Article

Hebephilia: Quintessence of Diagnostic Pretextuality

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Abstract

Hebephilia is an archaic term used to describe adult sexual attraction to adolescents. Prior to the advent of contemporary sexually violent predator laws, the term was not found in any dictionary or formal diagnostic system. Overnight, it is on the fast track toward recognition as a psychiatric condition meriting inclusion in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This article traces the sudden emergence and popularity of hebephilia to pressure from the legal arena and, specifically, to the legal mandate of a serious mental abnormality for civil commitment of sex offenders. Hebephilia is proposed as a quintessential example of pretextuality, in which special interests promote a pseudoscientific construct that furthers an implicit, instrumental goal. Inherent problems with the construct's reliability and validity are discussed. A warning is issued about unintended consequences if hebephilia or its relative, pedohebephilia, make their way into the DSM-5, due out in 2013.

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... In some cases, authors have evoked the culturally relative criteria used in determining dysfunction, which is similar to arguments that have been made about pedophilia as a mental disorder. Franklin (2010) suggested hebephilia is a novel concept, advanced by small group of researchers driven by personal interests. These criticisms were devastatingly refuted by Cantor (2012), who points out the many errors made by Franklin in her critique. ...
... This occurs even though hebephilia refers specifically to pubescent children as defined by maturation status. Blanchard and colleagues as well as other researchers have responded in depth to these critiques of hebephilia [see Blanchard (2010) for a response to arguments against the diagnosis of hebephilia and Cantor (2012) for a detailed response to Franklin's (2010) critique]. In considering these responses and the legitimacy of hebephilia, it is important to first consider the definition of what would constitute a mental disorder as reflected in DSM-IV-TR. ...
... Responding to one of Franklin's (2009Franklin's ( , 2010 criticisms, showing some sexual response to pubescent or prepubescent children is less important than the relative response to pubescent children. Most heterosexual men are most inter-ested in adult women, followed by adolescent girls and then pubescent and prepubescent children followed by males [referred to by Seto, Lalumière, and Kuban (1999), as the sexual response gradient; see Fig. 1]. ...
Chapter
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Hebephilia refers to a sexual interest in pubescent children in Tanner Stages 2 or 3 of sexual development, in other words children in early pubescence. Hebephilia is clearly differentiated from pedophilia (sexual interest in prepubescent children in Tanner Stage 1 of sexual development) and teleiophilia (sexual interest in fully mature adults). This chapter examines the research literature on hebephilia including the debate surrounding its inclusion in DSM-5. This chapter reviews the literature on the assessment of hebephilia and its relationship to sexual offending and etiology. Implications for clinical management of sexual offenders are discussed.
... Hebephilia, the erotic preference for pubescent children 1 , has been the focus of many discussions since its potential inclusion in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Many researchers and practitioners in the field argue against the very existence of hebephilia as a mental disorder, since there is only sparse and contradictory evidence regarding this issue (DeClue, 2009;Frances & First, 2011;Franklin, 2010;Green, 2010;Janssen, 2009;Kramer, 2011;Moser, 2009;Prentky & Barbaree, 2011;Tromovitch, 2009;Zander, 2009). ...
... Another concern is the potential consequences of the inclusion of hebephilia in the DSM-5 on the civil commitment of sexually violent predators, primarily in the United States, which requires a diagnosis of mental disorder/abnormality (Fabian, 2011;Frances & First, 2011;Franklin, 2010). Acknowledging hebephilia as a mental disorder could lead to a legitimization of civil commitments that might otherwise be found unconstitutional in the United States (Fabian, 2011;Frances & First, 2011;Franklin, 2010based on Knight, 2010. ...
... Another concern is the potential consequences of the inclusion of hebephilia in the DSM-5 on the civil commitment of sexually violent predators, primarily in the United States, which requires a diagnosis of mental disorder/abnormality (Fabian, 2011;Frances & First, 2011;Franklin, 2010). Acknowledging hebephilia as a mental disorder could lead to a legitimization of civil commitments that might otherwise be found unconstitutional in the United States (Fabian, 2011;Frances & First, 2011;Franklin, 2010based on Knight, 2010. Offenders who sexually abuse adolescents could receive civil commitment because they have a mental disorder that is characterized by sexual attraction towards adolescents; this seems highly tautological, since sexual attraction towards adolescents is often inferred on the very basis of sex offenses against them. ...
... 15 For a criticism of the hebephilia diagnosis, see for instance Franklin (2010) and Wakefield (2011). 16 On the SVP laws, see Janus (2009). ...
... The same diagnosis of paraphilia turns out to mean something different in a medical context than it does in a legal one. 18 From a forensic perspective, it would certainly be much more appropriate to ask directly whether a defendant lacks self-control than to ask whether he has a paraphilia, because the latter question is only an indirect and misleading way to get at the former question, which is the only one that matters forensically. Since the DSM claims that having a paraphilia is neither a sufficient nor a necessary condition for lacking self-control, there is no forensic reason for the paraphilias to remain in the DSM. ...
... 17 Winick rightly notes that "the language in DSM-IV describing even the impulse control disorders and sexual disorders -conditions involving repetitive criminal and sometimes violent behavior-suggests a failure on the part of the individual to resist strong impulses or urges, rather than an inability to do so" (Winick 1995, 579). 18 This problem is not restricted to the diagnosis of paraphilia but affects the category of mental disorder as a whole. As Michael S. Moore has shown, "writers in the area of legal insanity have often been confused between two quite distinct concepts: legal insanity and mental illness" (Moore 1980, 30). ...
Article
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This paper is divided into three parts. I begin with a short history of the way American psychiatrists have defined mental disorder in general, and paraphilias (sexual perversions) in particular, from the 1950s to 2013. I look at how the different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have articulated (or in the case of the future DSM-5, will articulate) the distinction between health and disease. In the second part I suggest how psychiatrists might want to modify their approach to the definition of mental disorder. In the third part I explain why the paraphilias in particular should be removed from the current psychiatric classification of diseases.
... have referred to sexual attraction to teenagers or those in early puberty as ephebephilia or hebephilia and have proposed the latter as a subtype of Pedophilia in DSM-5 (see www.dsm5.org). In response, Franklin (2010a) stated that ''the existence of adults who are attracted to pubescent and postpubescent minors is biologically normative across cultures and eras''(p. 763). ...
... 763). Franklin (2009Franklin ( , 2010a has argued that hebephilia is a normalconditionandthatattractiontoearlypubescentteenagersis not a sign of disorder. For instance, she argued that''heterosexual men's sexual attraction to pubescent girls was evolutionarily adaptive'' (Franklin,2010b,p.819).Shegoesontorelatesuchattractions to Neanderthal strategies for survival''under harsh environmental conditions'' (Franklin, 2010b, p. 819). ...
... This pattern is practiced, in part, because it keeps older males (elders) in control of younger males and limits competition from young men for females. So the opposite of what Franklin (2009Franklin ( , 2010aFranklin ( , 2010b suggests is in operation here: the older men know that age-mates are likely to be more interested in each other than in older men. In fact, in the eunoto ceremony held to turn warriors into elders, older men directly express their jealousy of younger menwhomayhavebeenmorefavoredbytheiryoungerwives (Hommel, 1998). ...
... Group polarization is the enhancement of a group's prevailing opinion following the discussion of an idea that most members already support, and it can lead to poor decision-making (VandenBos, 2007). With respect to the DSM-5, some Work Groups were said to be similar in opinion and limited in diversity (Franklin, 2010;Kramer, 2011). This would be fertile ground for group polarization to occur. ...
