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How is paedophilia a health issue

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How is paedophilia a health issue

Příspěvekod Plyšáček » 21.7.2016 12:23:12

How is paedophilia a health issue? (medicalrepublic.com.au)



No clinician wants to hear their patient is a paedophile. But experts say the visceral response to child sex abuse can hamper prevention and treatment.

Largely seen as the worst crime a person could commit, there is now a growing effort to think of paedophilia and child sex abuse outside of a criminal framework.
For Dr Kelly Richards, a criminologist and senior Lecturer in the School of Justice at Queensland University of Technology, the issue is simple: Prevention is a better strategy than waiting until at least one life is ruined.
While we normally talk of a paedophile as anyone who has a sexual interest in a child or teen under the age of consent, the research strictly defines it as an interest in a prepubescent child. This differentiates it from hebephilia, which describes a sexual interest in pubertal subjects.
However, in the real world the definition is not so clearcut, and depends on who you’re talking to. The definition of paedophilic disorder has changed in the recent DSM-5, covering those with recurrent and intense sexually arousing fantasies and sexual urges towards prepubescent children – generally 13 years or younger. It must also cause the individual distress or interpersonal problems, or they must have acted on it to meet the definition.
Paedophilia is a risk factor for child sex abuse, but it’s often not acknowledged that some individuals who realise they are attracted to children never want to act on that desire.
By better understanding and offering therapy to these celibate paedophiles, clinicians hope to be able to prevent child sex abuse.
“It’s crazy, there are so many men out there who are too scared to come forward, and this kind of stigma is creating the problem,” said Dr Richards. “If 10% of those people get helped, great. How many children might that have saved?”
Critics argue a more sympathetic attitude towards paedophiles may normalise this attraction, and potentially encourage offending.
But Dr Richards says this idea doesn’t stand up when you look at the reality.
“Every program that I’m aware of has a strong initial premise that it’s always unacceptable to act on those impulses,” she says.
Programs may offer empathy training, a support network or teach lifestyle interventions. These may help individuals identify potential triggers in their environment and have strategies to reduce stressors that might make them more likely to offend.
An estimated 2% to 9% of the adult male population and 1% to 5% of the female population have paedophilic urges, research suggests.
But the sexual proclivity itself is not considered pathological in the DSM-5. Nor is it illegal in Australia.
“One thing I always find strange is when news shows label someone as a ‘convicted paedophile’, Dr Richards said. “There’s no law against being a paedophile.”
While the terms paedophile and child sex offender were often used synonymously, not all paedophiles go on to act on their urges and not all people who sexually abuse children are sexually attracted to them, Dr Richards explained.
Some research suggests that paedophiles make up 40% to 50% of child sex offenders, and around 43% of paedophiles make sexual approaches to children.
Other research suggests that around half of all cases classified legally as child sex abuse occur in children between 12 to 17, and so may not all meet the strict criteria for paedophilia.
While paedophilia is a risk factor for child sex abuse, a lot of abuse is opportunistic and perpetrated by people without paedophilia but who have access to vulnerable children, Dr Richards said.
This group of abusers may have psychological pathologies such as antisocial personality disorders, and may target children in the knowledge they are less likely to be reported to authorities, she said.

TREATMENTS

Beginning in Berlin in 2005, the Preventative Project Dunkelfeld is one of the best-known attempts to focus on those at risk of abusing children before the damage is done.
The project was designed to help people unknown to authorities, but looking to control their sexual desires towards children and child pornography.
German for dark field, the Dunkelfeld project’s clients are those who have not committed or been convicted of a crime, and are thus largely invisible to society and authorities.
Through a nation-wide media campaign, paedophiles and hebephiles were promised a free and confidential medical treatment. Their slogan sums up the pre-emptive goal: “You are not guilty because of your sexual desire, but you are responsible for your sexual behaviour. There is help! Don’t become an offender!”
In the Dunkelfeld project, cognitive behaviour therapy is offered to help individuals with coping skills, stress management and sexual attitudes. Participants may also have access to medication, group and individual therapy.
These interventions are designed to help reduce risk factors for child sex abuse, which include high sexual arousal, disturbed self-control and low empathy.
To date, more than 2100 individuals have travelled to one of the Dunkelfeld centres for diagnosis and advice, and a number of studies have been undertaken with those who have participated.
In one study, sexual self-regulation increased, while emotional deficits and thinking that supported child sex offences decreased after a 12-month CBT-based program. None of these changes occurred in the control group.
However, a report last year by the Australian Institute of Family Studies cautions that Australia’s mandatory reporting laws may not allow for a project such as this.
Remember, the Dunkelfeld project is not for individuals who have been convicted of sex crimes against children.
But Australia’s mandatory reporting laws have a grey area when it comes to a patient disclosing accessing child pornography material online, said Dr Georgina O’Donnell, a forensic and clinical psychologist at ForensiClinic Consulting.
“If a patient discloses that they have a sexual attraction to children, and they are seeking help in relation to this, there is no requirement to report the patient to authorities,” said Dr O’Donnell, noting that it was desirable for patients to receive treatment and referral at this point.
And, of course, Child Protection Services must be notified if a patient discloses they have harmed a child or if a child in contact with them is at risk.
Accessing any child exploitation material online, including sexual depictions of children in cartoons and computer-generated images, is illegal. But reporting guidelines were not clear-cut, and GPs were encouraged to seek advice from the state authorities for clarification, she said.

