Research: A "cure" for pedophilia?

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Attempts to "treat" pedophilia are ineffectual and in many cases harmful. It's important to point out that pedophilia is the direction of one's sexuality, not the intensity of one's sexual interest. While there are drugs that can reduce sexual desire, reorientation is not possible.

Treatment

Efficacy

• Stelzmann, D., Jahnke, S., & Kuhle, L. F. (2022). Media Coverage of Pedophilia and Its Impact on Help-Seeking Persons with Pedophilia in Germany - A Focus Group Study. International Journal of Environmental Research and Public Health 19 (15), DOI: 10.3390/ijerph19159356

  “Both sexual preferences for prepubescent (pedophilia) and pubescent (hebephilia) children are only considered pathological if the sexual attraction to children resulted in previous sexual offending against children, or causes significant distress and/or interpersonal difficulties (pedophilic disorder or unspecified paraphilic disorder [10]). Currently, there is little evidence showing that the sexual attraction to children can be “cured” in the sense that it can be converted into a sexual attraction to adults (teleiophilia; overview see [23]). Therefore, preventive treatment often focuses on behavioral control and/or the reduction of psychological distress.”

• Berlin, Fred S. (2000). "Treatments to Change Sexual Orientation," American Journal of Psychiatry, 157, p. 838.

  "It may be no easier for a person with pedophilia to change his or her sexual orientation than it is for a homosexual or heterosexual individual to do so."

• Howitt, D. (1995). "The Treatment of Paedophiles," in Paedophiles and Sexual Offences Against Children, pp. 189-192.

  "Many of the early behaviour therapy treatments for paedophilia emerged from attempts to make homosexuals "normal" or, at least, stop "doing their thing". [...] As we will see, there is a degree of uncertainty about the effectiveness of even the best researched therapies for paedophiles. There are a number of reasons for this. Many of the therapies have not been subject to specific empirical evaluation of any sort; some have been tried with only a few clients. Often the criteria of therapeutic success have fallen well short of evidence of a decline in recidivism in offending, obviously one of the most important criteria. Research that includes a control or an alternatively treated group is in the minority of the evaluations. With a situation like this, claims of therapeutic success may sometimes be wishful thinking on the part of the clinician, the client or both."

• Van-Zessen, G. (1990). "A model for group counseling with male pedophiles," Journal of Homosexuality, 20(1-2), 189-198.

  "The majority of the reported studies have roots in behavior therapy. The early behavioral approaches were aimed at reducing the deviant sexual arousal by aversion therapy (Quinsey et al., 1976). The attraction to children is viewed as purely sexual (Howells, 1979). In its simplest form, the child is the stimulus that elicits sexual excitement in the adult (Quinsey et al., 1975). All other motivations and meanings of pedophile attraction are ignored. [...] In an overview of the literature concerning homosexual conversion therapies, James (1978) concluded that the majority of studies were unsuccessful in changing sexual orientation. It is likely that the same holds for pedophile conversion therapy."

• Seto, M. (2009). "Pedophilia," Annual Review of Clinical Psychology, 5, 391-407.

  "There is no evidence to suggest that pedophilia can be changed. [...] Across the following interventions, the underlying assumption is that pedophilia is a stable sexual preference that is unlikely to change, just as there is little, if any, evidence that heterosexual or homosexual orientation can be changed. Recent etiological research on neurodevelopmental correlates of pedophilia—including cognitive functioning, non-right-handedness, and structural volume differences—suggests that pedophilia is influenced by prenatal factors and thus is unlikely to respond to interventions delivered when the individual is an adult (e.g., Cantor et al. 2008)."

• Quinsey, V. L. (2008). "Seeking Enlightenment on the Dark Side of Psychology," Trauma, Violence, & Abuse, 9(2), 72-83.

  "Sexual age and gender preferences do not appear to be learned and malleable (e.g., our attempts to increase sexual arousal of normal subjects to slides of women through Pavlovian conditioning by pairing the slides with highly arousing videotapes were vitiated by habituation; Lalumière & Quinsey, 1998). Although sexual age and gender preferences can be measured with phallometric technology (for reviews of the assessment and treatment literature on sexual offenders against children, see Camilleri & Quinsey, in press; Quinsey & Lalumière, 2001) and responses to deviant categories can be reduced with standard conditioning techniques, these alterations now appear not to involve the preferences themselves but only their measurement. Fifty years after Kinsey et al. (1953) wrote the passage quoted at the beginning of this section, it appears that the role of learning in the development of sexual age and gender preferences is limited or nonexistent (for a review, see Quinsey, 2003)."

• Berlin, Fred S., Saleh, Fabian M., and Malin, H. Martin (2009). "Mental Illness and Sex Offending," in Sex Offenders, p. 124. Oxford University Press US.

