B4U-ACT Notifies APA of “Inaccurate and Misleading” DSM

July 25, 2011 — B4U-ACT has sent an open letter to the Board of Trustees of the American Psychiatric Association (APA) notifying the organization of the inaccuracies and misleading information contained in the current draft of its Diagnostic and Statistical Manual of Mental Disorders (DSM), currently under revision.

The letter requests the establishment of a working relationship between B4U-ACT and the APA’s work group in charge of revising the diagnostic criteria for pedophilia. B4U-ACT is a 501(c)(3) organization that promotes dialog between mental health professionals and people with a sexual attraction to children or adolescents.

The Diagnostic and Statistical Manual is the authoritative publication of the psychological sciences that provides the profession’s descriptions of mental disorders and their symptoms.

“The current revision of the DSM is full of inaccurate and misleading information on people who are attracted to children or adolescents,” said Howard Kline, science director of B4U-ACT. “It is based on data from prison studies, which completely ignore the existence of those who are law-abiding. The proposed new diagnostic criteria specify ages and frequencies with no scientific basis whatsoever. The DSM should meet a higher standard than that. We can help them, because we are the people they are writing about.”

Co-founder and chair of the B4U-ACT board, Russell Dick, a licensed social worker with 38 years of experience working with people who are attracted to minors said, “People with this attraction struggle to lead lives consistent with society’s rules. If we want them to succeed, we need to give them a reasonable level of support by providing them with welcoming, informed, and empathetic mental health services. The current revision of the DSM hinders that goal.”

Richard Kramer, director of operations for B4U-ACT, added, “Inaccurate negative stereotypes perpetuated by the DSM force people into hiding, leave young adolescents who are attracted to children hopeless with nowhere to turn, and do nothing to protect children. We have tried every available avenue to get the work group to meet with us and begin addressing this problem. We had a conference call with them last June, where it was apparent that they did not understand the stigmatic effects of the DSM. They then reneged on their promise of follow-up communication. Consequently, our only recourse is to go over their heads to the Board of Trustees of the APA itself.”

B4U-ACT is holding a symposium on pedophilia and the DSM in Baltimore on August 17. One of the ways it suggests the APA work group could start working with them is to send a representative to speak at the symposium. The work group has ignored the invitation.

Read the full text of the letter to the APA trustees at https://www.b4uact.org/wp-content/uploads/2014/08/b4uact-20110713.pdf.

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B4U-ACT Invites DSM-5 Paraphilias Group to Symposium

B4U-ACT sent the e-mail letter below to all members of the DSM Paraphilias Subworkgroup and leading officials of the DSM Task Force, inviting them to come and speak at its upcoming symposium. B4U-ACT suggested this as a way to restart the conversation begun the previous summer with a conference call between DSM officials and B4U-ACT, and thereby take steps “to ensure not only that the DSM is founded in sound science, but also that it does not engender stigma or diminish availability of care, and takes valid patient input into account.”

No reply was received.

Subject: B4U-ACT Symposium on Pedophilia and the DSM
From: Howard Kline
To: Ray Blanchard, Martin Kafka, Richard Krueger, Niklas Langstrom, Kenneth Zucker, David Kupfer, Darrel Regier, William Narrow
CC: Richard Kramer, Russell Dick, Irving M. Binik, Lori A. Brotto, Peggy T. Cohen-Kettenis, Jack Drescher, Cynthia Graham, Heino F. L. Meyer-Bahlburg, Friedemann Pfäfflin, Robert Taylor Segraves
Date: Tue, 03 May 2011 23:50:21

To Dr. Ray Blanchard, members of Paraphilias Subworkgroup, and APA DSM Task Force officials

Dear Gentlemen:

On August 17, B4U-ACT will hold a symposium on “Pedophilia, Minor-Attracted Persons, and the DSM: Issues and Controversies.” All of you have received the call for proposals for this event, which is also available at www.b4uact.org/callforproposals.htm. The purpose of this e-mail is to reach out to you with a special invitation to participate.

The symposium will be a collaborative exchange of ideas among researchers, scholars, clinicians, and minor-attracted people from a variety of disciplines and with a variety of views. We wish to have all views reflected as accurately and fairly as possible. As such, it would be beneficial to have Dr. Blanchard, other members of the Paraphilias Subworkgroup, and/or other representatives of the DSM Task Force present the perspective under review by the APA on these issues. We would like to have at least two DSM-5 representatives speaking at the symposium in order to ensure that your views are well and accurately represented and that the discussion is fair and meaningful. If none or only one of you is available on the date of the symposium, we’d be interested in your recommendation of others who could speak on your behalf.

