Contents: Obsessional Thoughts - DefinitionSymptomatologySociocultural FrameworkPrognosisDiagnostic DifferentiationComorbiditiesConclusionsLiterature

The Fear of Being A Pedophile

A new form of obsessive thoughts - and a new disease of our times?

For several years now, I have observed a significant rise in clients - especially male ones - who suffer from massive fears of having pedophilic tendencies. Even though these fears are often unfounded, they may cause intense symptoms like massive emotional pressure and suffering or even self-inflicted injuries. In diagnostic terms, however, what most of these clients were dealing with are in fact obsessive thoughts, a disorder that has to be clearly distinguished from pedophilia, which I will describe later on ('diagnostic diferentiation').

I would like to lead in with an excerpt from Chapter V of the ICD-10, the International Classification of diseases issued by the WHO, which defines obsessive-compulsive disorders and obsessive thoughts as follows:

"The essential feature of Obsessive Compulsive Disorder is recurrent obsessional thoughts or compulsive acts. Obsessional1 thoughts are ideas, images or impulses that enter the individual's mind again and again in a stereotyped form. They are almost invariably distressing (because they are violent or obscene, or simply because they are perceived as senseless) and the sufferer often tries, unsuccessfully, to resist them. They are, however, recognized as the individual's own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. The individual often views them as preventing some objectively unlikely event, often involving harm to or caused by himself or herself. Usually, though not invariably, this behaviour is recognized by the individual as pointless or ineffectual and repeated attempts are made to resist it; in very long-standing cases, resistance may be minimal. Autonomic anxiety symptoms are often present, but distressing feelings of internal or psychic tension without obvious autonomic arousal are also common."
1 For brevity, 'obsessional' will be used subsequently in place of "obsessive-compulsive" when referring to symptoms. (ICD-10, F42)

Examples of compulsions are compulsive checking (eg, check again and again whether the stove was turned off or the door is has been locked), obsessive counting (having to count the rings of a curtain rod again and again) or ablutomania (compulsion to wash - spending several hours a day for washing hands, clothes or showering).

The diagnostic criteria for obsessive behavior or thoughts are defined as follows:

For a definite diagnosis, the obsessional symptoms and/or compulsive acts must be present at most days for at least 2 successive weeks and be a source of distress or interfere with other activities.

How are affected persons experiencing their thoughts of possibly being a pedophile?

In most cases, an initial event may be cited in which the fear of possibly being a pedophile arose for the first time - eg, physical arousal at the touch of a young girl, a sexually colored dream, movie scenes perceived as exciting or images that may be classifiable as pedo-erotic or pedo-pornographic. From that moment on, one's own thoughts regarding 'young girls' or 'young boys' are observed very closely. For example, if an underage girl crosses their way, affected people might examine carefully whether they can sense any special emotional and physical reactions, or they might experiment with fantasy scenes in their mind to get a 'safe' clue about whether a sexual encounter with a certain girl in their neighborhood would make them feel aroused. Any change will also be noted - particularly if the intensity of thoughts is increasing or decreasing. Very often, this will directly affect the mood: if the intensity or frequency of upcoming ideas or thoughts is decreasing, the patients feel better; but if they increase, strong feelings of depression or self-hatred might come up that can be extremely distressing (leading to nightmares, insomnia, self-deprecating inner dialogues, or self-injury to either suppress the thoughts or to inflict self-punishment). As with other forms of obsessive disorders, there is also a reverse link: if the patients are generally in good spirits, the obsessive thoughts will typically reduce or even appear absurd to them.
The connection to moods is typical, as there is a close relationship between obsessional symptoms, particularly obsessional thoughts, and depression. Individuals with obsessive-compulsive disorder often have depressive symptoms, and patients suffering from recurrent depressive disorder may develop obsessional thoughts.

Unlike normal ways of dealing with the basic idea of possibly having pedophilic tendencies, people who suffer from obsessive thoughts are - to a very high extent - deprived of control over their thoughts. Although they commonly don't play out their fantasies and though their real sexual interest is directed at adult persons, in their thoughts they always worry about the worst case scenario, namely sudden and uncontrollable flare-ups of real sexual feelings for minors.

