La pedofilia es una atracción sexual continua hacia los niños prepuberales. Es una parafilia, una condición en la que la excitación y gratificación sexual de una persona depende de objetos, actividades o incluso situaciones que se consideran atípicas. La pedofilia se define como fantasías, impulsos sexuales o comportamientos sexuales recurrentes e intensos que involucran actividad sexual con un niño o niños preadolescentes, generalmente de 13 años o menos, durante un período de al menos seis meses. Los pedófilos son más a menudo hombres y pueden sentirse atraídos por uno o ambos sexos.
El trastorno de pedofilia se puede diagnosticar en personas que están dispuestas a revelar esta parafilia, así como en personas que niegan cualquier atracción sexual hacia los niños pero demuestran evidencia objetiva de pedofilia. Para que se diagnostique la afección, una persona debe actuar según sus impulsos sexuales o experimentar una angustia significativa o dificultades interpersonales como resultado de sus impulsos o fantasías. Sin estos dos criterios, una persona puede tener deseos sexuales pedófilos pero no un trastorno pedófilo.
Se desconoce la prevalencia del trastorno pedófilo, ya que el estigma social que lo rodea no invita a las personas a autoidentificarse. Las estimaciones de su prevalencia oscilan entre el uno y el cinco por ciento de la población masculina. Se cree que solo una pequeña fracción del uno por ciento de las mujeres, si es que alguna, experimenta pedofilia.
Los agresores sexuales pedófilos suelen ser familiares, amigos o parientes de sus víctimas. Los tipos de actividades pedófilas varían y pueden incluir simplemente mirar a un niño o desvestirlo y tocarlo. Sin embargo, los actos suelen implicar sexo oral o tocar los genitales del niño o del agresor.
Los estudios sugieren que los niños que se sienten desatendidos o solos pueden tener un mayor riesgo de abuso sexual.
Según el Manual Diagnóstico y Estadístico de los Trastornos Mentales, Quinta Edición (DSM-5), para que se diagnostique el trastorno pedófilo se deben cumplir los siguientes criterios:
- Fantasías, impulsos o comportamientos sexuales intensos y recurrentes con un niño preadolescente (generalmente de 13 años o menos) durante un periodo de al menos 6 meses.
- Se ha actuado sobre estos impulsos sexuales o han causado angustia significativa o deterioro social, ocupacional u otras áreas importantes de funcionamiento.
- La persona tiene al menos 16 años de edad y es al menos 5 años mayor que el niño con el que se involucra en el comportamiento sexual. Esto no incluye a una persona en la adolescencia tardía involucrada en una relación sexual continua con un niño de 12 o 13 años.
Además, un diagnóstico de trastorno pedófilo debe especificar si la persona se siente atraída exclusivamente por los niños o no, el género que atrae a la persona y si los impulsos sexuales se limitan a los niños de la propia familia de la persona.
Hay una serie de desafíos para diagnosticar la pedofilia. Las personas que padecen esta afección rara vez buscan ayuda de forma voluntaria; el asesoramiento y el tratamiento suelen ser el resultado de una orden judicial.
Sí. El trastorno pedófilo se ha clasificado como un diagnóstico psiquiátrico según el DSM-5 desde 1968. No es una elección que la gente haga conscientemente.
Las parafilias, como grupo, tienen una alta tasa de comorbilidad entre sí y una tasa igualmente alta de comorbilidad con ansiedad, depresión mayor o trastornos del estado de ánimo y trastornos por abuso de sustancias.
Se cree que la pedofilia es un fenómeno masculino. No existe una estimación fiable del trastorno pedófilo en las mujeres, aunque parece ser raro. Se considera una pregunta abierta si el trastorno existe entre las mujeres.
Un estudio encontró que, entre las víctimas de abuso sexual infantil, del 6 al 24 por ciento de las víctimas informaron haber sido abusadas por una mujer. Aunque ese número es alto y podría ser evidencia de un trastorno pedófilo en las mujeres, muchos niños que son abusados sexualmente no son abusados por personas con trastorno pedófilo, sino por personas que participan en instancias individuales de abuso sexual. Entre el 50 y el 60 por ciento de los delitos sexuales contra niños se incluyen en esta categoría.
El inicio de la pedofilia se produce antes de la edad adulta, a menudo durante la adolescencia. En algunos estudios, una minoría de los encuestados dijo que identificaba los sentimientos antes de la pubertad.
Dado que es probable que haya muchas personas con trastorno pedófilo que ocultan su condición, la prevalencia de la pedofilia solo puede estimarse. Las estimaciones van desde el 1 por ciento de la población masculina hasta el 5 por ciento.
La pedofilia se diagnostica con mayor frecuencia después de una investigación criminal. Las autoridades utilizan entrevistas, vigilancia o registros de Internet para diagnosticar el trastorno. El uso de pornografía infantil es un indicador importante del trastorno pedófilo. Además, la excitación sexual genital se puede medir en un laboratorio a través de estímulos sexuales y se basa en el cambio relativo en la respuesta del pene. Esta medición de laboratorio generalmente se realiza después de que una persona ha sido arrestada por un delito relacionado con la pedofilia, aunque esta medición se usa más ampliamente fuera de los Estados Unidos, ya que los Estados Unidos tienen leyes contra la pornografía infantil que restringen lo que las autoridades pueden mostrar.
The causes of pedophilia are not well known.
Physiological models are investigating the potential relationship between hormones and behavior, particularly the role of aggression and male sexual hormones. Early research is underway exploring possible neurological causes.
