You is pedophile

[tensin79]

That odd request for help got closed down for some reason.

Someone had posted a message saying they were having problems but was deleted by the admin for some reason.

I was just wondering how would a patient with that "problem" get treated in the world of psychiatry?

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[JMC_MarineCorps]

Jail is usually where most begin the process.

 

[aphenomenon]

Jail is usually where most begin the process.

Though that may be true in many cases, it's unfortunate. People are discouraged from coming forth to discuss their urges BEFORE a crime occurs because of stigma, dismissal, and other disregard for their struggles. Hopefully, proper treatment seeks to address urges in a compassionate and understanding way in order to have people feel more comfortable managing desires and lower symptoms of potentially comorbid mental illness that may make influence one's patterns of thinking and/or acting. I think it's also important for people to believe that they are not somehow contaminated or evil or wrong or responsible (though they can be in control) and to be commended for seeking help when they do.

Somewhat of an acceptance and commitment orientation, I suppose.

 

[Poetic Silence]

One of those camps they put homosexuals in, I guess.

(JK!)

 

[whopper]

Various ways.

Unfortunately I've never seen a case where someone sought help before they were caught.

Less invasive treatments include psychotherapy and an evaluation. It turns out that excessive sexual drives could be secondary to a mental illness such as bipolar disorder. More invasive includes SSRIs-this time with the doctor wanting to give the ones that cause sexual dysfunction first instead of last, or antipsychotics.

Going on the more extreme side is injection with Depo-Provera or other forms of what have been called "chemical castration." In some states, it's pretty much mandated for some sexual offenders to be on chemical castration. The treatment IMHO needs to be treated with great seriousness since the meds the state usually pushes is given at dosages several times more than the FDA recommends for Depo-Provera's typical purpose of birth control (often-times on the order of 6x the maximum dosage!). There are other chemical castration treatments that are less risky but they are more expensive and the state would rather go cheaper. (Yes I know...is that ethical?, I've brought this up to the state mental health system quite a few times).

Another problem is the data on the safety of chemical castration is not IMHO established well. Despite this, several states have come to the conclusion that it's perfectly fine. I had a debate with someone high up in the system that IMHO the safety opinion is merely that because people don't give a damn about sex offenders. During one debate, the person told me the data was solid that it doesn't cause any problems. Nope. So there's a few dozen people who were on it and only a few quite of them had extremely serious side effects--that's good enough when it's a sex offender I guess.

I've treated a few people on Depo Provera for sexual offenses, each time trying to get the state to pay for more expensive treatments that have less side effects with no success. Each time I had a case of this, I brought this up to the state that IMHO the side effect issue needed to be taken seriously and most people just blew me off. While the sex offender did volunteer for the treatment, it's IMHO on the order of making it under duress. E.g. some of them are told something to the effect of "you better take it" and not given a reasonable discussion of their choices, the risks and side effects.

 

[ghost dog]

Various ways.

Unfortunately I've never seen a case where someone sought help before they were caught.

Less invasive treatments include psychotherapy and an evaluation. It turns out that excessive sexual drives could be secondary to a mental illness such as bipolar disorder. More invasive includes SSRIs-this time with the doctor wanting to give the ones that cause sexual dysfunction first instead of last, or antipsychotics.

Going on the more extreme side is injection with Depo-Provera or other forms of what have been called "chemical castration." In some states, it's pretty much mandated for some sexual offenders to be on chemical castration. The treatment IMHO needs to be treated with great seriousness since the meds the state usually pushes is given at dosages several times more than the FDA recommends for Depo-Provera's typical purpose of birth control (often-times on the order of 6x the maximum dosage!). There are other chemical castration treatments that are less risky but they are more expensive and the state would rather go cheaper. (Yes I know...is that ethical?, I've brought this up to the state mental health system quite a few times).

Another problem is the data on the safety of chemical castration is not IMHO established well. Despite this, several states have come to the conclusion that it's perfectly fine. I had a debate with someone high up in the system that IMHO the safety opinion is merely that because people don't give a damn about sex offenders. During one debate, the person told me the data was solid that it doesn't cause any problems. Nope. So there's a few dozen people who were on it and only a few quite of them had extremely serious side effects--that's good enough when it's a sex offender I guess.

