homosexuality, fetishism, and pedophilia

[medimedimedi]

I came across an interesting question today about the difference in homosexuality, fetishism, and pedophilia. Obviously one is a huge topic of political debate and the other is a crime. From a purely psychiatric standpoint, what are the differences? From what I understand (as an oblivious medical student), therapy for all three (back when homosexuality was still classified as a mental disorder) aimed to suppress urges. Does anybody have experience with these topics?

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[deleted480308]

 

[hamstergang]

None of these are problems in and of themselves, and claiming there's pathology based strictly on the presence of homosexuality, pedophilia, or fetishism would seem very wrong to me. There are 2 issues that may arise with these, however:

1) Acting on these may lead to harming others. This is the case for pedophilia and some paraphilias, but not all paraphilias or homosexuality. Therapy is indicated to prevent acting on the urges, hurting others, and getting arrested.

2) These urges may be distressing to the individual experiencing them. This could be the case for all 3 issues. I'm fairly sure that suppressing the urges can't really be achieved, but therapy can definitely be done for the dysphoria (like a therapy for living with chronic pain).

Disclaimer: these views are based on my own research, experience, and common sense. The DSM or your exam may disagree.

 

[hamstergang]

I forgot to add that some paraphilias can develop and overwhelm the individual, being the only way they can achieve sexual pleasure. If they don't like this, they don't have to live with it. Just as it developed and intensified in them, other sexual activities can be substituted into their lives.

I would differentiate this from homosexuality and pedophilia, however, which don't seem to come and go like that.

 

[MacDonaldTriad]

By definition a fetish is the displacement of sexual arousal to an inappropriate object. By depathologizing homosexuality, we have implicitly concluded that same sex arousal is an appropriate object choice. The only “political debates” stem from conflicts between homophobic intolerant individuals who feel the need to marginalize the estimated 6% of citizens who happen to be gay and what I would describe as reasonable individuals who are not offended or threatened by other’s sexual object preferences (choices is probably not an accurate way to state this). You are not seeing pedophilia rights demonstrations because almost no one is arguing that children of either gender are appropriate sexual objects. Child molestation has been well documented to be a large risk factor for a number of mental illnesses including depression, PTSD, and borderline PD.

Now to sit back and watch the sparks fly.

 

[Ceke2002]

homophobic intolerant individuals who feel the need to marginalize the estimated 6% of citizens who happen to be gay

Not to mention the approximated 6-13% of non mono-gender attracted individuals who also incur their ire, and who also happen to have some of the worst mental health issues and outcomes of any group.

 

[birchswing]

I don't see the controversy or why sparks would fly. Pedophilia just is. It's only a problem for the person who has that orientation or if a person abuses a child, which could happen whether a person has pedophilia or not. I'm not sure if there is any connection between a person having pedophilia and feeling it more permissible to violate a child's autonomy. If an adult violates consent by raping another adult, it doesn't seem to be terribly connected toward that person's orientation. Pedophilia seems to be a fixed orientation that first presents during adolescence like other orientations, but I have never heard that it necessarily relates toward pursuing nonconsensual relationships--it's possible, but often when you hear about crimes against children, they don't sound like someone who feels they are in love with a child--they sound more disordered than that, like some the person has obsessive tendencies and a lack of empathy. From what I've read pedophilia sounds like an orientation that is dysphoric due to the inability to have meaningful relationships with adults due to lack of sexual attraction to them; it also sounds very under-studied, probably due to stigma and only looking at people in correctional settings. To the extent that homosexuality was extensively studied and found to be an intractable orientation, I would imagine that pedophilia is, as well, but I don't know if it has been studied to the same extent.

 

[kaserm]

"And so the probable outcome of too much freedom is only too much slavery in the
individual and the state"...

 

[MacDonaldTriad]

I was thinking the sparks might fly if some in the defense of marriage types got into it with some pro-gay rights folk. You are right about rape, it isn’t about lust and sex, it is more of a crime of violence and dominance. Sex has very little to do with it.

 

[touchpause13]

I came across an interesting question today about the difference in homosexuality, fetishism, and pedophilia. Obviously one is a huge topic of political debate and the other is a crime. From a purely psychiatric standpoint, what are the differences? From what I understand (as an oblivious medical student), therapy for all three (back when homosexuality was still classified as a mental disorder) aimed to suppress urges. Does anybody have experience with these topics?

For the record none of those are crimes because they aren't actions. You can be a pedophile without raping a child, you can be gay and celebate (not like I'm trying to put those things on equal footing for the record)

Also I wouldn't necessarily consider fetishism an orientation. Perhaps for some people, but not everyone. It doesn't seem to be nearly as "fixed" as the other two. There seems to be pretty broad spectrum of fetishism from people who dabble occasionally to those who can't achieve sexual pleasure any other way.

 

[Ceke2002]

For the record none of those are crimes because they aren't actions. You can be a pedophile without raping a child, you can be gay and celebate (not like I'm trying to put those things on equal footing for the record)

Also I wouldn't necessarily consider fetishism an orientation. Perhaps for some people, but not everyone. It doesn't seem to be nearly as "fixed" as the other two. There seems to be pretty broad spectrum of fetishism from people who dabble occasionally to those who can't achieve sexual pleasure any other way.

Agree to the first part, although yes definitely not correlating any part of the GLBTQI community with paedophilia. I mean people aren't asexual until the moment they have their first sexual encounter, you tend to know what your orientation is even before an action towards that orientation has taken place.

