Treatment of Offenders and Families

Byrgen P. Finkelman

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135581497
• Topic: Politique et relations internationales
• Subtopic: Politique

First Published in 1995. This is Volume VI in the Child Abuse: A Multidisciplinary Survey series. The articles in this volume address the treatment of perpetrators of physical and sexual child abuse and neglect. The articles in this volume provide many insights into the treatment of perpetrators of child maltreatment. This title discusses that, although there is still much to learn about treating offenders, many programs seek to offer hope that prevention through treatment can be effective at stopping child abuse-one perpetrator at a time.

Child Molestation and Pedophilia

An Overview for the Physician

A. Kenneth Fuller, MD

Child sexual abuse is a serious, pervasive problem with clinical, social, moral, and legal implications. Between 100 000 and 500 000 children in the United States are thought to be sexually molested annually. Physicians in all specialties may detect sexual exploitation of youngsters and are mandated to report such cases. Failure to diagnose child molestation and pedophilia and to treat their cause can have serious, long-lasting consequences for innocent victims and continued distress for the perpetrator and for the professional who missed the diagnosis. A single child molester may commit hundreds of sexual acts on hundreds of children. The etiology of paraphilic syndromes is multifactorial. There are substantial differences among sexual abusers of children in their personalities and psychopathologies. Although available interventions are symptomatically palliative rather than curative, many pedophiles can benefit from appropriate treatment. Primary prevention may be the key to reducing the frequency of child sexual abuse.

(JAMA 1989:261:602–606)

EACH YEAR in the United States between 100 000 and 500 000 children suffer abuse in the form of sexual molestation.¹–³ A larger number of youngsters are sexually abused, but they do not report this exploitation for fear of retaliation, embarrassment, or unknown consequences. Child molestation and pedophilia are common and often overlooked syndromes that risk the child victim’s well-being and further psychosocial development and adaptive functioning. The consequences of child sexual abuse are a major source of distress to the victim and, at times, the perpetrator, and are a source of concern to their respective families and communities.²–⁴

See also p 577.

Numerous books and articles have been published over the years positing opinions and often conflicting theories of the psychopathology of child molestation and pedophilia.³–²¹ The literature on this subject is well developed. The current article attempts to acquaint physicians with the serious problem of child sexual abuse and to provide a concise general review that will help the physician deal with perpetrators of these crimes. The reader is urged to consult appropriate literature for elaboration of details in problem cases.

Definitions

The Diagnostic and Statistical Manual of Mental Disorders (edition 3, revised)²² includes pedophilia among a group of sexual disorders, the paraphilias, characterized by recurrent intense sexual urges and fantasies in response to sexual objects or situations that are not part of normative arousal patterns. Pedophilia, which translates literally as “love of children,” requires a six-month period of recurrent, intense sexual urges and sexually arousing fantasies that involve sexual activity with prepu- bescent children (generally age 13 years or younger). In addition, the pedophile, or person with pedophilia, either must have acted on these urges or must be markedly distressed by them. Pedophilia, like child molestation, can be limited to incestuous, same sex, opposite sex, or both sex victims. Some patients are exclusively attracted to children; others are aroused by adults as well as children.²²

Child sexual abuse is the sexual exploitation of a child for the gratification or gain of an adult that may be manifest by sexual intercourse, physical force, rape, exhibitionism, voyeurism, fondling, digital penetration, pornography, or the like.²¹ Most perpetrators of child sexual abuse are classified as child molesters, herein defined as “older persons whose conscious sexual desires or responses are directed, at least in part, toward dependent, developmentally immature children and adolescents who do not fully comprehend these actions and are unable to give informed consent.”⁶

Sexual abuse by women occurs in approximately 5% to 20% of reported cases; however, child molestation and pedophilia are primarily perpetrated by men.¹, ², ⁴ Therefore, throughout this communication, the pronoun “he” is used to designate both genders. The term “patient” refers to a person undergoing medical treatment; its use does not imply that the child molester or pedophile meet legal or other nonmedical standards for exculpation, disability, incompetency, or lack of criminal responsibility.

Frequency and Importance of Child Molestation

Recent studies of adults found that between 5% and 60% had at least one experience of being sexually victimized before reaching the age of majority.²³–²⁸ Research also indicates that perhaps less than 6% of child molestations are ever reported.²⁵

This complex social, ethical, and clinical issue constitutes an important matter of public health. Child molestation is important clinically not merely because it is common. Child molesters and pedophiles often are distressed by their obsession to use children as sexual objects.²² Sexual abuse can have serious, long-lasting consequences for innocent victims and continued distress for the patient.