I've treated a few people on Depo Provera for sexual offenses, each time trying to get the state to pay for more expensive treatments that have less side effects with no success. Each time I had a case of this, I brought this up to the state that IMHO the side effect issue needed to be taken seriously and most people just blew me off. While the sex offender did volunteer for the treatment, it's IMHO on the order of making it under duress. E.g. some of them are told something to the effect of "you better take it" and not given a reasonable discussion of their choices, the risks and side effects.

Hey Whopper,

I'm actually following one such patient, and he is on a regimen of "chemical castration."

He was followed for a number of years by a mental health counsellor, but does not have any specialist follow up now. At the present time, I simply ask him how he is doing and monitor his hormone levels. I don't feel well suited for this role.

To complicate the issue further his particular medication was discontinued, and I had to find an alternate medication. He appears stable as previous. He denies urges, and lives in a group home.

How do you approach these patients in long term follow up ?

 

[Poetic Silence]

Pedophiles have to live in group homes? I didn't realize treatment was that intense. I thought CBT would have been sufficient.

 

[digitlnoize]

I heard of one patient while on my rural/peds rotation. Apparently, he was messing around with a teenage niece or something, and his wife caught him. They had a new baby. The wife was seeing the pediatrician for the baby checkup and for her own counseling. Apparently, husband had agreed that he had a problem and was undergoing counseling and/or meds with a psychiatrist. Not sure of the details, but the only case I've heard of where they sought treatment before being "caught" by law enforcement.

On another note: I have an acquaintance from high school who was arrested for child porn charges. Turns out a virus had hijacked her computer and was downloading many gigabytes of porn a day without her knowledge. She managed to get off on the charges, but it was still a nightmare. Make sure you know what your computer is doing!

 

[scarshapedstar]

Pedophiles have to live in group homes? I didn't realize treatment was that intense. I thought CBT would have been sufficient.

May or not be relevant, but once you are a registered sex offender you're basically not allowed to live anywhere. You have to be like 5 miles from a school, and if you draw a 5 mile circle around every school in the country there's almost nothing left - not that the remaining options want to rent to them anyway. Many end up under a bridge, which doesn't seem to be in anyone's interest.

Maybe there is an exception for group homes.

 

[Indryd]

May or not be relevant, but once you are a registered sex offender you're basically not allowed to live anywhere. You have to be like 5 miles from a school, and if you draw a 5 mile circle around every school in the country there's almost nothing left.

This is not true, for better or worse.

Pick almost any school and look at the sex offender map.

I live in an affluent neighborhood (rent control w00t!). My kid's school is 0.6 miles away from me. I have 3 sex offenders within 1 mile of my home, 2 of which are closer to the school than I am.

 

[billypilgrim37]

This is not true, for better or worse.

Pick almost any school and look at the sex offender map.

I live in an affluent neighborhood (rent control w00t!). My kid's school is 0.6 miles away from me. I have 3 sex offenders within 1 mile of my home, 2 of which are closer to the school than I am.

My in-laws, who lived about half a mile from a regional university and an elementary school, almost couldn't sell their house because a "pediatric sex offender" moved in next door. They weren't moving because of that, but apparently the house has been sold again about 3 times in the past 5 years.

 

[Yellowbug]

That odd request for help got closed down for some reason.

I was just wondering how would someone with that "problem" get treated in the world of psychiatry?

Thank you for seeking help for your problem.

Though the urges you experience may be out of your control, seeking help for them is not. And as uncomfortable as it may be to seek help for something so universally reviled, it will help protect people such as myself from having to seek help for a similarly reviled diagnosis that was the direct result of the abuse.

Nobody likes a borderline.

Please seek help from a professional.

 

[aphenomenon]

May or not be relevant, but once you are a registered sex offender you're basically not allowed to live anywhere. You have to be like 5 miles from a school, and if you draw a 5 mile circle around every school in the country there's almost nothing left - not that the remaining options want to rent to them anyway. Many end up under a bridge, which doesn't seem to be in anyone's interest.

