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 News.

"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 elusive.

"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 unknown."

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:

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 girl.

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 not."

Nonetheless, cognitive-behavioral therapy works only with pedophiles who" understand that having pedophilia urges is inappropriate," Saleh pointed out.

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 handle."

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 pedophiles.

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, Abel believes.

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." ▪