Pedophilia: a diagnosis in search of a disorder

Qualitative Analysis of Minor Attracted Persons' Subjective Experience: Implications for Treatment

Treatment for Minor Attracted Persons is inadequate and difficult to access. This qualitative study examined community-based MAPs' responses to narrative questions about their experiences and what they want society to understand, using an iterative thematic analysis. Notable responses from the participants included: 1) sexual attraction does not equal action; 2) minor attraction is immutable; 3) stigma leads to psychological burden; 4) therapy should aim to reduce distress, not change sexual feelings; and 5) sexual behavior can be controlled and remain within legal parameters. Further understanding of MAPs' experiences is key for developing more efficacious treatment modalities to help them live meaningful lives without endangering children.

"I'm Not like That, So Am I Gay?" The Use of Queer-Spectrum Identity Labels Among Minor-Attracted People

Largely based on an erroneous belief that individuals who are preferentially attracted to minors are necessarily sex offenders, queer communities have distanced themselves from this population over the past several decades. There are now those who object to the use of labels such as "gay" and "queer" by minor-attracted people (MAPs), raising the question, "to whom do queer-spectrum identity labels belong?" I engage with this question using data from my research with 42 MAPs, exploring their uses of queer-spectrum identity labels and the conflicts they have encountered regarding their use of these terms. I then discuss the potential consequences of accepting the use of these labels by MAPs.

Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder

Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.

What if the Child Appears to Enjoy It? Moral Attitudes Toward Adult-Child Sex Among Men With and Without Pedohebephilia

This study attempted to measure cognitions about adult-child sex by approaching the issue from a perspective of moral attitudes. We assessed ratings regarding direct and indirect harmfulness, nonconsent, exploitation, and differences in adults' and children's sexualities based on a description of adult-child sex without apparent child discomfort among an online sample of 120 pedohebephilic and 89 nonpedohebephilic German-speaking men. The results showed that only 7.5% among pedohebephilic men had equal or less permissive attitudes than the average control, while 4.5% of nonpedohebephilic men had equal or more permissive attitudes than the average pedohebephilic man. Both groups did not, however, differ in their appraisal that children may suffer indirect harm via stigmatization. The findings also indicate that the moral perception of adult-child sex shows little differentiation among German-speaking laypeople. We discuss the relevance of these findings for clinical practice and propose ideas for subsequent research.

Psychological Treatment of Sexual Offenders Against Children: A Meta-Analytic Review of Treatment Outcome Studies

Numerous meta-analyses and reviews have been conducted on the effectiveness of psychological treatment of sexual offenders in reducing recidivism, but no meta-analysis has been done on sexual offenders against children (SOAC) specifically. A moderate treatment effect has been shown in several evaluations of general sexual offenders, while many scholars maintain that the question remains unanswered until an adequate number of effectiveness studies with a strong research design have been carried out. In this meta-analysis, we evaluated 14 studies selected and coded according to Collaborative Outcome Data Committee (CODC) criteria. They included 1,421 adult offenders in psychotherapy and 1,509 nontreated controls, with a minimum average follow-up period of 3 years, published in peer-reviewed journals in 1980 or later. Recidivism was defined as rearrest or reconviction. Study quality was classified into strong, good, weak or rejected. The analysis revealed a treatment effect size of r = .03 for nine studies evaluated as Good or Weak, while all studies yielded an effect size of r = .08, including five studies classified as Rejected. The results show that the available research cannot establish any effect of treatment on SOAC. Despite a large amount of research, only a tiny fraction of studies meet a minimum of scientific standards, and even fewer provide sensible and useful data from which it is possible to draw conclusions.

Adult-child sex and the limits of liberal sexual morality

This article is a critical review of the most common arguments in the specialized literature about the moral status of sexual relationships between adults and prepubescent children. The intent is to reveal how the usual ethical analysis of these experiences, done from a general sexual morality, with a Kantian and utilitarian basis, very clearly shows us the limits and contradictions of contemporary liberal morality regarding sexual matters. It leaves open the possibility that, under certain circumstances, these relationships may be morally admissible. Some shortcomings and contradictions in these liberal arguments suggest that it would be of interest to refer to other authors and ideas to value adult-child sex, approaches that are based on a specific sexual morality concerning the issue of sexual virtues and a more complex conception of human sexual desire. Some of the scientific implications of these moral issues are also discussed.

Stigmatization of people with pedophilia: two comparative surveys

Despite productive research on stigma and its impact on people's lives in the past 20 years, stigmatization of people with pedophilia has received little attention. We conducted two surveys estimating public stigma and determining predictors of social distance from this group. In both studies, pedophilia was defined as a "dominant sexual interest in children." The survey was comprised of items measuring agreement with stereotypes, emotions, and social distance (among others). Responses were compared with identical items referring to either people who abuse alcohol (Study 1), sexual sadists or people with antisocial tendencies (Study 2). Study 1 was conducted in two German cities (N = 854) and Study 2 sampled 201 English-speaking online participants. Both studies revealed that nearly all reactions to people with pedophilia were more negative than those to the other groups, including social distance. Fourteen percent (Study 1) and 28 % (Study 2) of the participants agreed that people with pedophilia should better be dead, even if they never had committed criminal acts. The strongest predictors of social distance towards people with pedophilia were affective reactions to this group (anger and, inversely, associated, pity) and the political attitude of right-wing authoritarianism (Study 1). Results strongly indicate that people with pedophilia are a stigmatized group who risk being the target of fierce discrimination. We discuss this particular form of stigmatization with respect to social isolation of persons with pedophilia and indirect negative consequences for child abuse prevention.