Table of Contents

Pedophilic Disorder

Pedophilic Disorder

Table of Contents

Pedophilic Disorder

Primer

Epidemiology

Prognosis

Comorbidity

Risk Factors

DSM-5 Diagnostic Criteria

Criterion A

Criterion B

Criterion C

Criterion D

Criterion E

Criterion F

Specifiers

Episode Specifier

Severity Specifier

Specify if:

Signs and Symptoms

The likelihood of pedophilic disorder is diagnosed if there are multiple victims (likelihood increases with each victim), male victim (almost all pedophilic), non-cohabiting victims, pre-pubescent victims, child pornography offences, and/or positive phallometric testing.

Screening Tools and Scales

Pathophysiology

Differential Diagnosis

Investigations

Phallometric Assessment

Phallometric assessment, also known as penile plethysmography (PPG) is an investigation that measures changes in penile volume measured in response to visual stimuli (sensitivity of 55%, specificity of 96%, i.e. - if positive then very likely to have pedophilic disorder, but if negative it does not rule it out).^[1]
The investigation involves a comparison of relative level of response by the individual and this is compared with sample of sex offenders.
Penile erectile responses are reflective of arousal, and erectile responses in the laboratory setting are reflective of what would occur in the community (arousal is related to the risk for offending)

Treatment

See also:

Treatments for pedophilic disorder have been controversial due to various societal, cultural, and legal concerns. Additionally, there are few high quality research studies, and many obvious ethical concerns limit the study of treatments.

Psychotherapy

Cognitive-behaviour therapy and relapse prevention principles may have some evidence, with a specific focus on cognitive distortions, the offence cycle/cognitive-behavioural chain, responsibility, and empathy for victims. Relapse prevention is often a focus of these programs.
Individuals often receive these program while in custody and last between 1 to 2 years; for outpatients this may last between 12 to 16 weeks.

Pharmacotherapy

Since testosterone strongly influences sex behaviour in both males and females, anti-androgen therapy is the primary method of pharmacological treatment. This includes:
- Medroxyprogesterone (MPA)^[2]
- Cyproterone acetate (CPA)
- Leuprolide acetate (“chemical castration”)
Possible side effects from the use of these medications include weight gain (MPA), gallbladder/GI dysfunction, testicular atrophy/impaired sperm production, changes in insulin response (MPA), liver dysfunction (leuprolide/CPA), feminization (CPA), and/or bone demineralization (leuprolide/CPA)

Resources

For Patients

For Providers

Articles

Research

¹⁾ Leung, A. C., Christ, G. J., & Melman, A. (2004). Physiology of penile erection and pathophysiology of erectile dysfunction. Atlas of Male Sexual Dysfunction, 1-25.

²⁾ Meyer, W. J., Cole, C., & Emory, E. (1992). Depo provera treatment for sex offending behavior: an evaluation of outcome. Bulletin of the American Academy of Psychiatry & the Law.