The essential feature is the act or fantasy of engaging in sexual activity with
prepubertal children as a repeatedly preferred or exclusive method of achieving
sexual excitement. The difference in age between the adult with this disorder
and the prepubertal child is arbitrarily set at ten years or more. For late adoles-
cents with the disorder, no precise age difference is specified; and clinical judg-
ment must be used, the sexual maturity of the child as well as the age difference
being taken into account.
Adults with the disorder are oriented toward children of the other sex
twice as often as toward children of the same sex. The sexual behavior of these
two groups is different. Heterosexually oriented males tend to prefer eight-to-ten
year-old girls, the desired sexual activity usually being limited to looking or
touching. Most incidents are initiated by adults who are in the intimate inter-
personal environment of the child.

Homosexually oriented males tend to prefer slightly older children. The percentage of couples in this group who know each other only casually is higher than in the heterosexually oriented group. Individuals with undifferentiated sexual object preference tend to prefer younger children than either of the other two groups.
Most individuals oriented homosexually have not been married, whereas
most individuals oriented heterosexually either have been or are married.
Age at onset. The disorder may begin at any time in adulthood; most fre-
quently it begins in middle age.
Course. The course is unknown, although homosexually oriented Pedophilia tends to be chronic. The severity of the condition often fluctuates with
psychosocial stress.
The recidivism rate for homosexually oriented Pedophilia
is second only to that for Exhibitionism, and ranges from 13% to 28% of those
apprehended, roughly twice that of heterosexually oriented Pedophilia.
Differential diagnosis. Isolated sexual acts with children do not warrant the diagnosis of Pedophilia. Such acts may be precipitated by marital discord,
recent loss, or intense loneliness. In such instances the desire for sex with a child may be understood as a substitute for a preferred but unavailable adult.
In Mental Retardation, Organic Personality Syndrome, Alcohol Intoxication, or
Schizophrenia there may be a decrease in impulse control, particularly in the
elderly, that in rare instances leads to isolated sexual acts with children. However, sexual activity with children is generally not the consistently preferred method for achieving sexual excitement.
In Exhibitionism exposure may be to a child, but the act is not a prelude to further sexual activity with the child.
Sexual Sadism may, in extremely rare instances, be associated with Pedophilia, in which case both diagnoses are warranted.
Diagnostic criteria for Pedophilia
A, The act or fantasy of engaging in sexual activity with prepuhertal children is a repeatedly preferred or exclusive method of achieving sexual excitement,
B. If the individual is an adult, the prepubertal children are at least ten
years younger than the individual. If the individual is a late adolescent,
no precise age difference is required, and clinical judgment must take
into account the age difference as well as the sexual maturity of the child.