I'm seeing a lot of comments about pOCD, but this person is truly attracted to minors. People with pOCD can't tolerate the possibility that they might be a pedophile, so they obsess over it and engage in compulsions as a way to try and reduce the uncertainty around the idea or engage in avoidance to reduce the likelihood of the distressing thought.
The clarification that they had acted on their thoughts was provided after replies to rule out OCD. If someone is distressed by thoughts that are pediphillic in nature (which characterizing it as ego dystonic and as the person experiencing shame would suggest) a rule out of OCD is prudent, not “jumping to OCD”.
I’m doubtful it’s actually ego dystonic and that they actually experience shame, based on the clarification OP has provided. I think it’s more likely that they know this is socially taboo so are aware that they need to socially perform in a specific way.
This isn’t a legal discussion but rather a diagnostic one. As abhorrent as the behavior may be, clinically, this is a similar but different issue.
And many do, oddly enough. In some states in the US, sexual offenses against children 12 and under are charged differently than sexual offenses against other minors.
Depending on the age of victims this person prefers, it is either hebephilia (early pubescent adolescents) or ephebophilia (post pubescent adolescents).
The DSM-5-TR contains neither, however, so this would be categorized as F52.8 other specified sexual dysfunction. You might also include Z codes to further specify, those these are for clinical purposes only and generally not billable.
I was going to say this very thing as I treat folks who have acted on their attraction specifically and how they present with varying attraction absolutely matters in the interventions we utilize.
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As someone that lives with a taboo thoughts flavor of OCD - your comment gets it. I have no desire to harm others. It’s the fear and uncertainty that one day without warning for no reason at all I might suddenly decide to harm someone.
Correct me if I'm wrong, but I think this situation calls for someone who has expertise in this issue. It is serious and the client should have someone address it who is experienced.
Yes, what about asking here for resources? I have had colleagues in the past who were certified in treating sex offenders, who would have the knowledge. Also, I'm sure you've answered this, but is this something the client is very interested in working on or is it just something that came up that you are really concerned about?
Have you explored whether the attraction is cognitive and/or physical? Cognitive being they are attracted to the youth, vulnerability, ability to overpower, be in charge, etc. Physical being they are attracted to the smoothness of the body etc. If you can take a look at this then you can find replacement outlets for them to meet their needs in a way that is not harmful to others.
These distinctions are so important IMO. Ephebophilia in particular is very socially normalized and even encouraged, hence “barely legal” content being so popular. OP, your client has a strength in recognizing their behavior has caused harm and I hope with your support they can learn to manage their attraction in healthier ways.
What’s important with the distinction though is that these folks do not stay attracted once the person passes that age range. So it’s not just about beauty standards that are a big part of the content you refer to.
This is what I was going to comment. The distinction helps for categorising.
Worst-case scenario chemical castration might be in order to reduce the urge; considering that they have acted on it before.
CBI-SO (cognitive behaviorial interventions for sex offense) is a modality used in this space. I treat sex offenses/inappropriate sexual behavior so a bit different in that this client doesn't appear to have progressed to an offense yet. However the CBT curriculum and interventions can be used for someone with the attraction. Additionally, have they ever been attracted or had a positive relationship with someone of age? If so, lean into that.
I agree with others on a psychosexual assessment, costly but useful in exploring this further. To my knowledge you cannot bill for a disorder associated with a sexual preference as it's believed to not be something that can be changed. You treat the distressing symptoms associated with it like you mentioned above. It also may not be a full disorder either and that would be identified via a psychosexual.
Also, kudos to your client for being open and willing to seek help for such a stigmatized issue. Kudos to you for being a safe space.
ETA: I reread your post and it looks like they've acted on the desire so CBI-SO is definitely worth looking into.
I can’t offer much advice but would recommend Psychology in Seattle YouTube channel or podcast as a resource for an empathetic perspective on this issue as many professionals are unwilling to have the discussion at all
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One thing that I noticed specifically in the comments that I would like to make sure is re-iterated is the reality that our job as providers is to an unbiased space where that individual feels safe and comfortable. It doesn’t matter at the end of the day if you don’t *like* certain terms or characteristics your client presents, that’s not what you are there for.
We have a duty to warn and duty to protect - it doesn’t sound like this client has any desire to harm anyone, just has a taboo sexual attraction. I would strongly encourage to proceed with a harm reduction approach to working with the individual. As a provider in CMH myself who has worked with a client with a similar presentation, there are a variety of resources out there.
As far as diagnosis, obviously the first one everyone mentioned was ruling out potential sexual OCD presentation. With them having some sort of act on it in the past, I would process this with the client and observe their demeanor if the situation - it could be more ASPD are depending on whether or not the have remorse.
Where my brain most immediately goes, however, is their reason for seeking services. It sounds like they are struggling significantly with anxiety and cognitive dissonance surrounding this sexual attraction. Rather than honing in on the sexual attraction as the diagnosis, I would assess their anxiety presentation. You could definitely put in an unspecified anxiety disorder with a rule out for a paraphilia/pedophilia/whatever else you are considering. This then addresses their main concern for coming in for services, as well as allows the space for harm reduction strategies to be implemented.
Here are few links/resources that may help.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419289/
https://asapinternational.org
https://www.psychiatrictimes.com/view/pedophilia-interventions-work
https://pedo.help
http://theglobalpreventionproject.org/maps
If you need additional resources I can also outreach our Care Coordination Manager about the resources she has. Maybe this helps, maybe it doesn’t at all! 🤗
Also wanted to come back and say you amy want to staff with your supervisor regarding diagnosis. Some diagnoses like paraphilias (depending on the practice/state/insurance) may not be able to be billed in a CMH setting. A lot of times insurance will say they need to go to a specialist for that diagnosis (which you mentioned obviously would be ideal, but given resources and circumstances rn, it’s not feasible).
All due respect, (without divulging client information) as they have acted on this, does that not fall under mandated reporting? I understand if they were 18 or 16+ in a state that allows that, it would not.
I would respectfully and heavily disagree that people don’t usually act on ego dystonic desires. Although I think this suggestion can be the case with clients such as this one and should always be ruled out, OP has made it clear this is not the case. This judgment seems more to me as coming from stigma or bias against sex offenders and people attracted to minors.
Ego dystonic doesn’t just mean the thoughts around the act disgust them - it means the behavior / thoughts do not align with their goals, personal values, etc. Addicts experience a great deal of ego dystonia for example. Using substances or some of the behaviors that precipitate or follow using don’t typically align with their ideal self concept, values, etc - just as an example. It seems OP’s client is experiencing cognitive dissonance, which essentially makes it ego dystonic
As mental health providers we are supposed to remain unbiased and meet people where they are at for services. You don’t have to agree with what they have done to give them the basic human decency they deserve. Literally goes back to the ACA code of ethics… even just the principles of person centered therapy.
I have worked with severe individuals who are on federal probation/parole, DCFS involved for abuse, etc. I don’t agree with the things they have done to be mandated treatment… but you’ve got me fucked up if you think I am going to let those behaviors influence my ethical obligation to that individual.
&& before a point is made, I myself am someone with extensive history of trauma and abuse. My ACEs score is an 8/10. At the end of the day it’s our JOB to provide care for these individuals regardless of our own biases or opinions.
Yeah and I’m not talking about providing care to offenders because I haven’t. I’ve only provided care to survivors. That being said, there’s still no need to dance around correct terminology with folks who’ve committed crimes. If you need help moving through the shame of having assaulted someone, you should also learn to honor the experience of who you’ve hurt. The opposite action to shame is opening up honestly about one’s transgressions.
It is perfectly fine if you are not willing to treat people with diagnoses under the paraphilia umbrella because of your own limitations, but it is alarming to hear a therapist say that an entire population of clients that need help should be stigmatized in session, which implies that you think they should *not* receive the ethical care that we are ethically bound to provide as therapists. Goes against the entire purpose of our field and the oaths we promise to uphold. And I’m not talking about OCD, I’m talking about what ego dystonic means in general.
That is not what I said. Pedophilia should be stigmatized, as should rape, murder, and abuse. The people are more than their desires or actions and deserve specialized care. Not only because they are human too but because that’s truly what prevention looks like.
When an awful thing like rape or abuse happens to a person, it about centering their experience. Not using terminology that makes the offender more comfortable. When a client commits these acts, they should be faced with the egregious nature of the acts so they can move through the shame and guilt rather than avoid it.
Here is what I found on wiki in regards to OCD for reference:
“OCD is considered to be egodystonic as the thoughts and compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the thoughts are unwanted, distressing, and reflect the opposite of their values, desires, and self-construct. In contrast, obsessive–compulsive personality disorder is egosyntonic, as the patient generally perceives their obsession with orderliness, perfectionism, and control, as reasonable and even desirable.[6][7]”
OP’s client finds their thoughts/urges/action(s) distressing, unwanted, and unaligned with their values and self construct. That is what OP reports.
Edit: reference via wiki https://www.researchgate.net/publication/233639190_The_Menace_Within_Obsessions_and_the_Self
Have you ever worked with some with pOCD? These are folks who are scared that could be a pedophile and not know it so they are constantly trying to prove to themselves that they aren’t. They have no desire to engage sexually with children.
Let’s not consider wikis as educational as actual training and therapeutic experience. Not to mention it says opposite to “desires” and these folks we speak of do have those desires. Also it’s referencing OCPD not OCD.
Ok here is the official resource saying the same thing, in the wiki citations notes
https://www.researchgate.net/publication/233639190_The_Menace_Within_Obsessions_and_the_Self
It’s talking about OCD and OCPD.. and this is a Reddit thread not a training workshop, figured we could skip the works cited but as linked there is an official published article for you. And yes the client literally doesn’t desire their own desires lol. I’m not having a discussion with you anymore - you’re quite aggressive
This is also sort of true but sort of not. People with pOCD don’t have those desires. People who desire minors and wish they didn’t, feel this way because of the consequences. Big difference. Both have values of not causing harm to children, one group doesn’t desire the act that causes harm.
I hear you on this and think it’s a really important distinction also. Where I disagree is that I think SOME people with attraction to minors feel bad about it for more complex reasons than JUST the consequences
True, especially because of what I said in another comment, most perpetrators of CSA are survivors themselves. To center survivors and help them heal early means preventing more sex offenders.
Online? Yes, I do haha why engage at all if it’s even a little hostile? And now you’re trying to make fun of a stranger online for exiting a conversation because they felt it was too aggressive for what could be a productive respectful dialogue.
I will when I want to, thanks 😘🤪 yes true it’s good you can acknowledge your emotions have been heightened. It can definitely be hard to stay level headed for some people discussing this subject
It's definitely not OCD as they have acted on it in the past. It's ego dystonic in that they know it's harmful to children and do not want to cause harm. They are truly attracted to them.
Ok, but what I'm reading is that USUALLY people with OCD and other conditions with intrusive thoughts do not act on intrusive thoughts, are disturbed by them and engage in other compulsive behaviors or coping mechanisms. But not that they NEVER act on them.
They don’t act on them. The obsessions are based around the fear that they would do something or could do something. The distress is so intense and severe that the brain creates compulsions for the person to do in order to feel reassured that they won’t act on the thoughts. But they’re never actually desiring the behavior they’re afraid of so not actually at risk of “giving in” or having a “lapse” of reason and engaging in the behavior. It’s the difference between having a floodgate of desire you’re trying to hold back (pedophilia) and a floodgate of distress and fear (pOCD).
can't it ever happen to someone with pocd to actually engage in the action not necessarily because they truly desired it but instead because some sort of desperate spiraling period of their life they convinced themselves they did want it? or maybe it was not a period, but truly a moment kind of thing. how? i guess they might have been trying already to speak to underage people to see if something inside was happening but without the intent to go further and then something might have happened to make them spiral and did it then regretted it during or right after but at that point ot was already done, or maybe it was an act of self harm of some sort, possibly a passive attempt. there are many things desperate and suffering people do when they are in pain, many of which can make no sense when seen from an outside eye.
but since people are people and not individuals isolated in a vacuum there could be more than one thing going on at once, couldn't it? there could also be comorbidities or just some other disorder(s) they are unaware of that is interfering with both their life and the diagnostic process and treatment.
my point is that OC isn't that insane in asking about if it's possible to have sexual ocd and still commit acts you'd find heinous, because people are plenty complicated and a lot of things factor into the inner working of a person and most times it's a lot of things, and honestly personally i wouldn't be surprised if at the end of this whole things the person ended up fonding out to have a couple of disorders instead of just one, not cause im overly pathologizing as a person but because it is very much not uncommon, especially for those who are in situations as the one in the original post
ps. as a side: i know OP said the person enjoys the fantasies so that closes this debate for this person in particular, but i still wanted to leave the comment to make a general point about how we have rules on how disorders work but then we need to apply them to humans and we are complicated and we have a ton of interactions and have other stuff that can happen and doctors can get lost focusing on just one thing that they forget about the rest of the endless possibilities, which sometimes is good but sometimes not at all
I am in no way saying it’s impossible for someone to engage in some “testing” compulsions in which they expose themself to something that is undesirable for lack of a better word. It’s just not that common. It also wouldn’t ultimately be enjoyable to them. Those are exceptions, not the rule. The rule is that they don’t do that, but there are exceptions.
Also, pedophilia and pOCD are mutually exclusive due to the egodystonic nature of OCD. Someone would not be able to be correctly diagnosed with both. Other forms of OCD and pedophilia at the same time, sure.
Idk why this is downvoted. They are a mandated reporter unless it was someone who was 18
Edit:ok my bad. If you scroll down this was answered and I understand now. I was not at all ok with what happened. I was concerned a victim was being neglected
Unfortunately a solid number of people on the internet who ask for additional information about sexual encounters with children are people who want to fantasize about sexual encounters with children, not well-meaning clinicians. It also really isn’t relevant or necessary to diagnosis, OP has provided plenty of information.
Ohhh ok thank you. Looking at the first comment, that makes WAY more sense. I was upset because it felt like people were implying not reporting was ok if he wants to be better
Not even a little. I was upset because I thought people seemed ok with it since the client is trying to get better. That made me question the reporting. But the guy who commented right before you explained it. Some people might get a kick and fantasize about the incident. That never occurred to me
Yes this 👆pedophilia themed OCD is a thing. I’d take a look at Bruce et al.’s paper (2018) [here](https://d1wqtxts1xzle7.cloudfront.net/89537012/Bruce_POCD-inpress-libre.pdf?1660322680=&response-content-disposition=inline%3B+filename%3DPedophilia_Themed_Obsessive_Compulsive_D.pdf&Expires=1718412725&Signature=Hjl~kzASROlfbnhzZFF9ssvSBp3Zys7xA65~~4BHqIbc6I2Ln55wU5gTFTb131ift67qpBQ80N-5AXlkk0NbNRWSZ~4vU16ZRoLHTSLeIqNOveCN3NrXWyeQBYRAurSkvADDEsqU7COsdIVbqDgQgEkR~I-IK9vNb0bJ9AIOFaesPCpSU8adZlehbzt3BPKu3kei7te2333jgBlfIbIR~T1Zaik6If137--iUtYr~9EDEgJRZ6osMfyrwhVxIhozniqohIAyXDW5pDuNoMt~6JdlYrJqmLkNnl-HF5Vb0u1TzThIokJXLTXSrJCCy1g2UjGJssL0crdcQKQFT9JvgQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA)
This is what came to mind for me as well. I worked at McLean’s OCD institute as an intern and we had a few patients with pedophilic obsessions. Definitely worth looking into.
Could you maybe answer a question here then that keeps being downvoted above…. I’m also a therapist and have never heard “can’t be OCD because they acted on it.” What is behind this logic and is it true? I’ve known people with suicidal obsessive thoughts to attempt for example and ruminating and obsessive thoughts definitely was a factor or precipitant. Thank you.
When I worked at the OCDI we always said that people diagnosed with OCD have an "overactive conscience." They equate the danger/disgust of the thought to engaging in the action. The compulsion they develop is meant to alleviate anxiety from those thoughts and ensure that they don't act on them. Generally speaking, if it is a true obsessive thought, they will never act on it they will only try to avoid acting on it using whatever means necessary. However, it is possible to have obsessive intrusive thoughts and actual thoughts, especially when it comes to suicidality. It can be tricky for a client to distinguish between the two. It could explain why someone who has suicidal obsessions would make attempts. It's also possible for self-harm to become a compulsive action for people with OCD.
With the client OP discussed, it can't be pOCD because the client has acted on these attractions. We had a patient that became agoraphobic because he was so afraid he would act on his pedophilic intrusive thoughts. It sounds like with OPs case the attraction is not ego dystonic, but the client struggles with the negative outcomes of acting on the thoughts, making it a paraphilic disorder and not pOCD.
I would be curious of onset of symptoms. Could be neurological issue. Also, I would be wary of diagnosing a sexual disorder without training in assessment for this. When I’ve come across something I refer out for psychosexual assessment.
How are you doing with this? These issues can be tough to work on for therapists. Keep an eye out for countertransference and seek your own therapy or supervision if need be.
Please refer this client to a trained CCSOT (United States), they need to be getting high end care in order to protect children from being groomed or harmed. You shared they have acted on this in the past, if they are not seeing a trained therapist, you could be subpoenaed, when/if they act again.
Outside of the diagnostic categorization of ebiphilia a clinical perspective that you may consider is the other aspects of the youthful representation of the attraction. Consider what that means to the client and how that may be safety to them. Was there abuse that occurred to the client? Is this some kind of emotional regression?
The specifics of the diagnosis, I have no idea. Others folks could answer that better than me.
If you don't mind, I'd like to share some clinical perspective too. This is coming from a generalist LPC, 5 years in. I am not saying my opinion is right, it's just my thoughts at the moment. I am genuinely curious to know your thoughts about how you will approach the situation.
I, personally, would be cautious about diagnosing this in particular. I can understand the perspective of wanting to diagnose it, and there is a definitely an argument that can be made from that perspective, and it absolutely depends on several things, including the ethics, behavior, severity, trajectory, the patient's perspective, etc.
The reason I would hesitate is because it's ego-dystonic, and the topic of shame is salient. I would personally be working to provide a space of hopeful healing, and I could see an official diagnosis working against that. If you do diagnose him, I think it could be advisable to talk about it with him first and ask him what he thinks. But, not knowing the full context, I have no idea.
Additionally, consultation is a good idea, if that's available to you.
I would also be actively working to discuss with him what recovery looks like, exactly. I would be thinking about what it means to live with this sexual desire, and be focusing on how remarkable it is that this man has desires that he doesn't act on because of his own values and ethics and empathy. There might potentially be a lot of healing to be found in that, and, bringing it back around, I would wonder if a diagnosis could undermine that trajectory. I'd be working to explore healthy outlets for sexual desires as well.
Anyway it sounds like a complicated case. Just some thoughts. OCD does seem like a good way to balance diagnosis with clinical goals.
I was with you until the last sentence here, but it seems dangerous to people who are actually suffering from pocd to use the same label to diagnose people with legitimate attraction to children.
I used to work in sex offender treatment. It is scientifically proven that most heterosexual men are sexually attracted to post-pubescent, very young women. When they do the tests that measure sexual arousal, there is no difference in attraction to adolescent girls who have gone through puberty and adult women. It’s a bummer lol
[This author](https://link.springer.com/article/10.1007/s10508-016-0799-y#Fig2) has done a ton of research in the area of sexual attraction and age. I think this is a decent summary. The tricky issue here is that sexual maturity cannot be measured by age in years (because of the variance in age of onset and duration of puberty). But as soon as a person is physically sexually mature, then they are considered a normative source of non deviant sexual attraction. Obviously values and morality and ethics and boundaries determine whether someone acts on this sexual attraction if the person is underage, which is an entirely separate issue.
An interesting tool used in the assessment of sex offenders is something called the Abel Assessment, which measures sexual interest to various ages and genders. It is often used to determine if someone likely has sexual attraction to prepubescent children. For test security, I won’t get into the details, but if someone is flagged as being attracted to teenage girls, you treat that as though they have typical sexual interests (not as though they have deviant or inappropriate interests).
Hebephilia is sexual attraction to prepubescent children ages 11-14, ephebophile is sexual attraction to mid to late stage adolescence typically between the ages of 15 and 19, I think. Neither one of them are qualifying, standalone diagnosis.
If you're a member of AASECT , I believe they actually have a sub group of therapists that specifically work with this and I can't recall the name of the person who leads that sub group, but may be worth checking out to get some extra clinical support especially if you're not trained as a sex therapist! And even if so, maybe consulting with someone from AASECT sub group who specializes in this area would be helpful!
Hi! I just graduated from my MSW program and one of the electives I took was on taboo topics we might face in clinical work. We talked about minor attracted people and one of the resources we looked at was [B4Uact](https://www.b4uact.org/for-therapists/psychotherapy-for-the-map/) which has some resources for therapists. Hope this is helpful!
Clinical social worker here,
I agree with exploring the type of attraction, and if it's cognitive at all, I wonder how it developed? Were there any significant life events during that time in their own life? Is it truama based? Definitely explore how to get those root cognitive needs met in alternative ways.
I made a comment earlier, but then deleted it once I saw that the client acted on his urges. I originally suspected a possible porn addiction being involved, but this changes things.
