Pedophilia

==Signs and symptoms==

===Development===
Pedophilia emerges before or during puberty, and is stable over time.<ref name="cutler">{{cite encyclopedia | editor-last = Cutler | editor-first = Brian L. | title = Pedophilia | encyclopedia = Encyclopedia of Psychology and Law | publisher = [[SAGE Publishing]] | location=Thousand Oaks, California | year = 2008 | isbn = 978-1-4129-5189-0 | page = 549 | volume = 2}}</ref> It is self-discovered, not chosen.<ref name="faganJAMA"/> For these reasons, pedophilia has been described as a disorder of sexual preference, phenomenologically similar to a heterosexual or homosexual orientation.<ref name="cutler"/> These observations, however, do not exclude pedophilia from being classified as a mental disorder since pedophilic acts cause harm, and mental health professionals can sometimes help pedophiles to refrain from harming children.<ref name="Berlin">{{cite journal | first = Fred S. | last = Berlin | title = Treatments to Change Sexual Orientation | url = https://archive.org/details/sim_american-journal-of-psychiatry_2000-05_157_5/page/838 | journal = [[American Journal of Psychiatry]] | publisher = [[American Psychiatric Association]] | location = Philadelphia, Pennsylvania | date = May 2000 | volume = 157 | issue = 5 | page = 838 | doi=10.1176/appi.ajp.157.5.838 | pmid = 10784491 | department = Letter to the Editor}}</ref>

In response to misinterpretations that the [[American Psychiatric Association]] considers pedophilia a sexual orientation because of wording in its printed DSM-5 manual, which distinguishes between [[paraphilia]] and what it calls "paraphilic disorder", subsequently forming a division of "pedophilia" and "pedophilic disorder", the association commented: "'[S]exual orientation' is not a term used in the diagnostic criteria for pedophilic disorder and its use in the DSM-5 text discussion is an error and should read 'sexual interest.'" They added, "In fact, APA considers pedophilic disorder a 'paraphilia,' not a 'sexual orientation.' This error will be corrected in the electronic version of DSM-5 and the next printing of the manual." They said they strongly support efforts to criminally prosecute those who sexually abuse and exploit children and adolescents, and "also support continued efforts to develop treatments for those with pedophilic disorder with the goal of preventing future acts of abuse."<ref name="Wetzstein">{{cite news | first = Cheryl | last = Wetzstein | title = APA to correct manual: Pedophilia is not a 'sexual orientation' | work = [[The Washington Times]] | date = October 31, 2013 | access-date = February 14, 2014 | url = http://www.washingtontimes.com/news/2013/oct/31/apa-correct-manual-clarification-pedophilia-not-se/ | archive-date = March 17, 2021 | archive-url = https://web.archive.org/web/20210317020215/https://www.washingtontimes.com/news/2013/oct/31/apa-correct-manual-clarification-pedophilia-not-se/ | url-status = live}}</ref>

===Comorbidity and personality traits===
Studies of pedophilia in child sex offenders often report that it co-occurs with other [[psychopathology|psychopathologies]], such as low [[self-esteem]],<ref>{{cite journal | first=William L. |last = Marshall | title = The relationship between self-esteem and deviant sexual arousal in nonfamilial child molesters | url = https://archive.org/details/sim_behavior-modification_1997-01_21_1/page/86 | journal = [[Behavior Modification (journal)|Behavior Modification]] | publisher=[[SAGE Publishing]] | location=Thousand Oaks, California | volume = 21 | issue = 1 | pages = 86–96 | year = 1997 | pmid = 8995044 | doi = 10.1177/01454455970211005 | s2cid = 22205062 }}</ref> depression, anxiety, and personality problems. It is not clear whether these are features of the disorder itself, artifacts of [[sampling bias]], or consequences of being identified as a sex offender.<ref name="setocomorbidity"/> One review of the literature concluded 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.<ref>Okami, P. & Goldberg, A. (1992). "Personality Correlates of Pedophilia: Are They Reliable Indicators?", ''Journal of Sex Research'', Vol. 29, No. 3, pp. 297–328. "For example, because an unknown percentage of true pedophiles may never act on their impulses or may never be arrested, forensic samples of sex offenders against minors clearly do not represent the population of "pedophiles", and many such persons apparently do not even belong to the population of "pedophiles"."</ref> 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.<ref name="seto2004"/>