And yes, a lot of people use the term 'fetish' when what they're really describing is a kink.
~~~~~
I also agree with Birchswing's sentiments regarding stigma towards the study, or treatment, of paedophillia. Do I find the idea of paedophilia (or ephebophilia for that matter) to be utterly abhorrent? Of course I do, but I'd much rather a paedophile, who has not yet acted out on their urges, be able to seek treatment before it reaches the point of a criminal act towards a child taking place.

In regards to paedophilia, as well as it most likely being a fixed orientation for a small percentage of the population, I also wonder if there's some sort of delusional component to it, at least among a certain segment. I remember watching a documentary some years back, where they followed a group of paedophiles who had at least some history of offending, to varying degrees, and the tenacity to which they held onto the belief that the children they loved were capable of not only consenting to physical content, but also loving them back was bewildering to say the least. There was one scene where a self confessed 'proud paedophile' approached a group of boys, aged between 10 and 12, sitting on bikes outside a local deli, and proceeded to have what was actually a very innocent, non sexual conversation with them, but as soon as he'd walked away he was listing all the ways the boys had been 'covertly signalling him' as willing sex partners. To me that seems to go beyond just a simple orientation of attraction and/or sexuality.

 

[Shikima]

http://www.phillymag.com/news/2014/10/06/pedophilia-not-a-crime-rutgers-margo-kaplan/

 

[michaelrack]

Pedophilia can be a big issue for someone even if he successfully fights the urges (especially if he gets professional help and creates a medical/psychological record). Many state medical licenses ask about a diagnosis of pedophilia. I imagine this orientation would also cause problems in many other occupations.

 

[birchswing]

Pedophilia can be a big issue for someone even if he successfully fights the urges (especially if he gets professional help and creates a medical/psychological record). Many state medical licenses ask about a diagnosis of pedophilia. I imagine this orientation would also cause problems in many other occupations.

I don't know about the legal issues or licensure issues, but it doesn't seem like at a theoretical level that having an orientation of pedophilia should present a problem in most jobs unless a person is directly working with children. Even then, I wonder how problematic it is. If you consider it an orientation like heterosexuality or homosexuality then it seems like the equivalent would be an adult working with another adult and knowing that he/she cannot engage that person romantically without consent--the obvious difference being that a person with pedophilia would know that the person he/she has romantic feelings toward could never give consent or have a relationship. I wonder about how many people with pedophilia as an orientation simply live a celibate life. It seems to me there is a difference between having a romantic orientation toward children and having a sense of its appropriateness. Most people with orientations toward other adults don't violate consent toward other adults. But again I don't know if it's something that anyone has studied and if there is that separation.

 

[michaelrack]

Birchswing, what I was trying to say is that a pedophile is going to have practical problems in many careers (even if he never once acts on his feelings), especially if there is a medical record. Obviously, a pedophile pediatric resident is a huge red flag. But imagine if the program director of a family practice or psychiatry resident found out that the resident got counseling for pedophilic attractions in the past-- there are going to be questions about how child rotations are going to be handled, the resident will be brought before a committee and may get kicked out of residency.
Likewise, a pedophilic attending will be carefully scrutinized by licensure boards and have to go through similar programs that drug addicts do (ie, monitoring by a psychiatrist with reports to the board).
I am not arguing the scientific aspects, just saying that society is going to cause problems for the pedophile.

 

[Doctor Bagel]

Birchswing, what I was trying to say is that a pedophile is going to have practical problems in many careers (even if he never once acts on his feelings), especially if there is a medical record. Obviously, a pedophile pediatric resident is a huge red flag. But imagine if the program director of a family practice or psychiatry resident found out that the resident got counseling for pedophilic attractions in the past-- there are going to be questions about how child rotations are going to be handled, the resident will be brought before a committee and may get kicked out of residency.
Likewise, a pedophilic attending will be carefully scrutinized by licensure boards and have to go through similar programs that drug addicts do (ie, monitoring by a psychiatrist with reports to the board).
I am not arguing the scientific aspects, just saying that society is going to cause problems for the pedophile.

This type of stuff makes me really reminds me that how tricky it is to determine what to put into our notes. I've actually never seen this, but I've had colleagues who have had patients with some obsessive issues who worry they might be pedophiles, which they find abhorrent and would never act on. Thinking about OCD stuff, it's not too surprising that you would worry that you have the most hated thing in our society and possibly even have some intrusive images around that. Imagine that getting recorded in a chart in some careless way and coming back to haunt someone who is of no risk to children.

 

[Doctor Bagel]

For the record none of those are crimes because they aren't actions. You can be a pedophile without raping a child, you can be gay and celebate (not like I'm trying to put those things on equal footing for the record)

Also I wouldn't necessarily consider fetishism an orientation. Perhaps for some people, but not everyone. It doesn't seem to be nearly as "fixed" as the other two. There seems to be pretty broad spectrum of fetishism from people who dabble occasionally to those who can't achieve sexual pleasure any other way.

I think the latter would really be more of the concern for treatment with the idea that when fetishes are that fixed, it interferes with intimacy. On a meta level, that's the potential problem with fetishes. I can't see why we other care if someone is really into shoes or whatever. I attended the American Psychoanalytic Conference this year and went to a session on "perversions." The approach now seems amazingly open and actually accepting -- the goal is to approach things in a very non-judgmental curious manner.