Sexuality Journal Publishes B4U-ACT Concerns about DSM-5

A letter to the editor written by Richard Kramer, Director of Operations of B4U-ACT, has been published in the scientific journal Archives of Sexual Behavior. The letter “describes how the proposed DSM-5 criteria for pedohebephilia have been developed without following four key guidelines specified by the American Psychiatric Association (APA) and [points] out significant flaws that have resulted. It also proposes solutions.” See:

Kramer, Richard, APA Guidelines Ignored in Development of Diagnostic Criteria for Pedohebephilia, Archives of Sexual Behavior, V 40, #2, 233-235, October 30, 2010

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B4U-ACT Mourns Loss of Co-Founder Mike Melsheimer

With great sadness, B4U-ACT announces the death of Michael F. Melsheimer, co-founder of the organization in 2003. Mike died peacefully on July 15 after battling emphysema for several years. He was born August 21, 1942 in Jacksonville, FL the son of the late Richard L. and Nancy R. Ison Melsheimer. His spent his career as a social service worker, and his later volunteer work involved advocacy for patients and the disabled. Along with Russell Dick, he founded B4U-ACT to promote the understanding and humane treatment of minor-attracted people. Memorial contributions may be made to B4U-ACT, P.O. Box 1754, Westminster, MD 21158-9998.

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DSM-5 Officials Hold Conference Call with B4U-ACT

Six people from B4U-ACT who are attracted to minors participated in a conference call Friday morning, June 11, with seven people who are involved in revising the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). These seven included the four members of the Paraphilias Subworkgroup, responsible for the DSM entry for pedophilia (chair Dr. Ray Blanchard, Dr. Martin P. Kafka, Dr. Richard B. Krueger, and Dr. Niklas Langstrom), the chair of the Sexual and Gender Identity Disorders Workgroup (Dr. Ken Zucker), and two members of the DSM Task Force (vice chair Dr. Darrel Regier and research director Dr. William Narrow). Below is a summary of the main issues that were discussed.

The DSM criteria for pedophilia should be accurate and scientifically-based. As noted in DSM 5 promotional material, this means criteria must based on literature and expertise from diverse perspectives and fields. Currently, they are based solely on research involving unrepresentative forensic samples. Note that in contrast, the diagnostic criteria for all disorders other than the paraphilias are based on knowledge from outside forensic contexts. There is no scientific justification for making exceptions for the paraphilias, including pedohebephilia.

Scientific information beyond forensic studies would shed a clearer, brighter light on diagnostic issues regarding pedophilia. These issues include the age at which pedophilia can be diagnosed, whether hebephilia should be added to the DSM, the nature and role of distress, and whether a distinction should be made between pedophilia and pedophilic disorder. For example, the age cutoffs in the proposed criteria are not supported by any developmental literature on pedophilia and in fact contradict the available evidence.

The DSM criteria for pedophilia should assume and promote a collaborative, therapeutic relationship between doctor or therapist and patient. In contrast, the currently proposed diagnostic criteria, based on offender data, assume and accept that the patient will be dishonest. Even the nomenclature of the client as “offender” rather than “patient” in the literature review clearly implies an adversarial relationship between the individual and the mental health professional.

Ongoing collaboration is needed to promote good research to address these complex issues. There was some disagreement on this point, but it is clearly understood that the responsibility for suggesting changes to the DSM lies with the subworkgroup. B4U-ACT seeks to work with the APA as a resource both to fulfill its mission to seek input from stakeholder groups and to help ensure that the recommended changes are accurate and scientifically-based. B4U-ACT looks forward to future meetings, both in person and via conference calls.

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B4U-ACT Representatives Attend APA Annual Meeting

Three representatives of B4U-ACT recently returned from attending the Annual Meeting of the American Psychiatric Association in New Orleans. The APA recognized B4U-ACT as a patient advocacy group at the meeting. There were about 11,000 attendees at the conference, of whom about 8000 were psychiatrists (the rest were students, psychiatric nurses, chaplains, and others). The three B4U-ACT representatives were among only about 20 representatives of advocacy groups. The APA displayed 1000 copies of a flier about B4U-ACT prominently on their “Important Annual Meeting Information” booth in the registration area.

The B4U-ACT representatives attended three sessions related to DSM 5. The first one was entitled “DSM 5: Progress in Research and Development” and presented by Drs. Kupfer and Regier, chair and vice chair of the DSM 5 Task Force, respectively. During the question and answer period, B4U-ACT asked how stakeholder groups are involved in the DSM revision process, and how the Task Force would insure that pedohebephilia field trials (to test the DSM) would involve minor-attracted people who are not under the control of the criminal justice system in order to give unbiased results. Dr. Regier answered both questions, but his answer to the second question was evasive, saying limited funding would prevent such field trials for “low prevalence disorders.” However, he did say, in front of the assembled group of about 200 people, that the Task Force was in the process of initiating communication with a “consumer group” regarding pedohebehilia, meaning B4U-ACT. Afterwards, the B4U-ACT representatives introduced themselves to Dr. Regier and spoke with him about the need for a face-to-face meeting and about their policy for meeting with patient groups.

