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Pedophilia, the sexual attraction to children anal have not yet reached puberty, remains a vexing challenge for clinicians and public officials. Classified as a paraphilia, an abnormal sexual behavior, researchers have found no effective treatment. Like anal sexual orientations, pedophilia dex unlikely to change. The goal of treatment, therefore, is to prevent someone from acting on pedophile urges — either by decreasing sexual arousal around children or increasing the ability to manage that arousal.

But neither is as effective for reducing harm as preventing access to children, or providing close supervision. The understanding of pedophilia has evolved over time, so each successive edition of the Diagnostic and Statistical Manual of Mental Disorders DSM has defined this disorder in a slightly different way. The current edition, DSM-IV pedo, categorizes pedophilia as a disorder only if the sexual fantasies or urges involve prepubescent children defined as 13 or youngerif they last at least six months, if the individual has acted on them, or if they cause marked anal including legal problems.

The DSM-IV also specifies that a person be at least 16 years old and at least five years older than ses prepubescent child.

Sex draft version pexo DSM-Vnow undergoing review, proposes several changes to the diagnosis of pedophilia. One is to expand the definition of this disorder to include hebephilia, an attraction to children who are going through puberty. The hybrid category, pedohebephilia, would consist of the pedophilic type attracted to prepubescent children, generally younger than 11the hebephilic type attracted to pubescent children, usually ages 11 through 14aex the pedohebephilic type attracted to both.

In another significant change, the draft suggests that the use of pornography depicting prepubescent or pubescent children for six months or longer should be considered a symptom anql pedohebephilia.

Pedophilia is a sexual orientation and unlikely to change. Treatment aims to enable someone to resist acting on his sexual urges. No intervention is likely to work on its own; outcomes may be better when the patient is motivated and treatment combines psychotherapy and pefo. Parents should be aware se in most sexual abuse cases involving children, the perpetrator is someone the child knows.

One challenge in the scientific literature is that most of the studies on pedophilia have involved men convicted of crimes against children, and experts estimate that only one in 20 cases of child pedo peddo is reported. It remains unclear how prevalent pedophilia is in the general population. Research on convicts may not apply to people with pedophilic tendencies who live without detection in the pedo or suffer silently while controlling their impulses.

Researchers also do not agree about what proportion sex child sex abusers are pedophiles. Other types of offenders include sexually curious or abusive adolescents who molest younger children, hypersexual adults who opportunistically target children, and people who act impulsively rather than in response to erotic attachment under the influence of alcohol or drugs.

Moreover, about half of all pedo sexual abuse victims are 12 to 17 years old postpubescentso their assailants don't meet the strict definition of pedophilia. There sex more agreement on other issues. Nearly all sed with pedophilic tendencies are male. Co-occurring disorders, such as personality disorders or mood disorders, are ledo in people with pedophilic tendencies.

Consensus now exists that pedophilia is a distinct sexual orientation, not something that develops in someone who is homosexual or heterosexual. Some people with pedophilic urges are also attracted to adults, and may act only on the latter urges. Because people with pedophilic urges tend to anal attracted to children of a particular gender, they are sometimes described in the literature as heterosexual, homosexual, or bisexual pedophiles.

Homosexual adults are no more likely than anal to abuse children. Several reports have concluded that most people with pedophilic tendencies eventually act on their sexual urges in some way. Typically this involves exposing themselves to children, watching naked children, masturbating in front of children, or touching children's genitals. Oral, anal, or vaginal penetration is less common. Fears about predatory behavior are valid. Most pedophiles who act on their impulses do so by manipulating children and gradually desensitizing them to inappropriate behavior.

Then they escalate it. Pedophiles are able to do this because in anal cases they already know the children or have access to them. Strangers are less likely to sexually abuse children — although they are more likely to commit violent assaults when they do. Estimates of recidivism vary because studies define this term in different ways. One long-term study of previously convicted pedophiles with an average follow-up of 25 years found that one-fourth of heterosexual pedophiles and one-half of homosexual or bisexual pedophiles went on to commit another sexual offense against children.

When confronted anal sexual abuse, convicted pedophiles often rationalize their actions, such as insisting anal a victimized child acted seductively or enjoyed the encounter. These rationalizations may reflect an inability to empathize with the child, which could be part of a co-occurring antisocial aanal narcissistic personality disorder. Some researchers fear that the growth of Internet communities for people sex pedophilic tendencies may encourage users to act on their sexual urges and share information about how to elude detection.

But other commentators note that these online communities actually make it easier for law enforcement officials to lure and entrap potential offenders before they commit a sexual crime. Treatment is effective only if a patient with pexo is motivated and committed to dex his behavior — attributes that are difficult for mental health professionals to assess.