IS THERE A CURE?
Despite the occasional breathless media reporting, there is no evidence of a cure for paedophilia. Nevertheless, some medications may help individuals lower their sex drive.
Co-founder of the celibate paedophile site Shadows Project, Max Weber* first sought help through the Dunkelfeld project in his early 20s.
After coming to the realisation that he had never grown out of his attraction to prepubescent girls, Max accessed therapy and medication through the project.
Max stresses the need to protect children and prevent the damage abused children suffer. As well as trying to help people avoid acting on their desires, he hopes to help celibate paedophiles deal with the self-loathing, depression and desperation that many experience.
The anti-androgen medication, cyproterone, one of the drugs often referred to as inducing chemical castration, was effective in suppressing his sexual desire for about a year. However, severe side effects emerged, and after two and a half years he stopped treatment. At that point, his sexual desire returned, he said.
SSRIs are also used to lower sexual appetite and reduce obsessional thinking, although Max said there was no benefit for him.
While physical castration, or bilateral orchidectomy, is a potential option, medical testosterone suppression may be preferred because it takes three to 10 months to reduce sexual appetite and so requires regular contact with a clinician.
“Paedophilia can be compared with standing in the water, with the water coming up under your nose. You do everything you can to avoid drowning, and in that situation you can’t think of anything but not drowning.
“It’s a similar situation for many paedophiles, who are afraid of their feelings and afraid of being an offender. So those medications can lower the water so that it’s not as strong in your life – to stand a little higher, and to find ways to cope with those feelings.
“It gives you some freedom,” he said.
The telephone hotline Stop It Now! has seen success in the US and the UK, offering an anonymous avenue for people concerned about their thoughts or actions around children to talk to trained staff.
In the first 10 years of its existence, the UK hotline received more than 14,500 calls, half of whom were from individuals concerned about their own behaviour, according to the Australian Institute of Family Studies.
More recently, Australia began a trial of an overseas initiative, Circles of Support and Accountability, to provide support for convicted child sex offenders and prevent recidivism.
The results of the project, which pairs trained volunteers with high-risk sex offenders as they move back into society after their time in prison, have not yet been released.
But overseas versions of the program have seen repeat sexual offences drop by 70% or more compared with around 17% of individuals not in the program. Participants who did reoffend committed less severe offences than those for which they were originally incarcerated, research found.

WHAT IS THE CAUSE?

One of the difficulties of treating paedophilia is that it’s just not clear what causes somebody to become a paedophile. Unsurprisingly, it’s an extremely difficult group to access.
The powerful stigma around both paedophilia and child sex abuse can ruin a person’s life, making non-offending paedophiles reluctant to seek help or participate in research.
So far, most of the research has been done on those already convicted of child sex abuse. But this conflated child sex offenders with paedophiles, and might include offenders who weren’t attracted to children, while omitting non-offending paedophiles, Dr Richards cautioned.
One popular belief about the causes of paedophilia is that most paedophiles have been sexually abused themselves as children.
However, estimates are that 4% to 8% of Australian men and 7% to 12% of women have experienced penetrative sex abuse as children, and 12% to 16% of men and 23% to 36% of women have experienced non-penetrative child sex abuse.
Dr Richards also points out a majority of abused children are female, while the majority of perpetrators are male, which does not support this theory.
And research suggested that while reported rates of childhood victimisation among perpetrators was higher than among the general prison population, only a small portion of child sex abuse victims went on to abuse children themselves, she said.
However, these findings may be inaccurate for several reasons. Perhaps perpetrators, often undergoing psychological therapy, find it easier to disclose child sex abuse than those in the general population.
Or, as some suggest, could it be that perpetrators claim to have been victims to elicit sympathy from therapists and the justice system?
“Many men report realising their sexual attraction towards children while they were children, or during puberty, giving support to the idea that they see their paedophilia as a sexual orientation,” Dr Richards said.
Dr Lars Madsen, a forensic and clinical psychologist specialising in deviant sexual interests, agreed. The literature and his own experience showed that individuals with paedophilia report having a sexual attraction to children “very, very early on in their lives”, he says.
“Then there are people who have different experiences in childhood, either being a victim or victimising others, and from these experiences develop fantasies which then get reinforced,” he said.
“This fantasy and masturbation often happens in early adulthood, and once it becomes fixed it is difficult to shift,” he said, noting that some people with a sexual attraction to children can also be sexually attracted to adults to a certain degree.
But while an increasing number of studies are being conducted into the psychosocial and biological basis of paedophilia, sample sizes have been small and findings heterogeneous.
A 2014 critical review of brain alterations in paedophilia found that one of the more substantial findings is that paedophiles have smaller amygdala, suggesting disturbances in the emotional processing of sexual arousal.
Other research suggests the brains of paedophilic and non-paedophilic men may have different functional activation patterns. There have been some instances of tumours and brain lesions prompting paedophilic behaviour or child sex abuse, but the authors of the review say this is better explained by reduced inhibition and overall hypersexuality.
The most popular website for non-offending paedophiles, Virtuous Paedophiles, has around 1500 members. The site’s founder, Ethan Edwards, said around half of the members are under-25, and a third between 26 and 40.
“These guys need to know there’s a place where they can meet paedophiles who have gone decades without abusing kids who have built lives, a place where he can belong, and talk about his frustrations with people who understand,” he said. “And where he will be firmly turned away from any thoughts of actually abusing a kid.”
One of the criticisms of groups such as this is that they will enable the unhealthy sexual thoughts.
Max acknowledged this as a risk, and some online groups that initially began as support networks have ended up exchanging child sex abuse images or tips to abuse children.
But the moderation of Virtuous Paedophiles, also known as virped or VP, strictly prohibits exchanging pictures or content that was arousing, he said.
“What VP adds is a group where we recognise that adult-child sex is wrong and also don’t go daydreaming about some mythical society where it could all work out,” Edwards said, referring to other groups that advocate for changing laws to allow adult-child sex.
“Celibate paedophiles’ goals are much more modest. The ability to seek therapy without fear of being reported to police is a pretty basic one,” he said.

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