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Thursday, January 17, 2013

In light of the recent rape incident that shook the country, I was asked to write an article trying to better understand Pedophilia as one of the sexual deviancies/ sexual disorders. I wanted to share it in the forum in case it was useful to anyone.
Write back if you have any queries :).
Pedophilia is a psychiatric disorder that is used to describe an individual 16 years or older who has a primary sexual interest in prepubescent children, 11 years or younger.
According to the International Classification of Diseases (ICD-10), in order to make a diagnosis of pedophilia, the person initiating the sexual relationship must be at least five years older than the prepubescent child. The ICD- 10 describes it as a ‘disorder of adult personality and behavior’.
          The Diagnostic and Statistical Manual (DSM-IV TR) describes it as a paraphilia- a sexual attraction to something out of the norm.
Pedophilia as a practice is a punishable offense in most parts of the world. In the light of the current story that’s making the news- the story of Nirbhaya- the girl in Delhi that lost her life recently; we pause this New Year to ask ourselves- how much do we know about sexual offenses and sexual disorders. Further, how prepared are we to handle something like this?
          In order to better understand a concept like pedophilia, that seems so bizarre and unacceptable to all of us, a metanalysis conducted by Finkelhor and Araji proposed a four factor model to explain why adults get attracted sexually to young children. The first explanation they propose is called Emotional Congruence Theory developing from the psychoanalytical school of thought. This model proposes that people with pedophilia have arrested psychological development. Thus Pedophiles experience themselves as children with child like needs and thus wish to relate to other children.
A theory of symbolic mastery suggests that a relationship with a child helps the pedophile have a sense of mastery of shame, humiliation and guilt encountered as a child at the hands of an adult. Thus one of the ways in which the pedophile combats the childhood sense of powerlessness is by reversing the roles in adulthood and overpowering another child.
          A second model called sexual arousal to children comes from the point of view that the act is not sexual in nature at all. Like rape is a crime of violence, pedophilia is a crime of power and dominance.   
          A third group of theories called the blockage theories try to understand why pedophiles cannot get the same amount of sexual stimulation or satisfaction from heterosexual adults. Individual psychology theories claim that the individuals have an extremely high sense of castration anxiety that makes it impossible for them to function normally with adult women and have sexual relations with them. A more practical explanation from the same theoretical orientation claims that pedophilia is a reaction or an outcome to earlier experiences with failed sexual attempts- like impotency, abandonment by the first lover etc.
          A final explanation of this disorder is a group of theories called disinhibition theories. A number of studies conducted along these lines discovered that pedophiles generally have lower impulse control, neurological deficits, alcohol abuse or senility contributing to this behavior. Similar studies have also found pedophiles to have lower intelligence levels than normal people.
Further, they may have situational factors like unemployment, losses etc that are major stressors for them. This leads to another related factor that in the diathesis stress model, pedophiles have a lower threshold of stress tolerance making even small triggers very difficult to handle. A study also showed that early incidence of child molestation led to a cycle reaction inducing pedophilic behavior later on.
          A study conducted in 2008 identified a neural imbalance or a deficient mechanism in the amygdala of the brain which is responsible for arousal and emotional valuation. The normal regulating mechanism is absent in pedophiles thus reversing the mechanism and resulting in deviant sexual behavior.
          Clinical psychologists and researchers primarily use three methods to diagnose pedophilia- sexual behavior (history), self reports and psycho physiological behavior responses. Some of the tests used to measure psycho physiological behavior responses include polygraph tests and viewing time. In crime related questions, polygraph tests show an elevated rate of heartbeat, skin conductance, respiration etc. Further in viewing tests, pedophiles ‘linger’ on images of children longer than normal people.
          One of the surer predictors of pedophilic behavior include possession of child pornography. Further, a phallometric measure of sexual arousal to children is positively correlated to later sexual offense. Similarly, there is also a positive correlation between antisocial personality disorder and later sexually deviant behavior.
          With the above studies, we can see how pedophilia is a disorder and needs treatment and help. In terms of research conducted on how best to work with such a problem, studies show that there may be a few ways to develop insight in such individuals as they are often in denial.
          One way is to treat pedophile as an addiction and assign individuals to a de- addiction group. Another method suggests using insight oriented therapy to discuss in depth emotional and childhood concepts. Another way to work with this issue could be aversion therapy by associating the pedophilic urge/fantasy to something repulsive like an electric shock/nausea etc. Covert sensitization in which the person imagines the consequences of engaging in the activity like imprisonment may also prove to be beneficial in management of the tendencies.
          Finally, victim empathy training in which the individual is exposed to materials like audio and print material in which victims describe the horror and their experiences may help the perpetrator empathize with his victims better and check his impulses.
          With respect to medication, anti androgen medicines that reduce the sexual urges and desire are the only effectively researched drugs.
          It is important as parents and others working with such individuals that we work with the trauma of the victims first in a sensitive way. It is best to work with it like a post traumatic disorder in order to prevent uninhibited sexual promiscuity in later years or the extreme guilt and isolation (the other extreme).
          When working with such individuals, it’s important to always put the safety of the child first even if it means shifting the child away from its primary home if that is best for them at that time. The counselor or social worker is advised to work with caution and kindness but firmness to help the child understand that it is not their fault in any way.
What do we do as citizens, as social workers and counselors, as parents and people sensitizing the community? How would we ‘prevent rather than cure’ and protect our children from this evil?
          Some practical tips include,
1.    Never disclose personal information, such as your address, to strangers online.
2.    Never meet privately in person with anyone you have met online.
3.    Never get close to a car if a stranger stops and asks for directions.
4.    Never accept a ride from, or go anywhere alone with, an adult you don’t know.
5.    No adult should touch you or ask you to touch him in any way that is confusing or frightening. If this happens, refuse and tell your parent immediately.
6.    No adult should ever ask you to keep a touch or a kiss secret. If this happens, tell your parent immediately.
7.    If any of these things happens, you will not be punished even if you have broken a rule.
Teaching the children the difference between good and bad touch, having frank discussions about sex when appropriate and value based classes that constantly ingrain good values in children may help them to be better prepared for unforeseen events. They may be better equipped to say no if the situation is fishy or inappropriate. Finally, self defense must be incorporated in the school curriculum so that children are prepared to protect themselves at least early on by calling for help, stalling or buying more time. Basic things like keeping to a group, sticking to a curfew, avoiding peer pressure and substance abuse may also reduce the risk of being in a vulnerable position.
Finally, a healthy bond of trust should exist between parent and child so that in the event of any regrettable incident, the child feels comfortable sharing it with their parents without the fear of being blamed, condemned or worse yet, ignored.
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Sartorius, A. (2008). Abnormal amygdala activation profile in pedophilia. European Archives Of Psychiatry & Clinical Neuroscience, 258(5), 271-277.
Abel GG, et al. “Pedophilia,” in Gabbard GO, ed. Treatments of Psychiatric Disorders, Third Edition.
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Quinsey VL. “The Etiology of Anomalous Sexual Preferences in Men,” Annals of the New York Academy of Sciences (July 2003): Vol. 989, pp. 105–17.

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