Excerpt from Pessimism about Pedophilia. (2010). Harvard Mental Health Letter. July, 2010. Retrieved May 22, 2011 from www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/July/pessimism-about-pedophilia

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 sexual abuse 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 community or suffer silently while controlling their impulses.

There is more agreement on other issues. Co-occurring disorders, such as personality disorders or mood disorders, are common in people with pedophilic tendencies. And about 50% to 70% of people with pedophilic tendencies are also diagnosed with another paraphilia, such as exhibitionism, voyeurism, or sadism.

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 most cases they already know the children or have access to them.

Some researchers fear that the growth of Internet communities for people with 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.

Most psychotherapies used to treat pedophilia incorporate the principles and techniques of cognitive behavioral therapy. The focus of therapy is to enable the patient to recognize and overcome rationalizations about his behavior. In addition, therapy may involve empathy training and techniques in sexual impulse control.

Aversive conditioning, a behavioral method directed at associating a pedophilic fantasy or desire with an unpleasant sensation such as nausea, an electric shock, or a bad 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 over time.

Drugs that suppress production of the male hormone testosterone are used to reduce the frequency or intensity of sexual desire. Although physical castration is another option, testosterone suppression offers advantages such as the need for follow-up visits (which aids in monitoring behavior).

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 how children can protect themselves.

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.