Fred S. Berlin, MD, PhD
Dr. Berlin is Associate Professor, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.
Psychiatric terminology should convey information in as clear and unambiguous a manner as possible. In light of the associated stigma, that is especially so of the terms Pedophilia and Pedophilic Disorder. Although from a psychiatric perspective the term Pedophilia is intended to define a recognized clinical entity, in the collective consciousness of contemporary society, the term has become a demonizing pejorative. Good adjective - 'demonized' is a fitting description!
Many in society are likely to equate Pedophilia with child molestation. They are not the same. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) may be contributing inadvertently to the misconception that they are the same, for the following three reasons:
First, DSM-5 states that an indicator of a Pedophilic Disorder would be that an individual has “acted on” his sexual urges (Ref. 1, p 697). “Acted on” could mean that he has actually molested a child. On the other hand, it could also mean that he has masturbated to pedophilic fantasies or that he has viewed child pornography. The current criteria for diagnosing a Pedophilic Disorder place some persons who have never molested a child into the same diagnostic category as those who have done so. That could cause confusion, suggesting that the current definition of a Pedophilic Disorder may lack adequate diagnostic specificity. As a consequence, the distinction between being sexually attracted to children in some fashion (e.g., experiencing urges to view child pornography) and experiencing urges to act on that attraction with a child can easily be lost.
Second, at present, in discussing Pedophilia, DSM-5 makes reference to the term Pedophilic Sexual Orientation. Sexual Orientation is ordinarily used to designate the category, or categories, of persons whom a given individual finds to be sexually appealing. Those who are heterosexually oriented are sexually attracted to adults of the opposite sex; those who are homosexual, to adults of the same sex; men with a heterosexual pedophilic orientation, to prepubescent females; and men with a homosexual pedophilic orientation, to prepubescent boys.
In the face of significant criticism of its inclusion in the DSM-5, the American Psychiatric Association (APA) has stated its intention to remove the term Pedophilic Sexual Orientation from the diagnostic manual. Removing that term in response to public criticism would be a mistake. Experiencing ongoing sexual attractions to prepubescent children is, in essence, a form of sexual orientation, and acknowledging that reality can help to distinguish the mental makeup that is inherent to Pedophilia, from acts of child sexual abuse.
You're saying that the mental make-up is significantly different in pedophiles who molest children from those who just watch kiddie-porn? Seriously?
Why do some act on their pedophilia while others don't? Is it because their disorder is substantially different, or is it because some pedophiles are just too cowardly to act out? Or maybe they still have some remnant of morality telling them that molesting children is evil?
Third, in discussing the nature of a Pedophilic Disorder, DSM-5 has done little to characterize the multitude of psychiatric burdens associated with the condition, burdens that are frequently present, even in the absence of any acts of child sexual abuse.
Viewing Child Pornography
Viewing child pornography should not be considered a useful diagnostic indicator of a Pedophilic Disorder. DSM-5 states that the “extensive use of pornography depicting prepubescent children is a useful diagnostic indicator of a Pedophilic Disorder” (Ref. 1, p 698). Any diagnosis simply constitutes a way of conveying information in shorthand. For example, when a diagnosis of Diabetes, Schizophrenia, or Anorexia Nervosa is made, that diagnosis conveys a great deal of useful information to a properly trained physician. For that reason, it is critical that the information conveyed not be misleading, particularly in a forensic setting. Under current circumstances, a diagnosis of Pedophilic Disorder can infer a risk of hands-on offending with children. If the diagnosis is made largely on the basis of the use of child pornography, the inference may be inaccurate, with potentially unwarranted negative consequences for the individual. Or, it may be accurate with almost certain devastating consequences for the children they destroy.
There are two ways of trying to determine whether those who have viewed child pornography pose a risk of hands-on offenses with children. One way is statistical, and the other clinical.
From both a clinical and an actuarial statistical perspective, an early retrospective study conducted at a Federal Civil Commitment Facility in Butner, North Carolina, inferred an association between accessing child pornography and hands-on sexual offending. That study has been criticized regarding its methodology and lack of scientific rigor.
I'm sure it's been criticized, but perhaps more for its outcome than its methodology. Here is what that study concluded:
The study found that the child-pornography offenders who were convicted of the possession, receipt, or distribution of child-sexual-abuse images but had no known criminal history of “hands-on” sexual abuse were likely to have engaged in the actual sexual abuse of a child. Thus, they were similar in their sexual behavioral patterns toward children to the second group examined, which consisted of child-pornography offenders with documented histories of “hands-on” sexual offending against at least one child.
More recent prospective data have questioned the contention that there is a correlation between accessing child pornography and hands-on offending. For example, one such study found that less than one percent of 231 men who had viewed child pornography (but with no evidence of a prior hands-on sexual offense) had gone on to commit a hands-on sexual offense. From a purely statistical standpoint (all else being equal) individuals with no history of a hands-on sexual offense against a child, but who have accessed child pornography, are at low risk as a group of committing a hands-on sexual offense in the future.
I think that 'less than 1 per cent' study should be investigated as to who sponsored it.
From dont-offend.org Germany's program to intervene with pedophiles who have not yet sexually assaulted a child. The point of the intervention is to stop pedophilia from progressing to that level:
The therapy being offered to individuals with a pedophilic or hebephilic sexual preference, who are aware of their problem and seeking help for it, is aimed at preventing sexual offenses against children and/or early adolescents and at avoiding the consumption of child sexual abuse images. In this way the Prevention Network “Kein Täter Werden” (Meaning: Don’t offend)” actively contributes to the protection of children and early adolescents by addressing the problem before children become victims, thus preventing repeated abuse and counteracting their ongoing traumatization.
The distinction between those pedophiles who use child pornography and those physically abuse children is largely ludicrous. It's as if Dr. Berlin doesn't know that child pornography is made by the sexual abuse of children. Or, is he so patient-focused that victims don't really count for much in his economy? More from dont-offend.org:
The use of child sexual abuse images (so-called child pornography) provides an opportunity to satisfy sexual needs without having direct physical contact with children. However, there is often no awareness of the inherent problem that the production of child sexual abuse images relies on the sexual abuse of the depicted individuals. Being aware of this, some consumers of child sexual abuse images feel bad about their behavior.
A pedophile is a pedophile is a pedophile! Some act-out, some don't. That's all the categorization you need!
No-one in the scientific fields has any real idea where pedophilia comes from. They pose theories involving 'cross-wired brains', environmental issues while growing up, and having been a victim of csa oneself. The last category of offenders have very high rates of becoming pedophiles. That would suggest that something is passed on to victims from offenders. When you figure that out, you might finally get somewhere, but you will never figure that out because you don't believe in the existence of evil as an entity.