Title: Is pedophilia a mental disorder?
Author(s): Richard Green
Affiliation: Imperial College School of Medicine, London, England; Institute of Criminology, University of Cambridge, England
Citation:
Green, R., “Is pedophilia a mental disorder?”, Archives of Sexual Behavior, vol. 31, no. 6, 2002, pp. 467-471.
The author writes that 30 years ago, he argued vigorously for the removal of homosexuality from the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) of Mental Disorders. During the controversy over this proposal, several areas of research were examined: historical and cross-cultural studies, psychiatric features associated with homosexuality, emotional consequences of societal condemnation, and behaviors of other species.
He notes that adult-adult homosexuality does not involve the issues of harm and informed consent that adult-child sex involves, but that these issues are within the domain of law rather than science or psychiatry. Thus, this article does not address the legal status of adult-child sex.
The author writes that the designation of puberty as the boundary line for erotic attraction to be a mental illness is arbitrary. He cites examples of cultures which accept or condone child-adult sex as a part of their cultural or religious traditions: the Siwans in North Africa, eighteenth century Hawaiians, Polynesians, Oceanians, Tahitians, the Etoro in New Guinea, and the Kaluli. While these are most likely not examples of pedophilia as a perferential attraction to children, the author asks why frequent sex with a child would not be classified as a mental illness in such circumstances.
He also notes that in England, until 38 years before World War I, the age of consent in England was 10. The age was then raised not due to outrage over pedophilia, but rather concerns over child prostitution which become common when child labor laws prevented children from earning money in other ways.
The author also cites cross-species research finding that among bonobos, primates that are genetically close to humans, nonfertile sexual combinations including same-sex and juvenile-adult combinations are as common as fertile combinations.
He then turns to personality features that are associated with pedophilia. He notes that almost all research involves unrepresentative criminal or patient samples. Nevertheless, when imprisoned pedophiles were compared to nonsexually deviant psychiatric patients and controls, no differences were found in the psychopahtic deviate scale of the MMPI.
On the other hand, when compared with offenders against adolescents and adults, offenders against children have been found to have higher levels of social alienation, difficulty with interpersonal relations, trait anxiety, and anger, and lower levels of self-esteem. Anxiety and mood disorders have also been found among pedophiles receiving treatment. However, it is not known whether these characteristics are causes or social consequences of pedophilia.
A unique British study of 77 nonprisoner, nonpatient pedophiles found that they were more introverted than normal, and measures of psychoticism and neroticism were slightly elevated. However, levels were not pathological; they were similar to those of doctors, architects, actors, and students. The researchers concluded, as have others, that pedophiles are surprisingly normal on major personality measures.
In addition, sexual interest in children may be more common than realized. Two studies of university males found over 20% reported some sexual attraction to small children. Three other studies of normal volunteer males found 17-25% exhibited arousal to children or adolescents equal to or greater than arousal to adults, and one found that average males showed 50% as much arousal to prepubescent girls as to adults.
The author then describes the history of pedophilia in various editions of DSM, describing it as "a trip through Alice's Wonderland." Pedophilia was originally labeled as "sociopathic" due to its conflict with societal mores. In 1968 it was no longer listed as sociopathic, but as a nonpsychotic mental disorder. Then in 1980 it was listed as a paraphilia and defined as sexual activity or fantasy with children as the repeatedly preferred or exclusive method of achieving sexual excitement. Seven years later, the requirement that it be repeatedly preferred or exclusive was dropped. The current 2000 definition requires that the person has acted on his sexual feelings or they cause marked distress or interpersonal difficulty.
In 1984, Suppe wrote that the inclusion of "sexual paraphilias" in DSM has reinforced the suspicion that they are not mental disorders, but rather conflicts between an individual and society: "psychiatry has resorted to the codification of social mores while masquerading as an objective science."
The general criteria for a mental disorder in the current DSM require that it be associated with distress or disability or a significantly increased risk of suffering. The DSM also states that "Neither deviant behavior (e.g.,...sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual." Thus, a pedophile who is not distressed by his sexual feelings except in response to public condemnation would not qualify for a disorder. However, elsewhere, the current DSM says:
many individuals with pedophilic fantasies, urges, or behaviors do not experience significant distress. It is important to understand that experiencing distress about having the fantasies, urges, or behaviors is not necessary for a diagnosis of Pedophilia. Individuals who have a pedophilic arousal pattern and act on these fantasies or urges with a child qualify for the diagnosis.
The author writes:
So what then of the pedophile who does not act on the fantasies or urges with a child? Where does the DSM leave us? In Wonderland. If a person does not act on the fantasies or urges of pedophilia, he is not a pedophile.
The APA position with its DSM catalogue is logically incoherent...If a person's erotic fantasies are primarily of children and masturbatory imagined partners are children, that person does not have a mental illness...Never mind these mental processes, those readers of DSM who are psychiatrists and treaters of the disordered mind. These people with these fantasies do not have a mental disease unless that person translates thought into action. This turns psychiatry on its head. Certainly a society can set rules on sexual conduct and proscribe child-adult sex and invoke sanctions for tansgressors. But that is the province of the law and the penal system. The DSM should not provide psychiatry with jurisdiction over an act any more than it should provide the law with jurisdiction over a thought.
Sexual arousal patterns to children are subjectively reported and physiologically demonstrable in a substantial minority of "normal" people. Historically, they have been common and accepted in varying cultures at varying times. This does not mean that they must be accepted culturally and legally today. The question is: Do they constitute a mental illness? Not unless we declare a lot of people in many cultures and in much of the past to be mentally ill. And certainly not by the criteria of DSM.