According to the DSM-5-TR, the criteria to diagnose Pedophilia is defined as recurrent experiences of intense sexual arousal, fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children, usually under the age of 14.
The person must be at least 16 years of age and five years older than the child or children with whom he has these experiences or feelings towards. A person in late adolescence involved in a long term sexual relationship with a 12 or 13 year old is not included in this category (American Psychiatric Association, 2000). The disorder of pedophilia has been found almost exclusively in males.
It is very important for practitioners who work with sex offenders to understand the facts about their illness, rather than making judgments based upon assumptions. There is still much to learn about the mental illness of pedophilia
Some of the treatment methods for persons with pedophilia include cognitive-behavior therapy – such as relapse-prevention therapy, aversion therapy, masturbatory satiation and orgasmic reorientation; group therapy; psychotherapy (which is less prevalent now than prior to 1960;) and drug therapy such as androgen deprivation therapy (Comer, 2010) or the use of serotonin reuptake inhibitors.
Evidence exists that these anti-depression medications, that are used for treating obsessive compulsive disorders (OCD,) are effective in treating pedophilia.
While physical castration is considered barbaric in this country, it has been used in Europe in the past. It is no longer used as a means of treatment for sexual deviants in Europe today. Castration involves the physical removal of the testes, which is the organ in the male which produces the sex hormone testosterone.
Testosterone is mainly responsible for the sex drive in males. With pedophiles, there is more than a sex drive at play as they believe they love these children that they molest and believe they have a close and special relationship with them.
However, studies have shown that castration is effective in removing the desire for sexual behavior from sex offenders. Studies have found that between 67% and 97% of men who are castrated become asexual (Crawford, 1981). Please note, this is not a practice that is currently used today and is merely included in this article for informational purposes.
Androgen Deprivation Therapy
Androgen Deprivation Therapy is a drug treatment that involves the reduction of the male hormones in a pedophile’s system, especially the hormone testosterone. In simpler terms, ADT is chemical castration.
Studies have shown that physical treatment (hormone therapy and castration) in all types of paraphilias have proven more successful than psychosocial therapies. Pharmacological treatments are the treatments of choice for the most serious of sexual deviances. According to Rösler and Witztum, a combination of GnRh agonists and psychotherapy has shown positive results in treating pedophilia (Rice & Harris, 2011).
Three different types of hormone inhibiting medications used for diminishing the sex drive of sexual abusers have been studied. Those are the progestogens, the gonadotropin-releasing hormone agonists, and the competitive testosterone inhibitors.
These medications can take between three to 10 months to show results, all have negative side-effects, and they can be very expensive to administer.
Gonadotropin-releasing hormone agonists have become the preferred method of hormone treatment because they have fewer adverse effects and improved efficacy over the other testosterone inhibiting treatments.
One of the good “side effects” of this type of hormone therapy that has been discovered is that once the pedophile’s sexual impulses have been reduced by hormone therapy, they are more willing to participate in psychotherapy (Hall & Hall, 2007).
Specific Serotonin ReUptake Inhibitors (SSRIs)
Some specific serotonin reuptake inhibitors that are used for treating obsessive-compulsive disorder (OCD) have been found to be effective for treating sexual disorders.
It has been suggested that paraphilias are part of the spectrum of OCD. With this consideration in mind, the OCD medication Sertraline (Zoloft) was tested on pedophiles. This treatment proved effective and subsequent studies were conducted confirming the belief that paraphilias are related to obsessive compulsive disorders and the same anti-depressant treatments are effective for both.
According to Bradford and Kaye, SSRIs have less severe side-effects than anti-androgen therapy and hormone treatment (Bradford & Kaye, n.d.) In addition, pedophiles who have received SSRI treatment have reported limited side-effects and an ability to have non-paraphilic sexual relationships (Federoff & Moran, 1997).
Research was conducted on 58 pedophiles, comparing the effectiveness of three separate SSRIs – fluvoxamine, fluoxetine, and sertraline. Results indicated that the level of paraphilic fantasies decreased with no significant differences reported regarding the efficacy between the three SSRIs tested. (Greenberg, Bradford, Curry& O’Rourke, 1996).
Cognitive Behavior Therapy
The cognitive behavior therapist is mainly concerned with redirecting the pedophile’s thinking and, as a result, his behavior by using various methods to help eliminate his erotic thoughts toward children (Berlin & Krout, 1994).
There are a variety of cognitive behavioral therapy methods, including conditioning approaches, behavior skills training, social skills, empathy training, and trying to address the underlying sexual arousal pattern (University of Wisconsin, Board of Regents, 2002).
Aversion therapy is a type of behavior therapy that attempts to associate something negative with each of a pedophile’s inappropriate sexual thoughts. This type of therapy is accomplished using visualization techniques. One approach is to have sexual offenders fantasize about a deviant reaction and when they feel sexually aroused, fantasize about the consequences of being arrested, going to prison, and being raped in prison (University of Wisconsin, Board Of Regents, 2002).
Many sex-offenders are treated while in prison using group therapy where the therapist and other peers try to help other offenders confront their denial and rationalization behaviors. The groups are set up to provide a non-threatening environment where those being treated can feel relatively safe to share.
This type of treatment is called “therapeutic confrontation,” and its purpose to help offenders develop empathy for others. Having peers and therapists confront them on the irrational thinking they use to abuse children, hopefully, will help them break out of denial and change (University of Wisconsin, Board of Regents, 2002).
There is no specific conclusion on the efficacy of these treatments.