  "In the past, efforts to "recondition" homosexuality were a clear failure. The same would appear to be true of methods intended to "recondition" paraphilic conditions such as pedophilia."

• Camilleri, Joseph A., and Quinsey, Vernon L. (2008). "Pedophilia: Assessment and Treatment," in D. Richard Laws and William T. O'Donohue (eds.), Sexual Deviance, Second Edition.

  "The greatest problems with conditioning approaches (and other approaches described later) are (1) that changing actual preferences (as opposed to indices that reflect them) has been quite difficult (Furby, Weinrott, & Blackshaw, 1989; Lalumière & Quinsey, 1998); and (2) no studies have shown long-term changes in sexual preference or behavior after treatment (Laws, 2001; Quinsey & Earls, 1990). [p. 193] [...] Despite the strong relationship between neurobiological variables in sexual behavior and treatment, reducing general arousal does not alter sexual preference. Researchers found that men with phallometrically measured deviant sexual interests had the same preferences after hormonal treatment (Bancroft, Tennent, Loucas, & Cass, 1974; Cooper, Sandhu, Losztyn, & Cernovsky, 1992). [...] It appears as though treatment for paraphilias works by decreasing sexual interest in general, suggesting that medical treatments do not "cure" the sexual preference but mask it by reducing sexual desire. [p. 200]"

• 12/11/06 deposition of Michael B. First, M.D., in In Re the Detention of William Davenport AKA William Cummings, Franklin County, Washington, No. 99-2-50349-2.

  "I was the editor of the DSM-IV-TR. DSM-IV-TR was published in the year 2000. I was also the editor of the text and criteria of its immediate predecessor, which was the DSM-IV. [p. 9] [...] If you're attracted to children at age 13 you’re going to be attracted to children at age 70. [...] The fact that that's your focus of arousal remains constant. [...] The percentage of time you think about that would decline. [...] The time you spend masturbating thinking about that will go down, and the actual paraphilic behaviors go down, but the core of the paraphilia is present for life. There's no evidence, even when you have successful treatment of an individual paraphilia, which actually treating is the intensity of the paraphilia, not the arousal pattern. I don't believe there’s strong evidence that you could actually get someone who is attracted to children to lose [his or her] attraction. [p. 230]"

• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.), p. 698.

  "Adult males with pedophilic disorder may indicate that they become aware of strong or preferential sexual interest in children around the time of puberty — the same time frame in which males who later prefer physically mature partners became aware of their sexual interest in women or men. [...] Pedophilia per se appears to be a lifelong condition."

• Seto, Michael (2012). "Is Pedophilia a Sexual Orientation?", Archives of Sexual Behaviour, 41, p. 233.

  "Pedophilia is viewed by many researchers and clinicians as having a lifelong course. For some individuals, at least, it is discovered in early adolescence and sexual interest in children can be detected in adolescence (Seto, Lalumiere, & Blanchard, 2000; Seto, Murphy, Page, & Ennis, 2003); once identified, pedophilia can predict detected sexual behavior involving children up to 40 years later (Hanson, Steffy, & Gauthier, 1993). Changes in sexual arousal to children can be made using behavioral conditioning techniques, but follow-up studies have not shown evidence that this change generalizes outside the laboratory or persists over the longer-term."

Harm

• Gieles, Frans (2001). "Helping people with pedophilic feelings." Lecture at the 15th World Congress of Sexology, Paris, June 2001.

  "I have met clients who started this kind of treatment [to 'cure' their pedophilia] as a warm lively person and who have been changed into 'a stiff wooden doll' after it."

• Fog, Agner (1992). "Paraphilias and Therapy," Nordisk Sexologi, 10(4), pp. 236-242.

  Fog interviews a pedophile: "My sexual feelings for boys went away partially for about a year, and then at the end of the year I started waking up screaming and hollering with nightmares, and I would see a pitful of snakes and they were just everywhere and I would be screaming to get away from them. [...] 'Were your feelings towards boys reduced by the therapy?' They were reduced in the sense that my penis did not show the difference, but I still enjoyed being a teacher because I could be close to boys. I really don't think that feelings for boys or whoever we have feelings for has all that much to do with how much erection you have, but this is what they were reducing it to. [...] rather than destroy my feelings towards boys they destroyed me as an individual, it destroyed my security."

• Camilleri, Joseph A., and Quinsey, Vernon L. (2008). "Pedophilia: Assessment and Treatment," in D. Richard Laws and William T. O'Donohue (eds.), Sexual Deviance, Second Edition, p. 200.

