Pedophilia

=== For child molesters ===
{{See also|Child sexual abuse#Treatment 2}}

==== Cognitive behavioral therapy ====
[[Cognitive behavioral therapy]] (CBT) aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use [[cognitive restructuring]] to change views on sex with children. The most common form of this therapy is [[relapse prevention]], where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.{{r|seto|p=171}}

The evidence for cognitive behavioral therapy is mixed.{{r|seto|p=171}} A 2012 [[Cochrane Collaboration|Cochrane Review]] of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders.<ref name="cochrane">{{cite journal | vauthors = Dennis JA, Khan O, Ferriter M, Huband N, Powney MJ, Duggan C | year = 2012 | title = Psychological interventions for adults who have sexually offended or are at risk of offending | journal = Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD007507 | doi = 10.1002/14651858.CD007507.pub2 | pmid = 23235646 }}</ref> Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism.<ref>{{cite journal | vauthors = Lösel F, Schmucker M | year = 2005 | title = The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis | journal = Journal of Experimental Criminology | volume = 1 | issue = 1 | pages = 117–46 | doi=10.1007/s11292-004-6466-7 | s2cid = 145253074 }}</ref><ref>{{cite journal | vauthors = Hanson RK, Gordon A, Harris AJ, Marques JK, Murphy W, etal | year = 2002 | title = First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders | journal = Sexual Abuse | volume = 14 | issue = 2 | pages = 169–94 | doi=10.1177/107906320201400207 | pmid = 11961890 | s2cid = 34192852 }}</ref> There is debate over whether non-randomized studies should be considered informative.<ref name=SetoReview/><ref name="rice2012">{{cite book | vauthors = Rice ME, Harris GT | year = 2012 | chapter = Treatment for adult sex offenders: may we reject the null hypothesis? | title = Handbook of Legal & Ethical Aspects of Sex Offender Treatment & Management | veditors = Harrison K, Rainey B | location = London, England | publisher = [[Wiley-Blackwell]]}}</ref> More research is needed.<ref name="cochrane"/>

==== Behavioral interventions ====
Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and [[covert sensitization]] (or [[masturbation|masturbatory]] reconditioning) to increase sexual arousal to adults.{{r|seto|p=175}} Behavioral treatments appear to have an effect on sexual arousal patterns during phallometric testing, but it is not known whether the effect represents changes in sexual interests or changes in the ability to control genital arousal during testing, nor whether the effect persists in the long term.<ref>Barbaree, H. E., Bogaert, A. F., & Seto, M. C. (1995). Sexual reorientation therapy for pedophiles: Practices and controversies. In L. Diamant & R. D. McAnulty (Eds.), ''The psychology of sexual orientation, behavior, and identity: A handbook'' (pp. 357–383). Westport, CT: Greenwood Press.</ref><ref>Barbaree, H. C., & Seto, M. C. (1997). Pedophilia: Assessment and treatment. In D. R. Laws & W. T. O'Donohue (eds.), ''Sexual deviance: Theory, assessment and treatment'' (pp. 175–193). New York: Guildford Press.</ref> For sex offenders with mental disabilities, [[applied behavior analysis]] has been used.<ref>{{cite book | author1 = Maguth Nezu C. | author2 = Fiore A. A. | author3 = Nezu A. M | year = 2006 | title = Problem Solving Treatment for Intellectually Disabled Sex Offenders | journal = International Journal of Behavioral Consultation and Therapy | volume = 2 | pages = 266–275 | doi=10.1002/9780470713488.ch6 | isbn = 9780470713488 }}</ref>

==== Sex drive reduction ====
Pharmacological interventions are used to lower the sex drive in general, which can ease the management of pedophilic feelings, but does not change sexual preference.<ref name="camilleri199">{{cite book | first1 = Joseph A. | last1 = Camilleri | first2 = Vernon L. | last2 = Quinsey | date= 2008 | title = Sexual Deviance: Theory, Assessment, and Treatment, 2nd edition | url = https://archive.org/details/sexualdevianceth00laws | publisher = The Guilford Press | pages = [https://archive.org/details/sexualdevianceth00laws/page/199 199]–200 | chapter = Pedophilia: Assessment and Treatment |isbn= 9781593856052 | editor1-last = Laws | editor1-first = D. Richard}}</ref> [[Antiandrogens]] work by interfering with the activity of testosterone. [[Cyproterone acetate]] (Androcur) and [[medroxyprogesterone acetate]] (Depo-Provera) are the most commonly used. The efficacy of antiandrogens has some support, but few high-quality studies exist. Cyproterone acetate has the strongest evidence for reducing sexual arousal, while findings on medroxyprogesterone acetate have been mixed.{{r|seto|pp=177-181}}

[[Gonadotropin-releasing hormone analog]]s such as [[leuprorelin]] (Lupron), which last longer and have fewer side-effects, are also used to reduce libido,<ref name="pmid15985890">{{cite journal | vauthors = Cohen LJ, Galynker II | title = Clinical features of pedophilia and implications for treatment | journal = Journal of Psychiatric Practice | volume = 8 | issue = 5 | pages = 276–89 | year = 2002 | pmid = 15985890 | doi = 10.1097/00131746-200209000-00004 | s2cid = 22782583 }}</ref> as are [[selective serotonin reuptake inhibitor]]s.{{r|seto|pp=177-181}} The evidence for these alternatives is more limited and mostly based on open trials and case studies.<ref name=SetoReview/> All of these treatments, commonly referred to as "[[chemical castration]]", are often used in conjunction with cognitive behavioral therapy.<ref>{{cite journal | author = Guay, DR | year = 2009 | title = Drug treatment of paraphilic and nonparaphilic sexual disorders | journal = Clinical Therapeutics | volume = 31 | issue = 1 | pages = 1–31 | doi=10.1016/j.clinthera.2009.01.009 | pmid=19243704}}</ref> According to the [[Association for the Treatment of Sexual Abusers]], when treating child molesters, "anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan."<ref name="atsacast">{{cite web | title = Anti-androgen therapy and surgical castration | work = Association for the Treatment of Sexual Abusers | url = http://www.atsa.com/ppantiandro.html | year = 1997 | url-status = dead | archive-url = https://web.archive.org/web/20110829070929/http://www.atsa.com/ppantiandro.html | archive-date = August 29, 2011 }}</ref> These drugs may have side-effects, such as weight gain, breast development, liver damage and osteoporosis.<ref name=SetoReview/>

Historically, surgical [[castration]] was used to lower sex drive by reducing testosterone. The emergence of pharmacological methods of adjusting testosterone has made it largely obsolete, because they are similarly effective and less invasive.<ref name="camilleri199"/> It is still occasionally performed in Germany, the Czech Republic, Switzerland, and a few U.S. states. Non-randomized studies have reported that surgical castration reduces recidivism in contact sex offenders.{{r|seto|pp=181–182, 192}} The Association for the Treatment of Sexual Abusers opposes surgical castration<ref name="atsacast"/> and the [[Council of Europe]] works to bring the practice to an end in Eastern European countries where it is still applied through the courts.<ref>{{cite news | title = Prague Urged to End Castration of Sex Offenders | newspaper = DW.DE | date = 2009-02-05 | url = http://www.dw-world.de/dw/article/0,,4004260,00.html | access-date = 2015-01-19 | archive-date = 2012-01-07 | archive-url = https://web.archive.org/web/20120107041148/http://www.dw-world.de/dw/article/0,,4004260,00.html | url-status = live }}</ref>