The Criterion A clause, indicating that the signs or symptoms of pedophilia have per- sisted for 6 months or longer, is intended to ensure that the sexual attraction to children is not merely transient. However, the diagnosis may be made if there is clinical evidence of sustained persistence of the sexual attraction to children even if the 6-month duration can- not be precisely determined.
The extensive use of pornography depicting prepubescent children is a useful diagnostic indicator of pedophilic disorder. This is a specific instance of the general case that individ- uals are likely to choose the kind of pornography that corresponds to their sexual interests.
The population prevalence of pedophilic disorder is unknown. The highest possible prev- alence for pedophilic disorder in the male population is approximately 3%—5%. The pop- ulation prevalence of pedophilic disorder in females is even more uncertain, but it is likely a small fraction of the prevalence in males.
Adult males with pedophilic disorder may indicate that they become aware of strong or preferential sexual interest in children around the time of puberty—the same time frame in which males who later prefer physically mature partners became aware of their sexual interest in women or men. Attempting to diagnose pedophilic disorder at the age at which it first manifests is problematic because of the difficulty during adolescent development in differentiating it from age-appropriate sexual interest in peers or from sexual curiosity.
Hence, Criterion C requires for diagnosis a minimum age of 16 years and at least 5 years older than the child or children in Criterion A.
Pedophilia per se appears to be a lifelong condition. Pedophilic disorder, however, necessarily includes other elements that may change over time with or without treatment: subjective distress (e.g., guilt, shame, intense sexual frustration, or feelings of isolation) or psychosocial impairment, or the propensity to act out sexually with children, or both.
Therefore, the course of pedophilic disorder may ﬂuctuate, increase, or decrease with age.
Adults with pedophilic disorder may report an awareness of sexual interest in children that preceded engaging in sexual behavior involving children or self-identification as a pedo- phile. Advanced age is as likely to similarly diminish the frequency of sexual behavior involv— ing children as it does other paraphilically motivated and normophilic sexual behavior.
Temperamental. There appears to be an interaction between pedophilia and antisocial- ity, such that males with both traits are more likely to act out sexually with children. Thus, males with pedophilia.
Environmental. Adult males with pedophilia often report that they were sexually abused as children. It is unclear, however, whether this correlation reﬂects a causal inﬂuence of childhood sexual abuse on adult pedophilia.
Genetic and physiological. Since pedophilia is a necessary condition for pedophilic dis- order, any factor that increases the probability of pedophilia also increases the risk of pe- dophilic disorder. There is some evidence that neurodevelopmental perturbation in utero increases the probability of development of a pedophilic orientation.
Psychophysiological laboratory measures of sexual interest, which are sometimes useful in di- agnosing pedophilic disorder in males, are not necessarily useful in diagnosing this disorder in females, even when an identical procedure (e.g., viewing time) or analogous procedures (e.g., penile plethysmography and vaginal photoplethysmography) are available.