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==DSM-5 debate==
==DSM-5 debate==
{{main|DSM-5}}
===Overview===
===Overview===
A 2009 [[Academic publication|research paper]] by [[Ray Blanchard]] and colleagues proposed that, based on [[penile plethysmograph]]s, [[sex offender]]s could be grouped according to the ages of individuals they found most sexually attractive. Blanchard noted that the most common age of victims for sexual offenders was 14 years, and suggested there were qualitative differences between offenders who preferred pubertal sex-objects and those with a prepubertal preference. The paper concluded that the DSM-5 could better account for those data if it split [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]-IV-TR's existing criteria for pedophilia (attraction to children generally under 13) into pedophilia (attracted to prepubescent children, generally younger than 11) and hebephilia (attracted to early pubescent children, generally 11-14 years old). What DSM-IV called pedophilia would instead be termed "pedohebephilia", with pedophilic and hebephilic sub-types.<ref name=Blanchard/> The proposed criteria for DSM-5 involved an adult who, for six or more months, experienced sexual attraction to prepubescent or pubescent children that was equal to or greater than their attraction to adults, and who also either found the attraction distressing, used [[child pornography]] or had sought sexual stimulation from a child, on at least three occasions in the case of the hebephilic type. The proposed criteria would have been applied to subjects aged 18 or older and who are at least five years older than children to whom they are typically attracted.<ref name = Wakefield>{{cite doi | 10.1007/s10615-011-0353-2}}</ref>
A 2009 [[Academic publication|research paper]] by [[Ray Blanchard]] and colleagues proposed that, based on [[penile plethysmograph]]s, [[sex offender]]s could be grouped according to the ages of individuals they found most sexually attractive. Blanchard noted that the most common age of victims for sexual offenders was 14 years, and suggested there were qualitative differences between offenders who preferred pubertal sex-objects and those with a prepubertal preference. The paper concluded that the [[DSM-5]] could better account for those data if it split [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]-IV-TR's existing criteria for pedophilia (attraction to children generally under 13) into pedophilia (attracted to prepubescent children, generally younger than 11) and hebephilia (attracted to early pubescent children, generally 11-14 years old). What DSM-IV called pedophilia would instead be termed "pedohebephilia", with pedophilic and hebephilic sub-types.<ref name=Blanchard/> The proposed criteria for DSM-5 involved an adult who, for six or more months, experienced sexual attraction to prepubescent or pubescent children that was equal to or greater than their attraction to adults, and who also either found the attraction distressing, used [[child pornography]] or had sought sexual stimulation from a child, on at least three occasions in the case of the hebephilic type. The proposed criteria would have been applied to subjects aged 18 or older and who are at least five years older than children to whom they are typically attracted.<ref name = Wakefield>{{cite doi | 10.1007/s10615-011-0353-2}}</ref>


