual attraction to young girls and recognized that this was a potential problem for him in the village. He fulfilled DSM-IV-TR criteria for pedophilia.1 He was started on sertraline, 50 mg/day, which was increased to 100 mg/day after 3 weeks. He also became engaged in individual counseling, which initially involved establishing a therapeutic alliance and gaining the patient’s confidence. With this regimen and increased supervision, Mr. A had a significant behavioral improvement with no reports of similar incidents during the next 1 year of follow-up and reported a decrease in desire on a visual analogue scale.
The index patient presented with late-onset sexual activity with prepubescent girls in the absence of schizophrenic, affective, obsessive, or dementia symptoms. In contrast to the typically reported cases of pedophilia, the index patient had an unusual presentation with emergence of pedophilia in late life.
The etiology of pedophilia is unknown. Paraphiliac behavior has been reported secondary to temporal lobe epilepsy, post-encephalitic neuropsychiatric syndromes, septal lesions, frontal lobe lesions, bilateral temporal lobe lesions, multiple sclerosis, and tumors in various sites.7 Recent reports have noted the concurrence of emergence of pedophilia in late life and brain disease. One report described 2 patients with pedophilia who had temporal lobe hypometabolism as revealed by positron emission tomography; 1 patient had frontotemporal dementia and the other had bilateral hippocampal sclerosis.4 No evidence of structural brain lesion, however, was evident in our patient.
Management of pedophilia at any stage poses a serious clinical challenge. Antiandrogens and hormonal agents such as estrogen, medroxyprogesterone acetate, cyproterone acetate, and gonadotropin analogues have been used; however, the effectiveness of treatment was reduced because of the various adverse reactions,7 and only a minority of subjects are likely to take an antiandrogen on their own. Several recent reports suggest successful treatment of paraphilias with selective serotonin reuptake inhibitors, e.g., sertraline, fluoxetine, and fluvoxamine.8–10 However, the efficacy of these drugs in the treatment of pedophilia emerging in late life is not known. The case reported here suggests the efficacy of sertraline in pedophilia. In the elderly, it is critical to evaluate for underlying structural and functional brain abnormalities.
References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. 2000. .
  2. McConaghy N.. Paedophilia: a review of the evidence. Aust N Z J Psychiatry. 1998;32:252–265. [PubMed]
  3. Kurland ML.. Pedophilia erotica. J Nerv Ment Dis. 1960;131:394–403. [PubMed]
  4. Mendez MF, Chow T, and Ringman J. et al. Pedophilia and temporal lobe disturbances. J Neuropsych Clin Neurosci. 2000. 12:71–76.
  5. Burns JM, Swerdlow RH.. Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign. Arch Neurol. 2003;60:437–440. [PubMed]
  6. Folstein MF, Folstein SE, McHugh PR.. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. [PubMed]
  7. Bradford JM.. The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behavior. Can J Psychiatry. 2001;46:26–34. [PubMed]
  8. Greenberg DM, Bradford JM, and Curry S. et al. A comparison of treatment of paraphilias with three serotonin reuptake inhibitors: a retrospective study. Bull Am Acad Psychiatry Law. 1996. 24:525–532. [PubMed]
  9. Kafka MP.. Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Ann Clin Psychiatry. 1994;6:189–195. [PubMed]
  10. Stein DJ, Hollander E, and Anthony DT. et al. Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. J Clin Psychiatry. 1992. 53:267–271. [PubMed]

 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA 

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com, 

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved 

Provided by

DR WIDODO JUDARWANTO
FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA

Yudhasmara Foundation

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email : judarwanto@gmail.com,

https://pedophiliasexabuse.wordpress.com/

Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved

  •  
  • Pedophilia : rehabilitation

    Latest Paper:

    J Child Sex Abus. 2005 ;14:91-115 15914407
    This exploratory study used qualitative methodology to examine what pedophiles think about treatment, as well as their daily experience of a treatment program. To this end, twenty-three offenders receiving treatment from the La Macaza federal penitentiary clinic were interviewed using non-directive semi-structured interviews. Comparative analysis was used to analyze the resulting material. The following themes are discussed based on the results of this analysis:(a) the participants’ past experience of therapy;(b) motivations for choosing the La Macaza clinic for treatment;(c) the structure of the program;(d) the group dynamics;(e) the therapists; and (f) the hardships and difficulties of treatment. Results suggest that the therapists and the program may have a function of containment or holding. Although part of the therapeutic process involves a focus on identifying and reducing cognitive distortions, results also warn therapists against misusing this concept by applying it to legitimately different opinions. Findings are discussed in terms of possible program improvements. The authors conclude that greater attention must be given to process research.

    Most cited papers:

    J Child Sex Abus. 2005 ;14:91-115 15914407 (P,S,G,E,B) Cited:1
    This exploratory study used qualitative methodology to examine what pedophiles think about treatment, as well as their daily experience of a treatment program. To this end, twenty-three offenders receiving treatment from the La Macaza federal penitentiary clinic were interviewed using non-directive semi-structured interviews. Comparative analysis was used to analyze the resulting material. The following themes are discussed based on the results of this analysis:(a) the participants’ past experience of therapy;(b) motivations for choosing the La Macaza clinic for treatment;(c) the structure of the program;(d) the group dynamics;(e) the therapists; and (f) the hardships and difficulties of treatment. Results suggest that the therapists and the program may have a function of containment or holding. Although part of the therapeutic process involves a focus on identifying and reducing cognitive distortions, results also warn therapists against misusing this concept by applying it to legitimately different opinions. Findings are discussed in terms of possible program improvements. The authors conclude that greater attention must be given to process research.

    Provided by

    DR WIDODO JUDARWANTO
    FIGHT CHILD SEXUAL ABUSE AND PEDOPHILIA 

    Yudhasmara Foundation

    JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

    PHONE : (021) 70081995 – 5703646

    email : judarwanto@gmail.com, 

    https://pedophiliasexabuse.wordpress.com/

    Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved