Robert Dickey

Pedophilia, hebephilia, and the DSM-V.

The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.

Pedophiles: mental retardation, maternal age, and sexual orientation.

Intellectual functioning, parental age, andsexual orientation in 991 male sexual offenders wereinvestigated. Sources of data included semistructuredinterviews, clinical charts, phallometric tests, and self-administered questionnaires. The resultssuggest two main conclusions: (i) Among pedophiles ingeneral, erotic preference moves away from adult womenalong two dimensions: age and sex. The extent ofthis movementis greater, along both dimensions,forpedophiles with lower levels of intellectualfunctioning. (ii) High maternal age (or some factor itrepresents) increases the likelihood of exclusive sexual interest in boys. Intellectual deficiency (orsome factor it represents) decreases the likelihood ofexclusive sexual interest in girls. These two factorssummate, so that a pedophile with both factors is more likely to be sexually interested inboys than a pedophile with only one.

Self-Reported Head Injuries Before and After Age 13 in Pedophilic and Nonpedophilic Men Referred for Clinical Assessment

Previous research has found that pedophilic men referred for clinical assessment of their sexual behavior are more likely to report that they suffered head injuries before their 13th birthday than are nonpedophilic men referred for the same purpose. This study investigated whether pedophilic patients are also more likely to report head injuries after their 13th birthday. The 685 participants represented all patients with usable data from a consecutive series of men referred to a clinical laboratory specializing in phallometric assessment of erotic preferences. In addition to phallometric testing, participants were administered a brief neuropsychological test battery and a companion interview, which included questions on head injury, drug abuse, and childhood diagnosis of attention-deficit/hyperactivity disorder. The results showed that the pedophilic patients reported more head injuries before age 13 than did the nonpedophilic patients, but they did not report more head injuries after age 13. The association between pedophilia and childhood head injuries could mean either that subtle brain damage after birth increases a boys risk of pedophilia, or that neurodevelopmental problems before birth increase a boys accident-proneness along with his risk of pedophilia. Additional analyses showed that self-reported head injuries before age 13 were associated with attentional problems and with left-handedness; in contrast, head injuries after age 13 were associated with drug abuse and promiscuity. These analyses suggest that, among patients with primary presenting complaints of sexual rather than cognitive problems, childhood head injuries cluster with neuropsychological phenomena, whereas later head injuries cluster with lifestyle variables.

Retrospective self-reports of childhood accidents causing unconsciousness in phallometrically diagnosed pedophiles.

The present study investigated whether head injuries in childhood might increase the risk of pedophilia in males. The subjects were 1206 patients referred to a clinical sexology service for assessment of their erotic preferences. These were classified, on the basis of phallometric test results, as pedophilic (n = 413) or nonpedophilic (n = 793). Information regarding early head injuries, other signs of possible neurodevelopmental problems, and parental histories of psychiatric treatment were collected with self-administered questionnaires. The results showed that childhood accidents that resulted in unconsciousness were associated with pedophilia and with lower levels of intelligence and education. These associations were statistically significant for accidents that occurred before the age of 6, but not for accidents that occurred between the ages of 6 and 12. These results are compatible with the hypothesis that neurodevelopmental perturbations in early childhood may increase the risk of pedophilia. They are also, however, compatible with the alternative explanation that prior neurodevelopmental problems lead to accident-proneness and head injury, on the one hand, and to pedophilia, on the other, and that head injury has no causal influence on pedophilia. A secondary finding was that the pedophiles were more likely to report that their mothers had undergone psychiatric treatment. This finding suggests that pedophilia may be influenced by genetic factors, which are manifested in women as an increased risk of psychiatric problems, and in their sons, as an increased risk of erotic interest in children.

Does sexual abuse in childhood cause pedophilia: An exploratory study

The reliability of the notion that pedophilia is caused by sexual abuse in childhood was explored by examining retrospective self-reports of 344 males. Included in the study were 77 heterosexual pedophiles, 54 homosexual pedophiles, 51 nonpedophilic sex offenders against children, 36 sex offenders against physically mature females, 75 heterosexual paid volunteers who erotically preferred mature females, and 51 homosexual clients who preferred mature males. For each sex offender the differential diagnosis of an erotic preference for minors vs. a preference for physically mature partners was made by means of the phallometric test of erotic gender and age preferences. The analysis of self-reports confirmed that the proportion of pedophiles who report having been sexually abused in childhood by mature persons is larger than that of men who were not charged for or accused of a sex offense against a child though the difference is relatively small (28.6 vs. 13.9 and 10.7% for the heterosexual pedophiles and the two groups of gynephiles, respectively, and 25.9 vs. 11.8% for the homosexual pedophiles and androphiles, respectively). Further analysis demonstrated, however, that pedophiles who admitted having an erotic interest in children significantly more often claimed that they had been sexually abused as children than pedophiles who did not admit having such feelings. This interdependence renders the reliability of these self-reports questionable.