Yup. Like the Julia Tuttle sex offender colony: http://en.wikipedia.org/wiki/Julia_Tuttle_Causeway_sex_offender_colony

 

[aphenomenon]

Another problem is the data on the safety of chemical castration is not IMHO established well. Despite this, several states have come to the conclusion that it's perfectly fine. I had a debate with someone high up in the system that IMHO the safety opinion is merely that because people don't give a damn about sex offenders. During one debate, the person told me the data was solid that it doesn't cause any problems. Nope. So there's a few dozen people who were on it and only a few quite of them had extremely serious side effects--that's good enough when it's a sex offender I guess.

I've treated a few people on Depo Provera for sexual offenses, each time trying to get the state to pay for more expensive treatments that have less side effects with no success. Each time I had a case of this, I brought this up to the state that IMHO the side effect issue needed to be taken seriously and most people just blew me off. While the sex offender did volunteer for the treatment, it's IMHO on the order of making it under duress. E.g. some of them are told something to the effect of "you better take it" and not given a reasonable discussion of their choices, the risks and side effects.

Thank you for sharing; I think that's perfectly horrible.

 

[aphenomenon]

One thing I have found a little frustrating...as a medical student doing multiple forensics rotations that went through jails, prisons, long-term forensics institutes, I would always be allowed to sit in on any groups or observe any treatment sessions EXCEPT sex offender groups. Like that was somehow "too ______"(?) for a student. The NGRI cases of murder, sure, spend 8 hours listening to those explicit details, but you want exposure to sex offenders, no way! It's almost like the only contact possible is through a forensics fellowship (even the residents were not offered chances to participate in the SO groups). I found that pretty troubling. As students and residents we are there (anywhere) to learn how to best treat populations of people that may seek or somehow end up at needing our help. Talk about not encouraging seeking treatment before offense? Well, particularly if no one has experience in treating without a forensic fellowship...

 

[aphenomenon]

Also, this is an interesting post from Allen Frances last December.

Hebephilia is a Crime, Not a Mental Disorder

The DSM-5 Sexual Disorders Work Group has originated 3 poorly conceived proposals. Fortunately, 2 have already been rejected—rape will not be a mental disorder and there will not be a diagnosis for hypersexuality (aka, sex addiction). But the Work Group has not yet given up on "Hebephilia." The term was invented to describe men with persistent sexual urges for pubescent youngsters—in contrast to Pedophilia, which is restricted to urges for prepubescent children. The concept of "Hebephilia" has been widely and vigorously opposed—both by the experts in sexual disorders (aware of how weak is the supporting science) and by the forensic experts (aware of how it would be misused in Sexually Violent Predator court hearings). The Work Group first proposed an omnibus diagnosis, "Pedohebephilia," nesting "Hebephilia" within the already authorized "Pedophilia" category. The DSM-5 Web site has recently been revised—the term "Pedohebephilia" disappears altogether, but the concept of "Hebephilia" lives on—the definition of "Pedophilia" has been expanded to include pubescent children. The rationale section of the Web site doesn't bother to mention the change or discuss the highly controversial issues involved and their enormous forensic consequences.
"Hebephilia" is a simply terrible idea. The basic issue is that sexual attraction to pubescent youngsters is not the slightest bit abnormal or unusual. Until recently, the age of consent was age 13 years in most parts of the world (including the United Statse) and it remains 14 in many places. Evolution has programmed humans to lust for pubescent youngsters—our ancestors did not get to live long enough to have the luxury of delaying reproduction.
For hundreds of thousands of years, sex followed closely behind puberty. Only recently has society chosen to protect the moratorium of adolescence and to declare as inappropriate and illegal a sexual interest in the pubescent. This is a wonderful idea, but you can't change human nature by fiat. Surveys show that sexual interest in pubescent youngsters remains very common and anyone who doubts the numbers should do a study of Calvin Klein ads.
It is natural and no sign of mental illness to feel sexual attraction to pubescent youngsters. But to act on such impulses is, in our society, a reprehensible crime that deserves severe punishment. The proper disposition for those who break the law and selfishly violate the innocence of the vulnerable is prison—not a mental hospital.
And the scientific literature offered in support of "Hebephilia" contains very few and very poorly conducted studies—not coincidentally mostly done by the people associated with the DSM-5 Work Group. There are no data on how best to define "Hebephilia," whether it can be diagnosed reliably, or its predictive validity. "Hebephilia" is being dropped into the definition of Pedophilia with no scientific support and no consideration of risks.
This is not a good way to create a diagnostic manual that has such a huge impact in the legal system. The potential consequences to forensic psychiatry are terribly unsettling. "Hebephilia" is already being misused in SVP hearings as an excuse to justify lifelong involuntary psychiatric hospitalization. This constitutes an abuse of psychiatry and a questionably constitutional form of preventive detention—a slippery slope that should definitely be avoided.
How did we get here? The problem started with the composition of the Sexual Disorders Work Group, unduly dominated by individuals with ties to one institution who were given too much freedom to pursue their own idiosyncratic proposals and to overvalue their own very incomplete research. And this tightly sealed in-group has been remarkably insensitive to universal opposition coming from the field.
Time is short—final decisions on DSM-5 will be made soon. It is frightening that "Hebephilia" is so close to being made official—but there is reasonable hope that good sense will eventually prevail. This in-group has been twice forced to back down (on rape and sex addiction) and can probably be forced now to back down again on Hebephilia. But it will doubtless take continued, concerted, and organized opposition from the field.

http://www.psychiatrictimes.com/blog/frances/content/article/10168/2006997

 

[Ceke2002]

That odd request for help got closed down for some reason.

I was just wondering how would someone with that "problem" get treated in the world of psychiatry?

Thank you for seeking help for your problem.

Though the urges you experience may be out of your control, seeking help for them is not. And as uncomfortable as it may be to seek help for something so universally reviled, it will help protect people such as myself from having to seek help for a similarly reviled diagnosis that was the direct result of the abuse.

Nobody likes a borderline.

Please seek help from a professional.

*eyeballs*

Obviously disregard this if I've gotten the wrong end of the stick, but let me see if I have this straight - a self reported patient posted to this board asking for help in regards to what they thought of as their being a paedophile? If that's correct (and that is the impression I'm getting) then that is verrrry interesting, considering just this last week I was involved in several days worth of discussion with a person on another forum who was claiming the exact same thing/asking for help because they were convinced they were a paedophile. They didn't mention this board specifically, but they did say they browsed medical/psych related sites.

If somebody did post here asking for help in regards to their perceived paedophillia, and it is the same person, then this would be the third time they've posted online with their 'help me I'm a paedophile' spiel, and twice they've been told by numerous people that what they've reported experiencing sounds a heck of a lot more like intrusive thoughts, rather than any actual sexual urges towards kids. If they go for a fourth post I might just shout 'attention seeking troll' and call it a day

And thanks, I now have 'Nobody likes a borderline' stuck in my head to the tune of 'Nobody likes a bogan'.

http://www.youtube.com/watch?v=qA8gJoT5yl4

 

[Yellowbug]

I'm sorry to be a stick in the mud, but this isn't funny. It's not surprising that the mentally ill find their psychiatrists to be the most stigmatizing.

There are a handful of posters on this board who respect their patients and are doing well in the field as a result. For those of you creating artificial distinctions between yourselves and those you profess to want to help, thank your parents, genetics and sheer circumstance that you weren't on the other side of the couch.

 

[splik]

We should stay away from this IMHO, psychiatry deals with enough bogus problems as it is. Pedophilia is not a mental disorder and psychiatrists have not place in 'treating it'. Pedophilia itself is not a problem, it is only when people act on these phantasies that it becomes a problem, one that does not require psychiatric intervention. These individuals are usually recalcitrant antisocial personalities.

There is of course psychopathology such as OCD, schizophrenia and organic disease like brain tumors that may be associated but this is not common.

