Abstract

Non-offending pedophiles are a unique population of individuals who experience sexual interest in children, but despite common misperceptions, have neither had sexual contact with a child nor have accessed illegal child sexual exploitation material.

An emerging body of research has examined the prevalence of pedophilic interests, characteristics of non-offending pedophiles, correlates of pedophilic interests, and stigma associated with pedophilia.

Treatment programs are beginning to produce findings regarding the effectiveness of treatment in supporting non-offending pedophiles to remain offense-free.

The current review spans these areas of research and discusses potential treatment options for working with non-offending pedophiles based on that research base.

References

The references are numbered, and given in a separate PDF document:
< https://www.ipce.info/sites/ipce.info/files/biblio_attachments/cantor_ea_non-offending_refs.pdf >.

Introduction

• Papers of particular interest, published recently, have been highlighted as:
  • Of importance

Non-offending pedophiles are a unique population who have been gaining more attention in sexological research and treatment and in popular culture. These are individuals who experience sexual attraction to children but have no (known) sexual contact with a child, typically expressing the strong desire never to do so.

In recent years, online networks have been established for self-identified pedophiles
to share information and support as they cope with pedophilic interests (e.g., b4uact.org; virped.org).

Treatment programs for self-identified pedophiles at risk for offending have also begun to emerge. Examples of these include the Prevention Project Dunkelfeld in Germany [1] and the “Help Wanted” program, a prevention-focused project
based in the USA [2].

• Notes between square brackets refer tot the list of References, given here on the separate page
  < https://www.ipce.info/sites/ipce.info/files/biblio_attachments/cantor_ea_non-offending_refs.pdf >.

As well, a small body of empirical research examining the prevalence of pedophilic sexual interests in the population, the correlates of pedophilic interests, the characteristics and experiences of nonoffending pedophiles, and the stigma has begun to accrue.

This review summarizes the empirical research published in these areas and discusses treatment of non-offending pedophiles. [*1]

• [*1] In this article, we take pedophila to mean a range of possibilities in terms of sexual interest directly toward prepubescent children, rather than rely on a strict diagnostic definition that includes criteria regarding objective temporality, preferentiality of interest, and clinical distress when defining pedophilia (i.e., DSM-5 pedophilic disorder diagnosis).
  This broad approach is taken in order to accommodate the existent literature that
  typically does not attempt a diagnostic definition of pedophilia, but rather assesses constructs including “sexual interest in children” or “sexual fantasies involving children.”

Non-offending Pedophiles: Prevalence, Correlates, and Characteristics

Recent research has attempted to estimate the prevalence and incidence of sexual interest in children and how many of these individuals have not acted on such interests.

In a self-selected sample recruited online and through radio and newspaper advertisement (n =1516; 52.7 % female), 1.8 % of the male and
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0.8 % of the female respondents to an online, revised version of theWilson Sex Fantasy Questionnaire reported ever having fantasies involving sex with a child under the age of 12 years [3].

In a large, self-selected sample of 8718 German-speaking adult males recruited online, 2.4 % reported having experienced sexual fantasies involving children during adulthood (e.g., experiencing sexual excitement to imagining sexual behavior
with a child) and having no sexual contact with a child in the past [4].

Of these men, only six men indicated that they had perceived the need to seek professional help for sexual fantasies involving children. When considering both men who had sexual contact with children and those with no such contact, these authors estimated that 0.6 % of the sample may meet the DSM-5 diagnostic criteria for pedophilic disorder [5]. This estimate is only approximate, since the authors used proxies from their measurement protocol to estimate rates of pedophilic disorder and did not include a clinical interview.

In another prevalence study, of 367 German males, 15.5 % reported sexual fantasies (e.g., daydreams and masturbation fantasies) involving pre-pubescent children and, of these men, 26.3 % found children to be intensely arousing while 5.3 % reported experiencing distress due to pedophilic fantasies and arousal [6].

In a self-selected sample of university students, the rates of distressing, prolonged (i.e., > 6 months) sexual preoccupation with prepubertal children were 0.2 % in male and 0.8 % in female respondents [7].

