Asexual Explorations

DSM-5 Paraphilias Bibliography

The situation with the upcoming DSM-5 and the paraphilia diagnoses has involved considerable controversy. The purpose of this bibliography is to help document this ongoing controversy and to help interested person locate documents of relevance. The arrangement is partly topical and partly chronological.

As this is a bibliography documenting an ongoing process, I have created a blog--DSM-5 and the Paraphilias--to keep interested people informed about articles as I add them to this bibliography.

The alternation between DSM-V and DSM-5 is because of a decision mid-course to change its name.
APA Modifies DSM Naming Convention to Reflect Publication Changes.

In general, articles that have a link in the title are available without subscription. Articles that have a link afterwards that says "link" require subscription to access.

1. Historical Background

To understand the arguments, the various positions, and the debates in the articles in this bibliography, it is important to understand the historical, cultural, and political background against which these debates are taking place. While the secondary literature on the history of the paraphilias is very extensive, it tends to focus almost exclusively on homosexuality, which is presently not considered a paraphilia/sexual deviation, but historically was perhaps the most important one. It would be most useful to know more about the origin and historical trajectories of everything presently and/or formerly classified as a paraphilia. Unfortunately, the secondary literature on the history of those things now regarded as paraphilias is very sparse. In my view, the following are some of the most important factors involved that any serious historical work on the subject would need to consider. I make no attempt to fill in the details for each, nor do I presume to be qualified to do so. That said, the following seem to me to be among the most important historical factors involved:

a) The declassification of homosexuality, its effect on the DSM's definition of mental disorder, and how people understand/perceive what the implications for this at the present time are (or are not).

b) Changing attitudes towards sexuality and conservative backlash, especially regarding adult-child sexual relationships: The influence of traditional sexual morality has been waning in many ways, and many traditional arguments have been reapplied/applied with renewed vigor to the subject of adult-child sexual relationships and child-pornography. Liberal opposition to traditional morality has largely agreed on this subject, with the increasingly dominant "between consenting adults" standard, leaving conservative arguments largely unchecked. (The significance of this can be seen by the much greater size of the bibliography on pedohebephilia than on any other diagnosis.)

c) Public perception of "the sex-offender" and especially "the pedophile." The new sex-offender laws of the past few decades (especially laws permitting the civil commitment of some sex-offenders after completing their sentences [SVP commitment]), sex offender treatment, and the role of psychologists and psychiatrists in these issues. SVP commitment has proved extremely controversial; most of the diagnoses relied on are the paraphilias, including also Paraphilia NOS: nonconsent. Something very much like this, called Paraphilic Coercive Disorder [PCD] is being proposed for inclusion in DSM-5. Many critics feel that this would legitimate what they consider rogue use of Paraphilia NOS: nonconsent in SVP commitment. SVP commitment is discussed in numerous documents in this bibliography.

d) One major consequence of public perception of "the pedophile" and adult-child sexual relationships is that other groups (e.g. transgender people and kinky people) do not want to be associated with pedophiles and thus object to both being in the DSM together under the paraphilias. A second consequence is fear of advocating any position that might cause others to think that one might be supporting child molesting (or other sex offenses), and fear of advocating any position that could be twisted to give this impression.

e) The rise of the transgender community, their sexological activism, and their DSM activism. Transgender DSM activism has primarily focused on Gender Identity Disorder, with much less attention paid to Transvestic Fetishism, but this remains a concern of theirs.

f) The Kinky community. There is some political activism among kinksters, but it is fairly limited, and they are much less well organized than the trans community.

g) The creation in 2003 of B4U-ACT, a Maryland non-profit aiming to promote understanding between minor attracted people (MAPs) and mental health professionals, with the goal of being able to facilitate better mental health care for MAPs. In my own view, this one of the most unexpected factors in these controversies, as they are making new arguments and giving new perspectives that (as far as I can tell) really were not part of the debates previously.

h) The development of the DSM from edition to edition, criticisms of the DSM (and psychiatry--and psychology--more generally), and the distinct flavors that those in charge of each revision have brought to that revision process. There is enormous controversy surrounding the DSM-5 process, and controversies regarding the paraphilias (often happening specifically in the context of larger criticisms of the DSM-5 process) must be understood against this background.