Research²⁵, ²⁹ documents a high morbidity from the trauma of child sexual abuse. Posttraumatic stress disorder may develop in victims immediately after the sexual abuse; however, symptoms commonly develop or redevelop in the victim months or years after the molestation. The victim’s impairment may be mild or it may severely affect nearly all aspects of their life.

Pedophiles and child molesters do not, contrary to common opinion, limit themselves to a single victim or paraphilia.³⁰,³¹ Abusive acts are seldom a onetime occurrence. Sexual abusers of children commonly engage in exhibitionism, frotteurism, rape, sexual masochism, sexual sadism, and voyeurism. An individual child molester or pedophile may commit hundreds of sexual acts on a staggering number of children. The severity, number and type of victims, and permanence of the features vary from one child molester to the next and also vary with the passage of time in the same abuser.

Predisposition and Psychophysiology

The motivation for child molestation is complex and consists of both sexual and nonsexual factors.¹,²,⁴,¹⁴ Individuality with regard to etiology of paraphilias is the rule. So far, there is little evidence that race, religion, intelligence, education, occupation, or social class can differentiate a child molester or pedophile from the general population.²² Many people with pedophilia and child molestation were themselves victims of child sexual abuse. Other predisposing and maintaining factors ‘of pedophilia and child molestation include stress, dysfunctional home situations, familial violence, substance abuse, interpersonal deficits, failure of the incest taboo, antisocial mores, and distorted beliefs.¹,²,³⁰,³¹

Child molesters tend to differ from others in their cognitions.³⁰,³¹ These distorted beliefs may include the following: (1) a child who does not physically resist really wants to have sex, (2) having sex with a child is a good way to introduce him to sexual education; and (3) the adult-child relationship is enhanced by having sex with youngsters. Individuals who perceive the world in this deviant and distorted manner have built-in justification and rationalizations for their deviant sexual acting out that allow them to avoid negative intrapsychic aspects of their offensive behavior.

The physiological characteristics of child molesters and pedophiles have been subject to scientific investigation.³²–⁴⁵ Studies that delineate sexual arousal patterns using penile plethysmography, a device for measuring penile tumescence, have begun to produce useful information. Research indicates that it is possible to identify rapists and child molesters, to determine age and gender preference, and to document propensity for violence of sexual offenders by tracking their penile arousal patterns to audio and visual stimuli.

Just as the normal sexual response cycle is a true psychophysiological experience influenced by a large number of incompletely understood factors, deviant sexual arousal is multifactorial.² Our understanding of the neuronal mechanisms for sexual preferenc...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Series Introduction
• Volume Introduction
• Further Reading
• A Practical Approach to the Protection of the Abused Child and Rehabilitation of the Abusing Parent
• Working with Abusive Parents: A Social Worker’s View
• Working with Abusive Parents: A Psychiatrist’s View
• Working with Abusive Parents: A Parent’s View: An Interview with Jolly K.
• A Multidisciplinary Approach to the Treatment of Child Abuse
• A Psychodynamic Approach to the Study and Treatment of Child-Abusing Parents
• Treatment of the Abused Child and the Child Abuser
• Prevention of Child Abuse: Group Therapy for Mothers and Children
• Comprehensive Treatment of Parents Who Abuse Their Children
• Separation and Treatment of Child-Abusing Families
• Behavioral Intervention for Child Abuse
• Neglected Fathers: Limitations in Diagnostic and Treatment Resources for Violent Men
• A Bird’s Eye View of the Child Molester
• Legal Issues Raised in Treating Sex Offenders
• Theory and Treatment in Child Molestation
• Is Treatment Too Late: What Ten Years of Evaluative Research Tell Us
• How Perpetrators View Child Sexual Abuse
• Child Molestation and Pedophilia: An Overview for the Physician
• Future Directions in the Treatment of Physical Child Abuse
• Sex-Offender Risk Assessment and Disposition Planning: A Review of Empirical and Clinical Findings
• Evaluation of Treatment Outcome for Adult Perpetrators of Child Sexual Abuse
• Counseling Adult Sex Offenders: Unique Challenges and Treatment Paradigms
• Effective Intervention with Neglectful Families
• Acknowledgments
• Series Index by Author