Pedophilic disorder

Essential (Required) Features:

• A sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children.
• The individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them.
• The diagnosis does not apply to sexual arousal and accompanying behaviour between pre- or post-pubertal children who are close in age.

Additional Clinical Features:

• Pedophilic Disorder should not be diagnosed among children and should be diagnosed only with utmost caution among adolescents. Sexual experimentation is typical during adolescence and sexual acts may occur impulsively or opportunistically rather than representing a recurrent pattern of sexual arousal.
• The diagnosis of Pedophilic Disorder is generally not adequately supported when the evidence indicating a sustained, focused and intense pattern of sexual arousal consists solely of a single or very limited number of instances of pedophilic behaviour, as there may be other explanations for specific occurrences (e.g., intoxication, opportunity). In the absence of a report of the individual’s sexual thoughts, fantasies, or urges, examples of other forms of evidence supporting the presence of a pedophilic arousal pattern include a preference for specific types of pornography; preference over other forms of sexual behaviour; planning and repeatedly seeking out opportunities to engage in pedophilic behaviour; or the results of viewing time measures and/or penile plethysmography.
• Some individuals with Pedophilic Disorder are attracted only to males, others only to females, and others to both.
• Some individuals act on their pedophilic urges only with family members, while others have victims outside their immediate family or both.

Boundary with Normality (Threshold):

• A broad range of sexual behaviour with peers may occur in children or adolescents. A diagnosis of Pedophilic Disorder should not be assigned on the basis of sexual behaviours among pre- or post-pubertal children or adolescents with peers who are close in age.

Course Features:

• Individuals with Pedophilic Disorder often report the onset of pedophilic sexual interest during adolescence.
• Pedophilic Disorder is relatively stable after young adulthood, but sexual thoughts, fantasies, urges, and behaviours may change over time such that an individual who was assigned a diagnosis of Pedophilic Disorder no longer meets the diagnostic requirements.

Developmental Presentations:

• Advancing age may be associated with decreasing paraphilic sexual arousal and decreasing behavioural manifestations of Pedophilic Disorder due to increased impulse control and decreased sexual drive.

Culture-Related Features:

• Cultures vary in their legal definition of what constitutes a child or adolescent. The Tanner stages, a scale of physical development including primary and secondary sexual characteristics across the lifespan, may provide a more objective basis than age on which to base a definition.
• Cultures vary regarding the forms of affection that are considered appropriate between children and adults. For example, it is normative in some cultures for parents to kiss their children on the mouth as a sign of affection. Culturally normative behaviour should not be misattributed as inappropriate sexual activity.

Sex- and/or Gender-Related Features:

• Pedophilic Disorder is much more common in men.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Compulsive Sexual Behaviour Disorder: Both Pedophilic Disorder and Compulsive Sexual Behaviour Disorder may involve repetitive sexual impulses, urges or behaviours that result in marked distress or impairment. Pedophilic Disorder is characterized by sexual impulses, urges, or behaviours that are manifestations of a sustained, focused and intense pattern of sexual arousal involving pre-pubertal children. In contrast, Compulsive Sexual Behaviour Disorder is characterized by a persistent pattern of failure to control sexual impulses, urges, or behaviours, regardless of the focus of sexual arousal. If an individual with Pedophilic Disorder is able to exercise some degree of control over the behavioural expressions of the arousal pattern, an additional diagnosis of Compulsive Sexual Behavioural Disorder is generally not warranted.
• Boundary with Obsessive-Compulsive Disorder: Some individuals with Obsessive-Compulsive Disorder experience intrusive thoughts and images about possible attraction or sexual abuse of children. These are typically highly distressing to the individual and are not accompanied by sexual arousal, so do not reflect an underlying paraphilic arousal pattern even though the individual may be concerned that they do. These individuals may also experience other ego-dystonic thoughts or images with sexual content that are not experienced as sexually arousing.
• Boundary with Disorders Due to Substance Use: Episodes of impulsive or disinhibited sexual behaviour, including pedophilic behaviour, may occur during substance intoxication. Such episodes may not be a manifestation of a sustained, focused, and intense sexual arousal pattern. At the same time, some individuals with Pedophilic Disorder may use substances with the intention of engaging in pedophilic behaviour that does reflect an underlying paraphilic arousal pattern. A diagnosis of Pedophilic Disorder may be assigned together with a Disorder Due to Substance Use if the diagnostic requirements for both disorders are met.
• Boundary with other mental disorders: The occurrence or a history of sexual behaviours involving pre-pubertal children is not sufficient to establish a diagnosis of Pedophilic Disorder. Rather, these behaviours must reflect a sustained, focused, and intense pattern of pedophilic sexual arousal. When this is not the case, other causes of the behaviour need to be considered. For example, sexual behaviours involving children that do not reflect an underlying, persistent pattern of pedophilic sexual arousal may occur in the context of some mental disorders, such as Bipolar Type I Disorder during Manic or Mixed Episodes or Dementia.
• Boundary with sexual crimes that do not involve a Paraphilic Disorder: Sexual crimes involving pedophilic behaviour may consist of actions or behaviours that are not associated with a sustained underlying paraphilic arousal pattern. Rather, these behaviours may be transient and occur impulsively or opportunistically. The diagnosis of Pedophilic Disorder requires that these behaviours be a manifestation of a sustained, focused, and intense pattern of sexual arousal.
• Boundary with sexually aggressive behaviour in adolescents: Some adolescents present with a history of sexually abusing younger children. The diagnosis of Pedophilic Disorder should be applied with caution to adolescents. Unless there is a persistent pattern of such behaviour, reflecting a sustained, focused, and intense pattern of sexual arousal focused on pre-pubertal children, the diagnosis of Pedophilic Disorder is not appropriate.