过去的两个月，我们看到新闻里那一张张让人愤怒的照片，恋童癖进入了公众视野。我们这次翻译了哈佛大学医学系的期刊中的一篇科普文。这是2010年发表的文章，里面提到了恋童癖是无法治疗、无法改变的。正在实施的心理、药物治疗，也未见成效。我们该如何做，才能保护身边的孩子？
恋童癖无法治疗，我们该怎么办？
译者：徐唱、尹子梦
校对：朱宇晴
词汇：
王乐颖
策划：朱宇晴
Pessimism about pedophilia
对恋童癖的悲观
本文选自
Havard Health
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There is no cure, so the focus is on protecting children.
没有治愈恋童癖的方法，所以我们的关注点是保护儿童。
Pedophilia, the sexual attraction to children who have not yet reached puberty, remains a
vexing
challenge for clinicians and public officials. Classified as a
paraphilia
, an abnormal sexual behavior, researchers have found no effective treatment. Like other sexual orientations, pedophilia is unlikely to change. The goal of treatment, therefore, is to prevent someone from acting on pedophile urges — either by decreasing sexual arousal around children or increasing the ability to manage that arousal. But neither is as effective for reducing harm as preventing access to children, or providing close supervision.
恋童癖是指对青春期前的儿童产生性吸引。至今为止，对临床医师和公务人员来说，恋童癖依然是一个
恼人的
艰巨任务。它被归为性偏差，是一种
反常性行为
，研究人员还未找到有效的治疗方法。正如其他性取向一样，恋童癖并不太可能被改变。因此，治疗的目标则是防止恋童癖者随着自己的欲望行事。治疗的方法要么是降低由儿童产生的性欲，要么是增强对于性欲的控制力。但是就降低伤害而言，这两个方法都没有另一个来的有效——也就是防止恋童癖者接近孩童，或是提供密切的监管。
vex
['veks] V-T If someone or something vexes you, they make you feel annoyed, puzzled, and frustrated. 使烦恼; 使迷惑; 使沮丧
paraphilia
[,pærə'fɪlɪə] N any abnormal sexual behaviour; sexual anomaly or deviation 性反常行为
Consensus
now exists that pedophilia is a distinct sexual orientation, not something that develops in someone who is homosexual or heterosexual. Some people with pedophilic urges are also attracted to adults, and may act only on the latter urges. Because people with pedophilic urges tend to be attracted to children of a particular gender, they are sometimes described in the literature as heterosexual, homosexual, or bisexual pedophiles. Roughly 9% to 40% of pedophiles are homosexual in their orientation toward children — but that is not the same as saying they are homosexual. Homosexual adults are no more likely than heterosexuals to abuse children.
如今关于恋童癖有一个
共识
：恋童癖是一种独特的性取向，而并非是从同性恋或异性恋人群中发展出来的。部分有恋童欲望的人同样会被成人吸引，且可能仅仅根据对成人的欲望行动。由于有恋童欲望的人倾向于被某一性别的孩童吸引，所以他们有时会被描述为异性恋童癖者、同性恋童癖者，或者双性恋童癖者。大约9%到40%的恋童癖者是被同性孩童吸引的——但这并意味着他们就是同性恋。相较于异性恋，同性恋并非更有可能性侵儿童。
Several reports have concluded that most people with pedophilic tendencies eventually act on their sexual urges in some way. Typically this involves exposing themselves to children, watching naked children, masturbating in front of children, or touching children's genitals. Oral, anal, or vaginal penetration is less common.
一些研究报告指出，大多数有恋童倾向的人最终都会在某些方面按照他们的性欲行动。典型的行为包括在儿童面前裸露自己、观看儿童裸体、在儿童面前自慰，或者触摸儿童的性器官。对口腔、肛部，或者阴道的侵入相对少见。
Fears about predatory behavior are valid. Most pedophiles who act on their impulses do so by
manipulating
children and gradually desensitizing them to inappropriate behavior. Then they escalate it. Pedophiles are able to do this because in most cases they already know the children or have access to them. In about 60% to 70% of child sexual abuse cases involving pedophiles, the perpetrator is a relative, neighbor, family friend, teacher, coach, clergyman, or someone else in regular contact with the child. Strangers are less likely to sexually abuse children — although they are more likely to commit violent assaults when they do.
