Abstract
I reviewed the empirical literature for 1980–2008 on exhibitionism, voyeurism, and frotteurism for the American Psychiatric Association’s Sexual and Gender Identity Disorders Work Group in preparation for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Very limited empirical support was found for major changes of the current DSM-IV-TR criteria sets for these paraphilias. Some of the criticism of current criteria and the balancing of false negatives and false positive diagnoses are examined. The report concludes with suggestions for possible diagnostic criteria changes for the DSM-V.
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References
Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., & Rouleau, J. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153–168.
Abel, G. G., Becker, J. V., Mittelman, M., Cunningham-Rathner, J., Rouleau, J. L., & Murphy, W. D. (1987). Self-reported sex crimes of nonincarcerated paraphiliacs. Journal of Interpersonal Violence, 2, 3–25.
American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Associated Press. (2008). Sweden says transvestism is not a disease. Stockholm, Sweden: The Associated Press Archive.
Blanchard, R. (2009). The DSM diagnostic criteria for pedophilia. Archives of Sexual Behavior, doi:10.1007/s10508-009-9536-0.
Bradford, J., Boulet, J., & Pawlak, A. (1992). The paraphilias: A multiplicity of deviant behaviours. Canadian Journal of Psychiatry, 37, 104–108.
Cantor, J. M., Blanchard, R., & Barbaree, H. E. (2009). Sexual disorders. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed., pp. 527–548). New York: Oxford University Press.
Cauley, D. R. (2007). The diagnostic issue of antisocial personality disorder in civil commitment proceedings: A response to DeClue. Journal of Psychiatry and Law, 35, 475–497.
Fedora, O., Reddon, J. R., Morrison, J. W., Fedora, S. K., Pascoe, H., & Yeudall, L. T. (1992). Sadism and other paraphilias in normal controls and aggressive and nonaggressive sex offenders. Archives of Sexual Behavior, 21, 1–15.
Firestone, P., Kingston, D. A., Wexler, A., & Bradford, J. M. (2006). Long-term follow-up of exhibitionists: Psychological, phallometric, and offense characteristics. Journal of the American Academy of Psychiatry and the Law, 34, 349–359.
First, M. B., & Frances, A. (2008). Issues for DSM-V: Unintended consequences of small changes: The case of paraphilias. American Journal of Psychiatry, 165, 1240–1241.
Freund, K., & Blanchard, R. (1986). The concept of courtship disorder. Journal of Sex and Marital Therapy, 12, 79–92.
Freund, K., Seto, M. C., & Kuban, M. (1997). Frotteurism and the theory of courtship disorder. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 111–130). New York: Guilford Press.
Gebhard, P. H., Gagnon, J. H., Pomeroy, W. B., & Christenson, C. V. (1965). Sex offenders: An analysis of types. New York: Harper & Row.
Horley, J. (2001). Frotteurism: A term in search of an underlying disorder? Journal of Sexual Aggression, 7, 51–55.
Kafka, M. P. (1997). Hypersexual desire in males: An operational definition and clinical implications for males with paraphilias and paraphilia-related disorders. Archives of Sexual Behavior, 26, 505–526.
Kafka, M. P. (2009). The DSM diagnostic criteria for fetishism. Archives of Sexual Behavior, doi:10.1007/s10508-009-9558-7.
Kafka, M. P., & Hennen, J. (1999). The paraphilia-related disorders: An empirical investigation of nonparaphilic hypersexuality disorders in 206 outpatient males. Journal of Sex and Marital Therapy, 25, 305–319.
Kafka, M. P., & Hennen, J. (2002). A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders. Sexual Abuse: A Journal of Research and Treatment, 14, 349–366.
Kar, N., & Koola, M. M. (2007). A pilot survey of sexual functioning and preferences in a sample of English-speaking adults from a small South Indian town. Journal of Sexual Medicine, 4, 1254–1261.
Krafft-Ebing, R. von (1965). Psychopathia sexualis (12th ed.). New York: Stein & Day. (Original work published 1886)
Krueger, R. B. (in press). The DSM diagnostic criteria for sexual sadism. Archives of Sexual Behavior, doi:10.1007/s10508-009-9586-3.
Krueger, R. B., & Kaplan, M. S. (2008). Frotteurism: Assessment and treatment. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 150–163). New York: Guilford Press.
Långström, N., & Hanson, R. K. (2006). High rates of sexual behavior in the general population: Correlates and risk factors. Archives of Sexual Behavior, 35, 37–52.
Långström, N., & Seto, M. C. (2006). Exhibitionistic and voyeuristic behavior in a Swedish national population survey. Archives of Sexual Behavior, 35, 427–435.
Lussier, P., & Piché, L. (2008). Frotteurism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 131–149). New York: Guilford Press.
Mann, R. E., Ainsworth, F., Al-Attar, Z., & Davies, M. (2008). Voyeurism: Assessment and treatment. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 61–75). New York: Guilford Press.
Marshall, W. L., & Fernandez, Y. (2003). Phallometric testing with sexual offenders: Theory, research and practice. Brandon, VT: Safer Society Press.
Morin, J., & Levenson, J. (2008). Exhibitionism: Assessment and treatment. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 76–107). New York: Guilford Press.
Murphy, W., & Page, I. (2008). Exhibitionism: Psychopathology and theory. In D. R. Laws & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 61–75). New York: Guilford Press.
O’Donohue, W., Regev, L. G., & Hagstrom, A. (2000). Problems with the DSM-IV diagnosis of pedophilia. Sexual Abuse: A Journal of Research and Treatment, 12, 95–105.
Reiersøl, O., & Skeid, S. (2006). The ICD diagnoses of fetishism and sadomasochism. Journal of Homosexuality, 50, 243–262.
Richters, J., de Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. M. (2008). Demographic and psychosocial features of participants in bondage and discipline, “sadomasochism” or dominance and submission (BDSM): Data from a national survey. Journal of Sexual Medicine, 7, 1660–1668.
Rye, B. J., & Meaney, G. J. (2007). Voyeurism: It is good as long as we do not get caught. International Journal of Sexual Health, 19, 47–56.
Templeman, T. N., & Stinnet, R. D. (1991). Patterns of sexual arousal and history in a “normal” sample of young men. Archives of Sexual Behavior, 20, 137–150.
World Health Organization. (1992). International statistical classification of diseases and related health problems (10th ed.). Geneva: Author.
Acknowledgments
Niklas Långström is funded by the Swedish Research Council-Medicine. The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders (Chair, Kenneth J. Zucker, Ph.D.). I wish to acknowledge the valuable input received from the other members of the Paraphilias subworkgroup (Ray Blanchard, Marty Kafka, and Richard Krueger) and Kenneth J. Zucker. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.
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Långström, N. The DSM Diagnostic Criteria for Exhibitionism, Voyeurism, and Frotteurism. Arch Sex Behav 39, 317–324 (2010). https://doi.org/10.1007/s10508-009-9577-4
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DOI: https://doi.org/10.1007/s10508-009-9577-4