Sunday, May 29, 2016

What Is Pedophilia? And Those Other Hard To Pronounce Things?

The Three Terms

Pedophilia is the condition of being attracted to prepubescent children, while pedophilic disorder is the disorder that fits the diagnostic criteria in the DSM-V. Hebephilia is the condition of being attracted to pubescent children. Ephebophilia is the condition of being attracted to post-pubescent adolescents. It is possible for anyone who has at any time been attracted to those age groups to not meet the rest of the criteria for the disorder, and it is possible that those who have a primary attraction to one or more of those age groups do not meet the rest of the criteria for the disorder.

What Is Pedophilia? The Simple Answer:

There is no simple answer. I am sorry, if you were looking for one, that you came here to find one. But the topics of child sexual abuse, of sexual interest in children, and of child sexual exploitation are vast and complex. None of them can be explained, solved, or reacted to simply. Attempting to oversimplify these issues will likely result in more harm, not less.

Popular Culture

Most people think that pedophilia is the sexual abuse of a child, and equate pedophiles with people who have molested or abused children. They lump people who have viewed child pornography into this group, even though the impact of viewing child pornography is more about creating both a psychological and popularity demand (similar to how posting on social media gets 'liked', and results in more posts, the download counts of child sexual exploitation material result in a sort of internet popularity). To most people, pedophilia is synonymous with the sexual abuse of a child. This is wrong. Most abusers do not have a sexual attraction to children, and most who have a sexual attraction to children do not sexually abuse children.

Why Is Usage Important?

It is easy to think that sexual abuse could never happen to anyone you know. The statistics make it extremely likely that you already do know someone who was affected by child sexual abuse, but it is extremely unlikely that they will talk about it. By portraying those who do sexually abuse as the filthy, monstrous, inhuman pedophile, we blind ourselves to the facts about child sexual abuse. To use the incorrect terminology, to dehumanize child abusers means that we reinforce the myths that enable abuse to happen. That extreme minority of sexual predators relies on the fact that most people believe the myths about abuse and not the facts. And those that have already abused a child rely on those myths to ensure that they will not face the consequences for their actions. Those myths mean that abusers can walk free, and that the child will never tell. Breaking those myths is what will help prevent sexual abuse.

An Attraction To Children

Some people automatically equate an attraction to children (children of any age) with pedophilia. Some people also automatically equate pedophilia with child sexual abuse. Neither of these associations are completely accurate. While someone may have occasional attractions to children, that would not automatically necessitate a pedophilia diagnosis according to the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition). One can find pedophilic disorder, or pedophilia, on page 697 (PDF page # 729). There are three diagnostic criteria for pedophilia: Recurrent, sexually arousing fantasies, or urges, or behaviors involving prepubescent children; The person with the disorder has acted upon them or they find the fantasies or urges to cause marked distress or interpersonal difficulty; The person with the disorder is at least 16 years old and is at least 5 years older than the prepubescent child. There is also a note not to include someone in late adolescence in a sexual relationship with a 12-13 year old. That is just the criteria for pedophilic disorder.

There are other tidbits of useful information in the DSM-5, like the fact that pedophilia is treated as a different concept from pedophilic disorder, or the fact that a diagnosis in adolescence can be problematic due to the difficulty in determining what is curiosity and what is worthy of a diagnosis (thus the criteria of being 16 and 5 years older). They discuss the fact that pedophilic disorder can wax or wane with or without treatment due to differences in the distress of the person, social impairment, or likelihood to be sexual with a child, but that while the distress and social impairment might change, the sexual attraction to children (pedophilia) does not. In other words, pedophilia and its relatives, or the sexual attraction, functions as a sexual orientation that cannot be changed, cured, or treated.

In other words, pedophilia is a very specific thing that must meet very specific criteria to qualify as pedophilic disorder. It is possible to have the attractions and fantasies involving children without having the urge to act upon them. It is possible to be attracted to a child that is in the midst of puberty and not fit the diagnostic criteria for pedophilia, because the child they are attracted to is not prepubescent. It is possible to be attracted to a particular age group of children without having distress or interpersonal difficulties and thus not fit the diagnostic criteria for a disorder.

