sexually mature minors are unlikely to be pedophiles,
though they may be engaging in illegal behavior given
a jurisdiction’s legally defined age of sexual consent.
Pedophilia is probably the best-understood para-
philia, given society’s concerns about preventing
children from becoming victims of sexual offenses.
Pedophilia is an important motivation for sexual
offending against children, but the two concepts are
not synonymous: Some pedophiles have no known
history of sexual contacts with children, and perhaps
half the sex offenders against children are pedophiles.
Most of what we know about pedophilia is based on
research on adult males and samples recruited in clin-
ical or correctional settings. We know little about female
pedophiles, though some women meet the diagnostic
criteria, and we know relatively little about pedophiles
who are not involved in clinical services or who have
not been criminally charged for sexual offenses involv-
ing children. Pedophiles are much more likely to be
male; otherwise, pedophiles are a heterogeneous group
with regard to characteristics such as education level,
occupation, and socioeconomic status. The prevalence
of pedophilia in the general population is not known
because epidemiological surveys of sexuality have not
included the pertinent questions about the frequency
and intensity of sexual thoughts, fantasies, urges, arousal,
or behavior regarding prepubescent children.Assessment and Diagnosis
Pedophilia can be diagnosed on the basis of self-report,
sexual history, and penile responses. Self-report is the
simplest and most direct source of information, but
it is limited by individuals being reluctant to admit
to pedophilia. Among sex offenders, pedophilia is pos-
itively associated with having boy victims, multiple
child victims, younger child victims, or unrelated child
victims and the possession of child pornography and is
negatively associated with the number of adult sexual
partners. One of the most consistent assessment research
findings is that pedophilic men (such as sex offenders
with many unrelated child victims) can be distin-
guished from other men in their penile responses when
presented with sexual stimuli depicting children or adults
during phallometric testing.
Phallometric testing involves the recording of
changes in penile circumference or volume as men are
presented with audiotaped or visual stimuli. Penile
responses are more specific to sexual arousal thanother psychophysiological parameters such as skin
conductance, heart rate, and pupil dilation. For
pedophilia, the measure of interest is how much a man
responds to stimuli depicting children compared with
stimuli depicting adults. Because the overall penile
responsivity can vary for many reasons, including the
man’s age and health and the amount of time since he
last ejaculated, an index of relative response is more
informative than absolute responses. For example, inter-
preting the responses of an individual who exhibits a
10-mm increase in penile circumference in response to
pictures of children is possible only when we know
whether he exhibits a 5-or a 20-mm increase, for exam-
ple, in response to pictures of adults. The first set of
responses is from someone who is more sexually aroused
by children than by adults, indicating a sexual prefer-
ence for children; the second pattern of responses is
from someone who is more sexually aroused by adults
than by children, indicating a sexual preference
for adults.
Using cutoff values that produce high specificity
among nonpedophilic men (e.g., community volun-
teers, offenders who have committed only nonsexual
crimes), the sensitivity of phallometric testing among
men who deny pedophilia is approximately 60% using
optimal procedures and stimuli. The sensitivity is
approximately 90% among men who admit pedophilia.
Specificity refers to the proportion of nonpedophilic
men identified as such by the phallometric test, while
sensitivity refers to the proportion of sex offenders
against children who are identified as pedophilic.
Phallometrically assessed sexual arousal by children is
one of the strongest single predictors of sexual recidi-
vism in quantitative reviews of sex offender follow-
up research.
Studies have also shown that pedophiles and sex
offenders with child victims can be distinguished
from other men in the unobtrusively recorded amount
of time they look at pictures of children relative to pic-
tures of adults. No studies have yet demonstrated,
however, that viewing-time measures predict sexual
recidivism.
There are challenges in making the diagnosis of
pedophilia. The Diagnostic and Statistical Manual
(fourth edition, text revision; DSM-IV-TR) diagnostic
criteria have not been rigorously evaluated for interrater
or test-retest reliability, and different assessment meth-
ods may identify overlapping but nonidentical groups
of men as pedophiles. In addition, many phallometric548 ———PedophiliaP-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 548