... (b) Task Force had not developed an a priori methodology for Work Groups to follow (Skodol, 2012). (c) Franklin (2010) noted that the DSM-5 Paraphilias Subworkgroup had limited diversity. The Chair of the Subworkgroup, Ray Blanchard, PhD, was also is the first author of the research study upon which the pedohebephilia proposal was based. ...
Article
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The American Psychiatric Association (APA) published DSM-5 in May 2013. The revision process was fraught with controversy. In the first section of this article, we briefly summarise the controversies related to the actions of the APA and the Task Force responsible for the revision process. These include allegations of secrecy, accusations of conflicts of interest, apprehension over a promised paradigm shift, concerns about the definition of mental disorder, charges of medicalizing normality, and claims of poor methodology. In the second section, we briefly summarise the controversies related to some of the revisions to the DSM-5 disorders and diagnostic criteria. In the third section, we argue that DSM-5 development was unnecessarily contentious for reasons that could have been foreseen and prevented. Because incremental updates to the DSM-5 are anticipated in the near future (American Psychiatric Association, 2010, APA modifies DSM naming convention to reflect publication changes, Washington, DC: Author), we propose that psychologists external to the revision process should use their unique expertise to assist in resolving the controversies that have beset the DSM-5 and thereby facilitate a less contentious development of the next iteration of the DSM. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
... Insert Table 1 about here This recommendation has elicited a number of criticisms from both psychologists and psychiatrists. Psychologist Karen Franklin (2010), in particular, has inventoried these criticisms and concluded that "expanding the definition of pedophilia -a diagnosis with already poor interrater reliability -into a broader definition of pedohebephilia has the potential to dramatically increase the scope and power of the sex offender civil commitment industry" in a way that "will invite … expert witnesses (to) purposely distort their testimony to achieve desired ends" (pp. 764-765). ...
... The second set of results is much more attractive than the first for publication purposes. They may also, unfortunately, be useful in a consequential (Sreenivasan, Frances, & Weinberger, 2010) or pretextual sense (Franklin, 2010) for buttressing inaccurate sex offender risk assessment opinions. ...
Article
Psychiatrist and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) text editor Michael First has criticized the addition of victim counts to criteria proposed by the Paraphilia Sub-Workgroup for inclusion in DSM-5 because they will increase false-positive diagnoses. Psychologist and Chair of the DSM-5 Paraphilia Sub-Workgroup, Ray Blanchard, responded by publishing a study of pedohebephiles and teleiophiles which seemed to show that victim counts could accurately identify pedohebephiles who were selected per self-report and phallometric testing. His analysis was flawed because it did not conform to conventional clinical practice and because he sampled groups at opposite ends of the clinical spectrum. In an analysis of his full sample, we found the false-positive rate for pedohebephilia at the recommended victim count selection points was indeed very large. Why? Because data analyses that eliminate intermediate data points will generate inflated estimates of correlation coefficients, base rates, and the discriminative capacity of predictor variables. This principle is also relevant for understanding the flaws in previous research that led Hanson and Bussiere to conclude that sexual recidivism was correlated with "sexual interest in children as measured by phallometric assessment." The credibility of mental health professionals rests on the reliability of their research. Conducting, publishing, and citing research that reflects
... Ironically, some of the debate about the inclusion of hebephilia and hebephilic disorder misunderstood hebephilia to include attraction to sexually maturing adolescents, when the proposed criteria would have made it clearer that the attraction was to pubescent children(Blanchard, 2013;Franklin, 2010). A preference for sexually maturing adolescents has been described as ephebophilia in the literature(Seto, 2017), but I am not aware of anyone suggesting ephebophilia be listed as a paraphilia or paraphilic disorder.2 ...
... Ironically, some of the debate about the inclusion of hebephilia and hebephilic disorder misunderstood hebephilia to include attraction to sexually maturing adolescents, when the proposed criteria would have made it clearer that the attraction was to pubescent children(Blanchard, 2013;Franklin, 2010). A preference for sexually maturing adolescents has been described as ephebophilia in the literature(Seto, 2017), but I am not aware of anyone suggesting ephebophilia be listed as a paraphilia or paraphilic disorder.2 ...
Preprint
Invited Commentary on DSM-5-TR text for Pedophilic Disorder. To appear in journal Archives of Sexual Behavior
... It is mostly used to evaluate paedophilia (persistent sexual interest in prepubescent children) and to a lesser extent hebephilia (persistent sexual interest in pubescent children), although the latter has been criticised as a pathological construct lacking validity. 7 Not all PCSOs against children have these PSIs. There may be other determinants of offending, such as easy availability of victims. ...
Article
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Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.
... Viele suchten bereits zu Beginn ihrer beruflichen Karriere therapeutische Unterstützung, vielfach wegen depressiver Erkrankungen, Alkoholproblemen oder allgemeiner Erschöpfungszustände. Sexuelle Probleme wurden im Rahmen der ambulanten oder stationären Behandlungen jedoch nur selten thematisiert.10 Mit den derzeit verbindlichen diagnostischen Regelwerken ICD-10 und DSM-IV-TR lässt sich die Diagnose einer Ephebophilie nicht direkt erfassen, obwohl für Revisionen dieser Regelwerke bereits Kriterien in der Fachwelt kontrovers und kritisch diskutiert werden (z.B.Blanchard, 2010;Franklin, 2010;Frances & First, 2011). Nach dem DSM-IV-TR ist die Ephebophilie (309.2) unter der Diagnose "Paraphilie nicht anderweitig beschrieben" zu verschlüsseln. ...
... These issues had not been adequately addressed by Blanchard et al.'s (2009) rebuttal. It was also found that data on hebephiliac is too rare to produce solid foundations for a mental health diagnosis (DeClue, 2009;Frances & First, 2010;Franklin, 2010), and ongoing debates about hebephilia still exists as most studies have been published in the last 7 to 8 years especially after Blanchard et al.'s (2009) proposal (DeClue, 2009Prentky & Barbaree, 2011;Spape & Looman, 2012). Psychiatrists working with sex offenders still face this debate (see Spitzer, 1999). ...
Article
The current study aims to fill the gap on hebephile sex offenders by comparing them to a group of pedophile offenders as well as a group of teleiophile offenders. The focus of the study is to examine the victims’ and offenders’ characteristics, the crime characteristics, and the modus operandi used by a sample of 111 male sex assaults currently serving a sentence for sexual crimes in Korea. Looking at all the comparisons conducted, it seems that the hebephiliac is not more similar to the pedophile nor the teleiophiliac. He is in fact a mix of both. Aside from certain characteristics that make hebephiliacs different from the other two subtypes of sex offenders (e.g., sadism, travelling longer than 2 km to commit the crime, history of bipolar disorder), they mainly share characteristics of both groups. The current study uncovers very important differences that could prove useful for the management of these cases by the actors of the criminal justice system.
... The diagnostic status of hebephilia has been the focus of recent debate, as it was proposed for explicit inclusion with pedophilia in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). Some authors took issue with this proposal, arguing that the sexual preference for pubescent children is not a disorder (e.g., Franklin, 2009Franklin, , 2010. Much of this criticism was largely based on the misperception that hebephilia refers to sexual interest in adolescent rather than pubescent children. ...
