Diagnostic and statistical manual critique

Both have deliberately merged their diagnoses to some extent, but some differences remain.

It is not clear whether these are features of the disorder itself, artifacts of sampling bias, or consequences of being identified as a sex offender.

This increases the likelihood that they will show psychological problems. Similarly, pedophiles recruited from a correctional setting have been convicted of a crime, making it more likely that they will show anti-social characteristics. The pedophilic offenders in the study had elevated psychopathy and cognitive distortions compared to healthy community controls.

This was interpreted as underlying their failure to inhibit their criminal behavior. The most marked differences between pedophiles and controls were on the introversion scale, with pedophiles showing elevated shyness, sensitivity and depression.

The pedophiles scored higher on neuroticism and psychoticismbut not enough to be considered pathological as a group.

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The authors caution that "there is a difficulty in untangling cause and effect. We cannot tell whether paedophiles gravitate towards children because, being highly introverted, they find the company of children less threatening than that of adults, or whether the social withdrawal implied by their introversion is a result of the isolation engendered by their preference i.

Testing individuals from a variety of referral sources inside and outside the criminal justice system as well as controlsthese studies found associations between pedophilia and lower IQs[49] [50] [51] poorer scores on memory tests, [50] greater rates of non-right-handedness, [49] [50] [52] [53] greater rates of school grade failure over and above the IQ differences, [54] lesser physical height, [55] [56] greater probability of having suffered childhood head injuries resulting in unconsciousness, [57] [58] and several differences in MRI -detected brain structures.

Some studies have found that pedophiles are less cognitively impaired than non-pedophilic child molesters. The findings may also suggest "a dysfunction at the cognitive stage of sexual arousal processing".

While not causes of pedophilia themselves, childhood abuse by adults or comorbid psychiatric illnesses—such as personality disorders and substance abuse —are risk factors for acting on pedophilic urges.

Do particular genes or noxious factors in the prenatal environment predispose a male to develop both affective disorders and pedophilia, or do the frustration, danger, and isolation engendered by unacceptable sexual desires—or their occasional furtive satisfaction—lead to anxiety and despair?

A study analyzing the sexual fantasies of heterosexual men by using the Wilson Sex Fantasy Questionnaire exam determined that males with a pronounced degree of paraphilic interest including pedophilia had a greater number of older brothers, a high 2D: These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child with the diagnostic criteria for the disorder extending the cut-off point for prepubescence to age 13 for six months or more, or that the subject has acted on these urges or suffers from distress as a result of having these feelings.

The criteria also indicate that the subject should be 16 or older and that the child or children they fantasize about are at least five years younger than them, though ongoing sexual relationships between a to year-old and a late adolescent are advised to be excluded.

A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to incestand if the attraction is "exclusive" or "nonexclusive". The person must also have a persistent or predominant sexual preference for prepubescent children at least five years younger than them.

This diagnosis does not apply to sexual behaviours among pre- or post-pubertal children with peers who are close in age.

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Exclusive pedophiles are sometimes referred to as true pedophiles. They are sexually attracted to prepubescent children, and only prepubescent children. Showing no erotic interest in adults, they can only become sexually aroused while fantasizing about or being in the presence of prepubescent children, or both.

Non-exclusive offenders are sexually attracted to both children and adults, and can be sexually aroused by both, though a sexual preference for one over the other in this case may also exist. If the attraction is a sexual preference for prepubescent children, such offenders are considered pedophiles in the same vein as exclusive offenders.

The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis.

Acting on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposurevoyeuristic or frotteuristic behaviors, [4] or masturbating to child pornography.

Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation.

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A child molester satisfies criteria A because of the behavior involving sexual activity with prepubescent children and criteria B because the individual has acted on those urges.

As an explanation, it was suggested that the under-inclusiveness, as well as a lack of validity, reliability and clarity might have led to the rejection of the DSM classification. This meant namely a distinction between paraphilia and paraphilic disorder. The latter term is proposed to identify the diagnosable mental disorder which meets Criterion A and B, whereas an individual who does not meet Criterion B can be ascertained but not diagnosed as having a paraphilia.

He states that any sexual attraction to children is pathological and that distress is irrelevant, noting "this sexual attraction has the potential to cause significant harm to others and is also not in the best interests of the individual.

Barbaree and Michael C. Seto disagreed with the American Psychiatric Association's approach in and instead recommended the use of actions as the sole criterion for the diagnosis of pedophilia, as a means of taxonomic simplification.

Most categorize their participants by behavior rather than erotic age preference, which makes it difficult to know the specific treatment outcome for pedophiles.

Offenders who refuse or quit treatment are at higher risk of offending, so excluding them from the treated group, while not excluding those who would have refused or quit from the control group, can bias the treated group in favor of those with lower recidivism.

Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use cognitive restructuring to change views on sex with children.

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The most common form of this therapy is relapse preventionwhere the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.

Cyproterone acetate Androcur and medroxyprogesterone acetate Depo-Provera are the most commonly used. The efficacy of antiantrogens has some support, but few high-quality studies exist.

Cyproterone acetate has the strongest evidence for reducing sexual arousal, while findings on medroxyprogesterone acetate have been mixed. The emergence of pharmacological methods of adjusting testosterone has made it largely obsolete, because they are similarly effective and less invasive.This is a very informed and sympathetic assessment of psychiatry (and other mental health professions) and the many problems that come with understanding mental illness.

DIAGNOSTIC AND STATISTICAL MANUAL MENTAL DISORDERS Prepared by The Committee on Nomenclature and Statistics of the American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA) and offers a common language and standard criteria for the classification of mental disorders.

Diagnostic and Statistical Manual Critique The Diagnostic and Statistical Manual of Mental Disorders (DSM) has a long history, starting back during World War II. Abstract.

The proper understanding and use of statistical tools are essential to the scientific enterprise. This is true both at the level of designing one's own experiments as well as for critically evaluating studies carried out by others.

Summary Critique of the DSM By Ofer Zur, Ph.D., and Nola Nordmarken, MFT. TABLE OF CONTENTS. Introduction. Overview of Critique of the DSM Diagnostic and statistical manual of mental disorders-III-R.

Washington, DC. American Psychiatric Association.

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