Pedophilia Diagnosis Goes High-Tech - “Billie Jean Is Not My Lover”

by Brian Carty, MD, MSPH

In the Hollywood mansion of a famous pop music star, a sign on a heavy oak door read “Super-Secret Playroom - Do Not Disturb.” A SWAT team agent pounded on the door as hard as he could without hurting himself. He called this “knocking for the last time.”

Dynamic entry

Without waiting, the SWAT team sprang into action. They were dressed in black from head to toe, their lower faces covered with fireproof Nomex masks. Only their eyes were visible through clear eye shields. Two men stood to each side of the door, holding Heckler & Koch MP5 submachine guns pointed straight up. A short stocky man who had been standing in the background suddenly kneeled in front of the door and jammed the muzzle of a 12-gauge shotgun against the keyhole of the lock.

There was an explosion. A few flecks of wood and brass fell on the floor in front of the door. A small puff of acrid grey smoke slowly wafted upward. Their shoulders slamming into the now freely swinging door, the men charged forward into the room.

What is a pedophile?

While the preceding account is fictional, it does convey the extreme seriousness with which society regards child molestation. The account also provides a useful springboard for a discussion of the medical technology available to diagnose pedophilia and attempt to reduce the frequency of child molestation.

Pedophiles, almost always males, are individuals who are sexually attracted primarily to prepubertal children. A child molester is an individual who has committed a sexual offense against a child. Pedophiles are not always child molesters, and child molesters are not always pedophiles. For example, Lewis Carroll, the author of Alice in Wonderland, was a pedophile but apparently never acted on his impulses.

Evaluation of pedophiles and child molesters

Every evaluation in medicine starts with a history or interview and a physical examination, followed by other more specialized tests as necessary. For the pedophile or sex offender, historical information is often obtained from arrest records, court reports, victim testimony, family members, and other sources.

“Billie Jean is not my lover”

Yeah, yeah, yeah. Isn’t that what they all say? This is why objective, specialized tests are often used in the evaluation of sex offenders. The tests rely to a great extent on reflexive, automatic responses which are often not under conscious control. The tests are thus useful in obtaining information about sexual interest or acts which individuals may deny. These tests include penile plethysmography or phallometry, polygraphy, and viewing time assessments.


Phallometry is a technique in which the erectile response is measured in response to neutral or sexually explicit audio or visual stimuli. After a moonwalk down the hall to the phallometry lab, a gauge is attached to the penis to measure changes in the circumference of the penis. Phallometry is the best method currently available to measure deviant sexual arousal. Phallometry can distinguish between pedophiles and non-pedophiles, and it is one of the most reliable predictors of repeat offending by child molesters.

Of course, phallometry cannot determine guilt or innocence, that is, whether a person has committed an offense or not. Also, the test is not absolutely reliable. Individuals can sometimes “fake” the test. The sensitivity of the test is at least 50%, so at least half of pedophiles will have a positive test. Polygraphy, the “lie detector test,” has also been used to evaluate sex offenders, usually to follow sex offenders on parole or probation.

Viewing time assessment

Another technique for assessing sexual interest and deviance is viewing time assessment. In this procedure, an individual views photographic slides depicting subject matter which is potentially sexually attractive to the individual. The individual being tested rates the sexual attractiveness of the slides, and the length of time the individual views each slide is measured. Longer viewing time has been found to indicate greater sexual interest.

Functional imaging

Another method for the evaluation of sexual deviance, still in the research stage, is brain imaging. Functional imaging, for example functional MRI (fMRI), gives information about the metabolic activity of different parts of the brain.

fMRI scans have been done on normal controls and pedophiles during the viewing of different types of sexually neutral or sexually explicit slides. Increased brain activity is seen during viewing of opposite sex adults by the normal controls. When pedophiles look at slides of children which they find to be a “Thriller,” they have similar increases in brain activity.

So, in summary, when dealing with pedophilia and child molestation, are you willing to accept lame excuses like “I just really love hanging out with children” and “Billie Jean is not my lover?” Hell no. Do a serious, take-no-prisoners assessment as outlined above.


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