By way of comparison to understand prevalence estimates of pedophilic disorder, the lifetime prevalence of schizophrenia is estimated to be 0.87 % and bipolar I disorder estimated to be 0.24 % in population-based research [8].

Alanko and colleagues [9], in a population-based sample of 3904 male twins, found the incidence of pedophilic interests to be 1 % (n = 39) and hebephilic interests [*2] to be 5.7 % (n =223), with ten of these men reporting having had sexual contact with children.

• [*2] Hebephilic interests refers to sexual interest in pubertal children who have begun developing secondary sex characteristics.

Pedohebephilic interests [*3] were operationalized as having sexual interest in or sexual fantasies about prepubescent and pubescent children over the past 12 months.

• [*3] Pedohebephilic interests is the superordinate category that includes both pedophilic individuals and hebephilic individuals.

In this study, genetic influences significantly accounted for the findings; however, the nonshared environmental component explained 85.4 % of the variation in pedohebephilic interests.
These findings suggest that, whereas genetic heritability may influence development of pedophilic interests, other factors may also influence the development of these interests.

The (im)mutability of pedophilia is a key aspect of helping non-offending pedophiles manage their sexual arousal and to refrain from offending. The accrual of empirical data exploring this issue is central to understanding and providing treatment to non-offending pedophiles: If pedophilia is immutable, then treatments for these individuals need basically to focus on coping with and managing pedophilic interests while leading a meaningful and fulfilling life and not on changing the person’s basic orientation. Whereas some authors have claimed that pedophilic interests may remit [11, 12], reanalysis of these data and methodological and statistical issues identified by other authors suggest that no such changes in orientation actually occurred [13–16].

Whereas there are few, if any, data suggesting flexibility of pedophilic interests in non-offending individuals, some recent research examines correlates of exclusivity in pedophilic interests [17•]. This research examined the age at which pedophilic
individuals first recognized that their sexual interests were different from their peers, exclusiveness of sexual interests, and flexibility of pedohebephilic interests in a sample of 75 minor-attracted men recruited online. The age when these men first recognized their pedohebephilic interests ranged from 6 to 44 years, with a mean of 17 years of age; other research has also found that the majority of a sample of help-seeking, non-offending pedophiles were aware of their sexual interests by the age of 20 [18].

A majority of the men in Tozdan and Briken [17•] were motivated to pursue treatment; however, self-efficacy to change their pedophilic interests was associated with a non-exclusive attraction, suggesting that pedophiles who are exclusively attracted to children do not believe their attractions can be altered. As well, the age of realizing their pedohebephilic interests may also be important, because early age was associated with higher levels of exclusivity of these interests and lower flexibility of their pedohebephilic interests.

In a comparative study non-offending pedophilic men were less likely to report a behavioral propensity to engage in sexual contact with a child when compared with pedophilic men who had sexually offended in the past [19]; however, the non-offending pedophiles endorsed similar levels of arousal to and enjoyment of scenarios involving sexual contact with children.

This research suggests that one important characteristic of non-offending pedophiles is their lower level of willingness to engage in sexual activity with children. Nonoffending pedophiles have similar levels of working memory and selective attention for sexual cues as non-pedophilic men [20].

In addition, compared with incarcerated pedophiles, non-offending pedophiles have also been found to display less supportive attitudes toward sex with children and higher levels of self-efficacy for controlling sexual urges [21].

A further comparative study found that a sample of pedophilic men (55 % non-offending) had stronger automatic and implicit associations between children and sex than non-pedophilic men, providing support that implicit cognition plays a role in sexual interest in children [22].

Taken together, these findings suggest that non-offending pedophiles are less likely to view sexual activity with children as acceptable, may be more able to manage their responses to sexual stimuli, and may believe
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they are better able to control their sexual arousal and behavior than pedophilic individuals who do act on their sexual interests.

Other research has examined the correlates of pedophilic interests and provides an understanding of some clinically significant issues associated with pedophilic interest. Using a subsample from Alanko et al. [8], Santilla and colleagues [23] found that pedohebephilic interests were associated with reporting

• sexual and physical abuse in childhood,
• higher levels of general sexual desire,
• higher frequency of sexual fantasies, and
• more frequent masturbation.

