DSM 5 Needs To Reject Hebephilia Now says blogger

Article taken from Psychology Today's Blog

DSM 5 Needs To Reject Hebephilia Now
Striking New Evidence Further Undercuts This Poorly Conceived Proposal
by Allen J. Frances, M.D. in DSM5 in Distress

The DSM 5 sexual disorders work group recently rejected rape as a mental disorder. It is now (past) time for it also to drop the silly proposal to add "hebephilia" to DSM 5. "Hebephilia" is a medical sounding term for what is a purely legal issue- the statutory rape of pubescent youngsters aged 11-14. This is a crime deserving punishment, not a mental disorder deserving psychiatric hospitalization.

The work group has tried to package "hebephilia" as no more than a natural extension of the already existing DSM IV diagnosis Pedophilia. This is false advertising. Having sex with someone who is post-pubescent is not at all the same as having sex with someone who is pre-pubescent. Puberty is the most decisive of all rites of passage-it makes a world of difference whether the victim has attained it or not.

Let's define Pedophilia first. It describes individuals whose predominant sexual arousal pattern involves an intense and recurrent interest in pre-pubescent children. Pedophilia is an official DSM diagnosis and is suitable for use in SVP proceedings (so long as it is carefully distinguished from molestation that is merely opportunistic or substance induced). Preferential sexual attraction to pre-pubescent children is rare and deviant.

In contrast, Sexual attraction to pubescent youngsters is common and has never been considered a mental disorder. A clear marker of this significant distinction is that the age of consent has varied so widely with time and place. It was 13 in many parts of the US as recently as 100 years ago. To lust after youth is normal; to act on this lust was once part of the courting ritual but is now a serious crime. It is not now, and never has been, a sign of psychiatric illness.

The "hebephilia" proposal was always a poorly thought out, obvious non-starter. It failed on conceptual grounds, was unsupported by scientific evidence, and would create disastrous forensic problems. Fortunately, there is a now a new and piercing nail to seal the coffin on this truly bad idea. An important data reanalysis by Wollert and Cramer (accepted for publication by Behavioral Sciences and the Law) has recently proved that the suggested criteria set for "hebephilia" is fatally flawed.

Let's count the four strikes against "hebephilia" as a mental disorder:

Strike 1) Sex with a pubescent teenager is most certainly a heinous crime, but equally certain it is not at all indicative of deviant sexual interest. Surveys show that it is very common to be attracted to pubescent youngsters (Calvin Klein had this figured out long ago). Evolution explains why. Our ancestors didn't live long enough to afford the luxury of a sexless adolescence- they got around to the serious business of procreation as soon as nature permitted them. For this evolutionary reason, sexual interest in the pubescent is hard wired and is not by itself deviant.

Strike 2) The DSM 5 sexual disorders work group suggested the puzzling idea that mechanically counting the number of sexual crimes the offender had committed could somehow help determine if he suffered from a mental disorder. This seemed foolish on the face of it. But a work group member then published data suggesting that counting crimes had actually worked in accurately identifying "hebephiles". The statistically naïve (including the paper's author) took this result as evidence that the proposed criteria set might possibly be workable. But Wollert and Cramer smelled a statistical rat in the paper and worked hard to track it down. Reanalyzing the original raw data with appropriate statistical methods, they found that (contrary to the original report) there was an extremely high false positive rate in identifying "hebephelia". This had been obscured by an obvious statistical error in the original analysis- the highly selective sampling of subjects at the poles of the continuum, arbitrarily excluding those in the middle.

Strike 3) The literature on "hebephilia" is pathetically thin, methodologically flawed, and mostly completely irrelevant to whether it should be considered a mental disorder. There is nothing in the few available papers to provide support for "hebephilia" as a mental disorder, no indication of how this alleged diagnosis should be defined, and no evidence that it can be accurately distinguished from simple criminality.

Strike 4: "Hebephilia" is a already forensic nightmare- widely abused in SVP hearings under the false guise of Paraphilia NOS. This will be even more tempting now that the fad of diagnosing rape as a mental disorder is about to end. "Hebephilia" would provide a new misdiagnosis to facilitate improper psychiatric incarceration. DSM 5 should not support this misuse of psychiatry to bail out a purely correctional problem.

The DSM 5 work group made three peculiar proposals- to include rape, hebephilia, and hypersexuality as psychiatric disorders. It has already been forced on the evidence to back track and reject both rape and hypersexuality. The report by Wollert and Cramer makes clear that now is the time for it to reject "hebephilia" and relegate it to the obscurity it has so long and so justly deserved.

Sexual & Gender Identity Disorders | APA’s proposed changes

A few notes before the quoted text.

• The big changes from the last revision (not from the last DSM) are that

1. they’ve dropped ‘gender incongruence’ and gone with ‘gender dysphoria’

2. they have added a ‘B’ criteria of distress and

3. they have added a ‘post-transition’ specifier.

• Version 5 of the book is due out May 2013
• the current commenting period will end on June 15, 2011.
• This is the APA DSM 5 (American Psychiatric Association) site. The APA “writes” the DSM (Diagnostic and Statistical Manual)
• It’s important because this will be one of the key tools for how mental health professions view and define gender issues for the coming decade.

The following is quoted from the APA site:

_________________________________________________________

Updated May 4, 2011

Gender Dysphoria (in Adolescents or Adults)**

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2^* or more of the following indicators: [2, 3, 4]**

1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) [13, 16]

2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) [17]

3. a strong desire for the primary and/or secondary sex characteristics of the other gender

4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability**

Subtypes

With a disorder of sex development [14]

Without a disorder of sex development

See also: [15, 16, 19]

Specifier**

Post-transition, i.e., the individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is undergoing) at least one cross-sex medical procedure or treatment regimen, namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy, phalloplasty in a natal female).

Note: Three changes have been made since the initial website launch in February 2010: the name of the diagnosis, the addition of the B criterion, and the addition of a specifier.

Definitions and criterion under A remain unchanged.

Ego-dystonic sexual orientation ........

Egodystonic sexual orientation is an egodystonic condition characterized by perceiving a sexual orientation or experiencing an attraction that is at odds with one's idealized self-image, causing anxiety and a desire to change one's orientation or become more comfortable with one's sexual orientation.

Classifications

The World Health Organization lists egodystonic sexual orientation in the ICD-10, as a disorder of sexual development and orientation. The WHO diagnosis covers when gender identity or sexual orientation is clear, yet a patient has another behavioural or psychological disorder which makes that patient want to change it. F66.1 The diagnostic manual notes that a sexual orientation is not a disorder in itself.

The diagnostic category of "ego-dystonic homosexuality" was removed from the American Psychiatric Association's DSM in 1987 (with the publication of the DSM-III-R), but still potentially remains in the DSM-IV under the category of "sexual disorder not otherwise specified" including "persistent and marked distress about one’s sexual orientation”.

The Medical Council of India uses the WHO classification of ego-dystonic sexual orientation. The Chinese Classification and Diagnostic Criteria of Mental Disorders includes ego-dystonic homosexuality.

The American Psychological Association has officially opposed the category of ego-dystonic homosexuality since 1987.

Diagnosis

Ego-dystonic sexual orientation
Classification and external resources
ICD-10 F66.1
ICD-9 302.0

When the World Health Organization removed the diagnosis of homosexuality as a mental disorder in ICD-10, it included the diagnosis of ego-dystonic sexual orientation under "Psychological and behavioural disorders associated with sexual development and orientation". The WHO's ICD.10 diagnoses Ego-dystonic sexual orientation thus:
The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it. (F66.1)
The WHO notes that for codes under F66: "Sexual orientation by itself is not to be regarded as a disorder."
This is often a result of unfavorable and intolerant attitudes of the society or a conflict between sexual urges and religious belief systems.

Treatments

There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of egodystonic sexual orientations. Therapy can be aimed at changing sexual orientation, sexual behavior, or helping a client become more comfortable with their sexual orientation and behaviors. Human rights groups have accused some countries of performing these treatments on egosyntonic homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage and to monogamy. Treatment may include sexual orientation change efforts or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counseling or attendance in an ex-gay group.

