Pedophilia: causes, symptoms, diagnosis, treatment

Pedophilia is the preferred choice for sexual actions of pre-pubertal children. Pedophilia often leads to imprisonment; medical treatment should include pharmacotherapy and psychotherapy.

Sexual crimes against children constitute an essential part of registered criminal sexual acts. It is believed that the age of a person with pedophilia is 16 years and older, with the difference in age between the offender and the child 5 years or more. The child's age is usually up to 13 years. For older teens with pedophilia there are no established differences in age; it depends on the clinical and judicial decision.

Most pedophiles are men. Pedophiles prefer children of the opposite sex to children of the same sex in a ratio of 2: 1. In most cases, an adult knows the child and can be a member of his family, stepfather or a person enjoying authority. Examination and touching are more common than genital contact. Homosexual men usually have less familiarity with the child. Some pedophiles have an attraction only for children; a number of pedophiles may be attracted to adults.

[1], [2], [3], [4]

Incest

Some pedophiles limit their sexual activity to their own children or close relatives.

Incest is a crime committed in the case of coitus (vaginal sex) of a man with a woman who is with him in the first degree of kinship, provided that the man is aware of what he is doing. Since coitus is necessary for assigning a crime to incest, only 1% of sexual crimes against children fall into this category. Most often they qualify as obscenity towards the child or as an obscene attack. However, we should not exclude the possibility of an underestimation of the number of cases of vaginal sex with children within the family, since often the perpetrator prefers to admit his guilt over a less serious charge in order to avoid the charge of a more serious crime. In the absence of other judicial evidence, this may be the assertion of the child against the confirmation of the accused. Although most incest convictions concern incest between father and daughter, sexual relations between brothers and sisters are the most common. In 65% of cases of incest, girls aged 10-15 are involved in them (13). In recent years, cases of sexual abuses of mothers with regard to their young sons have been increasingly recognized. 20% of such victims are under the age of 4 years, and 70% are between 4 and 10 years old. The most common form of behavior on the part of a woman is stroking the child's genitals and oral sex. The least common is vaginal sex, as, indeed, in the case of intra-family sexual abuse by men. However, this behavior should also be considered in the context, and it should take its place among the studied phenomena. In 1993, only 12 women were imprisoned for crimes of a sexual nature in the United Kingdom.

The number of reported cases of incest decreased from 444 in 1986 to 183 in 1997. Criminal statistics do not take into account the age of victims of sexual crimes, with the exception of the gross obscenity of the child (1,259 in 1977) and the unlawful sexual intercourse with a girl under the age of 13 and under 16 (respectively 148 and 1,112 in 1997). According to the study, specialists of the Ministry of Internal Affairs came to the conclusion that the level of sexual crime against children is much higher than previously thought.

Previously, there was a distinction between intra-family criminals and criminals from outside. But as it turned out that 20 to 33% of "intramuscular" sex offenders show sexual arousal at the sight of children, which indicates a pedophilic attraction, this division is not currently considered valid. More than 80% of those who committed sexual crimes against children are either their relatives (13%) or familiar with it (68%). One third of these criminals are teenagers.

The UK Ministry of the Interior commissioned an evaluation of the effectiveness of community-based sexual offender treatment programs - the so-called STEP project (Sexual Offender Treatment Evaluation Project). It turned out that almost 90% of the studied criminals committed crimes against children. In general, researchers described this group as "isolated, isolated individuals who are not self-confident, usually unable to defend their interests, who are also unable to cope with their own negative emotions, nor are they able to assess the emotional distress of the victims of their criminal behavior." They compared the criminals from the family and from the outside. It was found one difference between these groups - the level of emotional congruence with children. A more detailed description will follow below. The researchers did not classify criminals on their connection with the victim, they found it more reliable to divide all persons who committed sexual crimes against children into groups with high and low deviation. In the group with a high degree of deviance, the following characteristics are distinguished:

1. They committed crimes both inside and outside the family.
2. They committed crimes against boys and against girls.
3. Among them, the probability of past crimes of a sexual nature is doubled.
4. For them, there was a high risk of repeated convictions on the Thornton Scale.
5. They were more likely than others to have been abused during their childhood.

Pedophiles, many of whom have an antisocial personality disorder, can use the force or threat of physical harm to a child or his pets if violence opens up. The course of pedophilia is chronic, and criminals often develop substance abuse or dependence, depression, family conflict. Many cases of violence against children are observed in the context of substance misuse or serious family problems.

Identifying a pedophile often constitutes an ethical issue for the doctor. The doctor should try to protect the patient's secret, but at the same time he must protect the children. The doctor needs to know the legal requirements for such messages.

Treatment of pedophilia

Long-term individual or group psychotherapy is usually necessary and can be particularly useful as part of multimodal treatment, which includes training of social skills, treatment of comorbid physical and mental disorders (eg, epilepsy, attention deficit disorder, depression) and drug therapy. Treatment is less effective if carried out by court decision, although many convicted of sexual crimes experience improvement from treatment, such as group psychotherapy and the appointment of antiandrogens.

In the US, the drug of choice is medroxyprogesterone intramuscularly; in Europe, cyproterone is used. The usual doses are 200 mg of medroxyprogesterone intramuscularly 2 to 3 times a week for 2 weeks, then 200 mg 1-2 times a week for 4 weeks, then 200 mg every 2-4 weeks. It is necessary to monitor the level of testosterone in the blood and maintain it in normal female boundaries (<62 ng / dL). Treatment is usually lengthy, since deviant fantasies usually return after weeks or months after discontinuation of treatment. Gonadotropin-releasing hormone (eg, leiprolide, gosarelin) drugs are also used intramuscularly. The effect of the appointment of antiandrogen to female pedophiles has been proved insufficiently. In addition to antiandrogens, the use of SSRIs (for example, high doses of fluoxetine 60-80 mg once daily or fluvoxamine 200-300 mg 1 time per day) may be helpful. Medications are most effective if used as part of a multimodal treatment program.