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The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12-14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11-14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.
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ORIGINAL PAPER
Pedophilia, Hebephilia, and the DSM-V
Ray Blanchard ÆAmy D. Lykins ÆDiane Wherrett ÆMichael E. Kuban Æ
James M. Cantor ÆThomas Blak ÆRobert Dickey ÆPhilip E. Klassen
Received: 8 April 2008 / Revised: 17 June 2008 / Accepted: 17 June 2008 / Published online: 7 August 2008
Springer Science+Business Media, LLC 2008
Abstract The term pedophilia denotes the erotic preference
for prepubescent children. The term hebephilia has been
proposed to denote the erotic preference for pubescent chil-
dren (roughly, ages 11 or 12–14), but it has not become widely
used. The present study sought to validate the concept of
hebephilia by examining the agreement between self-reported
sexual interests and objectively recorded penile responses in
the laboratory. The participants were 881 men who were
referred for clinical assessment because of paraphilic, crimi-
nal, or otherwise problematic sexual behavior. Within-group
comparisons showed that men who verbally reported maxi-
mum sexual attraction to pubescent children had greater
penile responses to depictions of pubescent children than to
depictions of younger or older persons. Between-groups com-
parisons showed that penile responding distinguished such
men from those who reported maximum attraction to pre-
pubescent children and from those who reported maximum
attraction to fully grown persons. These results indicated that
hebephiliaexists as a discriminable erotic age-preference. The
authors recommend various ways in which the DSM might be
altered to accommodate the present findings. One possibility
would be to replace the diagnosis of Pedophilia with Pedo-
hebephilia and allow the clinician to specify one of three
subtypes: Sexually Attracted to Children Younger than 11
(Pedophilic Type), Sexually Attracted to Children Age 11–14
(Hebephilic Type), or Sexually Attracted to Both (Pedohebe-
philic Type). We further recommend that the DSM-V encour-
age users to record the typical age of children who mostattract
the patient sexually as well as the gender of children who most
attract the patient sexually.
Keywords DSM-V Ephebophilia Hebephilia
Paraphilia Pedophilia Penile plethysmography
Phallometry Sexual offending Sexual orientation
Teleiophilia
Introduction
The DSM-IV-TR (American Psychiatric Association, 2000)
defines pedophilia as the erotic preference for prepubescent
children. A substantial body of evidence indicates that this
definition, if taken literally, would exclude from diagnosis a
sizable proportion of those men whose strongest sexual feel-
ings are for physically immature persons. Before we present
this evidence, we will first consider the classification of chil-
dren as pubescent or prepubescent.
The average age of menarche for American Caucasian
females is 12.9 years (Herman-Giddens et al., 1997). There
are various other indicators of pubertal onset, however,
which usually appear before menarche. In females, the first
stage of pubic hair development (sparse growth along the
R. Blanchard (&)A. D. Lykins M. E. Kuban
J. M. Cantor T. Blak R. Dickey P. E. Klassen
Law and Mental Health Program, Centre for Addiction
and Mental Health, 250 College Street, Toronto,
ON, Canada M5T 1R8
e-mail: ray_blanchard@camh.net
R. Blanchard J. M. Cantor R. Dickey P. E. Klassen
Department of Psychiatry, University of Toronto,
Toronto, ON, Canada
A. D. Lykins
Department of Psychology, University of Nevada,
Las Vegas, NV, USA
D. Wherrett
Division of Endocrinology, Department of Paediatrics,
The Hospital for Sick Children, University of Toronto,
Toronto, ON, Canada
123
Arch Sex Behav (2009) 38:335–350
DOI 10.1007/s10508-008-9399-9
labia) appears at an average age of 11.0 years, and the first
stage of breast development (breast buds) at 11.2 years
(Roche, Wellens, Attie, & Siervogel, 1995). In males, the first
stage of pubic hair development (sparse growth at the base of
the penis) appears at 11.2 years, and the first pubertal changes
to the penis and testes (e.g., changes in texture and coloration
of the scrotal skin) also at 11.2 years (Roche et al., 1995). In
females, adult-pattern pubic hair (inversetriangle spreading to
the thighs) appears at 13.1–15.2 years, according to different
studies, and adult-type breasts (projection of the papillae only,
after recession of the areolae) develop at 14.0–15.6 years
(Grumbach & Styne, 1998, Table 31-2). In males, adult-pat-
tern pubic hair (inverse triangle spreading to the thighs) app-
ears at 14.3–16.1 years, and the genitalia attain adult size and
shape at 14.3–16.3 years (Grumbach & Styne, 1998, Table
31-4). The pubertal growth spurt in height begins around age
10 in females and age 12 in males; it ends around age 15
in females and age 17 in males (Grumbach & Styne, 1998,
Fig. 31-11). In summary, pubescent children are generally
those from age 11 or 12 years to about 14 or 15; prepube-
scent children are those who are younger.
The modal age of victims of sexual offenses in the United
States is14 years (Snyder, 2000, Fig. 1; Vuocolo, 1969,p.77),
therefore the modal age of victims falls within the time-frame
of puberty. In anonymous surveys of social organizations of
personswho acknowledge havingan erotic interest inchildren,
attraction to children of pubescent ages is more frequently
reported than is attraction to those of prepubescent ages (e.g.,
Bernard, 1975;Wilson&Cox,1983). In samples of sexual
offenders recruited from clinics and correctional facilities,
men whose offense histories or assessment results suggest ero-
tic interest in pubescents sometimes outnumber those whose
data suggest erotic interest in prepubescent children (e.g.,
Cantor et al., 2004; Gebhard, Gagnon, Pomeroy, & Christen-
son, 1965; Studer, Aylwin, Clelland, Reddon, & Frenzel,
2002). The foregoing findings are consistent with the results of
large-scale surveys that sampled individuals from the general
population and included questions regarding sexual experi-
ences with older persons when the respondent was underage.
These results suggest that a substantial proportion of respon-
dents who had had such experiences reported ages at occur-
rence that fall within the normal time-frame of puberty (Bo-
ney-McCoy & Finkelhor, 1995;Briere&Elliott,2003;
Finkelhor, Ormrod, Turner, & Hamby, 2005). The precise
proportion, however, cannot be calculated from the published
data.
The existence of men whose erotic interest centers on
pubescents has not, of course, been totally ignored. Glueck
(1955) coined the term hebephiles to refer to them. This term
has not come into widespread use, even among professionals
who work with sex offenders. One can only speculate why
not. It may have been confused with the term ephebophiles,
which denotes men who prefer adolescents around 15–
19 years of age (Krafft-Ebing & Moll, 1924). Few would
want to label erotic interest in late- or even mid-adolescents
as a psychopathology, so the term hebephilia may have been
ignored along with ephebophilia.
A second possible reason why the term hebephilia has not
become more common has to do with female reproductive
physiology. The temporally discrete and developmentally
unique event of menarche seems to divide females naturally
into two classes; thus, the obvious distinction among men is
between those who prefer females before their first menses
and those who prefer females who have passed this mile-
stone. Such a division is consistent with various cultural and
religious attitudes towards menarche. It would also appear
consistent with an evolutionary psychology position that the
adaptive partner-preference is for fecund females (although
females are actually subfecund for 1–2 years after menar-
che; Wood, 1994, p. 407). In any event, this distinction may
have more to do with the ideological meaning of menarche
for the labelers than with the erotic preferences of the man
being labeled. From the man’s point of view, the sexual
attractiveness of a girl one year after menarche (e.g., age 14)
may equal that of a girl one year before menarche (e.g., 12),
not that of a girl five years after menarche (e.g., 18).
A third possible reason for the disuse of hebephilia is a
general resistance or indifference to the adoption of a
technical vocabulary for erotic age-preferences. There may
be as many mental health professionals who have heard of
‘granny porn’’ as have heard of gerontophilia (the erotic
preference for the aged), although the term gerontophilia
was introduced at least 80 years ago (Hirschfeld, 1920). It is
only a few years since anyone finally proposed a term—
teleiophilia—to denote the erotic preference for persons
between the ages of physical maturity and physical decline
(Blanchard et al., 2000), even though the word normal has
been effectively off-limits for describing erotic interests for
decades.
Several studies have demonstrated the utility of specifying
a hebephilic group, at least for research purposes. These
studies have compared pedophilic, hebephilic, and teleio-
philic men on a variety of dependent measures. The results
have shown hebephiles to be intermediate between pedophiles
and teleiophiles with regard to IQ (Blanchard et al., 2007;
Cantor et al., 2004), completed education (Blanchard et al.,
2007), school grade failure and special education placement
(Cantor et al., 2006), head injuries before age 13 (Blanchard
et al., 2003), left-handedness (Blanchard et al., 2007;Cantor
et al., 2005), and stature (Cantor et al., 2007).
The finding that the groups designated ‘‘hebephiles’’ were
intermediate in IQ, handedness, and so on, is consistent with
the notion that they were also intermediate in their erotic
preference, but it does not prove it. The designated hebephilic
groups might simply have been a mixture of pedophiles and
teleiophiles; in that case, one would also expect to observe
336 Arch Sex Behav (2009) 38:335–350
123
intermediate values on all these dependent measures. What is
needed to establish hebephilia as a legitimate diagnostic entity
is convergence between two or more lines of evidence bearing
directly on a man’s sexual interest in children, pubescents, and
adults.
The present study sought to validate the concept of hebe-
philia by examining the agreement between self-reported and
psychophysiologically assessed erotic responses. Psychophy-
siological assessment consisted of phallometric testing, an
objective technique for quantifying erotic interests in human
males. In phallometric tests for genderand age preference, the
individual’s penile blood volume is monitored while he is
presented with a standardized set of laboratory stimuli depict-
ing male and female children, pubescents, and adults. In-
creases in the examinee’s penile blood volume (i.e., degrees of
penile erection) are taken as an index of his relative attraction
to different classes of persons.
Our specific research questions were straightforward: Do
men who report maximum sexual attraction topubescent child-
ren have greater penile responses, in the laboratory, to depic-
tions of pubescent children than to depictions of younger or
older persons? Can such men be distinguished from those who
report maximum attraction to prep ubescent children, on the one
hand, and from those who report maximum attraction to fully
grown persons, on the other? Positive answers to these ques-
tions would argue for the recognition of hebephilia as a clini-
cally and perhaps theoretically significant erotic preference.
They would also imply that the current DSM definition of
pedophilia is excluding from specific diagnosis a considerable
proportion of men who have a persistent preference for humans
at an incomplete stage of physical development. In contrast,
negative answers would suggest that the hebephilic groups
studied in previous investigations have merely been mixtures
of pedophiles and teleiophiles, and that this explains why the
hebephiles’ results (for IQ, handedness, and so on) were inter-
mediate between those of homogeneously classified pedo-
philes and teleiophiles. Negative results wouldmoreover indi-
cate that the DSM diagnosis of Paraphilia Not Otherwise
Specified is probably adequate for the diagnosis of many men
who do not quite satisfy the DSM criteria for Pedophilia.
The research design sketched above is simple in principle
but challenging in practice. The great majority of men with an
erotic preference for children deny this to mental health pro-
fessionals and researchers, as they do to police, lawyers, and
judges. Perhaps 40% of ‘‘nonadmitting’’ pedophiles (and he be-
philes) are able to manipulate their phallometric test outcomes
sufficiently to avoid a diagnosis of pedophilia (e.g., Blanchard,
Klassen, Dickey, Kuban, & Blak, 2001). It is likely that many
nonadmitters who fail to avoid a diagnosis of pedo- or hebe-
philia nonetheless distort their phallometric data somewhat in
the attempt. Thus, nonadmitting pedophiles (and hebephiles)
are not useful for theoretical studies like thepresent one, which
depend on high-quality phallometric data from cooperative
participants. The present study was possible because the very
large volume of assessments carried out at the authors’ clinic
enabled us to collect, over an 11-year period, a sufficient num-
ber of men who acknowledged an erotic preference for persons
at some level of physical immaturity.
Method
Participants
Between August 1995 and April 2006, 2,868 male patients
were referred to the Kurt Freund Laboratory of the Centre
for Addiction and Mental Health (Toronto, Ontario, Canada)
because of paraphilic, criminal, or otherwise problematic
sexual behavior. The purpose of these referrals was to deter-
mine what kinds of sexual partners (or sexual victims) and
what kinds of sexual activities were most arousing to these
individuals. The assessment usually included testing for ero-
tic age-preference (pedophilia, hebephilia, teleiophilia), even
when the presenting problem did not involve offenses against
children. That is because paraphilias tend to cluster, and
because men who present with no known sexual offenses or
offenses solely against adults sometimes prove to have an
erotic preference for the immature phenotype. The identical
phallometric test for erotic age-preference was administered
to 2,591 of these men; this test also assessed their erotic
gender-preference (Blanchard et al., 2001).
Excluded from eligibility for the study were 191 men
whose phallometric test results were spoiled bytechnical pro-
blems or whose responses were too low (see later), 58 men
whose sexual history information was incomplete or had not
yet been computerized at the time of the data retrieval, and 38
men who did not give consent for their clinical assessment
data to be used for research purposes. The initial pool of poten-
tial patient participants therefore included 2,304 men, with a
mean age of 37.75 years (SD =13.24 years), and a median
education level of Grade 12.
The sources of the referrals included parole and probation
officers, prisons, defense lawyers, various institutions (rang-
ing from group homes for mentally retarded persons to reg-
ulatory bodies for health or educational professionals), and
physicians in private practice. As would be expected from the
preponderance of criminal justice sources, the majority of
patients had one or more sexual offenses. The phrase sexual
offenses, in this article, includes charges, convictions, credible
accusations, and self-disclosures of criminal sexual behavior.
Credible accusations were defined by default, that is, all
accusations excepting those that were made by an individual
who stood to gain in some way from criminal charges against
the accused,that had no corroborating evidence, and that were
not voiced at the time the alleged offense or offenses occurred.
Only a small proportion of accusations were not considered
Arch Sex Behav (2009) 38:335–350 337
123
credible; typical examples were allegations, not followed by
criminal charges, from estranged spouses in child custody-
and-access disputes.
The patient pool comprised approximately 10% men with
no known sexual offenses; 10% with offenses involving the
possession, distribution, or manufacture of child pornography;
18% with offenses against children age 5 or younger; 39%
with offenses against children age 6–10; 12% with offenses
against children age 11; 32% with offensesagainst pubescents
age 12–14; 15% with offenses against teenagers age 15–16;
and 27% with offenses against adults age 17 or older. These
percentages add up to more than 100%, because many patients
had offensesin more than one category. Offenses against adult
victims included some that involved physical contact (e.g.,
rape, frotteurism) and others that did not (e.g., exhibitionism,
voyeurism, obscene telephone calling). Men who had no
involvement with the criminal justice system and who initi-
ated referrals through their physicians included patients who
were unsure about their sexual orientation, patients concerned
about hypersexuality or ‘‘sex addiction,’’ patients experienc-
ing difficulties because of their excessive use of telephone sex
lines or massage parlors, clinically obsessional patients with
intrusive thoughts about unacceptable sexual behavior, and
patients with paraphilic behaviors like masochism, fetishism,
and transvestism.
Added to the initial pool of 2,304 patients were 51 men
with criminal offenses of a nonsexual nature, who were not
patients but paid research volunteers (Cantor et al., 2008).
They were included because they had all the same data as the
patients; because there was no reason to exclude them, given
the goals of the study; and because some of them reported
pedophilia or homosexuality, although they had not been
recruited on that basis. Thus, the total number of potential
participants was 2,355.
Materials and Measures
Sexual History
A standardized form, which has been employed in the Kurt
Freund Laboratory since 1995, was used to record thepatient’s
history of sexual offenses. Most of that information came
from objective documents that accompanied his referral, for
example, reports from probation and parole officers. The off-
ense-history data were cross-checked against, and supple-
mented by, information provided by the patient himself. This
included the number and nature of any additional sexual
offenses thatwere admitted by the patient but forwhich he was
never charged. The patient’s information was solicited by the
laboratory manager in a structured interview, which was con-
ducted, in the great majority of instances, immediately before
phallometric testing.
The patient’s sexual history was quantified and recorded
using a large number of predetermined categories, some per-
taining to the gender and ages of his sexual victims (if any) and
others pertaining to the nature of his criminal or other sexual
activities (e.g., indecent exposure, rape, consenting inter-
course). Of present relevance were the patient’s numbers of
female victims in six age-ranges—5 and younger, 6–10, 11,
12–14, 15–16, and 17 or older—and his numbers of male
victims in the samesix age-ranges. The numbersof female and
male victims 11 years of age were recorded as separate vari-
ables because it was unclear at the time that the structured
interview and its companion database were designed whether
children of this age should be classed with younger children
as prepubescent or with older children as pubescent. Also
recorded as separate variables were the patient’s criminal
charges and self-admissions regarding the use, manufacture,
or distribution of child pornography.
Self-Report of Erotic Preferences
The interviewer recorded the patient’s self-reported sex-
ual interest in other persons, using 12 separate variables: the
patient’s degree of sexual interest in females age 5 or younger,
6–10, 11, 12–14, 15–16, and 17 or older, and in males in the
same six age-ranges. In some cases, this required a great deal
of exploration: ‘‘Are you more attracted to adults or to chil-
dren?’’ ‘‘Are you more attracted to boys or to girls?’’ ‘‘Are you
more attracted to girls before they commence puberty or after
they have entered puberty?’ ‘‘Do you find 11-year-old girls
more attractive than 14-year-old girls, less attractive, or
equally attractive?’’ ‘‘Do you feel any interest at all in 11-year-
old boys?’’ In many instances, however, the process was rel-
atively brief and straightforward, because the patient stated
that his primary sexual interest was in females age 17 or older,
sometimes with a lesser degree of attraction to females age
15–16, and thathe had no attraction to females under the age of
15 or to males of any age.