Disidentify with LGB

A task force commissioned by the APA found that religious identity and sexual orientation identity develop through life, and psychotherapy, support groups, and life events can influence identity development; similarly, self-awareness, self-conception, and identity may evolve during treatment. Psychotherapy, support groups, and life events can change sexual orientation identity (private and public identification, and group belonging), but not actual sexual orientation, emotional adjustment (self-stigma and shame reduction), and personal beliefs, values and norms (change of religious and moral belief, behavior and motivation). The APA has stated that sexual orientation develops across a person’s lifetime".

Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor, David Matheson. "The emphasis in Mr. Matheson's counseling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He [says] he believe[s] that help[s] reduce homosexual desires.
Gender-affirmative therapy has been described by A. Dean Byrd as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".

Several organizations have started retreats led by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by Mankind Project, which is a "process of initiation and self-examination that is designed to catalyze the development of a healthy and mature masculine self." Joe Dallas, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Mans' Battle.

Ego-dystonic sexual orientation and religion

Further information: Religion and homosexuality

Some gay people have turned to pastoral care. Some churches publish specific instructions to clergy on how to minister to gay and lesbian people. These publications include Ministry to Persons with a Homosexual Inclination, produced by the Roman Catholic Church, and God Loveth His Children, produced by The Church of Jesus Christ of Latter-day Saints. In 1994, a church in the Presbyterian Church (USA) held a conference entitled “The Path to Freedom: Exploring healing for the Homosexual.” The APA encourages religious leaders to recognize that it is outside their role to adjudicate empirical scientific issues in psychology.
Mental health practitioners can incorporate religion into therapy by "integrating aspects of the psychology of religion into their work, including by obtaining a thorough assessment of clients’ spiritual and religious beliefs, religious identity and motivations, and spiritual functioning; improving positive religious coping; and exploring the intersection of religious and sexual orientation identities." Researchers have found that for some clients, identity conflicts can be reduced by reading religious texts, which will help clients increase self-authority and focus less on negative messages about homosexuality. Researchers also found that clients made further progress if they came to believe that regardless of their sexual orientation, God still loves and accepts them.

Alternatively, gay and lesbian people may decide to seek out "minority-affirming religious groups", or change churches to those that affirm LGBT people.

Internalized homophobia

(or egodystonic homophobia) refers to negative feeling towards oneself because of homosexuality. This term has been criticized because holding negative attitudes does not necessarily involve a phobia, and the term "internalized stigma" is sometimes used instead. It causes severe discomfort with or disapproval of one's own sexual orientation.
Such a situation may cause extreme repression of homosexual desires. In other cases, a conscious internal struggle may occur for some time, often pitting deeply held religious or social beliefs against strong sexual and emotional desires. This discordance often causes clinical depression, and the unusually high suicide rate among gay teenagers (up to 30 percent of non-heterosexual youth attempt suicide) has been attributed to this phenomenon. Psychotherapy, such as gay affirmative psychotherapy, and participation in a sexual-minority affirming group can help resolve the internal conflict between a religious and a sexual identity.

The label of internalized homophobia is sometimes applied to conscious or unconscious behaviors which an observer feels the need to promote or conform to the expectations of heteronormativity or heterosexism. This can include extreme repression and denial coupled with forced outward displays of heteronormative behavior for the purpose of appearing or attempting to feel "normal" or "accepted". This might also include less overt behavior like making assumptions about the gender of a person's romantic partner, or about gender roles. Some also apply this label to LGBT persons who support "compromise" policies, such as those that find civil unions an acceptable alternative to same-sex marriage.

Some argue that some or most people who are homophobic have repressed their own homosexuality. In 1996, a controlled study of 64 heterosexual men (half claimed to be homophobic by experience and self-reported orientation) at the University of Georgia found that men who were found to be homophobic (as measured by the Index of Homophobia) were considerably more likely to experience more erectile responses when exposed to homoerotic images than non-homophobic men.

A Response to the EU parliamentary question on the depathologisation of gender identity disorder ............