===Responses===
===Responses===
The proposal was presented at a 2009 meeting of the [[American Academy of Psychiatry and the Law]] along with several other prospective changes to the DSM's treatment of [[paraphilia]]s. Participants questioned whether sexual attraction to pubesecent children can be considered abnormal in a context where their sexualization is to a certain extent [[normative]]. Concern was also raised that the criteria could have produced both false positives and false negatives; hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, but could exclude offenders who had committed serious offences on only one or two victims.<ref name=cpn>{{cite journal | last = Frieden | first = J | date = 2009-12-01 | accessdate = 2013-01-07 | url = http://psych.imng.com/fileadmin/content_pdf/cpn/archive_pdf/vol37iss12/70438_main.pdf | format = pdf | title = DSM-V work on paraphilias begins in earnest | journal = Clinical Psychiatry News | volume = 37 | issue = 12 | pages = 21 }}</ref> During [[academic conference]]s for the American Academy of Psychiatry and Law and [[International Association for the Treatment of Sexual Offenders]], symbolic votes were taken regarding whether the DSM-V should include pedohebephilia, and in both cases an overwhelming majority voted against this.<ref>{{cite journal | last = Franklin | first = K | year = 2011 | title = Forensic Psychiatrists Vote No on Proposed Paraphilias | url = http://www.psychiatrictimes.com/display/article/10168/1773113 | journal = Psychiatric Times | volume = 27 | issue = 12 | authorlink = Karen Franklin }} {{subscription required}}</ref>
The proposal was presented at a 2009 meeting of the [[American Academy of Psychiatry and the Law]] along with several other prospective changes to the DSM's treatment of [[paraphilia]]s. Participants questioned whether sexual attraction to pubesecent children can be considered abnormal in a context where their sexualization is to a certain extent [[normative]]. Concern was also raised that the criteria could have produced both false positives and false negatives; hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, but could exclude offenders who had committed serious offences on only one or two victims.<ref name=cpn>{{cite journal | last = Frieden | first = J | date = 2009-12-01 | accessdate = 2013-01-07 | url = http://psych.imng.com/fileadmin/content_pdf/cpn/archive_pdf/vol37iss12/70438_main.pdf | format = pdf | title = DSM-V work on paraphilias begins in earnest | journal = Clinical Psychiatry News | volume = 37 | issue = 12 | pages = 21 }}</ref> During [[academic conference]]s for the American Academy of Psychiatry and Law and [[International Association for the Treatment of Sexual Offenders]], symbolic votes were taken regarding whether the DSM-V should include pedohebephilia, and in both cases an overwhelming majority voted against this.<ref>{{cite journal | last = Franklin | first = K | year = 2011 | title = Forensic Psychiatrists Vote No on Proposed Paraphilias | url = http://www.psychiatrictimes.com/display/article/10168/1773113 | journal = Psychiatric Times | volume = 27 | issue = 12 | authorlink = Karen Franklin }} {{subscription required}}</ref>


In a [[letter to the editor]], clinical psychologist Joseph Plaud criticized the study for lacking a [[Scientific control|control group]]s of post-pubescent and normal patterns of male sexual arousal, overlap between groups Blanchard believed were separate, and lack of specificity in the data.<ref>{{cite doi|10.1007/s10508-008-9423-0}}</ref> Blanchard replied that the initial publication used sex offenders who had committed crimes against post-pubescent adults as a control group, and that the results supported victim age preferences being a [[Continuum (measurement)|continuous]] rather than [[categorical variable]].<ref name = Blanchardreply>{{cite doi|10.1007/s10508-008-9427-9}}</ref> In separate letters to the editor, forensic psychologist Gregory DeClue and mathematician Philip Tromovitch agreed the term would be valuable for research purposes and to subdivide the current diagnosis of pedophilia into victim age preferences, but expressed concern that the term's potential to dramatically expand the number of people diagnosed with a paraphilia without an adequate research base to support it and the article did not include a definition of "mental disorder" and thus lacking the ability to distinguish the pathological from the nonpathological.<ref name = DeClue>{{cite doi | 10.1007/s10508-008-9422-1}}</ref><ref name = Tromovitch>{{cite doi | 10.1007/s10508-008-9426-x }}</ref> Blanchard stated in reply that his paper was written under the assumptions that the DSM5's definition of mental disorder and pathologizing of sexual activity with underaged individuals would be similar to the one found in DSM-IV.<ref name = Blanchardreply/>
In a [[letter to the editor]], clinical psychologist Joseph Plaud criticized the study for lacking a [[Scientific control|control group]]s of post-pubescent and normal patterns of male sexual arousal, overlap between groups Blanchard believed were separate, and lack of specificity in the data.<ref name = Plaud>{{cite doi|10.1007/s10508-008-9423-0}}</ref> Blanchard replied that the initial publication used sex offenders who had committed crimes against post-pubescent adults as a control group, and that the results supported victim age preferences being a [[Continuum (measurement)|continuous]] rather than [[categorical variable]].<ref name = Blanchardreply>{{cite doi|10.1007/s10508-008-9427-9}}</ref> In separate letters to the editor, forensic psychologist Gregory DeClue and mathematician Philip Tromovitch agreed the term would be valuable for research purposes and to subdivide the current diagnosis of pedophilia into victim age preferences, but expressed concern that the term's potential to dramatically expand the number of people diagnosed with a paraphilia without an adequate research base to support it and the article did not include a definition of "mental disorder" and thus lacking the ability to distinguish the pathological from the nonpathological.<ref name = DeClue>{{cite doi | 10.1007/s10508-008-9422-1}}</ref><ref name = Tromovitch>{{cite doi | 10.1007/s10508-008-9426-x }}</ref> Blanchard stated in reply that his paper was written under the assumptions that the DSM5's definition of mental disorder and pathologizing of sexual activity with underaged individuals would be similar to the one found in DSM-IV.<ref name = Blanchardreply/>