对于侵略性行为，人会感到恐惧是正常的。大部分按性欲行动的恋童癖者会通过
控制
儿童，并逐渐降低儿童对他们不正当行为的敏感度来进行侵犯。然后再逐渐将侵犯升级。恋童癖者能这样做是因为在大多数情况下，他们已经认识儿童，或已经接触到他们。在与恋童癖有关的儿童性侵犯案例中，60%-70%的犯罪者是亲属、邻居、家庭友人、老师、教练、牧师，或经常与儿童接触的人。陌生人相对不会性侵儿童——尽管当他们会的时候，他们更可能犯下暴力袭击。
Estimates of
recidivism
vary because studies define this term in different ways. One review found recidivism rates of 10% to 50% among pedophiles previously convicted of sexual abuse, although this could include anything from an arrest for any offense to reconviction on a crime against a child. One long-term study of previously convicted pedophiles (with an average follow-up of 25 years) found that one-fourth of heterosexual pedophiles and one-half of homosexual or bisexual pedophiles went on to commit another sexual offense against children.
对
累犯
的预测没有定论，因为不同研究中对“累犯”的定义不同。一评论文章指出，10%-50%因性侵获罪的恋童癖会再次犯罪，尽管再次犯罪不一定是性侵儿童，可能只是普通违规被捕。。一项对于有案底的恋童癖者的长期研究（平均每人跟踪调查25年）指出，四分之一的异性恋童癖者和一半的同性或双性恋童癖者会继续犯下新的对儿童的性侵。
recidivism
[rɪ'sɪdɪvɪzəm] NOUN The tendency of a convicted criminal to reoffend.再犯， 累犯
When
confronted
about sexual abuse, convicted pedophiles often rationalize their actions, such as
insisting
that a victimized child acted seductively or enjoyed the encounter. These rationalizations may reflect an inability to empathize with the child, which could be part of a co-occurring antisocial or narcissistic personality disorder.
被
质问
时，恋童癖犯罪者往往为他们的行为辩解，例如
坚称
受害儿童表现出引诱行为，或是受害儿童享受他们的犯罪过程。这些辩解可以反映出他们无法同情孩童，而这可能除了恋童癖外，他们还患有反社会性格或自恋人格混乱。
Some researchers fear that the growth of Internet communities for people with pedophilic tendencies may encourage users to act on their sexual urges and share information about how to
elude
detection. But other commentators note that these online communities actually make it easier for law enforcement officials to lure and
entrap
potential offenders before they commit a sexual crime.
一些研究人员担心越来越多有恋童倾向的人在网上汇集，这会鼓励他们行动，他们也会分享
躲避
侦查的讯息。但也有评论指出，线上团体其实让执法部门更容易地在潜在犯罪者实施性侵之前进行
诱导
抓捕。
elude
[ɪ'l(j)uːd] to escape from someone or something, especially by tricking them
〔机敏地〕逃避，躲避
entrap
[ɪn'træp; en-] to trap someone or something, or make it impossible for them to escape from a situation, especially by tricking them 使陷入圈套[困境]；诱捕
Management options
治疗方法
Treatment is effective only if a patient with pedophilia is motivated and committed to controlling his behavior — attributes that are difficult for mental health professionals to assess. Outcomes are better when treatment combines psychotherapy and medication.
只有当恋童癖患者表现积极，并承诺控制自身行为时，治疗方法才管用，因为心理健康专家很难评定疗效。心理治疗和药物治疗相结合，效果更好。
Psychotherapy
. Most psychotherapies used to treat pedophilia incorporate the principles and techniques of cognitive behavioral therapy. The focus of therapy is to enable the patient to recognize and overcome rationalizations about his behavior. In addition, therapy may involve empathy training and techniques in sexual impulse control.