In short, it is possible to have an attraction to children and have it not be worthy of the label "disorder". Having a disorder means that treatment and support are suggested to help manage the disorder and make the disorder less impactful. Having a disorder does not mean that someone is "damaged goods" or in any way deficient.

Medically And In Psychology

Medically and in psychology, pedophilia is a narrow and specific ongoing attraction to prepubescent children while hebephilia is a narrow and specific attraction to pubescent children and ephebophilia is a narrow and specific attraction to post-pubescent children. Popular usage of these terms, particularly pedophilia and pedophile, are not accurate to the understanding of doctors, psychologists, and psychiatrists who specialize in paraphilias, which is a catch-all term for the variety of sexual disorders people can have. As a researcher will tell you, there is no clear line on which sorts of sexual interests warrant a diagnosable disorder and which are just unusual. Paraphilia, like anything within mental health subjects, is a vast subject with a lot of debate over concepts, how those concepts are labeled, and how those labels can bring unnecessary weight to the concept they are meant to describe.

For example, pedophilia brings a different response than saying "having an ongoing sexual attraction to children who have not hit puberty", just as "child rapist" and "sex offender" have different connotations and arouse different feelings. That is why most academics prefer to use the term paraphilia rather than the more common "sexual perversion" or "sexual deviance" that would be more recognizable. While I am not a researcher, I think there is a lot of merit to choosing terms and labels that both accurately describe the concept they attempt to illustrate. However, there does come a point at which certain labels that, while they may be more accurate, are just too much for the average person to comprehend or process. For example, trying to get everyone to use the more technically accurate "child sexual exploitation material" rather than "child pornography" is just something that will not catch on except in academia.

With all of those discussions aside, I think it is safe to conclude that when certain conditions are met, an attraction to prepubescent children meets the criteria for pedophilia and the person with the condition can be known as a pedophile. Such a person would have the disorder of pedophilia.

Disorder Or Not?

A rather valid point is made about disorders: It is a stigmatizing and heavy word depending on who is using it and how, and who is hearing it and in what context. There is no universal understanding of what a disorder is (though, to that point, there is no universal understanding of most common words, and context, as always, plays a heavy role on how words are meant, perceived, and received), but I think we can generally say that a mental health disorder is something that warrants support and care so that someone with a disorder can live a life that is not as impacted by the disorder. Maybe this is just my perception, but I think that having a disorder is not a reflection of our choice to have it or not, but what someone with a disorder chooses to do about having it.

Words are always limited because of how they are perceived, and it is just not possible to be 100% accurate to the concept a word is meant to communicate. I think "disorder" is the word we have to describe a mental condition that causes interpersonal or personal difficulty and distress without automatically being negatively stigmatizing. There are some terms that will just never catch on in popular usage. While some people can waste time discussing what terms are more technically accurate and why, and what words best fit the concepts attempting to be communicated, I think those are discussions that will fly over the average person's head and bore most audiences. The trick in advocacy is coming up with the right words to use in the right order so that the wrong message is not conveyed, and so that an accurate picture is painted. Unfortunately, it is extremely difficult to do that in very few words.

With all of that said, pedophilia and its relatives, in general, should be considered a disorder in the vast majority of cases. Whether admitted by the person with the attraction or not, having such a stigmatized disorder automatically results in distress if one is aware of the stigma with which it is viewed by the majority of the world's population. While it is possible to have the attraction without having interpersonal difficulty or distress that would make it a disorder, those cases are likely rare because of the current climate and general attitude towards such an attraction, though the disorder seems to stem not from the attraction of itself, but the societal attitude and response to it and the internalized stigmas and beliefs that cause those difficulties.

Regarding the distinction between an orientation and a disorder, the DSM-5 states: "However, if they report an absence of feelings of guilt,shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder."

Primary Prevention Tie-In

If you have followed this blog for any length of time, you know I harp on the fact that child sexual abuse is not often perpetrated by people with attractions to children, and that people with attractions to children do not often sexually abuse children. This distinction is important because it serves to educate people on the reality of who sexually abuses children and the factors that lead them to engaging in behaviors that have serious effects on children. Without knowing who abuses children and why, child sexual abuse cannot be prevented.