  "Drawbacks unique to medical treatments for pedophilia include side effects and noncompliance. Commonly cited side effects include hypertension, hyperglycemia, feminization, depression, and headaches (Hill et al., 2003; Saleh & Guidry, 2003)."

• Johnston, Lucy, Hudson, Stephen M., and Ward, Tony (1997). "The suppression of sexual thoughts by child molesters: A preliminary investigation," Sexual Abuse: A Journal of Research and Treatment, 9(4), 303-319.

  "Ironically, attempted suppression may actually result in a worse situation compared to no attempts being made. The hyperaccessibility of formerly undesired thoughts has been documented in a number of studies. Once suppressed, unwanted thoughts have been shown to return and dominate mental life (Macrae et al., 1994; Wegner, 1989; Wegner & Gold, 1995). Once inhibitory mechanisms are relaxed this rebound effect may be pernicious, promoting the execution of maladaptive behaviors, such as binge eating. (Herman & Polivy, 1993) and, potentially, sexual offenses (Johnston, Ward, & Hudson, 1997). [...] However, prior suppression resulted in slower latencies for both the sex-related and the child-related words for the preferential child molesters than either the situational child molesters or the nonsexual offenders, who did not differ from one another. Thought suppression did, then, have greater subsequent effects on the preferential child molesters, as predicted. For some offender types at least, suppression results in greater accessibility of sex-related thoughts. Such rebound effects lead one to question the utility of thought suppression as a therapy technique."

Is pedophilia a choice?

• Berlin, Fred S. (2002). "Peer Commentaries on Green (2002) and Schmidt (2002): Pedophilia: When Is a Difference a Disorder?," Archives of Sexual Behavior, 31(6), 479-480.

  "It is likely that no one would choose voluntarily to develop a pedophilic sexual orientation. Those with such an orientation have no more decided to have it than have any of us decided as children to be either heterosexual or homosexual. Men with pedophilia get erections when fantasizing about children. Heterosexual men get erections when fantasizing about women. In neither case is that so because the individual in question has somehow decided ahead of time to program his mind to work in such a fashion. Persons with pedophilia have simply not chosen to experience an alternative state of mind."

• Fagan, Peter J.; Wise, Thomas N.; Schmidt, Chester W.; and Berlin, Fred S. (2002) "Pedophilia," Journal of the American Medical Association, 288, 2458-2465.

  "During psychosexual development, no one decides whether to be attracted to women, men, girls, or boys. Rather, individuals discover the types of persons they are sexually attracted to, ie, their sexual orientation."

Early development

• B4U-Act (2011). "Survey Results".

  "Question: Looking back now, how old were you when you first had a preferential attraction to boys or girls younger than yourself, whether or not you realized it at the time? Result: Of 192 respondents answering this question, the most common age of first attraction was 12. Eighty-five percent began to experience the attraction while still minors themselves."

• Freund, K. & Kuban, M. (1993). "Toward a testable developmental model of pedophilia: The development of erotic age preference," Child Abuse & Neglect, 17, 315-324.

  "[A] greater proportion of pedophiles than of individuals who prefer physically mature partners remembers curiosity in their own childhood to see nude children without remembering such curiosity in regard to adults. This suggests that in a substantial proportion of pedophiles the occurrence of this paraphilia is predetermined at a very early developmental phase." (From abstract.)

• Griesemer, Michael M. (2004). Ausmass und Auswirkungen massenmedialer Desinformation zum Stand der Wissenschaften über sexuellen Kindesmissbrauch. Ipce translation.

  "Rather, we see another astonishing fact: on the same age in pre-puberty, on which the attraction to boys or girls was reported, already the nine years olds of both groups differ. The later pedophiles distinguish themselves from the control group because their objects of attraction are dramatically younger then themselves -- on the average two years younger, while the later non-pedophiles tend to feel attracted to older children -- on average 10.8 years of age.

  Given the data, as now gathered, one might conclude that pedophilia develops itself already on a pre-pubertal age -- although we don't know how."

Mental health services for MAPs

Attraction does not require treatment, but MAPs often need help in improving their mental well-being. Mental health services and professionals may face the following challenges: high levels of anxiety, depression and other conditions in MAP, severe stigma (for both clients and those who provide compassionate approach), preventionism, attempts at conversion therapy, difficulties in choosing the right therapeutic targets (discrepancies between lay professional beliefs and client's needs), ethics of communication with the client, mandatory reporting laws

• Lievesley, R., Harper, C. A., Swaby, H. and Woodward, E. (2022) Identifying and working with appropriate treatment targets with people who are sexually attracted to children. Journal of Sex & Marital Therapy. DOI: 10.1080/0092623X.2022.2149437