European Commissioner for Health and Consumer Protection John Dalli answered a parliamentary question on the depathologisation of gender identity disorder:

The Commission refers the Honourable Members to its answer to written question P‑2625/10, in which the Commission explained the ongoing process of revision of the International Classification of Diseases, ICD-10.

The objective of the International Classification of Diseases is to facilitate the tasks of health professionals and health systems in helping individuals, in particular in relation to their reimbursement. This classification does not imply any social, cultural or moral judgement about individuals, behaviours or needs.

As mentioned in the Issue Paper on Human Rights and Gender Identity adopted by the Human Rights Commissioner of the Council of Europe in July 2009, many international and national medical classifications impose the diagnosis of mental disorder on transgender persons. Such a diagnosis may become an obstacle to the full enjoyment of human rights by transgender people especially when it is applied in a way to restrict the legal capacity or choice for medical treatment.

The issue paper also emphasises that transgender people appear to be the only group in Europe subject to state-enforced sterilisation and that married transgender persons find themselves forced to divorce prior to their new gender being officially recognised.

For these practices to be considered under the EU Charter of Fundamental Rights, namely with regard to the right of respect to human dignity, the right of respect to private and family life and the right to non-discrimination, they would have to fall within the remit of the implementation of Union law, which they do not.

As pointed out in a document produced by the European Parliament in relation to “Transgender Person’s Rights in the EU Member States”, which the Honourable Members mention in their question, the approach to regulate legal requirements for access to hormonal treatments and gender reassignment surgery without psychiatric monitoring varies between Member States. This is the result of the exclusive competence of the Member States in this matter.

The Commission is contributing to the revision of the 10th version of the ICD, and the 11th version of the ICD is scheduled to be adopted by the World Health Assembly in 2014. In the context of this revision, the Commission will take into account the issues raised by the Honourable Members.

Source

Meanwhile the vexed issue has also raised some concerns and responses on this side of the planet chiefly from Gender Identity Disorder Reform Advocates who are opponents towards its inclusion in the DSM V slated for release in May 2013.

In a clearly outlined piece as to reasons why Transvestic and other related disorders must be removed from the DSM Kelley Winters Ph. D said among other things "

The classification of gender diversity and nonconformity to birth-assigned gender roles as mental illness by the American Psychiatric Association (APA) has drawn growing protest and outrage from transpeople and and allies worldwide. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA, is regarded as the medical and social definition of mental disorder throughout North America and strongly influences international diagnostic nomenclature. The fifth edition of the manual, the DSM-5, is in development and scheduled for publication in 2013. While the diagnostic category of Gender Identity Disorder (GID) has garnered most of the controversy, a second category of so-called Transvestic Fetishism (TF) has harmed transwomen, including transsexual women, as well as male-to-female crossdressers, dual gender and gender nonconforming people since the earliest days of the DSM. Trans and LGB advocates have been inexplicably quiet about the TF category, even after the APA proposed to expand the category in the DSM-5, renamed Transvestic Disorder, to implicate gender nonconforming people of all sexes and all sexual orientations.

The proposed DSM-5 diagnosis of Transvestic Disorder, even worse than its predecessor Transvestic Fetishism, labels gender expression not stereotypically associated with assigned birth sex as inherently pathological and sexually deviant. The diagnosis is punitive and scientifically capricious, serving to punish social and sexual gender nonconformity and enforce binary stereotypes of assigned birth sex. Here are ten reasons why the Transvestic Disorder diagnosis should be eliminated entirely from the DSM-5.

1. Diagnosis of Diversity
The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association, (HBIGDA), publishes recognized standards of medical transition care for those who need it. In May, 2010, WPATH issued the following pivotal statement on de-psychopathologisation of gender variance,
The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide. The expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The [psychopathologisation] of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being. WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.
Gender expression that differs from social expectations of assigned birth sex does not meet any medical or scientific definition of mental pathology. Difference is not disease."

Please follow this and other related issues on my GLBTQ Jamaica Blog which also has Intersexed references as well as we look at our friends who are trans-gendered, inter-sexed who are looking for their rights to be recognized.

Peace and tolerance

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