Classification of pedophilia
Pedophilia is defined as an ongoing sexual attraction toward pre-pubertal children (Freund,
1963,
1967; Seto,
2009). In the new DSM-5, pedophilia is de-pathologized by differentiating between the sexual preference for prepubescent children (i.e., pedophilia) and the disorder in case of additional factors. These factors include experiencing significant distress and impairment by fantasies and urges, or the acting out on behavioral level, including child pornography consumption and/or committing hands-on CSA offenses.
The estimated prevalence leads to questions about the diagnostic validity and reliability of pedophilia as a classification entity. According to the DSM-5, pedophilic sexual preference and the pedophilic disorder must be differentiated. As can be seen in Table
Table1,1, the behavioral criterion was not included in the DSM-5 as a specifier, though it holds relevance for researchers and clinicians. From a clinical point of view, both child pornography consumption and/or hands-on CSA offenses would count as preference behaviors (Seto,
2010; First,
2011).
Table 1
Diagnostic criteria of a pedophilic disorder according to DSM-5.
DSM-5 pedophilic disorder
Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)
Specify if:
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both
The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Specify if:
Limited to Incest
The person is at least age 16 years and at least 5 years older than the child or children in Criterion A
Specify type:
Exclusive type (attracted only to children)
Non-exclusive type
From a clinical perspective, it is necessary to stress that there are pedophilic men who restrict their desire for sexual contact with children to fantasies only, and other men who are at risk to commit an offense because fantasy alone does not satisfy their sexual desire. This second group is potential offenders who wish to reduce their increasingly overwhelming impulses with therapeutic help (Beier et al.,
2009a,
b; Schaefer et al.,
2010; Wakefield,
2012). It is possible for these men to be diagnosed with Pedophilic Disorder – due to experiencing interpersonal distress – without them committing an offense.
The other group of pedophilic men includes those who have committed sexual offenses against children. These individuals may feel remorse (and seek help to avoid a relapse), while others do not. Note that both fulfill criterion B of the DSM-5, as shown in Table
Table1,1, means that it has to be diagnosed as Pedophilic Disorder. Furthermore, it is necessary to distinguish between the exclusive type of pedophilia (attracted only to children) and non-exclusive type, and whether the person is attracted to males, attracted to females, or to both.
It is a completely different situation for perpetrators who committed sexual offenses against children, which were not caused by a pedophilic preference. Those are the surrogate types of sex offenders and can be diagnosed within the category of impulse-control disorder, accounting for the lack of a sexual preference for children but the committed act of CSA (DSM-5: 312.89; ICD-10: 63.
. Moreover, most sexual assaults happen in the “Dunkelfeld” for approximately every reported case of CSA; another five are left unreported, suggest some scholars (Hall and Hall,
2007; Seto,
2009). Dunkelfeld is a German word that literally translates to “dark field.”
It is of great importance for clinical diagnosis whether or not an erotic preference for the body scheme of children on the fantasy-level exists. There is a high chance that this information would be given voluntarily by self-referred, self-motivated pedophilic men, but less likely by those who are already involved with the legal system (probation etc.). It is therefore essential for the assessment and a reliable diagnosis to obtain a cooperation/compliance level. In self-motivated pedophiles, this collaboration is highest and makes them a highly interesting target group for research (see Section “
Methods for Diagnosing Pedophilia”).
This underlines that pedophilia as a sexual preference must be seen independently from sexual offending against children – otherwise there would be only offending pedophiles. From a research point of view, it is imperative to understand in what way the neurobiological conditions – notwithstanding sexual preference – encourage the sexual behavior. These are possibly the same mechanisms that also encourage offense-like behavior in men with other sexual preferences (for instance in the case of rape on the background of sexual preference for adult women). Additionally, research efforts have to unravel which neurobiological mechanisms determine and regulate sexual preference, and how preference and behavior are interconnected.
In the research domain, pedophilia is currently viewed as a phenotype of sexual preference within the realm of human sexuality, including various different phenotypes (e.g., the sexual orientation toward the same gender), only that it concerns a preferred age in addition to gender (Beier et al.,
2009a,
b; Schaefer et al.,
2010). This is separate from, but in addition to, behavioral manifestations including the use of child pornography and the commitment of child sexual offenses (Beier et al.,
2009a,
b; Neutze et al.,
2011). Consequently, the sexual preference itself cannot be considered a mental disorder similar to how a homosexual orientation was considered in the 1970s in the United States of America (Green,
2002). Separating sexual preference from psychosocial impairment, thus allowing for the practice of various sexual behaviors with consenting partners, has been applied within the new DSM-5 with the other paraphilias as well, including fetishism, bondage/dominance-sadism/masochism, and is therefore not specific to pedophilia (Wright,
2010,
2014).