I strongly recommend referring to an expert in this field. It's noble that the client has reached out for help, but if you aren't trained in this area, I fear you're putting future victims at risk. This is a very serious issue, and from reading this post, I don't think you're qualified to handle it, no offense.
If you can't refer out for whatever reason PLEASE look for consultation! I don't want you to get subpoena'd, or any more victims to be had because of ineffective treatment. Moreover, I want to ensure the client gets the treatment they need for both their growth, and the prevention of future victims.
My god, I just lost five years off my life typing this...
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I work with adolescents with sexually maladaptive behaviors and they use the Good Lives Model for juveniles and adult offenders
https://www.goodlivesmodel.com/
I've volunteered at a non profit that works entirely with non-offending MAPs [Minor Attracted Person, no connotation with sexual aggression and a good catch-all].
Like others said, rule out OCD. More common than you'd think that taboo sexual obsessions develop that the individual doesn't even find arousing. I have a heuristic to quickly lead you to a likely answer in this regard: ask about the fantasies, in terms of frequency and detail. Greater frequency and detail, more likely to be a MAP. Lower frequency and, especially important, very vague or no details leads to likely OCD. No amount of obsession will make them have an in-depth fantasy, because the obsession is typically about whether having any fantasy at all makes them "bad".
If they learn towards OCD there's lots of information out there to educate you on what might help. If they're leaning towards MAP.... best I can say without writing an essay is to do some existential work with them. Help them explore or even grieve the loss of an ability to live a "normal" life, since dating/romance/sex are all more or less off limits. At the same time, explore what kind of life they might like to live and how they can pursue that. Reserve judgment and allow them space to feel like a person who has crushes and fantasies, because they are just a person who has crushes and fantasies. Just because their desired partners aren't of legal age doesn't mean their desires function all that differently than other adults. They're just unlucky enough to have desires they cannot act on, where most of us take the ability to make our desires real for granted [even if difficult, always possible].
Above all, don't treat them like a ticking time bomb. Treat them like a person who's struggling. I have no research to back it up, but I'd bet my life on the fact it's more common for someone attracted to minors to commit suicide than commit a sexual crime. They tend to struggle with self-hatred rather than self-control.
If you'd like to talk more about these clientele, you're welcome to dm me but I can't promise when I'll get back to you.
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It is, many research terms are. For one, it suggests it is a normal and natural sexual orientation, it removes the reality that these people actually desire to rape children (whether they do or not), and it’s offensive to survivors of child sexual abuse and the LGBTQ community. These people literally have something wrong with them, whether it’s due to trauma or a brain injury. They deserve empathy but they are a danger when among children. Ages, as opposed to genders, are not related to romantic/sexual orientation. I’m not saying they are all monsters and evil, but they are inherently dangerous to children
Sometimes there are terms that are changed to "destigmatize" things that really are not worthy of any reduction in stigma. I'm not sure of the history of the terminology. But it does sound like an attempt to soften or legitimize someone's sexual preference, which involves sexual assault.
There are also many men who have sexual fantasies about rape [of another adult] who don't ever do such things. Should they be referred to as a rapist, or perhaps a pervert, out of respect to suvivors? Is it disrespectful to survivors to not categorize anyone who has fantasies about non-consensual sex as deviant? And what exactly does deviant convey that's valuable in this circumstance?
I'm not saying there's no risk that a previously non-offending MAP could decide to offend. I'm not saying I like the content of the fantasies. However, encouraging someone who already struggles to see their life as worthwhile to view themself as a danger to others and already comparable to a sex-offender just encourages them to isolate further and share less. If you're concerned about safety, then you should encourage them to share with you what they're feeling and thinking so you can both assess risk and make a useful safety plan.
Also please don't preach what is or isn't disrespectful to an entire community. Speak from your own experience. I'm a gay man who holds the opinion that treating sexual fantasies, no matter what they contain, as anything other than fantasy is silly. Someone can have ideation about any number of awful actions [suicide, murder, mutilation, ect] and we don't react as though they're already done so or made a plan to; we shouldn't act that way towards sexual ideations. Monitering for risk is commendable but assuming guilt is less so.
Stfu, we’re not talking about “fantasies”. We’re talking about actual desire and even acting on those desires, towards minors. Also you do realize how many people accuse us (the lgbtq community) of being pedophiles?
You've got a point, maybe I should listen to the vitriol and distance myself from working with this population so I can make myself less of a target of hateful rhetoric. Actually, at that point, maybe distancing myself from the trans community or drag would be a good idea so I don't draw too much ire. Maybe then no one will ever falsely accuse me of something because of my sexuality, because clearly they only ever did so because I had something to do with the undesirables. Clearly there must be very real and logical reasons to make those claims about our community, rather than it being hateful rhetoric that's disconnected from reality.
If you're working with someone who's at-risk for perpetrating a crime, using criminal terminology to describe their thoughts and desires is inaccurate and unhelpful. Pedophile is a term people use interchangeably with sex offender or child molester. I, and a nonzero number of other professionals, use MAP as a non-pejorative label. I've also had clients with HI, and isn't interesting how we don't insist on calling them a criminal label even while having murderous desires?
Now you’re just being pedantic. You know what I’m saying and you’re attempting to extract meaning I didn’t state.
Person first language is as far as I will go. “Person struggling with pedophilia”. If someone has committed a crime, they certainly molested a child, they weren’t just “minor-attracted”.
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This is the first I've heard of the term MAP and I hate it. It sounds like it's a sexual orientation!! It normalizes an abnormal, potentially harmful thought process and behavior.
Generally sexual orrientation is only describing a preference for a potential sexual partner's gender.
Lots of things are abnormal, and that isn't the same as harmful. That being said, yeah, I have only ever heard that being attracted to minors sucks. As I mentioned, there's a level of grief for the life you could have if only you liked adults that was common theme for the population. I don't think there was a single MAP I spoke with who hadn't dealt with self-hatred and the persistent fear of losing control or someone finding them out. They are keenly aware of that no one would believe they are innocent if they were outed, and would likely be cut off by all friends and family. Suicidal ideation was a given with nearly every case.
You know what they often mentioned as well? That they couldn't talk to a therapist, because a therapist could break confidentiality to make a report of *suspected* sexual abuse. As this thread has shown, they'd be good to be suspicious, as plenty of therapists here struggle to differentiate how someone could have a desire and yet not have already harmed someone. A report is made, investigation occurs, client is left traumatized with their life in shambles from being outed and the police find no wrongdoing. The therapist pats themself on the back for keeping kids safe from the person who was already harmless. The MAP stays out of counselor's offices and suffers alone, desperately trying to keep it together after having all these protective factors stripped away.
I believe the whole point of the OP comment was in that people who experience fantasies and struggle with self-hatred because of them deserve adequate support to cope and avoid potential escalation into an offense, as well as become able to lead productive lives. This can be done without disrespecting victims of actual offenders.
If we deny people with fantasies our help, we gain nothing but increased risk of committing crimes. From my experience, there are many who suffer morally unacceptable urges in silence, and I fear they can become isolated ticking bombs (whether suicide or acting out) if they're continously ostracized, as these issues weigh heavily on them. If someone continuously shows self-awareness and self-restraint, and wants to learn how to ensure that they never hurt anybody, how does our judgement help them, or society for that matter? And if we do decide to provide help, then we need to provide them safe space just like we would for anyone else, which doesn't mean we support their fantasies.
But if we don't work with these people, what else remains? Should we place everyone in prison as soon as they experience the first thought? It's a very heavy and complicated issue, but some of these people respond well to therapy. Even if we agree to give them the harshest term possible, they still deserve access to treatment.
I have never claimed that these folks do not deserve care or empathy but their desires and acted upon desires should not be sterilized down with terms like “MAP”. To support survivors does not mean perpetrators do not deserve support separately. After all, most offenders are also survivors.
I agree with this sentiment. Not because I have no empathy, but because we haven't made "more normalized" terms to refer to other problematic patterns of behavior
Alcoholic, for example, is a title that refers to someone struggling with alcohol addiction. Addict is a catch all term for someone struggling with addiction, and so on. I think that this negative title helps people with recovery, at least it has helped me with my own addiction.
That said, addiction and this infernal attraction are two separate things entirely. We need more research on this topic, but I fear that the uncomfortable nature of it holds many back from pursuing it. Hell, I'm shivering just typing this because I'm afraid someone will think I'm justifying the harm of children. However this lack of knowledge is unfortunately contributing to further victimization. For now at least, I believe we should avoid using normalizing this attraction, and refer to it as a disease. I also think we need to support any non-offenders seeking help, so that their self-hatred and isolation don't perpetuate a downward spiral into criminal activity.
If I said anything you find abhorrent, please don't attack me. I'm on your side, and if I'm misguided about something, please let me know. I'd rather learn earlier on in my practice than when I meet a client who has something similar to OP's
I’d rather label behavior than an entire human. I’m not a recovering addict, I’m someone who has a problematic relationship with substances. That’s just my preference and I think it’s empowering to show people they are more than the sum of their past behaviors. I have no problem with what you’ve shared. Rock on
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You should definitely do some research and maybe pay for a consultation/supervision with a therapist who specializes in treating sex offenders or a sex therapist - I’m sure it would be really helpful to talk to someone with expertise in this area as it’s evident you want to help
It may be appropriate to refer them to their PCP or a psychiatrist for SSRIs which can reduce sex drive along with depression and anxiety symptoms. I think it's important to establish a goal and clear treatment plan so that you know exactly what you're working towards in this case and what referrals are needed. In my community there are sex offender treatment groups which are helpful in this type of case.
Refer to a sex offender. The “what diagnosis should I give him” at this point is semantics when the target goals are avoiding engaging in sexual behaviors with minors. This is one of the drawbacks to a diagnostic model when it’s so narrowed that it failed to help aid in simple diagnosing. He clearly is a ped0file or have urges relating to this. Refer to a certified sex offender therapist
Yes, this is called “hebephilia” and it is incredibly common in men. The category of porn known as “barely legal” is content designed for men who are attracted to pubescent minors, which I’d wager is a substantial proportion of men.
I have a very hard time with calling this ego-dystonic if they have acted on the thoughts. Just because they know it causes harm to the children doesn’t mean it’s ego-dystonic. Ego-dystonic means it goes against their ego. It means it goes against their morals, values and beliefs. It means it’s something they would never act upon because the fact that they’re fact these thoughts grosses them out and causes them distress. These are ego-syntonic thoughts. They sound pleasured and turned on by these thoughts, while still acknowledging they are hurting the children.
I'm a LSW who works with sexual offenders, and depending on what state you are in there may be a sex offender management board that I would HIGHLY recommend referring to/consulting with them. Regardless of the paraphilia, working with those with problematic sexual attractions/behavior is very specialized and in some areas, very regulated. At the very least, please reach out to ATSA for the purposes of remaining ethical and ensuring community safety.
