Skip to main content

Advertisement

Log in

Pedophilia: A Diagnosis in Search of a Disorder

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

This article presents a critical review of the recent controversies concerning the diagnosis of pedophilia in the context of the preparation of the fifth edition of the DSM. The analysis focuses basically on the relationship between pedophilia and the current DSM-IV-TR’s definition of mental disorder. Scholars appear not to share numerous basic assumptions ranging from their underlying ideas about what constitutes a mental disorder to the role of psychiatry in modern society, including irreconcilable theories about human sexuality, which interfere with reaching any kind of a consensus as to what the psychiatric status of pedophilia should be. It is questioned if the diagnosis of pedophilia contained in the DSM is more forensic than therapeutic, focusing rather on the dangers inherent in the condition of pedophilia (dangerous dysfunction) than on its negative effects for the subject (harmful dysfunction). The apparent necessity of the diagnosis of pedophilia in the DSM is supported, but the basis for this diagnosis is uncertain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1952). Diagnostic and statistical manual: Mental disorders. Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • American Psychiatric Association. (2011). Proposed revision for pedophilic disorder on DSM-5 web site. Retrieved December 25, 2011, from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=186#.

  • Arieti, S. E. (Ed.). (1967). American handbook of psychiatry. New York: Basic Books.

    Google Scholar 

  • Baltas, A. (2000). Classifying scientific controversies. In P. Machamer, M. Pera, & A. Baltas (Eds.), Scientific controversies: Philosophical and historical perspectives (pp. 40–49). New York: Oxford University Press.

    Google Scholar 

  • Bayer, R. (1981). Homosexuality and American psychiatry. New York: Basic Books.

    Google Scholar 

  • Berlin, F. S. (2002). Pedophilia: When is a difference a disorder? Archives of Sexual Behavior, 31, 479–480.

    Google Scholar 

  • Bernard, F. (1985). Paedophilia: A factual report. Rotterdam: Enclave.

    Google Scholar 

  • Bieber, I. (1987). On arriving at the American Psychiatric Association decision on homosexuality. In H. T. Engelhardt & A. L. Caplan (Eds.), Scientific controversies: Case studies in the resolution and closure of disputes in science and technology (pp. 417–436). Cambridge: Cambridge University Press.

    Google Scholar 

  • Blanchard, R. (2009). Reply to letters regarding pedophilia, hebephilia, and the DSM-V [Letter to the Editor]. Archives of Sexual Behavior, 38, 331–334.

    Google Scholar 

  • Blanchard, R. (2010). The DSM diagnostic criteria for pedophilia. Archives of Sexual Behavior, 39, 304–316.

    PubMed  Google Scholar 

  • Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M., Blak, T., et al. (2009). Pedophilia, hebephilia, and the DSM-V. Archives of Sexual Behavior, 38, 335–350.

    PubMed  Google Scholar 

  • Boletín Oficial del Estado. (2008). Proposición no de Ley presentada por el Grupo Parlamentario de Esquerra Republicana-Izquierda Unida-Iniciativa per Catalunya Verds, para que la apología a la pedofilia se tipifique como delito en el Código Penal [Proposal presented by the parliamentary group Esquerra Republicana-Izquierda Unida-Iniciativa per Catalunya Verds, for the characterization of apology of pedophilia as a crime in the Penal Code]. Boletín Oficial de las Cortes Generales. No. 62, pp. 7–8. Congreso de los Diputados. Spain. Retrieved February 23, 2010, from http://www.congreso.es/public_oficiales/L9/CONG/BOCG/D/D_062.PDF.

  • Brongersma, E. (1986). Loving boys (Vol. I). Elmhurst, NY: Global Academic Publishers.

    Google Scholar 

  • Brongersma, E. (1990). Loving boys (Vol. II). Elmhurst, NY: Global Academic Publishers.

    Google Scholar 

  • Bullough, V. L. (2002). Pedophilia and sexual harassment: Do they have similarities? Archives of Sexual Behavior, 31, 481–482.

    Google Scholar 

  • Cahill, L. S. (1987). On the connection of sex to reproduction. In E. E. Shelp (Ed.), Sexuality and medicine (pp. 39–50). Dordrecht: Reidel Publishing Company.

    Google Scholar 

  • Carson, R. C. (1991). Dilemmas in the pathway of the DSM-IV. Journal of Abnormal Psychology, 100, 302–307.

    PubMed  Google Scholar 

  • Conrad, P., & Schneider, J. W. (1980). Deviance and medicalization. From badness to sickness. London: Mosby.