Article
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Objective: Sexual interest in children is a well-known risk factor for sexual reoffending (recidivism). The present study examined the relationship between sexual interest in prepubescent children (pedophilia) or pubescent children (hebephilia) and sexual recidivism. It extended previous work by using multiple indicators of sexual interest, using a more sensitive phallometric procedure that measures change in penile blood volume, and examining both hebephilia alongside pedophilia, as well as noncontact sexual recidivism. Method: Six hundred fifty-six men who had committed a sexual offense underwent a comprehensive sexological assessment that included multiple sexual interest measures: volumetric phallometry, self-report, and sexual behavior. Criminal record data were acquired to examine recidivism. Offenders were followed for an average of 10 years of opportunity. Results: Indicators of hebephilia and pedophilia were significantly associated with noncontact sexual recidivism, but inconsistently associated with contact recidivism. The relationship with phallometrically assessed pedophilia and contact sexual recidivism was significant after controlling for offender age statistically. Phallometrically assessed sexual arousal to children did not add to risk appraised by an actuarial measure. Conclusion: Both hebephilia and pedophilia were predictive of noncontact sexual recidivism. The results for contact sexual recidivism are discussed, including a potential confound in previous work on the assessment of sexual interest in children. (PsycINFO Database Record
... Despite previous research on hebephilia, some have raised concern about the validity of the construct (e.g., Franklin, 2009Franklin, , 2010. Construct validity is a central concept in psychology. ...
Article
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Hebephilia refers to a persistent intense sexual interest in pubescent children. Although not as widely studied as pedophilia, studies of hebephilia have indicated convergence in self-report and sexual arousal. The present study expanded on previous work by examining convergent and divergent validity across indicators of hebephilia that included self-report, sexual behavior, and sexual arousal in a sample of 2,238 men who had sexually offended. We included men who denied such interest and specifically examined the overlap between hebephilia and pedophilia and examined pedohebephilia (i.e., sexual interests in both prepubescent and pubescent children). Results indicated that there was considerable convergence across indicators of hebephilia. The results suggested poor divergent validity between hebephilia and pedophilia, as there was substantial overlap between the two constructs across analyses. Finally, a distinct pattern of sexual arousal was found in offenders with pedohebephilia. The results of the present study were discussed with a focus on implications for the assessment of sexual interest in children and the conceptualization of pedohebephilia. Keywords: hebephilia; pedophilia; paraphilias; erotic-age interest; DSM-5
... Franklin (2009 also criticized the public policy implications of identifying a disorder among sexual offenders that exists as a prevalent sexual interest in the general population. She pointed out that marriage between older men and young adolescent girls is common in many parts of the world and that using this proposed disorder to "excuse" sexual offending is problematic (Franklin, 2010). This raises some questions about reasons for and implications of proposing ephebophilia as a distinct diagnosis for offending priests, especially in light of a lack of published outcome research regarding treatment for this subgroup. ...
Article
Objective: The following article deals with the international reprocessing of child sexual abuse in the Catholic Church, with an emphasis on Germany, regarding church and state inquiries into sexual abuse, as well as its consequences and ways of supporting victims. Material and methods: The quantitative and qualitative data of a state and a Catholic anonymous contact point for victims in Germany was compared and analysed according to various aspects. Results: Analyses of the data of both contact points showed that a large proportion of the reported cases at the time of contact lay in the past, that the abuse happened repeatedly, and that a majority of victims were male. Differences were found regarding demographic aspects, features of the offence, the context of abuse and demands for compensation. Conclusions: Anonymous contact points are an important resource to ensure that victims are heard in the process of dealing with the past; however, a successful reprocessing requires the implementation of what was learned from the countless messages.
... There exists debate regarding whether hebephilia should be diagnosed as a mental illness (cf. [22,23]). That is, there has been a vocal group of advocates arguing variously that sexually preferring 11-to 14-year-old children is normal, albeit illegal to actualize (e.g., [24]), and that no sexual interest, even pedophilia, should be diagnosed as a mental illness [25]. ...
Article
The phallometric test has been examined most widely in the literature with regard to its ability to detect pedophilia; however, it has become of increasing interest to clinicians and researchers to ascertain to what extent the test accurately detects hebephilia: Whereas pedophilia refers to an adult's sexual interest in prepubescent children (age 10 or younger, on average), hebephilia refers to an adult's sexual interest in pubescent children (ages 11-14, on average). The aim of this study was to estimate the accuracy of volumetric phallometry in distinguishing pedophilic men and hebephilic men from men who are teleiophilic (primarily sexually interested in adults, age 17 or older). A retrospective chart review was conducted on the cumulate database of a large phallometric laboratory and clinic to identify a group of 239 men who committed sexual offenses against extrafamilial adults age 17 or older and a group of 996 men who committed sexual offenses against extrafamilial children age 14 or younger, all of whom professed a greater sexual interest in adults over children. The sensitivity and specificity of the phallometric test is calculated for its accuracy in distinguishing sexual preferences for children spanning various age ranges. Receiver operator characteristic curves were highly significant for each classification decision: Using its previously established cut-point of +0.25 standard deviation (SD) units, the phallometric test detected hebephilia with a sensitivity and specificity of 70.0% and 90.7%, detected pedophilia with 46.9% and 100%, and detected pedohebephilia with 75.3% and 90.7%. At a new cut-point of +0.0 SD units, the sensitivity and specificity of the test for pedophilia was 71.9% and 95.3%. Volumetric phallometry significantly distinguishes teleiophilic sex offenders from each of pedophilic, hebephilic, and pedohebephilic sex offenders and can serve as a reliable diagnostic test of sexual age preference among men who deny sexual interest in children. Cantor JM, and McPhail IV. Sensitivity and specificity of the phallometric test for hebephilia. J Sex Med **;**:**-**. © 2015 International Society for Sexual Medicine.
... lic Disorder concept in DSM-5 has focused upon a variety of problems with the scientific research base. For clarity's sake, these criticisms can be grouped into the following headings: (a) undue influence of a single research group; (b) questionable research design and use of statistics; (c) a feeble epidemiological basis for the proposed category.Franklin (2010) provides a history of the development of the University of Toronto's Law and Mental Health program within the Centre for Addiction and Mental Health (CAMH), instituted by sexologist Kurt Freund, pioneer of phallometry (measurement of erectile arousal through volumetric displacement technology) and developing one of the most important ce ...
... The disorder, in turn, explains the presence of the paraphilic behaviours. Identifying this problem and arguing against 'hebephilia' as a psychiatric diagnosis, Franklin (2010) claims that attraction to adolescents is in fact common, 'evolutionarily adaptive', and that 'across time and culture' men have 'tended to prefer younger partners who are at the peak of both beauty and fertility'. In making these claims, she does not acknowledge that the beauty norms which mean that very young women are 'at the peak of. . . ...
... Franklin (2009 also criticized the public policy implications of identifying a disorder among sexual offenders that exists as a prevalent sexual interest in the general population. She pointed out that marriage between older men and young adolescent girls is common in many parts of the world and that using this proposed disorder to "excuse" sexual offending is problematic (Franklin, 2010). This raises some questions about reasons for and implications of proposing ephebophilia as a distinct diagnosis for offending priests, especially in light of a lack of published outcome research regarding treatment for this subgroup. ...
Article
Abstract Child sexual abuse (CSA) in the Catholic Church has been increasingly recognized as a problem not limited to individual institutions. Recent inquiry commission reports provide substantial information on offense dynamics, but their conclusions have not been synthesized with empirical research to date. The aim of this systematic literature review was to bring together key findings and identify gaps in the evidence base. The three main focus points were: (a) types of publications and methodology used, (b) frequency information on CSA in the Catholic Church, (c) individual factors in offending, and (d) institutional factors. It was found that reports, legal assessments, and research on CSA within the Catholic Church provide extensive descriptive and qualitative information for five different countries. This includes individual psychological factors (static risk predictors, multiple trajectories) and institutional factors (opportunity, social dynamics), as well as prevalence rates illustrating a high "dark figure" of CSA.
... 238 Certainly, it was evolutionarily adaptive for such attraction, considering that these ages represent the peak of reproductive fertility. 239 Even today, studies with community samples of men find that pedophilic sexual fantasies are not uncommon. 240 In a study of undergraduate students, twenty-one percent reported sexual attraction to small children, with nine percent having sexual fantasies involving children. ...