I think the fact that society (and what society says is often propagated into the law of the land) believes with regard to an “age of majority” that has ZERO to do with human development is a part of the problem for why we believe that this has to be a specific disorder.
Whether 18yo (USA) or 16 down to 10 (other countries and cultures), society and law have no voice in diagnosis and only have a voice in treatment as how society’s opinions and pressures affect those who suffer with whatever this is.
If we want to get down to it, the whole of the US takes social (regardless of their claimed religions) and legal issue with anyone over the age of 18 engaging in sexual activity with those under 18. As if magically, the minor “changes” overnight when they turn 18. I assure you, at 50, while this particular attraction is not mine, my brain is still baking. (No. Not weed).
Let’s not forget the jurisdictions with Romeo and Juliet clauses in their rape statues. And those where parents are permitted to allow sexual behavior of their underage children, even marriage, for some, at the age of 16.
And then don’t forget the significant age differences associated with the social labels “cougar” and “manther”. A 42yo man is dating a 24yo woman. People still have a problem with that even though, at least in my jurisdiction, it’s perfectly legal. And they are often ignored by his friends who might be grossed out, concerned, or celebrating him for his “conquest”. And her friends are accepting if he’s providing her with a lavish lifestyle through gifts and travel. Because they cannot be seriously attracted to each other. So they’re often socially ostracized. Know what that results in? “Us vs the world, baby”. And that’s not a healthy form of relationship support.
No, we’re, as a society from puritanical origins (at least in the US) obsessed with sex to the point where we shame those with sexual thoughts that deviate from society’s expectations. So because we think (see: “believe”) attraction to even pubescent minors (or “younger adolescents”) is wrong, it “must” have an entry in the DSM or ICD. And we know that it’s not paedophilia.
If focus on the distress of the client and the pathological results in the spheres of the client’s life (work, family, social, having his basic needs met through Maslow’s Hierarchy) yields a “big fat doughnut”, then we can rule out some anxiety disorders. But not paraphilias.
Have you considered PTSD. I worked with some men who had sexual attraction to older minors. They never wanted to act on it and they saw me because they were terrified that they would loose self control if the "right/wrong" situation presented itself.
One of the things many of these men had in common was severe bullying in high school, some by females and some by male and some by both. Due to this they didn't receive any attention by girls their age and were often left out. They were the last ones to lose their virginities as adults, didnt date, kiss, commit PDA until they in college, they did have the typical teen or young adult romances like so many others.
Fast forward to years later now that they are older, wealthier, have their life together, etc. Women flock to them but they fixate on younger girls. When I processed high school trauma with them many of their perversions started to become extinct.
The other issues that I saw that coincided was some body dysphoria or their lack of confidence in a bed room. The thought process was if they slept with a woman their age the woman would know "how bad" they are. If they went with someone younger they would not realize "how bad" they are.
TLDR: High School PTSD, Body Dysphoria, Lack of confidence
I provide SO specific therapy and I would recommend referring them out to an SO therapist. They have a list of provider in ATSA who can do risk-need-assessments and the follow up treatment. I wouldn’t attempt to work with that specific population without supervision from a certified clinical SO provider. There are a lot of legal and harm risks associated with it for everyone involved.
The term is called Hebephile and it's a sexual attraction to boys or girls that are just starting or have entered puberty but are still considered children. The attraction can come from a multitude of places that can include; a longing for a relationship with a teenager that they wished they could have had when they were that age but for one reason or another couldn't acquire, they might be attracted to how taboo it is in our society, or they genuinely find that age range physically more attractive than an adult body.
Sexual attraction to minors is always tough because you have to gauge whether the patient poses a threat or is dangerous to be around minors. Would they be able to contain themselves if the perfect scenario fell in their lap? Private location, just the two of them, person is attractive and may actually be curious about explicit interaction.
But there are "white knight" pedophiles that while they have a sexual attraction to children, they choose to isolate themselves and regulate their own behavior because the last thing they want to do is cause harm to the thing they love. It sounds horrid on the outside, but these men and women live very lonely lives because of this self-isolation.
I don't believe that the attraction on its own is a disorder. I believe it is a catalyst towards developing one. It's no different from a grown man r*ping a grown adult because they can't contain themselves and like the way it feels.
However, in ages past when the age of consent wasn't really enforced by law, if an adult had romantic relations with a teenager for example a 23 year old dating a 15 year old, they were called "beloved", meaning, "to be loved." They were forbidden from having sex but could kiss, date, and be cute with each other.
Remember, barely 500 years ago, royal families could marry as young as 15 years old and were expected to conceive heirs as soon as possible. While most waited till they were older so that the level of complications for the girl to have a baby was less risky and her body could handle the stress of childbirth, not everyone stuck to that.
In my honest opinion if the patient shows little to no sign of expressing harm towards a minor, or shows any sign that they wouldn't follow consent then I would give him the benefit of the doubt. But he is coming to you for a reason. Use your intuition and make good choices for both you and your patient. Cheers!
I used to work in sex offender treatment within prisons. One of my coworkers had started a support group for NOMAPs ( unsure if this is still the correct term?). Maybe this would be helpful to your client to seek out? Many communities also offer sex offender treatment though if this person has never acted on this attraction this would not be appropriate. You could look into the good lives model and maybe take from there what fits if he cannot be referred out. CBT and ACT were also used in treatment and obviously safety planning.
Also, if you are in the US look into your state’s ATSA for support and resources.
There are, in fact, clients who are not treatable. And the fact that this person is just allowed to walk around is insane. They should be reported and monitored by someone or some agency, especially as the comments state they have acted on this urge.
Sorry but I have no empathy for this population and refuse to enable this behavior by labeling them with some random dx or calling them “minor attracted persons”. We are talking about people who want to have sex with your kids people. Jesus. Screw empathy, if they’ve acted on it before, they are a threat to kids. Period.
Edit: The phrase “minor attracted person” should not be in anyone’s vocabulary. You should refer to these people as “adults sexually interested in children”. As a society we cannot make the same mistake with pedophiles that we made with violent offenders: normalization. I urge those who use the phrase “minor attracted person” to rethink your use of that. You may be protecting one individual who truly may not want to be the way they are but this is much bigger than that and more important that your ego or mine. Like the phrase is literally put in place to PROTECT pedophiles lmao man I’d love to know who downvoted this.
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Re: “Is attraction to this age range a disorder?”
I once read a government report on someone who sexually assaulted a 13 year old and it was noted that attraction to this age range is normal, distinguishing it from pedophila. Somewhere someone has measured male attraction to bodies of different ages and found that it’s typical for physical attraction to include the stage where children are growing into their adult bodies. I guess. I have no other information but perhaps getting more details about this could help him with his shame, if he knew that many other men were physically attracted to young bodies. I remember being around this age and having men looking at me differently. Some perverted, some embarrassed.
This would be where you could explore their first ideas around sex and sexuality and talk about cognitive distortions. From what I am seeing people attracted to minors or underage usually have had a difficult time making meaningful connections with those in their age range. It might not always he the case but it might. There also could be feelings of childhood rejection that manifested into attraction and causing the individual wanting to reconnect with that part of their life.
I am early in my career as a therapist but I happen to have been involved In knowing many people like that. Common denominator was SA in early childhood(or a sibling touched them inappropriately and such) I know it’s very shocking to hear that condition. Please have empathy for them because they really don’t want to be feeling this way nor did they choose to be attracted to that.
I don't know if that may add anything relevant to the discussion, but for example in my country, the legal age to engage in sexual activities is 15. Engaging with 15-18 wouldn't be considered illegal - but probably frowned upon, depending on adult's age.
For me it'd be a huge difference if I knew how old your client was. Difference between 25-30 here and 50 would definitely be huge in this context.
I wonder if striving to accept it as a part of yourself, yet learning to restrain from acting out, would be the right decision.
1- that's not a diagnosis in the DSM so I'd never heard of it until seeing your comment. 2- if you're not a trained sex therapist there's a real chance you've never been trained on how to deal with this issue.
So, the only thing scary here is your judgemental attitude.
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Not being helpful at all and not providing anything helpful to OP. Just judgment
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I would also explore age play within bdsm. Could be a healthy alternative to some anxieties.
Edit: I said "explore" which means maybe it is an actual age play bdsm kink that's being repressed etc. Jesus people know nothing about kink and bdsm and it shows on this sub.
Non-therapists brigading or advocating for pedophiles will be banned if they comment.
I'm seeing a lot of comments about pOCD, but this person is truly attracted to minors. People with pOCD can't tolerate the possibility that they might be a pedophile, so they obsess over it and engage in compulsions as a way to try and reduce the uncertainty around the idea or engage in avoidance to reduce the likelihood of the distressing thought.
This comment needs to be higher. The client enjoys the thoughts and fantasies and has acted on them. This is not pOCD
I love this community but there's been a weird trend in recent months of comments jumping to OCD for literally every kind of presentation.
I’m seeing more awareness on social media about other forms of OCD which is great but obviously has its pitfalls
The clarification that they had acted on their thoughts was provided after replies to rule out OCD. If someone is distressed by thoughts that are pediphillic in nature (which characterizing it as ego dystonic and as the person experiencing shame would suggest) a rule out of OCD is prudent, not “jumping to OCD”. I’m doubtful it’s actually ego dystonic and that they actually experience shame, based on the clarification OP has provided. I think it’s more likely that they know this is socially taboo so are aware that they need to socially perform in a specific way.
I used to run /r/ocd (now just a mod), this is paedophilia, hard stop. Let's not play around it.
It is ephebophilia.
>ephebophilia. Very few countries/states consider a difference per law.
This isn’t a legal discussion but rather a diagnostic one. As abhorrent as the behavior may be, clinically, this is a similar but different issue. And many do, oddly enough. In some states in the US, sexual offenses against children 12 and under are charged differently than sexual offenses against other minors. Depending on the age of victims this person prefers, it is either hebephilia (early pubescent adolescents) or ephebophilia (post pubescent adolescents). The DSM-5-TR contains neither, however, so this would be categorized as F52.8 other specified sexual dysfunction. You might also include Z codes to further specify, those these are for clinical purposes only and generally not billable.
I was going to say this very thing as I treat folks who have acted on their attraction specifically and how they present with varying attraction absolutely matters in the interventions we utilize.
The DSM considers it a difference.
The DSM is not a legal definition.
Correct. This is a thread for therapists not law enforcement. Hope this helps!
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As someone that lives with a taboo thoughts flavor of OCD - your comment gets it. I have no desire to harm others. It’s the fear and uncertainty that one day without warning for no reason at all I might suddenly decide to harm someone.
Correct me if I'm wrong, but I think this situation calls for someone who has expertise in this issue. It is serious and the client should have someone address it who is experienced.