    Google Scholar 

  • Cooper, R. (2005). Classifying madness. Dordrecht, The Netherlands: Springer.

    Google Scholar 

  • Culver, Ch. M., & Gert, B. (2006). Paraphilia. In A. Soble (Ed.), Sex from Plato to Paglia: A philosophical encyclopedia (pp. 740–747). Westport, CT: Greenwood Press.

    Google Scholar 

  • DeClue, G. (2009). Should hebephilia be a mental disorder? A reply to Blanchard et al. (2008) [Letter to the Editor]. Archives of Sexual Behavior, 38, 317–318.

    PubMed  Google Scholar 

  • Engelhardt, H. T., & Caplan, A. L. (Eds.). (1987). Scientific controversies: Case studies in the resolution and closure of disputes in science and technology. Cambridge: Cambridge University Press.

    Google Scholar 

  • Fink, P. J. (2005). Sexual and gender identity disorders: Discussion of questions for DSM-V. Journal of Psychology and Human Sexuality, 17, 117–123.

    Google Scholar 

  • First, M. B., & Frances, A. (2008). Issues for DSM-V: Unintended consequences of small changes: The case of paraphilias. American Journal of Psychiatry, 165, 1240–1241.

    PubMed  Google Scholar 

  • First, M. B., & Wakefield, J. C. (2010). Defining ‘mental disorder’ in DSM-V. Psychological Medicine, 40, 1779–1782.

    PubMed  Google Scholar 

  • Fog, A. (1992). Paraphilias and therapy. Nordisk Sexologi, 10, 236–242.

    Google Scholar 

  • Frances, A., & First, M. B. (2011). Hebephilia is not a mental disorder in DSM-IV-TR and should not become one is DSM-5. Journal of the American Academy of Psychiatry and the Law, 39, 78–85.

    PubMed  Google Scholar 

  • Frances, A. J., Widiger, T. A., & Pincus, H. A. (1989). The development of DSM-IV. Archives of General Psychiatry, 46, 373–375.

    PubMed  Google Scholar 

  • Franklin, K. (2009). The public policy implications of “hebephilia”: A response to Blanchard et al. (2008) [Letter to the Editor]. Archives of Sexual Behavior, 38, 319–320.

    PubMed  Google Scholar 

  • Franklin, K. (2010). Hebephilia: Quintessence of diagnostic pretextuality. Behavioral Sciences & the Law, 28, 751–768.

    Google Scholar 

  • Friedman, R. C. (2002). Pedophilia: Morality and psychopathology. Archives of Sexual Behavior, 31, 484–485.

    Google Scholar 

  • Fulford, K. W. M., & Thornton, T. (2007). Fanatical about “harmful dysfunction”. World Psychiatry, 6, 161–162.

    PubMed  Google Scholar 

  • Geller, J. L., Erlen, J., & Pinkus, R. L. (1986). A historical appraisal of America’s experience with “pyromania”. A diagnosis in search of a disorder. International Journal of Law and Psychiatry, 9, 201–229.

    PubMed  Google Scholar 

  • Gieles, F. (2001, June). Helping people with pedophilic feelings. Paper presented at the 15th World Congress of Sexology, Paris. Retrieved December 1, 2011, from http://www.helping-people.info/lecture.htm.

  • Goode, S. D. (2010). Understanding and addressing adult sexual attraction to children. London: Routledge.

    Google Scholar 

  • Green, R. (2002a). Is pedophilia a mental disorder? Archives of Sexual Behavior, 31, 467–471.

    PubMed  Google Scholar 

  • Green, R. (2002b). Rejoinder. Archives of Sexual Behavior, 31, 505–507.

    Google Scholar 

  • Green, R. (2010a). Sexual preference for 14-year-olds as a mental disorder: You can’t be serious!! [Letter to the Editor]. Archives of Sexual Behavior, 39, 585–586.

    PubMed  Google Scholar 

  • Green, R. (2010b). Hebephilia is a mental disorder? Sexual Offender Treatment, 1, Retrieved June 1, 2011, from http://www.sexual-offender-treatment.org/2-2010_01.html.

  • Gregory, I. (1961). Psychiatry: Biological and social. Philadelphia: Saunders Company.

    Google Scholar 

  • Hall, L. L. (2002). What patients and families look for psychiatric diagnosis. In J. Z. Sadler (Ed.), Descriptions and prescriptions: Values, mental disorders, and the DSMs (pp. 210–216). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Horn, D. G. (2003). The criminal body: Lombroso and the anatomy of deviance. New York: Routledge.

