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Pedophilia

Pedophilia is the most widely and intensely repudiated of the paraphilias. Pedophiles are men who erotically and romantically prefer children or young adolescents. They are grouped into categories depending on their erotic preferences for boys or girls and for very young, young, or pubertal children. Some pedophiles have highly age-and sex-specific tastes.

Because the diagnosis of pedophilia requires that for a period of at least 6 months there are recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children, the disorder should not be expected to be present in every person who is guilty of child molestation. Some intrafamilial child abuse occurs more quickly and results from combinations of deteriorated marriages, sexual deprivation, sociopathy.

Child molestation, whether paraphilic or not, is a crime, however. Child molesters show several patterns of erectile responses to visual stimulation in the laboratory. Some have their greatest arousal to children of a specific age, and others respond to both children and adults.

Treatment

The treatment of pedophilia involves four general approaches: evaluation only, psychotherapy, medications, and external controls. The psychiatrist is often called on.

Evaluation only is often selected when the psychiatrist concludes that the pedophilia is benign in terms of society, the patient will be resistant to the other approaches, and the patient does not suffer greatly in terms of social and vocational functioning in ways that might be improved. Often these patients are isolated men with private paraphilic sexual pleasures.

Psychotherapy

What constitutes psychotherapy for pedophilia heavily depends on the psychiatrist's training rather than on strident declarations of treatment of choice. Little optimism exists that any form of therapy can permanently change the nature of a long-established paraphilic erotic script, even among teenage sex offenders. Individual psychodynamic psychotherapy can be highly useful in diminishing paraphilic intensifications and gradually teaching the patient better management techniques.

Well-described cognitive-behavioral interventions exist for interrupting paraphilic arousal via pairing masturbatory excitement with either aversive imagery or aversive stimuli. Comprehensive behavioral treatment involves social skills training, assertiveness training, confrontations with the rationalizations that are used to minimize awareness of the victims of sexual crimes.

The self-help movement has created 12-step programs for sexual addictions to which many individuals now belong. Group psychotherapy is offered by trained therapists as well. When the lives of paraphilic patients are appreciated in various therapies.

Medications

In the early 1980s, medroxyprogesterone acetate (Provera) was first used to treat those who were constantly masturbating, seeking out personally dangerous sexual outlets, or committing sex crimes. The weekly 400-to 600-mg injections.

External Controls

Sexual advantage taking, whether it be by a paraphilic physician with his patients, or a pedophilic mentally retarded man in the neighborhood, or a grandfather who has abused several generations of his offspring and others, can often be stopped by making it impossible for these behaviors to remain unknown to most people in his life.

Treatment Summary

Psychiatrists need to be realistic about the limitations of various therapeutic ventures. Sexual acting out may readily continue during therapy beyond the awareness of the therapist. The more violent and destructive the paraphilic behavior to others.