 

[F0nzie]

We should stay away from this IMHO, psychiatry deals with enough bogus problems as it is. Pedophilia is not a mental disorder and psychiatrists have not place in 'treating it'. Pedophilia itself is not a problem, it is only when people act on these phantasies that it becomes a problem, one that does not require psychiatric intervention. These individuals are usually recalcitrant antisocial personalities.

There is of course psychopathology such as OCD, schizophrenia and organic disease like brain tumors that may be associated but this is not common.

I do not know much about pedophilia or whether it has anything to do with ASPD. However, if I were the treating provider I would focus on the distress of the individual rather than the morality of their beliefs. One can imagine how isolating this experience must be and how rejection from society may have a significant impact on the individual's psychological state. These heavy psychological factors may invariably increase their distress and risk for depression.

I can't count how many times I've disagreed with patient's beliefs. However, I cannot allow my personal beliefs to interfere with treatment. They are after all coming to me for help. As a physician, I do care about my patients' distress and whether that distress is resulting in clinical depression, anxiety, or significant social/occupational dysfunction. If I can successfully treat with medications and psychotherapy my job is done.

 

[whopper]

. I don't feel well suited for this role.

I've been in this problematic situation before and I'm a forensic psychiatrist-the one group you figure would have the background and training to be comfortable with it.

What usuallly ends up happening is the patient is told something to the effect that the only way they're going to get out of whatever incarceration they're in is to take the med, they're usually not given the standard of care of what they're supposed to be told concerning the risks, and then they're released. Then the system dumps the responsibility onto a doctor in the community who in this case (you) likely actually wants to follow the rules and inform the patient of the risks of this medication.

So you're stuck between a rock and a hard place. Take this guy off the meds increasing his risk of resuming his sexually problematic behavior or keep him on it. What if he wants to be taken off of it after you tell him the risks and side effects? Is he supposed to go back to prison or a forensic psych unit? You'll likely not get many answers here. Good luck in trying to talk to the judge. They're hardly ever responsive to clinical doctor's requests. As for anyone else, expect to spend lots of time over the phone that where you can't bill for it.

What I would do is find out what type of arrangement was made that got this person released, and if he has to answer to someone such as a probation officer or judge. Then inform them of the situation (with his permission of course) and work from there. In no way shape or form should you medicate this guy simply because the judge wants you to do it. Medication is supposed to be between the patient and doctor unless the judge has some legal ground to force it--and this may vary per state. Even then the doctor is supposed to be part of the decision making process.

If the patient agrees to take it knowing the risks fine. If they don't you're now caught in a very uncomfortable situation where now I don't know what to tell you because on the one side case-law firmly establishes that a patient needs to be told the risks/benefits and cannot be forced on a med unless court-ordered or is an immediate danger to others. On the other hand this person likely is only in the community because they're on this med, ordered by a judge who has no idea that there's a possibility the person could be taken off of it.

My advice for docs is don't even get into this position to begin with unless you are confident in this area.


Now also mind you that people aren't supposed to smoke while on Depo-Provera. If this guy is smoking it's contraindicated. Now WTF do you do when every single sex offender you see smokes and is given to you already on Depo-Provera and doesn't want to quit?

For yourself, I'd read up on the latest data on chemical castration. AAPL has a few articles on it. Here's an example of one.
http://www.jaapl.org/content/23/1/19.full.pdf+html?sid=473c71c3-2e54-41a2-ac2f-c73c21424023

We should stay away from this IMHO

As was the recommendation given to Supreme Court by several highly respected people in the field, yet the Court in essence responded something to the effect of somebody's got to deal with it, might as well be you....

How do you approach these patients in long term follow up ?

Treat this like it's an antipsychotic in terms of metabolic problems. Depo-Provera at megadoses for sex offenders can cause serious metabolic problems.
Don't be shy on ordering labs for coagulation values as this stuff can cause DVTs. If your patient is smoking (and they likely are...) get them off of smoking.
Consider checking for osteoporosis.
Document that the patient is on this medication voluntarily and that you discussed the risks and benefits with them.