===As a variation of normal sexual desires===
===As a variation of normal sexual desires===
[[Forensic psychology|Defence psychologist]] [[Karen Franklin]] has criticized hebephilia for pathologizing and criminalizing a "widespread and, indeed, evolutionarily adaptive" sexual attraction of homosexual and heterosexual males who, across cultures and throughout history "tend to prefer youthful partners who are at the peak of both beauty and reproductive fertility".<ref name=Franklin>{{cite doi|10.1002/bsl.934}}</ref> Franklin also objects to the use of hebephilia during trials of individuals who may be imprisoned on the basis of [[sexually violent predator laws]] in the United States.<ref name = Franklin/> A similar comment was made by DSM-IV editor [[Michael First]], who also questioned the degree to which hebephilic offenders might be opportunistically preying on vulnerable adolescents rather than expressing a pathological desire.<ref name=cpn/> Commenting on Blanchard et al.'s proposal, psychologists Robert Prentky and Howard Barbaree pointed out that examples of highly sexualized young girls appear frequently in advertising, [[fashion show]]s, television programs and films, making it questionable whether sexual attraction to pubescents is abnormal.<ref name = Prentky/>
[[Forensic psychology|Defence psychologist]] [[Karen Franklin]] has criticized hebephilia for pathologizing and criminalizing a "widespread and, indeed, evolutionarily adaptive" sexual attraction of homosexual and heterosexual males who, across cultures and throughout history "tend to prefer youthful partners who are at the peak of both beauty and reproductive fertility".<ref name=Franklin>{{cite doi|10.1002/bsl.934}}</ref> Franklin also objects to the use of hebephilia during trials of individuals who may be imprisoned on the basis of [[sexually violent predator laws]] in the United States.<ref name = Franklin/> A similar comment was made by DSM-IV editor [[Michael First]], who also questioned the degree to which hebephilic offenders might be opportunistically preying on vulnerable adolescents rather than expressing a pathological desire.<ref name=cpn/> Commenting on Blanchard et al.'s proposal, psychologists Robert Prentky and Howard Barbaree pointed out that examples of highly sexualized young girls appear frequently in advertising, [[fashion show]]s, television programs and films, making it questionable whether sexual attraction to pubescents is abnormal.<ref name = Prentky/>