心理疗法
。以前大多数用来医治恋童癖的心理疗法，会包含认知行为疗法的原理和技巧。心理疗法的重点在于让病人能够认识到自身的错误行为，并不再认为自己的行为是合理的。此外，心理疗法还可能包括共情训练和控制性冲动的技巧。
The most common type of cognitive behavioral therapy used with sex offenders, known as
relapse
prevention, is based on addiction treatment. Relapse prevention is intended to help the patient anticipate situations that increase the risk of sexually abusing or assaulting a child, and to find ways to avoid or more productively respond to them. Reviews that have included uncontrolled and nonrandomized studies concluded that relapse prevention programs reduced recidivism. Only one randomized controlled trial has evaluated how effective a relapse prevention program was, however, and it included sex offenders who had assaulted adults as well as those who hurt children. After an average of eight years, there was no significant difference in recidivism between sex offenders who underwent relapse prevention therapy and controls who did not undergo treatment.
用于治疗性犯罪者的认知行为疗法中，最常见的是以治疗上瘾为基础的，称为
复发
预防。也就是，当性虐待或性侵儿童风险上升时，帮助病人提前做准备，并找到方法避免或更有效地应对。涵盖无对照且非随机研究的评论报告得出结论说，复发预防项目减少了再次犯罪。然而，只有一个随机对照实验评估了复发预防项目的效果，而且此实验研究的性犯罪者中，有的曾性侵成年人，也有的性侵过儿童。实验得出结论，平均八年后，接受过复发预防治疗的性犯罪者和与此对照的没接受过治疗的性犯罪者相比，二者之间在累犯率上没有明显不同。
relapse
[rɪ'læps] V-I If you say that someone relapses into a way of behaving that is undesirable, you mean that they start to behave in that way again. 复发
Aversive
conditioning, a behavioral method directed at associating a pedophilic fantasy or desire with an unpleasant sensation such as nausea, an electric shock, or a bad smell, was once popular. Although a review concluded that aversive conditioning might increase someone's ability to control sexual attraction to children in the short term, there is no evidence that this approach is effective over time.
厌恶
疗法曾十分流行，这是将娈童的幻想或欲望与一种令人不适的感觉联系在一起的疗法，比如呕吐、电击或难闻的气味。虽然一评论报告得出结论称，厌恶疗法在短期内可能使一些人更好地控制自己对儿童的欲望，但并无证据证明这种方法随时间推移仍然有效。
aversive
[ə'və:siv] ADJ tending to dissuade or repel 令人嫌恶的; 令人厌恶的
Drug treatment.
Drugs that suppress production of the male hormone testosterone are used to reduce the frequency or intensity of sexual desire. Although physical castration is another option, testosterone suppression offers advantages such as the need for follow-up visits (which aids in monitoring behavior). It may take three to 10 months for testosterone suppression to reduce sexual desire.
药物疗法。
人们使用抑制男性荷尔蒙睾丸素分泌的药物，来降低性欲的频率和强烈程度。虽然物理阉割也是一种选择，但抑制睾丸素会有许多好处，比如患者需要随访（有助于监控患者行为）。抑制睾丸素需要花费三到十个月才能降低性欲。
Investigators were once optimistic about the potential of selective serotonin reuptake inhibitors (SSRIs) in treating pedophilia. But only case reports and open-label trials find that SSRIs are helpful; this has not been demonstrated in randomized, placebo-controlled trials. However, SSRIs may be a useful
adjunct
to other treatments, because they not only subdue sexual ruminations and urges but also help with impulse control.
研究者曾对选择性5-羟色胺再摄取抑制剂(SSRIs)在治疗恋童癖方面的潜力十分乐观。但只有病案报告和开放式实验认为SSRIs有效；在随机的安慰剂对照实验中，其疗效还未得到证实。然而，SSRIs在其他治疗中可能是个很有用的
辅助剂
，因为SSRIs不仅能抑制性欲和性冲动，还有助于提高自制力。
adjunct
['ædʒʌŋ(k)t] N-COUNT Something that is an adjunct to something larger or more important is connected with it or helps to perform the same task. 补充
Preventing child sexual abuse
防止儿童性侵
State programs such as Megan's Law and the Adam Walsh Act seek to limit where convicted sex crime offenders may live and work. Meanwhile, school- and community-based educational programs offer advice about how to identify situations that may endanger children, how to recognize behaviors such as
inappropriate
touching that may desensitize children so that they are more easily victimized, and how children can protect themselves.
