Is pedophilia a sexual orientation or a mental disorder?

Question

There are some different claims being made that pedophilia is a sexual orientation rather than a mental disorder.

At the moment there seems to be a growing group of psychologists advocating that pedophilia is, or at least should be considered a sexual orientation rather than a mental disorder.

For example:

GOOD: You're a member of a growing group of psychologists who say pedophilia should be considered a sexual orientation. Why?

Quinsey: Part of the definition of pedophilia is a person has a preference for a particular kind of partner. [...] pedophiles, unlike other men, show substantial sexual interest in prepubescent children. As far as we know—and many people have tried—these sexual interests are not modifiable by any method that’s been tried yet. So it appears like pedophilia is a sexual orientation. [...] You also can’t modify that interest; it’s stable through adulthood, just like pedophilia.

Another example:

“Pedophiles are not simply people who commit a small offence from time to time but rather are grappling with what is equivalent to a sexual orientation just like another individual may be grappling with heterosexuality or even homosexuality,” emphasized Van Gijseghem.

“True pedophiles have an exclusive preference for children, which is the same as having a sexual orientation. You cannot change this person’s sexual orientation.” He added, however: “He may however remain abstinent.”

There is also an advocacy/support group for people attracted to minors, B4UACT, who state in a section from their website (emphasis mine):

Why do you say that minor-attracted people are stereotyped?

Popular beliefs about minor-attracted people are not supported by the evidence. Research shows that they are no more violent or aggressive than the general population, nor do they suffer from psychopathology or personality disorders. As a group, they do not share any particular characteristics or behaviors other than their feelings of attraction.

As I understand things mental disorders tend to have observable associated symptoms, while a sexual orientation would not as it is just an instinctive attraction (in the general sense of the term).

Are there studies that suggest that pedophilia is a sexual orientation? Do traits typically associated with a mental disorder apply to pedophilia?

Answer 1

Before trying to give any sort of answer, it is important to address a common misconception. In popular culture, the terms child-molester and pedophile are often equated. Scientifically, they are not at all the same. The approximate scientific definition for a pedophile is:

an individual that has an unwavering sexual attraction to prepubescent children similar to attraction heterosexual men have for women

This means that a pedophile might or might not molest children, and a child-molester might or might not be a pedophile. Further, implicit in this definition is a close resemblance to a sexual orientation, and if you want a through and careful discussion of this (much better than my answer) then read:

Seto, M.C (2012) Is Pedophilia a Sexual Orientation? Archives of Sexual Behavior 41(1): 231-236.

Now, the actually relevant scientific discussion (as opposed to merely a semantic distinction) is threefold: (1) can pedophilia be considered a choice in the legal sense? (2) what causes it? (3) can it be treated?

Note that for what we typically consider sexual orientations, questions (1) and (3) have clear answers: no, and no. However, for mental disorders, all permutations of answers to (1) and (3) are possible. Thus, answering these questions does not let you clear up semantic ambiguity.

To start with question (2): in broad strokes Blanchard, et al. (1999) and Cantor, et al. (2004) suggest that pedophilia has a prenatal cause. For question (3) there has been no evidence to suggest that pedophilia can be treated or "cured", much like how you cannot "cure" homosexuality. This lead to Van Gijseghem expert testimony before the Canadian Parliment's Standing Committee on Justice and Human Rights that you quote from in your question. He concludes that pedophilia cannot be 'cured' through penal intervention. However, it is possible for a pedophile to abstain from becoming a child-molester.

This leaves us question (1), the legal part of this. In Canada, being a pedophile is not a crime, but molesting children is a crime. The status of pedophilia as a mental disorder or sexual orientation is irrelevant to this since both mental status and sexual orientation are protected by Canadian law as long as they do not infringe on other's rights. To help pedophiles abstain from molesting children there is the Circles of Support and Accountability (CoSA) program (note: it deals with all kinds of sexual offenders, not just child-molesters). This program is aimed to manage and not 'cure'. Wilson et al. (2007, 2009) have shown that CoSA produces dramatic decrease in re-offence rates for sexual offenders.