The interviewer quantified the patient’s self-reported
sexual interest in each of the 12 gender-age categories, using
a rating from 1 to 5. A rating of 5 indicated that persons of a
given gender and age (e.g., males age 15–16 years) stimu-
lated as much sexual interest as the participant was capable
of feeling (toward another person). A rating of 1 indicated
that the participant felt no sexual attraction for persons of
that age and gender. If the patient was willing and able to
discriminate multiple levels of sexual attraction, ratings of
2, 3, and 4 were used to record middling levels of erotic
interest. Any given rating-number could be used for more
than one gender-age category. A patient who reported an
erotic preference for pubescent males, for example, might
get ratings of 5 for 11-year-old boys and for 12–14 year-old
boys and ratings of 4 for 6–10 year-old boys and for 15–
16 year-old boys. This complicated method of assessing
338 Arch Sex Behav (2009) 38:335–350
123
erotic age-preference was used because its original purpose
in the structured interview was not to pinpoint the age or
physical maturation of persons for whom the participant
reported the strongest attraction, but rather to assess whe-
ther—or to what extent—he admitted an erotic interest in
persons of the same chronological age and gender as his
known sexual victims.
Phallometric Apparatus
All participants in this study underwent the standard testing
procedures of the Kurt Freund Laboratory. The Laboratory is
equipped for volumetric plethysmography, that is, the appa-
ratus measures penile blood volume change rather than pen-
ile circumference change. The volumetric method measures
penile tumescence more accurately at low levels of response
(Kuban, Barbaree, & Blanchard, 1999). A photograph and sch-
ematic drawing of the volumetric apparatus are given in Fre-
und, Sedlacek, and Knob (1965). The major components in-
clude a glass cylinder that fits over the penis and an inflatable
cuff that surrounds the base of the penis and isolates the air
inside the cylinder from the outside atmosphere. A rubber tube
attached to the cylinder leads to a pressure transducer, which
converts air pressure changes into voltage output changes.
Increases in penile volume compress the air inside the cylinder
and thus produce an output signal from the transducer. The
apparatus is calibrated so that known quantities of volume
displacement in the cylinder correspond to known changes in
transducer voltage output. The apparatus is very sensitive and
can reliably detect changes in penile blood volume below the
threshold of subjective awareness.
Phallometric Procedure
The participant placed the glass cylinder over his penis, acc-
ording to instructions from the test administrator. He then sat
in a reclining chair, which faced three adjacent projection
screens, and put on a set of headphones. After the set-up was
complete, the participant’s lower body was covered with a
sheet to minimize his embarrassment or discomfort. During
the test, the participant’s face was monitored with a low-light
video camera, in order to monitor stimulus avoidance strate-
gies such as closing the eyes or averting them from the test
stimuli.
The phallometric test used in this study has been described in
detail elsewhere (Blanchard et al., 2001,2007). The stimuli
were audiotaped narratives presented through the headphones
and accompanied by slides shown on the projection screens.
There were seven categories of narratives, which described
sexual interactions with prepubescent girls, pubescent girls,
adult women, prepubescent boys, pubescent boys, and adult
men, and also solitary, nonsexual activities (‘‘neutral’’ stimuli).
All narratives were written in the second person and present
tense and were approximately 100 words long. The scripts of
sample narratives have been reproduced in previous articles
(Blanchard et al., 2001,2007). The narratives describing het-
erosexual interactions were recorded with a woman’s voice,
and those describing homosexual interactions, with a man’s.
Neutral stimuli were recorded with both.
Each test trial consisted of one narrative, accompanied by
photographic slides on the three adjacent screens, which sim-
ultaneously showed the front view, rear view, and genital
region of a nude model who corresponded in age and gender to
the topic of the narrative. In other words, a narrative describing
sex with an adult man would be accompanied by multiple
images of nude adult men. A photograph that illustrates how
the modelswere posed for the full frontal view maybe found in
Blanchard et al. (2007). The neutral narratives (e.g., ‘‘You
climb down into the small rowboat, untie it, and pushoff from
thedockwithanoar’’) were accompanied by slides of
landscapes.
Each trial included three different models, each presented
for 18 s. Therefore the total durationof a trial was 54 s, during
which the participant viewed a total of nine slides, three at a
time. For example, in a stimulus trial depicting physically
mature females, the participant would hear one narrative
describing sex with an adult woman, while he viewed pho-
tographs of woman A from three angles, followed by woman
B from three angles, followed by woman C from three angles.
The full test consisted of four blocks of seven trials, with
each block including one trial of each type in fixed, pseu-
dorandom order. Although the length of the trials was fixed,
the interval between trials varied, because penile blood
volume was required to return to its baseline (flaccid) value
before a new trial was started. The time required to complete
a test was usually about 1 h.
Phallometric Stimuli
The narratives depicting sexual interaction with prepubescent
children and pubescent children explicitly stated the age of the
fictional child at the beginning of the script, for example,
‘You are babysitting a five-year-old girl for the evening. She
is taking a bath before she gets ready for bed. Through the
open bathroom door, she calls you to come in and scrub her
back’ In the narratives about prepubescent children, the
ages of the fictional children were variously stated as 5–
9 years. In the narratives about pubescent children, the ages
were given as 11–13 years. The narratives describing inter-
action with adult men and women did not state the age of the
fictional sexual partner, although they were clearly portrayed
as adults. There was no relation between the various activities
described in the narratives and the uniform, static poses of the
simultaneously presented models.
The original set of photographic models on which the
present test was based comprised prepubescent girls age 5–
Arch Sex Behav (2009) 38:335–350 339
123
11, pubescent girls 12–14, adult women 22–26, prepube-
scent boys 5–11, pubescent boys 12–14, and adult men 19–
25 (Freund, Langevin, Cibiri, & Zajac, 1973; Freund, Mc-
Knight, Langevin, & Cibiri, 1972). There have been some
additions or substitutions of models in the intervening years,
primarily involving the adults. The new models extended
the ages of the prepubescent girls to 3–11 years, the ages of
the adult women to 20–35 years, and the ages of the adult
men to 19–41 years.
Because of the central importance of the pubescent stimuli
in this study, the physical maturity ofthe photographic models
was rated by one of the authors (D.W.), a pediatric endocri-
nologist, and the results are presented below. The rating
system used the stages of sexual development originally
identified by Tanner (1978). Tanner stages pertain to breast
development and pubic hair growth in females, and to genital
development and pubic hair growth in males. Tanner stages
are rated from1 (prepubertal) to 5 (fullymature), according to
established criteria. Breast development and pubic hair
growth are not always perfectly correlated in females, and
genital development and pubic hair growth are not always
perfectly correlated in males; therefore Tanner stages are rated
separately for each feature.
According to Marshall and Tanner (1969), the criteria for
female breast development are as follows: stage 1—pre-
pubescent, projection of the papilla only; stage 2—breast bud
stage, elevation of breast, papilla as a small mound, enlarge-
ment of areolar diameter; stage 3—further enlargement of
breast and areola with no separation of their contours; stage
4—projection of areola and papilla to form a secondary
mound above the level of the breast; and stage 5—mature
stage, projection of papilla only, areola recessed to the general
contour of the breast. The genital development stages for
males (Marshall & Tanner, 1970) are as follows: stage 1—
prepubescent, genitals are about the same size and propor-
tion as in early childhood; stage 2—scrotum and testes have
enlarged, scrotal skin shows a change in color and tex-
ture; stage 3—growth of the penis in length and girth, fur-
ther growth of testes and scrotum; stage 4—penis is further
enlarged, development ofthe glans; and stage 5—genitalia are
adult in size and shape. With regard to both female and male
pubic hair growth, the Tanner stages are as follows: stage 1—
prepubescent, no pubic hair; stage 2—sparse growth of long,
slightly pigmented downy hair, appearing mainly along the
labia or base of the penis; stage 3—hair is darker and coarser,
spreads over the junction of the pubes; stage 4—hair is adult in
type, but area covered still significantly less than in a mature
adult; and stage 5—hair is adult in type and quantity and
distributed in an inverse triangle.
With only a few exceptions (one boy used as a pre-
pubescent stimulus had Tanner stage 2 genitals and another
had Tanner stage 2 pubic hair), all the prepubescent children
were rated as Tanner stage 1’s, and all the adults were rated as
Tanner stage 5’s, for all body regions. The mean Tanner stage
for the breasts of the pubescent girls was 2.67 (SD =1.03,
range, 2–4), and the mean Tanner stage for their pubic hair
growth was 2.33 (SD =0.82, range, 1–3). The corresponding
Tanner stages for the pubescent boys were as follows: genital
development, mean of 3.83 (SD =0.75, range, 3–5), and
pubic hair growth, mean of 3.33 (SD =0.82, range, 2–4).
Another of the co-authors (A.D.L.), who trained herself on
Tanner ratings for this subproject, also rated the Tanner stages
for the pubescent females and males; inter-rater reliabilitywas
r=.87 for female breast development, r=.93 for female
pubic hair growth, r=.87 for male genital development, and
r=.83 for male pubic hair growth (all were significant at
p\.05).
Phallometric Response Processing
Penile blood volume change was sampled four times per sec-
ond. The participant’s response was quantified in two ways: as
the extremum of the curve of blood volume change (i.e., the
greatest departure from initial value occurring during the 54 s
of the trial) and as the area under the curve. To identify par-
ticipants whose penile blood volume changes during the test
trials remained within the range typical of random blood vol-
ume fluctuations in nonaroused men, the mean of the three
highest positive extremum scores—a quantity called the Out-
put Index (Freund, 1967)—was calculated. The phallometric
data of participants who failed to meet the criterion output
index of 1.0 cc were excluded. As measured by the Labora-
tory’s equipment, full erection for the average man corres-
ponds to a blood volume increase of 20–30 cc.
Each participant’s 28 extremumscores were then converted
into standard scores, based only on his own extremum data,
and the same operation was carried out on his area scores.
Next, for eachparticipant, the standardized extremum and area
scores were combined to yield a separate composite score for
each of the 28 trials, using the formula: ZE
iþZA
i

2, where
ZE
iis the standardized extremum score for the ith trial, and ZA
i
is the standardized area score for the ith trial. These operations
were carried out for the following reasons: (a) In phallometric
work, some transformation of raw scores is generally required
in combining data from different participants, because the
interindividual variability in absolute magnitude of blood
volume changes can otherwise obscure even quite reliable
statistical effects. There are numerous sources of such vari-
ability, for example, the participant’s age, his state of health,
the size of his penis, and the amount of time since his last
ejaculation from masturbation or interpersonalsexual activity.
Empirical research has shown theZ-score transformation to be
optimal (Earls, Quinsey, & Castonguay, 1987; Harris, Rice,
Quinsey, Chaplin, & Earls, 1992; Langevin, 1985). (b) The
(highly correlated)area and extremum Z-scores were averaged
to obtain a composite that reflected both the speed and
340 Arch Sex Behav (2009) 38:335–350
123
amplitude of response and lessened the impact of anomalous
responses,that is, large changefrom initial valuebut small area
or vice versa (Freund, Scher, & Hucker, 1983).
In the last stage of basic processing, the data were reduced
to seven final scores for each participant by averaging his four
composite scores in each of the seven stimulus categories.
These seven category scores were taken as measures of the
participant’s relativeerotic interest in adult women, pubescent
girls, prepubescent girls, and so on.
Results
The first task of data analysis was assigning participants to
discrete groups according to the ages of their most desired
partners. No single item in our recorded data contained the
participant’s response to the simple question, ‘‘What is the
typical age of persons who most attract you sexually?’’ It
was, furthermore, impossible simply to classify participants
according to the gender-age category to which they gave
the maximum attractiveness rating, because participants
could—and sometimes did—report the maximum rating for
more than one category. We therefore attempted to classify
participants into non-overlapping age-preference groups
according to some parameter of their overall attractiveness
ratings profile. We investigated two different parameters for
this purpose. The first parameter was the oldest age category
whose attractiveness rating was greater than or equal to the
mean rating of all younger categories. The second parameter
was the youngest age category whose attractiveness rating
was greater than or equal to the mean rating of all older
categories. Use of the second parameter resulted in a better
distribution of cases across the younger age-preference
groups, and it was chosen on that basis. The complete algo-
rithm for converting our attractiveness ratings into age-
preference groups worked as follows.
If the mean of the participant’s attractiveness ratings for
all six categories of females (ages 5 and younger, 6–10, 11,
12–14, 15–16, and 17 or older) was greater than his mean for
all six categories of males, then the participant was desig-
nated as heterosexual. If the mean of his attractiveness
ratings for all categories of males was greater than his mean
for all categories of females, then he was designated as
homosexual. The 34 participants with exactly equal means
(i.e., bisexuals) were excluded from further processing.
Heterosexual participants were then classified into six
age-preference groups according to the following series of
tests performed in the following order.
1. If the participant’s attractiveness rating for females age
0–5 was greater than or equal to his mean attractiveness
rating for the five older age categories, then he was
classified as a Pedophile 1.
2. If the participant’s rating for females age 6–10 was
greater than or equal to his mean rating for the four older
age categories, then he was classified as a Pedophile 2.
3. If the participant’s rating for females age 11 was greater
than or equal to his mean rating for the three older age
categories, then he was classified as a Hebephile 1.
4. If the participant’s rating for females age 12–14 was
greater than or equal to his mean rating for the two older
age categories, then he was classified as a Hebephile 2.
5. If the participant’s rating for females age 15–16 was
greater than or equal to his rating for females age 17 or
older, then he was classified as an Ephebophile.
6. If the participant, having passed through all the
foregoing tests, had no known sexual offenses against
persons under the age of 15 and no child pornography
offenses, then he was classified as a Teleiophile.
Homosexual participants went through a parallel series of
tests, based on their attractiveness ratings for the six age-
categories of males and on their known sexual offenses, and
they were assigned to the corresponding six age-preference
groups.
Figures 1and 2show the empirical relations between the
computed age-preference groups and the attractiveness rat-
ings on which they were based. Figure 1shows the data for the
heterosexual groups, and Fig. 2, for the homosexual groups.
These data demonstrate that the classification algorithm wor-
ked as we had hoped and provide the empiricaljustification for
the group-labels, Pedophile 1, Pedophile 2, and so on.
Most of the individual participants had attractiveness rat-
ings profiles that resembled the mean profile of the age-
preference group to which they had been assigned. Thus, for
example, 90% of heterosexual Hebephile 1 group gave the
maximum attractiveness rating of ‘‘5’’ to females age 11 or
12–14 (or both), and 93% of the heterosexual Hebephile 2
group gave the maximum attractiveness rating to females age
12–14 or 15–16 (or both). In the homosexual Hebephile 1
group, 80% gave the maximum attractiveness rating to males
age 11 or 12–14;in the homosexual Hebephile2 group, 100%
gave the maximum attractiveness rating to males age 12–14 or
15–16. Because the ratings profiles were necessarilyrelated to
the age-preference groups via the computational algorithm,
we did not perform any statistical comparisons of them.
The offenders against persons under age 15 and child por-
nography offenders were excluded from the teleiophilic groups
(algorithm step #6) because men who claim a preference for
adults but have committed offenses against children are often
truly pedophilic or hebephilic (e.g., Blanchard et al., 2001,
2006; Freund & Blanchard, 1989; Seto, Cantor, & Blanchard,
2006). Thus, these participants were excluded on the grounds
that their phallometric responses would be relatively likely to
reflect deliberate attempts to manipulate the test outcome. The
data of many of these excluded ‘‘nonadmitters’’ have been
Arch Sex Behav (2009) 38:335–350 341
123
analyzed in previous studies (Blanchard et al., 2001,2006).
The offense-history criterion excluded 1,387 participants from
the heterosexual teleiophilic group and 53 from the homo-
sexual teleiophilic group.
The number of participants in each age-preference group
and their mean ages at testing are presented in Table 1. One-
way analyses of variance revealed no significant differences
in age among the heterosexual groups, F(5, 739) =2.15,
n.s., or among the homosexual groups, F(5, 130) \1.
Table 1also shows the median ages of the victims of the
participants’ sexual offenses. The median victim age was
determined, for each group, by summing their total number of
victims in all age-ranges and then determining the age-range
in which the median fell. Thus, for example, the heterosexual
Pedophile 1 group had 109 (female) victims:16 victims age 5
or younger, 52 victims age 6–10, 12 victims age 11, 12 victims
age 12–14, 11 victims age 15–16, and 6 victims age 17 or
older. The median age is the age of the 55th oldest victim, and
the 55th oldest victim fell in the 6–10 age-range.
There was one restriction on computing the median vic-
tim age. In order to prevent the few participants with very
large numbers of victims (usually exhibitionists) from dis-
torting the results, the participant’s number of victims in any
given gender-age category was artificially capped at 10.
Within-Groups Comparisons
The dependent measures of primary interest in this study were
the participants’ penile responses in the laboratory to stimulus
depictions of prepubescent children, pubescent children, and
adults. Figure 3shows, for each heterosexual age-preference
group,that group’s mean penile response to prepubescent girls,
its mean response to pubescent girls, and its mean response to
adult women. Thus, for example, the topmost panel of Fig. 3
shows that the heterosexual Pedophile 1 group responded most
to prepubescent girls, less to pubescent girls, and least to adult
women. The next panel down shows that the heterosexual
Pedophile 2 group responded slightly more to pubescent than
to prepubescent girls but still least to adult women. Figure 4
shows the analogous data for the homosexual age-preference
groups.
Our phallometric test did not include stimuli depicting
persons in mid-adolescence or late adolescence. Thus, there
MEAN ATTRACTIVENESS RATING
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
HETEROSEXUAL AGE-PREFERENCE GROUPS
Pedo 1 Pedo 2 Hebe 1 Hebe 2 Ephebo Teleio
FEMALE AGE-RANGES CANVASSED
17+15-1612-14116-100-5
Fig. 1 Attractiveness ratings
for females of various ages, for
the heterosexual age-preference
groups. The age-preference
abbreviations are interpreted as
follows: Pedo, pedophile; Hebe,
hebephile; Ephebo, ephebophile;
Teleio, teleiophile. The anchor-
points for the attractiveness
ratings are as follows: 1, females
of the canvassed age stimulate
no sexual interest; 5, females of
that age stimulate as much
sexual interest as the participant
is capable of feeling
342 Arch Sex Behav (2009) 38:335–350
123
was no optimal stimulus-category for the self-reported eph-
ebophiles to respond to. One might therefore expect that the
ephebophiles would respond about equally to pubescents and
adults. These are the two age-categories adjacent to adoles-
cence; the missing peak phallometric response between res-
ponses to pubescents and responses to adults would corre-
spond to the missing adolescent stimuli. The data did, in fact,
show precisely this pattern for the heterosexual ephebophiles
(Fig. 3) but not for the homosexual ephebophiles (Fig. 4). The
phallometric profile of the homosexual ephebophiles corre-
sponded to the expected pattern for hebephiles, not to our
hypothesized pattern for ephebophiles. In fact, the phallo-
metric profiles of the homosexual participants seemed gen-
erally to be shifted one category compared with the hetero-
MEAN ATTRACTIVENESS RATING
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
HOMOSEXUAL AGE-PREFERENCE GROUPS
Pedo 1 Pedo 2 Hebe 1 Hebe 2 Ephebo Teleio
MALE AGE-RANGES CANVASSED
17+15-1612-14116-100-5
Fig. 2 Attractiveness ratings
for males of various ages, for the
homosexual age-preference
groups. The age-preference
abbreviations are interpreted as
follows: Pedo, pedophile; Hebe,
hebephile; Ephebo, ephebophile;
Teleio, teleiophile. The anchor-
points for the attractiveness
ratings are as follows: 1, males
of the canvassed age stimulate
no sexual interest; 5, males of
that age stimulate as much
sexual interest as the participant
is capable of feeling
Table 1 Group size, mean age at testing, and median ages of the victims of the participants’ sexual offenses
Gender-preference Age-preference
Pedo 1 Pedo 2 Hebe 1 Hebe 2 Ephebo Teleio
Heterosexual
Group size 21 46 30 46 50 552
Age 33.14 (13.02) 30.48 (10.52) 35.30 (12.27) 34.96 (13.67) 33.68 (13.78) 35.85 (11.30)
Median victim age 6–10 11 12–14 12–14 12–14 C17
Homosexual
Group size 15 17 10 18 18 58
Age 36.00 (12.94) 40.41 (15.24) 40.30 (10.56) 39.00 (15.80) 35.39 (11.85) 39.12 (11.50)
Median victim age 6–10 11 12–14 12–14 15–16 C17
Arch Sex Behav (2009) 38:335–350 343
123
sexual participants. Thus, the profile of the homosexual Ephe-
bophile group resembled that of the heterosexual Hebe-
phile 2 group; the homosexual Hebephile 2 group resem-
bled the heterosexual Hebephile 1 group; the homosexual
Hebephile 1 group resembled the heterosexual Pedophile 2
group; and both homosexual pedophilic groups were shifted
toward response to younger persons compared with the het-
erosexual Pedophile 1 group. It is unclear whether this result
reflects a fact of nature, some specific properties of our phal-
lometric stimuli, some specific properties of our sample, or
simply the much smaller size of the homosexual group. In any
event, the phallometric profiles of the homosexual and het-
erosexual teleiophiles were very similar, so the results did not
reveal a uniform tendency for homosexual participants to
respond in the laboratory to younger persons than they indi-
cate in interview.
Statistical analyses were conducted on the data shown in
Figs. 3and 4to ascertain whether the pedophiles responded
significantly more to prepubescent children than they did to
older persons, whether the teleiophiles responded signifi-
cantly more to adults than to younger persons and—most
critically—whether the hebephiles responded significantly
more to pubescent children than they did to both older and
younger persons. These analyses used paired t-tests. For each
age-preference group, three such t-tests were performed: res-
ponse to pubescent children vs. response to prepubescent
children,response to pubescent children vs. response to adults,
and response to prepubescent children vs. response to adults.
The results for the heterosexual participants are presented
in Table 2. Although the reader can determine from the signs
of the reported t-statistics which of two compared means had
the higher value, the table is most readily interpreted in con-
junction with Fig. 3. In what follows, we comment only on the
key findings in Table 2.
The Pedophile 1 group did respond more to prepubescent
girls than to pubescent girls, but the Pedophile 2 group res-
ponded more strongly to pubescent girls. Both hebephilic
groups showed exactly the pattern we expected. They res-
ponded significantly more to pubescent girls than to pre-
pubescent girls or to adult women. The Ephebophiles, as pre-
viously noted, responded about equally to pubescent girls
and adult women. They responded least to prepubescent girls.
MEAN IPSATIZED PENILE RESPONSE
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
HETEROSEXUAL AGE-PREFERENCE GROUPS
Pedo 1 Pedo 2 Hebe 1 Hebe 2 Ephebo Teleio
FEMALE PHALLOMETRIC STIMULUS-CATEGORIES
Adult WomenPubescent GirlsPrepubescent Girls
Fig. 3 Mean penile response of
the six heterosexual age-
preference groups to laboratory
stimuli depicting prepubescent,
pubescent, and physically
mature females. The means for
the prepubescent, pubescent, and
physically mature males are not
shown
344 Arch Sex Behav (2009) 38:335–350
123
The Teleiophiles responded more to adult women than to
pubescent girls, and more to pubescent girls than to pre-
pubescent girls.
The findings for the homosexual participants are given in
Table 3, which can be interpreted with the aid of Fig. 4.Both
pedophilic groups responded more to prepubescent boys than
to pubescent boys. Neither hebephilic group showed exactly
the pattern we expected, in that neither group responded sig-
nificantly more to pubescent boys than to prepubescent boys.
This might have to do with small sample sizes and low sta-
tistical power, especially in the case of the Hebephile 2 group,
which did show a trend in the expected direction. The Eph-
ebophile group, as previously mentioned, showed the pattern
we expected for the hebephilic groups. They responded sig-
nificantly more to pubescent boys than to prepubescentboys or
adult men. The results for the homosexual Teleiophiles resem-
bled those of their heterosexual counterparts: They responded
more to adult men than to pubescent boys, and more to pube-
scent boys than to prepubescent boys.
In order to ensure that the key findings above were not an
artifact of our method for assigning cases to age-preference
groups, we confirmed these findings using a much simpler
method. We selected all heterosexual participants who gave the
maximumattractiveness rating of ‘‘5’’ to girls age 11 or to girls
age 12–14 (or to girls in both age categories). We ignored the
participants’ algorithmically computed age-preference group
assignment, and we ignored their attractiveness ratings for all
other age categories. This selection criterion identified 115
participants. We used paired t-tests to compare their penile
responses to pubescent girls vs. prepubescent girls, and to
pubescent girls vs. adult women. The participants responded
significantly more to pubescent girls than to prepubescent girls,
t(114) =5.26, p\.0001, and they responded significantly
more to pubescent girls than to adult women, t(114) =12.23,
p\.0001. We similarly selected 49 homosexual men who
gave the maximum attractiveness rating of ‘‘5’’ to boys age 11
or 12–14. These men did not respond significantly more to
pubescent boys than to prepubescent boys, t(48) \1, but they
did respond significantly more to pubescent boys than to adult
men, t(48) =8.89, p\.0001. In summary, the alternative
method of identifying hebephilic men led to the same conclu-
sions as the data presented in Tables 2and 3.
MEAN IPSATIZED PENILE RESPONSE
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
1.0
0.5
0.0
-0.5
HOMOSEXUAL AGE-PREFERENCE GROUPS
Pedo 1 Pedo 2 Hebe 1 Hebe 2 Ephebo Teleio
MALE PHALLOMETRIC STIMULUS-CATEGORIES
Adult MenPubescent BoysPrepubescent Boys
Fig. 4 Mean penile response of
the six homosexual age-
preference groups to laboratory
stimuli depicting prepubescent,
pubescent, and physically
mature males. The means for the
prepubescent, pubescent, and
physically mature females are
not shown
Arch Sex Behav (2009) 38:335–350 345
123
Between-Groups Comparisons
Figures 3and 4were designed to emphasize the isometry
between the phallometric data and the self-report data pre-
sented in Figs. 1and 2, and also to highlight the phallometric
response-profile that was characteristic of each age-prefer-
ence group. These bar graphs do not, however, provide the
clearest illustration of the relations between groups. The data
in Figs. 3and 4were therefore redrawn as line graphs in
Figs. 5and 6to illustrate these relations. The data for the
heterosexual groups are shown in Fig. 5, and the data for the
homosexual groups are shown in Fig. 6. The mean penile
responses of the six age-preference groups to prepubescent
children are connected by dotted lines, the mean responses to
pubescent children are connected by dashed lines, and the
mean responses to adults are connected by solid lines.
Figures 5and 6suggest three findings: (a) The pedophiles
had greater responses to prepubescent children than the
hebephiles or teleiophiles, (b) the teleiophiles had greater
responses to adults than the hebephiles or pedophiles, and—
most importantly—(c) the hebephiles had greater responses to
pubescents than the pedophiles or teleiophiles. These impres-
sions were tested in analyses of variance using the default
polynomial contrasts provided by SPSS-15 (SPSS, Inc., Chi-
cago, IL). The linear contrasts were used to demonstrate the
first two findings, and the quadratic contrasts were used to
demonstrate the third finding. The linear contrastcoefficients,
for the six age-preference groups from Pedophile 1 to Te-
leiophile,were -.598, -.359, -.120, .120, .359, and .598, and
the quadratic contrast coefficients were .546, -.109, -.436,
-.436, -.109, and .546. The quadratic contrasts were con-
venient for our purposes because the two ‘‘middle’’ means in
the series belonged to the Hebephile 1 and Hebephile 2
groups; thus, the quadratic contrasts, in effect, tested whether
the hebephiles’ penile responses differed from those of the
other age-preference groups.
For the heterosexual age-preference groups, linear and qua-
dratic contrasts were performed on mean penile responses to
prepubescent girls, pubescent girls, and adult women. Simi-
larly, for the homosexual age-preference groups, linear and
quadratic contrasts were performed on mean penile responses
to prepubescent boys, pubescent boys, and adult men. The
results are presented in Tables 4and 5.
Table 4is readily interpreted in relation to Fig. 5. The table
shows that the pedophilic groups responded more to the pre-
pubescent girls than did the other groups (linear contrast), the
Table 2 Ipsatized penile response: within-groups comparisons of means for heterosexual participants
Age-preference df Comparison
Pubescent girls vs. prepubescent girls Pubescent girls vs. adult women Prepubescent girls vs. adult women
tp tptp
Pedophile 1 20 -2.62 .02 4.38 .0003 5.48 \.0001
Pedophile 2 45 2.64 .01 7.10 \.0001 5.14 \.0001
Hebephile 1 29 4.94 \.0001 7.42 \.0001 2.66 .01
Hebephile 2 45 4.95 \.0001 7.00 \.0001 2.02 .05
Ephebophile 49 5.46 \.0001 0.53 n.s. -2.82 .007
Teleiophile 551 23.63 \.0001 -14.16 \.0001 -30.02 \.0001
Note: All p-values are two-tailed. A negative t-value indicates that the mean specified first in the column heading was lower than the mean specified
second
Table 3 Ipsatized penile response: within-groups comparisons of means for homosexual participants
Age-preference df Comparison
Pubescent boys vs. prepubescent boys Pubescent boys vs. adult men Prepubescent boys vs. adult men
tptptp
Pedophile 1 14 -3.00 .01 6.69 \.0001 6.94 \.0001
Pedophile 2 16 -2.97 .01 5.53 \.0001 6.81 \.0001
Hebephile 1 9 0.32 n.s. 4.12 .003 5.21 .001
Hebephile 2 17 1.83 n.s. 4.52 .0003 2.03 n.s.
Ephebophile 17 3.18 .005 2.70 .02 0.90 n.s.
Teleiophile 57 4.12 .0001 -5.82 \.0001 -8.18 \.0001
Note: All p-values are two-tailed. A negative t-value indicates that the mean specified first in the column heading was lower than the mean specified
second
346 Arch Sex Behav (2009) 38:335–350
123
hebephilic groups responded more to the pubescent girls than
the other groups (quadratic contrast), and the teleiophilic
group responded more to the adult women than the other
groups (linear contrast). The p-values for these three contrasts
were less than .0001.
There were a few ‘‘nuisance’’ results in Table 4that require
a word of explanation. There was a small but statistically
significant linear contrast for mean responses to pubescent
girls. That was because the inverted-Ushape of the dashed line
in Fig. 5was slightly tilted; in other words, the mean response
of the Pedophile 1 group was somewhat higherthan the mean
response of the Teleiophile group. There was also a small but
statistically significant quadratic contrast for mean responses
to adult women. That was because the increase in means from
the Pedophile 1 group to the Hebephile 2 group was less
pronounced than the increase from the Hebephile 2 group to
the Teleiophile group.
Table 5can be interpreted in relation to Fig. 6. The table
shows that the pedophilic groups responded more to the pre-
pubescent boys than did the other groups (linear contrast), the
hebephilic groups responded more to the pubescent boys than
the other groups (quadratic contrast), and the teleiophilic
group responded more to the adult men than the other groups
(linear contrast). The p-values for these three contrasts were
less than, or rounded to, .0001. There were no other statisti-
cally significant results, possibly because the smaller sample
size protected against ‘‘nuisance’’ results.
Discussion
The present study showed that hebephilia exists and—
incidentally—that it is relatively common compared with
other forms of erotic interest in children. This has two dir-
ect implications for the DSM, which also apply to clinical
research. First, the DSM-V should expand the definition of
HETEROSEXUAL AGE-PREFERENCE GROUPS
TeleioEpheboHebe 2Hebe 1Pedo 2Pedo 1
MEAN IPSATIZED PENILE RESPONSE
1.0
0.5
0.0
-0.5 Adult Women
Pubes Girls
Prepub Girls
PHALLOMETRIC
STIMULI
Fig. 5 Mean penile response of the six heterosexual age-preference
groups to laboratory stimuli depicting prepubescent, pubescent, and
physically mature females—redrawn to emphasize between-groups
differences. Prepub Girls, prepubescent females; Pubes Girls, pubes-
cent females; Adult Women, physically mature females
HOMOSEXUAL AGE-PREFERENCE GROUPS
TeleioEpheboHebe 2Hebe 1Pedo 2Pedo 1
MEAN IPSATIZED PENILE RESPONSE
1.0
0.5
0.0
-0.5 Adult Men
Pubes Boys
Prepub Boys
PHALLOMETRIC
STIMULI
Fig. 6 Mean penile response of the six homosexual age-preference
groups to laboratory stimuli depicting prepubescent, pubescent, and
physically mature males—redrawn to emphasize between-groups
differences. Prepub Boys, prepubescent males; Pubes Boys, pubescent
males; Adult Men, physically mature males
Table 4 Ipsatized penile response: between-groups comparisons of
means for heterosexual participants
Phallometric stimuli Polynomial contrast
Linear Quadratic
F(1, 739) pF(1, 739) p
Prepubescent girls 130.47 \.0001 3.61 n.s.
Pubescent girls 5.63 .02 39.09 \.0001
Adult women 56.33 \.0001 4.92 .03
Table 5 Ipsatized penile response: between-groups comparisons of
means for homosexual participants
Phallometric stimuli Polynomial contrast
Linear Quadratic
F(1, 130) pF(1, 130) p
Prepubescent boys 63.32 \.0001 2.44 n.s.
Pubescent boys 0.10 n.s. 17.38 .0001
Adult men 63.94 \.0001 3.56 n.s.
Arch Sex Behav (2009) 38:335–350 347
123
Pedophilia so that it includes erotic attraction to pubescent
and prepubescent children or, alternatively, add a separate
diagnosis of Hebephilia. If the latter option were chosen,
patients attracted to both prepubescent and pubescent chil-
dren more than to adults could be given both diagnoses
(Pedophilia and Hebephilia). That would cover those indi-
viduals referred to by Freund, Seeley, Marshall, and Glinfort
(1972) as ‘‘pedohebephiles.’’ Another possibility would be
to completely replace the diagnosis of Pedophilia with Pe-
dohebephilia and allow the clinician to specify one of three
subtypes: Sexually Attracted to Children Younger than 11
(Pedophilic Type), Sexually Attracted to Children Age 11–
14 (Hebephilic Type), or Sexually Attracted to Both (Pe-
dohebephilic Type).