Here's a good article as a start
http://www.jaapl.org/content/37/1/59.full?sid=072eed76-5d14-4536-b9cc-e6185fa8df67

 

[Iwillheal]

We should stay away from this IMHO, psychiatry deals with enough bogus problems as it is. Pedophilia is not a mental disorder and psychiatrists have not place in 'treating it'. Pedophilia itself is not a problem, it is only when people act on these phantasies that it becomes a problem, one that does not require psychiatric intervention. These individuals are usually recalcitrant antisocial personalities.

There is of course psychopathology such as OCD, schizophrenia and organic disease like brain tumors that may be associated but this is not common.

First off, pedophilia is a mental disorder. Secondly, to say that pedophilia "itself is not a problem" is cavalier and just stupid. Are you actually a resident or just trolling this thread? There is no iron wall between having a strong desire to have sex with children, fantasizing about it, masturbating to it, and actually engaging in sex acts with children. There are reasons having to do with the individual and also a number of societal deterrents in place, which is why it doesn't happen more often. I am not talking about having a thought police. But this is more than a passing thought, it's a strong desire, an inclination. If such a person is a guest at your house and having all kinds of thoughts about your kids, just because he doesn't happen to act on them when you guys are together, for whatever reason, that he has such consistent fantasies about your kids does not itself present a problem at all?

Third, some are ASPD but that's just a subgroup.

 

[Ibid]

First off, pedophilia is a mental disorder. Secondly, to say that pedophilia "itself is not a problem" is cavalier and just stupid. Are you actually a resident or just trolling this thread? There is no iron wall between having a strong desire to have sex with children, fantasizing about it, masturbating to it, and actually engaging in sex acts with children. There are reasons having to do with the individual and also a number of societal deterrents in place, which is why it doesn't happen more often. I am not talking about having a thought police. But this is more than a passing thought, it's a strong desire, an inclination. If such a person is a guest at your house and having all kinds of thoughts about your kids, just because he doesn't happen to act on them when you guys are together, for whatever reason, that he has such consistent fantasies about your kids does not itself present a problem at all?

Third, some are ASPD but that's just a subgroup.

The complicating factor here is that the number of people who look at "very nasty things on the internet" for instance runs to the millions and millions. The number who will ever act on an urge is very very small in comparison to that number and there is no way of telling who will go from looking to touching.

 

[tensin79]

It wasn't me who was asking for help yellow bug. The original thread got removed.

 

[Poetic Silence]

It wasn't me who was asking for help yellow bug. The original thread got removed.

It's ok, Tensin. This is a safe place for you.

 

[tensin79]

Haha, very funny.

It's interesting that on such a serious topic we basically get the concerned on one hand and the very dismissive on the other. I'm not sure I would be comfortable treating a pedophile any more than I would a murderer. Not comfortable but we have a duty not to judge I guess.

 

[Yellowbug]

No worries Tensin

It's a tough topic, to be sure, but I do believe it's important to show empathy and a lack of judgement to both the pedophile seeking help for urges outside of his/her control and the victim of said perpetrator, as difficult as that may be sometimes.

 

[whopper]

A recommendation I have for all of you is keep a good network of people to ask questions when you don't know what to do. There's a lot in this field you cannot learn in a textbook. Have a forensic psychiatrist you can ask questions if you're ever in a situation like this.

 

[Jorje286]

If people come to you requesting help because of a thought process that bothers them, then it's most definitely the domain of psychiatry - including pedophilia. How could it not be? There's nothing objective about what constitutes a mental disorder or even any illness - with the only parameter is that a human being is suffering, either the patient coming to you or one of those around him/her and we are there to help. And I definitely agree that there's a continuum between thinking and acting - it's not an iron wall, and the best way to redress the act is to act at the thought level.

I guess we would all agree that this is not something we would want to leave aside, not only because the pedophile is suffering but also there are victims in this kind of relationship. The way I see it is that we don't know enough about sexuality to act decisively besides "chemical castration", but we shouldn't run away from the responsibility if not currently in treatment, then certainly in research.