Article
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The criminal justice system’s effort to combat child sexual exploitation has taken on a primary and aggressive focus toward prosecuting those who violate child pornography laws. The deontological policy labels all child pornography offenders, whether they are producers or merely viewers, as morally bankrupt and a threat to the nation’s children. Yet the basis for the policy bears fundamental flaws, and this article explores them. The article first summarizes legislative efforts to bolster child pornography laws and lengthen sentences for violators. It then provides a synthesis of criminal justice initiatives that are expending substantial resources targeted toward investigating, prosecuting, and punishing child pornography offenders. The policy and the initiative rely on a presumption that child pornography consumers are in reality undetected pedophiles and child molesters who are at high risk of sexually abusing children. This article challenges the presumption by comprehensively analyzing certain of the most commonly cited studies that purport to empirically support correlations between child pornography, pedophilia, and child molestation. It also highlights other empirical evidence, as well as some practical considerations, that instead tend to show that most child pornography offenders are at low risk of committing contact sexual offenses. In sum, the concentration on child pornography crimes appears to be a misinformed policy that fails to directly protect real children from harm.
... Thus far, the courts have tended to agree with the doubts expressed above. Several courts have found the ''paraphilia NOS, hebephilia'' diagnosis used in civil commitment proceedings to be either not demonstrably a mental disorder at all or not a serious enough mental disorder to meet the threshold for application to the sexual predator civil hearings (Franklin 2010a). The attempt to place this disorder in the DSM is partly an attempt to legitimize this diagnosis and neutralize such objections. ...
Article
The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, I closely examine the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5—hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a “nonconsent” or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. I argue, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i.e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in “sexually violent predator” civil commitment proceedings. KeywordsDSM-5–Diagnosis–Validity–Sexual disorder–Hebephilia–Hypersexual disorder–Paraphilic coercive disorder–Harmful dysfunction–False positive
... Finally, the proposal to include hebephilia or pedohebephilia in the DSM ) generated a fresh round of debate (Blanchard, 2009;DeClue, 2009;Frances & First, 2011;Franklin, 2009Franklin, ,2010Green,2010a,b;Moser,2009;Tromovitch, 2009;Wakefield, 2011). ...
Article
This article presents a critical review of the recent controversies concerning the diagnosis of pedophilia in the context of the preparation of the fifth edition of the DSM. The analysis focuses basically on the relationship between pedophilia and the current DSM-IV-TR's definition of mental disorder. Scholars appear not to share numerous basic assumptions ranging from their underlying ideas about what constitutes a mental disorder to the role of psychiatry in modern society, including irreconcilable theories about human sexuality, which interfere with reaching any kind of a consensus as to what the psychiatric status of pedophilia should be. It is questioned if the diagnosis of pedophilia contained in the DSM is more forensic than therapeutic, focusing rather on the dangers inherent in the condition of pedophilia (dangerous dysfunction) than on its negative effects for the subject (harmful dysfunction). The apparent necessity of the diagnosis of pedophilia in the DSM is supported, but the basis for this diagnosis is uncertain.
... In various discussions and debates about the proposed diagnostic categories for psychosexual disorders in DSM-5, a concern has been expressed that including expanded or new paraphilic diagnoses will lead to increased civil commitment under the Sexually Violent Predator (SVP) statutes that exist in 20 states (Frances, 2010;Franklin, 2010;Zander, 2008;Zonana, 1997). ...
Article
“Sexually violent predator” (SVP) legislation requires, in part, that an individual has a mental abnormality that causes difficulty in controlling sexual behavior. Previous research has found paraphilia not otherwise specified (NOS) as one of the most prevalent diagnoses proffered in SVP evaluations. However, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) modified paraphilia NOS diagnosis in two ways. First, this diagnosis was divided into two new diagnostic categories: other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder. Second, OSPD required an added specifier to indicate the individual’s source of sexual arousal. To date, no study has systematically explored how the revision to paraphilia NOS has affected diagnoses within SVP evaluations. The current study explored the frequency and diagnostic reliability of paraphilic disorders in a sample of 190 adult men evaluated for SVP civil commitment using the DSM-5. Results indicated that OSPD was the second most common paraphilic disorder, next to pedophilic disorder. However, there was poor to fair agreement ( kappa = 0.21, p < .01) between independent evaluators in providing this diagnosis. Additionally, the two most common OSPD specifiers were non-consent and hebephilia, despite recent debate and rejection of these constructs from the DSM-5. While these constructs were the most prevalent, the specifiers contained quite varied terminology, suggesting vague diagnostic tendencies within these evaluations. Given that the presence of a mental abnormality is the cornerstone to the constitutionality of SVP commitment, diagnostic practices should be based in reliable and valid techniques.
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This paper analyses the lost oedipal stage of Humbert in Vladimir Nabokov’s Lolita. It aims to discover the main character’s motivation behind his sexual disorder and the inner conflicts of his psyche, in response to Humbert not experiencing the oedipal stage in his early years. The oedipal stage is a crucial development stage of a human being, and Humbert’s inexperience causes him to be unable to express his desires as an infant boy towards his mother resulting in his psyche developing abnormally. Humbert is considered a hebephiliac for his sexual attraction towards young girls due to the loss of maternal figure at the age of three. Thus, psychoanalysis theory by Sigmund Freud is used in order to analyse the impact of Humbert’s lost oedipal stage to his adult psyche by applying the tripartite theory. The data are collected using qualitative descriptive method, represented in direct quotes from the book. The paper reveals that Humbert’s lost oedipal stage holds a vital role in developing his sexuality in adult life. He only received a strong affection and love when he was thirteen, from Annabel that aged no older than fourteen. He has been holding on to the moment, in which he was able to express his desires as his id, and is unable to let it go even after Annabel’s decease, as his id was not fully fulfilled. This causes him a traumatic experience, leading to his sexual disorder which is developed further once he met Dolores Haze as Lolita.
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This groundbreaking text interrogates the constructed boundary between therapy and violence, by examining therapeutic practice and discourse through the lens of a psychologist and a survivor of sexual abuse. It asks, what happens when those we approach for help cause further harm? Can we identify coercive practices and stop sexual abuse in psychology, psychiatry, and medicine? Tosh explores these questions and more to illustrate that many of the therapies considered fundamental to clinical practice are deeply problematic when issues of consent and sexual abuse are considered. The book examines a range of situations where medical power and authority produces a context where the refusals and non-consent of oppressed groups are denied, dismissed, or ignored. Arguing that key concepts and discourses have resulted in the production and standardisation of a therapeutic rape culture in the helping professions. Tosh uses critical intersectionality theory and discourse analysis to expertly highlight the complex interrelationships between race, class, gender, sexuality, and disability in our understanding of abuse and how we define survivors. Drawing on a wide range of comprehensive examples, including experiences and perspectives from cisgender and transgender men and women, as well as nonbinary and intersex people, this is essential reading for students and researchers of critical and queer psychology, gender studies, as well as mental health practitioners and social workers.
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Cet article étudie deux controverses ayant eu lieu lors du travail de révision du Manuel diagnostique et statistique des troubles mentaux (DSM) entre 2008 et 2013. À cette occasion, le groupe de travail sur les « paraphilies » – des attirances et comportements sexuels considérés comme anormaux ou pathologiques – a proposé d’inclure deux nouveaux troubles mentaux controversés : l’un désignant l’attirance sexuelle pour le viol (trouble paraphilique coercitif) et le deuxième pour les adolescent-e-s au début de la puberté (hébéphilie). En mobilisant la critique féministe des sciences et la sociologie des sciences et des techniques, cette recherche analyse la manière dont les savoirs psychiatriques sur la sexualité masculine sont produits, façonnés et négociés au sein du travail de révision du DSM. Ce faisant, il interroge les frontières entre normal et pathologique ainsi que les tensions historiques et les paradoxes au cœur de la catégorie des paraphilies.
