Diagnosis Of Paraphilia Research Articles

Do risk measure scores and diagnoses predict evaluator opinions in sexually violent predator cases? It depends on the evaluator.

Field research increasingly reveals that forensic evaluators are not interchangeable. Instead, they tend to differ in their patterns of forensic opinions, in ways that likely reflect something about themselves, not just the persons evaluated. This study used data from sexually violent predator (SVP) evaluations to examine whether evaluator differences in making intermediate decisions (e.g., instrument scoring, assigning diagnoses) might explain their different patterns of final opinions. Although this study was generally exploratory and not strongly hypothesis driven, we expected that there might be evidence for a simple form of bias in which some evaluators would be more likely than others to consistently "find" indications of SVP status (i.e., consistently assigning higher risk scores and more SVP-relevant diagnoses) and, therefore, be more likely to find behavioral abnormality, the legal construct qualifying someone for commitment as an SVP. The study used data from 745 SVP evaluations conducted by 10 different evaluators who were assigned cases from the same referral stream. Potential evaluator difference variables included behavioral abnormality opinions, paraphilia and antisocial personality disorder diagnoses, and Psychopathy Checklist-Revised and Static-99 scores. Evaluator differences explained a statistically significant (p < .001) amount of variance in behavioral abnormality opinions (17%), paraphilia diagnoses (7%), and Psychopathy Checklist-Revised scores (16%). Contrary to our expectation of a simple tendency for some evaluators to find all indicators of SVP status more often than others, evaluators differed in the ways that underlying diagnoses and scores corresponded with their conclusions. The overall pattern was one in which different evaluators appeared to base their final opinions on different factors. Findings reveal further evidence of substantial forensic evaluator differences in patterns of assigning instrument scores and reaching forensic conclusions. But these findings are the first to also reveal wide variability in their patterns of reaching forensic conclusions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An exploration of racial and ethnic differences in paraphilic interests and behaviours among a nonoffending sample

ABSTRACT Paraphilic interests are often associated with sexual offending and recidivism, and therefore, accurately identifying paraphilias is crucial. Recently, there has been increased recognition of diversity as it relates to sexual offending; however, few studies have examined race/ethnicity as it pertains to paraphilias, and those that have are often limited to forensic samples. Given that important decisions such as post-incarceration civil confinement are, in part, based upon paraphilia diagnoses, information concerning population base rates of paraphilic interests and behaviours, and how they may vary by race/ethnicity, is needed. The current study explored racial/ethnic differences in paraphilic interests/behaviour among a non-offending U.S. sample of 2,292 participants over age 18, using a measure adherent to the DSM-5-TR paraphilia criteria. The findings revealed group differences, highlighting the need for further research examining these differences. PRACTICE IMPACT STATEMENT The results provide information regarding potential racial/ethnic differences in self-reported paraphilic interests and behaviour among a general population, non-offending sample. This information will assist clinicians who evaluate and diagnose paraphilic interests and disorders and represents a contribution to the larger goal of informing best practices for culturally competent risk assessment and evaluation, treatment, and prevention of sexual abuse.

A brief unstructured literature review on the history of paraphilias.

This unstructured review is based on a comprehensive literature search leading to a variety of selected studies that summarize the historical development of paraphilias. Firstly, paraphilias in ancient times are discussed. Secondly, the development of paraphilia diagnoses, including current critical aspects, is outlined. Finally, a short description of the development of treatment approaches for individuals with paraphilic disorders and those who commit sexual offenses, including medical and psychotherapeutic approaches as well as online intervention programs, is presented. The destigmatization of people with deviant sexual interest is deemed necessary. However, it is also recommended to always strive for a balance between protecting paraphilic individuals' rights and protecting vulnerable groups to whom paraphilic people can pose a danger.

Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory

Aggressiveness, assertiveness, and sexual deviance: An empirical-quantitative examination of Stoller's perversion theory Objectives: The main aim of the present study was to empirically examinate the psychodynamic-founded perversion theory of Robert D. Stoller (1979), particularly his assumption of a transformation of aggressive impulses into sexual deviant fantasies due to traumatic experiences. Methods: In the present study different aspects of the theory were examined by using a sample (N = 954) of individuals convicted of sexually motivated offenses who had been clinically and forensically assessed between 2002 and 2018 at the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. As a part of the psychological testing procedure, German-speaking questionnaires for the assessment of aggressiveness and assertiveness were applied. Results: The results indicated that participants with a diagnosis of paraphilia showed significantly less spontaneously expressed aggression and less social competence compared to individuals without such a diagnosis. Conclusions: The findings of the present study are in line with the core assumptions of Stoller's perversion theory by demonstrating an inverse relationship between the diagnosis of paraphilia and self-reported aggression.

Clinical, Demographic, and Criminal Behavior Characteristics of Patients With Intellectual Disabilities in a Canadian Forensic Program

Background: People with intellectual disability (ID) and forensic issues constitute a challenging clinical group that has been understudied in forensic settings. Methods: We assessed the characteristics of patients with ID under the authority of the Ontario Review Board (ORB) in a large forensic program of a tertiary psychiatric hospital (excluding those with a cognitive disorder) and compared their characteristics with those of a non-ID control group. Results: Among 510 adult ORB patients, 47 had an ID diagnosis. ID patients were of younger age at index offense, with a lower level of education, and were less likely to have been married or employed, more likely to have committed a sexual offense, more likely to have a diagnosis of paraphilia, less likely to be “not criminally responsible,” and more likely to be “unfit to stand trial.” They were also more likely to have committed their index offenses against care professionals and be treated in a secure unit. Conclusion: Our findings have major implications for clinicians, clinical leaders, and policymakers about the specific needs of patients with ID presenting with forensic issues and differing needs in terms of treatment and risk management.

Te role of disturbances of the psychosexual spherein schizophrenia in diagnosing of paraphilias

Te article is concerned with the study of disturbances in psychosexual sphere, which are specifc for schizophrenia spectrum disorders. Te results of a comparison of two groups are presented: 29 people were diagnosed with schizophrenia and schizotypal disorder and a comparison group of 34 people without endogenous pathology. Te study outcomes of their gender self-consciousness with methods «MF», «CTAT», «Coding» are shown that the presence of endogenous disorder changes the psychosexual profle of patients on a number of signs. Persons with schizophrenia and schizotypal disorder, regardless of their comorbide diagnosis of paraphilia are characterized by lower value of masculinity, high distinction with the male role, absence of intention to line up with the man-image, in some cases instability of identity, altered emotional attitudes to sex-role stereotypes, emotional ambivalence.

Field measures of psychopathy and sexual deviance as predictors of recidivism among sexual offenders.

Offenders with high levels of both psychopathy and deviant sexual interests are often described as being more prone to recidivate than other sexual offenders, and many forensic evaluators report considering this psychopathy and sexual deviance interaction when coming to conclusions about sex offender risk. However, empirical support for the interaction comes from studies using sexual deviance measures that are rarely used in the field. We examined the ability of Psychopathy Checklist-Revised (PCL-R) field scores and possible field measures of sexual deviance (e.g., paraphilia diagnosis, offense characteristics) to predict sexual recidivism among 687 offenders released after being evaluated for postrelease civil commitment (M follow-up = 10.5 years). PCL-R total scores and antisocial personality diagnoses were predictive of a combined category of violent or sexual recidivism, but not sexual recidivism. Paraphilia diagnoses and offense characteristics were not associated with an increased likelihood of reoffending. There was no evidence that those with high levels of both psychopathy and sexual deviance were more likely than others to reoffend. Although the psychopathy and sexual deviance interaction findings from prior studies are large and compelling, our findings highlight the need for research examining the best ways to translate those findings into routine practice. (PsycINFO Database Record

Psychopathological approach of unsafe games among teenagers: A case report

IntroductionVoluntary asphyxiation by practicing unsafe games such as choking, hanging, strangulation or other means of inducing hypoxia/anoxia is not uncommun among adolescents and can lead to unintended death but it stills not very well-known so underestimated by parents and underdiagnosed by health professionals.ObjectivesStudy of clinical, psychological and psychopathological features in adolescent practicing unsafe games through a case report and a literature review.MethodsWe will present the case of a 14-year-old boy followed up in the Child and Adolescent Psychiatry Department of Mongi Slim Hospital (La Marsa, Tunisia) for behavioral disorders and recurrent syncope. This case report will be supported by a literature review.Case reportS.B., 14-year-old boy, unique child of two divorced parents, with precarious family socio-economic conditions, no apparent medical problems and no known history of drug or alcohol abuse, suicidal ideation or suicide attempts, consulted first time in the department for behavioral disorders. The diagnostic of dysthymia was made. Seven months later, he was hospitalized in the medical intensive care unit for postictal coma. All medical investigations were normal. In the following, S.B. revealed that he used to practice voluntary asphyxiation by compressing the two carotids using his fingers until loss of consciousness. The diagnosis of paraphilia (DSM-5) was established.ConclusionsEarly recognition of such cases and awareness of psychological and psychopathological motivations might prevent serious complications and lethal outcome for these “unsafe-young-players”.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitional Impairment: Is There a Role for Cognitive Assessment in the Treatment of Individuals Civilly Committed Pursuant to the Sexually Violent Predator Act?

