Wednesday, December 2, 2009

More News on Paraphilic Coercive Disorder

A few months ago, I wrote a couple of posts here and here on a diagnosis proposed for DSM-V: Paraphilic Coercive Disorder (PCD), and I wrote about a profoundly troubling report on the matter by an advisor to the Paraphilias Subworkgroup for DSM-V (who, for some unknown reason, called it Coercive Paraphilic Disorder. If you google each of the names in quotes, you'll see the difference.) That report argued against including the diagnosis (a conclusion I agree with), but gave just about the scariest argument publishable in defense of that conclusion.

Since then, there have been three additional reports published by advisors to the paraphilias subworkgroup, two of which are on PCD (other groups only publish reports by workgroup members.) In my previous post I gave two possible explanations for the really scary report: either it is a diversionary tactic or they’re wanting to give the worst possible argument against the diagnosis in order to gain support for it.

The second of the reports on PCD seemed quite promising—the author gave some very sensible arguments against including it (basically, that it has dubious scientific support and would have rather undesirable consequences in terms of research on understanding the causes of rape [by causing researchers to focus on the wrong questions] and in terms of misapplication with respect to laws permitting the “civil commitment” of sex-offenders [i]after[/i] they finish their sentences. These laws, which a number of US states have, are, in my view, are of very questionable constitutionality: they essentially take away procedural due process rights and violate the US Constitution’s ex post facto and double jeopardy clauses, though the Supreme Court has [wrongly, I think] rejected these arguments to date.)

A third report has recently been published arguing in favor of adding the diagnosis. Having read it, it feels as though it would be very persuasive if I didn’t know anything about the matter (or know to be very skeptical of certain lines of research that he cites.) Based on this third report, I am fairly strongly inclined to think that the Paraphilias Subworkgroup members really do want to add this diagnosis in DSM-V. There is a very telling piece of evidence if you read the acknowledgements at the end of these reports:

First report, argues against PCD:
Thanks are due to Rick Beninger, Joe Camilleri, Grant Harris, Martin Lalumie`re, and Marnie Rice for their comments on an earlier version of this manuscript. The author is an Advisor to the DSM-V Paraphilias subworkgroup of the Sexual and Gender Identity Disorders Workgroup (Chair, Kenneth J. Zucker, Ph.D.). Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.


Second report, argues against PCD:
I would like to thank Jane Harries, Matthew King, Elizabeth Saunders, and Judith Sims-Knight for their insightful comments and suggestions on an earlier version of this article. The author is an Advisor to the DSM-V Paraphilias subworkgroup of the Sexual and Gender Identity Disorders Workgroup (Chair, Kenneth J. Zucker, Ph.D.). Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.


Third report, arguing in favor of including PCD:

The author is an Advisor to the DSM-V Paraphilias subworkgroup of the Sexual and Gender Identity Disorders Workgroup (Chair, Kenneth J. Zucker, Ph.D.). I wish to thank members of the subworkgroup for their discussion of an earlier version of this paper and their role in refining and developing the diagnostic options that are discussed. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association. (emphasis mine)


And, just for additional contrast, another report by an advisor to the paraphilias subworkgroup (on a different matter):
The author is an advisor to the Paraphilias subworkgroup of the DSM-V Sexual and Gender Identity Disorders Workgroup (Chair, Kenneth J. Zucker, Ph.D.). This article is a revised version of a commentary submitted on July 17, 2009 to the Workgroup. I would like to thank Jobina Li for help with the references. The views expressed are those of the author and not necessarily those of Public Safety Canada.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.


Which of these things is not like the others?

In case you hadn’t guessed from the section I bolded, only one of these authors mentions having ever discussed their report with members of the Paraphilias Subworkgroup. Now, my understanding was that the whole point of having official advisors is for them to, you know, advise? By, like, talking with the workgroup members? In just about every other report I’ve read so far, authors acknowledge the helpful input from other workgroup members. (The exceptions are those by Ray Blanchard who finished his reports of pedophilia and “transvestic fetishism” not long after the workgroups were formed; in the former, he thanked two people for comments about a single point, and in the latter, he thanked several people for “their stimulating conversations, over many years.”)

Now, I may be reading a little too much into the fact that only one of their advisors acknowledges ever speaking with the people they’re advising about the matter on which they are advising them. (Though I assume that they’ve probably all met before, as it isn’t that big of a field.) Still, it does seem suggestive.

And I really don’t like what it suggests. In the second report on PCD published online, Raymond Knight sums up the reasons:

First, identifying and reifying a taxon implies a research strategy that emphasizes extreme group designs that attempt to distinguish the putative taxon from other discrete groups of rapists that have been formed for comparison purposes [reference]… Searching for the identifying characteristics of a non-existent taxon will delay the task of discerning the underlying dimensions of rape and explicating their etiology and life course.

Second, the criteria for civil commitment depend on some form of mental disorder to legitimize the process and keep it from becoming unconstitutional preventive detention [references]. Moreover, it is required that it be demonstrated that the mental disorder is a likely source of the offender’s sexual offending. In commitment proceedings for rapists Paraphilia NOS, nonconsent has frequently served the role of a sexual aggression inducing mental disorder, despite the lack of specific criteria for its implementation and the absence of evidence of its reliability and validity [reference]. The inclusion of PCD would inappropriately legitimize this ‘‘disorder’’ and grant it the imprimatur of the DSM, which is almost universally cited by expert witnesses in civil commitment proceedings. The present review indicates that the diagnosis has little empirical support, and it would be a travesty to grant it a status that would perpetuate its misuse.