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A report commissioned and funded by the Royal Commission into Institutional Responses to Child Sexual Abuse
Article
The presidency of gender in the Anglo-American taxonomy of sexualities has historically been haunted by the irruption of “other” parameters of medicalization, censure and caesura, not in the least absolute and relative measures of age. Where today’s clinical psychologists feel the need to age-specify adult homosexuality in such Hirschfeldian terms as androphilia, however, the felt need is indeed still essentially clinical. That cosmopolitan expressions such as homosexual, LGB or queer rarely require such specifications relies on a protracted and today arguably complete disarticulation of sex/gender and age/maturity as parameters of sexual orientation, accreditation and mobilization. Notably disconnected scientific frames gave voice to this Anglophone crystallization of “the normal homosexual” (circa 1950–1980): criminological, psychiatric, psychophysiological and psychodynamic typologies of “sexual deviation” (variably tending to correlate, align or subsume same-sex and age-disparate intimacies); territorializing apologias of gay, but also of “Greek”, “pederast” and “man-boy”, socialities; anthropological-historical exotification of “age-stratified homosexualities”, and mostly European, proto-queer critiques of all “bourgeois” sexual classification.
Article
Hebephilia refers to sexual interest in pubescent children who are beginning to show early signs of sexual development but are sexually immature. The present study examined the relationship between hebephilia and victim age choice in a sample of 2,238 adult male sexual offenders. On average, offenders were 39 years old at the time of their assessments, and approximately half (48%) were referred by probation or parole offices. Assessment data included self-report, sexual arousal measured by volumetric phallometry, and victims’ ages. Results suggested that, similar to pedophilia, hebephilia had a medium sized association with a greater number of victims under age 11 and a small sized association with a greater number of victims ages 11 to 14. Unlike pedophilia, a small positive association was consistently found between hebephilia and a greater number of victims ages 15 or 16. Furthermore, a small positive association was observed between victim age polymorphism and hebephilia and pedophilia. The present results suggested that hebephilia was associated with a greater number of victims age 14 or younger and chose victims similar to pedophiles.
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The diagnostic category of “hebephilia” (the erotic preference for pubescent children) was suggested in 2008 for inclusion in the DSM-5. Immediately, a violent debate took place about whether this condition should be considered a disease or not, and the proposal to include hebephilia in the DSM-5 was rejected in 2012. In this paper I argue that the debate about the diagnostic validity of hebephilia was profoundly misguided. I first describe how the diagnosis of hebephilia plays a role in “sexually violent predator” (SVP) laws, which can preventively deprive “dangerous” people of their liberty if they are deemed mentally ill (for instance by suffering from hebephilia). I show that the legal requirement of mental illness for the application of SVP laws is supposed to serve two functions: to identify the most dangerous people, and to define them out of humanity by transforming them into quasi animals, thus safeguarding the constitutionality of SVP laws in a liberal context. I then argue that it fails to accomplish both tasks, and that the debate about hebephilia should have targeted this unsound legal requirement itself. Instead, because it was centered around the issue of diagnostic validity, the hebephilia debate rested on an implicit acceptance of the requirement of mental illness for the application of SVP laws.
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This essay examines the relation between the DSM and forensic psychiatry. Psychiatrists, lawyers and philosophers often assume that the forensic legitimacy of the DSM hinges on finding an objective definition of mental disorder. In the first part of this essay I show that the DSM’s quest for objectivity has never been successful. In the second part I argue that even if an objective definition could be found, the DSM should have no role to play in the courtroom. Today, the lawyers and forensic psychiatrists who rely on the DSM to give weight to their legal opinions and judgments are making a conceptual mistake: they conflate the concepts of disease and incapacity. Once these concepts are disentangled, it becomes apparent that the DSM (which classifies diseases) should have no business meddling with the law (which is concerned with incapacities). In the third and final part I describe the positive consequences for both parties of the divorce between the DSM and forensic psychiatry.
Article
Examining the treatment of persons with mental disabilities in the criminal justice system, this book offers new perspectives that are crucial to an understanding of the ways in which society projects onto criminal defendants prejudices and attitudes about responsibility, free will, autonomy, choice, public safety, and the meaning and purpose of punishment, all with a focus on ways to enhance dignity in the criminal trial process. It is a detailed exploration of issues of adequacy of counsel; the impact of international human rights law, following the ratification of the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the role of mental health courts; and the influence of therapeutic jurisprudence, procedural justice, and restorative justice on the legal process. It considers all of these perspectives in the context of criminal justice system issues such as competency findings, the insanity defense, and sentencing. Demonstrating how the question of treatment of persons with mental disabilities in the criminal justice system is not only a vital one for both scholars and practitioners, but also a central facet of international human rights law, this book suggests policy development, further scholarly inquiries, and newly invigorated thinking and action to place dignity at the core of the criminal justice system.
Article
The imprecise wording of DSM-IV led to an abusive use of the Paraphilia NOS diagnosis to hospitalize sexual predators for indefinite periods of time through Sexually Violent Predator statues. DSM-5 has threatened to compound the error of DSM-IV through the addition of three diagnosis that invite forensic abuse: 'coercive paraphilia', 'hypersexuality', and 'hebephilia'. This article reviews that status of those three diagnoses, as well as the arguments for excluding them from the new manual.
Article
This article questions the historical awareness of the DSM-5 by investigating first the treatment of prostitution from the Victorian period to today as a means of medicalizing desire; and second, by looking at the category of hebephilia, where modern medicalizing classifications are criticized for ignoring ancient evidence. By this comparative method, the article shows how ignoring historical evidence allows the social and ideological elements in the work of defining psychological sexual diseases to remain concealed.
Article
In 2008, the concept of hebephilia, which denotes an erotic preference for "pubescent children," was suggested by Blanchard and his team for inclusion in the DSM-5 (Blanchard et al., 2009). Four years later, the APA's Board of Trustees opted for the status quo and rejected that proposal. This essay sheds light on the reason for this rejection. I consider three important questions related to hebephilia: Does hebephilia exist? Is it a disease? And what would have been the social consequences of including it in the DSM? I argue that if Blanchard failed to convince others that hebephilia should be included in the DSM-5, it is not because he focused too much on the first question and was unable to offer a convincing answer to the second one, but because he made the mistake of dismissing the third one as extraneous. The DSM is not intended to be a pure research manual, and a category like hebephilia cannot be evaluated without taking into account its potential forensic impact. In part or in whole, the decision to include a new diagnostic category in the DSM is, and always should be, a political decision.
Article
Given that paraphilic disorders are diagnosed largely in forensic settings, virtually every significant change in the criteria has forensic implications. Several controversial changes were considered during the DSM-5 revision process, but most were ultimately not included in the published text. However, any changes that make it easier to assign a paraphilic disorder diagnosis to an individual must be considered with caution. Criterion A for paraphilic disorders has been changed to reduce one potential risk that could result in false-positive diagnoses (i.e., allowing evaluators to diagnose a paraphilic disorder based entirely on the presence of sexual acts). In contrast, many of the other changes including some of those in the text, make it easier to diagnose a specific paraphilia and thus increase the risk of false-positive diagnoses. Since the assignment of a paraphilic disorder diagnosis can result in adverse legal consequences, the actual forensic impact of the changes will depend on how the legal system incorporates these new definitions into statutes and case law.
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In her recent article, Hebephilia: Quintessence of Diagnostic Pretextuality (published in Behavioral Sciences and the Law, 2010), Karen Franklin expands on her previous argument that psychologists and psychiatrists should not diagnose as abnormal hebephilia, the sexual preference for early pubescent children. She supports her argument with a series of claims about the contents of the empirical literature and the scientists who produced it. The present document provides fact-checking of those claims, revealing that Franklin's conclusions are based largely on demonstrable falsehoods.