Second, the DSM diagnostic specifiers, which currently
include the gender of children who most attract the patient
sexually, should also include the typical age of children who
most attract the patient sexually. This second point agrees with
the suggestions of several authors that the DSM-V should
include continuous measures of psychopathology as well as
discrete diagnostic categories (Regier, 2007). The age of per-
sons to whom the individual is most attracted would be an ideal
continuous measure of erotic age-preference: It has a built-in
metric, it corresponds to something in the real world, and it can
be interpreted by any clinician without specialized training. It is
true that a most-preferred-age item, whether incorporated into
a self-administered questionnaire or a structured interview for
sex offenders, will elicit many lies and distortions, but that is
true of any self-report methodolo gy, and this item has the virtue
of simplicity. Examiners might find it useful, in determining
the most attractive age for intellectually limited patients, to
show them a standard set of nude photographs, line drawings,
or silhouettes that illustrate the characteristic body shapes of
males and females at all ages from infancy to senescence. Such
a set of illustrations might conceivably be obtained from
endocrinology texts or other medical sources. The patient
could simply pick the image that represents his erotic ideal, and
the examiner could record the associated age.
It is relevant here to consider the use of different age-ranges
for boys and girls when dichotomously classifying men’s
sexual targets as pubescent or prepubescent. As noted in the
introduction to this article, the pubertal growth spurt in height
starts about 2 years earlier for girls than for boys. Other signs
of maturation, for example, pubic hair, begin to appear at
about the same time in both sexes. One aspect of maturation—
fecundity—actually appears earlier in boys than in girls
(Wood, 1994, p. 404 and Fig. 9.4). Our study did not attempt
to address the question of different age-ranges. One would
probably not lose much precision in using the same age-range
(e.g., 11 through 14) in designating both male and female
children as pubescent, given that the onset of puberty varies
from child to child and given that the boundaries of puberty
are fuzzy to begin with. Thus, it does not seem absolutely
necessary to use different criteria when diagnosing hebephilia
in homosexual and heterosexual men.
Our demonstration of heterosexual hebephilia was more
clear-cut than our demonstration of homosexual hebephilia.
Our first main conclusion—men who verbally report maxi-
mum sexual attraction to pubescent children produce greater
penile responses to depictions of pubescent children than to
depictions of younger or older persons—applies in full only
to heterosexual men. We could not demonstrate that (self-
reported) homosexual hebephiles respond more to pubescent
boys than to prepubescent boys. One possible reason for this is
insufficient statistical power: Our combined number of homo-
sexual pedophiles and hebephiles was less than half our num-
ber of heterosexual pedophiles and hebephiles. There are at
least two other possible methodological reasons for this dis-
crepant finding: (a) Our prepubescent female modelswere age
3–11, whereas our prepubescent male models were age 5–
11, and (b) the sexual development of the pubescent female
models, according to their Tanner ratings, was somewhat less
advanced than the sexual development of the pubescent male
models. It is difficult to know how, or even whether, these
seemingly small differences affected the outcome. It is, of
course, conceivable that the results relate to some inherent
difference between heterosexual and homosexual hebephiles,
but it is impossible, given the above-mentioned inequalities,to
conclude that.
The main methodological limitation of the present study
was the absence of models age 15–18 (mid- to late-adoles-
cence) among the phallometric stimuli. That made it impos-
sible to directly validate self-reports of ephebophilia. On the
positive side, our cumbersome method of pinpointing the
participant’s erotic age-preference appears to have worked
tolerably well, althoughwe would not necessarily recommend
it to other researchers. It seems probable that the simply query,
‘What is the typical age of persons who most attract you
sexually,’ would obtain the same information more simply,
although it might require some follow-up questions before a
single value could be recorded.
The study produced various findings that lay outside our
main focus but are nonetheless of theoretical interest. First, the
phallometric profiles of the homosexual participants generally
paralleled those of the heterosexual participants. Thus, the
homosexual pedophiles differentiated between prepubescent
boys and adult men just as well as the heterosexual pedophiles
differentiated between prepubescent girls and adult women;
the homosexual and heterosexual teleiophiles also distin-
guished between children and adults of their preferred gender
to similar degrees (compare Figs. 3and 4). This parallelism
had previously been demonstrated for homosexual and het-
erosexual teleiophiles (Freund et al., 1973), but not for
homosexual and heterosexual pedophiles.
Second, there was a remarkable concordance between
the participants’ self-reported age-preferences and their phal-
348 Arch Sex Behav (2009) 38:335–350
123
lometric profiles. This shows that penile response in the lab-
oratory can be a fairly sensitive measure of erotic preferences
in cooperative participants. The inherent limitations of the
phallometric method are not the technical problems in mea-
suring penile blood volume or the creative problems in devis-
ing effective stimuli for a range of paraphilics, but rather the
willingness and abilityof uncooperative men to affect the test
outcome. Outside the criminal justice system and its associ-
ated clinics—where it is primarily used as a blunt instrument
in diagnosing paraphilia in nonadmitters (e.g., Blanchard
et al., 2001; Freund & Blanchard, 1989)—the phallometric
method is probably underutilized for examining subtle theo-
retical questions regarding erotic preferences.
Third, our missing data on ephebophilia notwithstanding,
erotic age-preferences appear to constitute a continuum
rather than a series of discrete taxa. This is not surprising,
when one considers the continuous nature of human physi-
cal development. Human beings, unlike butterflies, do not
disappear in one form and reappear in another. The con-
tinuous nature of erotic age-preferences does not, however,
tell us anything about etiology. It does not, for example,
imply that pedophilia and hebephilia have the same etiol-
ogy, with the difference between them reflecting some kind
of dosage effect. It is quite possible, in fact, that both variant
age-preferences have multiple etiologies (Blanchard et al.,
2002; Seto, 2008, p. 210). This appears to be the case for
variant erotic gender-preference: A substantial amount of
evidence indicates that homosexuality has one cause (or set
of causes) in right-handed men and another cause in non-
right-handed men (Blanchard, 2008). It would almost be
surprising if multiple etiologies did not contribute to pedo-
and hebephilia.
References
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC:
Author.
Bernard, F. (1975). An enquiry among a group of pedophiles. Journal
of Sex Research, 11, 242–255.
Blanchard, R. (2008). Review and theory of handedness, birth order,
and homosexuality in men. Laterality: Asymmetries of Body, Brain
and Cognition, 13, 51–70.
Blanchard, R., Barbaree, H. E., Bogaert, A. F., Dickey, R., Klassen, P.,
Kuban, M. E., et al. (2000). Fraternal birth order and sexual orien-
tation in pedophiles. Archives of Sexual Behavior, 29, 463–478.
Blanchard, R., Christensen, B. K., Strong, S. M., Cantor, J. M., Kuban,
M. E., Klassen, P., et al. (2002). Retrospective self-reports of
childhood accidents causing unconsciousness in phallometrically
diagnosed pedophiles. Archives of Sexual Behavior, 31, 511–526.
Blanchard, R., Klassen, P., Dickey, R., Kuban, M. E., & Blak, T.
(2001). Sensitivity and specificity of the phallometric test for
pedophilia in nonadmitting sex offenders. Psychological Assess-
ment, 13, 118–126.
Blanchard, R., Kolla, N. J., Cantor, J. M., Klassen, P. E., Dickey, R.,
Kuban, M. E., et al. (2007). IQ, handedness, and pedophilia in
adult male patients stratified by referral source. Sexual Abuse: A
Journal of Research and Treatment, 19, 285–309.
Blanchard, R., Kuban, M. E., Blak, T., Cantor, J. M., Klassen, P., &
Dickey, R. (2006). Phallometric comparison of pedophilic interest
in nonadmitting sexual offenders against stepdaughters, biolog-
ical daughters, other biologically related girls, and unrelated girls.
Sexual Abuse: A Journal of Research and Treatment, 18, 1–14.
Blanchard, R., Kuban, M. E., Klassen, P., Dickey, R., Christensen, B.
K., Cantor, J. M., et al. (2003). Self-reported head injuries before
and after age 13 in pedophilic and nonpedophilic men referred for
clinical assessment. Archives of Sexual Behavior, 32, 573–581.
Boney-McCoy, S., & Finkelhor, D. (1995). Prior victimization: A risk
factor for child sexual abuse and for PTSD-related symptomatol-
ogy among sexually abused youth. Child Abuse & Neglect, 19,
1401–1421.
Briere, J., & Elliott, D. M. (2003). Prevalence and psychological
sequelae of self-reported childhood physical and sexual abuse in a
general population sample of men and women. Child Abuse &
Neglect, 27, 1205–1222.
Cantor, J. M., Blanchard, R., Christensen, B. K., Dickey, R., Klassen,
P. E., Beckstead, A. L., et al. (2004). Intelligence, memory, and
handedness in pedophilia. Neuropsychology, 18, 3–14.
Cantor, J. M., Kabani, N., Christensen, B. K., Zipursky, R. B.,
Barbaree, H. E., Dickey, R., et al. (2008). Cerebral white matter
deficiencies in pedophilic men. Journal of Psychiatric Research,
42, 167–183.
Cantor, J. M., Klassen, P. E., Dickey, R., Christensen, B. K., Kuban, M.
E., Blak, T., etal. (2005). Handedness in pedophilia and hebephilia.
Archives of Sexual Behavior, 34, 447–459.
Cantor, J. M., Kuban, M. E., Blak, T., Klassen, P. E., Dickey, R., &
Blanchard, R. (2006). Grade failure and special education place-
ment in sexual offenders’ educational histories. Archives of Sexual
Behavior, 35, 743–751.
Cantor, J. M., Kuban, M. E., Blak, T., Klassen, P. E., Dickey, R., &
Blanchard, R. (2007). Physical height in pedophilic and hebe-
philic sexual offenders. Sexual Abuse: A Journal of Research and
Treatment, 19, 395–407.
Earls, C. M., Quinsey, V. L., & Castonguay, L. G. (1987). A comparison
of three methodsof scoring penile circumference changes. Archives
of Sexual Behavior, 16, 493–500.
Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The
victimization of children and youth: A comprehensive, national
survey. Child Maltreatment, 10, 5–25.
Freund, K. (1967). Diagnosing homo- or heterosexuality and erotic
age-preference by means of a psychophysiological test. Behav-
iour Research and Therapy, 5, 209–228.
Freund, K., & Blanchard, R. (1989). Phallometric diagnosis of pedo-
philia. Journal of Consulting and Clinical Psychology, 57,100
105.
Freund, K., Langevin, R., Cibiri, S., & Zajac, Y. (1973). Heterosexual
aversion in homosexual males. British Journal of Psychiatry, 122,
163–169.
Freund, K., McKnight, C. K., Langevin, R., & Cibiri, S. (1972). The
female child as a surrogate object. Archives of Sexual Behavior, 2,
119–133.
Freund, K., Scher, H., & Hucker, S. (1983). The courtship disorders.
Archives of Sexual Behavior, 12, 369–379.
Freund, K., Sedlacek, F., & Knob, K. (1965). A simple transducer for
mechanical plethysmography of the male genital. Journal of the
Experimental Analysis of Behavior, 8, 169–170.
Freund, K., Seeley, H. R., Marshall, W. E., & Glinfort, E. K. (1972).
Sexual offenders needing special assessment and/or therapy.
Canadian Journal of Criminology and Corrections, 14, 3–23.
Gebhard, P. H., Gagnon, J. H., Pomeroy, W. B., & Christenson, C. V.
(1965). Sex offenders: An analysis of types. New York: Harper &
Row.
Arch Sex Behav (2009) 38:335–350 349
123
Glueck, B. C., Jr. (1955). Final report: Research project for the study
and treatment of persons convicted of crimes involving sexual
aberrations, June 1952 to June 1955. New York: New York State
Department of Mental Hygiene.
Grumbach, M. M., & Styne, D. M. (1998). Puberty: Ontogeny,
neuroendocrinology, physiology, and disorders. In J. D. Wilson,
D. W. Foster, H. M. Kronenberg, & P. R. Larsen (Eds.), Williams
textbook of endocrinology (9th ed., pp. 1509–1625). Philadelphia:
W. B. Saunders.
Harris, G. T., Rice, M. E., Quinsey, V. L., Chaplin, T. C., & Earls, C.
(1992). Maximizing the discriminant validity of phallometric
assessment data. Psychological Assessment, 4, 502–511.
Herman-Giddens, M. E., Slora, E. J., Wasserman, R. C., Bourdony, C.
J., Bhapkar, M. V., Koch, G. G., et al. (1997). Secondary sexual
characteristics and menses in young girls seen in office practice: A
study from the Pediatric Research in Office Settings network.
Pediatrics, 99, 505–512.
Hirschfeld, M. (1920). Die Homosexualita
¨t des Mannes und des Weibes
[Homosexuality in men and women] (2nd ed.). Berlin: Louis Marcus.
Krafft-Ebing, R., & Moll, A. (1924). Psychopathia sexualis. Stuttgart:
Ferdinand Enke.
Kuban, M., Barbaree, H. E., & Blanchard, R. (1999). A comparison of
volume and circumference phallometry: Response magnitude and
method agreement. Archives of Sexual Behavior, 28, 345–359.
Langevin, R. (1985). Introduction. In R. Langevin (Ed.), Erotic pre-
ference, gender identity, and aggression in men: New research
studies (pp. 1–13). Hillsdale, NJ: Lawrence Erlbaum Associates.
Marshall, V. A., & Tanner, J. M. (1969). Variations in the pattern of
pubertal changes in girls. Archives of Disease in Childhood, 44,
291–303.
Marshall, V. A., & Tanner, J. M. (1970). Variation in the pattern of
pubertal changes in boys. Archives of Disease in Childhood, 45,
13–23.
Regier, D. A. (2007). Dimensional approaches to psychiatric classifica-
tion: Refining the research agenda for DSM-V: An introduction.
International Journal of Methods in Psychiatric Research, 16(S1),
S1–S5.
Roche, A. F., Wellens, R., Attie, K. M., & Siervogel, R. M. (1995). The
timing of sexual maturation in a group of US white youths.
Journal of Pediatric Endocrinology & Metabolism, 8, 11–18.
Seto, M. C. (2008). Pedophilia and sexual offending against children:
Theory, assessment, and intervention. Washington, DC: Ameri-
can Psychological Association.
Seto, M. C., Cantor, J. M., & Blanchard, R. (2006). Child pornography
offenses are a valid diagnostic indicator of pedophilia. Journal of
Abnormal Psychology, 115, 610–615.
Snyder, H. N. (2000). Sexual assault of young children as reported to
law enforcement: Victim, incident, and offender characteristics
(Report No. NCJ 18399). Washington, DC: U.S. Department of
Justice.
Studer, L. H., Aylwin, A. S., Clelland, S.R., Reddon, J. R., & Frenzel, R.
R. (2002). Primary erotic preference in a group of child molesters.
International Journal of Law and Psychiatry, 25, 173–180.
Tanner, J. M. (1978). Foetus into man: Physical growth from conception
to maturity. Cambridge, MA: Harvard University Press.
Vuocolo, A. B. (1969). The repetitive sex offender: An analysis of the
administration of the New Jersey sex offender program from 1949
to 1965. Menlo Park, NJ: New Jersey State Diagnostic Center.
Wilson, G. D., & Cox, D. N. (1983). Personality of paedophile club
members. Personality and Individual Differences, 4, 323–329.
Wood, J. W. (1994). Dynamics of human reproduction: Biology, bio-
metry, demography. New York: Aldine de Gruyter.
350 Arch Sex Behav (2009) 38:335–350
123
LETTER TO THE EDITOR
Should Hebephilia be a Mental Disorder? A Reply
to Blanchard et al. (2008)
Gregory DeClue
Published online: 16 October 2008
ÓSpringer Science+Business Media, LLC 2008
Blanchard et al. (2008) suggest possibilities for expanding
DSM to include a diagnosis for Hebephilia (mostly erotically
attracted to 11- to 14-year olds), but they do not suggest the
inclusion of a diagnosis for Ephebophilia (mostly attracted to
15- to 16-year olds), Teliophilia (mostly attracted to those
17 years old or older), or Gerontophilia (mostly attracted to
the aged).
Although Blanchard et al. present data regarding whether
reliable differences in erotic preference can be shown, they
completely overlook the question of how we decide which
sexual interest patterns should be considered a mental dis-
order. Pedophilia is a mental disorder. Homosexuality is not.
Should Hebephilia or Ephebophilia or Gerontophilia be
considered mental disorders? How about sexual preference
for people with different (or with the same) ethnic charac-
teristics as oneself?
The decision to classify a pattern of sexual attraction as a
mental disorder (paraphilia) inevitably entails more than (1)
reliable differences in patterns of sexual attractions and (2)
checking law books to see which sexual activities are cur-
rently illegal in a particular jurisdiction. In their Discussion
section, Blanchard et al. leap directly from ‘Hebephilia
exists’’ to ‘‘The DSM-V should expand the definition of
Pedophilia so that it includes erotic attraction to pubescent
and prepubescent children or, alternatively, add a separate
diagnosis of Hebephilia.’’ They completely ignore the middle
part of this syllogism: (A) Hebephilia exists. (B) Hebephilia
is a mental disorder. (C) Hebephilia should be included in
DSM-V.
Blanchard et al.’s findings are useful toward consider-
ation of whether a pattern of erotic preference for pubescent
and/or early post-pubescent humans is reliable, stable, and
identifiable. However, their discussion completely misses
other necessary considerations regarding whether a stable
pattern of differences (e.g., homosexual versus heterosexual;
right handed versus left handed) constitutes a disorder.
One of the co-authors (James Cantor) has graciously
responded to some queries on the Internet list psylaw-l
(http://listserv.unl.edu/), clarifying his perspective regarding
the recommendation that Hebephilia be listed as a mental
disorder in DSM-V. As I understand Cantor’s posts, listing
Hebephilia as a specific paraphilia should not result in a
greater number of people being diagnosed with paraphilia:
‘Hebephilia is well within the range of disorders already in
the DSM, and my recommendation pertains not to patholo-
gizing, but to replacing inaccurate labels (Paraphilia NOS
and Pedophilia with an unrealistic definition of puberty) with
an accurate label’’ (e-communication, August 30, 2008).