There is some evidence that pedophilia may run in families, though it is unclear whether this stems from genetics or learned behavior.
A history of childhood sexual abuse is another potential factor in the development of pedophilia, although this has not been proven. Behavioral learning models suggest that a child who is the victim or observer of inappropriate sexual behaviors may become conditioned to imitate these same behaviors. These individuals, deprived of normal social and sexual contacts, may seek gratification through less socially acceptable means.
Pedophilia may be a lifelong condition, but pedophilic disorder includes elements that can change over time, including distress, psychosocial impairment, and an individual's tendency to act on urges
This question remains an area of study. Pedophilic urges develop before or during adolescence, around the time one’s sexuality would emerge.
There is some evidence that people with pedophillic disorder have a higher rate of childhood trauma, including childhood sexual trauma, than average.
There is also some evidence that links people with pedophilic disorder with traumatic brain injuries in childhood. One study showed that those with pedophilic disorder sustained traumatic brain injuries as children at twice the average rate.
Some research indicates physical differences in the brains and hormones of those with pedophilic disorder, but more research is needed to corroborate and understand these initial findings.
The study of the brains of those with pedophilic disorder is an ongoing process with no conclusions. Evidence from some studies indicates that certain abnormalities in various sections of the brain correlate with pedophilic urges. These findings broadly focus on differences in the frontal and temporal lobes of the brain, which may contribute to a lower inhibition of sexual behavior or a dysfunction in the processing sexual urges. More study is required.
Pedophilic disorder seems to have a small heritable component. A Finnish study of nearly 4,000 male twins found that genetic influences explained only about 15 percent of variance from the general population when it comes to sexual interest, fantasies, or activity with prepubescent children. In contrast, psychiatric conditions as a whole have an average variance rate of 30 percent, with schizophrenia and bipolar disorder ranging as high as 70-80 percent. The evidence for heritability is not strong.
Treatment of pedophilic disorder can include behavioral therapies and medications. These treatments can reduce urges and the likelihood of acting on them, but pedophilic condition is most often a lifelong condition.
Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting a pedophile's thoughts that the child wishes to be involved in the activity. Empathy training involves helping the offender take on the perspective of the victim and understand the harm they are inflicting. Positive conditioning approaches center on social skills training and alternative, more appropriate behaviors. Reconditioning, for example, involves giving the patient immediate feedback, which may help him change his behavior.
Research has disproven the perception that sex offenders are especially prone to recidivism. In reality, recidivism rates for sex offenses are lower than for all other major types of crime, and the U.S. Department of Justice has found that only about 3 percent of child molesters commit another sex crime within three years of being released from prison. Meta-analysis of hundreds of studies confirms that once they are detected, most convicted offenders never sexually re-offend. (Not all sex offenders who victimize children are pedophiles; only about 40 to 50 percent of convicted sex offenders who have sexually assaulted children meet the diagnostic criteria for the disorder.)
While treatment may help pedophiles resist acting on their attraction to children, many do not seek clinical help because of the risk of legal consequences due to mandatory reporting laws for licensed professionals, including therapists.
The prognosis for reducing pedophilic desire is difficult to determine, as longstanding sexual fantasies about children can be difficult to change. Practitioners can help to reduce the intensity of fantasies and help a patient develop coping strategies. Dynamic psychotherapy, behavioral techniques, and pharmaceutical approaches all offer help, but lifelong maintenance may be the most pragmatic and realistic approach.
There are several therapeutic treatments that can be an option for those with pedophilic urges and can help modify one’s behavior and mental health while struggling with their situation. These include cognitive-behavioral therapy, empathy training, and reconditioning approaches. Many people with pedophilic urges do not seek psychiatric or psychological treatment due to the stigma around the condition in society and the mandatory reporting laws in the United States, which can lead to legal consequences if pedophilic acts are acknowledged.
For people with pedophilic disorder who do seek help, research suggests that cognitive-behavioral treatment models may have some effect. Such models include aversive conditioning, confrontation of cognitive distortions, building victim empathy (such as by showing videos of consequences to victims), assertiveness training (social skills training, time management, structure), relapse prevention (identifying antecedents to the behavior [high-risk situations] and how to disrupt antecedents), surveillance systems (family associates who help monitor patient behavior), and lifelong maintenance.
The Prevention Project Dunkelfeld clinics in Germany, which use cognitive-behavioral methodology to teach clients how to control their sexual impulses, have treated more than 5,000 people who have voluntarily come forward seeking services. (Germany does not have mandatory reporting laws comparable to those in the United States.) The clinic also offers psychopharmaceutical interventions, including, when needed, testosterone-lowering medication to dampen sexual appetite. The project’s initial results, while based on small samples, appear encouraging: Participants have been shown to experience improvements in their self-regulation abilities and decreases in attitudes that support sexual contact with children.
Medications can be used in conjunction with therapy to treat pedophilic disorder. Such medications include medroxyprogesterone acetate (Provera) and leuprolide acetate (Lupron), and antiandrogens to lower sex drive. Intensity of sex drive is not consistently related to the behavior of pedophilia and high levels of circulating testosterone do not predispose a male to pedophilia. Hormones such as medroxyprogesterone acetate and cyproterone acetate decrease the level of circulating testosterone, potentially reducing sex drive and aggression. These hormones, typically used in tandem with behavioral and cognitive treatments, may reduce the frequency of erections, sexual fantasies, and initiation of sexual behaviors, including masturbation and intercourse. Antidepressants such as fluoxetine have also been found to decrease sex drive but have not effectively targeted sexual fantasies.