In my experience, only men seem to be affected by this particular form of obsessive thoughts. Why that is, the following section might help to understand.

What creates the framework for such a 'disease du jour'?

It would be hard to imagine someone suffering from similarly intense symptoms without the current sociocultural context in our Western countries. It is also noteworthy that this particular form of obsessional thoughts has never been mentioned once in any of the diagnostic manuals (DSM IV or ICD-10) so far.

Only for a comparatively short time has the subject of pedophilia been present in the media with the current intensity. Hardly a week passes in which not at least one newspaper article mentions cases of child abuse or child pornography. But even in media which otherwise meticulously apply gender-neutral spelling and a formal implication of women as subjects of press articles: if it comes to pedophilia, we almost exclusively find masculine spelling regarding the perpetrators, as if pedophiles would be male per se, and child abuse only carried out by men. Particularly noteworthy is the emotional excitement that can be felt in the reporting just as in the public discussion of pedophilia: from the forms of punishment requested by some for the perpetrators it can be derived that for one, sexual abuse of minors is considered as one of the cruelest crimes in our times, and also, that pedophilia is identified with sexual abuse. In such a societal climate, men can draw a variety of conclusions:

  1. there is some deep emotional abyss in all of us, and one of its worst is to exceed certain sexual taboos.
  2. men belong to the sex that is the one pedophiles usually are of.
  3. thus, they may be potential child abusers (the equation of pedophilia and child abuse.
  4. therefore, one is well advised to monitor his own sexual depths as exactly as possible.
  5. the 'bulwark' is one's mental power: any further thoughts in a 'pedophile' direction must be suppressed.

Sexual fantasies with children are today's sexual taboo topic par excellence. The feeling of sexual attraction to minors is quickly understood as an indication of the aforementioned abyss, or even more as an indicator of potential pedophilic tendencies. Men consciously seeking for hidden sexual inclinations of this kind might quickly find themselves within a downright 'minefield', because our society also leads to a sexualization of many young people in an early pubertal age: the onset of puberty itself, but also the emphasis on physical appearance has moved well ahead in comparison to 50 years ago. Even 12-year-old girls advise each other on how to make their looks more 'sexy', following the instructions in youth magazines, on Youtube and other media. Many teens today have their first sexual experiences at a much younger age and are in a certain way directly 'competing' with adults on that level - at least on the surface and in terms of behavior and appearance, as the adolescent psychological and physical development has by no means completed at these ages - so despite a mixture of various 'mature' signals, both age groups are usually at very different stages of development.

One important factor that must not be underestimated in its impact on the awareness about this topic is the respective legislature of the established 'age of consent' in a given country. In the OECD countries, it stretches between 12 to 18 years, so it is obviously less based on psychological or even physiological stages of development (and thus potentially evident by rational means), but rather influenced by societal values and morals. So during pubertal development, psychological or hormonal 'thrusts' can cause a 14-year old to look and behave like a nearly 18-year-old, while the slower development of her seatmate in school can let her friend look and act significantly more 'childish'. For most 30-year-old men, even a sexual relationship with a 16-year-old will not come into question, while for an 18-year-old young man, the idea of a relationship or even an sexual act with a 14-year-old may not seem unthinkable. However, as a matter of fact, local laws would make this young man a sexual predator in some OECD countries. The combination of all these factors and the way they mesh together, can cause a disproportionately number of young men in the age of around 20 years to suffer from worries or obsessional thoughts of being pedophiles.