Thus, a subset of those people who meet criteria for the
general diagnosis of paraphilia would meet criteria for the
specific diagnosis of Hebephilia. If, both in design and
practice, listing a specific diagnosis of Hebephilia in DSM-V
would not result in any more people being classified as
paraphiles, then I would consider this proposal to be rea-
sonable and noncontroversial.
In a follow-up psylaw post (e-communication, September
1, 2008), Cantor recommends that the label Hebephile be
applied to people who show greater sexual arousal to
pubescent people than to mature adults. But neither Blan-
chard et al. nor Cantor (in his posts to psylaw) articulate a plan
for deciding which people who meet the criteria for the
descriptive label of Hebephile (greater relative sexual arousal
to pubescent people) should be considered to meet criteria for
the proposed diagnosis of Hebephilia.
If criteria similar to the DSM-IV-TR criteria for Pedophilia
are to be used for Hebephilia in DSM-V, then a person would
G. DeClue (&)
16443 Winburn Place, Sarasota, FL 34240, USA
e-mail: gregdeclue@mailmt.com
123
Arch Sex Behav (2009) 38:317–318
DOI 10.1007/s10508-008-9422-1
get a diagnosis of Hebephilia if criteria similar to the fol-
lowing are satisfied: (a) over a period of at least 6 months, he
or she has recurrent, intense sexually arousing fantasies,
sexual urges, or behaviors involving sexual activity with a
pubescent child or children (generally age 11–14) and (b) the
person has acted on these urges, or the sexual urges or fan-
tasies cause distress or interpersonal difficulty, and (c) the
person is at least 18 years of age and at least 5 years older
than the child or children (but do not include an individual in
late adolescence involved in an ongoing relationship with a
12- to 14-year-old). I consider it very likely that implemen-
tation of such criteria would expand the number of people
diagnosed with paraphilia, to include people who fantasize
about and/or engage in sex with 14-year-olds or with younger
children who have entered puberty.
Any changes to DSM that would lead to more people
diagnosed with a mental disorder should be carefully con-
sidered. Blanchard et al. recommend expansion of DSM to
include Hebephilia without any explicit articulation of why
Hebephilia should be considered a mental disorder, what
diagnostic criteria should be used, whether Hebephilia can be
diagnosed reliably in the field, and how inclusion of the new
diagnosis would likely impact individuals and society. This is
particularly disconcerting because in this article Blanchard is
advising himself and the Editor of this journal; Dr. Blanchard
is a member of the DSM-V Sexual and Gender Identity Dis-
orders Work Group, and the Editor of Archives of Sexual
Behavior, Kenneth J. Zucker, is its chair (see http://www.
psych.org/MainMenu/Newsroom/NewsReleases/2008News
Releases/dsmwg.aspx). Further, according to Robert L.
Spitzer, ‘‘Perhaps the best-kept-secret about DSM-V is that
rather than being ‘an open and transparent process’ as has
been claimed, it will essentially be developed in secret. Task
Force and Workgroup members have been required to
sign ‘confidentiality agreements’ prohibiting them from
discussing with anybody anything having to do with
DSM-V’’ (see http://taxa.epi.umn.edu/*mbmiller/sscpnet/
20080909_Spitzer/).
In sum, any changes to the Paraphilia section of DSM
should be carefully considered, and the entire DSM devel-
opment process should be conducted in the open, as it is for
the World Health Organization’s revision of ICD-10 (see
http://www.who.int/mental_health/evidence/en/).
Reference
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
318 Arch Sex Behav (2009) 38:317–318
123
LETTER TO THE EDITOR
The Public Policy Implications of ‘‘Hebephilia’’:
A Response to Blanchard et al. (2008)
Karen Franklin
Published online: 16 October 2008
ÓSpringer Science+Business Media, LLC 2008
Blanchard et al. (2008) present their article on ‘‘hebephilia’
as an objective analysis of research data. In fact, it is a text-
book example of subjective values masquerading as science.
Avoiding the crucial public policy implications of their
argument, Blanchard et al. advance hebephilia as if it exists
in a cultural vacuum. Their recommendations are even more
troubling in light of their study’s methodological flaws.
Blanchard et al. assert that their mere identification of
hebephilia as a ‘‘discriminable erotic age-preference’’ qual-
ifies it for inclusion in the forthcoming fifth edition of the
American Psychiatric Association’s influential Diagnostic
and Statistical Manual of Mental Disorders (DSM). They
ignore a crucial question at the heart of the current debate
over how the DSM should conceptualize sexual disorders
(Kleinplatz & Moser, 2005): What makes hebephilia a
pathology, as opposed to a normal variant of human sexual-
ity? Indeed, Blanchard et al.’s logic applies equally well to
homosexuality, which was gradually removed from the DSM
between 1973 and 1987.
The absurdity of describing erotic attraction to adolescents
as a mental disorder is that large proportions of heterosexual
men are sexually attracted to young pubescent girls (Freund
& Costell, 1970; Quinsey, Steinman, Bergerson & Holmes,
1975) and indeed such attractions are evolutionarily adaptive
(Kenrick & Keefe, 1992). Even Blanchard et al. acknowl-
edge that ‘‘few would want to label erotic interest in late- or
even mid-adolescents as a psychopathology.’’ A diagnosis of
hebephilia would be even more unreliable than the current
DSM-IV diagnosis of pedophilia (Marshall, 1997), thereby
inviting arbitrary and biased application.
To fully appreciate the radical nature of this proposal, we
must understand its context. Whereas Blanchard et al. ex-
press surprise at the dearth of previous research on hebe-
philia, it is actually the sudden interest in this ubiquitous and
age–old phenomenon that merits explanation. The construct,
which descends from German sexologist Magnus Hirsch-
feld’s efforts to catalogue the many varieties of sexuality
back around 1906–1908, has only exploded into common
parlance in the past few years. This timing is inextricably
linked with the advent of modern sex offender civil com-
mitment laws and a punitive era of ‘‘moral panic’’ (Jenkins,
2004).
Since 1990, 20 U.S. states and the federal government
have enacted laws enabling the civil incapacitation of certain
sex offenders. The legal requirement that these civil com-
mitments be predicated on a mental disorder or abnormality
(Kansas v.Hendricks, 1997) has spawned a booming cottage
industry in the mental health field. Because many sex
offenders do not suffer from traditional mental disorders,
forensic evaluators have developed a highly contested—
some would say pretextual—diagnostic nosology centering
around the triad of Antisocial Personality Disorder, Pedo-
philia, and Paraphilia Not Otherwise Specified (Doren, 2002;
First & Halon, in press; Zander, 2005). It is into this last
category that some government-retained clinicians are
attempting to shoehorn the unofficial diagnosis of hebephilia.
The study’s significant methodological flaws underscore
its goal of legitimizing this quasi-diagnosis. The most con-
spicuous of these are the absence of a control group of non-
deviant men and the curious omission of 15–18-year-old
models as a target stimulus group. Also problematic is the
exclusion of a majority of the eligible participants (1,440 of
K. Franklin (&)
P.O. Box 1084, El Cerrito, CA 94530, USA
e-mail: mail@karenfranklin.com
K. Franklin
California School of Professional Psychology, San Francisco,
CA, USA
123
Arch Sex Behav (2009) 38:319–320
DOI 10.1007/s10508-008-9425-y
the original pool of 2,355, or 61% by my calculation). This
was accomplished by labeling as potentially ‘‘noncoopera-
tive’’ any man who had sexually offended against children
but claimed a sexual preference for adults. Blanchard et al.’s
assumption that these men were being duplicitous runs
counter to evidence from other studies that only about half of
sex offenders against children are pedophiles (Seto, 2008).
Thus, the finding of ‘‘a remarkable concordance between the
participants’ self-reported age-preferences and their phallo-
metric profiles’’ was predetermined by the researchers’
a priori selection procedure.
In the forensic arena, the DSM is increasingly used as a tool
to legitimize the government’s capacities to civilly inca-
pacitate unwanted citizens. Especially in light of mounting
evidence of special-interest influence over the DSM (Lane,
2007), creating a controversial new diagnosis without com-
pelling scientific support would set an alarming precedent.
References
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Doren, D. M. (2002). Evaluating sex offenders: A manual for civil
commitments and beyond. Thousand Oaks, CA: Sage.
First, M. B., & Halon, R. L. (in press). Use of DSM paraphilia diagnoses
in sexually violent predator commitment cases. Journal of the
American Academy of Psychiatry and the Law.
Freund, K., & Costell, R. (1970). The structure of erotic preference in the
nondeviant male. Behaviour Research and Therapy, 8, 15–20.
Jenkins, P. (2004). Moral panic: Changing concepts of the child
molester in modern America. New Haven, CT: Yale University
Press.
Kansas v.Hendricks, 521 U. S. 346 (1997).
Kenrick, D. T., & Keefe, R. C. (1992). Age preferences in mates reflect
sex differences in human reproductive strategies. Behavioral and
Brain Sciences, 15, 75–133.
Kleinplatz, P. J., & Moser, C. (2005). Politics versus science: An
addendum and response to Drs. Spitzer and Fink. Journal of
Psychology & Human Sexuality, 17, 135–139.
Lane, C. (2007). Shyness: How normal behavior became a sickness.
New Haven, CT: Yale University Press.
Marshall, W. L. (1997). Pedophilia: Psychopathology and theory. In D.
R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory,
assessment, and treatment (pp. 152–174). New York: Guilford
Press.
Quinsey, V. L., Steinman, C. M., Bergerson, S. G., & Holmes, T. F.
(1975). Penile circumference, skin conductance, and ranking
responses of child molesters and ‘‘normals’’ to sexual and
nonsexual visual stimuli. Behavior Therapy, 6, 213–219.
Seto, M. C. (2008). Pedophilia and sexual offending against children:
Theory, assessment, and intervention. Washington, DC: American
Psychological Association.
Zander, T. K. (2005). Civil commitment without psychosis: The law’s
reliance on the weakest links in psychodiagnosis. Journal of Sex
Offender Civil Commitment: Science and the Law, 1, 17–82.
320 Arch Sex Behav (2009) 38:319–320
123
LETTER TO THE EDITOR
Hebephilia Plethysmographica: A Partial Rejoinder
to Blanchard et al. (2008)
Diederik F. Janssen
Published online: 14 February 2009
ÓSpringer Science+Business Media, LLC 2009
For even the most sober scientific investigator in sci-
ence, the most thoroughgoing Positivist cannot dis-
pense with fiction; he must at least make use of
categories, and they are already fictions, analogical
fictions, or labels, which give us the same pleasure as
children receive when they are told the ‘‘name’’ of a
thing. (Ellis, 1923, p. 89)
Money (1991) remarked: ‘‘I have a strong impression,
although I’ve never proved this, that we ought to have a Greek
word for twentyophiles, thirtyophiles, fortyophiles’’ (p. 5).
What Money meant by this remark was to open up a more
nuanced medical sociology of the intersection of erotic life
and the life course, where sexuality, gender, and maturational
categories function as much as clinically legible ‘‘classifiers’
as situated and interdependent rubrics of identity and soci-
ality. The recent suggestion to add hebephilia to the canons of
psychiatric classification (Blanchard et al., 2008) carries no
such message. Rather, it articulates a particularly turgid
clinical arrogance which would have penile response in the
context of ‘‘paraphilic, criminal, or otherwise problematic
sexual behavior’’ dictate nosological sensibility.
The article has been criticized by a number of commen-
taries (which are published in this issue), with a reply by
Blanchard. The debate rehearses much of an earlier exchange
of discourse in the Archives, in response to a paper by Green
(2002) on the nosological status of pedophilia. The question
then was how and whether disparate perspectives on the
matter do or do not add up to clinical commonsense. For
Blanchard et al., the matter of classification is a statistical
accomplishment uncorrupted by extensive consideration of
political implications. Thus, it ignores entirely the multi-
stranded discussions on the subject of categorization of
‘sexualities’’ within and across the humanities, history, and
social sciences of the past 30 years. From this perspective,
Blanchard et al.’s suggestion of having catered to ‘‘subtle
theoretical questions regarding erotic preferences’’ is nothing
but hilarious, a remarkable arrogance (Blanchard et al. did
not bother to cite Green).
However, commentators have not pinpointed the more
obvious ways in which thematic emergence, whether in
‘sexology’’ journals or in the ‘‘sexualities studies’’ context,
has the tendency to sexualize a potentially complicated spec-
trum of mental conditions. Hebephilia will strike contem-
porary clinicians as interesting only where it is criminal and
sexual rather than philic; what kind of orientation it seems
mostly considered resolved by the afforded arrogance in
deciding what kind of disorder it is. Most clinical theories of
pedophilia, however, foreground identity dynamics rather
than the erotic preference that would be its striking symptom
or corollary: elements of regression or fixation, overidenti-
fication with a child, a peripubescent or adolescent problem
of developmental selfhood. The hebephilia debate, while
distinguishing crime from desire, tramples a more convo-
luted tension between symptom and disease, process and
outcome, identity and orientation, substrate and phenome-
non. Blanchard et al. are not to blame for this situation, which
is cultural and historical. Yet, as commentators note, a cri-
tique of hebephilia can only take the inclusive form of a
critique of any generic primary classification that postulates
into psychiatry an unproblematically secondary specifier
(problematic object choice) of an unproblematically primary
Editor’s note: This letter was submitted to the Journal after Blanchard’s
reply to the other letters about the Blanchard et al. (2008) article was in
production; hence, the reply by Blanchard (2008) does not refer to the
content of this letter.
D. F. Janssen (&)
Berg & Dalseweg 209/60, Nijmegen 6522BK, The Netherlands
e-mail: diederikjanssen@gmail.com
123
Arch Sex Behav (2009) 38:321–322
DOI 10.1007/s10508-009-9479-5
classifier (sexual behavior), that is: paraphilia. Paraphilia
delivers psychiatric classification to the phalloplethysmog-
rapher and to victimological consensus, to concerns with the
crossing of behavioral, ‘‘sexual’’ boundaries between clas-
sificatory subjects, not with ‘‘mental health.’
Although its medicolegal ramifications are yet to be ex-
plored, here lies a defense of hebephilia. Hebephilia is being
proposed to function within a forensic context, and in this
context it may well function, at the level of the category of
offender and a concomitant entitlement to rehabilitation and
resignification. As long as the clinical realm sticks to ser-
vicing public, forensic, and jurisprudential demands, it will
want to classify offender characteristics. Arguments against
‘pathologization’’ are well-intended but they refer to a dif-
ferent set of commitments: commitments to social scientific,
legal, and humanistic implications of how diagnostic cate-
gories will be applied rather than the mere recognition of
categories (hebephilia is not a novel category). Regarding
‘child’’ sexual abuse, the American medicolegal apparatus
has always been an ancillary supplement to social consensus
over the abjection of age disparity. But this ancillary function
reflects a wider moral dispositif and a legal system to which
the plethysmograph and the plethysmographer are but instru-
ments. Pedophilia’s status as a disease of the mind pertains to
culture-wide consensus, not an incursion of clinical classi-
ficatory ambition. Neither sexology nor ‘‘sexuality studies’
have had any definite proven influence on public appraisal
of what it calls pedophilia and such will in all likelihood be
the case for hebephilia.
In its servicing of an American (if universalist) order
of justice, the clinic retains Greek jargon that belies any
primary and authentic psychiatric concern. The Penile Ple-
thysmographer proposes a forensic, posttraumatic sexology;
he will not be able to deal with the sorrow of a lifetime. There
are few John Moneys left to do this job. The pursuit of more
encompassing, humane, and phenomenologically sophisti-
cated classifications of ‘‘erotic preference,’’ and of eroticism
as a spectrum of ‘‘preferences,’’ however, should arise in a
debate about erotics and about preference, not about sex
offending or penile response. But then, if we stick to a
forensics of penises, we might as well talk the Greek talk.
References
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Ellis, H. (1923). The dance of life. Boston: Houghton Mifflin Company.
Green, R. (2002). Is pedophilia a mental disorder? Archives of Sexual
Behavior, 31, 467–471.
Money, J. (1991). Interview: John Money. Paidika, 2(3), 2–13.
322 Arch Sex Behav (2009) 38:321–322
123
LETTER TO THE EDITOR
When Is an Unusual Sexual Interest a Mental Disorder?
Charles Moser
Published online: 23 October 2008
Springer Science+Business Media, LLC 2008
Blanchard et al.’s (2008) excellent article distinguishing
Hebephilia (erotic arousal to pubescent children) from Pe-
dophilia (erotic arousal to prepubescent children) raises an
important issue. In the article, Blanchard et al. specifically
advocate incorporating Hebephilia into the forthcoming fifth
edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) published by the American Psychiatric
Association (APA). I am not challenging their conclusion
that sexual interests in pubescent and prepubescent minors
are distinct entities (albeit with some overlap) or that the
distinction may have utility for research purposes, but it is not
clear that a sexual interest in pubescent minors implies that
the individual suffers from a mental disorder, specifically a
Paraphilia. Blanchard et al. may assume that Hebephilia will
meet the other criteria required for a Paraphilia diagnosis and
a mental disorder, but that is neither obvious nor necessarily
true.
To be crystal clear, the following comments should not be
construed as supportive of any sexual activity between adults
and minors in any way. Having sex with a minor is a crime and
should be punished as such, but it is not clear that this
behavior constitutes a mental disorder.