Answer 2

I think it's important to clarify that pedophilia is currently classified by the DSM IV as a paraphilia. A paraphilia is as a "recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving non-human objects, the suffering or humiliation of oneself or one's partner, children, non-consenting persons.

The word "paraphilia" is considered by most to be pejorative.

It's interesting to note that until 1973, homosexuality was classified as a paraphilia. It was considered as deviant as pedophilia is currently. Today, homosexuality is classified as a sexual orientation.

The current edition, DSM-IV, categorizes pedophilia as a disorder only if the sexual fantasies or urges involve prepubescent children (defined as 13 or younger), if they last at least six months, if the individual has acted on them, or if they cause marked distress (including legal problems). The DSM-IV also specifies that a person be at least 16 years old and at least five years older than the prepubescent child.

The draft version of DSM-V, now undergoing review, proposes several changes to the diagnosis of pedophilia. One is to expand the definition of this disorder to include hebephilia, an attraction to children who are going through puberty. The hybrid category, pedohebephilia, would consist of the pedophilic type (attracted to prepubescent children, generally younger than 11), the hebephilic type (attracted to pubescent children, usually ages 11 through 14), and the pedohebephilic type (attracted to both). In another significant change, the draft suggests that the use of pornography depicting prepubescent or pubescent children for six months or longer should be considered a symptom of pedohebephilia.

The key points the article makes are these:

- Pedophilia is a sexual orientation and unlikely to change. Treatment aims to enable someone to resist acting on his sexual urges.

- No intervention is likely to work on its own; outcomes may be better when the patient is motivated and treatment combines psychotherapy and medication.

- Parents should be aware that in most sexual abuse cases involving children, the perpetrator is someone the child knows.

Pessimism About Pedophilia - Harvard Mental Health Letter - Harvard Health Publications - Harvard Medical School - July 2010

The article goes on to discuss that regardless of classification (paraphilia versus sexual orientation) the focus on pedophilia will have to be on treatment to prevent the pedophile from acting out on his/her sexual urges.

Anecdotally, when in a training on community sex offender management probably, oh, five years ago, the trainer classified three main sexual orientations: homosexuality, heterosexuality, and pedophilia. I remember being so taken aback by this, as I had never even remotely thought of pedophilia as a sexual orientation. In this training, bisexuality was not represented as a sexual orientation, but a note was made of it between homosexuality and heterosexuality on the triangle-shaped chart the trainer was using.

According to the Wikipedia's entry on sexual orientation, the American Psychiatric Association (APA) has stated, "some people believe that sexual orientation is innate and fixed; however, sexual orientation develops across a person's lifetime". The APA also says that "most people experience little or no sense of choice about their sexual orientation". Wikipedia - Sexual Orientation Note: the article elaborates, so you might want to read it in its entirety.

I think there is the impression that if pedophilia is classified as a sexual orientation then it is somehow condoning pedophilia. I disagree that this is true. Assigning any sexual orientation is merely a classification; it just so happens that pedophilia would be, technically, a criminal sexual orientation. I personally see validity in the classification of pedophilia as a sexual orientation, having had a good deal of training that focuses on sex offenders, and pedophiles in particular most of the time. That said, I recognize it's a very controversial topic.

Edited to Add: I wanted to update this answer with information about pedophilia as a sexual orientation and the difference between pedophilia and (child) molestation.

First, I want to reiterate regardless of classification (paraphilia versus sexual orientation) the focus on pedophilia will have to be on treatment to prevent the pedophile from acting out on his/her sexual urges. You might be interested in this quick read, No Known Cure.

These statistics are circa 2008 and the source is the trainers from the Colorado Sex Offender Management Board (SOMB). The following chart shows the proposal for classifying pedophilia as a sexual orientation, rather than a paraphilia.

