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Graham N, Calkins C, Jeglic E. Other Specified Paraphilic Disorder: Patterns of Use in Sexually Violent Predator Evaluations. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024:10790632241271086. [PMID: 39122249 DOI: 10.1177/10790632241271086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
"Sexually violent predator" (SVP) legislation requires, in part, that an individual has a mental abnormality that causes difficulty in controlling sexual behavior. Previous research has found paraphilia not otherwise specified (NOS) as one of the most prevalent diagnoses proffered in SVP evaluations. However, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) modified paraphilia NOS diagnosis in two ways. First, this diagnosis was divided into two new diagnostic categories: other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder. Second, OSPD required an added specifier to indicate the individual's source of sexual arousal. To date, no study has systematically explored how the revision to paraphilia NOS has affected diagnoses within SVP evaluations. The current study explored the frequency and diagnostic reliability of paraphilic disorders in a sample of 190 adult men evaluated for SVP civil commitment using the DSM-5. Results indicated that OSPD was the second most common paraphilic disorder, next to pedophilic disorder. However, there was poor to fair agreement (kappa = 0.21, p < .01) between independent evaluators in providing this diagnosis. Additionally, the two most common OSPD specifiers were non-consent and hebephilia, despite recent debate and rejection of these constructs from the DSM-5. While these constructs were the most prevalent, the specifiers contained quite varied terminology, suggesting vague diagnostic tendencies within these evaluations. Given that the presence of a mental abnormality is the cornerstone to the constitutionality of SVP commitment, diagnostic practices should be based in reliable and valid techniques.
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Affiliation(s)
- Nicole Graham
- Private Practitioner, Fort Lauderdale, FL, USA
- John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
| | - Cynthia Calkins
- John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
| | - Elizabeth Jeglic
- John Jay College of Criminal Justice, City University of New York (CUNY), New York, NY, USA
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Winters GM, Jeglic EL, Kaylor LE. The Development, Content Validation, and Pilot Testing of the Paraphilic Interests and Disorders Scale. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2023; 35:131-163. [PMID: 35400225 DOI: 10.1177/10790632221078297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The prevalence rates of paraphilic interests and disorders in the general population have been understudied, in large part due to the lack of a standardized assessment measure. As a result, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 provides little information regarding the prevalence of paraphilic disorders. The present study involved the development of a self-report measure, Paraphilic Interests and Disorders Scale (PIDS), that can be used to assess for the eight paraphilic interests/disorders in the DSM-5 for use with general population samples. Study 1 established the content validity of the PIDS using feedback from 22 experts in the field, and recommendations from these experts were utilized to modify the measure. In Study 2, the PIDS was piloted on 100 individuals in the general population, which supported the feasibility of implementation and its limited-efficacy. While the PIDS requires further psychometric support, the current research suggests the PIDS is a promising tool to gather self-report, population-based data on DSM-5 paraphilic interests and disorders.
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Affiliation(s)
- Georgia M Winters
- School of Psychology, 7856Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Elizabeth L Jeglic
- Psychology Department, 14775John Jay College of Criminal Justice, New York, NY, USA
| | - Leah E Kaylor
- Psychology Department, 7547Saint Louis University, Saint Louis, MO, USA
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Lehmann RJB, Brouillette-Alarie S, Pedneault A, Knight RA. Validating the Screening Scale of Pedophilic Crime Scene Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4085-4096. [PMID: 35896938 PMCID: PMC9663345 DOI: 10.1007/s10508-022-02354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
The Screening Scale of Pedophilic Crime Scene Behavior (SSPC) is a seven-item structured rating scale assessing pedophilic sexual arousal. In the current study, we cross-validated the scale's convergent validity using multiple measures of sexual interest in children (clinical diagnosis of pedophilia, the high fixation/low social competence type of the MTC:CM4, and phallometric assessment of sexual interests toward children) in two independent samples (USA and Canada). In both samples and in relation to all three criteria, the SSPC showed acceptable (phallometry) to excellent (clinical assessment) diagnostic accuracy. Furthermore, the SSPC showed incremental validity in relation to the Screening Scale for Pedophilic Interest and at times outperformed it in convergent validity analyses. The current study also provides psychometric information that can help users choose an appropriate SSPC cutoff score.
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Affiliation(s)
- Robert J B Lehmann
- Department of Psychology, MSB Medical School Berlin, Institute of Psychology, Rüdesheimer Str. 50, 14197, Berlin, Germany.
| | | | - Amelie Pedneault
- Department of Criminal Justice and Criminology, Washington State University, Pullman, WA, USA
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Ziogas A, Habermeyer B, Kawohl W, Habermeyer E, Mokros A. Automaticity of Early Sexual Attention: An Event-Related Potential Study. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2022; 34:507-536. [PMID: 34235992 PMCID: PMC9260476 DOI: 10.1177/10790632211024241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A promising line of research on forensic assessment of paraphilic sexual interest focuses on behavioral measures of visual attention using sexual stimuli as distractors. The present study combined event-related potentials (ERPs) with behavioral measures to investigate whether detection of a hidden sexual preference can be improved with ERPs. Normal variants of sexual orientation were used for a proof-of-concept investigation. Accordingly, 40 heterosexual and 40 gay men participated in the study. Within each group, half of the participants were instructed to hide their sexual orientation. The results showed that a match between sexual orientation and stimulus delays responses and influences ERP before motor responses. Late ERP components showed higher potential in differentiating hidden sexual preferences than motor responses, thereby showing how ERPs can be used in combination with reaction time measures to potentially facilitate the detection of hidden sexual preferences.