Professor of [[social work]] Jerome Wakefield described the inclusion as an inappropriate extension of the existing well-validated category of pedophilia, which would carry significant risk of [[Type I and type II errors#Type I error|false positives]], and ignored the large qualitative distinctions between prepubescent children and sexually mature pubescents. He summarized his discussion with the statement "it appears that the hebephilia proposal is one where criminality and social disapproval are being confused with mental disorder."<ref name = Wakefield/> However, [[child sexual abuse]] researcher [[William O'Donohue]] believes, based on the incentive for offenders to lie, that there is a far greater risk of false negatives. O'Donohue praised Blanchard et al.'s proposal to distinguish hebephilia from pedophilia, but questioned the inclusion of offender distress, the use of child pornography as a determining factor and requiring a minimum of three victims, believing the latter choice would result in delayed treatment for hebephiles who have not acted on their urges while ignoring the often hidden nature of child sexual abuse. O'Donohue also had concerns over how information for making decisions about the proposed diagnosis would be acquired, whether the diagnosis could be made with [[reliability (psychometrics)|reliability]] and sufficient [[inter-rater reliability|agreement between clinicians]] and issues related to treatment.<ref name=Donohue>{{cite doi|10.1007/s10508-010-9604-5}}</ref>
Professor of [[social work]] Jerome Wakefield described the inclusion as an inappropriate extension of the existing well-validated category of pedophilia, which would carry significant risk of [[Type I and type II errors#Type I error|false positives]], and ignored the large qualitative distinctions between prepubescent children and sexually mature pubescents. He summarized his discussion with the statement "it appears that the hebephilia proposal is one where criminality and social disapproval are being confused with mental disorder."<ref name = Wakefield/> However, [[child sexual abuse]] researcher [[William O'Donohue]] believes, based on the incentive for offenders to lie, that there is a far greater risk of false negatives. O'Donohue praised Blanchard et al.'s proposal to distinguish hebephilia from pedophilia, but questioned the inclusion of offender distress, the use of child pornography as a determining factor and requiring a minimum of three victims, believing the latter choice would result in delayed treatment for hebephiles who have not acted on their urges while ignoring the often hidden nature of child sexual abuse. O'Donohue also had concerns over how information for making decisions about the proposed diagnosis would be acquired, whether the diagnosis could be made with [[reliability (psychometrics)|reliability]] and sufficient [[inter-rater reliability|agreement between clinicians]] and issues related to treatment.<ref name=Donohue>{{cite doi|10.1007/s10508-010-9604-5}}</ref> Clinical and forensic psychologist Thomas Zander noted problems in distinguishing between prepubescent versus pubescent victims, and thus the difficulty in classifying offenders and the degree to which the potential diagnosis genuinely reflected normal versus abnormal sexual desire.<ref name = Zander>{{cite doi | 10.1007/s10508-008-9428-8}}</ref>


===In the criminal justice system===
===In the criminal justice system===
Considerable concern has been expressed regarding the potential for hebephilia to be used to indefinitely detain sex offenders with adolescent victims through [[involuntary commitment]]. Efforts to include it in the DSM-5 has been met with approval from [[prosecutor]]s and criticisms from [[criminal defense lawyer]]s.<ref name = Prentky/> In a letter to the editor, sexologist, lawyer and [[gender identity]] specialist [[Richard Green (sexologist)|Richard Green]] questioned whether sexual attraction to pubescent sexual partners was a mental health issue, analogizing the proposal to the decision to include homosexuality in earlier versions of the DSM which turned a [[sexual orientation]] into a [[mental disorder]]. Green also questioned the proposal's impact on the credibility of the APA, its potential to blur the distinction between psychiatry and law, and whether it was necessary to create mental disorders for criminal acts. Green agreed the term would be useful for research purposes but disagreed with efforts to include it in the DSM-5.<ref name=green>{{cite doi|10.1007/s10508-010-9602-7}}</ref> Prentky and Barbaree note that Blanchard et al. had identified Green's "law/psychiatry blur" in their initial article, but suggest distinctions can be made between normative attraction to pubescent girls and the exclusivity, disability, distress and impairment that would characterize hebephilia as [[Paraphilia|paraphilic]].<ref name = Prentky>{{cite pmid | 22159978}}</ref> In another letter to the editor, physician [[Charles Allen Moser]] agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia. Moser noted the problematic use of paraphilic labels to pathologize unusual sexual interests and incarcerate individuals on the basis of their paraphilia rather than their behaviour. Moser also questioned the usefulness of paraphilias in general when real issue may be criminal behaviours or stigmatization of unusual but benign and/or consensual sexual acts.<ref name=moser>{{cite doi|10.1007/s10508-008-9436-8}}</ref>
Considerable concern has been expressed regarding the potential for hebephilia to be used to indefinitely detain sex offenders with adolescent victims through [[involuntary commitment]]. Efforts to include it in the DSM-5 has been met with approval from [[prosecutor]]s and criticisms from [[criminal defense lawyer]]s.<ref name = Prentky/> In a letter to the editor, sexologist, lawyer and [[gender identity]] specialist [[Richard Green (sexologist)|Richard Green]] questioned whether sexual attraction to pubescent sexual partners was a mental health issue, analogizing the proposal to the decision to include homosexuality in earlier versions of the DSM which turned a [[sexual orientation]] into a [[mental disorder]]. Green also questioned the proposal's impact on the credibility of the APA, its potential to blur the distinction between psychiatry and law, and whether it was necessary to create mental disorders for criminal acts. Green agreed the term would be useful for research purposes but disagreed with efforts to include it in the DSM-5.<ref name=green>{{cite doi|10.1007/s10508-010-9602-7}}</ref> Prentky and Barbaree note that Blanchard et al. had identified Green's "law/psychiatry blur" in their initial article, but suggest distinctions can be made between normative attraction to pubescent girls and the exclusivity, disability, distress and impairment that would characterize hebephilia as [[Paraphilia|paraphilic]].<ref name = Prentky>{{cite pmid | 22159978}}</ref> In another letter to the editor, physician [[Charles Allen Moser]] agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia. Moser noted the problematic use of paraphilic labels to pathologize unusual sexual interests and incarcerate individuals on the basis of their paraphilia rather than their behaviour. Moser also questioned the usefulness of paraphilias in general when real issue may be criminal behaviours or stigmatization of unusual but benign and/or consensual sexual acts.<ref name=moser>{{cite doi|10.1007/s10508-008-9436-8}}</ref> A third letter to the editor by Thomas Zander also noted the serious consequences of a diagnosis of pedophilia - notably potential for permanent civil commitment - and accordingly the consequences of expanding the definition to include hebephilia. Zander also noted that the diagnosis would incorporate age ranges in which sexual activity were legal under [[age of consent]] laws within the United States and concluded that the term should require more research and consideration of implications before the DSM were changed.<ref name = Zander/>


==See also==
==See also==

Revision as of 00:42, 8 January 2013

Hebephilia is one of several types of chronophilia (a preference for a sexual partner who appears to be of a specific age), in this case a primary or exclusive sexual interest in pubescent individuals approximately 11–14 years old. Hebephilia differs from ephebophilia, which refers to the sexual preference for individuals in later adolescence,[1] and from pedophilia, which refers to the sexual preference for prepubescent children.[1] The onset of puberty varies from child to child, but, on average, girls begin the process of puberty at age 10 or 11; boys at age 11 or 12.[2] While individuals with a sexual preference for adults may have some sexual interest in pubescent-aged individuals,[3] true hebephilia is characterized by a preference of pubescent rather than adult partners.

Ray Blanchard and colleagues from the Centre for Addiction and Mental Health found that sex offenders could be separated into groups by victim age preference on the basis of penile plethysmograph response patterns. They suggested that the DSM-5 could account for these data by subdividing the existing diagnosis of pedophilia into hebephilia and a narrower definition of pedophilia.[4] The proposed addition to the DSM-5 proved controversial and was not adopted.

Etiology

As with sexual preference in general, it is not known what causes someone to experience sexual attraction focused on pubescent individuals. Between 2005 and 2007, researchers from the Centre for Addiction and Mental Health in Toronto, conducted a series of studies on physical and psychological correlates of hebephilia, including handedness,[5][6] intelligence quotient, being made to repeat a year in primary education[7] and height.[8] The work grew out of efforts to seek neurodevelopmental etiologies for pedophilia, transsexualism and male homosexuality, with a publication on in 2004[6] being the first to incorporate hebephilia into the program.[9]

History

The term is based on the Greek goddess and protector of youth Hebe, but in Ancient Greece also referred to the time before manhood in Athens (depending on the reference, the specific age could be 14, 16 or 18 years old). The suffix -philia is derived from -phil-, implying love or strong friendship.[10]