Fraternal Birth Order and Sexual Orientation in Pedophiles

Whether homosexual pedophiles have more older brothers (a higher fraternal birth order) than do heterosexual pedophiles was investigated. Subjects were 260 sex offenders (against children age 14 or younger) and 260 matched volunteer controls. The subjects relative attraction to male and female children was assessed by phallometric testing in one analysis, and by his offense history in another. Both methods showed that fraternal birth order correlates with homosexuality in pedophiles, just as it does in men attracted to physically mature partners. Results suggest that fraternal birth order (or the underlying variable it represents) may prove the first identified universal factor in homosexual development. Results also argue against a previous explanation of the high prevalence of homosexuality in pedophiles (25% in this study), namely, that the factors that determine sexual preference in pedophiles are different from those that determine sexual preference in men attracted to adults. An alternative explanation in terms of canalization of development is suggested.

The management of a case of treatment-resistant paraphilia with a long-acting LHRH agonist.

A patient with multiple paraphilias who had been treated for several years with sex drive reducing agents (cyproterone acetate and medroxyprogesterone acetate) with little effect on sexual activity or fantasy was offered treatment with long-acting leuprolide acetate, an LHRH agonist. This produced a marked decrease in all reported sexual thoughts and activities with no significant side-effects.

THE RELATION OF BIRTH ORDER TO SEXUAL ORIENTATION IN MEN AND WOMEN

Homosexual men have a higher mean birth order than do heterosexual men, primarily because they have a greater number of older brothers. The purpose of this study was to determine whether the same difference occurs in homosexual vs heterosexual women. The probands were 964 homosexual and heterosexual, male and female volunteers, from whom birth order data were collected with self-administered questionnaires. The homosexual men had more older brothers than the heterosexual men, but they did not have more older sisters, younger brothers, or younger sisters. The homosexual women did not differ from the heterosexual women with regard to any class of sibling. These results are consistent with the hypothesis that the high birth order of homosexual men reflects the progressive immunization of certain mothers to H-Y antigen by succeeding male fetuses, and the increasing effects of H-Y antibodies on sexual differentiation of the brain in succeeding male fetuses.

Age as a Differential Characteristic of Rapists, Pedophiles, and Sexual Sadists

In this study, we investigated the role of age in three categories of 168 sex offenders, including 53 rapists, 62 pedophiles, and 53 sadists. On the basis of the match between requisites of completing each type of sexual offense, we hypothesized that rapists would be less represented in the older age group, whereas pedophilic and sexually sadistic offenders would show a more muted decline with age. This hypothesis was supported by the data, clearly a showing smaller number of rapists in the over 40 group relative to the number of pedophiles and sadists ( p = 0.0009.) Further examination of the files eliminated the alternate explanation ascribing this pattern to lack of opportunity in older rapists because of incarceration. These results suggest that age over 40 may mitigate incidence of recidivism in rapists, but not in pedophiles or sexual sadists. Approximately one third of the sexual sadists had committed either first- or second-degree murder, whereas none of the nonsadistic rapists or pedophiles had these crimes on their records. The data further justify categorization of sex offenders into nonsadistic rapist, sadistic rapist, and pedophilic offenders in future research to enhance precision in delineating demographic characteristics and putative causal explanations for sexual offending.

Sexual Arousal to Female Children in Gynephilic Men

Phallometric assessments of single-victim sexual offenders against children have suggested that only about 50% of these men are more attracted to children than they are to adults. This has raised the question of what motivates the other 50% of men to approach young girls for sex. Freund et al. showed that gynephilic men (i.e., men preferentially attracted to adult women) evidenced greater arousal to images of prepubescent girls than to images of males of any age or to nonerotic images, arguing that gynephilic men may approach prepubescent girls as a “surrogate” for their preferred erotic targets (i.e., adult women). One might argue that these phallometric results are artifactual, given that they were obtained in a time period during which images of nudity were far less common than they are today (thus any female nudity might have elicited arousal). To address this issue, the authors examined the sexual arousal patterns of 214 contemporary men who, based on self-report, offense history, and phallometric responses, were purely gynephilic. Results showed the “classical control profile”: the greatest arousal to adult women, systematically decreasing arousal as the female stimuli became younger, and essentially no arousal to any age categories of males or to neutral (nonerotic) stimuli. Arousal to both pubescent and prepubescent girls was significantly greater than to neutral stimuli (p < .001 for both). Thus, Freund et al.’s results still appear to be valid, and the explanation for child molesting that they suggest still seems to be feasible.