poor parent-child attachment, social skills deficits,
and emotional regulation problems.Comorbidity
Pedophilia co-occurs with other paraphilias, such that
the prevalence of paraphilias is higher in a sample of
pedophiles than in the general population. Two studies
suggest that approximately one in six pedophiles has
engaged in exhibitionistic behavior, and approximately
one in five pedophiles has engaged in voyeuristic
behavior. Comorbidity of paraphilias has implications
for risk assessment and intervention because evidence
of any paraphilic behavior is significantly related to
sexual recidivism, and treatment may need to target
multiple paraphilias. This comorbidity also has impli-
cations for etiological theories because it suggests that
the factors influencing the development of one para-
philia may also influence the development of other
paraphilias. One implication of the neurodevelopmental
research mentioned earlier is that the nature, location,
and timing of perturbations (e.g., maternal malnutri-
tion,illness, exposure to toxins) might determine which
paraphilias emerge.Treatment
The most common approaches to the treatment of
pedophilia involve arousal conditioning, pharmaco-
logical sex drive reduction, or cognitive-behavioral
treatments designed to teach pedophilic sex offenders
how to identify risky situations and other situational
triggers that they can avoid or cope with in order
to avoid sexual contacts with children. The evidence
regarding these approaches is not strong, however.
Many clinicians and investigators assume that
pedophilia is a sexual disorder that can be managed
but not changed.
There is evidence that aversive conditioning is
effective in reducing sexual arousal by children, but it
is unclear how long such changes can be maintained
once the conditioning sessions have stopped. It is
likely that booster sessions are required to maintain
any treatment gains. The changes in sexual arousal
by children are unlikely to represent a change in
pedophilia; instead, participants learn to voluntarily
control their sexual arousal in the laboratory. The
hope is that this voluntary control can generalize out-
side the laboratory.Several randomized clinical trials suggest that some
medications can reduce sex drive and subsequently
reduce the frequency or intensity of sexual thoughts,
fantasies, urges, arousal, and behavior. Surgical castra-
tion can also reduce sex drive. Treatment attrition and
compliance are serious issues in the drug treatment of
pedophilic sex offenders, however, and castration
is controversial; it has not been demonstrated that
reduced sex drive leads to reductions in recidivism.
There is much debate as well about the efficacy of
cognitive-behavioral treatments for pedophilic sex
offenders. A recent meta-analysis of sex offender treat-
ment-outcome studies suggested that such treatments
are indeed effective, because there was a significant
difference between sex offenders in treatment versus
those in comparison conditions; however, the method-
ologically strongest study, California’s Sex Offender
Treatment and Evaluation Project (SOTEP), found no
significant difference between sex offenders randomly
assigned to treatment or to a control condition. There
was a nonsignificant trend for those who victimized
children to be more likely to re-offend after treatment
(22% of treated offenders and 17% of controls). In
light of these discouraging results, innovative treat-
ment approaches and rigorous evaluations are needed
if we are to make advances in the treatment of pedophilia.Michael C. SetoSee also Child Sexual Abuse; Rapid Risk Assessment for
Sexual Offense Recidivism (RRASOR); Sex Offender
Assessment; Sex Offender Civil Commitment; Sex
Offender Community Notification (Megan’s Laws); Sex
Offender Recidivism; Sex Offender Risk Appraisal Guide
(SORAG); Sex Offender Treatment; Sex Offender
Typologies; STATIC–99 and STATIC–2002 InstrumentsFurther Readings
Blanchard, R., Klassen, P., Dickey, R., Kuban, M. E., & Blak,
T. (2001). Sensitivity and specificity of the phallometric
test for pedophilia in nonadmitting sex offenders.
Psychological Assessment, 13,118–126.
Cantor, J. M., Blanchard, R., Robichaud, L. K., &
Christensen, B. K. (2005). Quantitative reanalysis of
aggregate data on IQ in sexual offenders. Psychological
Bulletin, 131,555–568.
Rice, M. E., Quinsey, V. L., & Harris, G. T. (1991). Sexual
recidivism among child molesters released from a
maximum security psychiatric institution. Journal of
Consulting and Clinical Psychology, 59,381–386.550 ———PedophiliaP-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 550