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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 87-88

Pedophilic Disorder: A Case Report


1 Assistant Professor, Department of Psychiatry, IGIMS, Patna, India
2 Professor & HOD, Department of Psychiatry, IGIMS, Patna, India
3 Associate Professor, Department of Psychiatry, IGIMS, Patna, India

Date of Web Publication20-Nov-2020

Correspondence Address:
Niska Sinha
Department of Psychiatry, IGIMS, Patna
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Pedophilic disorder is a paraphilic disorder in a person atleast 16 years or older and is characterised by sexual fantasies and attraction to children who have not yet attained puberty. These fantasies are acted upon causing marked distress or interpersonal difficulties in patient and risks the child victims well being, negatively affecting their psychosocial development. It remains a challenge for clinicians and researchers in terms of under reporting and effective treatment measures. In the present case we report a case with this disorder in order to better understand this clinical construct.

Keywords: Pedophilic disorder, paraphilia, sexual fantasies.


How to cite this article:
Sinha N, Kumar R, Singh KK. Pedophilic Disorder: A Case Report. J Indira Gandhi Inst Med Sci 2019;5:87-8

How to cite this URL:
Sinha N, Kumar R, Singh KK. Pedophilic Disorder: A Case Report. J Indira Gandhi Inst Med Sci [serial online] 2019 [cited 2020 Nov 26];5:87-8. Available from: http://www.jigims.co.in/text.asp?2019/5/1/87/301087




  Introduction: Top


The word pedophilia comes from the Greek word pedo meaning “child”, and philía meaning “friendly love”. Lets think back to our first childhood crush, be it a class fellow or a friend in neighbourhood, in our school days and into adulthood, our affections mostly focus on others in our approximate age group. But what if they did not. It is estimated that about 1 percent of population continues, to find themselves attracted to prepubescent children. These people are living with pedophilia, a sexual attraction to prepubescents that often constitutes a mental illness. It is sad to say that both our society and laws are failing them and henceforth ignoring opportunities to prevent child abuse.

Paedophilia appears in both psychiatric diagnostic systems, the ICD-10 and the DSM-5, under disorders of sexual preference (paraphilia). The American Psychiatric Association (APA) defines pedophilia as an intense and recurrent sexual interest in prepubescent children, and specifies it to be labelled a disorder only if it causes a person “marked distress or interpersonal difficulty” or if the person acts on his/her interests.[1] DSM-5 has depathologized paedophilia and has clearly distinguished it from paedophilic disorder. This is important from both a clinical and a forensic perspective, as pedophilia with mere sexual preference for children does not cause child harm and hence seldom requires therapy or prosecution; though preventive measures are indicated, because the preference may still constitute a risk factor for later offending. Unfortunately both our society and laws ignore pedophilia till the commission of a sexual offense, emphasizing punishment, not prevention. Like other sexual orientations, pedophilia is unlikely to change. The goal of treatment, therefore, is to prevent someone from acting on pedophile urges; either by decreasing sexual arousal for children or increasing the ability to manage that arousal and also preventing access to children by providing close

2 supervision.


  Case Summary: Top


Index patient Mr. N, a 55 year old male hailing from middle socioeconomic strata of urban Bihar, a father to two sons presented as outpatient in department of Psychiatry, IGIMS, Patna accompanied by his wife in month of December, 2017 with chief complaints of low mood and feeling of guilt with suicidal ideations for last 1 year. On detail assessment and history taking, patient an airport official with an average intelligence had been recently transferred as a disciplinary step from higher authorities revealed with a teary and downward gaze eyes, along with his wife who too was crying while discussing the ordeals of her husband, that all trouble and current state arosed because of his sexual interest towards little children of either sex boy or girl, which had been present for years since his adolescent days, and despite his efforts, this attraction remained persistant and often landed the whole family into moments of embarrassment and shame. When his wife left the room, he became a bit relaxed and communicated further. He told that he was from a conservative family and has been working as an airport official in climate observation wing in West Bengal and what he had lived, should not be known by anybody, or else he could not live. He told that he had many disturbing moments in his life when he was caught by his colleagues and family members but would somehow manage to convince others on the contrary or escape and had been successful till date in not getting into legal troubles. When he was asked non-judgmental questions to understand the real condition, he told that he did these involuntarily, and was sexually aroused seeing little children when he thought of them, he had fantasies about them, and he approached children under the cover of affection without drawing attention. He told that his affectionate behavior was never further than caressing and touching and had been apologising his wife for such acts in past but in the last event, despite warnings from family he involved again with similar acts with one of his colleagues child and eventually to his despair got transferred. The entire family had to abandon their house, they had been living for years all of a sudden, his children had to leave their course of study and shift to this city to avoid any legal consequences. Therefore, he told that a crises arose in their house, and subsequently has developed low mood and guilt to the extent of not wanting to live any more.