Prognosis for pedophilic obsessional thoughts

Obsessive thoughts can take very severe forms that massively restrict the quality of life. What begins with occasional, disturbing thoughts can reach a level within a few years or even months that makes keeping up with a regular life increasingly difficult and gradually takes away feelings of vitality and joy. A major problem is that patients often want to verify (not just in their fantasy, but in real life) whether a pedophilic sexual experience would feel as exciting as they fear it. This can lead to very awkward situations, influenced by strong taboo feelings (often, patients will interpret the following arising emotions as a sign of proof that they have indeed pedophilic tendencies). Tragically, such situations can also result in very real assaults on minors - which would then define the first time this borderline had been overstepped by the patient in real life. Such incidents would probably never have happened if these persons would have looked for therapeutic treatment in time. but they are very likely to involve legal and inner-psychical consequences: from then on, the thoughts will ceaselessly revolve about this scene, the aforementioned 'bulwark' appears to be broken, the feelings of guilt are growing while the self-esteem decreases further. Unlike most other forms of obsessive thoughts / OCD where the cross effects on third parties are generally relatively limited or completely absent, this particular form of obsession contains a certain risk to initiate acts that put patients on the borderline of undergoing criminal acts - or beyond.

The inherent risks of these dynamics alone strongly indicate the need to start with psychotherapeutic treatment as early as possible. Psychotherapists experienced in sexual counseling and -therapy can usually assess quite well whether there are indications of actual pedophilic tendencies or if what someone is dealing with rather fits the particular form of obsessive thoughts described in this article. Based on that, the therapist will recommend appropriate next steps. But whatever the final diagnosis may be (obsessions or pedophilia): an early as possible diagnosis and treatment will lead to much better prospects for treatment and therapy of the problem than waiting for too long.

In a diagnosis, I would consider it as essential not to pathologize the contents of the obsessional thoughts (as self-perception and perception will most likely be distorted by the OCD), but to assess and perceive the underlying psychological problem. And this problem will often turn out to be the 'compulsory situation' the patient has been maneuvered into due to his coinage by caregivers, environment, media and maybe epigenetical factors. This is an integral prerequisite of finding the right approach for treatment.

Differentiation between obsessional thoughts and pedophilia / ephebophilia

First, let us take a look at the current scientific definitions of pedophilia and paraphilia - again, quoting from the current version of the diagnostic manuals ICD and DSM:

According to the ICD-10 manual, pedophilia is 'a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age". A person 16 years of age or older meets the definition if they have a persistent or predominant sexual preference for prepubescent children at least five years younger than them. The DSM-IV manual defines pedophilia as "strong sexual attraction to prepubescent children'.
Paraphilias are described by the DSM-IV-TR manual as sexual disorders characterized by "recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving (..) children or other nonconsenting persons [or persons who are not capable of giving consent] that occur over a period of 6 months" (Criterion A), which "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" (Criterion B).
The manual defines pedophilia as one paraphilic form. (Source)
In the next version of the DSM manual (DSM-V) a paraphilic disorder will most probably still be defined as 'an atypical sexual interest that causes distress or impairment to the individual or harm to others.'

So for one, there is a substantial difference to the sexual preferences of others in regards to a focus on the younger age group (the sexual interest of so-called 'core pedophiles' is aiming mainly or exclusively at children or teenagers since their own puberty, also, sexual excitement is only experienced in relation to them) besides a significant power imbalance between pedophile and child.
But apart from focusing on this particular age group, pedophiles show no major differences to the sexual preferences of other people. Their desire for sex, relationships and love can be weighted differently as well (in other words, pedophilia is not always only about eroticism and sex): some pedophiles covet boys, some girls, and there are different preferences in terms of sexual practices (from exhibition to penetration). Some have only short contacts with many teenagers, others are looking for long-term relationships. There are also different ways in which contact is established with the minors: by far most pedophiles want to 'win' children for themselves, and they are sensitive and considerate, while others are manipulative. Only few use violence and coercion1 or are tempted by the child prostitution market. It is safe to assume (and also the finding of respective research studies) that most pedophiles 'are living abstinently for long periods of time or even their whole lives; with great mental effort they lead a life of renunciation' (Schmidt, 1999).