How we conceptualize a problem is important. Are the
problems associated with an unusual sexual interest primar-
ily sexual, related to another mental disorder, or are they
social rather than psychiatric? There is no doubt that some
people experience problems related to their sexual interests
or behavior, but the sex can be a manifestation of another
disorder rather than the cause of the problem. Compulsively
washing one’s hands can be a symptom of Obsessive-Com-
pulsive Disorder, but it is not a hand washing disorder. The
treatment and conceptualization of unusual sexual interests
as Paraphilias have not led to greater understanding of, or
more effective treatment for, individuals with these interests;
some would argue that pathologizing unusual sexual intere sts
has led to more discrimination and discouraged individuals
from seeking treatment for any problem (see Klein & Moser,
2006; Kleinplatz & Moser, 2004; Kolmes, Stock, & Moser,
2006).
Paraphilia diagnoses have been misused in criminal and
civil proceedings as an indication that these individuals
cannot control their behavior. Although there is some indi-
cation in the DSM (see APA, 2000, p. 663) that the Paraphilias
are Impulse Control Disorders, impulse control is not men-
tioned in the Paraphilia diagnostic criteria. At least from my
experience, most individuals with unusual sexual interests
are quite capable of controlling their behavior and, in fact, do
so. Those individuals who cannot control their sexual im-
pulses may qualify for another diagnosis based upon their
inability to control their impulses, but not based upon the
specific sexual behavior. The DSM specifically notes the
‘‘ Paraphiliasare not considered to be compulsions’’
(APA, 2000, p. 462); ‘‘compulsive masturbators’’ and
‘compulsive homosexuals’’ began to disappear once those
behaviors were no longer seen as signs or symptoms of
psychopathology.
I have been quite critical of the Paraphilias diagnostic
category in the past (Kleinplatz & Moser, 2005; Moser, 2001,
2002; Moser & Kleinplatz, 2002,2005a,2005b) and will not
repeat those criticisms here. I will question another aspect of
Editor’s note: This letter was submitted to the Journal after Blanchard’s
reply to the other letters about the Blanchard et al. (2008) article was in
production; hence, the reply by Blanchard (2008) does not refer to the
content of this letter.
C. Moser (&)
Department of Sexual Medicine, Institute for Advanced Study
of Human Sexuality, 45 Castro St., #125, San Francisco,
CA 94114, USA
e-mail: Docx2@ix.netcom.com
123
Arch Sex Behav (2009) 38:323–325
DOI 10.1007/s10508-008-9436-8
diagnosis, that is, whether those diagnosed with a Paraphilia
diagnosis exhibit a particular type of dysfunction.
The ‘‘B’’ criterion of all the DSM-IV-TR (APA, 2000, pp.
569–575) Paraphilia diagnoses state either that the sexual
interest causes ‘clinically significant distress or impair-
ment in functioning’’ or ‘‘marked distress or interper-
sonal difficulty.’’ (No rationale is given for the different
phrasing.) For brevity, I will refer to this as the dysfunction
resulting from the ‘‘disorder,’’ which is an essential part of
definition of all mental disorders (see APA, 2000, p. xxxi).
For completeness, the criminal Paraphilias (e.g., Exhibi-
tionism, Frotteurism, Pedophilia, Voyeurism, and Sexual
Sadism with a nonconsenting person) allow that acting on the
interest is enough to satisfy the ‘‘B’’ criterion, but more about
that later.
The dysfunction associated with one mental disorder
usually differs from the dysfunction associated with another
disorder. The dysfunction resulting from depression is dif-
ferent than anxiety, which, in turn, is different from the
dysfunction resulting from schizophrenia, which is different
from that seen with Obsessive-Compulsive Disorder, etc. So
the question becomes: How does the dysfunction associated
with the Paraphilias manifest? It needs be different from
other diagnostic categories or the other diagnoses would be
more appropriate. Even if 100% of individuals with a specific
sexual interest are clinically depressed, the dysfunction
associated with depression requires making a depression
diagnosis, not a Paraphilia diagnosis. The characteristic
Paraphilia dysfunction, whatever that might be, would need
to be present in order to make the additional Paraphilia
diagnosis. The dysfunction related to the Paraphilia diagnosis
should be unique to the Paraphilias and distinct from those
with ‘‘normal’’ (whatever that actually constitutes) interests.
Moser and Kleinplatz (2005a,b) have shown that the current
DSM (APA, 2000) diagnostic criteria do not distinguish
individuals with a paraphilia from those with ‘‘normal’
sexual interests. Unusual sexual interests are often blamed
inappropriately (and diagnosed incorrectly) for other prob-
lems (see Moser & Kleinplatz, 2002). Just having an unusual
sexual interest is not pathological anymore than having an
unusual hair color is; the interest must cause the dysfunction
to be a mental disorder.
I am sure that some people will point out immediately that
many of the Paraphilias are crimes against nonconsenting
individuals or individuals legally incapable of giving con-
sent, but just committing a crime does not indicate psycho-
pathology and most criminals do not have diagnoses based
upon their specific crimes. There are also real concerns that
some governments (and mental health professionals) use
psychiatric diagnoses to criminalize, marginalize, and pa-
thologize variant behavior inappropriately. Dissidents,
political and sexual, have been ‘‘interned’’ in psychiatric
hospitals, obviously ‘‘crazy’’ to oppose the government or
societal mores. Remember, African slaves were once thought
to suffer from drapetomania, a mental disorder that led them
to run away from their masters (Harris, Felder, & Clark,
2004).
Which sex crimes are diagnoses is actually quite confus-
ing. Some sex crimes are not diagnoses (e.g., rape) and some
Paraphilia diagnoses are not crimes (e.g., Fetishism, Sexual
Masochism, consensual Sexual Sadism, and Transvestic
Fetishism). Some sexual interests were both crimes and
diagnoses, but are no longer (e.g., homosexuality). Some
used to be just diagnoses, but are no longer (e.g., nympho-
mania), though some would like to resurrect the hypersexu-
ality diagnoses (see Kafka & Hennen, 1999). Some current
sexual diagnoses were thought to be normal in the past, but
are now diagnoses or proposed diagnoses (e.g., female sexual
arousal disorder, female orgasmic disorder, and hebephilia).
Some sexual behaviors were psychiatric disorders and were
believed to cause a variety of physical disorders, but are now
considered healthy (e.g., masturbation). Some sexual diag-
noses have ‘‘evolved’’ from primarily psychological to
physiologic causation (e.g., erectile dysfunction). What is
defined as ‘‘normal’’ sexual behavior, what is a mental dis-
order, what is a crime, and what constitutes a sex crime do
change over time. Psychiatry should be acutely aware of its
history; psychiatrists have been responsible for institution-
alizing far too many individuals for violating cultural (and
especially sexual) norms. I hope the DSM-V editors will ad-
here to the goal of basing diagnoses on empirical science and
not just support current social or cultural conventions.
Our society seems fixated on certain types of sexual
interests. Age of one’s sex partner seems to be the most
prevalent focus at this time. Even if not a crime or a mental
disorder, preferring much older or younger sex partners
leaves one open to derision. An 80-year-old with a 20-year-
old (of any combination of sexes) makes the skin of many
individuals crawl. This leads to a lot of speculation (and a few
research studies) to identify why this occurs and how to avoid
it in the future. In Blanchard et al.’s current study, they
question if one can distinguish pedophiles from hebephiles,
but do not seem interested if similar techniques can distin-
guish if a 45-year-old prefers 25-year-olds, 45-year-olds, or
even 65-year-olds. Can one distinguish a preference for legs
over breasts, large breasts over small breasts, slight over
muscular, hirsute over smooth, or blondes over brunettes? If
Blanchard et al.’s technique shows a difference between
these characteristics, what does that mean, especially con-
sidering how a response to pubescent individuals will be used
by our legal system?
Blanchard et al.’s subjects were mostly individuals who
admitted to their crimes, but any interest (possibly slight) to a
minor may condemn an innocent. Imagine a man (they are
almost always men) who admits or is measured to have some
sexual interest in pubescent children, who is now falsely
324 Arch Sex Behav (2009) 38:323–325
123
accused. He now has a mental disorder that implies he is a
danger to our children. Will he lose the benefit of the doubt, as
some believe it is just a matter of time before he will offend?
After all, in these cases, one could argue that we must err to
protect our children, even though most of us have sexual
fantasies we have no intention of acting upon. Is the era of the
thought crime upon us? I hasten to add that Blanchard et al.
have not suggested any of this, but it is where incorporating
Hebephilia into the DSM is leading us.
Historically, we have been obsessed (and I am not using
that term lightly) with the sex of one’s sexual partners, their
religion, their station in life, their income, their fecundity,
whether one’s parents were legally married at the time of
birth, whether one masturbates, etc. Now we are obsessed
with the desired age of one’s partner, but does that imply a
mental disorder? Again, I do not doubt that some individuals
have sexual preferences for certain aged partners. The
question is why is this important to enshrine into the DSM?
Why is a preference for blonde age-mates less important?
References
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text revision). Washington,
DC: Author.
Blanchard, R. (2008). Reply to letters regarding Pedophilia, Hebephilia,
and the DSM-V [Letter-to-the-Editor]. Archives of Sexual Behav-
ior. doi:10.1007/s10508-008-9427-9.
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Harris, H. W., Felder, D., & Clark, M. O. (2004). A psychiatric residency
curriculum on the care of African American patients. Academic
Psychiatry, 28, 226–239.
Kafka, M. P., & Hennen, J. (1999). The paraphilia-related disorders: An
empirical investigation of nonparaphilic hypersexuality disorders
in outpatient males. Journal of Sex and Marital Therapy, 25, 305–
319.
Klein, M., & Moser, C. (2006). SM (sadomasochistic) interests as an
issue in child custody proceedings. Journal of Homosexuality,
50(2/3), 233–242.
Kleinplatz, P. J., & Moser, C. (2004). Towards clinical guidelines for
working with BDSM clients. Contemporary Sexuality, 38(6), 1, 4.
Kleinplatz, P. J., & Moser, C. (2005). Is S/M pathological? Lesbian &
Gay Psychology Review, 6, 255–260.
Kolmes, K., Stock, W., & Moser, C. (2006). Investigating bias in
psychotherapy with BDSM clients. Journal of Homosexuality,
50(2/3), 301–324.
Moser, C. (2001). Paraphilia: Another confused sexological concept. In
P. J. Kleinplatz (Ed.), New directions in sex therapy: Innovations
and alternatives (pp. 91–108). Philadelphia: Brunner-Routledge.
Moser, C. (2002). Are any of the paraphilias in the DSM mental
disorders? Archives of Sexual Behavior, 31, 490–491.
Moser, C., & Kleinplatz, P. J. (2002). Transvestitic fetishism: Psycho-
pathology or iatrogenic artifact? New Jersey Psychologist, 52(2),
16–17.
Moser, C., & Kleinplatz, P. J. (2005a). DSM-IV-TR and the paraphilias:
An argument for removal. Journal of Psychology and Human
Sexuality, 17(3/4), 91–109.
Moser, C., & Kleinplatz, P. J. (2005b). Does heterosexuality belong in
the DSM? Lesbian & Gay Psychology Review, 6, 261–267.
Arch Sex Behav (2009) 38:323–325 325
123
LETTER TO THE EDITOR
Are There ‘‘Hebephiles’’ Among Us? A Response
to Blanchard et al. (2008)
Joseph J. Plaud
Published online: 16 October 2008
ÓSpringer Science+Business Media, LLC 2008
Blanchard et al. (2008) call for the addition of a paraphilic
condition to the DSM-V termed hebephilia. Beyond the fact
that there was no control group employed by Blanchard et al.
in order to compare the obtained results against normative
patterns of sexual arousal of men, there were multiple
methodological issues that preclude a call for the establish-
ment of hebephilia as a diagnostic entity in the DSM-V.
I find no problem with the plethysmography methodology
employed by Blanchard et al.; however, I would note that
Blanchard et al. did not specify whether the procedure for
eliciting self-report of the subjects described as ‘‘a great deal
of exploration’’ preceded or followed the physiological
measurements. It would have been more sound for this pro-
cedure to follow physiological measurement so as not to
serve as a potential sensitizing factor which could confound
the results. Further, the grouping algorithm employed con-
cerns me. There appears to be a significant amount of vari-
ability among the defined groups. Why not instead analyze
those who reported exclusive or near-exclusive ranges of
sexual responding to target age ranges? If none or too few of
the participants indicated primary sexual attraction to
pubescent males/females in the 11–14 year range in an ori-
ginal sample close to 3000, this is telling in and of itself.
Blanchard et al. take Fig. 1 to be evidence that ‘the classi-
fication algorithm worked.’’ My inspection of the data does
not leave me with this conclusion. On a 5-point Likert-type
scale measuring a subjective factor, inspection of Fig. 1
reveals a significant amount of variability that may not, in the
end, appropriately identify the subgroupings as described in
the text. I did not see any statistical analysis of the discrim-
inability of the labels assigned other than gross percentage
figures for maximum attractiveness. So the validity of the
group memberships themselves is at issue here.
The absence of 15–18 year old stimuli also was prob-
lematic. I would also like to have seen more multivariate
testing performed before charging in to a number of depen-
dent sample t-tests (family wise error rate?). What I find
astounding is how Blanchard et al. strongly word their dis-
cussion that these results mean ‘‘that hebephilia exists and––
incidentally––that it is relatively common compared with
other forms of erotic interest in children.’’ The data do not
support the conclusions reached in this article, especially the
inclusion of a significant change to the DSM-V. Again, the
data do not support the conclusions reached in this article.
There does not appear to be any homogeneity of groupings
along the axes of sexual interest groups (alluded to above). If
there are ‘‘hebephiles’’ among us, then this sexual interest/
arousal pattern appears to be a very heterogeneous one. If it is
heterogeneous, how can it have diagnostic specificity as
Blanchard et al. state it has in their conclusion? Look at
Fig. 3. In the pedophile groups (especially Pedo 2), there was
significant overlap between physiological arousal to both
pre-pubescent and pubescent girls. As a matter of fact, in their
Pedo 2 group, there was more arousal to pubescent girls than
to pre-pubescent girls. And this relation does not seem to hold
for homosexual males (even though Blanchard et al. state that
the hetero/homo groups were remarkably similar). How is
that a diagnostic indicator of pedophilia? Also, there was a
statistical difference in their pedophiles between pubescent
girls and adult women. Is this a group primarily composed of
non-exclusive pedophiles? If so, does this have different
implication from groupings that would contain exclusive
pedophiles? There is no way to answer that questio n given the
data in the study. If their pedophiles show discrepant findings
J. J. Plaud (&)
44 Hickory Lane, Whitinsville, MA 01588-1356, USA
e-mail: plaud@fdrheritage.org
123
Arch Sex Behav (2009) 38:326–327
DOI 10.1007/s10508-008-9423-0
such that they are also showing sexual arousal to pubescent
females, then this muddies up an established diagnosis, never
mind a proposed new diagnosis such as hebephilia.
Further, both hebephile groups tended to show more in
common with the physiological responding pattern of pe-
dophiles than teleiophiles. That is unexpected and inconsis-
tent with other research in this area (Plaud, Gaither, Rowan,
& Devitt, 1999). Take a look at Fig. 3 again. The two pedo
groups looked more similar to the two hebe groups in contrast
to the ephebo and teleio groups. Blanchard et al. did some
post-hoc contrasts among groups, but, in my opinion, they
should have started their statistics with multivariate analyses
with the groups to tease out more analysis between/among
groups.
It would have been interesting to have a condition where
just the faces (no evidence of actual secondary sexual char-
acteristics) were displayed in order to examine whether
subjects, for example, were responding to how ‘‘young’’ the
person looked in the absence of the actual sexual character-
istics of the person. What about the (possible) intercession
between sexual history/conditioning and the results of the
study? Since both hebephilia and ephebophila involve
pubescent children (the distinction is a social one involving
age of consent more than physiological development), how
do we disentangle physiological responding (sexual arousal)
from the social/legal contexts in which sexual behavior is
allowed to take place? Given that the subjects all had either
criminal or socially diagnosed ‘‘problematic sexual behav-
ior,’’ there appears to be a lot more going on here than is being
measured and talked about in this article.
In the final analysis, rather than establish the validity of a
bona fide diagnostic category such as hebephilia for inclusion
in the DSM-V, these data show that Blanchard et al. labeled
Hebe groups tend to be more Pedo ‘‘light’’ groups than a
separate class of sexual deviates, at least with the hetero-
sexual subjects. Changes to the forthcoming publication of
the DSM-V should not be based entirely or even in part on the
results reported in this article, as more questions are raised
than answered in the research methodology employed in this
study.
References
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Plaud, J. J., Gaither, G. A., Hegstad, H. J., Rowan, L., & Devitt, M. K.
(1999). External validity of psychophysiological sexual arousal
research: To whom do our research results apply? Journal of Sex
Research, 36, 171–179.
Arch Sex Behav (2009) 38:326–327 327
123
LETTER TO THE EDITOR
Manufacturing Mental Disorder by Pathologizing Erotic Age
Orientation: A Comment on Blanchard et al. (2008)
Philip Tromovitch
Published online: 16 October 2008
Springer Science+Business Media, LLC 2008
If I had been a peer-reviewer for the Blanchard et al. (2008)
article, ‘‘Pedoph ilia, Hebephilia, and the DSM-V,’’ with only
minor revisions, I would have recommended publication.
The article appears to provide a solid, basic science investi-
gation of some of the categories of erotic age orientation. The
bulk of this peer-reviewed article appears to be scientific and
to contribute to the advancement of knowledge.
