Part 1
Definition of the DSM-IV Disorder
Pedophilia is described as a psychological disorder where the individual takes a strong sexual liking towards prepubescent children. The DSM-IV criteria for this paraphilia requires that the individual have "recurrent, intense sexual arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (general age 13 years or younger)" for at least over a period of 6 months. These behavioral tendencies must also be severe enough to cause a clinically significant amount of distress or impairment in social and vocational functioning, as well as other areas of importance, and the individual must be at least the age of 16 and no less than 5 years older than the child or children of sexual preference. Some pedophiles are exclusively attracted to only children (Exclusive Type), and some are attracted to both children and adults (Nonexclusive Type). Some prefer female children over male children and vice versa, while others prefer both (American Psychiatric Association, 1994).

Conceptual Model
Although it is difficult to research how individuals come to develop pedophilia, there are substantial findings on three specific areas where pedophiles and sexual offenders often differ from the norm. The first of the three has to do with empathetic skills or lack thereof. Sexual offenses often lead us to wonder how a person can perpetrate such crimes, completely disregarding and invading the privacy of their victims. This has motivated researchers to focus their studies on empathy and whether there is a significant difference between sexual offenders and nonsexual offenders. The conceptual model used to demonstrate the deficiency of empathetic ability in pedophiles and sex offenders is known as the Process Model of Empathy (Marshall et al., 1995). Divided into four parts, the first stage is "emotional recognition" where, in order to attain the ability to empathize, the individual must first identify what the emotion the other person is experiencing. The second stage is "perspective-taking," where the individual must be able to place himself in another's position in order to understand what that person is experiencing. The third is "emotion replication," where the individual acquires the ability to experience the same emotion as the other person, and the final stage is known as "response decision," where the individual, after having empathized with the other person, decides how he is going to react to that person. With the assessment of this conceptual model, it is often found that pedophiles and sex offenders have trouble empathizing. Thus, enabled to be less inhibited than others, they become more inclined to disregard the privacy of others (Geer, Estupinan, and Manguno-Mire, 1999).

The second area of focus has to do with the social skills of pedophiles and sex offenders. It is often speculated that pedophiles and sex offenders have difficulty maintaining social relationships and often have deficits in the area of heterosocial skills. The conceptual model to further explain the cognitive processes of pedophiles and sex offenders is the social-information processing model where an individual's ability to socialize comes from being competent in the areas of decoding, decision-making, and execution-making. This model is hierarchically-related. An individual must excel in decoding skills, meaning being able to identify a specific task or situation, before he can excel in decision skills. He must excel in decision skills before succeeding in execution skills. Specifically for pedophiles and sex offenders, there is a found deficit in social information processing. Thus, according to this particular conceptual model, pedophiles and sex offenders are deficient in their social ability by failing to achieve each level of social information processing. This may explain why pedophiles find comfort in their relationships with children. As opposed to being dominated and vulnerable in a heterosexual adult relationship, the individual can find himself in a position of power and control over a child (Geer et al., 1999).

The third area in which pedophiles and sex offenders differ from the norm is cognitive processes. In order to explain this abnormality in cognition, the conceptual model of cognitive deconstruction theory is brought forth. This model suggests that some "people attempt to avoid the negative consequences of self-awareness in order to escape from the effects of traumatic or stressful experiences." Under normal circumstances, perpetrating a deed that may be socially unaccepted would produce negative sentiments such as guilt and shame. These consequential emotions would normally cease the execution of deviant behavior and cause the individual to further regulate himself. However, a deviant may enter a cognitively deconstructed state where socially unaccepted behavior has no effect on his emotions. Thus, void of the negative consequential sentiments of guilt or shame, the deviant has less desire to self-regulate and conform to the norms of society and may continue to practice his socially unaccepted behavior. This model suggests that over a period of time, distortion in cognition is possible. When a deviant refuses to be held responsible for the consequences of his crimes, he often distorts the situation and shifts blame onto external subjects for his behavior. Following the cognitive deconstruction theory, it is not impossible to see how the pedophile and the sexual offender often arrive to the justification that their victim or victims initiated the event rather than taking responsibility for their own offenses (Geer et al., 1999).

Assessment Instrument
Because gathering a subject-pool for pedophile research is often achieved by differentiating pedophiles from a group of incarcerated offenders, no instruments were used to assess the disorder. The subjects were already discriminated by the nature of their crimes. Instruments were used to discover discrepancies between child molesters and rapists. The tool administered was the Test of Reading Affective Cues (TRAC-D). The TRAC-D's purpose is to measure an individual's response to nonsexual and sexual cues. In comparing the data between child molesters, rapists, violent and nonviolent nonsex offenders, it was found that child molesters had a significant amount of deficiency in identifying an adult woman's affective and sexual cues (Geer et al., 1999).

Treatment
Finding abnormalities and deficits in empathy, social skills, and cognitive processes, the study took a cognitive-behavioral approach, where each area of focus was tackled with a separate treatment program. In the area of empathy, a program was designed to specifically train participants in the cognitive, affective, and behavioral components. For feedback on how the participants were responding to the program, the Davis IRI, a measuring tool for empathy, was administered. In the area of social skills, the participants underwent training in "establishing and maintaining appropriate long-term intimate relationships." They also endured several sessions of group therapy where participants learned how to better self-confidence, reduce social anxiety, increase interpersonal interaction, and "encourage the development of more appropriately assertive and socially expressive behaviors." The benefit of group therapy was giving participants the chance to express themselves amongst their peers, therefore reducing overall anxiety and decreasing the amount of uncomfort that accompanies the nature of their crimes. The final area of treatment focused on changing the participants' distorted cognitions. Providing education emphasizing attitudes towards women, socially accepted interactions with children, and the realization of responsibility and fault for offending (Geer et al., 1999).

Shortcomings
The general problem with the treatment of pedophiles and sex offenders is that there is no way of telling how effective a program is without looking at the recidivism rates. Thus, only after a certain period of time has passed can the percentage of released offenders who are convicted of reoffending, be calculated. This is problematic because any record of a released offender reoffending suggests that treatment has obviously failed. It is also problematic because the recidivism rate is only based on those offenders who are caught reoffending; the number of those released offenders who return to their sexually deviant behaviors is truly unknown because not all offenders are caught in their act of crime.

A major shortcoming of the treatment strategy is that while some research supports the idea of pedophiles and sex offenders as having a lack of empathy, and a deficiency in social skills, the results are not entirely conclusive. Also, there is not causal support that revitalizing empathy and social skills may deter pedophiles and sex offenders from further committing crimes. Treatment in these areas would be ineffective if they did not tackle the etiology of the disorder (Geer et al., 1999).

Part Two
Alternative Conceptual Model
Rather than focusing on the lack of empathy, deficits in social skills, and distortions of cognitive processes, the integrative model suggests that the etiology of a paraphilia such as pedophilia originates from a prosocial, inappropriate sexual event that may awaken sexual behavior prematurely. The first stage is an abrupt and inappropriate sexual event that occurs either vicariously, directly, or accidentally to the individual. In the next stage, the event is further suggested by either a dominating and elder figure (adult) or by a social event reinforcing the nature of the initial event. This appropriates inadequate development of the individual. The third stage has the individual self-reinforcing these inappropriate sexual behaviors through fantasies, and acts associated. The final stage prior to the onset of the paraphilia is a conflict within that individual, between the desire to inhibit his inappropriate sexual urges and the desire to express his sexual urges no matter how inappropriate (Barlow and Durand, 1999).

Alternative Treatment Strategy
In a study focusing on the pedophiliac traits, it was found that low intellectual functioning and mental retardation is unusually high among pedophiles. This supports the general idea that there is a deficit in moral understanding within these individuals (Blanchard, Watson, Choy, Dickey, Klassen, Kuban, and Ferren, 1999). With this in consideration, treatment programs must focus on reinforcing the difference between what is socially accepted and what is not socially accepted. More so, programs must not only emphasize on what is normal and what is abnormal, but a focus on prevention of reoffending is also necessary. A treatment program that carries a strong concentration in the area of prevention is the California Sex Offender Treatment and Evaluation Project (SOTEP). SOTEP uses a cognitive-behavioral approach as well, however, the focus extends much further than just empathy, social skills and cognitive processes. The justification of preferring SOTEP over other kinds of treatment comes from the promise that their method is more effective. With a sufficient program that requires the participants to undergo rigorous training in several areas of focus for a period of two years or longer, SOTEP has more assurance than any alternative treatment.

Components Of Treatment Strategy
The main component of SOTEP is the focus on relapse prevention (RP). RP strives to maintain the improved alterations of behavior by continuously exposing the individual to situations where relapse has chance to occur. With repetitive reinforcement by having aversive stimuli as the consequence of relapse, the individual becomes trained not to express his inappropriate sexual desires through classical conditioning. Also incorporated into these RP sessions is the stressed importance of motivation and responsibility. By going through past crimes, the individual is led through a detailed evaluation of why and how he became victim to his own desires. Furthermore, he is reinforced not to commit such acts again and how to avoid situations where he would become tempted to do so (Marques, 1999).

Prognosis
Unfortunately, as mentioned earlier, the only way of knowing how effective treatment is, is through reviewing the recidivism rates after the treatment package has been administered (Geer et al., 1999). This is inaccurate, and very unsafe because while it may be effective for some pedophiles and sex offenders, it is not effective for all. Thus, repeat offending is inevitable; this only means a guarantee of increase in the number of victims.

In a study using SOTEP it was found that child molesters, in comparison to other types of sexual offenders, often carry more guilt and have a stronger ability to empathize with their victims. It should also be noted that in the same study using SOTEP, rapists had a higher recidivism rate than child molesters. Due to these findings, the prognosis for child molesters, as opposed to rapists, appears healthier (Marques, 1999).

What is problematic of treatments regarding pedophiles is that it is caught between the mental health discipline and the law enforcement world. The mental health discipline is unsure of how and why individuals build this sexual desire for children, and thus, there is an etiological problem. With the conceptual models, speculations can be formed, but there are no identified factors that determine why or how a pedophile becomes what he is. Thus, while the initiative to treat the individual is optimistic, the rehabilitation programs may be unsubstantiated by the fact that they may not be tackling the actual problem.

From the law enforcement perspective, treatment is viewed as a naive way of dealing with what are possibly incorrigible individuals. With this perspective, treatment is usually rejected and incarceration is viewed as the only effective method of deterrence. Law enforcement officials often believe that by the time sex offenders commit their first crime, the criminal personality has already formulated. While they also strive to find rehabilitation programs that will ameliorate the conduct of deviants, they feel that the only deterrence to heinous crimes such as sex crimes are to isolate perpetrators from society. With the understanding that the criminal personality originates in childhood, they stress the importance of early prevention through educational programs (Douglas and Olshaker, 1997).

References
American Psychiatric Association. (1994). Diagnostic Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.

Barlow, D. H., and Durand, V. M. (1999). Abnormal Psychology: An Integrative Approach. Brooks/Cole Publishing Company: New York.

Blanchard, R., Watson, M. S., Choy, A., Dickey, R., Klassen, P., Kuban, M., and Ferren, D. J. (1999). Pedophiles: mental retardation, maternal age, and sexual orientation. Archives of Sexual Behavior, 28, 111-127.

Douglas, J. E., and Olshaker, M. (1997). Journey Into Darkness. Simon & Schuster, Inc.: New York.

Geer, J. H., Estupinan, L. A., and Manguno-Mire, G. M. (1999). Empathy, social skills, and other relevant cognitive processes in rapists and child molesters. Aggression and Violent Behavior, 5, 99-126.

Marques, J. K. (1999). How to answer the question "Does sex offender treatment work?" Journal of Interpersonal Violence, 14, 437-451.

Marshall, W. L., Jones, R., Hudson, S. M., & McDonald, E. (1995). Empathy in sex offenders. Clinical Psychology Review, 15, 99-113.

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