Tag Archives: DSM 5

Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

4 Comments

Filed under APA, News and politics, Psychology, Sex, sexual identity, sexuality, Uncategorized

OCD or pathological grooming?


On the way to work this morning, I listened to a story on NPR’s Morning Edition about “pathological grooming.” Never heard of this disorder? It’s called biting your fingernails…or other similar things (hair pulling, face picking, nose wiping, etc.). Apparently, the forthcoming DSM 5 will lump it into an OCD diagnosis.

Here’s a couple of interesting tidbits from the 8 minute show.

  • Those with OCD tend to have more of a conscious awareness of unwanted repetitious impulses while pathological groomers may be more thoughtless in their nail-biting
  • Some mice with a specific genetic variant are excessive groomers, to the point of going bald, but not everyone with the gene displays the grooming habits. Thus, genes are surely part of the problem but not all
  • Given the spectrum of OCD symptoms and mental health disorders, maybe nail-biting isn’t that important to eliminate.

So, what do you think? Do you think chronic nail-biting fit better within an anxiety disorder, an addictive disorder, a tic disorder or just merely a silly habit unrelated to any mental health category?

2 Comments

Filed under Anxiety, Psychology

More on Narcissism


Hadn’t read my Monitor on Psychology (Feb 2011 edition) til this morning and saw that the cover story is on the possible rise of narcissism in young folk these days. Now, this magazine is popular and doesn’t go too deep into reporting on research…and I haven’t followed up on the studies to read them for myself, but…

  • one study has 80% of middle school students scoring higher on self-esteem in ’06 than ’88
  • Another shows an increase in the lifetime prevalence of NPD
  • However, no nationally representative samples comparisons have been done to really shed light on whether a rise is truly taking place
  • One meta study of 85 studies (between ’82 and ’06) suggests an increase of narcissism among college students

The article goes on to muse about whether materialism and social networking lead the way toward narcissism but also wonders whether the decrease in availability to easy credit will lower the self-promoting trend a bit.

In an ironic twist, it appears that the DSM 5 may not include NPD as a diagnosis. Rather. It will include a more general diagnosis (see below taken from the DSM5.0rg site). Strangely, one of the “types” is NOT narcissism.

The essential features of a personality disorder are impairments in identity and sense of self and in the capacity for effective interpersonal functioning. To diagnose a personality disorder, the impairments must meet all of the following criteria:

A.    A rating of mild impairment or greater in self and interpersonal functioning on the Levels of Personality Functioning.

B.    Associated with a “good match” or “very good match” to a personality disorder type or with a rating of “quite a bit like the trait” or “extremely like the trait” on one or more personality trait domains.

C.    Relatively stable across time and consistent across situations.

D.    Not better understood as a norm within an individual’s dominant culture.

E.    Not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

3 Comments

Filed under counseling, counseling science, personality, Psychology