A popular treatment for pedophiliac individuals involves the sexual addiction model developed by Carnes (1990). The similarities between paraphilias and addictions include denial of a problem, secrecy of the deviant behavior, and urgency to gratify immediate urges, resulting in a chaotic lifestyle checkered by treatment failure (Lanyon 1997). The sexual addiction model views pedophiliac behavior as an addiction similar to alcoholism, drug abuse, overeating, or bulimia. Following a 12-Step Alcoholics Anonymous approach, pedophiliac patients are taught that they are unable to control their pedophiliac addiction and must surrender themselves and their addiction to a higher power. Although those addicted to sex do not go into traditional physiological withdrawal following discontinuation of pedophiliac behavior, as they would if they were addicted to a chemical substance, it is theorized that pedophiliac acts lead to biochemical phenomena that are physiologically gratifying to these individuals. It is hypothesized that individuals addicted to sex use such physiological gratification to deal with a variety of upsetting stresses and emotions. Contrary to the success reported by self-help groups (e.g., Sexaholics Anonymous, Sex and Love Addicts Anonymous), encouraging celibacy from masturbation or other forms of sexual expression did not aid in the control of pedophiliac fantasies (Brown et al. 1996).
Carnes (1991) identified a variety of characteristics of sexually addicted pedophiliac individuals that were similar to those of alcohol addicted individuals. In DSM-IV, sexual addiction is not included as a psychiatric disorder. Although psychological tests have failed to discriminate those addicted to sex from those who are not, and although those addicted to drugs are expected to permanently give up their drug of choice whereas those addicted to sex are not expected to permanently give up sex, the sexual addiction model addresses the importance of integrating various treatment approaches and relying on family intervention to help reduce recidivism. The reader is referred to Carnes (1990), Coleman (1990), and Naditch and Barton (1990) for further information regarding the sexual addiction model.
In recent years, a sexual trauma model, in which it is suggested that pedophiliac behavior results directly from childhood sexual abuse of the pedophiliac individual, has been offered (Schwartz and Brasted 1985). In this model, treatment focuses not only on helping pedophiliac persons to cease their pedophiliac acts but also on helping them to appreciate the severe consequences of their being molested in the past.
Although authors of a number of descriptive studies have examined the abused-abuser hypothesis, results are inconclusive. In a study comparing the sexual abuse histories of sex offender and non-sex offender inmates, Dhawan and Marshall (1996) concluded that sexual abuse appeared to be an important factor in the backgrounds of sex offenders. Interviews with preadolescents and adolescents who molest other children frequently reveal recent evidence of their own victimization; however, this link has not been consistently found in adult pedophiles. Indeed, because it has been consistently found that 20% of females are molested prior to age 18 years (Finkelhor et al. 1986) and yet true female pedophiles are rare, these findings suggest that the abused-abuser hypothesis is overemphasized.
Treatment using the sexual trauma model involves uncovering the pedophiliac patient’s sexual traumatization and using abreaction and insight-oriented psychotherapy to resolve the resultant traumas and thereby eliminate the inappropriately directed energies that lead to pedophiliac behaviors. Readers are referred to Schwartz and Brasted (1985) for further details regarding the sexual trauma model.
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD