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The DSM Diagnostic Criteria for Pedophilia

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Abstract

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.

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Notes

  1. In the DSM definition of mental disorder (e.g., DSM-IV-TR, p. xxxi), “an important loss of freedom” (presumably including imprisonment) is listed along with other sequelae that make a behavioral or psychological syndrome clinically significant: present distress (e.g., a painful symptom), disability (i.e., impairment in one or more important areas of functioning), and an increased risk of suffering death, pain, or disability. Since sexual acts against children are serious criminal offenses, they are closely associated with criminal conviction and incarceration (loss of freedom).

  2. It should be noted that these offenders have little objective motivation to be truthful and many good reasons to dissemble. Offenders are not necessarily rewarded for being truthful about pedophilic impulses; they might experience even more severe consequences of their actions if they acknowledge being pedophiles. Furthermore, some common treatment options are not really attractive, from the patient’s point of view. Many clinicians have turned to “relapse-prevention” treatment of pedophiles, which means, in essence, teaching pedophiles to control themselves. This may well be the best option relative to further offending and incarceration, but a life of sexual denial would hardly be viewed by most people as desirable in an absolute sense. The same considerations apply to treatment with sex-drive-reducing medication.

  3. When the distinction between paraphilias and paraphilic disorders is applied to other anomalous erotic behaviors, it will tend to correlate with a distinction between low severity vs. high severity, or benign vs. malignant. For example, a man or woman with masochistic interests in light spanking or verbal abuse from a safe, consensual partner is less likely to experience distress or impairment than a person with strong masochistic interests that cause serious injury or risk of death. Since real-life examples of mild and harmless masochism, mild and harmless sadism, mild and harmless fetishism, and so on, are relatively common, the paraphilia/paraphilic disorder distinction may seem more intuitive when applied to these other interests than when applied to pedophilia.

  4. In a study conducted after this report was submitted, Blanchard et al. (in press) demonstrated that the notion of preference not only can, but probably must, be applied in the interpretation of phallometric test results.

  5. The term teleiophilia (Blanchard et al., 2000) denotes the erotic preference for persons between the ages of physical maturity and physical decline.

  6. Packard and Levenson interpreted the difference in magnitude between the proportions of negative and positive agreement to suggest that “the evaluators were applying stringent criteria for inclusion in a diagnosis, with a preference given for eliminating false positives in favor of potentially allowing a greater proportion of false negatives” (p. 9).

References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

  • Bernard, F. (1975). An enquiry among a group of pedophiles. Journal of Sex Research, 11, 242–255.

    Article  Google Scholar 

  • Blanchard, R. (2009). Reply to letters regarding Pedophilia, Hebephilia, and the DSM-V [Letter to the Editor]. Archives of Sexual Behavior, 38, 331–334.

    Article  Google Scholar 

  • Blanchard, R., Barbaree, H. E., Bogaert, A. F., Dickey, R., Klassen, P., Kuban, M. E., et al. (2000). Fraternal birth order and sexual orientation in pedophiles. Archives of Sexual Behavior, 29, 463–478.

    Article  PubMed  Google Scholar 

  • Blanchard, R., Klassen, P., Dickey, R., Kuban, M. E., & Blak, T. (2001). Sensitivity and specificity of the phallometric test for pedophilia in nonadmitting sex offenders. Psychological Assessment, 13, 118–126.

    Article  PubMed  Google Scholar 

  • Blanchard, R., Kolla, N. J., Cantor, J. M., Klassen, P. E., Dickey, R., Kuban, M. E., et al. (2007). IQ, handedness, and pedophilia in adult male patients stratified by referral source. Sexual Abuse: A Journal of Research and Treatment, 19, 285–309.

    Article  Google Scholar 

  • Blanchard, R., Kuban, M. E., Blak, T., Cantor, J. M., Klassen, P., & Dickey, R. (2006). Phallometric comparison of pedophilic interest in nonadmitting sexual offenders against stepdaughters, biological daughters, other biologically related girls, and unrelated girls. Sexual Abuse: A Journal of Research and Treatment, 18, 1–14.

    Article  Google Scholar 

  • Blanchard, R., Kuban, M. E., Blak, T., Cantor, J. M., Klassen, P. E., & Dickey, R. (in press). Absolute vs. relative ascertainment of pedophilia in men. Sexual Abuse: A Journal of Research and Treatment.

  • Blanchard, R., Kuban, M. E., Klassen, P., Dickey, R., Christensen, B. K., Cantor, J. M., et al. (2003). Self-reported head injuries before and after age 13 in pedophilic and nonpedophilic men referred for clinical assessment. Archives of Sexual Behavior, 32, 573–581.

    Article  PubMed  Google Scholar 

  • Blanchard, R., Lykins, A. D., Wherrett, D., Kuban, M. E., Cantor, J. M., Blak, T., et al. (2009). Pedophilia, hebephilia, and the DSM-V. Archives of Sexual Behavior, 38, 335–350.

    Article  PubMed  Google Scholar 

  • Boney-McCoy, S., & Finkelhor, D. (1995). Prior victimization: A risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse & Neglect, 19, 1401–1421.

    Article  Google Scholar 

  • Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27, 1205–1222.

    Article  Google Scholar 

  • Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46, 423–429.

    Article  PubMed  Google Scholar 

  • Cantor, J. M., Blanchard, R., Christensen, B. K., Dickey, R., Klassen, P. E., Beckstead, A. L., et al. (2004). Intelligence, memory, and handedness in pedophilia. Neuropsychology, 18, 3–14.

    Article  PubMed  Google Scholar 

  • Cantor, J. M., Klassen, P. E., Dickey, R., Christensen, B. K., Kuban, M. E., Blak, T., et al. (2005). Handedness in pedophilia and hebephilia. Archives of Sexual Behavior, 34, 447–459.

    Article  PubMed  Google Scholar 

  • Cantor, J. M., Kuban, M. E., Blak, T., Klassen, P. E., Dickey, R., & Blanchard, R. (2006). Grade failure and special education placement in sexual offenders’ educational histories. Archives of Sexual Behavior, 35, 743–751.

    Article  PubMed  Google Scholar 

  • Cantor, J. M., Kuban, M. E., Blak, T., Klassen, P. E., Dickey, R., & Blanchard, R. (2007). Physical height in pedophilic and hebephilic sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 19, 395–407.

    Google Scholar 

  • Dohrenwend, B. P., & Dohrenwend, B. S. (1965). The problem of validity in field studies of psychological disorder. Journal of Abnormal Psychology, 70, 52–69.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10, 5–25.

    Article  PubMed  Google Scholar 

  • First, M. B., & Frances, A. (2008). Issues for DSM-V: Unintended consequences of small changes: The case of paraphilias. American Journal of Psychiatry, 165, 1240–1241.

    Article  PubMed  Google Scholar 

  • Freund, K., & Blanchard, R. (1989). Phallometric diagnosis of pedophilia. Journal of Consulting and Clinical Psychology, 57, 100–105.

    Article  PubMed  Google Scholar 

  • Freund, K., & Watson, R. J. (1991). Assessment of the sensitivity and specificity of a phallometric test: An update of phallometric diagnosis of pedophilia. Psychological Assessment, 3, 254–260.

    Article  Google Scholar 

  • Gebhard, P. H., Gagnon, J. H., Pomeroy, W. B., & Christenson, C. V. (1965). Sex offenders: An analysis of types. New York: Harper & Row.

    Google Scholar 

  • Glueck, B. C., Jr. (1955). Final report: Research project for the study and treatment of persons convicted of crimes involving sexual aberrations, June 1952 to June 1955. New York: New York State Department of Mental Hygiene.

    Google Scholar 

  • Green, R. (2002). Is pedophilia a mental disorder? Archives of Sexual Behavior, 31, 467–471.

    Article  PubMed  Google Scholar 

  • Kingston, D. A., Firestone, P., Moulden, H. M., & Bradford, J. M. (2007). The utility of the diagnosis of pedophilia: A comparison of various classification procedures. Archives of Sexual Behavior, 36, 423–436.

    Article  PubMed  Google Scholar 

  • Konopasky, R. J., & Konopasky, A. W. B. (2000). Remaking penile plethysmography. In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking relapse prevention with sex offenders (pp. 257–284). London: Sage Publications.

    Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.

    Article  PubMed  Google Scholar 

  • Levenson, J. S. (2004). Reliability of sexually violent predator civil commitment criteria in Florida. Law and Human Behavior, 28, 357–368.

    Article  PubMed  Google Scholar 

  • Marshall, W. L. (1997). Pedophilia: Psychopathology and theory. In D. R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 152–174). New York: Guilford Press.

    Google Scholar 

  • O’Donohue, W., & Letourneau, E. (1993). A brief group treatment for the modification of denial in child sexual abusers: Outcome and follow up. Child Abuse and Neglect, 17, 299–304.

    Article  PubMed  Google Scholar 

  • O’Donohue, W., Regev, L. G., & Hagstrom, A. (2000). Problems with the DSM-IV diagnosis of pedophilia. Sexual Abuse: A Journal of Research and Treatment, 12, 95–105.

    Article  Google Scholar 

  • Packard, R. L., & Levenson, J. S. (2006). Revisiting the reliability of diagnostic decisions in sex offender civil commitment. Sexual Offender Treatment, 1, 1–15.