In 1914, physician Kurt Boas described hebephilia as "an alleged form of female fetishism."[11] Anthropologist and ethnopsychiatrist Paul K. Benedict use the term to distinguish pedophiles from sex offenders whose victims were adolescents.[12] Forensic psychologist Karen Franklin traced the history of use of the term in a 2010 article. She states that it is a variation of ephebophilia, used by Magnus Hirschfeld in 1906 to describe homosexual attraction to males between puberty and their early 20s, who considered the condition normal and nonpathological. Historically, criminal hebephilic acts where victims were "biologically ready for coitus" (i.e. statutory rape) were considered distinct from other forms of criminal sexuality such as rape and pedophilia, with wide variations within and across nations regarding what age was acceptable for adult-adolescent sexual contacts.[9] Bernard Glueck, Jr. conducted research on sex offenders at Sing Sing prison in the 1950s, using "hebephilia" as one of several classifications of subjects according to offense. In the 1960s, sexologist Kurt Freund used the term to distinguish between age preferences of homosexual and heterosexual men during penile plethysmograph assessments, continuing his work with Ray Blanchard at the Centre for Addiction and Mental Health (CAMH) after emigrating to Canada in 1968. After Freund's death in 1996, researchers at CAMH conducted research on neurological explanations of pedophilia, transexuality and homosexuality, and based on this research, hypothesized that hebephiles could also be distinguished on the basis of neurological and physiological measures.[9] In 1999 a separate group, spurred by the Catholic sex abuse cases, attempted to develop a psychological test by combining questions from the Millon Clinical Multiaxial Inventory and Minnesota Multiphasic Personality Inventory, using the terms hebephilia to classify individuals attracted to adolescent members of the opposite sex. The group lobbied to create a new diagnosis of ephebophilia to identify individuals who had sexually abused adolescents; their efforts were unsuccessful. In court cases where the term "hebephilia" is used, it is placed within the DSM category of paraphilia, not otherwise specified.[9]

Franklin has stated that she believes the concept is largely the result of the Centre for Addiction and Mental Health,[9] though CAMH employee and clinical psychologist James Cantor challenged the factual accuracy of this claim, citing the existence of the concept in the ICD-10,[13] the use of the word in one hundred scholarly texts from a variety of disciplines and time periods, the existence of 32 peer reviewed papers researching the concept and a variety of other factual errors in Franklin's paper.[14]

Prevalence

The prevalence of hebephilia within the general population is unknown. There is evidence suggesting that within clinical and correctional samples,[15][16] as well as anonymous surveys of people sexually interested in children, there are more individuals with an erotic interest in pubescent rather than in prepubescent children.[17][18]

DSM-5 debate

Overview

A 2009 research paper by Ray Blanchard and colleagues proposed that, based on penile plethysmographs, sex offenders could be grouped according to the ages of individuals they found most sexually attractive. Blanchard noted that the most common age of victims for sexual offenders was 14 years, and suggested there were qualitative differences between offenders who preferred pubertal sex-objects and those with a prepubertal preference. The paper concluded that the DSM-5 could better account for those data if it split DSM-IV-TR's existing criteria for pedophilia (attraction to children generally under 13) into pedophilia (attracted to prepubescent children, generally younger than 11) and hebephilia (attracted to early pubescent children, generally 11-14 years old). What DSM-IV called pedophilia would instead be termed "pedohebephilia", with pedophilic and hebephilic sub-types.[4] The proposed criteria for DSM-5 involved an adult who, for six or more months, experienced sexual attraction to prepubescent or pubescent children that was equal to or greater than their attraction to adults, and who also either found the attraction distressing, used child pornography or had sought sexual stimulation from a child, on at least three occasions in the case of the hebephilic type. The proposed criteria would have been applied to subjects aged 18 or older and who are at least five years older than children to whom they are typically attracted.[19]

Responses

The proposal was presented at a 2009 meeting of the American Academy of Psychiatry and the Law along with several other prospective changes to the DSM's treatment of paraphilias. Participants questioned whether sexual attraction to pubesecent children can be considered abnormal in a context where their sexualization is to a certain extent normative. Concern was also raised that the criteria could have produced both false positives and false negatives; hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, but could exclude offenders who had committed serious offences on only one or two victims.[20] During academic conferences for the American Academy of Psychiatry and Law and International Association for the Treatment of Sexual Offenders, symbolic votes were taken regarding whether the DSM-V should include pedohebephilia, and in both cases an overwhelming majority voted against this.[21]

