Pedophilia is viewed as among the most horrifying social ills. But scientists who study the sexual disorder say it is also among the most misunderstood. 
When most of the public thinks of pedophilia, they assume it’s synonymous with child sexual abuse, a pervasive social problem that has exploded to crisis levels online. Researchers who study pedophilia say the term describes an attraction, not an action, and using it interchangeably with “abuse” fuels misperceptions.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders said pedophilia is defined by “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children.“ Scientists have in recent decades improved their understanding of pedophilia’s causes, prenatal and early childhood risk factors as well as how pedophiles can better control impulses. 
One of the most significant findings is that scientists who study the disorder say pedophilia is determined in the womb, though environmental factors may influence whether someone acts on an urge to abuse.
“The evidence suggests it is inborn. It’s neurological,” said James Cantor, a clinical psychologist, sex researcher and former editor-in-chief of, “Sexual Abuse: A Journal of Research and Treatment.” “Pedophilia is the attraction to children, regardless of whether the (person) ever … harms.”
Not all people who sexually abuse children are pedophiles. Some pedophiles never abuse children, experts say, and some people who sexually abuse children do not sexually prefer them, but use them as a surrogate for an adult partner. They may be disinhibited and anti-social, with impulse control problems.
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“There are child molesters and pedophiles. If you think of Venn diagrams, there’s a lot of overlap,” said Anna Salter, a psychologist, author, and internationally recognized expert who has done over 500 evaluations of high-risk sex offenders. “There are the people who are sexually attracted to children … (and then) there are some people who molest kids who are not pedophiles. They molest kids because of anger. They molest kids because they’re scared of adult women. They molest kids to get revenge, but they don’t actually have an age preference for prepubescent children.”
Michael Seto, forensic research director at the Royal Ottawa Health Care Group in Canada, said there is more neuroscientific knowledge of pedophilia than ever before. MRI research is showing how sexual interests develop in the brain.
“I think as a field, we’ve accepted the idea that this is not something that people choose,” Seto said.
Seto said pedophilia is something people are born with or at least have a predisposition to. Evidence shows men are more likely to have pedophilia than women. This aligns with research showing men are more likely to have other paraphilias, including exhibitionism, voyeurism and sadism. Men are also more likely than women to commit criminal acts.
Research also offers insights into risk factors. Seto said men with pedophilia have a much higher incidence of early childhood head injury. One study on diagnosed pedophiles showed they are more likely to report their mothers had received psychiatric treatment, which suggests the disorder may be influenced by genetic factors.
Salter said when she conducts trainings, she often asked the audience, “How many of you have ever had an inappropriate sexual thought?”
If no one raises their hand, she tells them they’re in denial. 
“Of course, people have had inappropriate sexual thoughts. You may be attracted to your wife’s sister. You may be attracted to a 16-year-old postpubescent babysitter. It doesn’t mean you act on it,” she said. “Pedophiles may not have control over the fact that they are attracted to kids, but they are responsible for whether they do or don’t act on it.”
Salter’s conceptualization of the dynamics of sexual abuse involves a motor and brakes. Many people experience inappropriate sexual thoughts (the motor) but there are brakes (empathy, for example) that keep someone from acting on them. For a pedophile, the motor is their sexual attraction to children, but they can still use brakes to stop from abusing. 
Salter said more research is needed to understand why some pedophiles do not act on their attractions, but her clinical observations suggest at least some pedophiles with bad brakes are raised in homes where they were mistreated or neglected. There is also a genetic component, as some pedophiles show psychopathic traits. 
An academic at Old Dominion University in Norfolk, Virginia, who talked about “destigmatizing pedophilia” and referred to pedophiles as “minor-attracted people” resigned in November following outcry over the phrase. Allyn Walker argued destigmatizing the attraction would allow more people to seek help and ultimately prevent child sexual abuse. 
There is growing support in the field for Walker’s point of view. While Cantor said there’s no treatment that can turn a pedophile into a non-pedophile, pedophiles can be taught self-control and compensatory strategies, which he said is more likely if they’re under the care of a professional. He argues that pedophiles need to be able to access therapy, which can be difficult since those afflicted may be ashamed to seek help or worried about being reported to the authorities if they do.    
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“Where do you want the person? Therapy is where he should be going, and all we’ve done is make it very, very difficult for a pedophile to get that,” Cantor said. “Which to me is insane. It makes the problem worse.”
Salter said while pedophiles do not choose their attractions, she does not believe those who offend are being punished unfairly. Treatment should be encouraged, but without minimizing the impact abuse has on victims’ lives. 
“It’s a choice to act on child molestation,” she said. “We don’t need to say, ‘Offending isn’t so bad. It really isn’t your fault. … You really couldn’t control it. You are a victim of a punitive society.’ We need to say, ‘Offending is devastating. It damages the lives of victims. It has damaged your life. You can learn to control yourself. You have the capacity to do better.'”

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