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Pedophilia: Clinical Features, Etiology and Treatment

Year 2010, Volume: 2 Issue: 2, 132 - 160, 01.06.2010

Abstract

There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally

References

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Pedofili: Klinik Özellikleri, Nedenleri ve Tedavisi

Year 2010, Volume: 2 Issue: 2, 132 - 160, 01.06.2010

Abstract

Son yıllarda çocukların cinsel istismarının çok önemli bir halk sağlığı sorunu olduğu kabul edilmektedir. Çocuklara cinsel istismarda bulunmak tıbbi bir tanı olmadığı, her çocuğa cinsel istismarda bulunan kişinin de pedofilik olmadığı bilinmektedir. Pedofili en az 6 aylık bir süre boyunca, kişide ergenlik dönemine girmemiş bir çocukla ya da çocuklarla cinsel etkinlikte bulunmayla ilgili yoğun, cinsel yönden uyarıcı fantezilerinin, cinsel dürtülerinin ya da davranışlarının yineleyici biçimde ortaya çıkması olarak tanımlanmıştır. Genellikle eylemlerini gizli yaptıkları ve tedavi için başvurmadıkları için pedofili olgularının yaygınlığını belirlemek mümkün olamamaktadır. Diğer cinsel saldırı yapan gruplarla karşılaştırıldığında pedofilik bireylerin daha büyük yaş grubunda oldukları, eylemlerin yapıldığı ortalama yaşların ise 40-70 yaş arası olduğu gösterilmiştir. Pedofili bireylerin büyük çoğunluğu erkeklerdir. Çocuğun cinsel istismarı sözel istismar, cinsel organlarını gösterme, çocukları soyma ve seyretme, cinsel ilişkiye veya mastürbasyona tanık etme, cinsel organını sürtme, bedenine cinsel amaçla dokunma, okşama, müstehcen yayınlara konu etme, oral seks, ağza, vajinaya ve/veya anüse penetrasyon gibi çok çeşitli şekillerde ortaya çıkabilmektedir. Pedofili olgularının eylemlerinde genellikle zor kullanmadığı, aksine önce masum dokunma sonra uygunsuz dokunma, açık resimler gösterme, porno izletme gibi birçok fizik manipülasyon ve desensitizasyon uyguladıkları gösterilmiştir. Bu bireyler için internet ortamı bilgi edinme, mağduru belirleme ve ilişki kurma, fantezi geliştirme, diğer sapkınlığı olan kişilerle bağlantı kurma gibi birçok istek ve ihtiyaçlarını karşılamak için bir araç olmaya başlamıştır. Pedofili bireylerin eylemlerinin nadir olarak impulsif bir cinsel eylem olarak ortaya çıktığı, büyük çoğunluğunun önceden planlandığı gösterilmiştir. Pedofilik bireylerin aile içinde ve dışında sosyal teması sınırlı, içe kapanık, eşi ya da ailesiyle sıcak ilişki kuramayan psikopatik, psikoseksüel ve sosyal açıdan immatür kişilik özelliklerine sahip olduğu belirtilmektedir. Pedofilik eğilimin ortaya çıkmasında gelişimsel, ailesel ve çevresel faktörler ve bu faktörlerin etkileşimi gibi birçok faktörün etkili olduğu anlaşılmaktadır. Uzun süreli psikoterapi, farmakolojik tedavi sonrasında cinsel arzu ve istekte azalma saptanmasına karşın bu bireylerin çocuğa cinsel yönelimlerinde bir farklılık tespit edilmediği için günümüzde pedofilik bireylerin tedavisinde hedef çocuklara cinsel yönelimi değiştirmek olmayıp, yeniden eylemde bulunma oranlarını azaltmaya yöneliktir. Kimyasal kastrasyon adı verilen erkeklerde libidoya etkisi olan testesteron düzeyini düşürmek, bu yolla cinsel eylem sıklığını azaltmak konusu son yıllarda önem kazanmıştır. Tedavide sıkı adli ve klinik izlem ve raporlama, kimyasal ve cerrahi kastrasyon, psikoterapi ve psikofarmakolojik ilaçların kombine olarak kullanımı en büyük yararı sağlamaktadır.Cinsel istismarı ortadan kaldırmanın en etkin