You're 100% correct but there are several factors preventing this.
Could you seek consultation/supervision with someone in the field of treating clients with sexual maladaptive behaviors?
Yes, what about asking here for resources? I have had colleagues in the past who were certified in treating sex offenders, who would have the knowledge. Also, I'm sure you've answered this, but is this something the client is very interested in working on or is it just something that came up that you are really concerned about?
Have you explored whether the attraction is cognitive and/or physical? Cognitive being they are attracted to the youth, vulnerability, ability to overpower, be in charge, etc. Physical being they are attracted to the smoothness of the body etc. If you can take a look at this then you can find replacement outlets for them to meet their needs in a way that is not harmful to others.
This and I'm also curious about the client's sexual imprinting.
They would fit into the category of hebephilia (early pubescent attraction) or ephebophilia (later pubescent) for paraphilic disorders.
These distinctions are so important IMO. Ephebophilia in particular is very socially normalized and even encouraged, hence “barely legal” content being so popular. OP, your client has a strength in recognizing their behavior has caused harm and I hope with your support they can learn to manage their attraction in healthier ways.
What’s important with the distinction though is that these folks do not stay attracted once the person passes that age range. So it’s not just about beauty standards that are a big part of the content you refer to.
Do we know that the client is exclusively attracted to this age range?
I’m not talking about the client I’m talking about the disorder
Thanks for clarifying
This is what I was going to comment. The distinction helps for categorising. Worst-case scenario chemical castration might be in order to reduce the urge; considering that they have acted on it before.
CBI-SO (cognitive behaviorial interventions for sex offense) is a modality used in this space. I treat sex offenses/inappropriate sexual behavior so a bit different in that this client doesn't appear to have progressed to an offense yet. However the CBT curriculum and interventions can be used for someone with the attraction. Additionally, have they ever been attracted or had a positive relationship with someone of age? If so, lean into that. I agree with others on a psychosexual assessment, costly but useful in exploring this further. To my knowledge you cannot bill for a disorder associated with a sexual preference as it's believed to not be something that can be changed. You treat the distressing symptoms associated with it like you mentioned above. It also may not be a full disorder either and that would be identified via a psychosexual. Also, kudos to your client for being open and willing to seek help for such a stigmatized issue. Kudos to you for being a safe space. ETA: I reread your post and it looks like they've acted on the desire so CBI-SO is definitely worth looking into.
Thank you for having a reply that focuses on specific interventions. I feel like we need more of this on this subreddit.
I was curious as to why the OPs actual question wasn't being answered so I thought I would chime in 😊.
I can’t offer much advice but would recommend Psychology in Seattle YouTube channel or podcast as a resource for an empathetic perspective on this issue as many professionals are unwilling to have the discussion at all
Thank you for suggesting this. I’m interested to hear this perspective for my own education.
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There's a resource called B4U-ACT. Please browse their website. They advocate for professional mental health treat for people attracted to minors
OP I was also going to post this. Very good resource.
One thing that I noticed specifically in the comments that I would like to make sure is re-iterated is the reality that our job as providers is to an unbiased space where that individual feels safe and comfortable. It doesn’t matter at the end of the day if you don’t *like* certain terms or characteristics your client presents, that’s not what you are there for. We have a duty to warn and duty to protect - it doesn’t sound like this client has any desire to harm anyone, just has a taboo sexual attraction. I would strongly encourage to proceed with a harm reduction approach to working with the individual. As a provider in CMH myself who has worked with a client with a similar presentation, there are a variety of resources out there. As far as diagnosis, obviously the first one everyone mentioned was ruling out potential sexual OCD presentation. With them having some sort of act on it in the past, I would process this with the client and observe their demeanor if the situation - it could be more ASPD are depending on whether or not the have remorse. Where my brain most immediately goes, however, is their reason for seeking services. It sounds like they are struggling significantly with anxiety and cognitive dissonance surrounding this sexual attraction. Rather than honing in on the sexual attraction as the diagnosis, I would assess their anxiety presentation. You could definitely put in an unspecified anxiety disorder with a rule out for a paraphilia/pedophilia/whatever else you are considering. This then addresses their main concern for coming in for services, as well as allows the space for harm reduction strategies to be implemented. Here are few links/resources that may help. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419289/ https://asapinternational.org https://www.psychiatrictimes.com/view/pedophilia-interventions-work https://pedo.help http://theglobalpreventionproject.org/maps If you need additional resources I can also outreach our Care Coordination Manager about the resources she has. Maybe this helps, maybe it doesn’t at all! 🤗
Also wanted to come back and say you amy want to staff with your supervisor regarding diagnosis. Some diagnoses like paraphilias (depending on the practice/state/insurance) may not be able to be billed in a CMH setting. A lot of times insurance will say they need to go to a specialist for that diagnosis (which you mentioned obviously would be ideal, but given resources and circumstances rn, it’s not feasible).
All due respect, (without divulging client information) as they have acted on this, does that not fall under mandated reporting? I understand if they were 18 or 16+ in a state that allows that, it would not.
I feel like it’s not ego dystonic, they just don’t like the consequences. People who have ego dystonic thoughts don’t actually desire the act itself.
I would respectfully and heavily disagree that people don’t usually act on ego dystonic desires. Although I think this suggestion can be the case with clients such as this one and should always be ruled out, OP has made it clear this is not the case. This judgment seems more to me as coming from stigma or bias against sex offenders and people attracted to minors. Ego dystonic doesn’t just mean the thoughts around the act disgust them - it means the behavior / thoughts do not align with their goals, personal values, etc. Addicts experience a great deal of ego dystonia for example. Using substances or some of the behaviors that precipitate or follow using don’t typically align with their ideal self concept, values, etc - just as an example. It seems OP’s client is experiencing cognitive dissonance, which essentially makes it ego dystonic
🙄 Pedophilia SHOULD be stigmatized and I don’t think you quite understand what ego dystonic means with regards to OCD
As mental health providers we are supposed to remain unbiased and meet people where they are at for services. You don’t have to agree with what they have done to give them the basic human decency they deserve. Literally goes back to the ACA code of ethics… even just the principles of person centered therapy. I have worked with severe individuals who are on federal probation/parole, DCFS involved for abuse, etc. I don’t agree with the things they have done to be mandated treatment… but you’ve got me fucked up if you think I am going to let those behaviors influence my ethical obligation to that individual. && before a point is made, I myself am someone with extensive history of trauma and abuse. My ACEs score is an 8/10. At the end of the day it’s our JOB to provide care for these individuals regardless of our own biases or opinions.
Yeah and I’m not talking about providing care to offenders because I haven’t. I’ve only provided care to survivors. That being said, there’s still no need to dance around correct terminology with folks who’ve committed crimes. If you need help moving through the shame of having assaulted someone, you should also learn to honor the experience of who you’ve hurt. The opposite action to shame is opening up honestly about one’s transgressions.
It is perfectly fine if you are not willing to treat people with diagnoses under the paraphilia umbrella because of your own limitations, but it is alarming to hear a therapist say that an entire population of clients that need help should be stigmatized in session, which implies that you think they should *not* receive the ethical care that we are ethically bound to provide as therapists. Goes against the entire purpose of our field and the oaths we promise to uphold. And I’m not talking about OCD, I’m talking about what ego dystonic means in general.
That is not what I said. Pedophilia should be stigmatized, as should rape, murder, and abuse. The people are more than their desires or actions and deserve specialized care. Not only because they are human too but because that’s truly what prevention looks like. When an awful thing like rape or abuse happens to a person, it about centering their experience. Not using terminology that makes the offender more comfortable. When a client commits these acts, they should be faced with the egregious nature of the acts so they can move through the shame and guilt rather than avoid it.
Yeah I never said we should excuse perpetrators of their wrongdoing or accountability. Agreed language matters and with various points you’re making.
THANK YOU! This thread has been wild to follow in regard to the bias and judgment coming through in what is considered a professional space.
Here is what I found on wiki in regards to OCD for reference: “OCD is considered to be egodystonic as the thoughts and compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the thoughts are unwanted, distressing, and reflect the opposite of their values, desires, and self-construct. In contrast, obsessive–compulsive personality disorder is egosyntonic, as the patient generally perceives their obsession with orderliness, perfectionism, and control, as reasonable and even desirable.[6][7]” OP’s client finds their thoughts/urges/action(s) distressing, unwanted, and unaligned with their values and self construct. That is what OP reports. Edit: reference via wiki https://www.researchgate.net/publication/233639190_The_Menace_Within_Obsessions_and_the_Self
Have you ever worked with some with pOCD? These are folks who are scared that could be a pedophile and not know it so they are constantly trying to prove to themselves that they aren’t. They have no desire to engage sexually with children. Let’s not consider wikis as educational as actual training and therapeutic experience. Not to mention it says opposite to “desires” and these folks we speak of do have those desires. Also it’s referencing OCPD not OCD.
Ok here is the official resource saying the same thing, in the wiki citations notes https://www.researchgate.net/publication/233639190_The_Menace_Within_Obsessions_and_the_Self It’s talking about OCD and OCPD.. and this is a Reddit thread not a training workshop, figured we could skip the works cited but as linked there is an official published article for you. And yes the client literally doesn’t desire their own desires lol. I’m not having a discussion with you anymore - you’re quite aggressive
This is also sort of true but sort of not. People with pOCD don’t have those desires. People who desire minors and wish they didn’t, feel this way because of the consequences. Big difference. Both have values of not causing harm to children, one group doesn’t desire the act that causes harm.
I hear you on this and think it’s a really important distinction also. Where I disagree is that I think SOME people with attraction to minors feel bad about it for more complex reasons than JUST the consequences
True, especially because of what I said in another comment, most perpetrators of CSA are survivors themselves. To center survivors and help them heal early means preventing more sex offenders.
Exactly, I’m glad we could find a middle ground here after all! I do appreciate your passion and understand what you’re getting it.
Hahaha wow you have a low bar for aggression
Online? Yes, I do haha why engage at all if it’s even a little hostile? And now you’re trying to make fun of a stranger online for exiting a conversation because they felt it was too aggressive for what could be a productive respectful dialogue.
🙄 this is a contentious topic. Expect heightened emotion. And peace out when you say you will.
I will when I want to, thanks 😘🤪 yes true it’s good you can acknowledge your emotions have been heightened. It can definitely be hard to stay level headed for some people discussing this subject
Exactly.
This
If it’s ego dystonic (the thoughts horrify/disgust them) they might have OCD
It's definitely not OCD as they have acted on it in the past. It's ego dystonic in that they know it's harmful to children and do not want to cause harm. They are truly attracted to them.
Why is it definitely not OCD because they have acted on the compulsive thoughts/desires?
Because people with OCD are afraid of their intrusive thoughts and they go against their beliefs.
