Treatment of Sex Offenders

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Chapter 1 Problems in the Classification and Diagnosis of the Paraphilias: What Is the Evidence That the DSM Warrants Use? William O’Donohue A classification system in science or an applied science is designed to achieve several intellectual as well as practical goals. When it is successful at achieving these goals it is an invaluable and even essential contribution to both basic and applied pursuits. When it fails to accomplish these it can be an impediment to progress as well as competent, safe practice. When the classification system is attempting to demarcate behavioral health problems such as the DSM-V (American Psychiatric Association, 2015 ) the extent to which these ends are achieved has a direct impact on the beneficial or iatrogenic effects of professional behavior. Therefore, it is important to critically evaluate the quality of any proffered classification system. This chapter reviews the quality of the DSM5 diagnostic categories of the paraphilias. Some of these problems are shared by other diagnostic categories and some are unique to the paraphilias. The major unsolved problems include: 1. It is unclear whether the paraphilias are natural kinds or social constructions. 2. It is unclear whether the paraphilias are better construed as categorical or dimensional entities. 3. It is unclear if each paraphilia is properly subtyped—especially as there is some unexplained variance in the way the DSM5 provides subtypes for each paraphilia. 4. The definitional strategy for each paraphilia is unclear, particularly whether each ought to be defined by necessary and sufficient criteria, by attributes as open concepts, by prototypes, or by an explication of their human history as social constructs. No argument is provided for the definitional strategy utilized. W. O’Donohue , Ph.D. (*) University of Nevada , Reno , NV 89503 , USA e-mail: wto@unr.edu © Springer International Publishing Switzerland 2016 D.R. Laws, W. O’Donohue (eds.), Treatment of Sex Offenders, DOI 10.1007/978-3-319-25868-3_1 1
2 W. O’Donohue 5. It is unclear who ought to properly define these and what interests these may represent and serve. It is possible that the conventional analysis of special interests do not apply to these constructs. 6. There are controversies whether the revisions were made with an open, transparent, fair, and reasonable process that was evidence-based. Explicit referencing of claims is not provided in the DSM5. 7. The justification supplied in the DSM5 for the revisions—i.e., that there was such significant progress in genetics, brain imaging, cognitive neuroscience and epidemiology that a revision became necessary does not seem to apply to the paraphilias. 8. The definition of mental disorders given in the DSM5 might possibly exclude some paraphilias as this definition specifically excludes sexual behavior that is socially deviant unless the deviance is due to dysfunction in the individual— and the exact nature of this internal dysfunction is not specified or known. 9. The general definition of mental disorder provided in the DSM5 necessitates that all mental disorders arise from a dysfunction (“in the psychological, biological or developmental processes underlying mental functioning”) in the individual but the diagnostic criteria of the paraphilias fails to specify this dysfunction. 10. Strangely, instead of relying on the general definition of mental disorders the DSM5 surprisingly provides two problematic candidates for demarcating the paraphilias—their commonness (relative to other paraphilias) and their noxiousness/illegality. There at least is some tension with the earlier exclusionary criteria of “social deviance.” 11. The DSM5 diagnostic criteria for paraphilia seem to be developmentally naïve. It is unclear how these diagnoses relate to the developmental spectrum although the DSM5 at times indicates that special consideration ought to be given to “old people.” 12. The DSM5 states that for actual diagnoses to be made the clinician must consider predisposing, precipitating, and protective factors yet this is impossible for the paraphilias as these are unknown. 13. There seems to be no clearly explicated relationships between the individual paraphilia diagnostic categories. These seem to be more of a heap than systematic network of interrelated constructs. 14. Importantly, the interrater reliability of these diagnostic categories is unknown and has been for at least a third of a century. 15. These diagnostic categories have unknown construct validity and predictive validity. 16. Each of the paraphilias now requires a problematic distinction between a paraphilic orientation and a paraphilic disorder. It is unclear that a paraphilic orientation is actually benign and the interrater reliability of this distinction is unknown. 17. It is unclear if all the paraphilias are included in the DSM5; for example an attraction to rape—a nonconsenting partner is not included. 18. There is a possible overconcern with false positives in diagnostic categories due to the miscategorization of homosexuality as a paraphilia in past editions of the DSM.
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68 R.J.B. Lehmann et al. offenders
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70 R.J.B. Lehmann et al. A good def
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72 R.J.B. Lehmann et al. Conclusion
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74 R.J.B. Lehmann et al. Babchishin
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76 R.J.B. Lehmann et al. Grove, W.
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78 R.J.B. Lehmann et al. Hilton, N.
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80 R.J.B. Lehmann et al. Pedneault,
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Chapter 4 Risk Formulation: The New
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4 Risk Formulation: The New Frontie
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108 R.J. Wilson and M.H. Miner Conv
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110 R.J. Wilson and M.H. Miner Circ
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112 R.J. Wilson and M.H. Miner Visu
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114 R.J. Wilson and M.H. Miner gyne
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116 R.J. Wilson and M.H. Miner View
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118 R.J. Wilson and M.H. Miner comp
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120 R.J. Wilson and M.H. Miner stim
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122 R.J. Wilson and M.H. Miner sign
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124 R.J. Wilson and M.H. Miner In t
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126 R.J. Wilson and M.H. Miner sexu
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128 R.J. Wilson and M.H. Miner Babc
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130 R.J. Wilson and M.H. Miner King
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Chapter 6 Polygraph Testing of Sex
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6 Polygraph Testing of Sex Offender
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Chapter 7 The Strengths of Treatmen
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7 The Strengths of Treatment for Se
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Chapter 8 Responsivity Dynamic Risk
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8 Responsivity Dynamic Risk Factors
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Chapter 9 Early Detection and Inter
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9 Early Detection and Intervention
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Chapter 10 Community Control of Sex
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10 Community Control of Sex Offende
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244 K.N. Daly SVP laws were passed
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246 K.N. Daly 750. 338 b. The condu
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248 K.N. Daly had largely been a re
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250 K.N. Daly By contrast successfu
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252 K.N. Daly In reaching his concu
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254 K.N. Daly with no accompanying
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256 K.N. Daly legal significance of
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258 K.N. Daly law which has caused
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Chapter 12 The Shortcomings of Sexu
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12 The Shortcomings of Sexual Offen
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286 P. Lussier Morton, & Harris, 20
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288 P. Lussier The authors compared
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290 P. Lussier relatively stable ch
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292 P. Lussier Offending Trajectori
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294 P. Lussier impact or a limited
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296 P. Lussier especially those han
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298 P. Lussier the role of social f
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300 P. Lussier Mulvey, 2009 ). In f
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302 P. Lussier opportunities and re
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304 P. Lussier Peer Influence While
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306 P. Lussier of offending. For ex
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308 P. Lussier Aging, self-identity
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310 P. Lussier & Rice, 2007 ; Lussi
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312 P. Lussier Individual and Socia
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314 P. Lussier als subject to incre
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316 P. Lussier opportunities extent
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320 P. Lussier Lussier, P., & Blokl
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324 J. Tabachnick et al. community
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326 J. Tabachnick et al. Fig. 14.1
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328 J. Tabachnick et al. The Need f
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330 J. Tabachnick et al. The CDC de
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332 J. Tabachnick et al. Practical
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342 J. Tabachnick et al. Tharp, A.
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344 Index Adolescent sexually abusi
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346 Index Offense-supportive attitu
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348 Index Structured assessment of
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