Impaired self-concept and interpersonal functioning were reported in a sample of child sex offenders who met the diagnostic criteria for pedophilia by Cohen et al. (2002), which the authors suggested could contribute to motivation for pedophilic acts. The pedophilic offenders in the study had elevated [[psychopathy]] and cognitive distortions compared to healthy community controls. This was interpreted as underlying their failure to inhibit their criminal behavior.<ref>{{cite journal | vauthors = Cohen LJ, McGeoch PG, Watras-Gans S, Acker S, Poznansky O, Cullen K, Itskovich Y, Galynker I | title = Personality impairment in male pedophiles | journal = [[Journal of Clinical Psychiatry]] | publisher=Physicians Postgraduate Press | location = Memphis, Tennessee |volume = 63 | issue = 10 | pages = 912–9 | date = October 2002 | pmid = 12416601 | doi = 10.4088/JCP.v63n1009 }}</ref> Studies in 2009 and 2012 found that non-pedophilic child sex offenders exhibited psychopathy, but pedophiles did not.<ref>{{cite journal | first1 = Donald S. | last1 = Strassberg | first2 = Angela | last2 = Eastvold | first3 = J. Wilson | last3 = Kenney | first4 = Yana | last4 = Suchy | title = Psychopathy among pedophilic and nonpedophilic child molesters | journal = [[Child Abuse & Neglect]] | publisher=[[Elsevier]] | location=Amsterdam, Netherlands | volume = 36 | issue = 4 | pages = 379–382 | date = April 2012 | doi=10.1016/j.chiabu.2011.09.018 | pmid = 22571910 }}</ref><ref>{{cite journal | first1 = Yana | last1 = Suchy | first2 = Wilson J. | last2 = Whittaker | first3 = Donald S. | last3 = Strassberg | first4 = Angela | last4 = Eastvold | title = Facial and prosodic affect recognition among pedophilic and nonpedophilic criminal child molesters | journal = [[Sexual Abuse (journal)|Sexual Abuse: A Journal of Research and Treatment]] | publisher=[[SAGE Publishing]] | location=Thousand Oaks, California | volume = 21 | issue = 1 | pages = 93–110 | date = March 2009 | doi=10.1177/1079063208326930 | pmid = 19218480 | s2cid = 25360637 }}</ref> 
 
Wilson and Cox (1983) studied the characteristics of a group of pedophile club members. The most marked differences between pedophiles and [[control variable|controls]] were on the introversion scale, with pedophiles showing elevated shyness, sensitivity and depression. The pedophiles scored higher on [[neuroticism]] and [[psychoticism]], but not enough to be considered pathological as a group. The authors caution that "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 isolation engendered by their preference i.e., awareness of the social [dis]approbation and hostility that it evokes" (p.&nbsp;324).<ref>{{cite journal | author1 = Wilson G. D. | author2 = Cox D. N. | year = 1983 | title = Personality of paedophile club members | journal = [[Personality and Individual Differences]] | publisher=[[Elsevier]] | location=Amsterdam, Netherlands | volume = 4 | issue = 3 | pages = 323–329 | doi = 10.1016/0191-8869(83)90154-X }}</ref> In a non-clinical survey, 46% of pedophiles reported that they had seriously considered suicide for reasons related to their sexual interest, 32% planned to carry it out, and 13% had already attempted it.<ref name="jahnkeblind"/>

A review of qualitative research studies published between 1982 and 2001 concluded that child sexual abusers use [[cognitive distortion]]s 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.<ref>{{cite journal | first=Louanne | last = Lawson | title = Isolation, gratification, justification: offenders' explanations of child molesting | journal = [[Issues in Mental Health Nursing]] | publisher=[[Taylor & Francis]] | location=Abingdon, England | volume = 24 | issue = 6–7 | pages = 695–705 | year = 2003 | pmid = 12907384 | doi=10.1080/01612840305328 | s2cid = 13188168 }}</ref> Other cognitive distortions include the idea of "children as sexual beings", uncontrollability of sexual behavior, and "sexual entitlement-bias".<ref>{{cite journal | first1 = Stephen | last1 = Mihailides | first2 = Grant J. | last2 = Devilly | first3 = Tony | last3 = Ward | title = Implicit cognitive distortions and sexual offending | journal = [[Sexual Abuse (journal)|Sexual Abuse: A Journal of Research and Treatment]] | publisher = [[SAGE Publishing]] | location=Thousand Oaks, California | volume = 16 | issue = 4 | pages = 333–350 | date = October 2004 | pmid = 15560415 | doi = 10.1177/107906320401600406 | s2cid = 220359426 }}</ref>

