I was able to acquire a digital copy of The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
Changes are made to these books to be representative of the empirical consensus and serve as a base for practitioners, experts, researchers, for recognizing, understanding, and ultimately diagnosing mental disorders and other conditions. This is a standard and expected facet of the sciences, and psychological and psychiatric fields are no different.
The purpose of this thread is to document certain changes to their sections regarding ‘Pedophilic Disorder’ and provide personal commentary on it, as well as append commentary posted by others (whose commentary is ultimately more valuable than mine).
I’m not a researcher, but I read a lot and occasionally network with researchers and experts.
Here we go…
Diagnostic Criteria 302.2 (F65.4)
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual
urges, or behaviors involving sexual activity with a prepubescent child or children
(generally age 13 years or younger).
B. The individual has acted on these sexual urges, or the sexual urges or fantasies cause
marked distress or interpersonal difficulty.
C. The individual is at least age 16 years and at least 5 years older than the child or children
in Criterion A.
Note: Do not include an individual in late adolescence involved in an ongoing sexual
relationship with a 12- or 13-year-old.
- Exclusive type (attracted only to children)
- Nonexclusive type
- Sexually attracted to males
- Sexually attracted to females
- Sexually attracted to both
- Limited to incest
The diagnostic criteria for pedophilic disorder are intended to apply both to individuals who
freely disclose this paraphilia and to individuals who deny any sexual attraction to prepubertal
children (generally age 13 years or younger), despite substantial objective evidence to the
contrary. Examples of disclosing this paraphilia include candidly acknowledging an intense
sexual interest in children and indicating that sexual interest in children is greater than or equal
to sexual interest in physically mature individuals. If individuals also complain that their sexual
attractions or preferences for children are causing psychosocial difficulties, they may be diagnosed
with pedophilic disorder. However, if they report an absence of feelings of guilt,
shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses
(according to self-report, objective assessment, or both), and their self-reported and legally
recorded histories indicate that they have never acted on their impulses, then these
individuals have a pedophilic sexual interest but not pedophilic disorder.
Examples of individuals who deny attraction to children include individuals who are
known to have sexually approached multiple children on separate occasions but who deny
any urges or fantasies about sexual behavior involving children, and who may further claim
that the known episodes of physical contact were all unintentional and nonsexual. Other individuals
may acknowledge past episodes of sexual behavior involving children but deny any
significant or sustained sexual interest in children. Since these individuals may deny experiences
impulses or fantasies involving children, they may also deny feeling subjectively distressed.
Such individuals may still be diagnosed with pedophilic disorder despite the absence
of self-reported distress, provided that there is evidence of recurrent behaviors persisting for
6 months (Criterion A) and evidence that the individual has acted on sexual urges or experienced
interpersonal difficulties as a consequence of the disorder (Criterion B).
Presence of multiple victims, as discussed above, is sufficient but not necessary for diagnosis;
that is, the individual can still meet Criterion A by merely acknowledging intense
or preferential sexual interest in children.
The Criterion A clause, indicating that the signs or symptoms of pedophilia have persisted
for 6 months or longer, is intended to ensure that the sexual attraction to children is
not merely transient. However, the diagnosis may be made if there is clinical evidence of
sustained persistence of the sexual attraction to children even if the 6-month duration cannot
be precisely determined.
Associated Features Supporting Diagnosis
The extensive use of pornography depicting prepubescent children is a useful diagnostic
indicator of pedophilic disorder. This is a specific instance of the general case that individuals
are likely to choose the kind of pornography that corresponds to their sexual interests.
The population prevalence of pedophilic disorder is unknown. The highest possible prevalence
for pedophilic disorder in the male population is approximately 3%–5%. The population
prevalence of pedophilic disorder in females is even more uncertain, but it is likely
a small fraction of the prevalence in males.
Development and Course
Adult males with pedophilic disorder may indicate that they become aware of strong or
preferential sexual interest in children around the time of puberty—the same time frame
in which males who later prefer physically mature partners became aware of their sexual
interest in women or men. Attempting to diagnose pedophilic disorder at the age at which
it first manifests is problematic because of the difficulty during adolescent development in
differentiating it from age-appropriate sexual interest in peers or from sexual curiosity.