Similar findings were reported by Klein and colleagues [24] who used a subsample
from Dombert and colleagues [4]. In this research, pedophilic interests were associated with

• higher total sexual outlets,
• higher sex drive,
• greater amounts of time engaging in sexual fantasies and adult pornography consumption, and
• contact offending and illegal online child sexual exploitation material use.

For individuals who reported having experienced childhood sexual abuse, 8.2 % also reported pedohebephilic interests.

Other research found that paraphilic interests in general, including pedophilic interests, are associated with

• being single,
• engaging in extra-relationship sexual contacts,
• ever having used pornography for sexual arousal,
• lower subjective health [7],
• total sexual outlets,
• sexual preoccupation (e.g., frequency of masturbation and partnered or illegal sexual activity),
• sexual compulsivity (e.g., impairment and distress due to meeting sexual needs),
• impulsivity, and
• sensation-seeking [10].

Self-reports of pedophilic individuals and the nature of their attractions can provide a rich source of data that complements and expands upon recent quantitative studies [25•].

Most of the sample became aware of their pedophilic attraction as they matured into adulthood and described the experience as aging while their attractions did not age along with them. A majority of the sample described experiencing romantic feelings toward children, rather than their attractions being strictly sexual in nature, and included falling in love with a child or having fantasies about a romantic relationship with a child.

For some, being in social relationships with children (e.g., friendships and coaching) and the emotional attraction they experienced were more satisfying than the possibility of having a sexual relationship with a child [25•, 26].

Further, when some of these men did not have social relationships with children, they felt more fixated on and troubled by their attraction.

• Some used substances to avoid their feelings,
• others sought help from professionals,
• other non-offending pedophiles, or other supports in their lives;
• still others were less focused on their pedophilic interests when in a meaningful relationship with an adult partner.

Professionals helped some of these men accept their pedophilic interests by separating their sexual attraction from their sexual behavior and by managing their sense of selves (e.g., distancing themselves from stories of “child rapists” [25•, p. 8]).

Engaging with other pedophilic individuals helped these men see that others with their interests were able to avoid offending, which brought a sense of hope. Having other social supports that knew about their interests helped because their supports could help them maintain boundaries with children, challenge potentially distorted thinking, and provide them with feedback regarding their behavior with children. Half of the sample used pornography depicting adults to relieve sexual arousal, and one man used child sex dolls for that purpose.

This research, while using qualitative methodologies with relatively small samples,
highlights several ways these men cope with their attraction toward children and provide a preliminary suggestion that their interests in children expand beyond sexual attraction and include a complex set of sexual, emotional, and romantic processes.

Stigma

A recent review of the literature examining stigma toward individuals with pedophilia suggests that while there is generally a lack of research with this population, there are a number of stigma-related phenomena facing pedophilic individuals [27].

For instance, lay people

• attribute pedophilia variously to
  • being physically or sexually abused in childhood,
  • parents being absent during childhood,
  • having negative early sexual experiences,
  • being allowed to watch pornography at a young age, and
  • inadequate coping with emotions [28]

• ascribe negative judgments and traits to pedophilic individuals (e.g., being evil or “disgusting”); and
• are pessimistic about treatability ofpedophilia [29, 30].

One main ramification of having a sexual interest in children, even if one does not act on it, is that these individuals are likely to face intense stigma due to their pedophilic interests and because of this stigma-related stress, be at increased risk of negative mental health and interpersonal outcomes.

Stigma for non-offending pedophiles is an important area of research, because the negative outcomes associated with stigma-related stress

• (e.g., social and interpersonal problems,
• emotional dysregulation [31],
• limited life opportunities[27])

are also theorized to be central risk factors for the initiation of sexual offending [32, 33].

In two studies, Jahnke and colleagues [34] examined the strength and prevalence of the public’s stigma toward pedophilic individuals compared with attitudes toward individuals with other mental disorders. Participants (n = 854; 51.9 % women) expressed

• more stigmatizing attitudes toward pedophilic individuals,
• greater fear of and anger toward pedophilic individuals,
• less pity for pedophilic individuals, and
• exhibiting desire for greater social distance from pedophilic individuals compared with alcoholic individuals.

