The Utility of the Diagnosis of Pedophilia: A Comparison of Various Classification Procedures (original) (raw)
Related papers
2005
This study examined the utility of the diagnosis of pedophilia in a sample of extra-familial child molesters assessed at a university teaching hospital between 1983 and 1995. Pedophilia was defined in one of four ways: 1) A DSM diagnosis made by a psychiatrist 2) A deviant phallometric profile 3) A DSM diagnosis and a deviant phallometric profile, and 4) high scores based on the Screening Scale for Pedophilic Interest (Seto & Lalumière, 2001). Demographic data and information on psychological tests, offence history and recidivism were gathered and group differences were analyzed along with the ability of certain variables to uniquely contribute to the classification of pedophilia. Results indicated that few differences existed on psychological measures between pedophilic and nonpedophilic sexual offenders regardless of the classification system used. Additionally, results indicated that the construct of pedophilia was unable to reveal differences in sexual, violent, or criminal reci...
The DSM Diagnostic Criteria for Pedophilia
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.
Commentary on pedophilia diagnostic criteria in DSM-5
The journal of the American Academy of Psychiatry and the Law, 2011
Human beings differ in sexual makeup. Most adults are not sexually attracted to prepubescent children, but some are. Societal values can be of relevance in determining whether such a difference is considered to be a psychiatric condition. Were a society to believe that adult-child sexual interactions should not be prohibited, such a difference might not be viewed as a disorder. According to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), a difference in sexual makeup can be considered a disorder when it causes interpersonal difficulty or marked distress. In contemporary society, pedophilia can do both. According to DSM-IV-TR, for a diagnosis of pedophilia, there must be both a qualitative difference in sexual makeup (i.e., sexualized urges directed toward children) and a quantitative difference (i.e., the sexualized urges must be intense). However, just as a heterosexual man with low (i.e., nonintense) sexual urges is still heterosex...
Recidivism in pedophiles: an investigation using different diagnostic methods
Journal of Forensic Psychiatry & Psychology, 2009
The relationship between pedophilia and recidivism was examined in a sample of 206 extrafamilial child molesters assessed at a university teaching hospital between 1982 and 1992. To address definitional issues, pedophilia was defined in one of four ways: (1) a DSM diagnosis made by a psychiatrist; (2) a deviant phallometric profile; (3) a combination of DSM diagnosis and deviant phallometric results; and, (4) high scores based on the Screening Scale for Pedophilic Interest (SSPI; Seto & Lalumière, 2001). Only phallometric assessment was associated with sexual recidivism, but with a small effect size. Overall recidivism rates were 22.8%, 33.9%, and 45.6% for sexual, violent, and any reoffence, respectively. No differences were found between pedophiles and nonpedophiles with respect to recidivism rates, regardless of how pedophilia was defined. Based on these results, the utility of the diagnosis of pedophilia for the purpose of predicting future reoffending is questioned. Recidivism in pedophiles 3 KEY WORDS: pedophilia, child molesters, phallometric assessment, diagnoses, recidivism RECIDIVISM IN PEDOPHILES: AN INVESTIGATION USING DIFFERENT DIAGNOSTIC METHODS The purpose of diagnoses is to categorize individuals into homogeneous subgroups, which can promote accurate prognosis and effective treatment. Despite this, clinicians and researchers have raised concerns about the validity and thus the application of the diagnosis of pedophilia (Marshall, 1997; 2006; O'Donohue, Regev, & Hagstrom, 2000). In her study, Levenson (2004) examined interdiagnostician reliability of four paraphilias based on individuals referred for sexually violent predator civil commitment consideration. She found concerning results suggesting inconsistent reliability in the diagnosis of these types of disorders using DSM-IV criteria. Specifically, she reported the following rates of reliability; pedophilia (kappa = 0.65), sexual sadism (kappa = 0.30), exhibitionism (kappa = 0.47), and paraphilia NOS (kappa = 0.36). Under the guidelines proposed by Cicchetti and Sparrow (1981) this range in scores is considered "poor" to "good." Levenson concludes that the degree of inconsistency in diagnosis has troubling implications in the application to legal processes (e.g. dangerous offender legislation, sexually violent predator statutes). With respect to pedophilia specifically, O'Donohue et al. (2000) identified problems with the DSM-IV diagnostic criteria. For example, they stated that the ambiguous nature of the terms "recurrent" and "intense" within Criterion A forced clinicians to draw inferences as to the nature of the disorder. Given the limitations regarding the accuracy of clinical judgment (Meehl, 1996), these inferences may adversely affect the reliability and validity of this diagnosis. Another
Problems with the DSM-IV Diagnosis of Pedophilia
Sexual Abuse: A Journal of Research and Treatment, 2000
This paper examines the taxonomic adequacy of the Diagnostic and Statistical Manual, 4th ed., DSM-IV (American Psychiatric Association, 1994) diagnostic category of pedophilia. This diagnosis, as well as the other sexual disorders, have been ignored in DSM field trials. There is no empirical information about the reliability or validity of this diagnosis. Moreover, because the vagueness of the diagnostic criteria, clinicians would need to make inferences that would likely lead to reliability problems in diagnosis. Further, the DSM diagnostic criteria include constructs that are not intersubjectively verifiable and for which there are no valid measures. This can also lead to lack of diagnostic reliability and accuracy. Most problematical however, there are aspects of the diagnostic criteria, most notably the presence of an "ego dystonic sexual attraction to children," that are incorrect exclusion criteria. Suggestions for improvement are provided.
