DSM5 in Distress

The DSM's impact on mental health practice and research

DSM 5 Needs to Reject Hebephilia Now

Striking new evidence further undercuts a poorly conceived proposal.

The DSM 5 sexual disorders work group recently rejected rape as a mental disorder. It is now (past) time for it also to drop the silly proposal to add "hebephilia" to DSM 5. "Hebephilia" is a medical sounding term for what is a purely legal issue- the statutory rape of pubescent youngsters aged 11-14. This is a crime deserving punishment, not a mental disorder deserving psychiatric hospitalization.

The work group has tried to package "hebephilia" as no more than a natural extension of the already existing DSM IV diagnosis Pedophilia. This is false advertising. Having sex with someone who is post-pubescent is not at all the same as having sex with someone who is pre-pubescent. Puberty is the most decisive of all rites of passage-it makes a world of difference whether the victim has attained it or not.

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Let's define Pedophilia first. It describes individuals whose predominant sexual arousal pattern involves an intense and recurrent interest in pre-pubescent children. Pedophilia is an official DSM diagnosis and is suitable for use in SVP proceedings (so long as it is carefully distinguished from molestation that is merely opportunistic or substance induced). Preferential sexual attraction to pre-pubescent children is rare and deviant.

In contrast, Sexual attraction to pubescent youngsters is common and has never been considered a mental disorder. A clear marker of this significant distinction is that the age of consent has varied so widely with time and place. It was 13 in many parts of the US as recently as 100 years ago. To lust after youth is normal; to act on this lust was once part of the courting ritual but is now a serious crime. It is not now, and never has been, a sign of psychiatric illness.

The "hebephilia" proposal was always a poorly thought out, obvious non-starter. It failed on conceptual grounds, was unsupported by scientific evidence, and would create disastrous forensic problems. Fortunately, there is a now a new and piercing nail to seal the coffin on this truly bad idea. An important data reanalysis by Wollert and Cramer (accepted for publication by Behavioral Sciences and the Law) has recently proved that the suggested criteria set for "hebephilia" is fatally flawed.

Let's count the four strikes against "hebephilia" as a mental disorder:

Strike 1) Sex with a pubescent teenager is most certainly a heinous crime, but equally certain it is not at all indicative of deviant sexual interest. Surveys show that it is very common to be attracted to pubescent youngsters (Calvin Klein had this figured out long ago). Evolution explains why. Our ancestors didn't live long enough to afford the luxury of a sexless adolescence- they got around to the serious business of procreation as soon as nature permitted them. For this evolutionary reason, sexual interest in the pubescent is hard wired and is not by itself deviant.

Strike 2) The DSM 5 sexual disorders work group suggested the puzzling idea that mechanically counting the number of sexual crimes the offender had committed could somehow help determine if he suffered from a mental disorder. This seemed foolish on the face of it. But a work group member then published data suggesting that counting crimes had actually worked in accurately identifying "hebephiles". The statistically naïve (including the paper's author) took this result as evidence that the proposed criteria set might possibly be workable. But Wollert and Cramer smelled a statistical rat in the paper and worked hard to track it down. Reanalyzing the original raw data with appropriate statistical methods, they found that (contrary to the original report) there was an extremely high false positive rate in identifying "hebephelia". This had been obscured by an obvious statistical error in the original analysis- the highly selective sampling of subjects at the poles of the continuum, arbitrarily excluding those in the middle.

Strike 3) The literature on "hebephilia" is pathetically thin, methodologically flawed, and mostly completely irrelevant to whether it should be considered a mental disorder. There is nothing in the few available papers to provide support for "hebephilia" as a mental disorder, no indication of how this alleged diagnosis should be defined, and no evidence that it can be accurately distinguished from simple criminality.

Strike 4: "Hebephilia" is a already forensic nightmare- widely abused in SVP hearings under the false guise of Paraphilia NOS. This will be even more tempting now that the fad of diagnosing rape as a mental disorder is about to end. "Hebephilia" would provide a new misdiagnosis to facilitate improper psychiatric incarceration. DSM 5 should not support this misuse of psychiatry to bail out a purely correctional problem.

The DSM 5 work group made three peculiar proposals- to include rape, hebephilia, and hypersexuality as psychiatric disorders. It has already been forced on the evidence to back track and reject both rape and hypersexuality. The report by Wollert and Cramer makes clear that now is the time for it to reject "hebephilia" and relegate it to the obscurity it has so long and so justly deserved.

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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