Author Affiliations: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Lutherville, Md.
This article addresses the risk factors associated with the psychiatric
disorder pedophilia, its treatment, and treatment outcomes. It addresses physician
responsibilities associated with case identification of victims and possible
roles in the medical management of pedophilia. The essential feature of pedophilia
is that an individual is sexually attracted exclusively or in part to prepubescent
children. While pedophilia may be limited to fantasies and impulses, pedophilic
behaviors are the primary concern of both the mental health and criminal justice
systems. Remote risk factors for development of pedophilia often include the
individual having been sexually abused as a child. Proximate risk factors
for its behavioral expression are prevalence of comorbid psychiatric disorders
and substance abuse disorders. Current treatment goals focus on stopping the
behavior and achieving long-term behavioral control in the community. Common
treatment methods are cognitive-behavioral, group therapy, and, when appropriate,
medications such as androgen-lowering agents that can act as sexual appetite
suppressants. Meta-analyses have established that treatment is more effective
than nontreatment in preventing recidivism of sexual offenders in general,
a finding that has a high probability of application to individuals with pedophilia.
Pedophilia is a chronic psychiatric disorder, but it is treatable in terms
of developing strategies for preventing behavioral expression. Ultimately,
reducing the prevalence of pedophilic behavior requires further collaboration
between the criminal justice system and the health care communities.
Fagan PJ, Wise TN, Schmidt, Jr CW, Berlin FS. Pedophilia. JAMA. 2002;288(19):2458-2465. doi:10.1001/jama.288.19.2458