Pedophilic Disorder 699
Development and Course
Adult males with pedophilic disorder may indi cate that they become aware of strong or
preferential sexual interest in children arou nd the time of puberty—the same time frame
in which males who later prefer physically ma ture partners became aware of their sexual
interest in women or men. Attempting to diag nose pedophilic disorder at the age at which
it first manifests is problematic because of th e difficulty during adolescent development in
differentiating it from age-appropriate sexual interest in peers or from sexual curiosity.
Hence, Criterion C requires for diagnosis a minimum age of 16 years and at least 5 years
older than the child or children in Criterion A.
Pedophilia per se appears to be a lifelong condition. Pedophilic disorder, however,
necessarily includes other elements that may change over time with or without treatment:
subjective distress (e.g., guilt, shame, intense se xual frustration, or feelings of isolation) or
psychosocial impairment, or the propensity to  act out sexually with children, or both.
Therefore, the course of pedophilic disorder may fluctuate, in crease, or decr ease with age.
Adults with pedophilic disorder may report an awareness of sexual interest in children
that preceded engaging in sexual behavior invo lving children or self-identification as a pedo-
phile. Advanced age is as likely to similarly di minish the frequency of sexual behavior involv-
ing children as it does other paraphilically  motivated and normophilic sexual behavior.
Risk and Prognostic Factors
Temperamental. There appears to be an interaction between pedophilia and antisocial-
ity, such that males with both traits are more  likely to act out sexually with children. Thus,
antisocial personality disorder may be consid ered a risk factor for pedophilic disorder in