References

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  • Craissati J, McClurg G. The challenge project: Perpetrators of child sexual abuse in South East London. Child Abuse Negl 1996; 20:1067–1077.
  • Çeçen AR. Çocuk cinsel istismarı: Sıklığı, etkileri ve okul temelli önleme yolları. Ulusla- rarası İnsan Bilimleri Dergisi, 2007;4:1-17.
  • İşeri E. Cinsel istismar. In Çocuk ve Ergen Psikiyatrisi Temel Kitabı (Eds FÇ Çetin, B Pehlivantürk, F Ünal, R Uslu, E İşeri, T Türkbay, A Coşkun, S Miral, N Motavallı): 470- 477. Ankara, Hekimler Yayın Birliği, 2008.
  • Snyder HN. Sexual Assault of Young Children as Reported to Law Enforcement: Victim, Incident, and Offender Characteristics. Washington, DC, USA, US Department of Justice, Bureau of Justice Statistics, 2000.
  • Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı, Yeniden Gözden Geçirilmiş 4. Baskı (DSM-IV-TR) (E.Köroğlu, Çev.). Ankara, Hekimler Yayın Birliği, 2001.
  • Freund K, Scher H, Chan S, Ben-Aron M. Experimental analysis of pedophilia. Behav Res Ther 1982; 20:105−112.
  • Abel GG, Harlow N. The Stop Child Molestation Book. Philadelphia, USA, Xlibris, 2001.
  • Blanchard R, Christensen BK, Strong SM, Cantor JM, Kuban ME, Klassen P et al. Retrospective selfreports of childhood accidents causing unconsciousness in phallometrically diagnosed pedophiles. Arch Sex Behav 2002; 31:511-526.
  • Raymond NC, Coleman E, Ohlerking F, Christenson GA, Miner M. Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry 1999; 156:786–788.
  • Aktepe E. Çocukluk çağı cinsel istismarı. Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2009; 1:95-119.
  • Taner Y, Gökler B. Çocuk istismar ve ihmali: Psikiyatrik yönleri. Hacettepe Tıp Dergisi 2004; 35:82-86.
  • McConaghy N. Paedophilia: a review of the evidence. Aust NZJ Psychiatry 1998; 32:252-265.
  • Bagley C, Wood M, Young L. Victim to abuser: mental health and behavioral sequels of child sexual abuse in a community survey of young adult males. Child Abuse Negl 1994; 18:683-697.
  • Akduman GG, Ruban C, Akduman B, Korkusuz I. Çocuk ve cinsel istismar. Adli Psiki- yatri Dergisi 2005; 3:9–14.
  • Ceylan A, Tuncer O, Melek M, Akgün C, Gülmehmet F, Erden O. Van bölgesindeki çocuklarda cinsel istismar. Van Tıp Dergisi 2009; 16:131-134.
  • Vandiver DM, Kercher G. Offender and victim characteristics of registered female sexual offenders in Texas: A proposed typology of female sexual offenders. Sex Abuse 2004; 16:121-137.
  • Fagan PJ, Wise TN, Schmidt CW, Berlin FS. Pedophilia. JAMA 2002; 288:2458-2465.
  • Abel GG, Becker JV, Mittelman M, Cunningham-Rathner J, Rouleau JL, Murphy WD. Self-reported sex crimes of nonincarcerated paraphiliacs. J Interpers Violence. 1987;2:3-25.
  • Lanning KV. Child Molesters: A Behavioral Analysis. 4th ed. Alexandria, Va, National Center for Missing & Exploited Children, 2001.
  • Cohen LJ, Galynker II. Clinical features of pedophilia and implications for treatment. J Psychiatr Pract 2002; 8:276-289.
  • Hall RC, Hall RC. A profile of pedophilia: Definition, characteristics of offenders, recidivism, treatment outcomes, and forensic ıssues. Mayo Clin Proc 2007; 82:457- 471.
  • Danni K, Hampe GD. An analysis of predictors of child sex offender types using presentence investigation reports. Int J Offender Ther Comp Criminol 2000; 44:490- 504.
  • Murray JB. Psychological profile of pedophiles and child molesters. J Psychol 2000; 134:211-224.
  • Dickey R, Nussbaum D, Chevolleau K, Davidson H. Age as a differential characteristic of rapists, pedophiles, and sexual sadists. J Sex Marital Ther 2002; 28:211-218.
  • Green A. Child sexual abuse and incest. In Child and Adolescent Psychiatry. A Comprehensive Textbook, 2nd ed (Ed M Lewis): 1041-1048. Baltimore, MA, Williams&Wilkins, 1996.
  • Blanchard R, Barbaree HE, Bogaert AF, Dickey R, Klassen P, Kuban ME et al. Fraternal birth order and sexual orientation in pedophiles. Arch Sex Behav 2000; 29:463-478.
  • Greenberg DM, Bradford J, Curry S. Infantophilia—a new subcategory of pedophilia? a preliminary study. Bull Am Acad Psychiatry Law 1995; 23:63- 71.
  • Bogaerts S, Declercq F, Vanheule S, Palmans V. Interpersonal factors and personality disorders as discriminators between intra-familial and extra-familial child molesters. Int J Offender Ther Comp Criminol 2005; 49:48−62.
  • Akbaş S, Turla A, Karabekiroğlu K, Senses A, Karakurt MN, Taşdemir GN ve ark. Cinsel istismara uğramış çocuklar. Adli Bilimler Dergisi 2009; 8:24-32.
  • Avcı A, Tahiroğlu AY. Cinsel İstismar. In Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları (Eds A Aysev, YI Taner): 721-736. İstanbul, Golden Print, 2007.
  • Tardif M, Van Gijseghem H. Do pedophiles have a weaker identity structure compared with nonsexual offenders? Child Abuse Negl 2001; 25:1381–1394.
  • Cohen LJ, Gans SW, McGeoch PG, Poznansky O, Itskovich Y, Murphy S et al. Impulsive personality traits in male pedophiles versus healthy controls: Is pedophilia an impulsive-aggressive disorder? Compr Psychiatry 2002; 43:127-134.
  • Gacono CB, Meloy JR, Bridges MR. A Rorschach comparison of psychopaths, sexual homicide perpetrators, and nonviolent pedophiles: where angels fear to tread. J Clin Psychol 2000; 56:757-777.
  • Curnoe S, Langevin R. Personality and deviant sexual fantasies: an examination of the MMPIs of sex offenders. J Clin Psychol 2002; 58:803-815
  • Whitaker DJ, Le B, Hanson RK, Baker CK, McMahon PM, Ryan G et al. Risk factors for the perpetration of child sexual abuse: A review and meta-analysis. Child Abuse Negl 2008; 32:529–548.
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There are 91 citations in total.

Details

Primary Language Turkish
Journal Section Review
Authors

Ayten Erdoğan This is me

Publication Date June 1, 2010
Published in Issue Year 2010 Volume: 2 Issue: 2

Cite

AMA Erdoğan A. Pedofili: Klinik Özellikleri, Nedenleri ve Tedavisi. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. June 2010;2(2):132-160.

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