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April 20, 2014 / 20 Nisan, 5774
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Posts Tagged ‘DSM’

The Impressions of an Expert on Pedophilia

Wednesday, July 31st, 2013

Guest Post by Anonymous, Ph.D.

The following short post was written by a psychologist who is a Ph.D. and widely respected in his field. He originally wrote it as a comment to the previous post. But because of my respect for this man and my belief in his expertise I am offering it as a guest post. The poster has chosen to remain anonymous, and I am going honor his wishes. The following are his unedited words:

I am impressed with many of the comments here, and I welcome this discussion.

Firstly, I am a psychologist. Secondly, I have watched the positions of the APA for years. While this Rind et al. paper is not an official position of APA, it represents a sizable percentage of the field of psychology.

If we retrospect on many of the position changes that occurred in APA over the past several decades, we find a liberal bend that is unmistakable. There is validity to the premise that the revisions of the DSM (Diagnostic and Statistical Manuel of Mental Disorders) involved greater attention to empirical research, but there is likewise a major intrusion of “political correctness” that has affected these positions (and the field as a whole).

The revision of the DSM that omitted homosexuality was not based on research, nor was much else. It was “political” pressure. It essentially stated that, “If I don’t want such-and-such to be considered pathological, then leave it out of the manual”. Fortunately, subsequent revisions included less of this liberal thinking and more of the scientific research.

Now, let’s address a new concept that should be part of this discussion. It’s called “hardiness.” It is true that not every victim of CSA (child sexual abuse) will manifest symptoms. Some will have suppressed them enough to function normally, others will first display symptoms later, even years later (which is a strong challenge to the notion of statutes of limitations). But many will suffer no ill effects.

There is major trouble with the research on this, as most studies focus on known victims who manifest symptoms, while hardy victims are not under scrutiny. Let’s give an example. The recent jewelry heist of $136 million is undoubtedly significant. If someone had stolen a Bic pen from the sign in board at that display, it would be meaningless, although it was a theft. The child who overcomes the experience of CSA is hardy. But the crime occurred, the damage was attempted, and there is a pedophile that deserves all the imaginable consequences of removal from society.

All in all, I am unimpressed with the Rind paper. It trivializes the condition of the perpetrator just because some (even many) children are strong enough to maintain their emotional health despite what was inflicted upon them.

As for the “illness of pedophilia”, I’m not convinced of the accuracy of many of the labels in the DSM (worthy of discussion in a forum more targeted to the subject). There are obsessive features to pedophilia, there may be a hard wired attraction, there could be an addiction, and, yes, a tinge or more of sociopathy. We may be mislabeling this, and counting the angels who dance on the head of a pin.

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Diagnosing Mental Illness: How DSM-5 Will Change the Rules

Thursday, May 31st, 2012

Mental health specialists tend to speak about their patients according to a classification referred to as the DSM, which stands for the Diagnostic and Statistical Manual of Mental Disorders. This classification system was first published in 1952 by the American Psychiatric Association as a method to classify mental disorders and develop a statistical baseline through which disorders can be understood, studied and treated. It is not the only classification system available: the International Classification of Diseases, published by the World Health Organization, contains mental health diagnoses that parallel those of the DSM, but the DSM is most widely used in the mental health field, especially in the United States.

All classification systems evolve over time, and we are about to receive the latest iteration of the DSM in 2013. To understand why changes are made, one need only look at the changes made in each of the DSM revisions in the past. In the first DSM, which was based primarily on soldiers’ reactions to the stresses of World War II, all of the 106 diseases listed were termed reactive, or caused by reactions to social or environmental factors. This limited classification to traumas and environmental stressors.

In the DSM II, which contained 182 illnesses, the word reactive was removed, allowing for a broader approach to understanding possible biological or genetic contributions and other non-stress induced disorders.

DSM III, published in 1980, formulated a system that included a description of 265 diagnostic categories without any suggestion as to cause, unless it was very well documented, and conformed to very specific diagnostic criteria.

In 1994, the DSM IV added and deleted a variety of categories based on the research available at the time. In that version, which was further revised in 2000, only symptoms that caused clinically significant distress or impairment in functioning were included. Definitions of Attention Deficit Hyperactivity disorders and Autistic Spectrum disorders were expanded, and all of the disorders had a checklist of specific diagnostic criteria that had to be met in order to apply a diagnosis. This gave both clinicians and researchers a measurable way to classify their patients, the goal of which was to help find empirically validated treatments.

Every revision of the DSM causes a reaction among professionals and the public. Changes are often attributed to political considerations rather than research that supports the suggested changes. For example, in 1973, the DSM declassified homosexuality as a disorder, and the diagnosis was replaced by the category of Sexual Orientation Disturbance (SOD) because research failed to identify a specific abnormality caused by this sexual preference. Over the years, SOD has been modified and expanded to include a wider variety of sexual disorders and paraphilias. Some individuals still believe that gay activists advocating for their own agenda brought about this change, although that is highly unlikely.

The task force working on the DSM-5 was initially sworn to secrecy. This caused an uproar in the scientific community, which rightfully demanded an open process. Once the revision process was publicized and the recommendations for change became available, critics of the DSM-5 voiced three primary concerns. These include lowering of diagnostic thresholds that would increase the number of individuals who fit a diagnosis, introducing new disorders that are currently considered normal behavioral patterns, and questions regarding the scientific validity of certain categories.

If the DSM-5 goes forward as proposed, it could include changes such as a significantly broader definition of Attention Deficit Hyperactivity disorder; an Attenuated Psychosis Syndrome which would allow the diagnosis of individuals without a psychotic disorder to be classified as having one; and the categorization of shyness as a pathology.

Another proposed change would be a complete overhaul of the category now referred to as personality disorders. Perhaps the greatest concern of the scientific community is the neuro-biological emphasis of the DSM-5, and what some are calling the “over-medicalization” of disorders that are clearly a combination of biological, psychological, and social stressors. This is of great concern because it would provide justification for wider use of psychotropic medications, many of which have questionable utility, in vulnerable people who might benefit more from psychotherapy or counseling.

The need for practical interventions that are proven effective should be the primary motivator, but financial considerations are a pragmatic driving force. In the end, there is a great fear that the new criteria proposed in the DSM-5 will favor medical interventions, which may be seen by insurance companies as cheaper than therapy.

Printed from: http://www.jewishpress.com/sections/health/diagnosing-mental-illness-how-dsm-5-will-change-the-rules/2012/05/31/

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