Critical Appraisals of the Proposed DSM-5 Paraphilia Diagnoses

Richard B. Krueger

The following four contributions grew out of two presentations at the annual meetings of the American Academy of Psychiatry and the Law, in 2009 in Baltimore, MD, and in 2010 in Tucson, AZ. The first involved an appraisal by each of the four authors offering their criticisms of the Diagnostic and Statistical Manual, 5th Edition (DSM-5), Paraphilia Diagnostic Criteria, and the second consisted of a spirited debate concerning the pros and cons of the three most controversial suggestions of the Sexual and Gender Identity Disorders Work Group: hypersexual disorder, paraphilic coercive disorder, and pedohebephilic disorder. Each of the authors presents sage and constructive critiques of the proposed diagnostic criteria for the paraphilias in DSM-5.

The up-to-date criteria for the paraphilias can be found on the American Psychiatric Association (APA) website devoted to the development of DSM-5 (www.dsm5.org). Although the APA did not choose to fund large institutional trials of the proposed criteria, there are at least two unofficial multi-site studies in progress. Further, the APA is actively recruiting mental health professionals (psychiatrists, psychologists, social workers, and nurse practitioners) to field test their proposed criteria individually, using the APA's on-line diagnosis system. All clinicians are encouraged to participate. Further information concerning this opportunity can be found on the DSM-5 website.

We hope that these articles will stimulate further discussion and submission of thoughtful criticism. Forensic psychiatrists are particularly well suited to offer commentary concerning the use or misuse of paraphilia diagnoses in legal proceedings, and observations on any aspect of the proposed criteria would be welcome. Indeed, editors of relevant journals have been generous in publishing commentary and articles. The Journal of the American Academy of Psychiatry and the Law, Sexual Abuse, the Archives of Sexual Behavior, the Journal of Sex Research, and The Journal of Sexual Medicine have published criticisms of DSM-5. There is still time to submit comments. Even if suggestions are not actually incorporated or reflected in the revised criteria, the published record would be valuable and relevant for the future.