There is an important reason for the APA to participate in this symposium. Seven of the recipients of this e-mail took part in a conference call with representatives of B4U-ACT in June 2010. Promises were made of specific follow-up by the APA after that call, however none of that follow-up took place despite numerous attempts by B4U-ACT to obtain it. We are reaching back out to you now in an attempt to restart the conversation. We know how busy you are and understand how various pressures on your time may have interrupted your follow-through last summer. However, we also trust that you are committed to “the best interests of patients and those actually or potentially making use of mental health services” [APA Bylaws] and to enabling care to be provided “with compassion and respect for human dignity and rights” [AMA Ethics]. Therefore, we trust that you want to take all reasonable steps to ensure not only that the DSM is founded in sound science, but also that it does not engender stigma or diminish availability of care, and takes valid patient input into account. These objectives are the key focus areas of the symposium.

If none of you is able to participate in the symposium, and if there is no one else to nominate to represent you, then we urge you to delegate one of you to speak with us about an alternative course of action to resume the conversation started with the conference call last summer.

While this is a matter of professionalism for you, for us it is a matter both of professionalism and of life and limb. Legions of minor-attracted people are suffering daily and reporting inability to find compassionate and respectful mental health services. Most are left to cope by themselves, and some fail. Too many, including many teenagers who find themselves attracted to younger children, take their own lives, or try to. We trust that such outcomes are as unsatisfactory to the APA as they are to us. Please work with us to find solutions that properly diagnose disorder and support its appropriate treatment. Please come and speak at our symposium or get back to us about other ways to get our conversation back on track.

Thank you.

Howard Kline
Science Director
B4U-ACT, Inc.

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B4U-ACT Responds to Harvard Mental Health Publication

B4U-ACT joined with seven mental health professionals to object to an article recently published in the Harvard Mental Health Letter. The open letter sent in response follows:

April 25, 2011
The Editor
Harvard Mental Health Letter
Harvard University
Cambridge, MA

Dear Editor:

We wish to respond to the article “Pessimism About Pedophilia” published in your July 2010 issue.

A broader examination of the facts demonstrates that pessimism as a professional response to pedophilia and hebephilia is unjustified and leads to serious undesirable consequences.

People who are attracted to children or adolescents can and do contribute positively to their communities and to society. The non-profit organization B4U-ACT, based in Maryland, consists of such people working together with mental health professionals to promote dialog, the dissemination of accurate information, and the accessibility of compassionate mental health services. The people who are attracted to minors that we know deal with their sexuality in responsible ways and live within the law. They care about the well-being of children and adolescents as much as other people; many are parents themselves.

Most available information about minor-attracted people is inaccurate and incomplete. Most minor-attracted people do not come to the attention of the criminal justice or mental health systems, or when they do, their positive characteristics and contributions are not acknowledged. As a result, descriptions are based solely on non-representative forensic samples and inaccurate assumptions about their feelings and motives. Non-forensic research presents a more hopeful picture, finding that they may be similar to the general population in personality and psychological functioning (Okami & Goldberg, 1992; Wilson & Cox, 1983). In addition, there is strong evidence that their feelings of attraction may be similar to those of people attracted to adults: they may involve feelings of affection, tenderness, and romantic attraction (Blanchard, 2009; Li, 1990b; Sandfort, 1987; Wilson & Cox, 1983).

Treatment can be very effective. Some minor-attracted people connected to B4U-ACT have experienced therapy that helped them to find ways of coping with their sexuality and society’s response to it, and to develop fulfilling relationships while living within the law. Such treatment is only effective when the therapist has an accurate understanding of pedophilia or hebephilia, shows empathy and compassion for the patient, and works cooperatively with the patient to develop treatment goals and approaches.