He was counselled and psychoeducated about his illness along with his wife and also warned about possible consequences if he does not guard his behaviour. Wife was asked to keep a close supervision on the patient. He was investigated thoroughly with MRI and other routine investigations being normal, harmonal assessment showing hypothyroidism for which was started on thyroxine. He was put on antidepressant sertraline and antipsychotic aripiperazole and called for frequent follow ups for supportive therapy and behavioral psychotherapy. He has benefitted from the therapy and in his last follow up in October 2018, reported that now he could suppress his interest for children to a considerable bit, and also was getting support from his wife which made him feel better. His wife confirmed the same and told that there was no new problem, patient informed that he paid special care so as not to be alone with other children; although when his sexual urges arose, he could hold himself back, thinking about legal issues, and how much his wife would be sorry if he did not control his urges. He told that his interest for children continued, but he did not reflect this behaviour. The patient is continuing his drugs and is regularly coming for follow ups.


  Discussion: Top


Pedophilia cases are socially disturbing. Therefore, these pedophilic disorder patients rarely come to psychiatry clinics for treatment, rather are more often seen in clinic due to legal cases of sexual assaults to children.[3] The present case came as psychiatry outpatient due to the familial crisis. Defense mechanisms of pedophilia cases may be denial, underestimation, rationalism and fabrication.[4] Some conditions which increase risk of pedophilic disorder are prenatal androgen exposure, traumatic experiences during childhood (including sexual abuse), cranial trauma, low intelligence, temporal lobe epilepsy, post-encephalitic neuropsychiatric disorders, multiple sclerosis, and brain tumors.[5] No pathology was determined in cranial imaging, physical and neurological examinations in our patient, so organicity was ruled out.

It is reported the best treatment response can be obtained by close follow-ups, psychotherapy, and drug treatment.[6] Hormonal agents such as antiandrogens, estrogen, medroxyprogesterone acetate, cyproterone acetate, and gonadotropin analogues may be used in the drug treatment. However, their efficacies are less than their side effects.[7] In a couple of recent studies, it has been reported that selective serotonin reuptake inhibitors (SSRI) (sertraline, fluoxetine, and fluvoxamine) have been successful in treatment by decreasing sexual ruminations and sexual desire.[8] Also, cognitive behavioral treatment methods have been promising options to decrease frequency of acting out on impulses in treatment of pedophilic cases. DSM-5 states that the “course of pedophilic disorder may fluctuate, increase, or decrease with age”. Some cases may be even unaware that this is a disorder and psychoeducation, prevention and development of programs about this issue are the most effective ways to curb this social menace.


  Conflict of Interests: Top


The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.



 
  References Top

1.
American Psychiatric Association, 2013: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing, 947 pp.  Back to cited text no. 1
    
2.
Erdogan A. Pedophilia: Clinical Features, Etiology and Treatment. Current Approaches in Psychiatry 2010;2:132-160.  Back to cited text no. 2
    
3.
Lanning KV. Child Molesters: A Behavioral Analysis. 4th ed. Alexandria, National Center for Missing & Exploited Children, 2001.  Back to cited text no. 3
    
4.
Tenbergen G, Wittfoth M, Frieling H. et al. The neurobiology and psychology of pedophilia: recent advances and challenges. Front Hum Neurosci 2015;9:344.  Back to cited text no. 4
    
5.
Murphy L, Bradford JB, Fedoroff JP. Paraphilia and paraphilic disorders. In: Gabbard GO, ed. Gabbards Treatments of Psychiatric Disorders. Washington, DC: American Psychiatric Publishing; 2008:669-694.  Back to cited text no. 5
    
6.
Fedoroff JP. Managing versus successfully treating paraphilic disorders: the paradigm is changing. In: Levine CB, Althof SE, eds. Handbook of Clinical Sexuality for Mental Health Professionals. New York: Taylor and Francis; 2016:345-361.  Back to cited text no. 6
    
7.
Zonana H, Abel G, Bradford J. Pharmacological treatment of sex offenders, In Dangerous Sex Offenders: A Task Force Report of the American Psychiatric Association. Washington DC, American Psychiatric Association 1999,103-127.  Back to cited text no. 7
    
8.
Kafka MP. Sertraline pharmacotherapy for paraphilias and paraphilia related disorders: an open trial. Ann Clin Psychiatry 1994; 6:189-195.  Back to cited text no. 8
    




 

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