 

[sunlioness]

Well, there's a whole book full of more or less objective criteria for mental illness. I think if we started saying that anything anyone finds subjectively distressing is a mental illness then we would definitely be guilty of pathologizing the normal. And for that matter, I'm having a crappy day today and am tired of hearing the word "Xanax". Maybe that's a mental illness too and I should be exempted from having to deal with drug seeking patients. . Though that of course doesn't touch on whether pedophilia is or isn't one, so I grant I'm probably missing the intended point.

 

[Jorje286]

Well, there's a whole book full of more or less objective criteria for mental illness. I think if we started saying that anything anyone finds subjectively distressing is a mental illness then we would definitely be guilty of pathologizing the normal. And for that matter, I'm having a crappy day today and am tired of hearing the word "Xanax". Maybe that's a mental illness too and I should be exempted from having to deal with drug seeking patients. . Though that of course doesn't touch on whether pedophilia is or isn't one, so I grant I'm probably missing the intended point.

I'm just not so hung up on what constitutes a "mental illness" and what doesn't to start with. If someone comes to me because he or she is psychologically distressed to the point that his/her usual life becomes impaired then that's reason enough for me to help, and it wouldn't be outside the scope of my expertise at all. Psychiatrists are scholars of the mind - it's their to job to fix it. Is that book you're talking about DSM? It's there to help psychiatrists do their job better, not to merely label what is a mental illness and what isn't so we could run around telling people what is normal and what isn't, at least in the way I see it.

I also think that's one of the reason mental illness and illness in general are stigmatized. Nature doesn't judge what is a pathology and what is "normal" - processes just happen and we put value judgement on them based on our personal, cultural and social values. My philosophy on all of medicine is that we are here to lessen suffering, not to pretend that we are objective judges on what is normal/abnormal, as I don't believe that's possible to start with.

 

[erg923]

We should stay away from this IMHO, psychiatry deals with enough bogus problems as it is. Pedophilia is not a mental disorder and psychiatrists have not place in 'treating it'. Pedophilia itself is not a problem, it is only when people act on these phantasies that it becomes a problem, one that does not require psychiatric intervention. These individuals are usually recalcitrant antisocial personalities.

There is of course psychopathology such as OCD, schizophrenia and organic disease like brain tumors that may be associated but this is not common.

I guess I dont follow. Are you arguing psychiatry shouldnt be involved in things that are, or lead to, criminal behaviors? Atascadero was full of psychiatrists last time I checked.

 

[sunlioness]

If someone comes to me because he or she is psychologically distressed to the point that his/her usual life becomes impaired then that's reason enough for me to help, and it wouldn't be outside the scope of my expertise at all.

I agree with you actually. I just think it's helpful to have a framework within which to conceptualize things. A flawed framework, though it undoubtedly is.

I'm honestly not sure what to think of pedophilia from a psych disorder perspective. I agree that to act on it is a horrible crime and a matter for the courts. I agree that having those urges could understandably cause significant distress for the person experiencing them and that psychiatry has a role in helping people with that. I don't know that other than potentially killing any sex drive whatsoever if there's any treatment for the actual being attracted to kids. It seems a cruel joke to play on a person, being wired that way.

I would think it would be possible not to offend, but people would probably want to avoid careers working with children and not have any of their own. And missing out on the beauty that is adult consensual romances/partnerships/relationships is just so sad.

 

[blossompp3]

With regards to how to approach treating these individuals, several other countries have specific programs in place (some rehabilitative, some preventative). I think it's a shame that we (as a society) have stigmatized this so much that people don't feel like that can get the help they need to *prevent* actually crossing that line - and the more prevention we can do, the fewer victims there will be. Rehabilitating someone after they've committed an offense means that someone (or several someones) have already been harmed by their behavior.

