Excerpt from Blanchard, R. (2010). The DSM diagnostic criteria for pedophilia. Archives of Sexual Behavior, 39, 304-16.
In clinical practice, the patient’s history of sexual offenses against children is often the only basis for making a diagnosis of pedophilia. It is well established that self-report alone cannot be used to diagnose pedophilia in offenders against children. Offenders are not necessarily rewarded for being truthful about pedophilic impulses; they might experience even more severe consequences of their actions if they acknowledge being pedophiles.
The widespread clinical opinion that self-report is unreliable in pedophiles has been reinforced by laboratory studies. In these studies, sexual interest in children was measured with phallometric testing, a procedure in which blood volume in the examinee’s penis is monitored while he is presented with a standardized set of laboratory stimuli including visual and auditory representations of children and adults. In a series of studies in my laboratory, my predecessor and I specifically studied men who had committed sexual offenses against children but who claimed that they were sexually attracted only to adults. The self-report of the majority was directly contradicted by their laboratory results.
The DSM-IV-TR excludes from diagnosis a sizable proportion of patients whose strongest sexual feelings are for physically immature persons. The modal age of victims of sexual offenses in the United States falls within the time-frame of puberty. In anonymous surveys of social organizations of persons who acknowledge having an erotic interest in children, attraction to children of pubescent ages is more frequently reported than is attraction to those of prepubescent ages. In samples of sexual offenders recruited from clinics and correctional facilities, men whose offense histories or assessment results suggest erotic interest in pubescents sometimes outnumber those whose data suggest erotic interest in prepubescent children.
Other studies have shown hebephiles to be intermediate between pedophiles and teleiophiles with regard to IQ, completed education, school grade failure and special education placement, head injuries before age 13, left-handedness, and stature.
The DSM-V should include hebephilia to recognize the clinical and scientific importance of patients preferentially attracted to children who have entered puberty but are still physically quite immature. This would systematize what is already happening unsystematically. Levenson has noted that practitioners evaluating patients for civil commitment under sexually violent predator statutes typically diagnose such patients with “Paraphilia NOS (Hebephilia).”