Pedophilic Disorder: Prevention and How to Get Confidential Help
No one chooses their feelings, but actions are always a choice. This article explains pedophilic disorder from a medical and child-protection perspective, and shows where to get help before any child is harmed.
Key points
- No one chooses to have sexual feelings towards children, but actions are a choice. Sexual contact with a child, or viewing, possessing or sharing sexual images of children, is always abuse and always a crime.
- Confidential treatment genuinely helps, and works best when started before any child is harmed.
- Help is available from Thailand's 1323 mental-health hotline, the 1300 social assistance hotline, the Troubled Desire online programme, or a confidential consultation with a doctor.
This article may not be easy to read, but I have written it for one reason only: to protect children. Prevention work around the world has found that some people who have sexual feelings towards children do not want to hurt anyone and are looking for help, but do not know where to start because they are afraid of being judged. Opening a path for these people to get treatment early is one of the most effective ways to prevent child sexual abuse.
If you are worried about your own feelings, please read to the end, and know that there are people ready to help you without judgment. This article is part of the Paraphilic Disorders series.
Three terms that are not the same thing
- Pedophilia is a pattern of sexual attraction directed at prepubertal children.
- Pedophilic disorder is when that attraction meets medical criteria: the person has acted on it, or it causes marked distress.
- Child sexual abuse is an act, and it is always a crime, whether or not the person who commits it has this disorder.
This distinction matters, because not everyone with these feelings acts on them, and not everyone who offends has this disorder. Keeping them separate helps prevention target the right people.
Medical criteria
DSM-5-TR (2022) diagnoses pedophilic disorder when:
- There are intense, recurrent sexual fantasies, urges or behaviours involving prepubertal children (generally aged 13 or younger), lasting at least 6 months.
- The person has acted on these urges, or the urges cause marked distress or interpersonal difficulty.
- The person is at least 16 years old and at least 5 years older than the child.
Clinicians also specify whether it is the exclusive type (attracted only to children) or the nonexclusive type (also attracted to adults), the sex of the children the person is attracted to, and whether it is "limited to incest". Unlike the other conditions in this group, pedophilic disorder has no "in full remission" specifier, because the risk needs ongoing care. ICD-11 classifies it as 6D32 Pedophilic disorder. Other conditions with a child-related subtype, such as exhibitionistic disorder, also need a child-protection assessment.
The exact prevalence is not known. Medical textbooks estimate an upper limit of around 3% of men, and it is much less common in women.
Criterion A
- Feelings toward prepubertal children
- For at least 6 months
Criterion B
- Has acted on them, or
- Marked distress / relationship problems
Criterion C
- Aged at least 16
- At least 5 years older than the child
Unlike other conditions
- No "in full remission" specifier
- Needs ongoing care
ICD-11 code 6D32. Feelings are not actions, but acting on a child is always a crime.
A preference vs a condition that needs treatment: feelings are not chosen, actions are
In the other articles in this series, I separate a "preference" from a "condition that needs treatment" based on distress and consent. Here the principle is different, because children cannot give sexual consent at all. So:
| What is happening | What it means |
|---|---|
| Having unwanted feelings or thoughts, and never having acted on them | Not a crime, but you should get a confidential assessment and treatment as prevention |
| The feelings cause distress, shame or preoccupation | Meets the criteria for a condition that needs treatment, and therapy helps |
| Sexual contact with a child, or sexualised talk with a child, in person or online | Abuse and a crime |
| Viewing, possessing or sharing sexual images or videos of children | Abuse and a crime, because every image is a real child who was harmed |
Under Thai law, sexual acts with a child under 15 are an offence even if the child "agrees". Possessing child sexual abuse material for sexual purposes is an offence under Section 287/1 of the Thai Criminal Code, punishable by up to 5 years' imprisonment, a fine of up to 100,000 baht, or both, with higher penalties for distributing it.
Children who are abused can be affected for a long time, with fear, depression, relationship problems and broken trust. This is why prevention before anything happens matters most.
When the feelings involve your own child or a child in the family
The clinic has received questions from parents such as, "I have romantic feelings towards my own child. What should I do?" I want to answer clearly, with the child's safety first.
The fact that you have noticed this and had the courage to ask is a good sign that you want to protect your child. But these feelings are not something to wait and hope will fade on their own. Medically, sexual feelings towards a child in the family are what DSM-5-TR calls "limited to incest", and abuse within the family causes especially deep harm, because the person doing it is the one the child should be able to trust most.
What to do now:
- Get professional help as soon as possible, for example from a psychiatrist or a doctor who works in sexology. You can call 1323 today.
- Reduce risky situations, for example by having another trusted adult handle the child's personal routines, such as bathing or bedtime, while you are receiving care.
- Do not involve the child in these feelings in any way.
- If any contact has already happened, or the child may be in danger, the child's safety comes before everything else. Contact the social assistance hotline 1300 or the police on 191, and take the child for medical and psychological care.
Some people have unwanted intrusive thoughts about harming a child and feel intense fear and disgust about those thoughts. This may be a symptom of obsessive-compulsive disorder (OCD), not pedophilic disorder. Telling the two apart needs a professional assessment, which is one more reason to come and talk to someone.
