How can sexual abuse against children be prevented? And is it possible to treat those who commit abuse?
These are the questions Agatha Chronos explored in her doctoral thesis on the prevention of sexual abuse against children at the University of Bergen.
Hard to get paedophiles to seek help
Her research shows that people with sexual attraction to children often live with severe stress, anxiety, and depression.
Many want help – but the fear of being exposed and met with rejection makes them afraid to seek treatment.
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The key to reducing this barrier appears to be therapists who approach them with empathy and expertise.
This can be confirmed by psychologist specialist and researcher Pål Grøndal. He says that the enormous stigma tied to paedophilia can stand in the way of treatment.
Psychologist Pål Grøndahl believes there are challenges regarding psychiatric assessment and treatment of this group.(Photo: Anette Karlsen / NTB)
"This means some people would rather stay under the radar than talk to someone – because it almost becomes a kind of civil defence stance against those who have committed such acts and who struggle to return to society afterward," Grøndahl tells Science Norway.
Gender, age, and intelligence
At the same time, the thesis points to clear differences between those who have committed abuse and those who have not.
About the study
Informing the Treatment of People with a Sexual Interest in Children is a doctoral thesis conducted by Agatha Chronos. It consists of 3 studies.
The first article reviews 40 studies and identifies treatment needs, motivation, and barriers for people with this sexual attraction.
The second is based on a meta-analysis of 24 studies examining factors that distinguish offenders from non-offenders. These results are intended to provide valuable insights to improve risk assessments and prevention strategies.
The third article uses a vignette experiment (a research method where participants are presented with brief descriptions of situations or people, called vignettes).
The study found that clinician's decisions were significantly influenced by both a history of abuse and sexual interest. A prevention-oriented goal was therefore often given to clients with both sexual interest and a history of abuse.
The articles are intended to provide a comprehensive framework to guide best practices for mental health professionals, ensuring treatment is precise, evidence-based, and provides a good balance between preventing abuse and the client's overall well-being.
A large review of earlier studies found that gender, age, intelligence, and stigma levels play a role.
Men, older individuals, those with lower intelligence, and those who reported more stigma were significantly more represented among those who had acted on their interest.
A stronger preference for children over adults, cognitive distortions, having children of their own, and experiences of sexual abuse in childhood were also more common among those who had committed abuse.
Such insights can improve risk assessments and allow for more targeted prevention, according to Chronos.
The study also looked at how clinicians actually assess such cases. In an experiment with 200 clinicians, the outcome was clear: both a criminal background and a sexual interest in children led to more prevention-oriented measures.
This shows that the sexual interest itself is often treated as a risk factor that clinicians want to address.
Possible to get help for sexual feelings towards children
Treatment options for people with these feelings have improved noticeably compared to just a few years ago, says Grøndahl.
"We now have a national service which offers support in prisons, a helpline, and the option to seek help anonymously for thoughts and feelings related to paedophilia," he says.
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No referral from a doctor or psychologist is required.
"At the same time, very few doctors and psychologists feel confident talking about sexuality in general, and especially about sexual problems or deviations. The competence here is low," he says.
Grøndahl explains that this may prevent many from opening up about what they experience as dark or forbidden thoughts and feelings.
"I don't believe the district psychiatric centres are either adequately equipped for this issue or especially focused on it," he says.
He also points out challenges in psychiatric evaluation and treatment for this group, including uncertainty about how effective therapy actually is.
"Research shows some effect, but not a very strong one. The weaker the study, the greater the reported effect; the stronger the study, the smaller the effect," he says.
Rehabilitation challenges
He also mentions rehabilitation as a challenge. The national initiative was launched in September 2020 with the aim of preventing thoughts and feelings from turning into actions, thereby preventing sexual abuse of children.
A similar motivation drives a specialised outpatient clinic at Oslo University Hospital, where psychiatrists work with people who have a sexual interest in children.
"A great deal of shame and stigma is tied to this issue – a stigma that those of us working in the field also carry," Anne Wold, head of the Forensic Psychiatry Committee in the Norwegian Psychiatric Association, says on the Norwegian Medical Association's website.
The clinic works with BASIS, a programme for convicted patients considered at high risk of reoffending. These patients serve their sentences while clinicians travel to the prisons involved.
The clinic operates under the same section as the Competence Centre for Security, Prison, and Forensic Psychiatry (KPS). KPS has also set up a medical quality registry (KvaSO), where information from patients, with consent, is anonymised and stored.
"Over time, we hope to learn more about what characterises those who have a sexual interest in children, what kinds of difficulties they've experienced, and whether treatment actually helps," Wold says on the Medical Association's website.
How many paedophiles are there in Norway?
As of September 2024, around 60 patients were in active treatment, the national service had 20-25 patients at any given time, and more than 300 people nationwide had received help through the service since 2020.
Most of them are men.
Although exact numbers are uncertain, international research suggests that at least 2 percent of adult men have a sexual interest in children, Wold told the Norwegian broadcasting corporation NRK in August 2024.
That could mean close to 110,000 men in Norway.
Earlier, a German study found that paedophiles who do not commit physical abuse have stronger self-control than those who do.
Grøndahl emphasised in an interview with TV2 that being paedophilic is not the same as being an abuser.