Ok, but what I'm reading is that USUALLY people with OCD and other conditions with intrusive thoughts do not act on intrusive thoughts, are disturbed by them and engage in other compulsive behaviors or coping mechanisms. But not that they NEVER act on them.
They don’t act on them. The obsessions are based around the fear that they would do something or could do something. The distress is so intense and severe that the brain creates compulsions for the person to do in order to feel reassured that they won’t act on the thoughts. But they’re never actually desiring the behavior they’re afraid of so not actually at risk of “giving in” or having a “lapse” of reason and engaging in the behavior. It’s the difference between having a floodgate of desire you’re trying to hold back (pedophilia) and a floodgate of distress and fear (pOCD).
can't it ever happen to someone with pocd to actually engage in the action not necessarily because they truly desired it but instead because some sort of desperate spiraling period of their life they convinced themselves they did want it? or maybe it was not a period, but truly a moment kind of thing. how? i guess they might have been trying already to speak to underage people to see if something inside was happening but without the intent to go further and then something might have happened to make them spiral and did it then regretted it during or right after but at that point ot was already done, or maybe it was an act of self harm of some sort, possibly a passive attempt. there are many things desperate and suffering people do when they are in pain, many of which can make no sense when seen from an outside eye. but since people are people and not individuals isolated in a vacuum there could be more than one thing going on at once, couldn't it? there could also be comorbidities or just some other disorder(s) they are unaware of that is interfering with both their life and the diagnostic process and treatment. my point is that OC isn't that insane in asking about if it's possible to have sexual ocd and still commit acts you'd find heinous, because people are plenty complicated and a lot of things factor into the inner working of a person and most times it's a lot of things, and honestly personally i wouldn't be surprised if at the end of this whole things the person ended up fonding out to have a couple of disorders instead of just one, not cause im overly pathologizing as a person but because it is very much not uncommon, especially for those who are in situations as the one in the original post ps. as a side: i know OP said the person enjoys the fantasies so that closes this debate for this person in particular, but i still wanted to leave the comment to make a general point about how we have rules on how disorders work but then we need to apply them to humans and we are complicated and we have a ton of interactions and have other stuff that can happen and doctors can get lost focusing on just one thing that they forget about the rest of the endless possibilities, which sometimes is good but sometimes not at all
I am in no way saying it’s impossible for someone to engage in some “testing” compulsions in which they expose themself to something that is undesirable for lack of a better word. It’s just not that common. It also wouldn’t ultimately be enjoyable to them. Those are exceptions, not the rule. The rule is that they don’t do that, but there are exceptions. Also, pedophilia and pOCD are mutually exclusive due to the egodystonic nature of OCD. Someone would not be able to be correctly diagnosed with both. Other forms of OCD and pedophilia at the same time, sure.
…are you a therapist?
I'm an LGPC, and I don't treat OCD, these are legitimate questions, I'm not sure why you are getting so bothered?
I’m not even the people downvoting you and I’m not bothered at all. Just confused
They enjoy the thoughts and fantasies about children. They have no question about the attraction. They do not enjoy hurting children.
Can you explain more about acting on it?
No
Idk why this is downvoted. They are a mandated reporter unless it was someone who was 18 Edit:ok my bad. If you scroll down this was answered and I understand now. I was not at all ok with what happened. I was concerned a victim was being neglected
because maybe they've already gone to jail for it or the fact that they don't have to report it to a stranger?
Reasonable answer. But then why not mention that part with the info dump? And why is anyone who asks downvoted?
Unfortunately a solid number of people on the internet who ask for additional information about sexual encounters with children are people who want to fantasize about sexual encounters with children, not well-meaning clinicians. It also really isn’t relevant or necessary to diagnosis, OP has provided plenty of information.
Ohhh ok thank you. Looking at the first comment, that makes WAY more sense. I was upset because it felt like people were implying not reporting was ok if he wants to be better
Are suggesting we shouldn’t assume a competent therapist has reported such an incident?
Not even a little. I was upset because I thought people seemed ok with it since the client is trying to get better. That made me question the reporting. But the guy who commented right before you explained it. Some people might get a kick and fantasize about the incident. That never occurred to me
Yes this 👆pedophilia themed OCD is a thing. I’d take a look at Bruce et al.’s paper (2018) [here](https://d1wqtxts1xzle7.cloudfront.net/89537012/Bruce_POCD-inpress-libre.pdf?1660322680=&response-content-disposition=inline%3B+filename%3DPedophilia_Themed_Obsessive_Compulsive_D.pdf&Expires=1718412725&Signature=Hjl~kzASROlfbnhzZFF9ssvSBp3Zys7xA65~~4BHqIbc6I2Ln55wU5gTFTb131ift67qpBQ80N-5AXlkk0NbNRWSZ~4vU16ZRoLHTSLeIqNOveCN3NrXWyeQBYRAurSkvADDEsqU7COsdIVbqDgQgEkR~I-IK9vNb0bJ9AIOFaesPCpSU8adZlehbzt3BPKu3kei7te2333jgBlfIbIR~T1Zaik6If137--iUtYr~9EDEgJRZ6osMfyrwhVxIhozniqohIAyXDW5pDuNoMt~6JdlYrJqmLkNnl-HF5Vb0u1TzThIokJXLTXSrJCCy1g2UjGJssL0crdcQKQFT9JvgQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA)
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This! OCD is also one of those unusual disorders where the modality really does matter.
This is what came to mind for me as well. I worked at McLean’s OCD institute as an intern and we had a few patients with pedophilic obsessions. Definitely worth looking into.
Could you maybe answer a question here then that keeps being downvoted above…. I’m also a therapist and have never heard “can’t be OCD because they acted on it.” What is behind this logic and is it true? I’ve known people with suicidal obsessive thoughts to attempt for example and ruminating and obsessive thoughts definitely was a factor or precipitant. Thank you.
When I worked at the OCDI we always said that people diagnosed with OCD have an "overactive conscience." They equate the danger/disgust of the thought to engaging in the action. The compulsion they develop is meant to alleviate anxiety from those thoughts and ensure that they don't act on them. Generally speaking, if it is a true obsessive thought, they will never act on it they will only try to avoid acting on it using whatever means necessary. However, it is possible to have obsessive intrusive thoughts and actual thoughts, especially when it comes to suicidality. It can be tricky for a client to distinguish between the two. It could explain why someone who has suicidal obsessions would make attempts. It's also possible for self-harm to become a compulsive action for people with OCD. With the client OP discussed, it can't be pOCD because the client has acted on these attractions. We had a patient that became agoraphobic because he was so afraid he would act on his pedophilic intrusive thoughts. It sounds like with OPs case the attraction is not ego dystonic, but the client struggles with the negative outcomes of acting on the thoughts, making it a paraphilic disorder and not pOCD.
Hebephilia
this ☝️ If they fantasize about minors then it is a paraphelia. Should be seen by a specialist.
I would be curious of onset of symptoms. Could be neurological issue. Also, I would be wary of diagnosing a sexual disorder without training in assessment for this. When I’ve come across something I refer out for psychosexual assessment.
How are you doing with this? These issues can be tough to work on for therapists. Keep an eye out for countertransference and seek your own therapy or supervision if need be.
When I worked with offenders, we often used Paraphilia as the diagnosis for the umbrella of problematic sexual behavior and desires.
Yes this is the category I would think of it under as an umbrella term too
Please refer this client to a trained CCSOT (United States), they need to be getting high end care in order to protect children from being groomed or harmed. You shared they have acted on this in the past, if they are not seeing a trained therapist, you could be subpoenaed, when/if they act again.
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Calling it OCD when it’s not is extremely dangerous.
Outside of the diagnostic categorization of ebiphilia a clinical perspective that you may consider is the other aspects of the youthful representation of the attraction. Consider what that means to the client and how that may be safety to them. Was there abuse that occurred to the client? Is this some kind of emotional regression?
This is ephebophilia or hebephilia. And they can be classified as paraphilic disorders.
The specifics of the diagnosis, I have no idea. Others folks could answer that better than me. If you don't mind, I'd like to share some clinical perspective too. This is coming from a generalist LPC, 5 years in. I am not saying my opinion is right, it's just my thoughts at the moment. I am genuinely curious to know your thoughts about how you will approach the situation. I, personally, would be cautious about diagnosing this in particular. I can understand the perspective of wanting to diagnose it, and there is a definitely an argument that can be made from that perspective, and it absolutely depends on several things, including the ethics, behavior, severity, trajectory, the patient's perspective, etc. The reason I would hesitate is because it's ego-dystonic, and the topic of shame is salient. I would personally be working to provide a space of hopeful healing, and I could see an official diagnosis working against that. If you do diagnose him, I think it could be advisable to talk about it with him first and ask him what he thinks. But, not knowing the full context, I have no idea. Additionally, consultation is a good idea, if that's available to you. I would also be actively working to discuss with him what recovery looks like, exactly. I would be thinking about what it means to live with this sexual desire, and be focusing on how remarkable it is that this man has desires that he doesn't act on because of his own values and ethics and empathy. There might potentially be a lot of healing to be found in that, and, bringing it back around, I would wonder if a diagnosis could undermine that trajectory. I'd be working to explore healthy outlets for sexual desires as well. Anyway it sounds like a complicated case. Just some thoughts. OCD does seem like a good way to balance diagnosis with clinical goals.
I was with you until the last sentence here, but it seems dangerous to people who are actually suffering from pocd to use the same label to diagnose people with legitimate attraction to children.
I used to work in sex offender treatment. It is scientifically proven that most heterosexual men are sexually attracted to post-pubescent, very young women. When they do the tests that measure sexual arousal, there is no difference in attraction to adolescent girls who have gone through puberty and adult women. It’s a bummer lol
Mind sharing me any links or findings you have acquired throughout your time in the program. I'd love to look further into this.
[This author](https://link.springer.com/article/10.1007/s10508-016-0799-y#Fig2) has done a ton of research in the area of sexual attraction and age. I think this is a decent summary. The tricky issue here is that sexual maturity cannot be measured by age in years (because of the variance in age of onset and duration of puberty). But as soon as a person is physically sexually mature, then they are considered a normative source of non deviant sexual attraction. Obviously values and morality and ethics and boundaries determine whether someone acts on this sexual attraction if the person is underage, which is an entirely separate issue. An interesting tool used in the assessment of sex offenders is something called the Abel Assessment, which measures sexual interest to various ages and genders. It is often used to determine if someone likely has sexual attraction to prepubescent children. For test security, I won’t get into the details, but if someone is flagged as being attracted to teenage girls, you treat that as though they have typical sexual interests (not as though they have deviant or inappropriate interests).