An important classification criterion for obsessional thoughts in contrast to pedophilia in these regards is thus the lack of exclusive or predominant orientation of one's sexuality towards children (pedophilia) or adolescents (ephebophilia). An indication for pedophilic tendencies, however, could be regular active consumption of pornographic products in which children are displayed ('child pornography') or establishing contacts with minors with the aim of maintaining closer or regular contact. A history of personal abuse experiences is a possible, but not a necessary indicator.
Another necessary classification criterion for obsessive thoughts in contrast to paraphilias is the lack of a need, of long-term or regular fantasies (in terms of scenes perceived as pleasurable) that relate to children or other minors. The only potential point of intersection could be considered what is described as some unspecified 'behavior' in the ICD-10 manual, however, these patterns are rarely constant in my observation of patients and are often inflicted by the current mood, the relationship status and other factors in the lives of those involved.

1) this aspect deserves further attention: contrary to popular belief, there is a clear distinction between pedophile disposition and violent sexual abuse. Especially in casual discussions or the media, a 'pedophile' is usually assumed as a violent male sex offender. However, studies show that a majority of sexual offenses against children - especially girls - are actually committed by non-pedophiles. Most male perpetrators, however, are 'compensatory offenders' who are abusing minors - maybe from their own families - out of sexual pressure, something that is much less so a cause for female offenders. But sexual arousal about minors is not only restricted to pedophiles (Green, 2002). In contrast, pedophilia is a disorder of sexual preference, but it can be assumed that very few actual pedophiles ever actively act out their sexuality (Tanner, 2005). In media reports, however, this important differentiation is rarely to be found so that as one result, the number of crimes committed by pedophiles is perceived as being much higher than it actually is.

Common forms of comorbidity

For all the differences between pedophiles and people who suffer from obsessive thoughts or similar 'fears', there are also some similarities. Often the ego strength and self-esteem of those affected in both groups is relatively small, which can make them feel that children are much more accessible on a communicative level compared to adults. Furthermore, the intensity in which men who suffer from the described obsessional thoughts are directing their thoughts on teenagers or children, might create a certain sexual fascination as well - but not the same kind of sexual attraction pedophiles are experiencing, but roughly comparable to the importance a slot machine has for a gambler - related to the 'libidinous charge' Sigmund Freud described. Their focus is on the child as an object, serving as an emotionally charged point of projection for one's own thoughts, but neither the minor's personality nor it's sexuality play a central role.
Other frequent comorbidities are depressive disorders and social anxieties.

Conclusions for psychotherapy and counseling

Diagnosis, assessment, counseling - and all of it as early as possible!

There is reason to fear that by not involving advisory services, therapists or counselors who are specialized in sex therapy, many people suffering from the particular kind of obsessional thoughts described in this article might be incorrectly 'diagnosed' and treated as pedophiles or pre-pedophiles. If that happens, the dynamics outlined above will involve an inherent risk to make the problem even worse - or, to put it in hypnosystemic terms: once this 'diagnosis' has been made, it will be extremely difficult to get the idea of such a possibility out of the 'system' again. Thus, if there are no specific assaults but rather reports of fears, anxieties and fantasies, I strongly recommend to seek a professional diagnosis if thinking patterns continue to be related to possible pedophilia for longer than 2 weeks.
On the other hand, whenever professionals, relatives or other persons are confronted with a possibility of pedophilia, it is a good idea to counter-check for symptoms of obsessive-compulsive thoughts (ICD-10, F42.0), considering the the relative obscurity (and potential moral charge?) of the symptoms and the odd behavior persons suffering from obsessional thoughts may display when it comes to dealing with (or even just talking about) minors.
A professional diagnosis should allow adequate assessment and thus, better results from whatever form of treatment should be required than otherwise.

Literature and Sources

Discussion

DSP Richard L. Fellner is psychotherapist, sex therapist and counselor in Vienna (Austria) and Thailand.
Reprints welcome, but correct citation requested.
Full text reprints or quotations require a formal permit of the author.

Related topics and terms: sex therapy, sexual deviances, paraphilia, pedophilia, obsessional thoughts, obsessive-compulsive disorder, counseling, therapy, compulsion, fear, anxiety, abuse, child abuse, sexual trauma

Appendix: literature about this topic, with reader comments: