700 Paraphilic Disorders
Differential Diagnosis
Many of the conditions that could be differ ential diagnoses for pedophilic disorder also
sometimes occur as comorbid diagnoses. It is th erefore generally necessary to evaluate the
evidence for pedophilic disord er and other possible condit ions as separate questions.
Antisocial personality disorder. This disorder increases the li kelihood that a person who
is primarily attracted to the mature physique will approach a child, on one or a few occa-
sions, on the basis of relative availability. The individual often shows other signs of this
personality disorder, such as recurrent law-breaking.
Alcohol and substance use disorders. The disinhibiting effects of intoxication may also
increase the likelihood that a person who is primarily attracted to th e mature physique will
sexually approach a child.
Obsessive-compulsive disorder. There are occasional individuals who complain about
ego-dystonic thoughts and worries about possi ble attraction to children. Clinical inter-
viewing usually reveals an absence of sexual thoughts about children during high states of
sexual arousal (e.g., approaching orgasm during masturbation) and sometimes additional
ego-dystonic, intrusive se xual ideas (e.g., concerns about homosexuality).
Comorbidity
Psychiatric comorbidity of pedophilic disorder includes substance use disorders; depres-
sive, bipolar, and anxiety disorders; antisocial personality disorder; and other paraphilic
disorders. However, findings on comorbid disorders are largely among individuals con-
victed for sexual offenses involving childre n (almost all males) and may not be general-
izable to other individuals wi th pedophilic disorder (e.g., individuals who have never
approached a child sexually but who qualify for the diagnosis of pedophilic disorder on
the basis of subjective distress).
Fetishistic Disorder