In a letter to the editor, clinical psychologist Joseph Plaud criticized the study for lacking a control groups of post-pubescent and normal patterns of male sexual arousal, overlap between groups Blanchard believed were separate, and lack of specificity in the data.[22] Blanchard replied that the initial publication used sex offenders who had committed crimes against post-pubescent adults as a control group, and that the results supported victim age preferences being a continuous rather than categorical variable.[23] In separate letters to the editor, forensic psychologist Gregory DeClue and mathematician Philip Tromovitch agreed the term would be valuable for research purposes and to subdivide the current diagnosis of pedophilia into victim age preferences, but expressed concern that the term's potential to dramatically expand the number of people diagnosed with a paraphilia without an adequate research base to support it and the article did not include a definition of "mental disorder" and thus lacking the ability to distinguish the pathological from the nonpathological.[24][25] Blanchard stated in reply that his paper was written under the assumptions that the DSM5's definition of mental disorder and pathologizing of sexual activity with underaged individuals would be similar to the one found in DSM-IV.[23]

As a variation of normal sexual desires

Defence psychologist Karen Franklin has criticized hebephilia for pathologizing and criminalizing a "widespread and, indeed, evolutionarily adaptive" sexual attraction of homosexual and heterosexual males who, across cultures and throughout history "tend to prefer youthful partners who are at the peak of both beauty and reproductive fertility".[9] Franklin also objects to the use of hebephilia during trials of individuals who may be imprisoned on the basis of sexually violent predator laws in the United States.[9] A similar comment was made by DSM-IV editor Michael First, who also questioned the degree to which hebephilic offenders might be opportunistically preying on vulnerable adolescents rather than expressing a pathological desire.[20] Commenting on Blanchard et al.'s proposal, psychologists Robert Prentky and Howard Barbaree pointed out that examples of highly sexualized young girls appear frequently in advertising, fashion shows, television programs and films, making it questionable whether sexual attraction to pubescents is abnormal.[26]

Professor of social work Jerome Wakefield described the inclusion as an inappropriate extension of the existing well-validated category of pedophilia, which would carry significant risk of false positives, and ignored the large qualitative distinctions between prepubescent children and sexually mature pubescents. He summarized his discussion with the statement "it appears that the hebephilia proposal is one where criminality and social disapproval are being confused with mental disorder."[19] However, child sexual abuse researcher William O'Donohue believes, based on the incentive for offenders to lie, that there is a far greater risk of false negatives. O'Donohue praised Blanchard et al.'s proposal to distinguish hebephilia from pedophilia, but questioned the inclusion of offender distress, the use of child pornography as a determining factor and requiring a minimum of three victims, believing the latter choice would result in delayed treatment for hebephiles who have not acted on their urges while ignoring the often hidden nature of child sexual abuse. O'Donohue also had concerns over how information for making decisions about the proposed diagnosis would be acquired, whether the diagnosis could be made with reliability and sufficient agreement between clinicians and issues related to treatment.[27] Clinical and forensic psychologist Thomas Zander noted problems in distinguishing between prepubescent versus pubescent victims, and thus the difficulty in classifying offenders and the degree to which the potential diagnosis genuinely reflected normal versus abnormal sexual desire.[28]

