Defining Paraphilia in DSM-5: Do Not Disregard Grammar

Abstract

Blanchard (2009a, 2009b, 2009c) proposed a definition of paraphilia for Diagnostic and Statistical Manual (DSM)-5, delimiting a range of so-called normative sexuality and defining paraphilia as any intense and persistent sexual interest other than that. The author examines the wording and intended meaning of this definition, and he argues that there are many problems with it that “correct” interpretation requires ignoring what it says. Because of these problems and the possibility of civil commitment under sexually violent predator/person laws on the basis of a diagnosis of paraphilia NOS, caution and careful consideration of grammar and wording is urged in drafting a definition for paraphilia for DSM-5.

Notes

1. Scare quotes are used because, although the question of at what age someone is elderly is a difficult and controversial one, 45 seems to be an unusual cutoff.

2. In DSM-III, the definition of paraphilia said that the sexual interest had to be necessary for sexual arousal, although none of the individual diagnoses required this. Most required that the behavior (or behavior or fantasy in the cases of pedophilia and zoophilia) be the preferred or exclusive means of sexual excitement, but exhibitionism did not require this, and transvestism did not even require that the behavior still be sexually arousing.

3. Huddleston and Pullum (2002, p. 554) illustrated this difference with the noun phrase the industrious Chinese. Under the restrictive interpretation of the adjective, the phase refers to the subset of Chinese who are industrious. Under the nonrestrictive interpretation, it refers to all Chinese and attributes to them the property of being industrious.

4. In DSM-III-R, all of the paraphilias involved “recurrent, intense sexually arousing fantasies and sexual urges.”

5. A similar point is made in the opinion in U.S. v. Carta (2009) when discussing problems with understanding the meaning of child in the DSM-IV-TR's definition of paraphilia: “The age of legal consent is of no use to psychologists seeking a uniform diagnostic standard because the age of consent varies from jurisdiction to jurisdiction. It is one thing to criminalize conduct in one state that is legal in another. It is quite another to label a sexual interest pathological in Pennsylvania and normal in New York” (p. 27).

6. Sexually arousing sexual interests, as opposed to interests focused on sex research, sex therapy, sex education, or reading papers discussing definitions of deviant sexuality, all of which can be seen as sexual interests of sorts. The point is that sexual interests is less explicit than might be desired.

7. “[Individuals with a paraphilia] may selectively view, read, purchase, or collect photographs, films, and textual depictions that focus n their preferred type of paraphilic stimulus” (American Psychiatric Association, 2000, p. 567).

8. Would actual genital stimulation during the fantasy count regardless of the content of the fantasy?

9. Winters (2008) observed that this formulation in DSM-IV-TR is syntactically ambiguous—sexually arousing can modify either sexual fantasies only, or it can modify each of the three disjuncts. In the case of the former, it would mean that someone could be diagnosed with transvestic fetishism regardless of whether the behavior is—or ever was—sexually motivated.