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Since the advent of the internet, law-enforcement officials and advocacy organizations have raised alarms about the ever-increasing availability of child pornography as well as the proliferation of forums where those who seek it can find one another. And in the past 20 years, those fears have been borne out in a big way. According to a New York Times investigation, the spread of child pornography has reached a breaking point: In 1998, there were 3,000 reports of child-sexual-abuse imagery online; in 2018, there were 45 million.

In its harrowing report, the Times found evidence of online pedophilia communities that treat abusive imagery as a kind of collector’s item, forcing child victims to hold signs with the group’s name or other identifying details to prove the images are “fresh.” This behavior, alongside others identified by the study (including the prevalent use of the dark web and encrypted technologies), has encouraged some experts in pedophilia to reexamine certain long-held beliefs — including one that the overwhelming majority of those with pedophilic attraction never go on to commit physical abuse.

According to the Times, that presumption began to change in 2007, when psychologists at the Federal Bureau of Prisons reported that 85 percent of convicted online offenders admitted later in therapy that they had sexually abused children. Though the study was eventually withdrawn from peer review and its methodology was widely criticized — the study sample comprised only 155 convicts, all of whom self-selected for therapy — its authors, supported by a few other, more recent studies, maintain that many more offenders than we might think were convicted for possessing and sharing child pornography but also committed physical abuse.

This growing body of evidence challenges the presumed trajectory associated with the consumption of child pornography, which suggests that viewing it might encourage someone to commit abuse. “We shouldn’t assume that viewing online images leads to abuse of a child victim in person,” Joe Sullivan, a specialist in sex crimes against children in Ireland and Britain, told the Times. “In my clinical experience, it’s the other way around. Most of these men have already committed hands-on offenses.” Michael L. Bourke, chief of the behavioral-analysis unit of the United States Marshals, says it’s not so much that viewing child-sexual-abuse imagery “awakens latent desires” but rather that one’s continued viewing, as well as participation in online forums with like-minded individuals, can help a pedophile overcome ethical inhibitions and evade law enforcement.

Though the federal government anticipated these challenges to a degree, enacting the Protect Our Children Act in 2008, the Times found the Justice Department has neglected to write the monitoring reports mandated by the legislation and to appoint any official to lead the efforts. The federal government has also fallen far short of the funding goals specified by the law. Pedophiles and child abusers remain a poorly understood group, and efforts to punish them have been largely ineffective — researchers say sex-offender registries and neighborhood notification policies only further alienate those convicted while doing little to prevent future sexual violence.

Anyone glancingly familiar with true crime and/or crime procedurals is familiar with the tenet that child abusers are born of child abuse, but experts are lately questioning this hypothesis, too. Victims of child abuse, researchers say, are far more likely to endure substance abuse, depression, stress, and continued criminal aggression than to become abusers themselves. Pedophiles, then, are not made but born. “The biological clues attached to pedophilia demonstrate that its roots are prenatal,” James Cantor, director of the Toronto Sexuality Center, told the Times, adding that these clues aren’t genetic but can be traced to development in the womb — though it’s still unclear which factors might play a role, and to what degree, and what could ethically be done with that information if and when we get it.

If pedophilia is an innate sexual orientation like any other, as some researchers argue, how can it be helped, and how can it be curbed before harm is done? Therapy for pedophilia may include testosterone suppression and behavior modification, such as restricted internet browsing. But these methods are based largely on outdated presumptions — that all pedophiles are male (they’re not) and that reducing access to sexual imagery necessarily reduces one’s sex drive.

Still, Dr. Fred Berlin, director of the Johns Hopkins Sex and Gender Clinic, tells the Times that treatment is worthwhile, and prevention is possible: “There’s a subgroup out there [who] are quite convinced that they do not want real-life sex with children.” Finding them and treating them before they become abusers — and before they participate in the exploding internet child-sex-abuse marketplace — presents an overwhelming challenge.