In the criminal justice system

Considerable concern has been expressed regarding the potential for hebephilia to be used to indefinitely detain sex offenders with adolescent victims through involuntary commitment. Efforts to include it in the DSM-5 has been met with approval from prosecutors and criticisms from criminal defense lawyers.[26] In a letter to the editor, sexologist, lawyer and gender identity specialist Richard Green questioned whether sexual attraction to pubescent sexual partners was a mental health issue, analogizing the proposal to the decision to include homosexuality in earlier versions of the DSM which turned a sexual orientation into a mental disorder. Green also questioned the proposal's impact on the credibility of the APA, its potential to blur the distinction between psychiatry and law, and whether it was necessary to create mental disorders for criminal acts. Green agreed the term would be useful for research purposes but disagreed with efforts to include it in the DSM-5.[29] Prentky and Barbaree note that Blanchard et al. had identified Green's "law/psychiatry blur" in their initial article, but suggest distinctions can be made between normative attraction to pubescent girls and the exclusivity, disability, distress and impairment that would characterize hebephilia as paraphilic.[26] In another letter to the editor, physician Charles Allen Moser agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia. Moser noted the problematic use of paraphilic labels to pathologize unusual sexual interests and incarcerate individuals on the basis of their paraphilia rather than their behaviour. Moser also questioned the usefulness of paraphilias in general when real issue may be criminal behaviours or stigmatization of unusual but benign and/or consensual sexual acts.[30] A third letter to the editor by Thomas Zander also noted the serious consequences of a diagnosis of pedophilia - notably potential for permanent civil commitment - and accordingly the consequences of expanding the definition to include hebephilia. Zander also noted that the diagnosis would incorporate age ranges in which sexual activity were legal under age of consent laws within the United States and concluded that the term should require more research and consideration of implications before the DSM were changed.[28]

See also

References

  1. ^ a b Krafft-Ebing, R (1924). Psychopathia Sexualis, with Especial Reference to the Antipathic Sexual Instinct; a Medico-Forensic Study. Stuttgart: Ferdinand Enke. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  2. ^ Kail, RV (2010). Human Development: A Lifespan View (5th ed.). Cengage Learning. pp. 296. ISBN 0495600377. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  3. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 4714830 , please use {{cite journal}} with |pmid= 4714830 instead.
  4. ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1007/s10508-008-9399-9, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1007/s10508-008-9399-9 instead.
  5. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 16010467, please use {{cite journal}} with |pmid= 16010467 instead.
  6. ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1037/0894-4105.18.1.3 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1037/0894-4105.18.1.3 instead.
  7. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 16708284, please use {{cite journal}} with |pmid= 16708284 instead.
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  9. ^ a b c d e f g Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1002/bsl.934, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1002/bsl.934 instead.
  10. ^ Powell, A (2007). Paedophiles, Child Abuse and the Internet: A Practical Guide to Identification, Action and Prevention. Radcliffe Publishing. pp. 4-5. ISBN 1857757742.
  11. ^ Boas, K (1914). "Über Hebephilie, eine angebliche Form des weiblichen Fetischismus". Archiv für Kriminialanthropologie. 61: 1–38.
  12. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1007/BF01568731, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1007/BF01568731 instead.
  13. ^ Cantor states "The current version of the International Classification of Diseases (ICD-10) contains code F65.4, which defines paedophilia as 'A sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age' (World Health Organization, 2007; emphasis added). That is, people with a sexual preference for early pubescent children do indeed receive a diagnosis in the ICD system. In Franklin's defense, one could claim that the word 'hebephilia' does not appear in the ICD; however, the people with hebephilia would receive a diagnosis nonetheless."
  14. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 22745581 , please use {{cite journal}} with |pmid= 22745581 instead.
  15. ^ Gebhard, PH (1965). Sex offenders: An analysis of types. New York: Harper & Row. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  16. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 12071103 , please use {{cite journal}} with |pmid= 12071103 instead.
  17. ^ Bernard, F (1975). "An enquiry among a group of pedophiles". The Journal of Sex Research. 11 (3): 242–255.
  18. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi: 10.1016/0191-8869(83)90154-X, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi= 10.1016/0191-8869(83)90154-X instead.
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  20. ^ a b Frieden, J (2009-12-01). "DSM-V work on paraphilias begins in earnest" (pdf). Clinical Psychiatry News. 37 (12): 21. Retrieved 2013-01-07.
  21. ^ Franklin, K (2011). "Forensic Psychiatrists Vote No on Proposed Paraphilias". Psychiatric Times. 27 (12). (subscription required)
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External links

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