Article
As mass media and the advertising industry sexualize children at earlier ages, DSM-5 is considering a proposal for a new mental disorder involving sexual attraction to adolescents. Despite the fact that most men are sexually aroused by pubescent teens, some clinicians and researchers believe they have identified a new subgroup of chronically impaired men who are compulsively drawn to older children. We discuss the proposal and conclude that it is insufficiently documented and that with such potentially serious medicolegal consequences, inclusion in the new manual is not advised. Clinically, there are insufficient data showing the construct to be reliable and valid. Forensically, a new diagnosis of hebephilia is likely to be used to justify indefinite civil commitment and other onerous punishments.
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This commentary addresses the controversy surrounding the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5) diagnosis of pedohebephilia. We examine adult male sexual attraction to young pubescent females and whether such attraction is deviant and constitutes a mental disorder, and, independent of that question, whether there is any defensible basis for asserting that hebephilia is a legitimate paraphilia. We conclude our analysis by looking at three profiles: adults with sexualized interest in pre- and postpubescent children, adults with sexualized interest in adult and pubescent adolescent women, and adults with exclusive sexualized interest in young pubescent women. We suggest that in the third instance of exclusivity, the Criterion B requirement of impairment may become critical to legitimizing a diagnosis of hebephilia.
Article
In recent years, state and federal legislative initiatives have heavily emphasized punitive laws to combat sexual crime. These statutes include indefinite civil commitment, which is the ultimate infringement on sexual offenders' civil liberties. Many of these committed offenders have repeatedly offended against prepubescent children (pedophiles), and many have committed nonconsensual sexual offenses against adults (rapists). A substantial number of sex offenders have offended against postpubescent adolescents and teenagers outside the age range of pedophilia (commonly referred to by some clinicians and researchers as hebephilia). The use of the term hebephilia has recently received heightened scrutiny in sexually violent predator civil commitment proceedings. Specifically, experts debate whether hebephilia is recognized within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and whether it is a generally accepted diagnosis within the field of sexual offender assessment. Scholars and practitioners question how hebephilia pertains to sexual deviance and one's risk of reoffending and whether it ultimately meets the legal mental abnormality threshold of civil commitment through DSM diagnostic criteria. This article addresses these questions and provides recent federal case law that attends to hebephilia in sexually violent predator proceedings.
Article
The paraphilia section of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is being misinterpreted in the forensic evaluations of sexually violent offenders. The resulting misuse of the term paraphilia not otherwise specified, hebephilia, has justified the inappropriate involuntary commitment of individuals who do not in fact qualify for a DSM-IV-TR diagnosis of mental disorder. This article has two purposes: to clarify what the DSM-IV-TR was meant to convey and how it has been twisted in translation within the legal system, and to warn that the DSM-5 proposal to include pedohebephilia threatens to make the current bad situation very much worse in the future.
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The proposed inclusion of a hebephilic sexual orientation (early pubescent males and/or females) in DSM-5 compromises the scientific credibility of psychiatry. Moralism about the age of an acceptable sexual partner drives this proposal. It ignores common patterns of sexual arousal, cultural variability, and historic precedents. It blurs the domains of psychiatry and law. The age of sexual consent is 14 in much of Europe. An example of the new "mentally disordered" would be a 19 year old with a consenting 14 year old. Where sexual interaction is legally accepted, but pathologized as mental disorder, psychiatry attempts to act as an agent of social control.
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The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. A ttention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.
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The DSM-IV-TR (2000) sets its own standards for inclusion of diagnoses and for changes in its text. The Paraphilia section is analyzed from the perspective of how well the DSM meets those standards. The concept of Paraphilias as psychopathology was analyzed and assessed critically to determine if it meets the definition of a mental disorder presented in the DSM; it does not. The Paraphilia diagnostic category was critiqued for logic, consistency, clarity, and whether it constitutes a distinct mental disorder. The DSM presents “facts” to substantiate various points made in the text. The veracity of these “facts” was scrutinized. Little evidence was found in their support. Problems with the tradition of equating particular sexual interests with psychopathology were highlighted. It was concluded that the Paraphilia section is so severely flawed that its removal from the DSM is advocated.
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Hypothesized that men prefer women around their own age, but that as they grow older, men develop a preference for women who, although not absolutely younger, are progressively younger than themselves and that women begin with a preference for older men, and compared with men, show less variation in that preference over their life span. Six studies support this gender-differentiated prediction in age preferences expressed in 218 personal advertisements, 1,189 marriages from 2 US cities, 100 marriages in 1923, matrimonial advertisements from 2 European countries and India, 1,789 marriages recorded from 1913–1939 on a small island in the Philippines, and 213 singles advertisements placed by financially successful American women and men. Limitations of normative and evolutionary explanations of age preferences are considered. 30 commentaries and an author response follow. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This posting contains the introduction and one chapter from my new book 'Failure to Protect: America's Sexual Predator Laws and the Rise of the Preventive State' (Cornell University Press 2006). Most crimes of sexual violence are committed by people known to the victim - acquaintances and family members. Yet politicians and the media overemphasize predatory strangers when legislating against and reporting on sexual violence. In this book, I seek to look beyond sensational headlines to expose the reality of the laws designed to prevent sexual crimes. I show that sexual predatory laws, which have intense public and political support, are counterproductive. I contend that measures such as civil commitment and Megan's law, which are designed to restrain sex offenders before they commit another crime, are bad policy and do little to reduce sexual violence. Further, these new laws make use of approaches such as preventative detention and actuarial profiling that violate important principles of liberty. I argue that to prevent sexual violence, policymakers must address the deep-seated societal problems that allow it to flourish. In addition to criminal sanctions, I endorse the specific efforts of some advocates, organizations, and social scientists to stop sexual violence by, for example, taking steps to change the attitudes and behaviors of school-age children and adolescents, improving public education and promoting community treatment and supervision of previous offenders. I also warn that the principles underlying the predator laws may be the harbingers of a preventive state in which the government casts nets of surveillance and intervenes to curtail liberty before crimes occur. I also show that the architecture of sexual violence that these new legal approaches nurture is at odds with the advances promoted by feminist thinkers during the last several decades. More than a critique of the status quo, this book discusses alternatives and how best to overcome the political obstacles to achieving rational policy.
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Twenty male child molesters confined in a maximum sercurity psychiatric institution were compared with eleven non-sex offender patients from the same institution and ten persons from the community. Each subject was shown a total of 20 slides which were of persons varying in age and sex as well as neutral or nonperson slides. Penile circumference and skin conductance responses (PCRs and SCRs) to the slide stimuli were recorded. PCRs differentiated between the child molesters and “normals” but the SCRs did not. Subjects' rankings of the sexual attractiveness of the slides were similar in the “normal” and child molester groups. Correlations between the PCR, SCR, and ranking measures were low. PCRs varied with the child molesters' histories of victim choice.
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This article is a reply to letters from Gregory DeClue, Karen Franklin, Diederik F. Janssen, Charles Moser, Joseph J. Plaud, Philip Tromovitch, and Thomas K. Zander regarding the article, Pedophilia, hebephilia, and the DSM-V. Blanchard et al. (2009). Archives of Sexual Behavior, 38, 335–350.
