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Yes, Virginia, There Are Real Pedophiles: 
A Need to Revise and Supervise, Not Eliminate, DSM

Ron Langevin, Ph.D., 
Juniper Associates, 
5468 Dundas St. West, Suite 402, Etobicoke, Ontario M9B 6E3, Canada 
(e-mail: rlangevin@sprint.ca )


Green concluded that pedophilia is not a mental illness 

"unless we declare a lot of people in many cultures and in much of the past to be mentally ill. And certainly not by the criteria of DSM."

I disagree with Green for two main reasons. 


DSM should be revised, not eliminated, from consideration in addressing the definition and criteria for pedophilia. Green notes the inadequacies of the DSM criteria for pedophilia as have others 

(O'Donohue, Regev, & Hagstrom, 2000). 

Of course, DSM never claimed to be more than a guide for clinical, educational, and research purposes and specifically warns about treating its contents as a cookbook (American Psychiatric Association, 2000). The expectation of its developers is that it will evolve with time and new information. 

Behind Green's attack on DSM is a more fundamental question: What is a mental disorder? 

DSM does not provide even a clear definition of the main theme of their classification system, acknowledging that 

"No definition adequately specifies precise boundaries for the concept of 'mental disorder.' The concept of mental disorder, like many other concepts in medicine and science, lacks a consistent operational definition that covers all situations" (
American Psychiatric Association, 2000, p. xxi).

DSM has been particularly dismissive of mental disorders that have a neurological, endocrine, or other physical basis. 

For example, it dropped Organic Personality Syndrome in DSM-IV. It frequently has as exclusion criteria "Due to a medical condition" and the terms endocrine, neurologic, and genetic do not even appear in the DSM-IV index. Based on the current logic of DSM, one may expect that were a physical basis for schizophrenia found, this diagnosis would no longer appear in DSM. 

In short, 
DSM tends to dismiss an area of knowledge wherein the etiology of sexual disorders, including pedophilia, as well as many other mental health problems, may lie. Psychoses and neuroses are not at the heart of sexual disorders. Even unreliably diagnosed personality disorders are not key. 


(Bain et al., 1988; Gaffney & Berlin, 1984) 

and neurological findings 

(Hucker, Langevin, Wortzman, Bain, & Handy, 1986) 

seem to be the logical avenue to explore in understanding the etiology of pedophilia and the persistence of this sexual preference pattern throughout the life span. 

DSM should 
be focused more on describing mental symptoms and conditions associated with physical conditions that play a major role in the mental manifestations of the disorders rather than eliminating them. The false compartmentalization of knowledge between professions, such as neurology, endocrinology, and psychiatry, has led to ignoring the interface of mental and physical conditions in sexual disorders as well as in other areas, such as diabetes, thyroid disorders, and brain damage and insult.

A second reason for disagreeing with Green 

is his overgeneralization of our Western society's view of pedophilia to other cultures. His "many cultures" and "much of the past" is presented in terms of a few examples. He does not tell us that 10 % or 50 % or 80 % of cultures allowed the practice of pedophilia as we know it. 

Moreover, it is important not to take examples from other cultures and times out of context as Green has done. He provides examples of adult-child contacts at other times and in other cultures without a full description of context. One senses that there are conditions in his examples (noted by my italics[*]) that may not parallel the contemporary definition of pedophilia as an enduring sexual preference for children. 

[* Italics are lost in the process of reformatting the text.]

Green notes, 

"Among the Aranda aborigines of Central Australia for example men who are fully initiated but not yet married, takes a boy of 10 or 12 ... and Captain Cook (1773) ... reported copulation in public in Hawaii between an adult male and a female estimated to be 11 or 12 ..." 

As an example, without doing any reading of cultural anthropology, I wonder what the life expectancy was in 1773; it certainly was not the 75 - 80 years an individual in Western society can expect today. 

Did the youth marry at 15 and were they dead by 30? 
Did the public copulation have religious, social, or political significance that separated it from rape or sexual assault? 
And most important, can you show that the examples reflect the current meaning of pedophilia as a sexual preference for minors over adults? 
For example, did the men carrying out this public copulation have a life long sexual preference for children? 
Would they be allowed to copulate with 11or 12-year-old girls at any time in their life or only at times of rites of passage? 
Would they copulate with female minors in preference to adult females? 

Given the examples, these questions may be unanswerable, but they illustrate the difficulty of generalizing to other cultures and other times.

Even if we assume that there is an exact parallel between adult-child sexual contacts in other cultures and our own, does that make it acceptable? 

Cultural relativism can


be carried too far and there should be some cultural universals that we can strive for. One of these is basic human rights and the protection of children. A number of war-torn countries in the twentieth century have given 10-year-olds guns to wage battle. 

Should we endorse 10-year-olds going to war because some other cultures do it? 

Similarly, we need to protect children from sexual exploitation and allow them to mature at their own rate and in their own way.

Green also uses the poor example of Briere and Runtz's (1989) study of 193 university male students to suggest that 21 % reported some sexual attraction to small children and 7 % indicated that they might have sex with a child if not caught. 

The Briere and Runtz study is an abuse of statistics that distorts the typical psychological scale to arrive at their results, which were as follows:

Sexual Attraction to Some Small Children 

Completely True








Completely False 

  1 % 1 % 2 % 3 % 2 % 12 % 79 %  

On this type of response scale, a 4 is usually an undecided midpoint, 1 - 3 have some degree of acceptance, and 5 - 7 indicate that it is unacceptable. Briere and Runtz add together categories 1 - 6 to get 21 %, which misrepresents the actual responses of the students. Similarly, they have distorted the hypothetical likelihood of acting out with children at 7 % which is, at best, 1 % and represents 2 students of the total 193 respondents.


Green confounds the incidence of pedophilia with the reliability of phallometric testing in diagnosing this sexual disorder. There are problems with the widely used circumference device that leads to some misdiagnosis of pedophilia and have little to do with the respondent 

(cf. Kuban, Barbaree, & Blanchard, 1999). 

Moreover, when dealing with any psychological test, there will be limitations of reliability and validity and phallometry is no exception, albeit it is one of the best measures of sexual preference available.

In conclusion, 

various professional organizations, such as the International Academy of Sex Research, the Association for the Treatment of Sexual Abusers, and the IATSO should work to improve DSM criteria for defining pedophilia, not removing it. It would be valuable to have experts in the area of sexual disorders on the working group deciding criteria. In the new DSM-IV-TR, there is little change. Of the four committee members and chairperson, not one has published an empirical study on sexual disorders in the past 5 years, as indicated in PsychInfo. A change in future committee membership for DSM-V sexual disorders may improve the definitions we have to work with on a daily basis.

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