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Michael H. Miner, Ph.D.,
Program in Human Sexuality,
Department of Family Practice and Community Health,
University of Minnesota,
1300 So. Second Street, Suite 180, Minneapolis, Minnesota 55454
(e-mail: MMiner@famprac.umn.edu )
Green raises the question of whether pedophilia can be considered a mental disorder. In general, Green argues that pedophilia, or sexual interest in children, cannot be deemed a mental illness because it is present in "normal" populations and has been socially sanctioned in many cultures. He also describes the criteria for pedophilia across the various versions of the DSM, noting the inconsistencies in definition and problems with the definition of disability in the most recent edition (American Psychiatric Association, 2000).
Green, while presenting an interesting case for not classifying pedophilia as a mental disorder, fails to consider the similarities between pedophilia and impulse control disorders, which also are not necessarily defined by the nature of the fantasy or urges, but on the failure to refrain from acting on socially sanctioned or intrusive behaviors (American Psychiatric Association, 2000).
In DSM-IV, the
"essential feature of Impulse-Control Disorders is the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others" (American Psychiatric Association, 2000, p. 663).
This is rather similar to the definition of Pedophilia, which requires
"recurrent, intense sexually arousing sexual fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child ..."
which are acted upon or the
"fantasies cause marked distress or interpersonal difficulty"
(American Psychiatric Association, 2000, p. 572).
While it is true that Criterion B for Pedophilia is not met simply by the individual being upset by the legal sanctions imposed for his/her behavior, it may be that the failure to resist the urges, in spite of the significant sanctions for such action, constitutes an impulse-control problem. In many ways, the failure to resist the urges to engage in sexual behavior with children, in a society that sanctions such behavior, is not much different than Pathological Gambling, Kleptomania, or Pyromania. All of these disorders are characterized by a failure to resist urges to engage in self-destructive or socially sanctioned behavior.
Green indicated that pedophilia could not be a mental disorder because many "normal" individuals report sexual
fantasies or sexual arousal to prepubescent children.
Again, this situation is not inconsistent with other mental disorders defined in the DSM. Pathological Gambling is a behavior that is engaged in by many individuals without negative consequences. It is when the behavior becomes preoccupying, escalates, and results in negative consequences that it is considered a mental illness.
The same can be said for substance use disorders. Many individuals use a variety of substances, both legal and illegal. The use of drugs and/or alcohol becomes problematic, and thus meets criteria for a mental disorder, when its recurrent use results in
|(1) "... a failure to fulfill major role obligations at work, school, or home";|
|(2) the substances are used "in situations in which it is physically hazardous";|
| (3) the individual experiences
"recurrent . . . legal problems" due to their substance use;|
(4) there is "continued substance use despite having persistent or
recurrent social or interpersonal problems" |
(American Psychiatric Association, 2000, p. 199).
In the case of Substance Use Disorders, it is not the use of substances or even the heavy use of substances that results in the diagnosis. Rather, it is the use of substances, coupled with problems associated with their use.
The same can be said for pedophilia. The DSM not only requires that an individual have recurrent sexual fantasies, urges, and behavior, but that these fantasies, urges, and/or behaviors result in clinically significant problems.
Certainly, legal problems are not necessary and sufficient to be considered "clinically significant"; however, contact with the criminal justice system generally results in such "clinically significant" consequences as loss of jobs, disruption in marriages and relationships, and financial hardships.
Additionally, the negative sequelae of pedophilia does not require contact with the criminal justice system. Many men with a recurrent pattern of sexual interest and behavior with children experience social isolation resulting from their failure to develop primary interpersonal relationships, their estrangement from peers, and a deep sense of shame related to their pedophilic interests.
These factors may result in significantly debilitating affective and/or mood states
(Raymond, Coleman, Ohlerking, Christenson, & Miner, 1999),
as well as an inability to engage in appropriate major role obligations such as remaining gainfully employed and/or successfully attending school or other training programs.
Thus, while Green raises some interesting issues, many of his concerns are consistent across the DSM, not inconsistent, as is his contention.
Pedophilia, like the impulse-control disorders, appears to be characterized by acting on urges in spite of the threat of social sanctions and other significantly negative consequences. Like the substance use disorders, pedophilia is the persistence of urges, fantasies, and behaviors despite experiencing numerous, significant negative consequences.
The fact that men in Polynesia in the eighteenth century engaged in sexual behavior with children does not mean that pedophilia should not be defined as a mental disorder. Pedophilia may be thought of as the extreme manifestation of a behavior that many "normal" people experience, which is, for the most part, the defining characteristic of many, if not all, mental disorders.