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Affiliation(s)
| | - Benedikt Habermeyer
- Department of Psychiatry and Psychotherapy,
Psychiatric Services Aargau, Brugg, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy,
Psychiatric Services Aargau, Brugg, Switzerland
- Department of Psychiatry, Psychotherapy and
Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | - Andreas Mokros
- University Hospital of Psychiatry Zurich,
Switzerland
- FernUniversität in Hagen, Germany
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Lockhart J, DiCiro M, Rokop J, Brennan A. California Sexually Violent Predator (SVP) Evaluations in the Field: Static-99R and Diagnostic Field Reliability. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2022; 34:425-455. [PMID: 34549636 DOI: 10.1177/10790632211042364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tests and diagnoses used in sexually violent predator (SVP) evaluations must be reliable, as reliability is foundational to validity. The current study contained a stratified sample of evaluations of 395 individuals referred as potential SVPs between 2012 and 2017. Each individual was initially evaluated by at least two experts. The sample included three groups: individuals not meeting SVP criteria (N = 200, or 400 evaluations), individuals meeting SVP criteria (N = 95, with 190 evaluations), and individuals where evaluators disagreed (N = 100, with 200 evaluations). The sample also included 200 subsequent independent evaluations on these "disagree" cases. Static-99R score intraclass coefficient (ICC) interrater reliability was good to excellent within each group and overall. Evaluators scored the Static-99R within one point of each other 87% of the time. Cohen's kappa diagnostic agreement for Pedophilic Disorder was substantial. ASPD and substance abuse kappa were in the "fair" range, while OSPD diagnoses in the positive group were at the "moderate" level of agreement. Ethnic differences in diagnoses were consistent with other studies, with equivalent Static-99R ICC values across ethnic groups. There were no significant differences between state civil servants versus contracted experts in Static-99R ratings or final determinations. The results suggest that Static-99R scores have acceptable reliability in these evaluations, and Pedophilic Disorder (the most common paraphilic disorder in our study) and OSPD can be reliably diagnosed. We discuss limitations of the study, as well as the need for care in high-stakes evaluations given the imperfect reliability of psychological measurements.
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Affiliation(s)
- Joseph Lockhart
- 6475California Department of State Hospitals, Forensic Services Division, Sacramento, CA, USA
| | - Melinda DiCiro
- 6475California Department of State Hospitals, Forensic Services Division, Sacramento, CA, USA
| | - James Rokop
- 6475California Department of State Hospitals, Forensic Services Division, Sacramento, CA, USA
| | - Anna Brennan
- 6475California Department of State Hospitals, Forensic Services Division, Sacramento, CA, USA
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Seto MC. Clinical and Conceptual Problems With Pedophilic Disorder in the DSM-5-TR. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1833-1837. [PMID: 35471678 DOI: 10.1007/s10508-022-02336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Michael C Seto
- Royal Ottawa Health Care Group, 1804 Highway 2 East, Brockville, ON, K6V 5W7, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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„Die Relevanz eines kohärenten forensischen Beurteilungs- und Behandlungsprozesses“: großer Wurf oder alter Wein in undichtem Schlauch? FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2020. [DOI: 10.1007/s11757-020-00592-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungBorchard und Gerth legen in ihrem Beitrag „Die Relevanz eines kohärenten forensischen Beurteilungs- und Behandlungsprozesses: Grenzen der allgemeinpsychiatrischen Diagnosesysteme ICD und DSM für die forensische Fallkonzeption“ (Borchard und Gerth 2020) ein Plädoyer für ein eigenes forensisch-psychiatrisches Diagnosesystem vor. Der folgende Beitrag setzt sich mit diesem Anliegen kritisch auseinander und zeigt, warum der Forderung nach einem forensisch-psychiatrischen Diagnosesystem jenseits von DSM‑5 und ICD-10/ICD-11 nicht gefolgt werden kann. Ein eigener forensisch psychiatrischer Diagnose- und Krankheitsbegriff ist weder erforderlich, noch kann er in der juristisch-medizinischen Schnittstelle sinnvoll angewandt werden. Stattdessen drohen terminologische Schwierigkeiten und die Gefahr einer Pathologisierung delinquenten Verhaltens, was am Beispiel des von Borchard und Gerth empfohlenen FOTRES und Urteilen des Schweizerischen Bundesgerichts dargestellt und diskutiert wird.
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Münch R, Walter H, Müller S. Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder. Front Psychiatry 2020; 11:558655. [PMID: 33093836 PMCID: PMC7523554 DOI: 10.3389/fpsyt.2020.558655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.
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Affiliation(s)
- Ricarda Münch
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabine Müller
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Pedophilia, Substance-use Disorder, and Intellectual Disability: A Case Report. ADDICTIVE DISORDERS & THEIR TREATMENT 2019. [DOI: 10.1097/adt.0000000000000149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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