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Pedophilia: When Is a Difference a Disorder?

Fred S. Berlin, M.D., Ph.D., 
National Institute for the Study, Prevention and Treatment of Sexual Trauma, 
104 E. Biddle St., Baltimore, Maryland 21202 
(e-mail: )


The spectrum of human sexuality is diverse. Thus, a visitor from a distant planet could easily observe 

that there are some adults here on earth who are strongly, and perhaps exclusively, attracted to other adults of the opposite gender. 
Such persons are said to have a heterosexual orientation. 
That visitor would also be able to note that there are others who are strongly attracted to adults of the same gender, and who are therefore said to have a homosexual orientation. 
Finally, he could observe that there are those who are strongly attracted to children, and who are therefore said to have a pedophilic orientation.

Each of the above-noted categories constitutes a different sexual phenomenology (i.e., a difference in sexual makeup). The label used to define each category conveys descriptive information about such differences, presumably devoid of any value judgments about their relative merits. The critical questions, then, are 

(1) When, if at all, does a difference in sexual makeup become a disorder? and 
(2) How is it that a label such as pedophilia intended to convey descriptive information can instead become a stigmatizing pejorative?

Our hypothetical visitor from another planet would also be able to observe a remarkable spectrum of other differences. For example, he would be able to identify and distinguish two clearly different biological processes, 

one of which he might label "cellular regeneration," 
and the other "rapid cellular proliferation." 

He could then further study each of these in its own right. However, our esteemed visitor might further discover that we here on earth consider certain forms of rapid cellular proliferation to be a disorder; a disorder that we call cancer. 

Even though at one level cellular regeneration and rapid cellular proliferation are nothing more than different biological processes, because the latter can both impair function and cause suffering, we have made a value judgment about it and chosen to label it a disorder. 

Calling something a disorder always involves making such a judgement. Sickle-cell anemia, considered to be a disorder because of its bad consequences, is nevertheless still protective against malaria in those parts of the world where it is endemic.

When can sexual orientation become a disorder? 

God or nature has put sexual drive into each and every one of us for a very important reason -- the preservation of the human race. If a person stops eating, he will die. If we all stopped having sex, the human race would die. In a society in which sex between two adults was forbidden, how many of us would be able (or even willing) to maintain celibacy for a lifetime, particularly if confronted with a number of potentially acquiescent sexual partners?

Behaviors enacted in response to powerful biological appetites, be it for food or for sex, can become associated with some degree of volitional impairment. Consider that to diet successfully one needs only to eat a bit less each day. Yet, so many fail to succeed. 

When sexual drive becomes "aimed" in an unacceptable direction (e.g., towards children), it still recurrently craves satiation. Thus, in a society such as ours, which for good reasons feels that it must prohibit adultchild sexual interactions, at least some of those with a pedophilic sexual orientation (especially if it is directed exclusively towards children) may be in need of help. 

They may require assistance in the same way that alcoholics may need help in order to be able to successfully resist their unacceptable cravings. On the other hand, in a society permissive of adult-child sexual interactions, such persons might not be in need of help, and in that sort of a society their sexual orientation, although still different, might not be seen as disordered. Even in our society, in rare instances when confined to non-distressing fantasies, a pedophilic orientation might represent a benign condition not requiring treatment.

It is likely that no one would choose voluntarily to develop a pedophilic sexual orientation. Those with such an orientation have no more decided to have it than have


any of us decided as children to be either heterosexual or homosexual. Men with pedophilia get erections when fantasizing about children. Heterosexual men get erections when fantasizing about women. In neither case is that so because the individual in question has somehow decided ahead of time to program his mind to work in such a fashion. Persons with pedophilia have simply not chosen to experience an alternative state of mind.

In our society, to have a pedophilic sexual orientation can create both psychological burdens and impairments. Thus, it seems reasonable to view pedophilia as a disorder. In doing so, perhaps we can learn more about how to prevent it. In addition, perhaps we can lighten that burden by finding ways to help such persons be better able to resist acting upon unacceptable cravings. One way of doing so may be through treatments that can pharmacologically suppress the intensity of sexual appetite.

Terms such as pedophilia 

are used as a way of conveying information. Such terms are intended to identify mental conditions in a way that can enhance our understanding of them and that can guide both future research and the development of effective treatments when needed. Schizophrenia, manic-depressive illness, and pedophilia are all bad things to have. However, they are afflictions that can develop within good people. If labeling them as disorders allows mental health professionals to be better able to help such people, then doing so can serve a useful purpose. Such labels should not be used as ostracizing pejoratives.

Finally, a word about children. 

When a person with pedophilia interacts with a child sexually, he has done wrong. He may, or may not, have caused harm. In 1999, the United States Congress condemned a study (Rind, Tromovitch, & Bauserman, 1998) that had documented that many children who had had such an experience had not suffered adverse psychological consequences. How many youngsters have been inadvertently hurt, treated as if they must inevitably have become "damaged goods," because of a failure to distinguish between having been wronged versus having been harmed?

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