Regrettably, however, Blanchard et al. did not merely
report on their research and draw appropriate conclusions.
Instead, they recommended a potentially dramatic expansion
or addition to the DSM diagnostic categories of mental dis-
orders without any evidence or reasoning that those who
would be newly included under the mental disorder rubric can
be properly categorized as mentally disordered. Blanchard
et al. did not define mental disorder. They did not measure
mental disorder. They did not examine associations with
mental disorder. They did not provide reasoning that leads to
a conclusion of mental disorder. However, they did assert,
without evidence or reasoning, that the DSM should be ex-
panded to include more people as having a mental disorder—
and they did this in the most prominent ‘‘take home message ’
locations in their article—in the abstract and in the first par-
agraph of their discussion section—even the title alludes to
the article’s connection to DSM modification. In the first
paragraph of the discussion section, Blanchard et al. wrote:
the DSM-V should expand the definition of Pedo-
philia so that it includes erotic attraction to pubescent
and prepubescent children or, alternatively, add a sep-
arate diagnosis of Hebephilia.Another possibility
would be to completely replace the diagnosis of
Pedophilia with Pedohebephilia and allow the clinician
to specify one of three subtypes
Like masturbation and homosexuality, pedophilia (infor-
mally: erotic attraction to prepubescent people) appears to have
entered the DSM as a ‘‘mental disorder’’ without any scientific
or rational basis, perhaps because, like masturbation and ho-
mosexuality, pedophilia does not usually lead to procreation.
Indeed, even today, there appears to be no rational scientific
basis for the inclusion of pedophilia as a defined mental dis-
order (cf. Green, 2002; Moser & Kleinplatz, 2005; Suppe,
1984). When appearing in an article that did not examine or
discuss the concept of mental disorder, I find the Blanchard
et al. (2008) call to expand the definition problematic.
The Archives andtheauthorsshouldpublishanerrataclearly
indicating that the Blanchard et al. (2008) article provided
no evidence or reasoning to support their recommendation
regarding the expansion of the problematic diagnostic category
of pedophilia. The Archives should additionally examine its
peer-review system to determine how such a prominent rec-
ommendation—that does not follow fro m the research reported
in the article—was allowed to be published, and take steps to
minimize this type of problem from reoccurring.
References
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Green, R. (2002). Is pedophilia a mental disorder? Archives of Sexual
Behavior, 31, 467–471.
Moser, C., & Kleinplatz, P. J. (2005). DSM-IV-TR and the paraphilias:
An argument for removal. Journal of Psychology and Human
Sexuality, 17(3/4), 91–109.
Suppe, F. (1984). Classifying sexual disorders: The Diagnostic and
Statistical Manual of the American Psychiatric Association.
Journal of Homosexuality, 9, 9–28.
P. Tromovitch (&)
College of Liberal Arts and Sciences, Tokyo Medical and Dental
University, 2-8-30 Konodai, Ichikawa, Chiba 272-0827, Japan
e-mail: tromovitch.las@tmd.ac.jp
123
Arch Sex Behav (2009) 38:328
DOI 10.1007/s10508-008-9426-x
LETTER TO THE EDITOR
Adult Sexual Attraction to Early-Stage Adolescents: Phallometry
Doesn’t Equal Pathology
Thomas K. Zander
Published online: 18 October 2008
ÓSpringer Science+Business Media, LLC 2008
The finding of Blanchard et al. (2008) that adult self-reports
of sexual preference for early-stage adolescents generally
matched their phallometric responses to such adolescents
does not justify the broad and startling conclusion of these
researchers that ‘‘hebephilia exists as a discriminable erotic
age-preference’ so as to justify an expansion of the DSM
diagnostic category of Pedophilia to include early-stage
adolescents.
DSM-IV-TR draws the distinction between pathological
and non-pathological age-related sexual arousal at the onset
of pubescence: adult arousal to prepubescents is considered
pathological and adult arousal to pubescents and post-pu-
bescents is considered non-pathological. This distinction is
more than academic. It has serious, real world implications,
given that, in the U.S., a diagnosis of Pedophilia can result in
the diagnosed individual being subject to potential lifetime
confinement pursuant to so-called ‘‘sexually violent preda-
tor’’ civil commitmen t laws (Zander, 2005). There are at least
three major reasons why the Blanchard et al. proposal to
extend the diagnostic criteria for Pedophilia to include adult
sexual attraction to early-stage adolescents is a leap that is
insufficiently supported by their data.
First, as conceded in their article, ‘‘The main methodo-
logical limitation of the present study was the absence of
models age 15–18 (mid- to late-adolescence) among the
phallometric stimuli.’’ This means that we do not know if men
who were aroused to early-stage adolescents—whom Blan-
chard et al. would now classify as paraphilic—might not also
be equally or more aroused to mid- to late-stage adolescents,
with respect to which they acknowledge, ‘‘Few would want to
label erotic interest in late-or even mid-adolescents as psy-
chopathology.’’ Yet, their proposal may do just that by pa-
thologizing men attracted to early-stage adolescents as part of
an overall arousal pattern to adolescents in all stages of sexual
development. In other words, conspicuous by their absence
are any data to refute the alternative hypothesis that sexual
attraction to adolescents at all stages of sexual development
is a discriminable, but not pathological, erotic preference.
Second, the proposal to extend the already problematic
diagnosis of Pedophilia to include early-stage adolescents
would complicate the diagnosis further by exacerbating the
problem of the diagnostic discriminability that Blanchard
et al. aptly and punningly identify by pointing out that ‘‘[T]he
onset of puberty varies from child to child and.. the bound-
aries of puberty are fuzzy to begin with.’’ Clinicians already
wrestle with the line of demarcation between pre-pubescence
and pubescence in the current diagnostic criteria, given: (1)
the many definitions of pubertal onset (e.g., for girls is it
menarche [mean age, 12.1 years, for African-American
girls] or thelarche/pubarche [mean age, 9 years, for African-
American girls]); (2) the wide variability of individual
pubertal onset age; and (3) the overall decreasing age of
pubertal onset (Herman-Giddens, 2006). Imagine how much
more impractical it would be to require forensic evaluators to
determine the existence of Pedophilia based on the stage of
adolescence of the examinee’s victim. Such determinations
could literally devolve into a splitting of pubic hairs—
resulting in an interrater reliability for the expanded diag-
nosis of Pedophilia that is even worse than is the case with
the current version (Wollert, 2007). Their proposal to have
diagnosticians specify the examinee’s preferred age to which
he is aroused does little to solve the problem of discriminating
early-stage adolescents from mid- to late-adolescents given
the aforementioned diagnostic ambiguities resulting from
variable and decreasing age of puberty.
T. K. Zander (&)
10936 N. Port Washington Rd. #285,
Mequon, WI 53092-5031, USA
e-mail: DrTomZander@aol.com
123
Arch Sex Behav (2009) 38:329–330
DOI 10.1007/s10508-008-9428-8
Third, the decision to designate a behavior as pathological
should be based not merely on phallometric evidence but also
on consideration of the extent to which the behavior is
abnormal in our culture and other cultures. Given previous
research establishing the ubiquity of adult male attraction
to adolescents, the proposal of Blanchard et al. represents
an unprecedented ascription of pathology to what may be
common arousal—albeit sometimes socially proscribed
when acted on. Had they limited their commentary to sug-
gested semantics of the terms pedophilia and hebephilia,
their article would have been uncontroversial. By the same
token, an article presenting phallometric research about
middle-aged male sexual response to 18-year-olds might
comment on the proper use of the term teleiophilia. When
these terms are used merely to describe adult sexual re-
sponses that are based on stages of human development, they
are objective, and carry no social policy implications.
However, the article went beyond mere description to a
recommendation of pathologization—a conceptual leap that
required much more substantiation than was provided. If it
turns out that 50% of nonoffending men consistently exhibit
penile arousal to images of early-stage adolescents, would
they still advocate labeling them mentally disordered? Since
DSM does not require that a Paraphilia diagnosis be premised
on the paraphilic interest being exclusive or even preferred,
anyone whose behavior indicated arousal to early-stage
adolescents would be diagnosable as pedophiles under the
proposal made by Blanchard et al. Given that 14 years is the
age of consent to sexual activity in some U.S. states and many
countries (Salopek, 2004), does it make sense to label as
mentally disordered all of the adults who legally engage in
sexual activity with 14-year-olds who happen to be ‘‘late
bloomers’’?
Clinicians who are currently using the miscellaneous DSM
diagnosis of Paraphilia Not Otherwise Specified to patholo-
gize adult sexual attraction to adolescents of all stages of
sexual development are creating a diagnosis on an ad hoc
basis. They are ignoring the fact that there is neither a pro-
fessional consensus nor a convincing body of research to
support such pathologization, and much to call it into ques-
tion, including research that shows a common human male
sexual response to adolescents (Freund & Costell, 1970;
Quinsey, Steinman, Bergersen, & Holmes, 1975), and an-
thropological research that demonstrates that this male sex-
ual response is broadly represented in cultures that sanction
marriage between mature adults and adolescents, including
early-stage adolescents (Diamond, 1990; Salopek, 2004).
Nevertheless, a disturbing number of forensic psychologists
are making such ad hoc diagnoses to support recommenda-
tions that adults who have engaged in mutually agreeable
sexual activity with adolescents be civilly committed and
confined in prison-like facilities—potentially for the rest of
their lives (Zander, 2005). DSM should not be amended to
accommodate these rogue diagnosticians.
The DSM section on Paraphilias is not a dictionary of
terms describing types of sexual response patterns. Rather, it
is a compendium of social judgments about what sexual
behavior does and does not constitute mental disorder justi-
fying the clinical intervention of mental health professionals
and, in some cases, legal intervention to force treatment and
potential lifetime confinement on those whose behavior
matches DSM diagnostic criteria. Phallometric evidence that
some men are sexually aroused by images of early-stage
adolescents no more justifies the designation of such arousal
as pathology than does phallometric evidence that some men
are aroused by images of other men—even though acting on
either form of arousal is illegal in many countries. Any new or
expanded DSM diagnosis that can have implications as pro-
found as the one proposed by Blanchard et al. requires a
broad base of replicated research (not just one study with a
glaring methodological omission), as well as extensive field
testing to ensure its interrater reliability, and a full and open
debate about its conceptual validity. Researchers proposing
expansion of DSM criteria must be sensitive to the validity,
reliability, and social implications of their recommendations.
References
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
Diamond, M. (1990). Selected cross-generational sexual behavior in
traditional Hawaii: A sexological ethnography. In J. Feierman
(Ed.), Pedophilia: Biosocial dimensions (pp. 422–424). New
York: Springer.
Freund, K., & Costell, R. (1970). The structure of erotic preference in the
nondeviant male. Behaviour Research and Therapy, 8, 15–20.
Herman-Giddens, M. E. (2006). Recent data on pubertal milestones in
United States children: The secular trend toward earlier develop-
ment. International Journal of Andrology, 29, 241–246.
Quinsey, V. L., Steinman, C. M., Bergersen, S. G., & Holmes, T. F.
(1975). Penile circumference, skin conductance, and ranking
responses of child molesters, and ‘‘normals’ to sexual and
nonsexual visual stimuli. Behavior Therapy, 6, 213–219.
Salopek, P. (2004, December 12). From child to bride: Early marriage
survives in the U.S. Chicago Tribune, 22, http://www.chicagotri
bune.com/news/local/chi-0412120359dec12,0,2045063.story.
Wollert, R. (2007). Poor diagnostic reliability, the Null-Bayes logic
model, and their implications for sexually violent predator eval-
uations. Psychology, Public Policy, and Law, 13, 167–203.
Zander, T. K. (2005). Civil commitment without psychosis: The law’s
reliance on the weakest links in psychodiagnosis. Journal of Sexual
Offender Civil Commitment: Science and the Law, 1, 17–82.
330 Arch Sex Behav (2009) 38:329–330
123
LETTER TO THE EDITOR
Reply to Letters Regarding Pedophilia, Hebephilia, and the DSM-V
Ray Blanchard
Published online: 16 October 2008
Springer Science+Business Media, LLC 2008
The on-line publication of our article, ‘‘Pedophilia, Hebe-
philia, and the DSM-V’ (Blanchard et al., 2008), quickly
prompted the writing of several letters to the editor of this
journal. I am writing this letter of reply as sole author, and any
inadequacies or inaccuracies in it can be attributed to me
alone.
The letters by Tromovitch (2008) and DeClue (2008) fo-
cus on our recommendation that hebephilia (the erotic pref-
erence for pubescent children) be considered for inclusion in
the fifth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-V). Tromovitch and DeClue point
out that we did not provide a definition of mental disorder,
and we did not investigate whether hebephilia would satisfy
the definition of mental disorder. That is true. We could and
perhaps should have included a statement to this effect: ‘‘The
clinical implications of this study depend on the DSM-V using
a definition of mental disorder that is similar to the definition
supplied in the DSM-IV-TR (American Psychiatric Associ-
ation, 2000, pp. xxxi) and on the future interpretation of that
definition as including the erotic preference for physically
immature individuals. The sex-research implications of the
study, however, do not depend on these outcomes.’
There is a sense in which Tromovitch’s views accord with
the implications of our study. Tromovitch writes that there is
no basis for classifying pedophilia (the erotic preference for
prepubescent children) as a mental disorder, and that there
has been no rationale for including pedophilia in any edition
of the DSM. Since pedophilia should not be in the DSM,
hebephilia should not be in it either. The clinical implications
of our study are essentially the obverse: If pedophilia is in-
cluded in the DSM, then hebephilia should be included also.
Thus, he and we appear to agree that clinical judgments
regarding the one preference are relevant to the other.
It is difficult to divine whether some of the other letter-
writers share Tromovitch’s view, or whether they are willing
to accept pedophilia as a psychopathology but not hebephilia.
Franklin supports one of her criticisms with a reference to
Kleinplatz and Moser (2005), who argued in that paper and in
similar papers published elsewhere that all paraphilias should
be removed from the DSM. That suggests that Franklin might
agree with Tromovitch that neither pedophilia nor hebephilia
belongs in the DSM. On the other hand, Franklin argues that
erotic attractions to ‘‘young pubescent girls are evolu-
tionarily adaptive,’’ which suggests that she might be making
some distinction between sexual interest in prepubescent
girls and sexual interest in pubescent girls on the basis of
fecundity, or on the basis of males’ reproductive strategies for
ensuring that they are the fathers of all their mates’ offspring.
It is not clear how, or whether, she would apply this distinc-
tion to homosexual pedophilia and hebephilia. DeClue reg-
isters no objection to the classification of pedophilia as a
psychopathology; he is willing to contemplate hebephilia as a
psychopathology on the condition that this would produce no
increase in the total number of men diagnosed as paraphilic
by DSM criteria. He does not explain how this condition
squares with his view that erotic preferences should be
classified as mental disorders according to some previously
stated definition of mental disorder.
Zander (2008) appears not to agree with Tromovitch, since
he begins his critique with an affirmation of the status quo:
‘‘ DSM-IV-TR draws the distinction between pathological and
non-pathological age-related sexual arousal at the onset of
pubescence: adult arousal to prepubescents is considered
R. Blanchard (&)
Kurt Freund Laboratory, Law and Mental Health Program,
Centre for Addiction and Mental Health, 250 College Street,
Toronto, ON, Canada M5T 1R8
e-mail: ray_blanchard@camh.net
123
Arch Sex Behav (2009) 38:331–334
DOI 10.1007/s10508-008-9427-9
pathological and adult arousal to pubescents and post-pube-
scents is considered non-pathological.’’ It is, of course, pre-
cisely this ‘‘bright red line’’ between prepubescents and
pubescents that our paper questioned. Plaud (2008) does not
state whether he thinks pedophilia is a mental disorder or
whether pedophilia should be listed in the DSM.Heis
skeptical that hebephilia exists, so the question of it being a
psychopathology would presumably be moot.
Other criticisms by Franklin, Plaud, and Zander cover a
miscellany of matters. For example, Franklin (2008) flatly
states that ‘‘A diagnosis of hebephilia would be even more
unreliable than the current DSM-IV diagnosis of pedophilia,’’
and Zander argues much the same, although less tersely.
Neither offers any evidence to support this position, but it is
an easy point to concede. The population of pedophiles in-
cludes a subgroup of men who approach very young children,
and whose diagnoses are therefore unmistakable. There is,
however, no such thing as being extremely pubescent, in the
sense that an individual can be extremely young or extremely
old. There can therefore be no subgroup of hebephiles who
preferentially molest ‘‘extreme pubescents,’’ and whose di-
agnoses are accordingly unmistakable. It seems reasonable
that the absence of a subgroup of hebephiles whose diagnoses
are virtually certain on the basis of victim-age alone would
make the diagnosis of hebephilia somewhat less reliable than
the diagnosis of pedophilia.
But so what? Should there exist no diagnosis for men who
say they are most attracted to pubescents, who have com-
mitted repeated sexual offenses against pubescents, and who
respond most strongly to laboratory stimuli depicting pube-
scents just because there are other men who produce less
consistent findings? And what—back to Franklin—has the
relative reliability of diagnosing pedophilia got to do with it?
Some of our critics have misread or mischaracterized the
text in ways that seem difficult to explain by simple care-
lessness. It is perfectly clear, throughout our article, that we
define hebephiles not as men who respond sexually to
pubescents, but as men who respond more to pubescents than
they do to prepubescent children or to adults. Furthermore,
our key statistical test, which we conducted using two
somewhat different methodologies to be on the safe side,
compared hebephiles’ penile responses to pubescent girls vs.
prepubescent girls, and to pubescent girls vs. adult women.