    Google Scholar 

  • Safron, A., Barch, B., Bailey, J. M., Gitelman, D. R., Parrish, T. B., & Reber, P. J. (2007). Neural correlates of sexual arousal in homosexual and heterosexual men. Behavioral Neuroscience, 121, 237–248.

    Article  PubMed  Google Scholar 

  • Schiffer, B., Krueger, T., Paul, T., de Greiff, A., Forsting, M., Leygraf, N., et al. (2008a). Brain response to visual sexual stimuli in homosexual pedophiles. Journal of Psychiatry and Neuroscience, 33, 23–33.

    PubMed  Google Scholar 

  • Schiffer, B., Paul, T., Gizewski, E., Forsting, M., Leygraf, N., Schedlowski, M., et al. (2008b). Functional brain correlates of heterosexual paedophilia. NeuroImage, 41, 80–91.

    Article  PubMed  Google Scholar 

  • Seto, M. C. (2002). Precisely defining pedophilia. Archives of Sexual Behavior, 31, 498–499.

    Google Scholar 

  • Seto, M. C., Cantor, J. M., & Blanchard, R. (2006). Child pornography offenses are a valid diagnostic indicator of pedophilia. Journal of Abnormal Psychology, 115, 610–615.

    Article  PubMed  Google Scholar 

  • Snyder, H. N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics (Report No. NCJ 18399). Washington, DC: U.S. Department of Justice.

  • Studer, L. H., Aylwin, A. S., Clelland, S. R., Reddon, J. R., & Frenzel, R. R. (2002). Primary erotic preference in a group of child molesters. International Journal of Law and Psychiatry, 25, 173–180.

    Article  PubMed  Google Scholar 

  • Vuocolo, A. B. (1969). The repetitive sex offender: An analysis of the administration of the New Jersey sex offender program from 1949 to 1965. Roselle, NJ: Quality Printing.

    Google Scholar 

  • Walter, M., Witzel, J., Wiebking, C., Gubka, U., Rotte, M., Schiltz, K., et al. (2007). Pedophilia is linked to reduced activation in hypothalamus and lateral prefrontal cortex during visual erotic stimulation. Biological Psychiatry, 62, 698–701.

    Article  PubMed  Google Scholar 

  • Wilson, G. D., & Cox, D. N. (1983). Personality of paedophile club members. Personality and Individual Differences, 4, 323–329.

    Article  Google Scholar 

  • Wormith, J. S. (1983). A survey of incarcerated sexual offenders. Canadian Journal of Criminology, 25, 379–390.

    Google Scholar 

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Acknowledgments

The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders. He wishes to thank James M. Cantor and Kenneth J. Zucker for their input regarding the distinction between paraphilias and paraphilic disorders. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.

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Correspondence to Ray Blanchard.

Appendix

Appendix

Diagnostic Criteria for Pedophilia in DSM-III (1980)

  1. A.

    The act or fantasy of engaging in sexual activity with prepubertal children is a repeatedly preferred or exclusive method of achieving sexual excitement.

  2. B.

    If the individual is an adult, the prepubertal children are at least 10 years younger than the individual. If the individual is a late adolescent, no precise age difference is required, and clinical judgment must take into account the age difference as well as the sexual maturity of the child.

Diagnostic Criteria for Pedophilia in DSM-III-R (1987)

  1. A.

    Over a period of at least 6 months, recurrent intense sexual urges and sexually arousing fantasies involving sexual activity with a prepubescent child or children (generally age 13 or younger).

  2. B.

    The person has acted on these urges, or is markedly distressed by them.

  3. C.

    The person is at least 16 years old and at least 5 years older than the child or children in A.

Note: Do not include a late adolescent involved in an ongoing sexual relationship with a 12- or 13-year-old.

Specify: same sex, opposite sex, or same and opposite sex.

Specify if limited to incest.

Specify: exclusive type (attracted only to children), or nonexclusive type.

Diagnostic Criteria for Pedophilia in DSM-IV (1994)

  1. A.

    Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

  2. B.

    The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  3. C.

    The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

Specify if:

  • Sexually Attracted to Males

  • Sexually Attracted to Females

  • Sexually Attracted to Both

Specify if:

  • Limited to Incest

Specify type:

  • Exclusive Type (attracted only to children)

  • Nonexclusive Type

Diagnostic Criteria for Pedophilia in DSM-IV-TR (2000)

  1. A.

    Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

  2. B.

    The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

  3. C.

    The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

Specify if:

  • Sexually Attracted to Males

  • Sexually Attracted to Females

  • Sexually Attracted to Both

Specify if:

  • Limited to Incest

Specify type:

  • Exclusive Type (attracted only to children)

  • Nonexclusive Type

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Blanchard, R. The DSM Diagnostic Criteria for Pedophilia. Arch Sex Behav 39, 304–316 (2010). https://doi.org/10.1007/s10508-009-9536-0

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