Pedophilia - Imaginal Desensitization

McConaghy and co-workers (McConaghy 1990; McConaghy et al. 1985) described a treatment component for decreasing pedophiliac arousal without aversion therapy. Pedophiliac individuals frequently report having irresistible urges to become sexually involved with children. These urges are accompanied by sensations of elation, anxiety, nervousness, and/or hypervigilance. After learning progressive muscle relaxation, pedophiliac patients are instructed to imagine and describe the highly charged, anxiety-provoking scenes that normally precede initiating acts against a child. Once their typical feelings or emotions are aroused, they immediately implement the relaxation technique, waiting and experiencing the loss of the deviant urge while simultaneously experiencing relaxation. This process is repeated with a number of highly charged scenes until patients acquire the skill to tolerate the emotional discomfort that previously drove them to act on these urges to escape their discomfort. The advantage of this treatment is that patients can practice tolerating the emotions and anxiety that previously led them to believe that they must act on the pedophiliac urges. The therapist's role is to train the pedophiliac patient in the use of this methodology and to monitor the patient's application of it in vivo.

Psychosurgery

Surgical castration and stereotactic neurosurgery are highly invasive procedures that are not condoned, for a variety of ethical reasons. However, reviews of such treatment (Bradford 1985, 1988; Heim and Hursch 1979) have indicated that surgical interventions are very effective. Indeed, a number of long-term outcome studies have suggested recidivism below 5% following these procedures (Bradford 1985).

Pharmacological Interventions

Drug intervention serves a critical role in treating individuals with pedophilia. The majority of such individuals are nonviolent and have reasonably good control over their pedophiliac urges. In every group of patients treated, however, there are individuals with very poor impulse control who compulsively molest children. Less commonly, there are persons who have been sexually violent with children and, in very rare cases, who have carried out sadistic acts against children. In these cases, prompt intervention is essential, especially if the pedophiliac individual remains in the community. The reduction of sex drive with selective serotonin reuptake inhibitors (SSRIs), hormonal agents, or both is much more rapidly effective than cognitive-behavioral interventions. In approximately 5% of cases, pedophiliac behavior is concomitant with a psychotic illness or major depression, and drug intervention, hospitalization, or both may be urgent. In fact, Raymond et al. (1999) concluded that Axis I and Axis II comorbidity rates are high for pedophiliac individuals. Thus, psychiatrists serve a critical role in the care of those more acutely ill or more dangerous individuals, for whom their therapeutic skills are sorely needed.