Curiously, one fact that (at present) seems to play relatively little role in the DSM-5 paraphilias controversies is

i) The history of the paraphilias (other than homosexuality--historically a paraphilia, but presently not), how and why they came to be regarded as mental disorders, and how and why they were first included in the DSM. This appears to be a history largely untold, so there are no stories that people are now telling each other; as such historical development seems to play relatively little role in these debates. (There are a few exceptions, but even among these, there is extremely little that deals seriously with events before 1970.)

To keep the size manageable, the present bibliography is restricted to materials since the formation of the DSM-5 Workgroups in 2008. Within this time frame, there is one document that deserves to be included under "Historical Background."

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.

2. Publications of the DSM-5 Workgroup and advisors

2.1 Early sources and conference presentations.

In May 2008, the APA announced members for the DSM-V workgroups, including the Sexual and Gender Identity Disorders Workgroup; a few addition members were added later that year.

A list of members

November 2008 Workgroup Report

April 2009 Workgroup Report

The earliest information available (as far as I know) about the proposals of the DSM-V Paraphilias Subworkgroup were some conference presentations given in 2009.

Blanchard, R. Paraphilias vs. Paraphilic Disorders, Pedophilia vs. Pedo- And Hebephilia, and Autogynephilic vs. Fetishistic Transvestism Paper presented at the Annual Meeting of the Society for Sex Therapy and Research (SSTAR), April 3, 2009, Arlington, Virginia.

Blanchard, R. Paraphilias and the DSM-V: General Diagnostic Issues and Options Exemplified with Pedohebephilic Disorder. Paper presented at 19th WAS World Congress for Sexual Health, June 25, 2009, Göteborg, Sweden

Blanchard, R. DSM-V Options: Paraphilias and Paraphilic Disorders, Pedohebephilic Disorder, and Transvestic Disorder. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas.

Along with the third of these presentations, others were given by members of the Paraphilias Subworkgroup at the same conference, which are all found in the same pdf.

Långström, N, (2010). DSM-V Options: Exhibitionistic Disorder, Voyeuristic Disorder, and Frotteuristic Disorder. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas

Kafka, M. P. (2010). DSM-V Options: Hypersexual Disorder. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas

Kafka, M. P. (2010). DSM-V Options: Fetishism. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas

Krueger, R. B. (2010). DSM-V Options: Sexual Sadism, Sexual Masochism, and Paraphilic Coercive Disorder. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas

2.2 Literature Reviews of the Paraphilias Subworkgroup

The reports of the DSM-V Sexual and Gender Identity Disorders Workgroup and their advisors were published in Archives of Sexual Behavior, with the exception of those on sexual dysfunctions in men, which were published in the Journal of Sexual Medicine. They were later posted on the dsm5.org webpage.

Zucker, K. J. (2010). Reports from the DSM-5 Work Group on Sexual and Gender Identity Disorders. Archives of Sexual Behavior, 39:217-220.

Blanchard, R. (2010). The DSM Diagnostic Criteria for Pedophilia. Archives of Sexual Behavior, 39, 304-316.

Blanchard, R. (2010). The DSM Diagnostic Criteria for Transvestic Fetishism. Archives of Sexual Behavior, 39, 363-372.

Kafka, M. P. (2010). The DSM Diagnostic Criteria for Fetishism. Archives of Sexual Behavior, 39, 357-362.

Kafka, M. P. (2010). The DSM Diagnostic Criteria for Paraphilia Not Otherwise Specified. Archives of Sexual Behavior, 2009; 39:373-376.

Kafka, M. P. (2010). Hypersexual Disorder: A Proposed Diagnosis for DSM-V. Archives of Sexual Behavior, 2009; 39:377-400.

Krueger, K. B. (2010) The DSM Diagnostic Criteria for Sexual Sadism. Archives of Sexual Behavior, 2009; 39:325-345.

Krueger, R. B. (in press). The DSM Diagnostic Criteria for Sexual Masochism. Archives of Sexual Behavior.

Långström, N. (2010). The DSM Diagnostic Criteria for Exhibitionism, Voyeurism, and Frotteurism. Archives of Sexual Behavior, 39, 317-324.