International journal of law and psychiatry, 2016
We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in children. Participants were evaluated by two independent psychiatrists with an interview and questionnaire regarding demographic characteristics, sexual history, and self-reported sexual interests; they also completed phallometric and visual reaction time testing. Kappa was .59 for ever meeting DSM-IV-TR criteria for pedophilia and .52 for ever meeting the proposed DSM-5 criteria for pedohebephilia. Ever meeting DSM-IV-TR diagnosis was significantly related to self-reported index of sexual interest in children (highest AUC=.81, 95% CI=.70-.91, p<.001) and to indices of sexual interest in children from phallometric testing (AUC=.70; 95% CI=....
Pedophilia: Psychiatric Insights
Family Court Review, 2003
Sex offenses against children are considered the worst of cnrnes, even arnong cnminals thernselves. Attitudes have changed frorn blaming the victim to holding the perpetrator responsible for the actions. The prevalence of such offenses continues unabated despite the stigma for the offender and the irreparable trauma to the victim. Society and the medical and legal comrnunities have to present a more feasible definition ofthe problern, addressing specifically the acts that fdl under the term ofpedophilia. A plan needs to be formulated by various disciplines working together for the common goal of identifj4ng the most effective method to deal with the victims and perpetrator and also to lower the incidence and recidivism rates. Different psychological and biological tests have been devised for investigations but fall short of the desired purpose. Various treatment modalities have been suggested and tried, but much work still needs to be done in that area.
Pedophilia is a taxon among 706 adult males assessed at a civil commitment center
Journal of Psychopathology and Clinical Science, 2022
This study examined whether pedophilia is best understood as a dimension or a discrete class (taxon). We considered pedophilia to include both physical sexual attraction to children as well as emotional attraction to children and childhood. Archival data from 901 adult males from a U.S. civil commitment treatment center for sexually dangerous persons were used. Three indicators were submitted to Meehl and Ruscio's taxometric analyses: (a) a screening scale for pedophilic interests based on criminal history, (b) a composite indicator of pedophilic physical attraction, and (c) a composite indicator of pedophilic emotional attraction. All analyses supported a taxon. Compared with nontaxon members, taxon members had more interpersonal deficits, more neurodevelopmental perturbations, more sex-crime specific problems, and fewer problems related to criminality overall. Although previous research showed mixed results (some dimensional, some taxonic), the current study moves the balance of evidence toward considering pedophilia as a distinct disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
JAMA, 1980
This article addresses the risk factors associated with the psychiatric disorder pedophilia, its treatment, and treatment outcomes. It addresses physician responsibilities associated with case identification of victims and possible roles in the medical management of pedophilia. The essential feature of pedophilia is that an individual is sexually attracted exclusively or in part to prepubescent children. While pedophilia may be limited to fantasies and impulses, pedophilic behaviors are the primary concern of both the mental health and criminal justice systems. Remote risk factors for development of pedophilia often include the individual having been sexually abused as a child. Proximate risk factors for its behavioral expression are prevalence of comorbid psychiatric disorders and substance abuse disorders. Current treatment goals focus on stopping the behavior and achieving long-term behavioral control in the community. Common treatment methods are cognitive-behavioral, group ther...