The second study replicated these findings when comparing attitudes toward
pedophilic individuals versus attitudes toward individuals with sexual sadism and individuals with antisocial tendencies.

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Other research has found that the public sees a direct link between pedophilic interests and abusing a child [35]. When participants were presented with a pedophilia label versus a sexual interest in children, the pedophilia label was related to more punitive attitudes, especially for those who ascribed more intentionality to pedophilic individuals.

This study suggests that the terms pedophile, pedophilic, and pedophilia may have a more negative connotation that the more descriptive label sexual interest in children. Qualitative research examining the content of comments posted online in response to an episode of the National Public Radio podcast This American Life focusing on a pedophilic individual found that the majority of comments were positive and supportive or were a mixture of positive and negative sentiment toward the pedophilic individual featured in the episode [36].

The lay public appears to hold stigmatizing attitudes toward pedophilic individuals, but that in certain instances (e.g., presenting a pedophilic youth in a sympathetic light), members of the public are willing to express their support for individuals struggling with their pedophilic interests.

The impact of negative attitudes on non-offending pedophiles is a key consideration in stigma research, as the experience of stigma-related stress is associated with multiple negative mental health and health outcomes [31, 37].

In a sample of non-offending pedophilic individuals, high levels of perceived social distance and fear of discovery were reported [21]. When this sample of non-offending pedophiles was compared with the normative samples for the self-reported measures used in the research, pedophilic individuals were found to have higher levels of psychopathology and social isolation and lower problem-focused approaches to coping with stress (e.g., not reacting with strong emotion or using wishful thinking to cope with stress). As well, fear of discovery was correlated with lower emotion-focused coping, lower self-esteem, higher perceived social distance, and higher fear of negative evaluation and social isolation. Whereas a majority of participants reported that they would consider seeking professional support (52 %), only 36 % believed a professional would understand their problems.

Other research suggests that pedophilic individuals are concerned that professionals they approach for help would stigmatize them further [26]. Recent findings also suggest that stigma, stereotypes, negative affective responses, and discriminatory intent toward pedophilic individuals displayed by psychotherapy trainees can be reduced through educational interventions [38].

Taken together, these studies suggest that non-offending pedophilic individuals experience stigma-related stress and that this stress may be linked to negative mental health and social outcomes.

Fortunately, there is some evidence to suggest that stigmatizing processes exhibited by psychotherapists might be reduced through educational interventions targeting psychotherapists, which may in turn make non-offending pedophiles more comfortable seeking professional help to cope with issues arising from stigma, their
sexual attractions, or other life problems.

Qualitative research provides some additional insights into how pedophilic individuals understand and cope with stigma.
Pedophilic men reported that they disliked using the term pedophile to describe themselves, given the negative connotation of the term [26]. This description of the term pedophile as more negative maps onto the findings reported in Imhoff [35]. When disclosing their sexual interests in children, participants reported that they feared losing friends, being seen as a “sicko,” or not being accepted and that these fears lead some to isolate themselves, not pursue new friendships, or feel anxious or suspicious about social relationships [see also 25].

As well, not being able to disclose their sexual identities made some participants feel excluded from aspects of social relationships (e.g., sharing love interests, having intimate discussions with friends) or that they were not being authentic with their friends. Some participants had overall positive experiences when disclosing their interests, but most reactions were mixed, such as experiencing stress and tension in their relationships.
Of interest, receiving compassion, sympathy, and support and being able to discuss their attraction to counselors was helpful for some participants.

Treatment with Non-offending Pedophiles

Recently, effectiveness research from the Prevention Project Dunkelfeld has produced some preliminary results [39]. The treatment group in this project participated in a year-long cognitive behavioral therapy programand included targets such as

• motivation for change,
• self-efficacy,
•  self-monitoring (including sexual fantasies and interests),
• sexualized vs. adequate coping strategies,
• emotional and sexual self-regulation,
• social functioning,
• attachment and sexuality,
• offense-supportive attitudes,
• developing empathy for children involved in child sexual abuse or child sexual exploitation materials, and
• relapse prevention strategies and goals.

