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Diagnostic Issues in the Paraphilias

  • Sexual Disorders (LE Marshall and WL Marshall, Section Editors)
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Abstract

Purpose of Review

To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis.

Recent Findings

Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests lead them to sexually offend. Even among these clients, research has, for the most part, failed to distinguish those who meet criteria for a paraphilia from those who do not, thereby limiting the possibility of drawing firm conclusions regarding the value of a paraphilic diagnosis.

Summary

Speculations regarding the etiology of the paraphilias are for the most part limited to those who sexually offend and these theories do not distinguish those who do, or do not, meet paraphilic criteria. Treatment of sex offenders, when effective, appears to have the same impact regardless of whether or not clients meet criteria for a paraphilia. In terms of prognosis, it was only among untreated child molesters that a paraphilic diagnosis (in this case “pedophilia”) predicted long-term outcome. In the face of these problems, we suggest a dimensional approach to diagnoses may represent an improvement over the current categorical model.

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Authors and Affiliations

  1. Queen’s University and Rockwood Psychological Services, Kingston, Canada

    William L. Marshall

  2. Integrated Forensic Program, Royal Ottawa Health Care Group and Institute of Mental Health Research, Ottawa, Canada

    Drew A. Kingston

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  1. William L. Marshall
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Correspondence to William L. Marshall.

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William L. Marshall is a section editor for Current Psychiatry Reports.

Drew A. Kingston declares no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sexual Disorders

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Marshall, W.L., Kingston, D.A. Diagnostic Issues in the Paraphilias. Curr Psychiatry Rep 20, 54 (2018). https://doi.org/10.1007/s11920-018-0919-6

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