Pedophilia: the problem with diagnosis and limitations of CBT in treatment

This paper asserts two main points. First, there is little reason to include pedophilia among the mental disorders of the Diagnostic and Statistical Manual (DSM). The diagnostic criteria as specified in the DSM-IV-TR (2000) are both over-inclusive in that all acts of child molestation warrant diagnosis, and under-inclusive in that individuals who have not acted upon, and who are not distressed by their sexual interest in children do not meet diagnostic criteria. On both sides of this debate there are problems. A diagnosis of pedophilia seems to "medicalize" an illegal behavior, or "criminalize" fantasy; depending on the diagnostic criteria used, or the use made of the diagnosis. Secondly, the typical CBT-based relapse prevention treatment for pedophilia, which represents current best practice, is reviewed. It is suggested that this, as a stand alone therapy, is suboptimal. CBT components are necessary but not sufficient for comprehensive therapy. It is imperative that process issues are given primacy in treatment programs. The common factors literature makes it clear that the therapeutic relationship is at least as potent a factor promoting change as the system or techniques that clinicians employ. Diagnosis per se is not required for adequate treatment of these individuals. For the CBT components, some offence specific information is required but that is a far cry from true diagnosis.