For the non-offending, pedohebephilic individuals (22.6 % of the treatment group;
n =12), no significant treatment gains were reported. Of these men, none engaged in sexual contact with a child and 24 %  accessed online child sexual exploitation material over the year they were in treatment.

Given the emerging findings on stigma, mitigating the negative impacts of the experience of stigma associated with having a pedophilic orientation may be an important aspect of treating non-offending pedophiles. Research on stigma in sexual minorities suggests that experienced and perceived discrimination is linked with psychological distress, particularly if stigmatized individuals expect to be rejected [31, 40]. As well, stigma-related stress may be involved in problems with emotion regulation, social and interpersonal issues, and
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specific cognitive processes (e.g., experience of shame, anxiety) that increase risk for psychopathology.

For pedophilic individuals, the experience of stigma and discrimination and their expectations of rejection may inform treatment, because these processes may increase the level of distress for these clients. Awareness of stigma, pedophilic clients’ experience of stigma and discrimination, and how these affect their functioning may be issues to monitor and address in prevention focused treatment.

Another potential approach to the treatment of nonoffending pedophiles would be to address psychologically meaningful risk factors that have been linked to future offending by individuals who have been convicted of a sexual offence against a child. Whereas these risk factors are taken from the forensic literature, certain risk factors make sense in the context of treating non-offending pedophiles to support an offense-free lifestyle.

Cantor [41] suggested that individuals offend when they are at their most vulnerable and experience pervasive loneliness. Loneliness and social rejection are key risk factors in etiological theories of child sexual abuse [42], as well as being linked to suicidality [43], reduced intelligent thought, and decreased self-regulation [44].

As well, interacting with children to meet social, emotional, and intimacy needs, while being a strong predictor of sexual offending against a child [45], has also been linked to loneliness and social rejection in sexual offenders and may be a means that a pedophilic individual uses to reduce the experience of loneliness [46, 47].Working through the experience of loneliness and finding ways to satisfy social and intimacy
needs may be key aspects of preventative treatment with non-offending pedophiles.

Helping non-offending pedophiles manage their sexual arousal to children in everyday life is also a logical target for prevention-focused interventions. Because sexual arousal to children is another strong predictor of engaging in sexual behavior with children in adjudicated sexual offenders [48, 49], providing cognitive and behavioral techniques for managing sexual arousal may improve non-offending pedophiles’ ability to manage sexual urges in their daily lives.

This treatment focus is supported by recent research that finds self-reported pedohebephilic sexual interests are associated with markers of sexual preoccupation, such as higher rates of masturbation and higher frequency of sexual fantasies [23, 24]. Such findings may suggest that dealing with pedophilic sexual fantasies are issues potentially facing non-offending clients in their daily lives.

Individuals who have sexually offended against children are more likely than other populations to report histories of having been abused themselves as children [50], and recent research indicates experiencing childhood sexual abuse is associated
with higher rates of self-reported pedohebephilic interests [23, 24]. Clinicians may also screen for trauma histories among pedophilic clients. Treating ongoing symptomatology associated with trauma and abuse may also improve non-offending pedophilic individuals’ ability to function in daily life and successfully manage their sexual behavior.

Conclusions

A non-trivial number of non-offending pedophiles exist, and recent research is providing some initial understanding of them. We see that non-offending pedophiles experience a range of problems relevant to clinical interventions, such as childhood abuse, hypersexuality, and lower perceived health.

Research on the mental health needs of non-offending pedophiles should continue to develop our understanding of the consequences of living with pedophilic interests. More research is also needed to identify in sharper relief what psychological processes distinguish non-offending pedophiles from those who do offend against a child or access online child sexual exploitation material. In this research domain, qualitative research is likely to expand greatly and complement quantitative approaches, so this triangulated approach is strongly encouraged.

Future research and theoretical work into the nature of pedophilia should consider recent developments in understanding sexualities [51]. Specifically, there is evidence to suggest [25, 26, 46, 47] that some pedophilic individuals, both those who have offended and those who have not, experience romantic attachments to children that are not strictly sexual and include love and nurturance, both in a romantic sense and a non-romantic sense (e.g., friendships and mentoring relationships).