Nevertheless, Zander asks, ‘‘If it turns out that 50% of non-
offending men consistently exhibit penile arousal to images
of early-stage adolescents, would they still advocate labeling
them mentally disordered?’’ The answer, which should be
obvious to anyone who has read our article, is that it would be
irrelevant if 100% of hypothetical non-offending men con-
sistently respond to pubescents, just so long as they respond
even more to adults. Franklin similarly ignores our explicit
definition of hebephilia in her assertion, ‘‘The absurdity of
describing erotic attraction to adolescents as a mental
disorder is that large proportions of heterosexual men are
sexually attracted to young pubescent girls.’’ It is ironic that
both Franklin and Zander should attack our paper on the
grounds that erotically normal men show some penile re-
sponse to pubescent girls, when our laboratory was one of the
first to report this (Freund, McKnight, Langevin, & Cibiri,
1972). That reliable finding is one reason why we define
pedophiles as men with an erotic preference for children,
1
and why we classify men as pedophilic, hebephilic, or
teleiophilic on the basis of relative penile responses rather
than absolute increases in penile blood volume (e.g., Blan-
chard, Klassen, Dickey, Kuban, & Blak, 2001; Freund &
Blanchard, 1989).
Franklin, Zander, and especially Plaud collectively raise a
great number of points that they conceive as serious or fatal
methodological flaws. Both Franklin and Plaud stress the fact
that our study did not include separate groups of heterosexual
and homosexual teleiophiles (persons most attracted sexually
to physically mature adults) who were recruited from the
community and who lacked any known history of sexual
offending. The implication of this criticism is that there is
some realistic chance the data from such groups would
overturn the conclusions of our study. It is worthwhile ex-
amining this notion more closely.
The essential goal of our study was to investigate whether
men who say that they are more attracted to pubescents than
to prepubescent children or to adults produce greater penile
responses in the laboratory to depictions of pubescents than to
depictions of prepubescent children or adults. We were not
questioning the existence of pedophiles and teleiophiles, and
we expected our pedophilic and teleiophilic groups to re-
spond most to prepubescent children and adults, respec-
tively—which by and large they did. The heterosexual
teleiophiles (many, but not all, of whom had sexual offenses
against women over age 17) responded most to adult women,
less to pubescent girls, and less yet to prepubescent girls
(Blanchard et al., 2008, Fig. 3). The homosexual teleiophiles
responded most to adult men, less to pubescent boys, and less
yet to prepubescent boys (Blanchard et al., 2008, Fig. 4). The
phallometric response-profiles of our heterosexual teleio-
philes and homosexual teleiophiles were similar to those
presented by Freund, Langevin, Cibiri, and Zajac (1973,
1
The definitions of erotic age-preferences used in our laboratory are
modeled on the examples given by Freund (1981, p. 161): ‘‘let us define
pedophilia as a subject’s sustained erotic preference for children (within
the age range up to and including 11 or 12) as compared to this subject’s
erotic inclination toward physically mature persons, and under the
condition that there is a free choice of partner as to sex and other
attributes which may co-determine erotic attractiveness. In this def-
inition the term ‘child’ denotes primarily a person characterized by a
particular typical set of gross somatic features. Let us define analogously
the term hebephilia as an erotic preference for pubescents and let us
define the age bracket of pubescents to be approximately 11 or 12 to 13 or
14 for girls, and to 15 or 16 for boys.’
332 Arch Sex Behav (2009) 38:331–334
123
Fig. 1) for paid community volunteers. The results for our
heterosexual teleiophiles also resemble those observed by
Frenzel and Lang (1989, Fig. 1), who studied nonoffending,
heterosexual, teleiophilic, community volunteers.
If our nominally teleiophilic groups had produced unex-
pected age-preference profiles in the phallometric laboratory,
it might be reasonable to conjecture that additional teleio-
philic groups recruited from the community might produce
data that would overthrow our conclusions. Every indication,
however, is that such additional teleiophilic groups would
look similar or identical to the teleiophiles we already had. It
is therefore unclear why Franklin and Plaud lay such weight
on the fact that some of our teleiophiles had committed sexual
offenses against persons of the age and gender they claim to
prefer—something that might actually be seen as validating
the teleiophiles’ self-report.
Another putative flaw mentioned by Franklin, Plaud, and
Zander is that the phallometric stimuli did not include models
age 15–18, that is, in mid- to late-adolescence. We described
this in our Discussion section as a methodological limitation,
because the absence of such models made it impossible to
directly validate self-reports of ephebophilia. (It would have
been nice to validate self-reports of ephebophilia for the sake
of completeness, although this preference was not the focus
of the study.) Both Plaud and Franklin assert that the absence
of 15–18-year-old models is problematic, but neither ex-
plains how or why it poses a threat to our conclusions
regarding hebephilia.
Zander argues—if I understand him correctly—that men
who claim they are most attracted to persons age 11–14 might
actually be equally or even more attracted to persons age 15–
18; if nude models age 15–18 had been included in the
phallometric test stimuli, this could become apparent. This
argument is, in my opinion, far-fetched. Why should a man
with a principal attraction to 16-year-olds, which is already
socially undesirable, inaccurately claim a principal attraction
to 12-year-olds, which could be downright dangerous to
admit?
Much of Plaud’s criticism appears to be based on the
assumption that erotic age-preferences are truly taxonic rather
than truly continuous. In the taxonic model, pedophiles should
respond sexually only to prepubescent children, hebephiles
should respond only to pubescents, and teleiophiles should
respond only to adults. In the continuous model, pedophiles
should respond most strongly to prepubescent children,
somewhat less to pubescents, and least to adults. Teleiophiles
should respond most strongly to adults, somewhat less to
pubescents, and least to prepubescent children. Hebephiles
should respond most strongly to pubescent children and
somewhat less to prepubescent children and to adults.
Zander and Franklin seem to assume a continuous model,
because both of them, in support of their arguments, point to
research showing that teleiophilic men respond to pubescents.
Plaud’s assumption of the veridicality of the taxonic model
causes him to identify as problematic results that would be
expected fromthe continuous model. Thus,he writes, as prima
facie evidence of something wrong with the study, ‘‘there was
a statistical difference in their pedophiles between pubescent
girls and adult women’’—in other words, the heterosexual
pedophiles produced greater penile responses to pubescent
girls than to adult women (see Blanchard et al., 2008,Ta-
ble 2). This is precisely the result one would expect if the
continuous model of erotic age-preferences is true (and if one
has sufficient statistical power for that comparison).
The continuous model also predicts that teleiophiles
should respond more to pubescents than to prepubescent
children. This was observed in our study both for hetero-
sexual and homosexual teleiophiles (Blanchard et al., 2008,
Tables 2 and 3, respectively). Plaud does not, for some rea-
son, object to this finding, although it is the exact analog of the
finding that pedophiles respond more to pubescents than to
adults.
It is unclear, from Plaud’s discussion of our classification
algorithm, whether he appreciates that the self-report data
presented in our Figs. 1 and 2 are, in effect, averages of
individual generalization gradients. It is, in fairness to Plaud,
unclear whether anyone could grasp this point from our brief
allusion to it in the second paragraph of our article’s section
Self-Report of Erotic Preferences. In any event, the group
profiles look as they do, not because the groups are so het-
erogeneous, but because the group profiles reflect the shape
of individual profiles.
In order to clarify this possibly confusing point for other
readers, I have presented individual data for all 10 subjects in
our smallest group, the homosexual Hebephile 1 group.
Figure 1shows that the men identified by our classification
algorithm as reporting maximum interest in pubescent males
generally reported diminishing degrees of attractiveness for
males of other ages in proportion to those males’ distance
from the age of puberty. (Subject 10 is the most notable
exception to this pattern.) Thus, the behavior of individual
subjects—not some deficiency in our classification algo-
rithm—is the main source of the ‘‘significant amount of
variability’’ (‘‘kurtosis’’ would be a better analogy) noted by
Plaud.
I will not discuss any more of the specific criticisms of-
fered by Plaud, Franklin, and Zander in this letter. Some of
the matters they present as problematic were explicitly raised
and addressed in the original article (e.g., possible reasons
why the findings for the homosexual men did not precisely
mirror those for the heterosexual men). Motivated readers
can study that article and decide the merits of the remaining
criticisms for themselves. I do not think that any of the
methodological criticisms offered by the letter-writers
threaten the conclusion of our study that a literal interpreta-
tion of the DSM-IV-TR definition of pedophilia would
Arch Sex Behav (2009) 38:331–334 333
123
exclude from diagnosis a sizable proportion of those men
whose strongest sexual feelings are for physically immature
persons.
References
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text revision). Washington,
DC: Author.
Blanchard, R., Klassen, P., Dickey, R., Kuban, M. E., & Blak, T. (2001).
Sensitivity and specificity of the phallometric test for pedophilia in
nonadmitting sex offenders. Psychological Assessment, 13, 118–
126.
Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M.,
Blak, T., et al. (2008). Pedophilia, hebephilia, and the DSM-V.
Archives of Sexual Behavior. doi:10.1007/s10508-008-9399-9.
DeClue, G. (2008). Should hebephilia be a mental disorder? A reply to
Blanchard et al. (2008) [Letter to the editor]. Archives of Sexual
Behavior. doi:10.1007/s10508-008-9422-1.
Franklin, K. (2008). The public policy implications of ‘‘hebephilia’’: A
response to Blanchard et al. (2008) [Letter to the editor]. Archives
of Sexual Behavior. doi:10.1007/s10508-008-9425-y.
Frenzel, R. R., & Lang, R. A. (1989). Identifying sexual preferences in
intrafamilial and extrafamilial child sexual abusers. Annals of Sex
Research, 2, 255–275.
Freund, K. (1981). Assessment of pedophilia. In M. Cook & K. Howells
(Eds.), Adult sexual interest in children (pp. 139–179). New York:
Academic Press.
Freund, K., & Blanchard, R. (1989). Phallometric diagnosis of pedo-
philia. Journal of Consulting and Clinical Psychology, 57, 100–
105.
Freund, K., Langevin, R., Cibiri, S., & Zajac, Y. (1973). Heterosexual
aversion in homosexual males. British Journal of Psychiatry, 122,
163–169.
Freund, K., McKnight, C. K., Langevin, R., & Cibiri, S. (1972). The
female child as a surrogate object. Archives of Sexual Behavior, 2,
119–133.
Kleinplatz, P. J., & Moser, C. (2005). Politics versus science: An
addendum and response to Drs. Spitzer and Fink. Journal of
Psychology & Human Sexuality, 17, 135–139.
Plaud, J. J. (2008). Are there ‘‘hebephiles’’ among us? A response to
Blanchard et al. (2008) [Letter to the editor]. Archives of Sexual
Behavior. doi:10.1007/s10508-008-9423-0.
Tromovitch, P. (2008). Manufacturing mental disorder by pathologiz-
ing erotic age orientation: A comment on Blanchard et al. (2008)
[Letter to the editor]. Archives of Sexual Behavior. doi:10.1007/
s10508-008-9426-x.
Zander, T. K. (2008). Adult sexual attraction to early-stage adolescents:
Phallometry doesn’t equal pathology [Letter to the editor].
Archives of Sexual Behavior. doi:10.1007/s10508-008-9428-8.
Fig. 1 Attractiveness ratings for males of various ages, for the 10
individual subjects in the homosexual Hebephile 1 group. The anchor-
points for the attractiveness ratings are as follows: 1, males of the
canvassed age stimulate no sexual interest; 5, males of that age stimulate
as much sexual interest as the participant is capable of feeling
334 Arch Sex Behav (2009) 38:331–334
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... In both types of phallometric assessment, individuals are exposed to audio and/or visual stimuli that vary the sex and stage of sexual development of depicted targets; however, there is a lack of standardization in phallometric testing, which means that the stimuli and test procedures can vary greatly across different laboratories (e.g., Howes, 1995). Despite this lack of standardization, on average, phallometry distinguishes those suspected of having sexual interest in children from those not suspected to have sexual interest in children (e.g., Blanchard et al., 2001Blanchard et al., , 2009aMcPhail et al., 2019;Stephens et al., 2017a). In addition, phallometrically assessed sexual interest in children is one of the best predictors of sexual reoffending (e.g., Hanson & Morton-Bourgon, 2005). ...
... We have only included variables from the larger dataset that are relevant to our research question. Men in the present study overlap with previous studies that have addressed distinct research questions (Bailey et al., 2020;Barbaree et al., 2003;Blanchard, 2011;Blanchard & Barbaree, 2005;Blanchard et al., 2001Blanchard et al., , 2006Blanchard et al., , 2009bBlanchard et al., , 2012Blanchard et al., , 2009aCantor & McPhail, 2015;Lykins et al., 2010Lykins et al., , 2015Seto et al., 2006Seto et al., , 2017Stephens et al., 2017aStephens et al., , 2017bStephens et al., , 2019Stephens et al., , 2018. ...
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Phallometric assessment is used to assess men’s sexual interest in children and to assist in risk assessment and treatment planning. A common response pattern, especially when the assessment is conducted in a forensic context, is an indiscriminate pattern of penile responses: No sexual stimulus seems to produce a substantially higher response than another. This indiscriminate response profile could be the result of (1) faking good (in particular, reducing the responses to child stimuli); (2) floor or ceiling effects caused by low or high arousability, or (3) non-exclusivity (the individual is similarly sexually interested in both children and adults). In this study of 2,858 adult male patients who underwent volumetric phallometric assessment for sexual interest in children between 1995 and 2011, we tested these three possible explanations. Results showed support for each of the explanations, but the variance accounted for in response discrimination was quite small when considering each explanation (separately or when considered together). We discuss avenues for future research to better discern the causes of indiscriminate responding in phallometric assessment.
... The present article focuses on label preferences among people who experience a sexual attraction to prepubescent or pubescent children (i.e., pedophilia or hebephilia, respectively, according to psychiatric conventions, American Psychiatric Association, 2013; Blanchard et al., 2008). 1 As with homo-, bi-, or heterosexuality, previous research indicates that sexual attraction to children is mostly stable throughout life (Grundmann et al., 2016;Seto, 2012Seto, , 2017, at least in cases where the attraction to children is more exclusive (Tozdan & Briken, 2019). The most common label to refer to people who are sexually attracted to children (i.e., "pedophile") is colloquially used as a slur and/or way to refer to people who have committed sexual offenses against children (Feelgood & Hoyer, 2008;Harper & Hogue, 2015;McCartan, 2010). ...
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The primary label for people who are sexually attracted to children (“pedophile”) is conflated with sexual offending behavior and tainted with stigma. In the present pre-registered mixed-method study, we therefore investigated attitudes and preferences regarding "pedophile/hebephile" and other labels among 286 people who report a stronger or equally strong sexual attraction to prepubescent and pubescent children than to adults. Overall, quantitative data showed acceptance of “pedophile/hebephile” as well as a range of alternative labels in a personal (Labeling Oneself) and a professional context (Being Labeled by Others). “Minor-attracted person” and “pedophile/hebephile” received generally higher support than other terms and appeared to be least divisive across three major online fora. Qualitative data revealed four themes: “Contested self-labels,” “Person-first language and pathologizing sexuality/identity,” “Stigma and shame,” and “Reclaiming the pedophile label.” Our results allow deeper insight into reasons for adopting certain labels over others, as well as difficulties of finding a non-stigmatizing label. We discuss limitations of the study and practical implications for clinical and research contexts.
... The present article focuses on label preferences among people who experience a sexual attraction to prepubescent or pubescent children 1 (i.e., pedophilia or hebephilia, respectively, according to psychiatric conventions, American Psychiatric Association, 2013; Blanchard et al., 2008). As with homo-, bi-or heterosexuality, previous research indicates that sexual attraction to children is mostly stable throughout life (Grundmann et al., 2016;Seto, 2012Seto, , 2017, at least in cases where the attraction to children is more exclusive (Tozdan & Briken, 2019). ...
Preprint
Full-text available
The primary label for people who are sexually attracted to children (“pedophile”) is conflated with sexual offending behavior and tainted with stigma. In the present pre-registered mixed-method study, we therefore investigated attitudes and preferences regarding "pedophile/hebephile" and other labels among 286 people who report a stronger or equally strong sexual attraction to prepubescent and pubescent children than to adults. Overall, quantitative data shows acceptance of “pedophile/hebephile” as well as a range of alternative labels in a personal (Labelling Oneself) and a professional context (Being Labeled by Others). “Minor-attracted person” and “pedophile/hebephile” received generally higher support than other terms and appeared to be least divisive across three major online fora. Qualitative data revealed four themes: “Contested self-labels”, “Person-first language and pathologizing sexuality/identity”, “Stigma and shame”, and “Reclaiming the pedophile label.” Our results allow deeper insight into reasons for adopting certain labels over others, as well as difficulties of finding a non-stigmatizing label. We discuss limitations of the study and practical implications for clinical and research contexts.
... Pedophilia is broadly defined as an enduring sexual interest in prepubertal children (often between ages 3-10; Seto, 2017), whereas pedophilic disorder requires enduring interest as well as harm, distress, and/or feelings of guilt and remorse (American Psychological Association, 2020). Hebephilia refers to sexual interest in pubescent children (commonly between 11 and 14 years; Blanchard et al., 2009). Sexual interest in children is a term used throughout this research encompassing both pedophilia and hebephilia. ...
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The rampant conflation between having a sexual interest in children and engaging in acts of sexual abuse contributes substantially to high levels of stigma directed toward people living with a sexual interest in children. Stigmatization and societal punitiveness surrounding people living with these interests can impact their well-being, obstruct help-seeking, and potentially increase risk of offending behavior. Previous research employing