"The importance of addressing mental health issues is best highlighted by looking at the prevalence of suicidal ideation and intention among MAPs, with around 40% admitting to experiencing chronic suicidal ideation (Cohen, Ndukwe, Yaseen, & Galynker, 2018; Cohen et al., 2020). Research has also shown how MAPs experience high rates of anxiety, depression, and self-hatred (e.g., Jahnke et al., 2015; Lievesley et al., 2020; Stevens & Wood, 2019). Thought suppression is common among MAPs, with this taking many forms, including the active avoidance of children and potential reminders of minor attraction (Lievesley et al., 2020) or through problematic levels of substance use (Stevens & Wood, 2019; Walker, 2021). Such behavior often leads MAPs to become socially isolated and lacking in emotional and social supports (Elchuk, McPhail, & Olver, 2022; Jahnke et al., 2015)."

"this finding suggests that the most pressing problems that MAPs believe are present in their lives relate to the emotional responses that they experience in relation to their sexual attractions, and not in relation to their (lack of) potential propensities to act on these".

"we have also identified one potential treatment-related construct—self-compassion [...] with decreased self-compassion being associated with a greater need to address mental health and stigma-related concerns, increased sexual frustration, and a desire to change one’s sexual attraction patterns."

"The observation that lower levels of self-compassion were associated with an increased desire to control or change one’s attractions to children is perhaps indicative of the internalization of stigma (see Jahnke et al., 2015; Lievesley et al., 2020). [...] low levels of self-compassion might lead to unattainable treatment targets, and thus self-compassion and self-acceptance may be an important treatment aim when working with MAPs."

• Schaefer, A., Wittenberg, A., Galynker, I. and Cohen, L.J. (2022) Qualitative Analysis of Minor Attracted Persons’ Subjective Experience: Implications for Treatment. Journal of Sex and Marital Therapy. DOI: 10.1080/0092623X.2022.2126808

"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."

• Mundy, C. (2022). 10 years later: Revisiting Seto’s (2012) conceptualization of orientation to sexual maturity among pedohebephilic persons. The Canadian Journal of Human Sexuality. DOI:10.3138/cjhs.2022-0006

"As noted by researchers and clinicians in this area, there are clear clinical implications associated with a shift in the conceptualization of sexual attraction to children. [...] Despite resistance to such conceptualizations, the findings indicate that orientation to sexual maturity closely mirrors the developmental trajectory of gender sexual orientation, as outlined in Seto’s seminal paper."

excerpted from B4QR:

"Mundy explains that the conceptualization of attraction to minors as a sexual orientation is not of purely theoretical interest but can have important implications for treatment approaches.[...] Mundy cites studies showing that attraction to minors should be approached through acceptance and strengths-based practices that inculcate resilience and self-efficacy, as attempts to reduce or eliminate attraction to minors have not proven effective or beneficial to minor-attracted people."

See also

• Preventionism

Excerpt Graphic Library

The EGL on Pedophilia and Hebephilia characteristics contains some useful information re efficacy and effects of treatments.

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  A warning about the political nature of Psychiatry
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  Moser and Kleinpatz - Paraphilia is a questionable concept
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  Haeberle on paraphilia
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  Americal Psychiatric Assiciation's DSM-5 Manual says pedophilia can be an orientation
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  Charles Moser on the subsequent coverage and bumbling by the APA
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  DSM-5 another graphic
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  Some chronophilias
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  Seto - extended chronophilias
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  High Emotional Empathy (Schuler et al, 2019)
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  Mirkin on methodological flaws and gay analogy
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  Gaither: How does the idea of pedophilia as an orientation stand against the evidence?
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  Blanchard/DSM debate opinions on drawn material - relevant to Lolicon-MAP Equivalence Debate
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  Sociocultural perspective on pedophilia as a disorder - Chenier
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  Orientation or Disorder?
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  Development of pedophilia, choice and abused-abuser myths
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  The myth of psychopathy
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  Retarded or perturbed pedophile myth
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  Nonsexual aspects
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  Non-offending pedophilia and impulse control
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  The efficacy and consequences of attempts to treat Pedophiles
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  2017 UK Gov review of attempts to reform sex offenders via "treatment"
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  Dutch Rapporteur: "On Solid Ground" Prevalence of pedophilia in a criminal sample, broken down
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  Lievesley/Lapworth 2021 - State of play with female MAPs
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  Even in an online sample of MAPs (biased towards low AoAs), hebephilia is very common.
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  Hebephilia is also common in the gen-pop
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  Neoteny - a review (source unknown)
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  Rind and Yuill on adaptive hebephilia
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  Rind and Yuill (cont'd)
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  Rind and Yuill (cont'd)
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  Rind and Yuill (cont'd)