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Psychological Science
2017, Vol. 28(1) 115 –123
© The Author(s) 2016
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DOI: 10.1177/0956797616677082
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Research Article
Sexual orientation is typically understood as relative
attraction to men versus women. At least two other
dimensions that vary among men in particular might also
characterize sexual orientation. One dimension distin-
guishes the degree of sexual maturity of individuals to
whom men are sexually attracted (Seto, 2012, 2016). Most
men are sexually attracted to adults, but a minority are
attracted to prepubescent children (pedophilia) or to
pubescent children (hebephilia; the latter two prefer-
ences may be considered together as pedohebephilia).
The other dimension is both less familiar and more puz-
zling: the degree to which a man is sexually attracted to
other individuals or instead sexually aroused by the idea
or fantasy of himself as one of those individuals
(Blanchard, 1991; Freund & Blanchard, 1993; Lawrence,
2009). This dimension may be thought of as an erotic
target’s location: external or internal. Other researchers
(Blanchard, 2015; Seto, 2016) have also argued that sex-
ual orientation encompasses multiple dimensions, includ-
ing gender, sexual maturity, and location.
Most men are sexually attracted to other individuals
and thus have external erotic targets (e.g., women).
Sometimes, however, a man’s erotic target is located
within his own body. In the latter case, he is sexually
aroused by the idea or fantasy of being the erotic target,
and his sexuality is characterized by an erotic-target
identity inversion (ETII; Freund & Blanchard, 1993). Men
with ETIIs are often also capable of sexual attraction to
other individuals (Blanchard, 1989b, 1992). In these
cases, the external and internal erotic targets are similar.
ETIIs may motivate men to change their bodies and
behavior to become more like their internalized erotic
target.
Autogynephilia and Apotemnophilia as
ETIIs
Autogynephilia is a natal male’s propensity to be sexually
aroused by the thought or image of being a woman
677082PSSXXX10.1177/0956797616677082Hsu, BaileyAutopedophilia
research-article2016
Corresponding Author:
Kevin J. Hsu, Department of Psychology, Northwestern University,
2029 Sheridan Rd., Evanston, IL 60208
E-mail: khsu@northwestern.edu
Autopedophilia: Erotic-Target Identity
Inversions in Men Sexually Attracted to
Children
Kevin J. Hsu and J. Michael Bailey
Department of Psychology, Northwestern University
Abstract
The most salient dimension of men’s sexual orientation is gender: attraction to males versus females. A second
dimension is sexual maturity: attraction to children versus adults. A less appreciated dimension is location: attraction
to other individuals versus the sexual fantasy of being one of those individuals. Men sexually aroused by the idea or
fantasy of being the kinds of individuals to whom they are sexually attracted have an erotic-target identity inversion
(ETII). We conducted an online survey to investigate the prevalence and phenomenology of ETIIs among 475 men
sexually attracted to children. Autopedophilia, or sexual arousal by the idea of being a child, was common. Furthermore,
autopedophilic men tended to be sexually aroused by imagining themselves as the kinds of children (with respect
to gender and age) to whom they are sexually attracted. Results support the concept of ETIIs and exemplify the
simultaneous importance of three dimensions of male sexual orientation.
Keywords
autopedophilia, pedohebephilia, erotic-target identity inversion, autogynephilia, paraphilia, sexual orientation
Received 4/29/16; Revision accepted 10/11/16
116 Hsu, Bailey
(Blanchard, 1989a), and it is the best studied ETII
(Blanchard, 2005; Lawrence, 2013). In the conceptualiza-
tion of autogynephilia as an ETII, natal males who are
otherwise sexually attracted to women are sexually
aroused by resembling or impersonating them (Blanchard,
1991). Thus, autogynephilic men often find cross-dressing
to be erotic (Blanchard, 1991; Hsu, Rosenthal, & Bailey,
2015; Lawrence, 2013). Some also find it erotic to fantasize
about having female-typical anatomy, and these men are
more likely to report gender dysphoria and the desire for
sex reassignment (Blanchard, 1993a, 1993c). Because
women are the preferred erotic targets of most men, auto-
gynephilia is likely to be the most common form of ETII
(Blanchard, 1993b).
Autogynephilia may be considered a paraphilia.
Indeed, Freund and Blanchard (1993) suggested that all
ETIIs are paraphilias. Paraphilias encompass an ill-defined
set of unusual sexual interests, including pedohebephilia,
exhibitionism, masochism, and sadism. Some writers have
criticized the concept of paraphilias as representing noth-
ing more than the value judgment that certain sexual
interests and behaviors are undesirable (e.g., Moser &
Kleinplatz, 2006). An alternative view—which we hold—
is that the concept of paraphilias has some limited empir-
ical support and remains scientifically promising, if open
(see Meehl, 1986, for a discussion of “open concepts”).
Two main observations support the latter view. First, para-
philias occur almost exclusively in men rather than in
women (Abel & Osborn, 1992; Dawson, Bannerman, &
Lalumière, 2016). Second, there is a tendency for at least
some paraphilias to co-occur within a given individual.
At least two unusual sexual interests that might be classi-
fied as paraphilias tend to co-occur with autogynephilia:
masochism (Lawrence, 2006) and gynandromorphophilia
(sexual interest in transgender women who retain their
penis; Hsu, Rosenthal, Miller, & Bailey, 2016). These two
general findings together suggest that classifying an unusual
sexual interest as a paraphilia may reflect a fact of nature
rather than (or in addition to) a mere value judgment.
The tendency for autogynephilic men to be sexually
attracted to women is consistent with the concept of
ETIIs. However, this tendency might also be predicted by
base rates alone, because most men are attracted to
women. A second, less common, behavioral syndrome
provides more persuasive evidence for the concept of
ETIIs. In turn, the concept of ETIIs has helped illuminate
this otherwise perplexing phenomenon: men who desire
limb amputation. Lawrence (2006) argued that such men
are motivated by apotemnophilia, an ETII in which men
find it sexually arousing to be an amputee. The tendency
for men who desire limb amputation to report both sex-
ual attraction to amputees and sexual arousal by the
thought or image of themselves as an amputee is consis-
tent with an ETII conceptualization. This tendency can-
not be explained by high base rates.
Autopedophilia as an ETII Candidate
Besides autogynephilia and apotemnophilia, no other
putative ETII has received much empirical study. There is
little indication that anyone has looked for them, although
Freund and Blanchard (1993) provided at least one good
lead by presenting several cases of pedophilic men who
were sexually aroused by dressing in children’s clothing
or fantasizing about having a child’s body. These pedo-
philic men might be conceptualized as having an ETII
involving sexual arousal by the thought or image of being
a child, which Lawrence (2006, 2009) has called autope-
dophilia.1 Despite strong scientific and cultural interest in
pedohebephilia (Seto, 2008), autopedophilia has remained
unexplored since Freund and Blanchard’s (1993) case
reports, with the exception of two other cases (Dickey,
2007; Howitt, 1995). In part, this likely reflects a lack of
clinical concern about fantasies directed internally as
opposed to externally (toward children) among pedohe-
bephilic men. But it also likely reflects a lack of apprecia-
tion for the potential of the ETII concept to account for
known phenomena that have been difficult to explain
and to make novel predictions about them.
Autopedophilia provides a promising opportunity to
further test the concept of ETIIs empirically, for several
reasons. First, Freund and Blanchard’s (1993) case reports
established autopedophilia as a plausible, if not likely,
ETII. Second, a large number of pedohebephilic men (a
population especially likely to have autopedophilia) can
be recruited for research from the Internet, because they
can be guaranteed anonymity and have a high level of
interest. Third, and most important, the concept of ETIIs
generates novel and potentially revealing predictions
about autopedophilia, an otherwise puzzling phenome-
non: Because they are preferentially attracted to children
rather than to women, pedohebephilic men should show
higher rates of autopedophilia than of autogynephilia,
despite the fact that autogynephilia is almost certainly
more common in general. More compellingly, the con-
cept of ETIIs predicts correspondence between the kinds
of children that autopedophilic men find sexually attrac-
tive on the outside and the kinds of children they find it
sexually arousing to be on the inside. For example, men
sexually attracted to prepubescent girls should, if they
are autopedophilic, fantasize about being a prepubescent
girl. The current study represents an attempt to examine
autopedophilia as an ETII using a large Internet sample
of pedohebephilic men.
Autopedophilia 117
Method
Participants
Pedohebephilic men were recruited for an anonymous
online questionnaire via advertisements initially placed
on the Web site B4U-ACT (www.b4uact.org) and on the
LISTSERV for members of Virtuous Pedophiles (www
.virped.org). Both organizations caution people not to
have sex with children and are in this way different from
some other organizations or Web sites frequented by
men sexually attracted to children. Pedohebephilic par-
ticipants were reassured that their responses would be
completely anonymous and that they would not be asked
about illegal acts not already known to authorities, which
thereby presented them with no greater concern than
that associated with their anonymous participation in
B4U-ACT and Virtuous Pedophiles. They were also
encouraged to send the questionnaire to other pedohe-
bephilic men and to post it on other Web sites that pedo-
hebephilic men might frequent. Those who did not
report that they were male (n = 22) and sexually attracted
to children (n = 2) were excluded.
The resulting sample comprised 475 pedohebephilic
men (mean age = 28.6 years, SD = 10.6), which was more
than sufficiently large and statistically powerful for detect-
ing effects of at least medium size (Cohen, 1992). Of
these participants, 233 (49.1%) reported that they were
recruited via an Internet forum for individuals sexually
attracted to children, 85 (17.9%) reported that they were
recruited via Virtuous Pedophiles, and 58 (12.2%) reported
that they were recruited via B4U-ACT. The remaining 99
participants (20.8%) reported some other recruitment
source, such as blogs dedicated to discussing pedohebe-
philia. Participants did not receive compensation for com-
pleting the questionnaire.
Measures
Participants completed an anonymous questionnaire
online, which took about half an hour. Among other
material, the questionnaire included two relevant catego-
ries of self-report items. Measures of specific aspects of
autopedophilia, autogynephilia, and their potential cor-
relates were also assessed but are omitted here for the
purposes of concision. We will report on these other mea-
sures in a future article.
Sexual interests. For autopedophilia to be character-
ized as an ETII, autopedophilic participants should be
both sexually attracted to children and sexually aroused
by the idea of being a child, just as autogynephilic men
tend to be sexually attracted to women and are sexually
aroused by the idea of being a woman (e.g., Blanchard,
1992; Hsu et al., 2015). To assess sexual interests related
to both autopedophilia and autogynephilia, we asked
participants to rate the degree to which they are sexually
attracted to males and females of different age ranges:
girls 3 years old or less, boys 3 years old or less, 4- to
10-year-old girls, 4- to 10-year-old boys, 11- to 14-year-old
girls, 11- to 14-year-old boys, 15- and 16-year-old girls,
15- and 16-year-old boys, women 17 years old or more,
and men 17 years old or more. Ratings were made on an
11-point scale (0, not at all sexually attracted, to 10, most
sexually attracted). Participants also rated the degree to
which they are sexually aroused by the thought, idea, or
fantasy of being members of each of these gender-age
categories on an analogous 11-point scale.
To reduce bias due to carryover effects, we asked par-
ticipants to rate their sexual attraction to the various
erotic targets (i.e., individuals of different gender-age cat-
egories) near the beginning of the questionnaire, and
they rated their sexual arousal by the idea of being those
targets near the end.
Expression of autopedophilia. Participants reported whe-
ther they have ever imagined being a child or having a child’s
body, and if so, the degree to which they were sexually
aroused by doing so (not at all, mildly, or strongly). Those
who reported sexual arousal also reported whether they
find it sexually arousing to imagine themselves as a girl
(14 years old or less), a boy (14 years old or less), or
either a girl or a boy (14 years old or less).
Participants rated their frequencies of dressing in chil-
dren’s clothing (0, never, to 6, daily) during the past year
and during the year that they dressed in children’s cloth-
ing most as an adult. In addition, they reported whether
they had ever considered the possibility that they would
be better off as a child and whether they had ever consid-
ered hormones or surgery to make themselves look more
like a child. Finally, we asked potentially autopedophilic
participants to provide detailed answers to open-ended
questions about the precise nature of their fantasies and
experiences: Those who reported at least mild arousal
while imagining themselves as a child or having a child’s
body described their relevant fantasies and actual experi-
ences more specifically.
Results
Pedohebephilic men are sexually attracted to children of
different genders and ages (Bailey, Hsu, & Bernhard,
2016; Blanchard et al., 2012; Blanchard et al., 2009). To
facilitate a broad assessment of participants’ overall
degree of pedohebephilia and autopedophilia, we con-
structed general variables for sexual attraction to children
and sexual arousal by the idea of being a child that were
not specific to any gender-age category. The general vari-
able for sexual attraction to children was the maximum
118 Hsu, Bailey
single-item rating of sexual attraction to any of the differ-
ent kinds of children 14 years old or less (e.g., girls 3 years
old or less, 11- to 14-year-old boys). For instance, partici-
pants who rated sexual attraction to 11- to 14-year-old
boys as 7 but no sexual attraction to any other kinds of
children scored 7 on this new variable. Participants scored
an average of 9.09 (SD = 1.69).
The general variable for sexual arousal by the idea of
being a child was the maximum single-item rating of sex-
ual arousal by the thought, idea, or fantasy of being any
of the different kinds of children 14 years old or less. For
instance, participants who rated sexual arousal by the
idea of being 11- to 14-year-old boys as 7 but no sexual
arousal by the idea of being any other kinds of children
scored 7 on this new variable. We used this variable as a
continuous measure of general autopedophilia that was
not specific to any gender-age category.
Prevalence of autopedophilia
Autopedophilia was common among pedohebephilic
participants: 233 (49.1%) reported feeling at least mildly
sexually aroused when they have imagined being a child
or having a child’s body. The average degree of general
autopedophilia among the participants was 4.40 (SD =
4.05). The distribution of general autopedophilia was
bimodal, with over half the participants scoring either 0
(33.6%) or 10 (21.0%). Thus, a substantial minority of our
sample was intensely autopedophilic.
Is the rate of autopedophilia among the pedohebe-
philic sample unusually high, as might be predicted by
the fact that both autopedophilia and pedohebephilia are
paraphilias, and paraphilias tend to co-occur? To examine
this question, we compared the rate of autopedophilia
in the present sample of pedohebephilic men, 49.1%
(233/475), with the combined rate of autogynephilia
from two prior samples of heterosexual men recruited
from Amazon Mechanical Turk, 15.5% (50/323; Hsu et al.,
2015; Rosenthal, Hsu, & Bailey, 2016). Rates of autogyne-
philia in those samples (14.3% and 16.1%, respectively)
were based on any endorsement of sexual arousal by the
idea of being a woman or having various parts of the
female body. Autopedophilia among the pedohebephilic
men was much more common than autogynephilia was
among the heterosexual men, χ2(1, N = 798) = 94.69, p <
.0001.
Participants recruited via the three most common
sources did not differ in either the prevalence or the
degree of autopedophilia, both ps > .10. They did, how-
ever, significantly differ in their sexual attraction to chil-
dren of different gender-age categories, because different
Web sites and forums tend to cater to men interested in
children of different gender-age categories. Furthermore,
these differences predicted significant differences in the
specificity of autopedophilia endorsed by participants
(e.g., the idea of being a prepubescent girl vs. a pubes-
cent boy), which is the focus of the next section.
Specificity of autopedophilia
Men with ETIIs locate external erotic targets within their
own body (Blanchard, 1991; Freund & Blanchard, 1993;
Lawrence, 2009). Thus, there should be strong similarity
between the external erotic targets that these men prefer
and the kinds of individuals they fantasize being.
We have noted that the most common ETII is likely to
be autogynephilia (Blanchard, 1993b). Although less
prevalent than autopedophilia, autogynephilia was also
not uncommon among participants: 151 (31.8%) rated
their sexual arousal by the thought, idea, or fantasy of
being women 17 years old or more as greater than 0.
Using this same rating, however, we found that the aver-
age degree of autogynephilia among the participants was
1.61 (SD = 2.89), which was significantly and substan-
tially lower than their average degree of general autope-
dophilia, t(417) = 15.37, p < .0001, d = 1.50. Unlike that
of autopedophilia, the distribution of autogynephilia was
highly and positively skewed. Thus, consistent with the
idea that autopedophilia reflects an ETII, results showed
that pedohebephilic participants, who are preferentially
attracted to children rather than to women, reported
more autopedophilia (i.e., sexual arousal by the idea of
themselves as children) than they did autogynephilia
(i.e., sexual arousal by the idea of themselves as women).
Interestingly, autopedophilia was significantly correlated
with autogynephilia, r(416) = .48, p < .0001.
For more stringent, specific tests of autopedophilia as
an ETII, we took advantage of the fact that pedohebe-
philic men prefer children of different genders and ages
(Bailey et al., 2016; Blanchard et al., 2012; Blanchard
et al., 2009). First, we examined the correspondence of
pedohebephilic and autopedophilic preferences with
respect to gender. Of the pedohebephilic participants
who were also autopedophilic, 106 (45.5%) reported sex-
ual attraction to girls, 56 (24.0%) reported sexual attrac-
tion to boys, and the remaining 71 (30.5%) reported
sexual attraction to both girls and boys. We examined
whether these autopedophilic participants’ sexual attrac-
tion to children of one gender tended to correspond with
their sexual arousal by imagining themselves as a child of
that same gender. This also allowed us to exclude an
alternative to conceptualizing autopedophilia as an ETII:
A pedohebephilic man may fantasize about being a boy
because it facilitates fantasies about sexual interactions
with other children (e.g., by reducing guilt about having
a sexual interaction with a child as an adult or by increas-
ing the plausibility of the fantasies). Although possible,
this alternative does not predict that such men sexually
Autopedophilia 119
fantasize that they are a girl. In contrast, the ETII concept
predicts that autopedophilic men sexually attracted to
girls are likely to find it sexually arousing to imagine
themselves as a girl.
Table 1 presents the numbers and percentages of
autopedophilic participants who were sexually attracted to
girls, to boys, and to both and who were sexually aroused
by imagining themselves as a girl, a boy, and either a girl
or a boy. There was a marked tendency for the preferred
gender of external erotic targets to match the preferred
gender of the child that participants have imagined them-
selves being, χ2(4, N = 230) = 122.15, p < .0001. More
specifically, autopedophilic participants exclusively
attracted to girls were more likely to find it sexually arous-
ing to imagine themselves as a girl than as a boy, and
those exclusively attracted to boys showed the completely
opposite pattern, χ2(1, N = 130) = 79.17, p < .0001. We
excluded participants from the previous analysis who
were sexually attracted to both girls and boys, as well as
those who were sexually aroused by imagining themselves
as either a girl or a boy. Because they are not exclusively
attracted or aroused by one gender, the predictions from
the ETII concept are less clear for those men.
Next, we examined the correspondence of pedohebe-
philic and autopedophilic preferences with respect to
both gender and age. Specifically, we correlated ratings
of participants’ sexual attraction to the different gender-
age categories of children, in addition to those of late
adolescents and adults, with their ratings of sexual
arousal by the thought, idea, or fantasy of being mem-
bers of those same gender-age categories. Table 2 pres-
ents these correlations for autopedophilic participants.
The results were consistent with conceptualizing autope-
dophilia as an ETII: Sexual attraction to members of each
gender-age category was significantly and positively cor-
related with sexual arousal by the idea of being members
of the same gender-age category (see the diagonal of
Table 2). Such correlations were particularly high for cat-
egories of children 14 years old or less. Sexual attraction
to a particular gender-age category of children tended to
be significantly and positively correlated, if less strongly,
with sexual arousal by the idea of being members of
adjacent gender-age categories. For example, sexual
attraction to 11- to 14-year-old girls was most strongly
correlated with sexual arousal by the idea of being 11- to
14-year-old girls, but the next highest correlations were
with sexual arousal by the idea of being 4- to 10-year-old
girls and 15- and 16-year-old girls. This pattern is consis-
tent with the “stimulus generalization gradient” (p. 13)
proposed by Blanchard et al. (2012). Their model pre-
dicted that men’s second-most attractive category of per-
son was usually of the same gender and of the next most
similar level of sexual maturity, compared with their most
attractive category.
Expression of autopedophilia
We examined how pedohebephilic participants’ autope-
dophilia was expressed in their lives. Autopedophilia was
significantly correlated with the frequencies of dressing in
children’s clothing during the past year, r(415) = .19, p <
.0001, and during the year that participants dressed in chil-
dren’s clothing most as an adult, r(413) = .18, p < .0005. It
was also significantly associated with participants’ having
considered the possibility that they would be better off as
a child, odds ratio (OR) = 1.18, p < .0001, and considered
hormones or surgery to look more like a child, OR = 1.29,
p < .0001. Among autopedophilic participants, 13.2% had
dressed in children’s clothing as an adult, 58.0% had con-
sidered that they would be better off as a child, and 11.2%
had considered hormones or surgery. (The percentage of
them who had dressed in children’s clothing was based on
the number of participants who reported a frequency
other than “never” on either of the relevant measures.)
Among nonautopedophilic participants, these values were
2.2%, 31.4%, and 2.2%, respectively. Each of the differ-
ences in percentage between the two groups was signifi-
cant, all ps < .0001. Participants from the three most
Table 1. Numbers and Percentages of Autopedophilic Men Sexually
Attracted to Girls, to Boys, or to Both Who Were Sexually Aroused by
Imagining Themselves as a Girl, a Boy, or Either a Girl or a Boy
Internal erotic target
External erotic target
Girls (n = 106a) Boys (n = 56) Both (n = 71)
Girl 60 (58.3%) 0 (0.0%) 20 (28.2%)
Boy 16 (15.5%) 54 (96.4%) 19 (26.8%)
Either 27 (26.2%) 2 (3.6%) 32 (45.1%)
Note: Boldface indicates numbers and percentages for which autopedophilic men’s
sexual attraction to girls, to boys, or to both corresponded with their sexual arousal by
imagining themselves as a girl, a boy, or either a girl or a boy.
aThe numbers in this column do not add up to 106 because 3 participants did not
provide an answer to this item.
120
Table 2. Correlations for Autopedophilic Men Between Ratings of Sexual Attraction to Members of Different Gender-Age Categories and Ratings of Sexual Arousal by
the Idea of Being Members of Those Same Gender-Age Categories
Internal erotic
target
External erotic target
Women
ages ≥ 17
Girls
ages 15–16
Girls
ages 11–14
Girls
ages 4–10
Girls
ages ≤ 3
Boys
ages ≤ 3
Boys
ages 4–10
Boys
ages 11–14
Boys
ages 15–16
Men
ages ≥ 17
Women ages ≥ 17 .46*** .44*** .32*** .20** .14* .08 −.11 −.19* −.06 .14
Girls ages 15–16 .46*** .60*** .53*** .32*** .09 −.03 −.25** −.35*** −.12 .02
Girls ages 11–14 .30*** .52*** .64*** .54*** .18* −.01 −.25** −.45*** −.26** −.14*
Girls ages 4–10 .09 .23** .45*** .70*** .32*** .09 −.17* −.49*** −.32*** −.22*
Girls ages ≤ 3 −.03 .04 .13 .35*** .60*** .32*** .07 −.19* −.16* −.09
Boys ages ≤ 3 −.06 −.08 −.08 .11 .30*** .63*** .30*** −.00 −.04 −.04
Boys ages 4–10 −.17* −.25** −.25** .01 .05 .37*** .59*** .26** .09 .05
Boys ages 11–14 −.17* −.22** −.34*** −.31*** −.16* .14* .41*** .56*** .37*** .18*
Boys ages 15–16 .04 .02 −.11 −.16* −.10 .05 .10 .30*** .48*** .42***
Men ages ≥ 17 .13 .12 .01 −.01 .08 .08 −.01 .02 .19* .31***
Note: Boldface indicates correlations for which autopedophilic men’s sexual attraction to members of a particular gender-age category corresponded with their sexual arousal by the idea
of being members of that same gender-age category.
*p < .05. **p < .005. ***p < .0001.
Autopedophilia 121
common recruitment sources did not differ on any mea-
sures related to the expression of autopedophilia, ps > .09.
Narratives of autopedophilia
We present three brief narratives that emphasize aspects
of autopedophilia relevant to its conceptualization as an
ETII. They also provide case examples of this paraphilic
phenomenon, which has not been well studied. Each
narrative is a selection from the responses that an autope-
dophilic participant provided for the open-ended ques-
tions. We edited the narratives for grammar, style, and
concision, while preserving content.
Two participants described their autopedophilic fanta-
sies in ways that implicate an ETII conceptualization:
Sometimes I fantasize about being with a child
myself, but then I end up thinking about it from the
child’s perspective, being sexually active with an
adult. Sometimes I fantasize about spanking a child,
and then I would think about being the child getting
spanked. Other times, I fantasize about being a little
girl being sexually active with another little girl.
I am attracted to young boys, so I wished to be
younger. I fantasize about being a young boy who
befriends another young boy who wears cartoon
underwear. Eventually, we fall in love and have sex.
I also wear cartoon underwear and superhero
clothing every day.
The following participant described extensive engage-
ment in autopedophilic behaviors, some of which could
have been motivated by sexual masochism rather than by
an ETII:
I used to dress in dresses appropriate for young
girls and play with dolls while watching Disney
cartoons about princesses. I found this extremely
sexually arousing. I also visited a woman who I
would pay to be my “mother” for the day. I would
dress as a little girl, and she would make me dance
for her and do chores. At the end of the day, I
would masturbate in front of her. She started to
invite men, and I would have oral and anal sex with
them while dressed as a little girl. I had similar
feelings to when I dressed on my own, but with the
added sexual excitement of being humiliated.
Discussion
Autopedophilia was common among pedohebephilic
men, characterizing almost half of our sample. The higher
prevalence of autopedophilia compared with autogyne-
philia is consistent with the concept of ETIIs: Pedohebe-
philic men are sexually attracted to children, and thus
children are the external erotic targets most likely to be
located within their own body. Also consistent with the
concept of ETIIs, results showed a tendency among
autopedophilic men for the kinds of children they found
sexually attractive to correspond with the kinds of chil-
dren they found it sexually arousing to be. This tendency
was found independently for gender and also for com-
bined gender-age categories.
Expected correlates of autopedophilia, such as dress-
ing in children’s clothing, consideration of hormones or
surgery to look more like a child, and another ETII such
as autogynephilia, were indeed correlated with autope-
dophilia. They were also more common among pedohe-
bephilic men who were autopedophilic than among
those who were not. Dressing in children’s clothing, con-
sidering that one would be better off as a child, and con-
sidering hormones or surgery to look more like a child in
autopedophilic men appear analogous to cross-dressing,
gender dysphoria, and considering sex-reassignment sur-
gery in autogynephilic men.
Given its apparently high prevalence, why has autope-
dophilia not been appreciated until now? First, pedohe-
bephilia is itself rare (Seto, 2008), and autopedophilia is
still rarer, even if common among pedohebephilic men.
Second, investigating phenomena associated with pedohe-
bephilia has understandably received lower priority than
predicting sex offenses against children. Indeed, autopedo-
philia is not defined by attraction toward actual children,
and as such, can be innocuous. It is conceivable, however,
that both goals may further each other. Finally, the notion
of ETIIs has been seemingly difficult for clinicians to
embrace, despite their increasing empirical support. Auto-
gynephilia, apotemnophilia, and now autopedophilia are
a small but growing set of phenomena that are difficult to
understand without the concept of ETIIs.
