A Diagnostic and Statistical Manual of Mental Disorders (DSM)–based diagnosis of pedophilia has so far failed to predict sexual reoffense in convicted child molesters, probably because of its broad and unspecific conceptualization. In this study, therefore, we investigated the prognostic value of the subtype exclusive pedophilia and a series of customary risk assessment instruments (SSPI, Static-99, Stable-2007, VRS:SO) and the PCL-R in a sample of prison released pedophilic sexual offenders. First, we examined the convergent validity of risk assessment instruments (N = 261). Then, we calculated the predictive accuracy of the measures and diagnosis for sexual recidivism by ROC analyses and subsequent Cox regression (N = 189). Also, predictive values with more clinical immediacy were calculated (sensitivity, specificity, PPV and NPV). The VRS:SO, the SSPI, and the Static-99 significantly predicted sexual recidivism, as did a diagnosis of exclusive pedophilia. Also, the VRS:SO predicted sexual reoffense significantly better than the Stable-2007, the Static-99/Stable-2007 combined score, and the PCL-R. When used combined, only the VRS:SO and a diagnosis of exclusive pedophilia added incremental validity to each other. Our findings support that the clinical diagnosis of an exclusive pedophilia based on DSM criteria and VRS:SO defined risk factors can reliably discriminate higher from lower risk offenders, even within the select subgroup of pedophilic child molesters.

Contemporary research and clinical practice underscores the importance of discerning subgroups of child molesters on the basis of an underlying pedophilic preference. Indeed, prior meta-analytic reviews (e.g., Hanson & Bussière, 1998) have identified pedophilia, as with other paraphilias, to be an important marker of sexual reoffense risk. Closer scrutiny of primary sources included in past reviews, however, reveals that operationalizations of pedophilia are frequently inconsistent and unclear, while the magnitudes of association between clinical diagnoses of pedophilia and recidivism are often...