This review examines theory, research, and clinical practice relating to child molesters' cognitive distortions. First we review development of cognitive distortion theory and examine its epistemological usefulness. Then we critically evaluate available research evidence for current conceptualizations of cognitive distortions. This evaluation of the latest research suggests that clinical practice with child molesters has run ahead of scientific knowledge. We conclude that there is confusion about the exact nature of cognitive distortions, about the role that they play in sexual offending, and about what constitutes evidence of their existence. Although it seems likely that distorted cognition plays a role in some child molesters' offenses, our concern is that from a scientific standpoint, the majority of the research conducted cannot be used either to support or refute this view. We suggest that future research in this area should concentrate upon developing new methods and adapting methods established in other domains to enable measurement of child molesters' cognitive distortions in a more sophisticated way. Use of more diverse designs that better operationalize the construct of distorted cognition will ensure that future research (a) appreciably advances our knowledge of the scientific status of cognitive distortions in child molesters, and (b) promotes more effective empirically driven clinical practice with child molesters.