Pedophilic disorder is a mental health condition that centers on sexual thoughts or behaviors involving a child well below the age of legal consent. The American Psychiatric Association (APA), which publishes the primary diagnostic guidebook used by mental health professionals across the United States, classifies the condition along with a larger group of illnesses called paraphilic disorders. In May 2013, the APA changed the names used for these disorders, and also significantly altered the criteria used to define most of them. However, while the name used to describe pedophilic conduct changed, the basic criteria used to qualify this conduct as a mental disorder remain unchanged.
Pedophilic Disorder Basics
People with pedophilic disorder engage in a pattern of sexual activity called pedophilia. In turn, pedophilia belongs to a larger group of abnormal sexual behavioral patterns called paraphilias. Some paraphilias – such as transvestism, voyeurism, exhibitionism, fetishism, sexual sadism and sexual masochism – exist in forms that don’t cause lasting harm to an affected individual or to people exposed to that individual, as well as in forms that do cause lasting harm to self or others. This is true because these behaviors can take place between consenting adults, in addition to taking place in circumstances where consent does not exist. Pedophilia is unique, and inherently more dangerous, because it always involves thought and behavioral patterns targeted at people who can’t give consent for any form of sexual participation.
The American Psychiatric Association lists the basic criteria for diagnosing pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders or DSM, a reference text that categorizes and defines the full gamut of mental illness. The first of these criteria states that all people with the disorder must experience strong, repeated urges or fantasies involving sexual conduct with a child who has not gone through puberty – or must actively engage in sexual conduct with a prepubescent child – for at least half a year prior to diagnosis. This criterion notes, but does not strictly stipulate, that the maximum age for the target of an affected individual’s urges, fantasies and behaviors is typically 13.
The second criterion for pedophilic disorder states that, if an affected individual has not acted on his or her pedophilic urges and fantasies, these urges and fantasies must cause a level of mental anguish or disruption of social relationships severe enough to degrade his or her ability to participate in everyday life. The third basic criterion for the disorder states that each individual eligible for a diagnosis must be age 16 or older and target children who are a minimum of 5 years younger in age.
There are also several secondary characteristics, known as “specifiers,” that mental health professionals can use to further describe and categorize people with pedophilic disorder. The first of these specifiers distinguishes between individuals who have sexual attractions to male children, individuals who have sexual attractions to female children, and individuals who have sexual attractions to children of both sexes. The second of these specifiers allows doctors to specifically identify people with pedophilic disorder who only experience incest-related urges and fantasies, or who only engage in incest-related behaviors. The third specifier for pedophilic disorder allows doctors to differentiate between people whose only sexual interests are pedophilic in nature and people who also have sexual interest in adults.
Males constitute the majority of pedophiles, the Merck Manual for Health Care Professionals reports. When dealing with pedophiles, doctors must simultaneously work to protect the targets of pedophilic activity and treat the mental health problems in the people who perpetrate that activity. As a rule, the steps that a doctor can and must take when dealing with a pedophilic disorder patient actively engaged in pedophilic behavior are outlined by the legal system and by the social services departments of each individual state.
Doctors typically treat pedophilic disorder with a combination of medication and individualized or group psychotherapy, as well as programs to improve social skills and additional treatments designed to address any simultaneously occurring mental health issues. Medications commonly used include hormone-altering drugs called antiandrogens and antidepressants called SSRIs. Generally speaking, both psychotherapeutic and medical treatments for an affected individual are long-term efforts that must be sustained, monitored and reassessed over time.
In May 2013, the American Psychiatric Association changed the basic criteria for most paraphilic disorders as part of the publication of the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). This change was designed to acknowledge the fact that people with most types of paraphilias can potentially engage in paraphilic sexual practices without harming themselves or other people. The APA symbolized this new approach by adding the word “disorder” to each paraphilia when identifying that paraphilia in the context of mental illness (e.g., voyeurism the mental illness became voyeuristic disorder). While DSM 5 changes the name for the mental disorder pedophilia into pedophilic disorder, it does not make the same alterations in the disorder’s basic criteria that were made for the other paraphilic disorders. This lack of alteration specifically highlights the uniquely damaging nature of pedophilic behaviors.