===Child pornography===
Consumption of [[child pornography]] is a more reliable indicator of pedophilia than molesting a child,<ref name="setocp">{{cite journal | vauthors = Seto MC, Cantor JM, Blanchard R | title = Child pornography offenses are a valid diagnostic indicator of pedophilia | url = https://archive.org/details/sim_journal-of-abnormal-psychology_2006-08_115_3/page/610 | journal = J Abnorm Psychol | volume = 115 | issue = 3 | pages = 610–5 | date = August 2006 | pmid = 16866601 | doi = 10.1037/0021-843X.115.3.610 | quote = The results suggest child pornography offending is a stronger diagnostic indicator of pedophilia than is sexually offending against child victims | citeseerx = 10.1.1.606.7677 }}</ref> although some non-pedophiles also view child pornography.<ref name="lanning79">{{cite journal | title = Child Molesters: A Behavioral Analysis, Fifth Edition | first = Kenneth V. | last = Lanning | year = 2010 | journal = [[National Center for Missing and Exploited Children]] | page = 79 | url = https://www.missingkids.org/content/dam/missingkids/pdfs/publications/nc70.pdf | url-status = live | archive-url = https://web.archive.org/web/20220513215400/https://www.missingkids.org/content/dam/missingkids/pdfs/publications/nc70.pdf | archive-date = 2022-05-13 }}</ref> Child pornography may be used for a variety of purposes, ranging from private sexual gratification or trading with other collectors, to preparing children for sexual abuse as part of the [[child grooming]] process.<ref name=CrossonTower208>{{cite book | title = Understanding child abuse and neglect | first = Cynthia | last = Crosson-Tower | isbn = 978-0-205-40183-3 | publisher = Allyn & Bacon | year = 2005 | page = 208}}</ref><ref name=Wortley14>{{cite journal | title = Child Pornography on the Internet | author1 = Richard Wortley | author2 = Stephen Smallbone | journal = Problem-Oriented Guides for Police | number = 41 | pages = 14–16 | url = http://www.cops.usdoj.gov/Publications/e04062000.pdf | url-status = dead | archive-url = https://web.archive.org/web/20150107070400/http://www.cops.usdoj.gov/Publications/e04062000.pdf | archive-date = 2015-01-07 }}</ref><ref name= Levesque64>{{cite book | title = Sexual Abuse of Children: A Human Rights Perspective | first = Roger J. R. | last = Levesque | year = 1999 | page = [https://archive.org/details/sexualabuseofchi0000leve/page/64 64] | publisher = Indiana University | isbn = 978-0-253-33471-8 | url = https://archive.org/details/sexualabuseofchi0000leve/page/64 }}</ref>

Pedophilic viewers of child pornography are often obsessive about collecting, organizing, categorizing, and labeling their child pornography collection according to age, gender, sex act and fantasy.<ref name=CrossonTower200>{{cite book | title = Understanding child abuse and neglect | first = Cynthia | last = Crosson-Tower | isbn = 978-0-205-40183-3 | publisher = Allyn & Bacon | year = 2005 | pages = 198–200}}</ref> According to FBI agent Ken Lanning, "collecting" pornography does not mean that they merely view pornography, but that they save it, and "it comes to define, fuel, and validate their most cherished sexual fantasies".<ref name="lanning79"/> Lanning states that the collection is the single best indicator of what the offender wants to do, but not necessarily of what has been or will be done.<ref name="lanning107">{{cite journal | title = Child Molesters: A Behavioral Analysis, Fifth Edition | first = Kenneth V. | last = Lanning | year = 2010 | journal = [[National Center for Missing and Exploited Children]] | page = 107 | url = https://www.missingkids.org/content/dam/missingkids/pdfs/publications/nc70.pdf | url-status = live | archive-url = https://web.archive.org/web/20220513215400/https://www.missingkids.org/content/dam/missingkids/pdfs/publications/nc70.pdf | archive-date = 2022-05-13 }}</ref> Researchers Taylor and Quayle reported that pedophilic collectors of child pornography are often involved in anonymous internet communities dedicated to extending their collections.<ref>{{cite journal | author1 = Quayle, E. | author2 = Taylor, M. | year = 2002 | title = Child pornography and the internet: Assessment Issues | url = https://archive.org/details/sim_british-journal-of-social-work_2002-10_32_7/page/867 | journal = British Journal of Social Work | volume = 32 | issue = 7 | page = 867 | doi=10.1093/bjsw/32.7.863}}</ref>