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There is a proposal to establish a paraphilic coercive disorder as a new paraphilia in the DSM-V. The empirical data do not, however, support the hypothesis that a distinct syndrome exists that comprises males who are sexually aroused by the coercive elements of rape per se. Purported evidence for this syndrome has centered on the results of phallometric studies. Higher plethysmographic responses of rapists to coercive rape scenarios may, however, be better explained by the failure of coercive elements to inhibit arousal to sexual aspects of the stimuli rather than by arousal specifically to the coercive elements. In addition, sexual fantasies about forcing sex and about struggling victims are highly correlated with sadistic fantasies and have not been shown to identify a syndrome that can be discriminated from sadism. Finally, taxometric evidence strongly supports the hypothesis that the underlying components of rape are distributed as dimensions and do not constitute a separate taxon. Consequently, the criteria purported to categorize rapists into the proposed syndrome would have to be arbitrarily determined. Not only does there seem to be little empirical justification for the creation of this new syndrome, the inclusion of this disorder among the paraphilias would have serious potential for misuse. It would imply endorsement of Paraphilia, NOS, nonconsent, which is currently inappropriately employed in civil commitment proceedings to justify commitment.
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This paper contains the author's report on pedophilia, submitted on June 2, 2008, to the work group charged with revising the diagnoses concerning sexual and gender identity disorders for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The author reviews the previously published criticisms and empirical research concerning the diagnostic criteria for pedophilia and presents criticism and relevant research of his own. The review shows that the DSM diagnostic criteria for pedophilia have repeatedly been criticized as unsatisfactory on logical or conceptual grounds, and that published empirical studies on the reliability and validity of these criteria have produced ambiguous results. It therefore seems that the current (i.e., DSM-IV-TR) diagnostic criteria need to be examined with an openness to major changes in the DSM-V.
Article
A review of surveys and available information relating to sex offender civil commitment programs reveals important information about the characteristics of those programs and the demographics of those persons detained or civilly committed within. Although most of these programs provide a number of clinical services that are consistent with recommended standards, whether or not other aspects of these treatment programs meet accepted standards has not been widely researched, and standards of treatment for several components of sex offender civil commitment treatment are yet to be elucidated and established by professionals in this field.
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In the 1970s, a small group of leading psychiatrists met behind closed doors and literally rewrote the book on their profession. Revising and greatly expanding the Diagnostic and Statistical Manual of Mental Disorders (DSM for short), they turned what had been a thin, spiral-bound handbook into a hefty tome. Almost overnight the number of diagnoses exploded. The result was a windfall for the pharmaceutical industry and a massive conflict of interest for psychiatry at large. This spellbinding book is the first behind-the-scenes account of what really happened and why. With unprecedented access to the American Psychiatric Association archives and previously classified memos from drug company executives, Christopher Lane unearths the disturbing truth: with little scientific justification and sometimes hilariously improbable rationales, hundreds of conditions-among them shyness-are now defined as psychiatric disorders and considered treatable with drugs. Lane shows how long-standing disagreements within the profession set the stage for these changes, and he assesses who has gained and what's been lost in the process of medicalizing emotions. With dry wit, he demolishes the façade of objective research behind which the revolution in psychiatry has hidden. He finds a profession riddled with backbiting and jockeying, and even more troubling, a profession increasingly beholden to its corporate sponsors.
Article
The finding that women are attracted to men older than themselves whereas men are attracted to relatively younger women has been explained by social psychologists in terms of economic exchange rooted in traditional sex-role norms. An alternative evolutionary model suggests that males and females follow different reproductive strategies, and predicts a more complex relationship between gender and age preferences. In particular, males' preference for relatively Younger females should be minimal during early mating years, but should become more pronounced as the male gets older. Young females are expected to prefer somewhat older males during their early years and to change less as they age. We briefly review relevant theory and present results of six studies testing this prediction. Study 1 finds support for this gender-differentiated prediction in age preferences expressed in personal advertisements. Study 2 supports the prediction with marriage statistics from two U.S. cities. Study 3 examines the cross-generational robustness of the phenomenon, and finds the same pattern in marriage statistics from 1923. Study 4 replicates Study 1 using matrimonial advertisements from two European countries, and from India. Study 5 finds a consistent pattern in marriages recorded from 1913 through 1939 on a small island in the Philippines. Study 6 reveals the same pattern in singles advertisements placed by financially successful American women and men. We consider the limitations of previous normative and evolutionary explanations of age preferences and discuss the advantages of expanding previous models to include the life history perspective.
Book
This book discusses what makes a person crazy. For many mental health professionals, the DSM is an indispensable diagnostic tool, and as the standard reference for psychiatrists and other psychotherapists, it has had an inestimable influence on the way we view other human beings. What goes in it, and what stays out, is of monumental importance. This book also discusses how things have taken a strange turn. The fight is no longer about who escapes DSM labeling, but rather, how a person can qualify for a diagnosis. Now mental health professionals must label their clients as pathological in order for them to be reimbursed by their insurance companies. This disturbing trend toward making us crazy when we are simply grappling with everyday concerns has even worse public implications. The authors also argue that the DSM is not the scientifically based reference work it purports to be, but rather a collection of current phobias and popular mores. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In the first half of the twentieth century, Americans' intense concern with sex crimes against children led to a wave of public discussion, legislative action, and criminal prosecution. Stephen Robertson provides the first large-scale, long-term study of how American criminal courts dealt with the prosecution of sexual violence against children. Robertson describes how the nineteenth-century approach to childhood as a single phase of innocence began to shift at the end of the century to include several stages of childhood development, prompting reformers to create legal categories such as statutory rape and carnal abuse to protect children. However, while ordinary New Yorkers' involvement in the prosecution of those offenses reshaped their understandings of who was a child and produced a new concern to establish the age of their sexual partners, their beliefs in childhood innocence and in a concept of sexuality centered on sexual intercourse remained unchanged. As a result, families' use of the law and jurors' decisions ultimately diminished the protection the new laws offered to children. Robertson's study, based on the previously unexamined files of the New York County district attorney's office, reveals the importance of child sexuality and sex crimes in twentieth-century American culture.
Article
The latest study from the Kinsey Institute, to determine whether persons convicted of sex offenses differ from other individuals, and if so, how, is a truly herculean labor. In a volume of almost 900 pages, the authors record in exhaustive detail various facets (chiefly sexual) of the lives of 1,356 sex offenders, 477 control subjects, and 888 prison inmates convicted of nonsexual crimes. The study is limited to white men over 16.The amount of printed minutiae is monumental, numbing the eye and brain with the profusion of statistical data and tables. The following heading of one of the 167 tables exemplifies the excessive minuteness of inquiry: "Sexual Arousal From Pictures of Sexual Action by Sexual Arousal From Seeing or Thinking About Females for Control, Prison and Sex-Offender Groups with Female Objects." This table alone contains 208 separate percentage figures.The authors' subdivide sex offenders into 14 classes, including heterosexual
Article
Every psychiatric expert involved in writing the standard diagnostic criteria for disorders such as depression and schizophrenia has had financial ties to drug companies that sell medications for those illnesses, a new analysis has found. Of the 170 experts in all who contributed to the manual that defines disorders from personality problems to drug addiction, more than half had such ties, including 100 percent of the experts who served on work groups on mood disorders and psychotic disorders. The analysis did not reveal the extent of their relationships with industry or whether those ties preceded or followed their work on the manual. "I don't think the public is aware of how egregious the financial ties are in the field of psychiatry," said Lisa Cosgrove, a clinical psychologist at the University of Massachusetts in Boston, who is publishing her analysis today in the peer-reviewed journal Psychotherapy and Psychosomatics. The analysis comes at a time of growing debate over the rising use of medication as the primary or sole treatment for many psychiatric disorders, a trend driven in part by definitions of mental disorders in the psychiatric manual. Cosgrove said she began her research after discovering that five of six panel members studying whether certain premenstrual problems are a psychiatric disorder had ties to Eli Lilly & Co., which was seeking to market its drug Prozac to treat those symptoms. The process of defining such disorders is far from scientific, Cosgrove added: "You would be dismayed at how political the process can be." The American Psychiatric Association, which publishes the guidelines in its bible of disorders, the Diagnostic and Statistical Manual (DSM), said it is planning to require disclosure of the financial ties of experts who write the next edition of the manual --due around 2011. The manual carries vast influence over the practice of psychiatry in the United States and around the world.
