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Pädophilie

Ätiologie, Diagnostik und Therapie

Pedophilia

Etiology, diagnostics and therapy

Zusammenfassung

Sexuelle Übergriffe zum Nachteil eines Kindes zählen zu den schwerwiegendsten negativen Ereignissen für dessen gesunde psychische Entwicklung. Die Pädophilie ist nach den aktuellen psychiatrischen Klassifikationssystemen als eine anhaltende oder dominierende sexuelle Präferenz für präpubertäre Kinder definiert. Nur etwa die Hälfte aller Kindesmissbrauchstäter erfüllt die diagnostischen Kriterien der Pädophilie. Im vorliegenden Beitrag werden die bei der Diagnosestellung und differenzialdiagnostischen Abgrenzung zu anderen Störungen zu beachtenden Kriterien erläutert, epidemiologische und ätiologische Erkenntnisse vermittelt. Ätiologisch wird gegenwärtig von multikausalen Wirkmechanismen ausgegangen; hierbei sind genetische, lerntheoretische und neurobiologische Faktoren zu diskutieren. Psychotherapeutische und medikamentöse Behandlungsmöglichkeiten werden referiert. Nach aktuellem Kenntnisstand stellen kognitiv-verhaltenstherapeutische Ansätze die Methode der Wahl dar. Metaanalysen zeigen einen positiven Effekt dieser Behandlungsansätze, wobei nicht eine Veränderung der devianten sexuellen Orientierung, sondern die Verhinderung weiterer sexueller Übergriffe das Behandlungsziel darstellt. Abschließend werden wichtige Aspekte des Risikomanagements bei Pädophilie ebenso wie zu beachtende Aspekte bei der forensisch-psychiatrischen Begutachtung dargestellt.

Summary

Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented.

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Fromberger, P., Jordan, K. & Müller, J. Pädophilie. Nervenarzt 84, 1123–1135 (2013). https://doi.org/10.1007/s00115-013-3805-9

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Schlüsselwörter

  • Sexualverhalten
  • Paraphilien
  • Sexuelle Abweichungen
  • Kindesmissbrauch, sexuell
  • Risikofaktoren

Keywords

  • Sexual behavior
  • Paraphilias
  • Sexual deviations
  • Child abuse, sexual
  • Risk factors