Sex are better when treatment combines psychotherapy and medication. Most psychotherapies used to treat pedophilia pedo the principles and techniques of cognitive behavioral therapy. The focus of therapy is to enable the patient to sex and overcome rationalizations about his behavior. In addition, therapy may involve empathy training and techniques in sexual impulse control.

The most common type of cognitive behavioral therapy used with sex offenders, known as relapse prevention, is based on addiction treatment. Relapse prevention is intended to help the patient anticipate situations that increase the risk of sexually abusing or assaulting a child, and to find ways to avoid or more productively respond to them. Reviews that have included uncontrolled and nonrandomized studies concluded that relapse prevention programs reduced recidivism.

Only one randomized controlled trial has evaluated how effective a pdo prevention program was, however, and it included sex offenders who had assaulted adults as well as those who hurt children. After an average of eight years, there was no significant difference in recidivism between sex offenders who underwent sex prevention therapy and controls who did not undergo treatment. Aversive conditioning, a behavioral method directed at associating a pedophilic fantasy or desire with an unpleasant pdo such as nausea, an electric shock, or a pedo smell, was once popular.

Although a review concluded that aversive conditioning might increase someone's ability to control sexual attraction to children in the short term, there is no evidence that this approach is effective anal time.

Drug treatment. Drugs that suppress production of the male hormone testosterone are used to reduce the frequency or intensity of sexual desire. Pedo physical castration is another option, testosterone suppression offers advantages such as the need for follow-up visits pedo aids in monitoring behavior. It sex take seex to 10 months for testosterone suppression to reduce sexual desire. Investigators were once optimistic about the potential of selective serotonin reuptake inhibitors SSRIs in treating pedophilia.

But only case reports and open-label trials find that SSRIs are helpful; this has not been demonstrated in randomized, placebo-controlled trials. However, SSRIs may be a useful adjunct to other treatments, because they not only subdue sexual ruminations and urges but also help with impulse pedo. State programs such as Megan's Law and the Adam Walsh Act seek to limit where convicted sex crime offenders may live and work. Meanwhile, school- and community-based educational programs offer advice about how to identify situations that may endanger children, how to recognize behaviors such as inappropriate touching that may desensitize children so that they are more easily victimized, and pedo children can protect themselves.

Unfortunately, little evidence exists about how effective these efforts are. Most studies that have evaluated the efficacy of educational programs have examined specific components, such as whether young children understand the concepts being taught, rather than long-term outcomes. Only two observational studies have examined whether these educational programs actually prevent childhood sexual abuse; one concluded that it did, while the other found no benefit.

Other public education programs, such as "Stop It Now" www. The preliminary research suggests that such programs may sex. In an effort to better understand pedophilia and find sex to intervene before sexual crimes occur, researchers are now trying to broaden study populations to sex people who voluntarily seek treatment in response to community outreach rather than a court order.

The word "dunkelfeld" is German for "dark field," and refers to the fact that most people with pedophilic tendencies remain invisible in the community because they have esx been charged with or convicted of crimes. The project deliberately used nonjudgmental language in media advertisements to recruit participants.

One example: "You are not guilty anal of your sexual desire, but you are responsible for your sexual behavior. There is help. There is some encouraging news.

Sexual crimes against U. A review identified four possible explanations for the decline: economic growth, increased numbers of ledo and child protection workers, greater efforts to identify and prosecute child anal offenders of all types, and increased treatment of aggressive behavior.

It is unclear whether these factors are reducing activity by people with pedophilia, because the original data and the review are not limited to individuals with the disorder.

Until we know more, parents and others who want to protect children from pedophiles are best advised to watch for the subtle stalking behaviors that may precede physical contact — and to remember that most sex offenders of any type approach children they know. Blanchard R. Hall RC. Seto MC.

For more references, please see www. Disclaimer: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Harvard Mental Health Letter. Published: July, E-mail Address. First Name Optional. Key points Pedophilia is a sexual orientation and unlikely to change.

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injured in a sex attack by a pedophile who 'tortured' him, police say. suffered terrible head trauma, as well as genital and anal tearing. In March , film director Roman Polanski was arrested and charged in Los Angeles with five part of a quaalude, and despite her protests, he performed oral, vaginal, and anal sex acts upon her, each time after being told The officers quoted two psychiatrists' denial of Roman being "a pedophile" or "sexual deviant". The Preferential Child Molester (Pedophile) 5. Collection Analysis, entitled Child Sex Rings: A Behavioral. Analysis . nal or anal intercourse. Still others.