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The diffusion of sexual psychopath laws has followed this course: a community is thrown into panic by a few serious sex crimes, which are given nation-wide publicity; the community acts in an agitated manner, and all sorts of proposals are made; a committee is then appointed to study the facts and to make recommendations. The committee recommends a sexual psychopath law as the scientific procedure for control of sex crime. This recommendation is consistent with the trend toward treatment policies in criminal justice in preference to policies of punishment.
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Criminal record, personal history, social-sexual competence, and physiological responses to erotic stimuli were examined in incarcerated pedophiles, hebephiles, and rapists. There were significant differences among groups in criminal and personal background; in particular, pedophiles tended to be older, more poorly educated, more likely to be unmarried, and less frequently involved in nonsexual crime. Social and social-sexual inadequacy was common to all groups, reflected in under-assertiveness, low self-esteem, and negative sexual attitudes. Rapists and hebephiles both responded maximally to adults as sexual partners, and both responded more to cues for consensual sex than to cues for rape. Thus it appears that deviant sexual arousal is a factor in deviant sexual behavior only in the case of pedophiles.
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Journal of Social History 40.1 (2006) 231-233 Stephen Robertson's Crimes Against Children is an important book, and a significant contribution to the history of children and childhood. Because it is also ambitious in its range and complex in its argument, it deserves to be read by an array of historians concerned with matters of culture, society and law. By examining in depth and detail changes in how sexual crimes against children were defined, popularly understood, and implemented by juries and judges in New York City from the late nineteenth century to the mid twentieth century, Robertson also makes a valuable contribution to the important intersection among law, sexuality, and psychiatry in the twentieth century. In seriously engaging this complex historical juncture, Robertson's book can be both extremely illuminating and occasionally frustrating. Robertson argues that beginning in the 1880s, social reformers and reform organizations, especially the New York Society for the Prevention of Cruelty to Children, began vigorously to extend to older children (both female and male) its protective umbrella by appropriating the guiding nineteenth century visions of the innocence of children. In so doing, it sought to bring to court a variety of sexual offenders who were previously not legally culpable. This argument is not new, since several historians have demonstrated that the campaigns to raise the age of consent in the United States and elsewhere in the West changed the nature of rape prosecutions and our understanding of who was capable of giving sexual consent. But, Robertson's careful attention to the court records and the New York SPCC files reveals not only how frequent and varied these crimes were, but that the success of this initial campaign, in New York at least, was actually quite limited because juries, drawn from ordinary citizens, and even judges rarely approached the law in the categorical ways that reformers hoped to institutionalize through the passage of new laws. In what Robertson calls the actual legal culture, reforms were often stymied, as those who dispensed laws brought to their legal conclusions views about law and about childhood that drew on traditional and often local perspectives regarding gender, maturity, race, ethnicity and class as well attention to the specifics of the cases. Thus, juries made clear distinctions between statutory rape and violent rapes, and prosecutors accepted plea bargains that often included agreements by offenders to marry the victims of statutory rape. Law was not a simple or uniform instrument in the way it was practiced. The category of age, as a simple marker, did not eclipse other ways of understanding sexuality until the twentieth century, and even then in complex and ambiguous ways. By the twentieth century, the new psychology of child development began to change views of childhood and adolescence as these intersected with new perspectives on matters of sexuality. As older views of adolescent (and even childhood) sexual innocence was replaced with a vision of progressive development, cultural and legal views changed also. In the 1920s this perspective was gaining ground, though its influence was still new and uncertain. But in the 1930s and, especially, by the 1950s, the dominance of a developmental model of sexuality intersected with matters of law, and the new psychology began to alter both legislation and legal culture in strategic ways. In many ways, this description reduces the complex and frequently knotty story that Robertson tells and which he illustrates with real cases and specific (and sometimes gruesome) details of violence against children. One of the great strengths of this book is the careful way in which Robertson approaches his subject, and the fact that his analysis is grounded in statistical patterns while the story is brought home through specific cases. Nevertheless this description certainly corresponds to the trajectory laid out in Crimes Against Children. And Robertson's documentation of this pattern is a signal contribution to our understanding of two profoundly important medico-legal matters: the way in which sexuality became an important site for medical expertise in the law; and the specific way...
Article
The United States Conference of Catholic Bishops commissioned John Jay College of Criminal Justice to conduct a national study that was descriptive of the nature and extent of clerical sexual abuse, demographics of offenders and victims, and other factors. Embedded in the report however was clear evidence that the majority of victims were pubescent or post-pubescent males lending support for the need of an additional diagnostic category: ephebophilia. We examine the report concluding there is evidence for the validity of the ephebophilia construct and its differentiation from pedophilia.
Article
In two prior studies, item-level analyses of the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Minnesota Multiphasic Personality Inventory (MMPI-2) were conducted to construct an MCMI-II scale and an MMPI-2 scale that could discriminate priest same-sex ephebophiles from priests with nonsexual psychiatric disorders. The resulting 11 -item MCMI-II scale and the 16-item MMPI-2 scale were combined in the present study to determine if they can better discriminate these two groups than either scale by itself. The ability of the combined 11-item scale from the MCMI-II and the 16-item scale from the MMPI-2 (i.e., the combined scale) to discriminate the two groups when compared to the ability of these scales individually to discriminate these two groups was statistically significant. Not only did the Combined-Scale classify more participants correctly than the individual scales, but unlike the 11 -item MCMI-II scale its internal consistency was more robust. It was further suggested that though specially constructed scales from objective personality tests are useful in identifying priest ephebophiles, they must be used in conjunction with other methods of identification.
Article
A study of sex offenders (54 exhibitionists and 55 pedophiles) referred by court to an outpatient clinic. The major psychiatric, social, and psychological characteristics of each group are outlined. Exhibitionists showed a recidivism rate of 20% as compared to a 13% recidivism rate for the pedophiles. In the exhibitionist group those exposing to children showed a higher rate of recidivism than those exposing to adults. In the pedophilic group the recidivism rate for the homosexual pedophile was 3 times the rate for the heterosexual pedophiles. The recidivism rate was higher for offenders who had more than 1 sex offense before coming to the clinic. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Studied differences between 381 male inmates diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) criteria as having antisocial personality disorder (APD) and 257 male inmates given other diagnoses in terms of background characteristics, criminal histories, and prison behavior. Findings indicate that inmates diagnosed with APD do not differ from other diagnosed inmates in terms of background characteristics, except race, but do differ in terms of criminal histories. Because of the difference between the diagnosed groups regarding race, the groups were also compared controlling for race. These results support the idea that the diagnosis APD is applied arbitrarily and that if an inmate is Black, he/she may qualify for the diagnosis more easily than if White. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In discussing the psychopathology and theories associated with pedophilia, this chapter specifically addresses: diagnostic issues raised by and presented in various editions of the DSM; epidemiology; associated features; juvenile/developmental issues; forensic issues; theories of etiology; and future directions. The author suspects the major stumbling block to continued progress in this field to be the problem of the heterogeneity of child molesters. Therefore, future research ought to focus on reducing this heterogeneity to manageable proportions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This book, written by the psychologist in charge of the sex clinic of the Penitentiary of the City of New York at Riker's Island, constitutes a general survey of the sex criminal problem. There are 15 chapters, each replete with illustrative case material, and emphasis is placed upon the need for better public educational measures to meet the problem. (PsycINFO Database Record (c) 2012 APA, all rights reserved)