[Pedophilic Disorder and the Use of Child Sexual Abuse Material: The Need for a Multimodal Treatment Approach]

In DSM-5 and ICD-11, pedophilic and/or hebephilic disorder is defined by either psychological distress and/or acting on one's sexual preference-such as through the use of child sexual abuse material (CSAM). It is assumed that most CSAM users remain unknown to law enforcement. Studies on undetected CSAM offenders indicate a higher relapse rate compared to forensic samples. This presents unique challenges for treatment, as the goal is not only to alleviate psychological distress but also to achieve complete behavioral control. This study outlines the multimodal treatment approach for CSAM users within the prevention network "Kein Täter werden" and examines both psychotherapeutic and pharmacological interventions. Between 2018 and 2023, 570 individuals presented to the Berlin site of the prevention network seeking help. The sample was analyzed based on sociodemographic and diagnostic characteristics, as well as the use of medication to reduce sexual preoccupation. Initial exploratory analyses also assesed relapse rates during therapy. Case studies illustrate the therapeutic approach, and a proposal for treatment guidelines regarding the indication for pharmacological interventions in undetected individuals with pedophilic and/or hebephilic disorder is discussed.