Heterosexuality (non-deviant), homosexuality (non-deviant), and pedophilia (deviant) are defined as the three main sexual orientations. I included bisexuality (non-deviant) as being on the spectrum of sexual orientation, and child molestation (deviant) separate from the sexual orientation spectrum, because molestation is often an opportunistic event rather than an ingrained paraphilia or orientation, and can be non-preferential when it comes to victims.

Why would pedophilia be considered a sexual orientation? (The following is from my notes and I cannot cite specific sources for, say, MRI studies). Pedophiles are sexually attracted to children. It is not a matter of seeing pedophiles who are attracted to the same or opposite sex; it is a matter of being attracted to children in general. Often pedophiles will fixate on prepubescent boys, but if you look at a pedophile's offense history (if they are involved in the criminal justice system) you will find a preponderance of male victims. However, a male-fixated pedophile will also have sexual contact with females when males are not available, which is circumstantial, but the point is pedophiles are sexually aroused by children. Pedophilia is like heterosexuality or homosexuality in that it is innate. It it not a sought after or chosen sexual orientation.

MRI studies have shown there are brain differences in pedophiles; there are areas of the brain that are "missing" or show dark spots or "holes" where gray matter should be. (I'm sorry my notes don't specify which part of the brain is involved)

In comparison, persons who molest a child, but who are not pedophiles, are more opportunistic about their crime(s). As far as sexual orientation goes, a pedophile's orientation is to children; a molester's orientation is to his/her peers, whether heterosexual or homosexual. A pedophile's attraction to children is permanent; a molester's is temporary. The average number of pedophiles who had sexual contact with a child by the age of 19 or younger is 74%; the average number of molesters who had sexual contact with a child by the age of 19 or younger is 57%. The average victim target for pedophiles are males under the age of 13; for molesters, the average target are females approximately the age of 13. Pedophiles are typically not in a relationship or marriage, or are in a marriage of convenience; molesters are typically in a relationship or marriage.

Yet, in opposition to the position that pedophilia is a sexual orientation, there are also statements like this from the SOMB, the same board that provided the training on pedophila as a sexual orientation. Go figure! Anyhow, it says:

Sexual offenses are defined by law and may or may not be associated with or accompanied by the characteristics of sexual deviance which are described as paraphilias. Some sex offenders also have co-existing conditions such as mental disorders, organic disorders, or substance abuse problems.

Many offenders can learn through treatment to manage their sexual offending behaviors and decrease their risk of re-offense. Such behavioral management should not, however, be considered a “cure” and successful treatment cannot permanently eliminate the risk that sex offenders may repeat their offenses.

No Known Cure Position Paper -- Colorado Department of Safety, Division of Criminal Justice, Sex Offender Management Board

I hope this information is useful and not just a lot of jargon to wade through.

Edited to Add: Per your request, a couple paragraphs on paraphilias and mental disorders. Currently, the DSM-IV-TR classifies paraphilia as an Axis I mental disorder (you will also find mental illnesses on Axis I, such as mood disorders, schizophrenia, anxiety disorders, and dysthymia or unipolar depression). The DSM-IV-TR does differentiate between a latent paraphilia, consenting adults engaging in sexual activity that includes paraphilic interest(s), and an active paraphilia in which harm is caused to another person. It is only the latter that is classified as a mental disorder. Is it inherently a mental disorder to have a paraphilia? No. It becomes a mental disorder when acting upon one's paraphilia causes victimization and harm to another person.

Interestingly, some studies have found a solid co-morbidity of paraphilia and other Axis I mental illnesses. For example, A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders (US National Library of Medicine, National Institute of Health). One interesting statistic from the aforementioned paper: The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype. Of course one sentence is out of context, so I encourage you to read the abstract in full. As a major symptom of ADHD is impulsivity, I found it a fascinating correlation.

Answer 3

Is pedophilia a sexual orientation?

The common definition of "sexual orientation" is:

A preference for sexual partners of a specific gender.