    Google Scholar 

  • Howitt, D. (1995). Paedophiles and sexual offences against children. Chichester, UK: Wiley.

    Google Scholar 

  • Kingston, D. A., Firestone, P., Moulden, H. M., & Bradford, J. M. (2007). The utility of the diagnosis of pedophilia: A comparison of various classification procedures. Archives of Sexual Behavior, 36, 423–436.

    PubMed  Google Scholar 

  • Klein, D. F. (1978). A proposed definition of mental disorder. In D. F. Klein & R. L. Spitzer (Eds.), Critical issues in psychiatric diagnosis (pp. 41–71). New York: Raven Press.

    Google Scholar 

  • Knight, R. A. (2010). Is a diagnostic category for paraphilic coercive disorder defensible? Archives of Sexual Behavior, 39, 419–426.

    PubMed  Google Scholar 

  • Krueger, R. B., & Kaplan, M. S. (2002). A favorable view of the DSM-IV diagnosis of pedophilia and empathy for the pedophile. Archives of Sexual Behavior, 31, 486–488.

    Google Scholar 

  • Kutchins, H., & Kirk, S. A. (1997). Making us crazy. DSM: The psychiatric bible and the creation of mental disorders. New York: The Free Press.

    Google Scholar 

  • Langström, N. (2009). The DSM diagnostic criteria for exhibitionism, voyeurism, and frotteurism. Archives of Sexual Behavior, 39, 317–324.

    Google Scholar 

  • Lautmann, R. (1994). Attraction to children. Hamburg: Ingrid Klein.

    Google Scholar 

  • Li, C. K. (1990). “The main thing is being wanted”: Some case studies on adult sexual experiences with children. Journal of Homosexuality, 20, 129–143.

    PubMed  Google Scholar 

  • Lilienfeld, S. O., & Marino, L. (1995). Mental disorder as a Roschian concept: A critique of Wakefield’s “harmful dysfunction” analysis. Journal of Abnormal Psychology, 104, 411–420.

    PubMed  Google Scholar 

  • Malin, H. M., & Saleh, F. M. (2007). Paraphilias: Clinical and forensic considerations. Psychiatric Times, 24(5). Retrieved January 8, 2012, from http://www.psychiatrictimes.com/display/article/10168-55266?pageNumber=3.

  • Marshall, W. L. (1997). Pedophilia: Psychopathology and theory. In D. Laws & W. O’Donohue (Eds.), Sexual deviance (pp. 152–174). New York: Guilford.

    Google Scholar 

  • Mayer-Gross, W., Slater, E., & Roth, M. (1954). Clinical psychiatry. London: Cassell.

    Google Scholar 

  • Mayes, R., & Horwitz, A. V. (2005). DSM-III and the revolution in the classification of mental illness. Journal of the History of the Behavioral Sciences, 41, 249–267.

    PubMed  Google Scholar 

  • Money, J. (1984). Paraphilias: Phenomenology and classification. American Journal of Psychotherapy, 38, 164–179.

    PubMed  Google Scholar 

  • Moser, C. (2001). Paraphilia: Another confused sexological concept. In P. J. Kleinplatz (Ed.), New directions in sex therapy: Innovations and alternatives (pp. 91–108). Philadelphia: Brunner-Routledge.

    Google Scholar 

  • Moser, C. (2002). Are any of the paraphilias in the DSM mental disorders? Archives of Sexual Behavior, 31, 490–491.

    Google Scholar 

  • Moser, C. (2009). When is an unusual sexual interest a mental disorder? [Letter to the Editor]. Archives of Sexual Behavior, 38, 323–325.

    PubMed  Google Scholar 

  • Moser, C., & Kleinplatz, P. J. (2005). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology and Human Sexuality, 17, 91–109.

    Google Scholar 

  • Murphy, D., & Woolfolk, R. L. (2001a). The harmful dysfunction analysis of mental disorder. Philosophy, Psychiatry, and Psychology, 7, 241–252.

    Google Scholar 

  • Murphy, D., & Woolfolk, R. L. (2001b). Conceptual analysis versus scientific understanding: An assessment of Wakefield’s folk psychiatry. Philosophy, Psychiatry, and Psychology, 7, 271–292.

    Google Scholar 

  • Noyes, A. P. (1968). Modern clinical psychiatry. Philadelphia: Saunders.

