Should Hebephilia be a Mental Disorder? A Reply to Blanchard et al. (2008)
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- DeClue, G. Arch Sex Behav (2009) 38: 317. doi:10.1007/s10508-008-9422-1
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Blanchard et al. (2008) suggest possibilities for expanding DSM to include a diagnosis for Hebephilia (mostly erotically attracted to 11- to 14-year olds), but they do not suggest the inclusion of a diagnosis for Ephebophilia (mostly attracted to 15- to 16-year olds), Teliophilia (mostly attracted to those 17 years old or older), or Gerontophilia (mostly attracted to the aged).
Although Blanchard et al. present data regarding whether reliable differences in erotic preference can be shown, they completely overlook the question of how we decide which sexual interest patterns should be considered a mental disorder. Pedophilia is a mental disorder. Homosexuality is not. Should Hebephilia or Ephebophilia or Gerontophilia be considered mental disorders? How about sexual preference for people with different (or with the same) ethnic characteristics as oneself?
The decision to classify a pattern of sexual attraction as a mental disorder (paraphilia) inevitably entails more than (1) reliable differences in patterns of sexual attractions and (2) checking law books to see which sexual activities are currently illegal in a particular jurisdiction. In their Discussion section, Blanchard et al. leap directly from “Hebephilia exists” to “The DSM-V should expand the definition of Pedophilia so that it includes erotic attraction to pubescent and prepubescent children or, alternatively, add a separate diagnosis of Hebephilia.” They completely ignore the middle part of this syllogism: (A) Hebephilia exists. (B) Hebephilia is a mental disorder. (C) Hebephilia should be included in DSM-V.
Blanchard et al.’s findings are useful toward consideration of whether a pattern of erotic preference for pubescent and/or early post-pubescent humans is reliable, stable, and identifiable. However, their discussion completely misses other necessary considerations regarding whether a stable pattern of differences (e.g., homosexual versus heterosexual; right handed versus left handed) constitutes a disorder.
One of the co-authors (James Cantor) has graciously responded to some queries on the Internet list psylaw-l (http://listserv.unl.edu/), clarifying his perspective regarding the recommendation that Hebephilia be listed as a mental disorder in DSM-V. As I understand Cantor’s posts, listing Hebephilia as a specific paraphilia should not result in a greater number of people being diagnosed with paraphilia: “Hebephilia is well within the range of disorders already in the DSM, and my recommendation pertains not to pathologizing, but to replacing inaccurate labels (Paraphilia NOS and Pedophilia with an unrealistic definition of puberty) with an accurate label” (e-communication, August 30, 2008). Thus, a subset of those people who meet criteria for the general diagnosis of paraphilia would meet criteria for the specific diagnosis of Hebephilia. If, both in design and practice, listing a specific diagnosis of Hebephilia in DSM-V would not result in any more people being classified as paraphiles, then I would consider this proposal to be reasonable and noncontroversial.
In a follow-up psylaw post (e-communication, September 1, 2008), Cantor recommends that the label Hebephile be applied to people who show greater sexual arousal to pubescent people than to mature adults. But neither Blanchard et al. nor Cantor (in his posts to psylaw) articulate a plan for deciding which people who meet the criteria for the descriptive label of Hebephile (greater relative sexual arousal to pubescent people) should be considered to meet criteria for the proposed diagnosis of Hebephilia.
If criteria similar to the DSM-IV-TR criteria for Pedophilia are to be used for Hebephilia in DSM-V, then a person would get a diagnosis of Hebephilia if criteria similar to the following are satisfied: (a) over a period of at least 6 months, he or she has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a pubescent child or children (generally age 11–14) and (b) the person has acted on these urges, or the sexual urges or fantasies cause distress or interpersonal difficulty, and (c) the person is at least 18 years of age and at least 5 years older than the child or children (but do not include an individual in late adolescence involved in an ongoing relationship with a 12- to 14-year-old). I consider it very likely that implementation of such criteria would expand the number of people diagnosed with paraphilia, to include people who fantasize about and/or engage in sex with 14-year-olds or with younger children who have entered puberty.
Any changes to DSM that would lead to more people diagnosed with a mental disorder should be carefully considered. Blanchard et al. recommend expansion of DSM to include Hebephilia without any explicit articulation of why Hebephilia should be considered a mental disorder, what diagnostic criteria should be used, whether Hebephilia can be diagnosed reliably in the field, and how inclusion of the new diagnosis would likely impact individuals and society. This is particularly disconcerting because in this article Blanchard is advising himself and the Editor of this journal; Dr. Blanchard is a member of the DSM-V Sexual and Gender Identity Disorders Work Group, and the Editor of Archives of Sexual Behavior, Kenneth J. Zucker, is its chair (see http://www.psych.org/MainMenu/Newsroom/NewsReleases/2008NewsReleases/dsmwg.aspx). Further, according to Robert L. Spitzer, “Perhaps the best-kept-secret about DSM-V is that rather than being ‘an open and transparent process’ as has been claimed, it will essentially be developed in secret. Task Force and Workgroup members have been required to sign ‘confidentiality agreements’ prohibiting them from discussing with anybody anything having to do with DSM-V” (see http://taxa.epi.umn.edu/~mbmiller/sscpnet/20080909_Spitzer/).
In sum, any changes to the Paraphilia section of DSM should be carefully considered, and the entire DSM development process should be conducted in the open, as it is for the World Health Organization’s revision of ICD-10 (see http://www.who.int/mental_health/evidence/en/).