The second DSM 5 session consisted of reports from the chairs of 5 of the 13 DSM workgroups. One of them was Dr. Zucker, head of the sexual and gender identity disorders workgroup. During the question and answer period after he presented, B4U-ACT asked him why the literature review supporting the proposal for pedohebephilia was so narrowly focused on sex offender literature, ignoring the literature from psychology and other relevant fields, and ignoring the DSM research agenda. He responded by saying a literature review must be delimited, but he also mentioned that Archives of Sexual Behavior (which he edits) was going to publish a long article by Bruce Rind which would draw from some of these fields.

The third session about DSM 5 was entitled “Feedback on Criteria and Terminology in DSM 5,” moderated by Drs. Kupfer and Regier. It consisted of a series of multiple choice questions presented by the moderators, to which attendees were to reply using remote control devices. They then tallied the answers for everyone to see. The questions were about whether particular newly proposed disorders should be added to the DSM, or about whether certain disorder names were clinically useful and/or stigmatizing. There were no questions about pedohebephilia.

In addition to the DSM sessions, B4U-ACT representatives attended a few other sessions that were relevant: on suicide risk assessment, ethical dilemmas in psychiatry, and stigma. At each of these, during the question and answer period, the B4U-ACT representatives mentioned mentioned the organization’s work and raised relevant questions involving people attracted to minors. The answers were generally not satisfying, but resondents were respectful. After the session on ethical dilemmas, two psychiatrists from the audience approached the B4U-ACT representatives to say they were impressed by B4U-ACT’s work and courage. They were given B4U-ACT’s flier.

On Tuesday, B4U-ACT representatives spent some time walking through the exhibit hall and chatted with representatives of a half dozen behavioral health institutions, telling them about B4U-ACT and giving them the flier. Most seemed interested in B4U-ACT’s work.

B4U-ACT representatives also circulated among five evening receptions held by various groups, including two from Maryland. Again, they talked face to face about B4U-ACT and the situation faced by minor-attracted people, especially adolescents. They talked with chairs of the psychiatry departments at two major universities and with a person who heads two major mental health policy programs. They also spoke with the chair of one of the DSM workgroups (but unrelated to sexual disorders).

Overall, attendance at the APA meeting was quite productive. By simply speaking up at sessions they attended, B4U-ACT representatives exposed a total of a few hundred psychiatrists to the organization’s work and to one or two issues facing minor-attracted people. They had more in-depth, one-on-one conversations with two dozen or so individuals, including some important people in psychiatry or DSM development.

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B4U-ACT Urges DSM-5 Group to Participate in Meeting

The American Psychiatric Association (APA) is currently revising its Diagnostic and Statistical Manual (DSM), the authoritative handbook used by mental health professionals to diagnose mental disorders. The DSM influences the beliefs and practices of mental health professionals, the criminal justice system, the media, and the public. Therefore, it has an enormous impact on all of society, especially those who are diagnosed with mental disorders. For that reason, the APA states that DSM revisions must be based on accurate and complete scientific information, that revision workgroups should include representation from “patient and family groups,” that the revision process must seek “input from stakeholders,” and that DSM should be “sensitive to the needs of clinicians and their patients.”

B4U-ACT is in strong agreement with this position of the APA, particularly in regard to DSM revisions regarding sexual attraction to minors. The DSM has an especially  profound effect on people (including teenagers) who are emotionally and sexually attracted to children or adolescents, who number in at least the hundreds of thousands in North America.

Yet the DSM is currently being revised in the absence of information from the vast majority of these people. Instead, revisions are being based on limited data from unrepresentative correctional populations who cannot be honest with researchers. It is well-known among social scientists that such data are highly biased and misleading. The lack of accurate information feeds irrational fears surrounding people who are attracted to children or adolescents. These fears are extraordinarily intense and lead to severe stigma and adversarial policies which force minor-attracted people into hiding, making the gathering of accurate information even more difficult. Perpetuating this vicious cycle neither protects children nor leads to effective policies. It renders the APA powerless to gather and disseminate accurate information.

B4U-ACT is proposing a solution to this otherwise intractable problem by proposing that at least one member of the paraphilias subworkgroup meet in person with a small group of minor-attracted people who are not under the supervison of the criminal justice system. B4U-ACT is emailing the paraphilias subworkgroup to urge them to participate in such a meeting. B4U-ACT is also informing the public of this proposal by emailing researchers, mental health agencies, child protection organizations, political leaders, media outlets, and others.