    Google Scholar 

  • O’Donohue, W., Regev, L. G., & Hagstrom, A. (2000). Problems with the DSM-IV diagnosis of pedophilia. Sexual Abuse: A Journal of Research and Treatment, 12, 95–105.

    Google Scholar 

  • Paris, J. (2005). The fall of an icon: Psychoanalysis and academic psychiatry. Toronto: University of Toronto Press.

    Google Scholar 

  • Paris, J. (2008). Prescriptions for the mind: A critical view of contemporary psychiatry. Oxford: Oxford University Press.

    Google Scholar 

  • Pincus, H. A., & McQueen, L. (2002). The limits of an evidence-based classification of mental disorders. In J. Z. Sadler (Ed.), Descriptions and prescriptions: Values, mental disorders, and the DSMs (pp. 9–23). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Pratt, J. (2000). Dangerousness and modern society. In M. Brown & J. Pratt (Eds.), Dangerous offenders: Punishment and social order (pp. 35–48). London: Routledge.

    Google Scholar 

  • Prentky, R. A., & Burgess, A. W. (2000). Forensic management of sexual offenders. New York: Kluwer/Plenum.

    Google Scholar 

  • Quinsey, V. L. (2011). Pragmatic and Darwinian views of the paraphilias. Archives of Sexual Behavior, doi:10.1007/s10508-011-9872-8.

    Google Scholar 

  • Reich, W. (1991). Psychiatric diagnosis as an ethical problem. In S. Bloch & P. Chodoff (Eds.), Psychiatric ethics (pp. 101–133). Oxford: Oxford University Press.

    Google Scholar 

  • Sadler, W. S. (1953). Practice of psychiatry. London: Henry Kimpton.

    Google Scholar 

  • Sadler, J. Z. (2009). Values and psychiatric diagnosis. Oxford: Oxford University Press.

    Google Scholar 

  • Sadler, J. Z., & Agich, G. J. (1996). Disease, functions, values and psychiatric classification. Philosophy, Psychiatry, and Psychology, 2, 219–231.

    Google Scholar 

  • Schmidt, C. W. (1995). Sexual psychopathology and the DSM-IV. American Psychiatric Press Review of Psychiatry, 14, 719–733.

    Google Scholar 

  • Schmidt, G. (2002). The dilemma of the male pedophile. Archives of Sexual Behavior, 31, 473–477.

    PubMed  Google Scholar 

  • Seto, M. (2002). Precisely defining pedophilia. Archives of Sexual Behavior, 31, 498–499.

    Google Scholar 

  • Seto, M. (2008). Pedophilia and sexual offending against children. Washington, DC: American Psychological Association.

    Google Scholar 

  • Seto, M. (2012). Is pedophilia a sexual orientation? Archives of Sexual Behavior, doi:10.1007/s10508-011-9882-6.

    Google Scholar 

  • Silverman, J., & Wilson, D. (2002). Innocence betrayed. Paedophilia, the media and society. Cambridge: Polity Press.

    Google Scholar 

  • Silverstein, C. (2009). The implications of removing homosexuality from the DSM as a mental disorder [Letter to the Editor]. Archives of Sexual Behavior, 38, 161–163.

    PubMed  Google Scholar 

  • Simon, W. (1994). Deviance as history: The future of perversion. Archives of Sexual Behaviour, 23, 1–20.

    Google Scholar 

  • Spitzer, R. L. (1973). A proposal about homosexuality and the APA nomenclature: Homosexuality as an irregular form of sexual behavior and sexual orientation disturbance as a psychiatric disorder. American Journal of Psychiatry, 130, 1214–1216.

    Google Scholar 

  • Spitzer, R. L. (1981). The diagnostic status of homosexuality in DSM-III: A reformulation of the issues. American Journal of Psychiatry, 138, 210–215.

    PubMed  Google Scholar 

  • Spitzer, R. L. (1987). The diagnostic status of homosexuality in DSM-III: A reformulation of the issues. In H. T. Engelhardt & A. L. Caplan (Eds.), Patterns of controversy and closure: The interplay of knowledge, values, and political forces (pp. 401–415). Cambridge: Cambridge University Press.

    Google Scholar 

  • Spitzer, R. L. (1999). Harmful dysfunction and the DSM definition of mental disorder. Journal of Abnormal Psychology, 108, 430–432.

    PubMed  Google Scholar 

  • Spitzer, R. L. (2005). Sexual and gender identity disorders: Discussion of questions for DSM-V. Journal of Psychology and Human Sexuality, 17, 111–116.

