Why Can’t Pedophilic Disorder Remit?

Abstract

The DSM-5 (American Psychiatric Association, 2013) was released in May 2013. Although there had been discussions about the pedophilia category during the development of DSM5 (Blanchard, 2010, 2013; Blanchard et al., 2009; Fedoroff, Di Gioacchino, & Murphy, 2013; First, 2010; Green, 2010; O’Donohue, 2010), in the end, when compared to DSM-IV-TR (American Psychiatric Association, 2000), only small changes were made. One was that ‘‘Pedophilia’’ was changed to ‘‘Pedophilia’’ or ‘‘Pedophilic Disorder’’to makeit consistentwiththe distinction between Paraphilias and Paraphilic Disorders throughout the chapter on Paraphilias in the DSM-5. The DSM-5 now defines Pedophilic Disorder as follows: Criterion A: a paraphilia with‘‘recurrent,intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)’’andCriterionB:‘‘the individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.’’ The criterion for‘‘Pedophilia’’is the same as for‘‘Pedophilic Disorder’’but without the B criterion. The proposed and finally accepted DSM-5 diagnostic criteria for Pedophilic Disorder have been soundly criticized both for what they include and exclude (e.g., Blanchard, 2013; Fedoroff et al., 2013; First, 2010; Green, 2010; O’Donohue, 2010). For example, debates have occurred over the potential inclusion of a diagnostic category for people with a sexual preference for early pubertal adolescents (so called Hebephilia), about the importance of victim counting, about mixing up pedophilic interest with sexual orientation, about disregarding attentiontomotivation or disinhibition, and the lack of field trials to test reliability and validity of criteria. This commentary is intended to draw attention to another important part of the DSM-5 criteria for Pedophilic Disorder that is problematic due to its absence, namely, the absence of the specifier ‘‘in remission.’’