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.