    Google Scholar 

  • Spitzer, R. L., & Endicott, J. (1978). Medical and mental disorder: Proposed definitions and criteria. In D. F. Klein & R. L. Spitzer (Eds.), Critical issues in psychiatric diagnosis (pp. 15–39). New York: Raven Press.

    Google Scholar 

  • Spitzer, R. L., & Wakefield, J. C. (2002). Why pedophilia is a disorder of sexual attraction, at least sometimes. Archives of Sexual Behavior, 31, 499–500.

    Google Scholar 

  • Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. M., Sadler, J. Z., & Kendler, K. S. (2010). What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychological Medicine, 40, 1759–1765.

    PubMed  Google Scholar 

  • Stern, P. (2010). Paraphilic coercive disorder in the DSM: The right diagnosis for the right reasons. Archives of Sexual Behavior, 39, 1443–1447.

    PubMed  Google Scholar 

  • Stern, P. (2011). Wollert (2011) demonstrates again how ideology taints scientific debate [Letter to the Editor]. Archives of Sexual Behavior, 40, 1099–1100.

    Google Scholar 

  • Suppe, F. (1987). Classifying sexual disorders. The diagnostic and statistical-manual of the American Psychiatric Association. In E. E. Shelp (Ed.), Sexuality and medicine (pp. 111–135). Dordrecht: Reidel Publishing Company.

    Google Scholar 

  • Tromovitch, P. (2009). Manufacturing mental disorder by pathologizing erotic age orientation: A comment on Blanchard et al. (2008) [Letter to the Editor]. Archives of Sexual Behavior, 38, 328.

    PubMed  Google Scholar 

  • Tucker, D., & Brakel, S. J. (2012). DSM-5 paraphilic diagnoses and SVP law [Letter to the Editor]. Archives of Sexual Behavior, doi:10.1007/s10508-011-9893-3.

    PubMed  Google Scholar 

  • van Naerssen, A. (1991). Man–boy lovers: Assessment counseling and psychotherapy. In T. Sandfort, E. Brongersma, & A. van Naerssen (Eds.), Male intergenerational intimacy: Historical, socio-psychological and legal perspectives (pp. 175–187). New York: Harrington Park Press.

    Google Scholar 

  • Vogt, H. (2006). Pädophilie; Leipzicher Studie zur gesellschaftlichen und psychischen Situation pädophiler Männe [Pedophilia: The leipzig study of the social an psychical situation of pedophilic men]. Lengerich: Pabst Science Publishers.

    Google Scholar 

  • Wakefield, J. C. (1992a). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373–388.

    PubMed  Google Scholar 

  • Wakefield, J. C. (1992b). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99, 232–247.

    PubMed  Google Scholar 

  • Wakefield, J. C. (2011). DSM-5 proposed diagnostic criteria for sexual paraphilias: Tensions between diagnostic validity and forensic utility. International Journal of Law and Psychiatry, 34, 195–209.

    PubMed  Google Scholar 

  • Walker, N. (1994). Dangerousness and mental disorder. In A. G. Phillips (Ed.), Philosophy, psychology and psychiatry (pp. 179–190). Cambridge: Cambridge University Press.

    Google Scholar 

  • Wilson, G., & Cox, D. (1983). The child-lovers. A study of paedophiles in society. London: Peter Owen Publishers.

    Google Scholar 

  • Zander, T. K. (2005). Civil commitment without psychosis: The law’s reliance on the weakest links in psychodiagnosis. Journal of Sexual Offender Civil Commitment: Science and the Law, 1, 17–82.

    Google Scholar 

  • Zessen, G. (1991). A model for group counseling with male pedophiles. In T. Sandfort, E. Brongersma, & A. van Naerssen (Eds.), Male intergenerational intimacy: Historical, socio-psychological and legal perspectives (pp. 189–198). New York: Harrington Park Press.

    Google Scholar 

  • Zonana, H., Abel, G., Bradford, J., Hoge, S. K., Metzner, J., Becker, J., et al. (1999). Dangerous sex offenders: A task force report of the American Psychiatric Association. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Zucker, K. J. (2002). Introduction to the special section on pedophilia: Concepts and controversy. Archives of Sexual Behavior, 31, 465.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Agustin Malón.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Malón, A. Pedophilia: A Diagnosis in Search of a Disorder. Arch Sex Behav 41, 1083–1097 (2012). https://doi.org/10.1007/s10508-012-9919-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-012-9919-5

Keywords

Navigation