Limitations of the study
It is unclear how representative our sample of pedohebe-
philic men was, given the variety of sources through
which we recruited such participants. Our pedohebe-
philic participants may have been especially likely to be
autopedophilic, although the prevalence and degree of
autopedophilia did not differ among those from the three
most common recruitment sources. We note that there is
presently no way to ensure that any sample of pedohe-
bephilic men is representative.
There are at least two plausible alternatives to concep-
tualizing autopedophilia as an ETII. The first is referenced
in the last narrative, in which a participant was aroused
by the humiliation of dressing as a little girl and having
122 Hsu, Bailey
sex with men. Freund and Blanchard (1993) argued that
some autopedophilic fantasies are motivated by masoch-
ism. Such fantasies exaggerate the difference between
men and their preferred erotic targets (e.g., women),
increasing their feelings of submissiveness. In contrast,
autopedophilic fantasies motivated by an ETII increase
the similarity between men and the children to whom
they are attracted. A second alternative is that autopedo-
philia is motivated by a desire to become emotionally or
physically closer to children. For instance, pedohebe-
philic men might find it easier to fantasize about having
sex with children if they themselves are a child, perhaps
because they feel shame or guilt about the idea of having
sex with children as an adult, or because such a scenario
is more realistic to them. Our findings that autopedo-
philic men sexually attracted to girls tend to find it sexu-
ally arousing to imagine themselves as a girl, however,
present evidence in favor of an ETII rather than either
alternative, at least for those men.
Conclusions
Blanchard (1991) started with the idea that some cases of
male-to-female gender dysphoria and transsexualism are
fundamentally motivated by an ETII, in which natal males
who are otherwise sexually attracted to women eroticize
the idea of being women to such an extent that they want
to become a woman themselves. Freund and Blanchard
(1993) later extended this idea to an analogous ETII that
might motivate some pedophilic men to impersonate or
fantasize about being children. These specific phenom-
ena are autogynephilia and autopedophilia, respectively.
Autogynephilia has since received much empirical sup-
port in favor of its conceptualization as an ETII (e.g.,
Blanchard, 1992; Hsu et al., 2015). In contrast, with the
exception of a few case studies (Dickey, 2007; Freund &
Blanchard, 1993; Howitt, 1995), autopedophilia had not
been researched until our study.
It is fitting that the most compelling finding of our
study—that autopedophilic men sexually attracted to
girls tend to find it sexually arousing to imagine them-
selves as a girl—reflects the likely confluence of the two
ETIIs that had been proposed many years ago: one that
involves locating an individual of a different gender
within one’s own body, and the other that involves locat-
ing an individual of a different age within one’s own
body. At a broader level, this finding exemplifies the
simultaneous importance of three dimensions of male
sexual orientation: gender (attraction to females), sexual
maturity (attraction to children), and location (attraction
to the idea of being another individual).
Two related approaches may guide future research on
ETIIs. The first, exemplified by Lawrence’s (2006) work
on apotemnophilia, is to identify unusual conditions in
which men (especially) desire to transform their bodies
or identities, and to examine the extent to which these
phenomena can be explained by the concept of para-
philic ETIIs. The second, which we employed here, is to
recruit men with paraphilias and examine whether a sub-
set of them report sexual arousal by the idea or fantasy
of being their paraphilic target, consistent with ETIIs. Our
current results in pedohebephilic men suggest that ETIIs
may be common among paraphilic men.
Action Editor
Steven Gangestad served as action editor for this article.
Author Contributions
J. M. Bailey conceived of the study with significant input from
K. J. Hsu. K. J. Hsu and J. M. Bailey designed the study. Data
were collected and analyzed by K. J. Hsu under the supervision
of J. M. Bailey. K. J. Hsu and J. M. Bailey wrote and revised the
manuscript.
Acknowledgments
We thank Ethan Edwards, Nick Devin, and Richard Kramer for
their feedback and support.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interest with
respect to their authorship or the publication of this article.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Note
1. Although the term autopedohebephilia is more accurate, it is
both unwieldy and inconsistent with the most common termi-
nology. Thus, we use the term autopedophilia but mean it to
encompass sexual arousal by the idea of being either a prepu-
bescent or a pubescent child.
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