The common definition of "pedophilia" is:

A preference for sexual partners of a specific age (prepubescent).

Since age is not the same as gender, it follows that pedophilia is not a sexual orientation by definition.

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Is pedophilia a disorder?

Pedophilia is a disorder according to the current diagnostic system DSM-5 only if a child is actually abused (Criterion B of the DSM-5 diagnostic criteria):

Most people with atypical sexual interests do not have a mental disorder. To be diagnosed with a paraphilic disorder, DSM-5 requires that people with these interests:

• feel personal distress about their interest, not merely distress resulting from society’s disapproval;

or

• have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent

See this question for a distinction between paraphilia and paraphilic disorder: Is paraphilia a disorder?

Answer 4

I'm just gonna point out that in the DSM-5 there's a new distinction (in general) between a paraphilia and a paraphilic disorder. While nothing else changed in the operational definition given in the manual, in DSM-5 the formerly known pedophilia (of DSM-IV) is now called pedophilic disorder. The official change notice says:

In the case of pedophilic disorder, the notable detail is what wasn’t revised in the new manual. Although proposals were discussed throughout the DSM-5 development process, diagnostic criteria ultimately remained the same as in DSM-IV TR. Only the disorder name will be changed from pedophilia to pedophilic disorder to maintain consistency with the chapter’s other listings).

And the guy who was apparently in charge of this, Ray Blanchard, said specifically:

If you take [an] individual who has a very strong erotic attraction for children, but who has never acted on it, who never would act on it, who agrees that society’s prohibition of adult child sexual interactions should be in place, do you want to say this individual has a mental disorder?

So the DSM-5 position is not that pedophilia is a "sexual orientation", but that it might not always be a disorder either... just a paraphilia (with the new definition thereof). The latter is defined in DSM-5 as:

[A]ny intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.

A review-ish article concludes (on the classification issue) by saying that

Paraphilias occupy an uneasy place in psychiatric nosology.

And also note that the American Psychological Association disagreed with the Psychiatric one by saying explicitly in a 2013 press release:

The American Psychological Association maintains that pedophilia is a mental disorder;

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And Seto's paper (pointed out by Artem) says that

pedophilia can be viewed as a sexual age orientation based on the more limited evidence available regarding its age of onset, associations with sexual and romantic behavior, and stability over time.

Note however that word 'age' is key here in the distinction he makes later:

But what about the legal and social implications? In particular, what impact might there be in conceptualizing pedophilia as a sexual age orientation, based on empirical evidence, akin to sexual gender orientation such as heterosexuality or homosexuality? For example, there are anti-discrimination laws or policies that specifically mention ‘‘sexual orientation’’ as grounds for redress. The makers of these laws and policies surely had sexual gender orientation in mind, not sexual age orientation.

So basically his answer is that calling pedophilia a sexual orientation is unacceptable in society, because of the widespread use of "sexual orientation" referring only to gender orientation, the consequences of which (sexual acts) are lawful (well, in most of the world), whereas acting on pedophlia impulses breaks the law almost everywhere, and this is unlikely to change.

The DSM-5 apparently did (for a brief time) describe in one place (a discussion section) pedophilia as a sexual orientation, however this was described as an error that was fixed in November 2013:

The phrase "sexual orientation" was used erroneously in the discussion section about pedophilia in the recently released fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In a press release, the American Psychiatric Association (APA) notes that the correct terminology is "sexual interest" and that it will correct the error in the manual's electronic version and in the next print edition.

"Sexual orientation is not a term used in the diagnostic criteria for pedophilic disorder, and its use in the DSM-5 text discussion is an error," said the organization in its statement.

The APA adds pedophilic disorder is a "paraphilia" and not a sexual orientation. Other paraphilic disorders included in the manual include exhibitionistic disorder, sexual sadism disorder, and fetishistic disorder.

It surely didn't help the Psychiatric Association's image that the discovery of the error was apparently made public by an evangelical Christian magazine.