Pessimism, inaccurate and negative characterizations, and a reliance on law-enforcement rather than therapeutic approaches by the mental health profession seriously discourage minor-attracted people from seeking services. Such responses strongly suggest to potential clients that mental health professionals will not understand them, will respond to them with suspicion or hostility, will ignore their mental health needs, or will report their feelings to authorities. In a recent survey of minor-attracted people conducted by B4U-ACT, one respondent said, “I have no way of knowing if they’ll call the cops just for telling them my attraction. I wouldn’t want to see a psychologist unless I can be truly open and honest. So that’s out.” Another said, “I can never reveal the fact that I am a pedophile. At least now, they do not know that they hate me, and that is the best that I can ever hope for.” Altogether, 54% of 166 respondents cited fears that therapists would report their feelings to authorities or others, 63% feared negative judgmental reactions, and 48% feared they would be treated unethically by therapists. Minor-attracted people learn that they must remain in hiding. This does not protect children.

In short, negative stereotypes and reliance on law-enforcement approaches by mental health professionals intensify stigma, causing serious negative consequences. The very same issue of the Harvard Mental Health Letter also contained an article on this topic: “The Evolving Understanding of Stigma.” The article noted that “the constant background noise of stereotyped or inaccurate information contributes to the persistent stigma about mental illness…stigma is important because it contributes to delays in seeking treatment for mental health disorders and problems in accessing care.” In B4U-ACT’s survey, 40% of respondents said at some point they had wanted services to deal with issues related to their sexuality, but never received them due to fear or stigma. In addition, 27% said they wanted services for other reasons but did not seek them because they could not be honest with a therapist about their sexuality. Sixteen percent also said they had received such services, but these services were inadequate for the same reason.

Adolescents and young adults just realizing they are attracted to minors are especially vulnerable to stigma. Feelings of hopelessness can lead them to depression, substance abuse, and suicidal thoughts. Some of the volunteers at B4U-ACT have experienced this in their youth. Others have been contacted by youth who abused alcohol, engaged in self-harming behavior, or were suicidal due to the stigma of their attraction to children. In the B4U-ACT survey, 44% of respondents had thought seriously about suicide due to their sexuality; the most common age for such thoughts was 16.

Inaccurate stereotypes lead to dehumanization. As the stigma article notes, “people who are stigmatized experience social death when others in society hold attitudes and behave in ways to turn the stigmatized person into an ‘other,’ or a non-person…This leads to dehumanizing treatment, such as making psychiatric patients in China wear outfits like those of prisoners, [or] prohibiting them from participating in family gatherings…If stigma is primarily psychological, then eradicating it may involve psychotherapy to help patients boost self-esteem. If it is more of a social construct, the way to fight it is through awareness campaigns to change public opinion and policies. And if stigma is a moral issue, then it may be necessary to advocate for basic human rights.”

We urge mental health professionals to reject pessimistic responses and to join in a hopeful effort both to protect children and to promote the well-being of people who are attracted to minors. Such an effort would involve reducing stigma, conducting non-forensic research on pedophilia and hebephilia, making accurate information available to professionals, the public, and minor-attracted people, and providing visible therapeutic services to minor-attracted people.


Russell Dick, LCSW-C, Board Chair, B4U-ACT, Inc.
Richard Kramer, Director of Operations, B4U-ACT, Inc.
Tom Scott, MSW, LCSW-C, Executive Director of Clinical Services, National Center on Institutions and Alternatives
Kevin J. McCamant, Ph.D., Private Practitioner, Clinical and Forensic Psychology, Sex Offender Treatment Provider
Wayne Bowers, President of the Board, Sex Abuse Treatment Alliance
Eric Anderson, Sociologist and Professor, University of Winchester, U.K.
Lee Beckstead, PhD, Private practitioner
Marjorie Diehl, ACSW
Amy Craig-Van Grack, LCSW-C


Blanchard, R. (2009), Paraphilia scales from Kurt Freund’s Erotic Preferences Examination Scheme

Li, C.K. (1990b), Some case studies of adult sexual experiences with children Journal of Homosexuality, 20 (1-2), 129-144.

Okami, P. & Goldberg, A. (1992), Personality correlates of pedophilia: Are they reliable indicators?. Journal of Sex Research, 29, 297-328.

Sandfort, T. (1987), Boys on their contacts with men: A study of sexually expressed friendships. New York: Global Academic Publishers.

Wilson, G. & Cox, D. (1983), The Child-Lovers: A Study of Paedophiles in Society. London: Peter Owen Publishers.

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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

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.


Michael Melsheimer
Richard Kramer
William Andriette

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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