Knight, R. A. (2010). Is a Diagnostic Category for Paraphilic Coercive Disorder Defensible? Archives of Sexual Behavior, 39, 419-426.

Quinsey, V. L. (2010). Coercive Paraphilic Disorder. Archives of Sexual Behavior, 39, 405-410.

Thornton, D. (2010). Evidence Regarding the Need for a Diagnostic Category for a Coercive Paraphilia. Archives of Sexual Behavior, 39, 411-418.

Stern, P. Paraphilic Coercive Disorder in the DSM: The Right Diagnosis for the Right Reasons. Archives of Sexual Behavior, 2010; 39:1443-1447.

2.3. More recent publications and presentation

Blanchard, R. (2009). Reply to Letters Regarding Pedophilia, Hebephilia, and the DSM-V. Archives of Sexual Behavior 38 (3), 331-334.

Blanchard, R. (2010). The Fertility of Hebephiles and the Adaptationist Argument against Including Hebephilia in DSM-5, Archives of Sexual Behavior,

Blanchard, R. (2010). The specificity of victim count as a diagnostic indicator of pedohebephilia. Archives of Sexual Behavior, 39, 1245-1252.

Blanchard, R. (in press). A Brief History of Field Trials of the DSM Diagnostic Criteria for Paraphilias. Archives of Sexual Behavior.
(link)

Kafka, M. P. (2010). Sexual offender assessment: DSM-5 proposals modifying diagnostic criteria for paraphilias and related disorders.

Kafka, M. P. & Krueger, R. B. (2011). Response to Moser’s (2010) Critique of Hypersexual Disorder for DSM-5. Archives of Sexual Behavior, 40, 231-232.

Zucker K. J. (Feb 22, 2010). DSM5: Pandora Replies to Dr Frances. Psychiatric Times.

American Psychiatric Association. (May 17, 2010). Recent Updates to Proposed Revisions for DSM-5.

3. Materials on each diagnosis

In his introduction to the issue in which most of the above reports/literature reviews (everything except the Stern article), Kenneth Zucker invited people to write commentaries to be published in [i]Archives of Sexual Behavior[/i] (which he is editor of). In addition, on February 10, 2010, the website DSM5.org was launched, giving the proposed diagnostic criteria for DSM-5 and the rationale. Readers were invited to provide comments. Other than a petition objecting to Kenneth Zucker, Ray Blanchard, and Martin Kafka being on the Sexual and Gender Identity Disorders Workgroup and an article about hebephilia and responses (see below), most of the published material about the paraphilias section of DSM-5 (other than the above) has followed the publication of the literature reviews. Because the amount of material increases considerably once these started to be published, the remainder of this bibliography will appear topically. (Archives of Sexual Behavior, like many journals, publishes online in advance of print, and the literature reviews began to be published online in September, 2009.)

3.1 Pedohebephilia

Karen Franklin maintains a bibliography about hebephilia and I have relied on this for part of this section.

The following Blanchard et al. paper (published well before the Paraphilas Subworkgroup's literature reviews) argued for the inclusion of hebephilia in DSM-V, which resulted in six letters to the editor responding to it, largely critical, and following these, Ray Blanchard wrote a response.

Blanchard, R.; Lykins, A. D.; Wherrett, D., Kuban, M. E.; Cantor, J. M.; Blak, T.; Dickey, R.; & Klassen, P.E. (2009). Pedophilia, Hebephilia, and the DSM-V. Archives of Sexual Behavior, 28, 335-350. (link

DeClue, G. (2009). Should Hebephilia be a Mental Disorder? A Reply to Blanchard et al. Gregory DeClue, Archives of Sexual Behavior, 38 (3), 317-318. (link)

Franklin, K. (2009). The Public Policy Implications of “Hebephilia”: A Response to Blanchard et al. Archives of Sexual Behavior, 38, 319-320. (link)

Janssen, D. F. (2009). Hebephilia plethysmographica: A partial rejoinder to Blanchard et al. (2008). Archives of Sexual Behavior, 38, 321-322. (link)