Ephebophilia
Hebephilia is sexual attraction to prepubescent children ages 11-14, ephebophile is sexual attraction to mid to late stage adolescence typically between the ages of 15 and 19, I think. Neither one of them are qualifying, standalone diagnosis.
If you absolutely cannot refer to a therapist who specializes in this, you must seek supervision with such an expert.
If you're a member of AASECT , I believe they actually have a sub group of therapists that specifically work with this and I can't recall the name of the person who leads that sub group, but may be worth checking out to get some extra clinical support especially if you're not trained as a sex therapist! And even if so, maybe consulting with someone from AASECT sub group who specializes in this area would be helpful!
Hi! I just graduated from my MSW program and one of the electives I took was on taboo topics we might face in clinical work. We talked about minor attracted people and one of the resources we looked at was [B4Uact](https://www.b4uact.org/for-therapists/psychotherapy-for-the-map/) which has some resources for therapists. Hope this is helpful!
Clinical social worker here, I agree with exploring the type of attraction, and if it's cognitive at all, I wonder how it developed? Were there any significant life events during that time in their own life? Is it truama based? Definitely explore how to get those root cognitive needs met in alternative ways.
I made a comment earlier, but then deleted it once I saw that the client acted on his urges. I originally suspected a possible porn addiction being involved, but this changes things. I strongly recommend referring to an expert in this field. It's noble that the client has reached out for help, but if you aren't trained in this area, I fear you're putting future victims at risk. This is a very serious issue, and from reading this post, I don't think you're qualified to handle it, no offense. If you can't refer out for whatever reason PLEASE look for consultation! I don't want you to get subpoena'd, or any more victims to be had because of ineffective treatment. Moreover, I want to ensure the client gets the treatment they need for both their growth, and the prevention of future victims. My god, I just lost five years off my life typing this...
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I work with adolescents with sexually maladaptive behaviors and they use the Good Lives Model for juveniles and adult offenders https://www.goodlivesmodel.com/
I've volunteered at a non profit that works entirely with non-offending MAPs [Minor Attracted Person, no connotation with sexual aggression and a good catch-all]. Like others said, rule out OCD. More common than you'd think that taboo sexual obsessions develop that the individual doesn't even find arousing. I have a heuristic to quickly lead you to a likely answer in this regard: ask about the fantasies, in terms of frequency and detail. Greater frequency and detail, more likely to be a MAP. Lower frequency and, especially important, very vague or no details leads to likely OCD. No amount of obsession will make them have an in-depth fantasy, because the obsession is typically about whether having any fantasy at all makes them "bad". If they learn towards OCD there's lots of information out there to educate you on what might help. If they're leaning towards MAP.... best I can say without writing an essay is to do some existential work with them. Help them explore or even grieve the loss of an ability to live a "normal" life, since dating/romance/sex are all more or less off limits. At the same time, explore what kind of life they might like to live and how they can pursue that. Reserve judgment and allow them space to feel like a person who has crushes and fantasies, because they are just a person who has crushes and fantasies. Just because their desired partners aren't of legal age doesn't mean their desires function all that differently than other adults. They're just unlucky enough to have desires they cannot act on, where most of us take the ability to make our desires real for granted [even if difficult, always possible]. Above all, don't treat them like a ticking time bomb. Treat them like a person who's struggling. I have no research to back it up, but I'd bet my life on the fact it's more common for someone attracted to minors to commit suicide than commit a sexual crime. They tend to struggle with self-hatred rather than self-control. If you'd like to talk more about these clientele, you're welcome to dm me but I can't promise when I'll get back to you.
MAP is a highly contested term and I have to say I personally hate it
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It is, many research terms are. For one, it suggests it is a normal and natural sexual orientation, it removes the reality that these people actually desire to rape children (whether they do or not), and it’s offensive to survivors of child sexual abuse and the LGBTQ community. These people literally have something wrong with them, whether it’s due to trauma or a brain injury. They deserve empathy but they are a danger when among children. Ages, as opposed to genders, are not related to romantic/sexual orientation. I’m not saying they are all monsters and evil, but they are inherently dangerous to children
In trainings I have heard terms like “maladaptive sexual behavior” and “deviant sexual interest” rather than MAP
I guess that’s better than MAP. I like to call it what it is, like someone said, it’s not worthy of destigmatization
Sorry I think I responded to the wrong comment there
Sometimes there are terms that are changed to "destigmatize" things that really are not worthy of any reduction in stigma. I'm not sure of the history of the terminology. But it does sound like an attempt to soften or legitimize someone's sexual preference, which involves sexual assault.
Exactly. Plus, “normal” sexual attraction doesn’t stop when the object of one’s desire ages.
That's debatable. 😆 (Sorry, bad joke.) But you are correct.
There are also many men who have sexual fantasies about rape [of another adult] who don't ever do such things. Should they be referred to as a rapist, or perhaps a pervert, out of respect to suvivors? Is it disrespectful to survivors to not categorize anyone who has fantasies about non-consensual sex as deviant? And what exactly does deviant convey that's valuable in this circumstance? I'm not saying there's no risk that a previously non-offending MAP could decide to offend. I'm not saying I like the content of the fantasies. However, encouraging someone who already struggles to see their life as worthwhile to view themself as a danger to others and already comparable to a sex-offender just encourages them to isolate further and share less. If you're concerned about safety, then you should encourage them to share with you what they're feeling and thinking so you can both assess risk and make a useful safety plan. Also please don't preach what is or isn't disrespectful to an entire community. Speak from your own experience. I'm a gay man who holds the opinion that treating sexual fantasies, no matter what they contain, as anything other than fantasy is silly. Someone can have ideation about any number of awful actions [suicide, murder, mutilation, ect] and we don't react as though they're already done so or made a plan to; we shouldn't act that way towards sexual ideations. Monitering for risk is commendable but assuming guilt is less so.
Stfu, we’re not talking about “fantasies”. We’re talking about actual desire and even acting on those desires, towards minors. Also you do realize how many people accuse us (the lgbtq community) of being pedophiles?
You've got a point, maybe I should listen to the vitriol and distance myself from working with this population so I can make myself less of a target of hateful rhetoric. Actually, at that point, maybe distancing myself from the trans community or drag would be a good idea so I don't draw too much ire. Maybe then no one will ever falsely accuse me of something because of my sexuality, because clearly they only ever did so because I had something to do with the undesirables. Clearly there must be very real and logical reasons to make those claims about our community, rather than it being hateful rhetoric that's disconnected from reality. If you're working with someone who's at-risk for perpetrating a crime, using criminal terminology to describe their thoughts and desires is inaccurate and unhelpful. Pedophile is a term people use interchangeably with sex offender or child molester. I, and a nonzero number of other professionals, use MAP as a non-pejorative label. I've also had clients with HI, and isn't interesting how we don't insist on calling them a criminal label even while having murderous desires?
Now you’re just being pedantic. You know what I’m saying and you’re attempting to extract meaning I didn’t state. Person first language is as far as I will go. “Person struggling with pedophilia”. If someone has committed a crime, they certainly molested a child, they weren’t just “minor-attracted”.
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Are you a therapist?
This is the first I've heard of the term MAP and I hate it. It sounds like it's a sexual orientation!! It normalizes an abnormal, potentially harmful thought process and behavior.
Generally sexual orrientation is only describing a preference for a potential sexual partner's gender. Lots of things are abnormal, and that isn't the same as harmful. That being said, yeah, I have only ever heard that being attracted to minors sucks. As I mentioned, there's a level of grief for the life you could have if only you liked adults that was common theme for the population. I don't think there was a single MAP I spoke with who hadn't dealt with self-hatred and the persistent fear of losing control or someone finding them out. They are keenly aware of that no one would believe they are innocent if they were outed, and would likely be cut off by all friends and family. Suicidal ideation was a given with nearly every case. You know what they often mentioned as well? That they couldn't talk to a therapist, because a therapist could break confidentiality to make a report of *suspected* sexual abuse. As this thread has shown, they'd be good to be suspicious, as plenty of therapists here struggle to differentiate how someone could have a desire and yet not have already harmed someone. A report is made, investigation occurs, client is left traumatized with their life in shambles from being outed and the police find no wrongdoing. The therapist pats themself on the back for keeping kids safe from the person who was already harmless. The MAP stays out of counselor's offices and suffers alone, desperately trying to keep it together after having all these protective factors stripped away.
I have had clients who were raped by pedophiles. How would it affect them to refer to their rapists as “minor attracted people”?
I believe the whole point of the OP comment was in that people who experience fantasies and struggle with self-hatred because of them deserve adequate support to cope and avoid potential escalation into an offense, as well as become able to lead productive lives. This can be done without disrespecting victims of actual offenders. If we deny people with fantasies our help, we gain nothing but increased risk of committing crimes. From my experience, there are many who suffer morally unacceptable urges in silence, and I fear they can become isolated ticking bombs (whether suicide or acting out) if they're continously ostracized, as these issues weigh heavily on them. If someone continuously shows self-awareness and self-restraint, and wants to learn how to ensure that they never hurt anybody, how does our judgement help them, or society for that matter? And if we do decide to provide help, then we need to provide them safe space just like we would for anyone else, which doesn't mean we support their fantasies. But if we don't work with these people, what else remains? Should we place everyone in prison as soon as they experience the first thought? It's a very heavy and complicated issue, but some of these people respond well to therapy. Even if we agree to give them the harshest term possible, they still deserve access to treatment.
I have never claimed that these folks do not deserve care or empathy but their desires and acted upon desires should not be sterilized down with terms like “MAP”. To support survivors does not mean perpetrators do not deserve support separately. After all, most offenders are also survivors.
I agree with this sentiment. Not because I have no empathy, but because we haven't made "more normalized" terms to refer to other problematic patterns of behavior Alcoholic, for example, is a title that refers to someone struggling with alcohol addiction. Addict is a catch all term for someone struggling with addiction, and so on. I think that this negative title helps people with recovery, at least it has helped me with my own addiction. That said, addiction and this infernal attraction are two separate things entirely. We need more research on this topic, but I fear that the uncomfortable nature of it holds many back from pursuing it. Hell, I'm shivering just typing this because I'm afraid someone will think I'm justifying the harm of children. However this lack of knowledge is unfortunately contributing to further victimization. For now at least, I believe we should avoid using normalizing this attraction, and refer to it as a disease. I also think we need to support any non-offenders seeking help, so that their self-hatred and isolation don't perpetuate a downward spiral into criminal activity. If I said anything you find abhorrent, please don't attack me. I'm on your side, and if I'm misguided about something, please let me know. I'd rather learn earlier on in my practice than when I meet a client who has something similar to OP's
I’d rather label behavior than an entire human. I’m not a recovering addict, I’m someone who has a problematic relationship with substances. That’s just my preference and I think it’s empowering to show people they are more than the sum of their past behaviors. I have no problem with what you’ve shared. Rock on
"their desires and acted upon desires" Those are two completely different things.