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B4U-ACT Requests Meeting with DSM-5 Paraphilias Group

Three representatives of B4U-ACT sent the following letter to the members of the DSM-5 Paraphilias Subworkgroup and the chair of the DSM-5 Task Force, asking for a meeting with members of the subworkgroup in order to provide input on the revision of the DSM as it relates to minor-attracted people.


December 5, 2009

Dr. Ray Blanchard
Centre for Addiction and Mental Health
250 College Street
Toronto, Ontario M5T 1R8
Canada

Dear Dr. Blanchard:

We represent an organization that is dedicated to dialog and mutual understanding between mental health professionals and people who are emotionally and sexually attracted to children or adolescents. One of our core principles is “Nothing about us without us”; that is, we believe that important decisions that seriously affect the lives of any group of people should include input from that group of people.

Similarly, the APA website on the DSM revision process states that the work groups include representation from “patient and family groups.” The recent APA Statement on GID and the DSM-V also says that the revision process seeks “input from stakeholders” and that the APA’s goal is to develop a manual that is “sensitive to the needs of clinicians and their patients.”

It is in this spirit that we, as people who are attracted to minors, request the opportunity to meet with members of the DSM-V sub-work group on the paraphilias. We believe a meeting would be mutually beneficial. We welcome your reply by mail, telephone, or email. Michael Melsheimer can be reached at 410-751-9571, and Richard Kramer can be reached at rkramer@b4uact.org. We would greatly appreciate your response in a timely manner.

Sincerely,

Michael Melsheimer
Richard Kramer
William Andriette

cc:
Richard B. Krueger, M.D.
Niklas Langstrom, M.D., Ph.D.
Martin P. Kafka, M.D.
David J. Kupfer, M.D.

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B4U-ACT Holds First Workshop for Professionals

B4U-ACT held its one-day workshop entitled “Beyond Fear and Mistrust: Toward Open Communication between Mental Health Professionals and Minor-Attracted People” in Westminster, Maryland. The workshop was highly interactive, with four mental health professionals and four minor-attracted people taking leadership roles as presenters or discussion leaders. Attendance was by invitation only and the number was intentionally kept small to encourage interaction and honesty.

The goals was to define the communication problem that exists between mental health professionals and minor attracted people and to understand its consequences. Throughout the day, there was respectful communication between mental health professionals and minor-attracted people, and some new friendships and partnerships were forged.

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TogetherChat Submits Report to BMHS

Participants at the TogetherChat submitted a report of their discussions to Baltimore Mental Health Systems. This report identifies several barriers to communication that exist between mental health professionals and minor-attracted people, including self-interest, media sensationalizing, culturally enforced secrecy, drastic and ineffective legal policies, inaccurate stereotypes, the silencing of minor-attracted people who behave responsibly, misleading paradigms used to understand them, adversarial professional relationships, derogatory professional language, severe stigma, marginalization, and fear on both sides. The report describes how improved communication would contribute to the prevention of harm to minor-attracted adults and adolescents, the well-being of children, increased understanding by mental health professionals, and more effective and just policies.

The report proposes a variety of interventions, such as workshops to promote honest communication between the two groups and a change in the existing paradigm, the creation of an infrastructure of highly visible mental health services, a review and revision of professional language, the organizing of informal meetings held around the country where both groups could speak honestly about common concerns, and the formation of a working group that would disseminate accurate information to stakeholders. The report also identifies possible obstacles to these interventions and ways of working around them.

Finally, the report outlines plans for a workshop to be held by B4U-ACT in late fall or winter, with support from BMHS. The proposed workshop would involve interactive sessions where attendees work together toward the following goals:

  • To define the communication problem that exists between mental health professionals and minor attracted people in society
  • To promote understanding of the harmful consequences of this problem, and the benefits of eliminating the barriers to communication
  • To develop mutual empathy among mental health professionals and minor attracted people
  • To help mental health professionals see minor attracted people as diverse in their characteristics and behaviors
  • To form a working group that would develop and carry out plans to promote communication between the two groups over a period of time, and on a larger scale

The full report can be found here (Word document).

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TogetherChat Begins

B4U-ACT opened its forum for mental health professionals and minor-attracted adults to discuss the barriers that hinder communication between them. Three professionals, all of whom specialize in treatment for minor-attracted adults, and three minor-attracted adults were recruited to participate. Over the next several months, the group expects to include additional participants. Participants are charged with identifying the barriers that hinder communication between them, understanding how the elimination of these barriers would benefit both parties and society in general, identifying interventions to overcome them, and formulating plans for educational conferences on the subject. The group is expected to report its plans to Baltimore Mental Health Systems by June 1, 2007.

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