Saturday, July 3, 2010

Further explorations of the landscape of the paraphilias and DSM-5

A few weeks ago, I wrote about some of the background relevant to understand the current controvercies regarding this part of the DSM. In this post, I want to continue on that focusing specifically on events beginning in May 2008 when the American Psychiatric Association (APA) announced the membership of the various workgroups (although some additinoal people were added later. (See here for short biographies of the members of the Sexual and Gender Identity Disorders Workgroup.) The Sexual and Gender Identity Disorders Workgroup is divided into three subworkgroups: The Gender Identity Disorder Subworkgroup, the Paraphilias Subworkgroup, and the Sexual Dysfunctions Subworkgroup.

There was substantial negative reaction on the part of the trans community to the committee's membership, especially regarding the appointment of Kenneth Zucker as the chair of that committee and Ray Blanchard as the chair of the Paraphilias subworkgroup, as they are not necessarily the most popular psychologists among some in the trans community. (See this article as an example of an article unhappy about this appointment.) There was even a petition urging the APA to remove them. The petition was later modified to urge the removal of Martin Kafka (who is currently on the Paraphilias Subworkgroup) on the grounds that he has supported pharmacological treatment for cross dressing. The petition got over 9500 signatures.

The next major controversy regarding the Paraphilias Subworkgroup occured in response to the article Pedophilia, Hebephilia, and the DSM-V by Ray Blanchard, Amy Lykins, Diane Wherrett, Michael Kuban, James Cantor, Thomas Blak, Robert Dickey, and Philip Klassen. The abstract states:
The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory....[The] results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.

There were seven letters to the editor published in Archives of Sexual Behavior in response to this article, which, along with the original article and a response by Blanchard to the seven letters to the editor, were published in the June 2009 issue of that journal. In general, the responses pointed out that the argument "It exists; therefore it is a mental disorder" is missing some crucial steps in the middle. They also pointed out methodological problems with the study (because when you don't like someone's politics, you attack their methodology; that's just how stuff works in scientific areas with potentially significant political consequences.) For those interested in this, the forensic psychologist Karen Franklin has a page on her website about Hebephilia and the DSM-5 Controversy that has a bibliography including some more recent articles on the subject.

There's plenty more to write about regarding controversies surrounding DSM-5, and I'll definitely have more to say about the matter.

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