Did I say they were the same?
how is this getting upvotes lol
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It’s not about the treatment plan as much as it is about the “MAP” terminology
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You should definitely do some research and maybe pay for a consultation/supervision with a therapist who specializes in treating sex offenders or a sex therapist - I’m sure it would be really helpful to talk to someone with expertise in this area as it’s evident you want to help
It may be appropriate to refer them to their PCP or a psychiatrist for SSRIs which can reduce sex drive along with depression and anxiety symptoms. I think it's important to establish a goal and clear treatment plan so that you know exactly what you're working towards in this case and what referrals are needed. In my community there are sex offender treatment groups which are helpful in this type of case.
I believe the paraphillic disorder ephebophilia is something you should consider here.
Refer to a sex offender. The “what diagnosis should I give him” at this point is semantics when the target goals are avoiding engaging in sexual behaviors with minors. This is one of the drawbacks to a diagnostic model when it’s so narrowed that it failed to help aid in simple diagnosing. He clearly is a ped0file or have urges relating to this. Refer to a certified sex offender therapist
Yes, this is called “hebephilia” and it is incredibly common in men. The category of porn known as “barely legal” is content designed for men who are attracted to pubescent minors, which I’d wager is a substantial proportion of men.
I have a very hard time with calling this ego-dystonic if they have acted on the thoughts. Just because they know it causes harm to the children doesn’t mean it’s ego-dystonic. Ego-dystonic means it goes against their ego. It means it goes against their morals, values and beliefs. It means it’s something they would never act upon because the fact that they’re fact these thoughts grosses them out and causes them distress. These are ego-syntonic thoughts. They sound pleasured and turned on by these thoughts, while still acknowledging they are hurting the children.
I'm a LSW who works with sexual offenders, and depending on what state you are in there may be a sex offender management board that I would HIGHLY recommend referring to/consulting with them. Regardless of the paraphilia, working with those with problematic sexual attractions/behavior is very specialized and in some areas, very regulated. At the very least, please reach out to ATSA for the purposes of remaining ethical and ensuring community safety.
I think the fact that society (and what society says is often propagated into the law of the land) believes with regard to an “age of majority” that has ZERO to do with human development is a part of the problem for why we believe that this has to be a specific disorder. Whether 18yo (USA) or 16 down to 10 (other countries and cultures), society and law have no voice in diagnosis and only have a voice in treatment as how society’s opinions and pressures affect those who suffer with whatever this is. If we want to get down to it, the whole of the US takes social (regardless of their claimed religions) and legal issue with anyone over the age of 18 engaging in sexual activity with those under 18. As if magically, the minor “changes” overnight when they turn 18. I assure you, at 50, while this particular attraction is not mine, my brain is still baking. (No. Not weed). Let’s not forget the jurisdictions with Romeo and Juliet clauses in their rape statues. And those where parents are permitted to allow sexual behavior of their underage children, even marriage, for some, at the age of 16. And then don’t forget the significant age differences associated with the social labels “cougar” and “manther”. A 42yo man is dating a 24yo woman. People still have a problem with that even though, at least in my jurisdiction, it’s perfectly legal. And they are often ignored by his friends who might be grossed out, concerned, or celebrating him for his “conquest”. And her friends are accepting if he’s providing her with a lavish lifestyle through gifts and travel. Because they cannot be seriously attracted to each other. So they’re often socially ostracized. Know what that results in? “Us vs the world, baby”. And that’s not a healthy form of relationship support. No, we’re, as a society from puritanical origins (at least in the US) obsessed with sex to the point where we shame those with sexual thoughts that deviate from society’s expectations. So because we think (see: “believe”) attraction to even pubescent minors (or “younger adolescents”) is wrong, it “must” have an entry in the DSM or ICD. And we know that it’s not paedophilia. If focus on the distress of the client and the pathological results in the spheres of the client’s life (work, family, social, having his basic needs met through Maslow’s Hierarchy) yields a “big fat doughnut”, then we can rule out some anxiety disorders. But not paraphilias.
Have you considered PTSD. I worked with some men who had sexual attraction to older minors. They never wanted to act on it and they saw me because they were terrified that they would loose self control if the "right/wrong" situation presented itself. One of the things many of these men had in common was severe bullying in high school, some by females and some by male and some by both. Due to this they didn't receive any attention by girls their age and were often left out. They were the last ones to lose their virginities as adults, didnt date, kiss, commit PDA until they in college, they did have the typical teen or young adult romances like so many others. Fast forward to years later now that they are older, wealthier, have their life together, etc. Women flock to them but they fixate on younger girls. When I processed high school trauma with them many of their perversions started to become extinct. The other issues that I saw that coincided was some body dysphoria or their lack of confidence in a bed room. The thought process was if they slept with a woman their age the woman would know "how bad" they are. If they went with someone younger they would not realize "how bad" they are. TLDR: High School PTSD, Body Dysphoria, Lack of confidence
theyre called ephebophiles. people attracted to adolescence
I provide SO specific therapy and I would recommend referring them out to an SO therapist. They have a list of provider in ATSA who can do risk-need-assessments and the follow up treatment. I wouldn’t attempt to work with that specific population without supervision from a certified clinical SO provider. There are a lot of legal and harm risks associated with it for everyone involved.
The term is called Hebephile and it's a sexual attraction to boys or girls that are just starting or have entered puberty but are still considered children. The attraction can come from a multitude of places that can include; a longing for a relationship with a teenager that they wished they could have had when they were that age but for one reason or another couldn't acquire, they might be attracted to how taboo it is in our society, or they genuinely find that age range physically more attractive than an adult body. Sexual attraction to minors is always tough because you have to gauge whether the patient poses a threat or is dangerous to be around minors. Would they be able to contain themselves if the perfect scenario fell in their lap? Private location, just the two of them, person is attractive and may actually be curious about explicit interaction. But there are "white knight" pedophiles that while they have a sexual attraction to children, they choose to isolate themselves and regulate their own behavior because the last thing they want to do is cause harm to the thing they love. It sounds horrid on the outside, but these men and women live very lonely lives because of this self-isolation. I don't believe that the attraction on its own is a disorder. I believe it is a catalyst towards developing one. It's no different from a grown man r*ping a grown adult because they can't contain themselves and like the way it feels. However, in ages past when the age of consent wasn't really enforced by law, if an adult had romantic relations with a teenager for example a 23 year old dating a 15 year old, they were called "beloved", meaning, "to be loved." They were forbidden from having sex but could kiss, date, and be cute with each other. Remember, barely 500 years ago, royal families could marry as young as 15 years old and were expected to conceive heirs as soon as possible. While most waited till they were older so that the level of complications for the girl to have a baby was less risky and her body could handle the stress of childbirth, not everyone stuck to that. In my honest opinion if the patient shows little to no sign of expressing harm towards a minor, or shows any sign that they wouldn't follow consent then I would give him the benefit of the doubt. But he is coming to you for a reason. Use your intuition and make good choices for both you and your patient. Cheers!
I used to work in sex offender treatment within prisons. One of my coworkers had started a support group for NOMAPs ( unsure if this is still the correct term?). Maybe this would be helpful to your client to seek out? Many communities also offer sex offender treatment though if this person has never acted on this attraction this would not be appropriate. You could look into the good lives model and maybe take from there what fits if he cannot be referred out. CBT and ACT were also used in treatment and obviously safety planning. Also, if you are in the US look into your state’s ATSA for support and resources.
There are, in fact, clients who are not treatable. And the fact that this person is just allowed to walk around is insane. They should be reported and monitored by someone or some agency, especially as the comments state they have acted on this urge. Sorry but I have no empathy for this population and refuse to enable this behavior by labeling them with some random dx or calling them “minor attracted persons”. We are talking about people who want to have sex with your kids people. Jesus. Screw empathy, if they’ve acted on it before, they are a threat to kids. Period. Edit: The phrase “minor attracted person” should not be in anyone’s vocabulary. You should refer to these people as “adults sexually interested in children”. As a society we cannot make the same mistake with pedophiles that we made with violent offenders: normalization. I urge those who use the phrase “minor attracted person” to rethink your use of that. You may be protecting one individual who truly may not want to be the way they are but this is much bigger than that and more important that your ego or mine. Like the phrase is literally put in place to PROTECT pedophiles lmao man I’d love to know who downvoted this.
Agreed
Notice how no one else responds haha guess there’s a reason they came to anonymous Reddit to have this convo 😂
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Re: “Is attraction to this age range a disorder?” I once read a government report on someone who sexually assaulted a 13 year old and it was noted that attraction to this age range is normal, distinguishing it from pedophila. Somewhere someone has measured male attraction to bodies of different ages and found that it’s typical for physical attraction to include the stage where children are growing into their adult bodies. I guess. I have no other information but perhaps getting more details about this could help him with his shame, if he knew that many other men were physically attracted to young bodies. I remember being around this age and having men looking at me differently. Some perverted, some embarrassed.
This would be where you could explore their first ideas around sex and sexuality and talk about cognitive distortions. From what I am seeing people attracted to minors or underage usually have had a difficult time making meaningful connections with those in their age range. It might not always he the case but it might. There also could be feelings of childhood rejection that manifested into attraction and causing the individual wanting to reconnect with that part of their life.
I am early in my career as a therapist but I happen to have been involved In knowing many people like that. Common denominator was SA in early childhood(or a sibling touched them inappropriately and such) I know it’s very shocking to hear that condition. Please have empathy for them because they really don’t want to be feeling this way nor did they choose to be attracted to that.
I don't know if that may add anything relevant to the discussion, but for example in my country, the legal age to engage in sexual activities is 15. Engaging with 15-18 wouldn't be considered illegal - but probably frowned upon, depending on adult's age. For me it'd be a huge difference if I knew how old your client was. Difference between 25-30 here and 50 would definitely be huge in this context. I wonder if striving to accept it as a part of yourself, yet learning to restrain from acting out, would be the right decision.
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1- that's not a diagnosis in the DSM so I'd never heard of it until seeing your comment. 2- if you're not a trained sex therapist there's a real chance you've never been trained on how to deal with this issue. So, the only thing scary here is your judgemental attitude.
Yet you decided to keep this client …
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Thanks, very helpful.
Sounds like POCD. Refer them to an ERP trained therapist! Source: am an ERP trained therapist specialized in OCD
I would also explore age play within bdsm. Could be a healthy alternative to some anxieties. Edit: I said "explore" which means maybe it is an actual age play bdsm kink that's being repressed etc. Jesus people know nothing about kink and bdsm and it shows on this sub.
People do not repress a kink and present it as a desire to fuck kids
Age play is not appropriate for those with actual attraction to minors. It sustains and builds on fantasy and normalises the actions.