Sexual behaviour in older people with dementia is a different matter
The clinic once published an article on inappropriate sexual behaviour in people with dementia, such as touching, undressing or inappropriate talk. This is part of the behavioural and psychological symptoms of dementia (BPSD), usually caused by decline in the frontal parts of the brain that control inhibition. It is not pedophilic disorder, and patients should not be stigmatised.
Children must still always be protected. Families should make sure children are not left alone with a patient who shows this behaviour, and should talk to a doctor to look for treatable causes such as pain, a urinary tract infection or medication effects. Adjusting the environment and using distracting activities help, and a doctor may consider medication when needed. Read more about whole-person care for older adults in Family medicine and Palliative care.
Assessment and treatment
Assessment is confidential. It covers the nature and duration of the feelings, access to children in daily life, online behaviour, co-occurring issues such as depression, loneliness or alcohol use, and protective factors such as motivation and supportive people.
Psychological therapy is the first-line approach.
- CBT to address distorted thinking, practise controlling urges and understand the impact on children.
- An offence-prevention plan that identifies risky situations and sets clear boundaries in daily life, including internet use.
- Treating co-occurring conditions and building a meaningful life with good relationships with adults.
Medication: the WFSBP (2020) guidelines use medication according to risk level, from SSRIs to testosterone-lowering drugs such as anti-androgens or GnRH agonists for people at high risk. These are always combined with psychotherapy, under a psychiatrist's care, with monitoring for side effects such as loss of bone density.
An example of an effective prevention programme: Germany's Dunkelfeld project (the "Kein Täter werden", or "Don't Offend", network) started at the Charité in Berlin in 2005. It offers free, confidential treatment to people who are attracted to children and are not facing prosecution, based on the principle that "you are not to blame for your feelings, but you are responsible for your actions". In 2017 it launched Troubled Desire, an anonymous online programme available in many languages. Data from more than 4,000 users showed that most people with sexual interest in children were distressed by those feelings (Schuler et al., 2021), confirming that the need for help is real.
Get help before anyone is harmed
- 1323, Thailand's mental-health hotline, open 24 hours (Thai language; ask for English support), when you feel distressed or afraid you might lose control.
- Troubled Desire, the Charité's anonymous online self-help programme, available in English and other languages.
- A confidential consultation with a doctor. See When to see a clinical sexologist.
- 1300, Thailand's social assistance hotline, when a child may be in danger or you suspect abuse.
- Emergencies: 191 (police) or 1669 (medical).
- If the problem is being unable to control your use of sexual material, read more in Other paraphilic disorders and compulsive sexual behaviour.
Dr. Kris Clinic offers confidential initial screening and consultations at the clinic and online, including in English, with referral to a psychiatrist or specialist treatment team. For parents who want to teach their children about their bodies and staying safe, read Sex education for teenagers: a guide for parents, and if the family needs care together, see Family therapy.
- 1Call 1323Mental-health hotline, open 24 hours
- 2Troubled DesireAnonymous online programme by Charité
- 3Consult confidentiallyA doctor or clinical sexologist, with referral to a psychiatrist
- 4A child may be in dangerCall 1300 or 191; the child's safety comes first
Seeking help before anyone is harmed is the best way to protect children.
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Frequently asked questions
If I have sexual feelings towards children but have never done anything, am I doing something wrong?
You did not choose these feelings, and having them is not a crime. But you should talk to a professional confidentially now, to make sure no child is ever harmed.
Is viewing sexual images of children harmful if I never touch a real child?
Yes. Every image is a real child who was abused. Viewing, possessing or sharing it repeats the abuse and is a crime under Thai law. If you cannot stop, seek help immediately.
If I see a doctor, will I be reported to the police?
Talking about your feelings is medically confidential. The exception is when a child is in danger, because the child's safety must come first.
Can this condition be cured?
The underlying attraction usually does not disappear completely, but treatment helps people control their behaviour, reduce distress and live without harming anyone.
Is inappropriate sexual behaviour in an older person with dementia pedophilic disorder?
Generally not. It usually comes from dementia reducing inhibition. Families should still make sure children are not left alone with the patient, and talk to a doctor about causes and care.
อ่านบทความนี้เป็นภาษาไทย
ภาวะใคร่เด็ก (Pedophilic Disorder): การป้องกันและการขอความช่วยเหลือ →
References
- American Psychiatric Association. DSM-5-TR. 2022. Pedophilic Disorder (specifiers: exclusive/nonexclusive type; sexually attracted to males/females/both; limited to incest).
- World Health Organization. ICD-11 MMS. 6D32 Pedophilic disorder.
- Beier KM, Grundmann D, Kuhle LF, et al. The German Dunkelfeld Project: A Pilot Study to Prevent Child Sexual Abuse and the Use of Child Abusive Images. Journal of Sexual Medicine. 2015;12(2):529–542.
- Schuler M, Gieseler H, Schweder KW, von Heyden M, Beier KM. Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children. JMIR Mental Health. 2021;8(2):e22277.
- Thibaut F, et al. The WFSBP 2020 guidelines for the pharmacological treatment of paraphilic disorders. World Journal of Biological Psychiatry. 2020. doi:10.1080/15622975.2020.1744723
- Thai Criminal Code, Sections 287/1 and 287/2 (as amended by the Act Amending the Criminal Code (No. 24) B.E. 2558 (2015)) (in Thai)
This article is for education and does not replace diagnosis or treatment by a doctor. If you have symptoms or concerns, please see a doctor.
