Whether it is media reports about the Catholic priest pedophile scandal;
child molester Joseph Edward Duncan III; or Richard Allen Davis, who abducted,
then killed 12-year-old Polly Klaas, one gets the impression that pedophilia
is a pervasive and pernicious problem in the United States.
And while there are no hard epidemiologic data to confirm this perception,
pedophilia experts tend to agree that the assumption reflects reality.
"Pedophilia is endemic in our society and affects not only the
afflicted individual, but many, many others in the community as well,"
Fred Berlin, M.D., a Johns Hopkins University associate professor of
psychiatry and a leading authority on pedophilia, told Psychiatric
Lisa Cohen, Ph.D., who studies pedophiles and has treated victims of
child molestation, believes that a "one-size-fits-all draconian
response" is not the answer to America's pedophilia problem.
"If you had a child who had been molested, you would certainly say
that it is a significant problem," Howard Zonana, M.D., told
Psychiatric News. Zonana, a Yale University professor of psychiatry,
chaired APA's Task Force on Sexual Offenders a few years ago.
"We are seeing a huge increase in arrests for possession of child
pornography over the Internet or for solicitation and enticement of children
over the Internet," Richard Krueger, M.D., medical director of New York
State Psychiatric Institute's sexual behavior clinic, attested.
Nonetheless, the causes of pedophilia, which DSM-IV defines as"
recurrent, intense, sexually arousing fantasies, sexual urges, or
behaviors involving sexual activity with a prepubescent child," are
"Certain individuals who have suffered insults to their brain engage
in pedophilic behaviors," said Fabian Saleh, M.D., an assistant
professor of psychiatry at the University of Massachusetts and director of
research at the National Institute for the Study, Prevention, and Treatment of
Sexual Trauma. "There, you can say the injury caused pedophilia in that
individual... .But if we take all the individuals with pedophilia, and we
wanted to look for a cause, we would have to say that, in most cases, it is
One reason that more is not known about the origins of pedophilia is that
many American researchers have been loath to have anything to do with
pedophiles. The same for American research funding agencies. In Krueger's
opinion, "The primary rate-limiting factor has been lack of government
or private funding for research in this area."
Still, during the past few years some intrepid American investigators have
attempted to better understand the disorder and to identify factors that might
set the stage for it. So have some Canadian scientists. Both groups have come
up with some valuable discoveries. Among them:
Igor Galynker, M.D.: "There are researchers who want nothing to do
with sex offenders. [So] the most important thing is to put pedophilia
research into the research mainstream."
One study suggests that pedophiles are easily aroused sexually. Igor
Galynker, M.D., Ph.D., associate chair of psychiatry at Beth Israel Medical
Center in New York City, along with Lisa Cohen, Ph.D., an associate professor
of clinical psychiatry there, exposed male pedophiles attracted to girls aged
13 or younger, as well as control subjects, to three tapes. One contained
neutral words, a second described a sexual encounter between a man and a
woman, and a third related a sexual encounter between a man and an 8-year-old
girl. The pedophiles were found to experience much higher sexual arousal to
all three tapes than did the controls, but especially to the tape with the
Just as societal aversion to pedophilia has slowed efforts to understand
the condition, so has it retarded efforts to find effective treatments for it.
Still, some progress toward this end has been achieved.
The most robust data are for agents that lower sex hormones, Saleh
reported. "There is a lot of data going back to the beginning of the
last century showing that castration or lowering sex hormones in pedophilia
decreases sexual offending behavior, decreases their urges, and decreases
their sexual thoughts and fantasies."
"With cognitive behavioral therapy, it is hard to do long-term
studies," Zonana said. "But some studies show that pedophiles in
treatment seem to have a lower recidivism rate than those who are
Nonetheless, cognitive-behavioral therapy works only with pedophiles who"
understand that having pedophilia urges is inappropriate," Saleh
Some progress on how to approach pedophilia treatment has also been made
during the past decade or so, Berlin reported. "We now see pedophilia as
a chronic behavioral disorder, a craving disorder, similar to drug addiction
and alcoholism, and recognize that, although we can successfully treat it, we
cannot cure it, and part of the successful treatment is to help these folks
make the necessary changes in lifestyle so that they are not putting
themselves in a situation of temptation they may not be able to
Yet more insights into pedophilia and better treatments for it may well
emerge during the next five or 10 years, especially as the American public is
increasingly pressuring elected officials to protect children from
For instance, Saleh and Berlin have found that endogenous opiates are
released in the human brain during sexual arousal. They would like to
investigate whether pedophiles produce an abnormally large number of these
opiates, and if so, whether that might be related to their sexual fantasies,
arousal, or behavior.
"I think we will have a confirmation of something we already know,
which is that there is almost certainly more than one type of pedophilia and
therefore more than one cause," Fedoroff predicted. "We know, for
example, that, of incest offenders who sexually assault children, probably
about a third of them have pedophilic tendencies. Most don't. So clearly,
incestuous pedophiles are acting on the basis of something quite different
from nonincestuous pedophiles."
Some tools to prevent pedophilia may even become available during the next
decade or so.
Abel and his coworkers are in their second year of testing a screening tool
to identify adults who are at high risk of molesting children. The test takes
about half an hour and can be used with both men and women. Also, since the
average age of child molesters in the United States is 13 years, helping
families identify adolescents who have fantasies about sexually molesting
children might help keep those adolescents from acting on their fantasies,
Fedoroff and his colleagues recently applied for a grant to use a new
branch of mathematics called chaos theory to find better ways of identifying
pedophiles who are going to reoffend. "What we'd like to do,"
Fedoroff explained, "is look at large numbers and pick out the instances
that don't fit the pattern, which in a way is the way that sexual offenders
tend to present."
Also, if treatment were offered to pedophiles before they commit offenses,
it could help prevent such offenses, Federoff believes. "I think the way
to do that is to publicize that there are effective treatments."
But would such advertising really bear fruit? "Huge numbers of people
are being arrested for possession of child pornography," Fedoroff
replied. Many of these individuals, he said, are pedophiles who have not yet
victimized children, and many, he is convinced, do not want to be sexual
criminals. So if they are given the option of treatment, "maybe they
will take it," he said.
And if they take it, he added, chances are good that they can be helped."
People who come into our pedophile treatment program say it actually
changes their lives." ▪