Moser, C. (2009). When Is an Unusual Sexual Interest a Mental Disorder? Archives of Sexual Behavior, 38, 323-325. (link)

Plaud, J. J. (2009). Are There “Hebephiles” Among Us? A Response to Blanchard et al. Joseph J. Plaud (2009), Archives of Sexual Behavior, 38, 326-327. (link)

Tromovitch. P. (2009). Manufacturing Mental Disorder by Pathologizing Erotic Age Orientation: A Comment on Blanchard et al., Archives of Sexual Behavior, 38, 328. (link)

Zander, T. K. (2009) Adult Sexual Attraction to Early-Stage Adolescents: Phallometry Doesn’t Equal Pathology. Archives of Sexual Behavior, 38, 329-330. (link)

Blanchard, R. (2009). Reply to Letters Regarding Pedophilia, Hebephilia, and the DSM-V. Archives of Sexual Behavior, 38, 331-334. (link)

Following this, Franklin wrote a response to Blanchard's response, and then Blanchard wrote a response to that.

Franklin, K. (2010). Why the Rush to Create Dubious New Sexual Disorders? Archives of Sexual Behavior, 39, 819-820. (link)

Blanchard, R. (2010). The Fertility of Hebephiles and the Adaptationist Argument against Including Hebephilia in DSM-5, Archives of Sexual Behavior, 39, 817-818.

Paraphilias Subworkgroup Publications and Responses

Blanchard, R. (2009). Paraphilias vs. Paraphilic Disorders, Pedophilia vs. Pedo- And Hebephilia, and Autogynephilic vs. Fetishistic Transvestism Paper presented at the Annual Meeting of the Society for Sex Therapy and Research (SSTAR), April 3, 2009, Arlington, Virginia.

Blanchard, R. (2009). Paraphilias and the DSM-V: General Diagnostic Issues and Options Exemplified with Pedohebephilic Disorder. Paper presented at 19th WAS World Congress for Sexual Health, June 25, 2009, Göteborg, Sweden

Blanchard, R. (2009). DSM-V Options: Paraphilias and Paraphilic Disorders, Pedohebephilic Disorder, and Transvestic Disorder. Paper presented at the 28th Annual Meeting of the Association for the Treatment of Sexual Abusers, October 1, 2009, Dallas, Texas.

Blanchard R. (2009). The DSM Diagnostic Criteria for Pedophilia. Archives of Sexual Behavior, 2009; 39:304-316.

Green, R. (2010). Sexual Preference for 14-Year-Olds as a Mental Disorder: You Can’t Be Serious!! Richard Green (2010), Archives of Sexual Behavior, 39, 585-586. (link)

Kramer, R. (2011). APA guidelines ignored in development of diagnostic criteria for pedohebephilia. Archives of Sexual Behavior, 40, 233-235. (link)

O'Donohue, W. (2010). A Critique of the Proposed DSM-V Diagnosis of Pedophilia, Archives of Sexual Behavior, 39, 587-590. (link)

Seto, M. C. (2010). Child Pornography Use and Internet Solicitation in the Diagnosis of Pedophilia. Archives of Sexual Behavior, 39, 591-593. (link)

Longer Articles and responses

Green, R. (2010). Hebephilia is a Mental Disorder? Sexual Offender Treatment, 5.

Franklin, K. (2010). Hebephilia: Quintessence of Diagnostic Pretextuality, Behavioral Sciences and the Law, 28, 751–768

Frances, A. & First, M. B. (2011). Hebephilia is not a mental disorder in DSM-IV-TR and should not become one in DSM-5. Journal of the American Academy of Psychiatry and the Law Online, 39, 78-85. (link)

Wakefield, J. C. (in press). DSM-5 proposed diagnostic criteria for sexual paraphilias: Tensions between diagnostic validity and forensic utility, International Journal of Law and Psychiatry. (link)

Chenier, E. (in press). The Natural order of disorder: Pedophilia, stranger danger and the normalising family. Sexuality & Culture. DOI: 10.1007/s12119-011-9116-z.

Fabian, J. M. (2011). Diagnosing and litigating hebephilia in sexually violent predator civil commitment proceedings. Journal of the American Academcy of Psychiatry and the Law, 39, 496-505.