Josh Duggar, executive director of FRC Action, speaks at the Arkansas state Capitol in Little Rock, Ark.on Aug. 29, 2014.
Danny Johnston—AP
By Jeffrey Kluger
May 22, 2015

Want a challenge? Try feeling sorry for a pedophile—those guys (and they’re almost always guys) who lust for children, stalk children and may eventually molest or rape children. Even in prison they’re targets of violence from other inmates. When a murderer finds you morally repugnant, you know you’ve fallen far.

That universal loathing is on display again with public outrage around the news that reality TV star Josh Duggar, 27, of TLC’s 19 Kids and Counting, responded to allegations that he molested five underage girls when he was 15, saying that he “acted inexcusably for which I am extremely sorry and deeply regret.”

There is more unknown about these charges than known: How old were the girls? What did the molestation involve? These and other questions are critical to understanding both the psychology and the alleged criminality at play.

But let’s address the worst possibility—that the girls were not teens like Duggar, but much younger. That he was drawn to them as an adult pedophile is drawn to a child, and that under the care of a psychiatrist or psychologist, he would be diagnosed with clinical pedophilia. What does that mean for him—and for society?

Pedophilia is thought to be a relatively rare condition, afflicting from 1% to 5% of men, and a vanishingly small number of women. Admittedly 1% to 5% is a wide range, but unlike people suffering from, say, depression or phobias, people with pedophilic stirrings are not likely to step forward for treatment. Pedophiles are sexually drawn to children exclusively and as a group, prey on same sex and opposite sex children more or less equally. The condition has nothing at all to do with homosexuality.

Psychologists stress that not all child molesters are pedophiles and not all pedophiles molest. Only about 10% of known child abusers are thought to be clinical pedophiles. In most non-pedophilic cases of child abuse, the crime is an act of violence, of rage, sometimes a result of trauma. Often molesters were themselves molested in childhood—anywhere from one third to three quarters of them—though the studies on which these findings are based are often called into question because they rely on trusting the abusers to tell the truth about their past.

What’s barely in dispute anymore is that true pedophilia is a disorder with physiological roots. Scans of pedophiles’ brains show less connective white matter than the brains of other people; other studies show that pedophiles have a greater tendency to be left-handed, that they score poorly on visual and spatial tests and that they may even be shorter, on average, than other males. All of this points either to the genes or prenatal womb environment, or both, meaning that pedophilia is innate, unchosen and as fixed as anyone else’s sexuality.

“None of us decides the sorts of people we’re going to be attracted to,” says Dr. Fred Berlin of the National Institute for the Study, Prevention and Treatment of Sexual Trauma, in Baltimore. “We discover that, and that’s true too of people who discover they’re attracted to children. This is not the result of a choice.”

That’s where treatment becomes hard, and where sympathy—if you’re inclined to feel it—may be warranted. In the days in which homosexuality was punished, gays and lesbians spent their entire lives either denying themselves a sexual outlet or doing so furtively and fearfully. That led to profound suffering—made all the worse because it was unjust suffering. In a sexual encounter with another consenting adult, no one generally gets hurt—and the laws in most countries have finally come around.

But there will be no such coming around in the case of pedophilia, nor should there be, because by definition a child incapable of consent will always be hurt by the act. That means therapy for pedophiles—with luck before they act, but certainly afterwards.

Part of this may involve libido-lowering drugs; part involves an abstinence strategy similar to what’s used in day-at-a-time groups like Alcoholics Anonymous. And part involves other kinds of group support, such as the website Virtuous Pedophiles, for people who recognize their disorder and are determined not to act on it. That can work.

“Virtuous pedophiles make the point that pedophilia is by no means synonymous with child molestation,” says Berlin. “Some people can control their urges on their own or with a group. Others who have those attractions with perhaps a higher degree of desire may need more intervention, including medicine.”

In one study of 300 patients Berlin treated, only 3% who fully complied with treatment re-offended within five years. Among men who receive no treatment, 18% re-offend within three years.

There are no good answers for pedophilia, only less bad ones. Fury at men who hurt children is not misplaced, but nor is appreciation for those who struggle with their disorder and keep it under control. No one would choose to leave a child alone with an untreated pedophile. But no one would choose to be that pedophile either.

Read next: Arkansas Police Destroy Record of Josh Duggar Investigation

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