For those interested, Dan Savage has published a couple of recent columns dealing with these issues and containing letters from self-identified pedophiles. These columns helped me to change the framework through which I view people suffering from pedophilia (and I do believe they're suffering). Specifically, one letter that states "For the record, while I am a pedophile, I am not a child molester" - a distinction that is often overlooked.

http://www.thestranger.com/seattle/SavageLove?oid=12927907
http://slog.thestranger.com/slog/archives/2012/04/19/sl-letter-of-the-day-wheres-my-gold-star

 

[sunlioness]

Dan Savage is pretty darned cool.

 

[Poetic Silence]

Anyone here ever read Lolita?

 

[aphenomenon]

Anyone here ever read Lolita?

I'm glad someone with the username Poetic Silence is the one bringing up Nabokov. It's a beautiful book. The most recent of his that I read was Speak, Memory - such hesitantly gorgeous writing.

 

[michaelrack]

Various ways.

Unfortunately I've never seen a case where someone sought help before they were caught.
.

I know of one case- fortunately the person didn't come to me. This is a difficult issue for a treating psychiatrist to deal with- he/she must make difficult decisions about reporting/warning, even if the pedophile hasn't yet committed a crime.

 

[michaelrack]

. And missing out on the beauty that is adult consensual romances/partnerships/relationships is just so sad.

I worked some in a juvenile sex abuse unit during residency (mostly teenagers who molested younger kids). Part of treatment is helping them to develop the capacity for "nomal" romantic relationships.

 

[Poetic Silence]

I'm glad someone with the username Poetic Silence is the one bringing up Nabokov. It's a beautiful book. The most recent of his that I read was Speak, Memory - such hesitantly gorgeous writing.

Hauntingly surreal. His words stay with you long after the story has ended. It's a rare thing when a writer can truly create life out of his words.

 

[Poetic Silence]

I worked some in a juvenile sex abuse unit during residency (mostly teenagers who molested younger kids). Part of treatment is helping them to develop the capacity for "nomal" romantic relationships.

There was a kid like that in my middle school class. He molested his cousin, a little girl that lived on my street at that time. Dude creeped me out long before then.

 

[PikminOC]

No worries Tensin

It's a tough topic, to be sure, but I do believe it's important to show empathy and a lack of judgement to both the pedophile seeking help for urges outside of his/her control and the victim of said perpetrator, as difficult as that may be sometimes.

Do you also consider substance abusers who seek benzos and stimulants "seeking help for urges outside of his/her control"?

I am not asking trying to be a butt, I am really asking so maybe I can see things from another standpoint.

 

[Yellowbug]

Do you also consider substance abusers who seek benzos and stimulants "seeking help for urges outside of his/her control"?

I am not asking trying to be a butt, I am really asking so maybe I can see things from another standpoint.

I do believe that substance abusers seeking benzos and stimulants are seeking immediate relief from a pain those who've never experienced it cannot fully understand, though at the same time that is not reason enough to dispense them.

The hard part is maintaining some form of empathy while saying no. It's definitely not easy.

 

[PikminOC]

i think there are so many other options out there for patients but they are so fixated on their specific med

 

[kugel]

Is it more likely to be OCD if the "urges" are best described as repetitive intrusive thoughts which the Pt finds disgusting and he is horrified at the possibility that he might be/become a pedophile? If so, aren't OCDers very UNlikely to commit the crime they fear?

 

[birchswing]

While I doubt these are terms used by psychiatrists, in the OCD community, they talk about pOCD (pedophilia OCD) and hOCD (which I've seen both reference homosexuality and harm). The focus tends to shift to whatever is considered bad societally at the moment. I've heard of doctors not being aware of this and the patients' obsessions and fears thus being reinforced.

http://en.wikipedia.org/wiki/Sexual_obsessions

 

[imp3tigo]

That odd request for help got closed down for some reason.

Someone had posted a message saying they were having problems but was deleted by the admin for some reason.

I was just wondering how would a patient with that "problem" get treated in the world of psychiatry?

People can fantasize about whatever the hell they want but just don't act on it, then there's no problem. Trying to get psychotherapy to treat your fantasies is probably misguided. The real problem with many pedophiles is that their sexual fantasies about children tend to be ego syntonic and hence they are at risk to victimize children.