DSM–5

View and Comment on Recently Proposed Changes to DSM–5

The following proposal was approved by the DSM Steering Committee and are being posted for a 45-day public comment period.

Comment Period Opens: July 16, 2018

Comment Period Closes: August 29, 2018

Proposal: Text Change to the Development and Course of Pedophilia

Comment on Proposal

Issue

The DSM Steering Committee received a proposal requesting that a change be made to a portion of the text in the Development and Course section of Pedophilic Disorder. Specifically, the proposal pointed to a statement in the text that it claimed was inaccurate: "pedophilia per se appears to be a lifelong condition." The proposal suggested that there is insufficient evidence to support this conclusion and that this statement could potentially create deleterious consequences for individuals who undergo evaluation for pedophilia. The proposal recommended that the statement be deleted and replaced with a statement reflecting that very little is known about the persistence of pedophilia over time.

After review of the relevant literature by the DSM Review Committee on Externalizing Disorders and by the Steering Committee, the following change to the text of the DSM is being proposed.

The Fix

  1. Omit the sentence "Pedophilia per se appears to be a lifelong condition" from paragraph 2 on p. 699 (under the heading "Development and Course"), without replacing it (i.e., simply delete it).
  2. Have the remainder of what is now paragraph 2 continue as an extension of paragraph 1, with the first part of the sentence after the omitted one amended to read: "Pedophilic disorder includes elements that may change over time..."

With these revisions, the passage of text in question would read as follows: "...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. Pedophilic disorder includes elements that may change over time with or without treatment:..."

DSM-5 p. 699:

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 become 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.

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