Hence, Criterion C requires for diagnosis a minimum age of 16 years and at least 5 years
older than the child or children in Criterion A.
Pedophilia per se appears to be a lifelong condition. Pedophilic disorder, however,
necessarily includes other elements that may change over time with or without treatment:
subjective distress (e.g., guilt, shame, intense sexual frustration, or feelings of isolation) or
psychosocial impairment, or the propensity to act out sexually with children, or both.
Therefore, the course of pedophilic disorder may fluctuate, increase, or decrease with age.
Adults with pedophilic disorder may report an awareness of sexual interest in children
that preceded engaging in sexual behavior involving children or self-identification as a pedophile.
Advanced age is as likely to similarly diminish the frequency of sexual behavior involving
children as it does other paraphilically motivated and normophilic sexual behavior.
Risk and Prognostic Factors
There appears to be an interaction between pedophilia and antisociality,
such that males with both traits are more likely to act out sexually with children. Thus,
antisocial personality disorder may be considered a risk factor for pedophilic disorder in
males with pedophilia.
Adult males with pedophilia often report that they were sexually abused
as children. It is unclear, however, whether this correlation reflects a causal influence of
childhood sexual abuse on adult pedophilia.
Genetic and physiological.
Since pedophilia is a necessary condition for pedophilic disorder,
any factor that increases the probability of pedophilia also increases the risk of pedophilic
disorder. There is some evidence that neurodevelopmental perturbation in utero
increases the probability of development of a pedophilic interest.
Gender-Related Diagnostic Issues
Psychophysiological laboratory measures of sexual interest, which are sometimes useful in diagnosing pedophilic disorder in males, are not necessarily useful in diagnosing this disorder in
females, even when an identical procedure (e.g., viewing time) or analogous procedures (e.g., penile plethysmography and vaginal photoplethysmography) are available.
Psychophysiological measures of sexual interest may sometimes be useful when an individual’s
history suggests the possible presence of pedophilic disorder but the individual
denies strong or preferential attraction to children. The most thoroughly researched and
longest used of such measures is penile plethysmography, although the sensitivity and specificity
of diagnosis may vary from one site to another. Viewing time, using photographs of
nude or minimally clothed persons as visual stimuli, is also used to diagnose pedophilic
disorder, especially in combination with self-report measures. Mental health professionals
in the United States, however, should be aware that possession of such visual stimuli, even
for diagnostic purposes, may violate American law regarding possession of child pornography
and leave the mental health professional susceptible to criminal prosecution.
Many of the conditions that could be differential diagnoses for pedophilic disorder also
sometimes occur as comorbid diagnoses. It is therefore generally necessary to evaluate the
evidence for pedophilic disorder and other possible conditions as separate questions.
Antisocial personality disorder.
This disorder increases the likelihood that a person who
is primarily attracted to the mature physique will approach a child, on one or a few occasions,
on the basis of relative availability. The individual often shows other signs of this
personality disorder, such as recurrent law-breaking.
Alcohol and substance use disorders.
The disinhibiting effects of intoxication may also
increase the likelihood that a person who is primarily attracted to the mature physique will
sexually approach a child.
There are occasional individuals who complain about
ego-dystonic thoughts and worries about possible attraction to children. Clinical interviewing
usually reveals an absence of sexual thoughts about children during high states of
sexual arousal (e.g., approaching orgasm during masturbation) and sometimes additional
ego-dystonic, intrusive sexual ideas (e.g., concerns about homosexuality).
Psychiatric comorbidity of pedophilic disorder includes substance use disorders; depressive,
bipolar, and anxiety disorders; antisocial personality disorder; and other paraphilic
disorders. However, findings on comorbid disorders are largely among individuals convicted
for sexual offenses involving children (almost all males) and may not be generalizable
to other individuals with pedophilic disorder (e.g., individuals who have never
approached a child sexually but who qualify for the diagnosis of pedophilic disorder on
the basis of subjective distress).