Some pedophilic individuals report that spending time with children in social situations was a means they employed to mitigate the intensity of their sexual attractions to children and meet social needs [26] or that this social contact was more valued than the sexual component of their interests in children
[25].

These preliminary findings suggest the cautious clinician will assess the meaning of social contact with children for a non-offending pedophilic client. Assessing for the meaning for social contact with children will provide a clearer understanding of whether this social behavior is engaged in to groom a child for sexual contact or if it may be serving a protective function or increasing risk for a client.

Research is needed to expand our understanding of the nature of these affective connections, the role they play in non-offending pedophiles’ lives, and whether these feelings toward children are protective or risk factors for sexual contact with children.

In comparison with treatment with criminal justice involved individuals, the treatment of non-offending pedophiles is an area that is in dire need of development. While preliminary evidence suggests that treatment can prevent the majority of these men from pursuing sexual contact or online sexual material involving children, the understanding of how treatment helps these individuals is currently lacking.

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Recent research literature suggests several issues germane to the treatment of non-offending pedophiles in order to help these individuals not offend (e.g., sexual pre-occupation, hypersexuality, managing sexual arousal).

We have suggested a number of potential treatment targets to prevent offending based on our experience with criminal justice-involved individuals and the existent literature with non-offending pedophiles. Given the prevention focus of such interventions and research, clinicians and researchers are encouraged to follow guidelines for developing and implementing prevention research in order to increase the impact and quality of their research (e.g., [52]).

Clinicians should consider the stigma-related stressors facing non-offending pedophiles, how these individuals make meaning of themselves and cope with their attractions, how they pursue social contact with children in ways that are beneficial or detrimental, ongoing psychological sequelae from earlier experiences of abuse, and improving interpersonal functioning.

Stigma reduction efforts may be a key aspect in encouraging individuals struggling to cope with pedophilic interests to seek help, since stigma is a major impediment to seeking mental health treatments [53]. Because it is likely that non-offending pedophiles, as a stigmatized group, will experience stigma-related stress and psychological risk factors caused by this stress (e.g., alcohol use, anxiety, depression
[31]), improving coping with stigma-related stress (e.g., reducing rumination, hypervigilance, suppression), improving social support networks, and reducing pessimism and hopelessness are potential processes to target in future treatment
efforts.

These aspects of treatment with non-offending pedophiles focus on supporting their ability to live a meaningful and fulfilling life and improving overall psychological wellbeing and sense of self-efficacy. The difficulties in treating non-offending pedophiles are complex, not insurmountable, and clinicians and researchers are encouraged to get involved in this most challenging and open frontier in our field.

Given what is known about the effects of stigma in sexual minorities [31], we anticipate that the experience of stigma will be associated with problematic outcomes such as alcohol use [54, 55] and maladaptive forms of coping (e.g., suppressive or reactive coping; [56]). Because stigmatized statuses confer risk for mental health problems, such as anxiety, depression, alcohol use, and polysubstance abuse [31], future research should assess for elevated rates of these mental health concerns in non-offending pedophiles and whether experiences of stigma are associated with greater symptomatology.

Public stigma has been researched by Jahnke and colleagues [34], while provider-based stigma [37] has received less formal attention. Furthering our understanding of the stigmatizing stereotypes, prejudices, and discrimination toward non-offending pedophiles by treatment providers, child protection workers, and law enforcement officers will also be a fruitful avenue of research.

Having said this, it is also important to consider, both for the individual clinician and in research studies, the potential courtesy stigma [37] associated with working with a stigmatized group like non-offending pedophiles. Clinicians who do offer treatment to this population may face prejudice and discrimination for simply providing services to non-offending pedophiles. This research will provide knowledge about the specific hesitancies and potential roadblocks to treating non-offending pedophiles and improve the ability to dispel myths that impede the provision of services to this population.

References

The references are numbered, and given in a separate PDF document:
< https://www.ipce.info/sites/ipce.info/files/biblio_attachments/cantor_ea_non-offending_refs.pdf >.

Download: 

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