Sexually Violent Predator statutes allow the involuntary treatment of individuals who are found to pose a threat to public safety. Most sex offender treatment programs rely on cognitive interventions to reduce the risk of recidivism. The purpose of this study was to examine (a) whether individuals with paraphilia diagnoses have cognitive deficits compared with the general population; (b) whether individuals diagnosed with pedophilia differed on cognitive performance when compared with individuals diagnosed with paraphilia not otherwise specified (NOS), nonconsent; and (c) whether individuals with paraphilia plus antisocial personality disorder (ASPD) differed in cognitive performance when compared with individuals with a paraphilia diagnosis only. The sample consisted of 170 males (M age = 50.21; SD = 10.22) diagnosed with pedophilia or paraphilia NOS, nonconsent, who were detained or civilly committed to a forensic psychiatric hospital. Assessments included Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Wechsler Abbreviated Scale of Intelligence (WASI), and Wide Range Achievement Test 4 (WRAT4). Individuals diagnosed with pedophilia and paraphilia NOS, nonconsent, obtained lower scores than matched controls based on the RBANS Immediate Memory, Visuospatial/Constructional, Delayed Memory indices and Total Score. In comparison with individuals with paraphilia NOS, nonconsent, those with pedophilia diagnosis had lower scores on the RBANS Delayed Memory. Individuals diagnosed with a paraphilia disorder combined with ASPD demonstrated trends toward lower IQ scores than those with a paraphilia diagnosis only. Treatment programs can improve their chance of success by assessment of cognitive processes, and offer therapy in a style that is consistent with the cognitive abilities of their clients.

Pharmacological treatment of sex offenders

Most people recognize that incarceration alone will not solve sexual violence. Indeed, treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. In most cases, a diagnosis of paraphilia is associated with sexual violence. This review is intended to present and summarize the first recently published international guidelines about pharmacological treatment of paraphilias. Pharmacological interventions should be part of a more comprehensive treatment plan including psychotherapy and, in most cases, behavior therapy. Antiandrogens, and mostly GnRH analogues, significantly reduce the intensity and frequency of deviant sexual arousal and behavior. GnRH analogue treatment constitutes the most promising treatment for sex offenders at high risk of sexual violence, such as pedophiles or serial rapists, however informed consent is necessary. SSRIs remain an interesting option in adolescents, in patients with depressive or OCD disorders, or in mild paraphilias such as exhibitionism.Disclosure of interestThe author has not supplied his declaration of competing interest.

Psychopathy Checklist-Revised Use and Reporting Practices in Sexually Violent Predator Evaluations.

We surveyed evaluators who conduct sexually violent predator evaluations ( N = 95) regarding the frequency with which they use the Psychopathy Checklist-Revised (PCL-R), their rationale for use, and scoring practices. Findings suggest that evaluators use the PCL-R in sexually violent predator cases because of its perceived versatility, providing information about both mental disorder and risk. Several findings suggested gaps between research and routine practice. For example, relatively few evaluators reported providing the factor and facet scores that may be the strongest predictors of future offending, and many assessed the combination of PCL-R scores and sexual deviance using deviance measures (e.g., paraphilia diagnoses) that have not been examined in available studies. There was evidence of adversarial allegiance in PCL-R score interpretation, as well as a "bias blind spot" in PCL-R and other risk measure (Static-99R) scoring; evaluators tended to acknowledge the possibility of bias in other evaluators but not in themselves. Findings suggest the need for evaluators to carefully consider the extent to which their practices are consistent with emerging research and to be attuned to the possibility that working in adversarial settings may influence their scoring and interpretation practices.

Disputed paraphilia diagnoses and legal decision making: A case law survey of paraphilia NOS, nonconsent.

Disputed paraphilia diagnoses and legal decision making: A case law survey of paraphilia NOS, nonconsent.

Incognito Libido: Introducing the Sexual False Self Scale

The 10-item Sexual False Self (SFS) scale is introduced to measure the sense of stigma attached to one's sexual impulses and the corresponding motivation to conceal them. As expected, the SFS proved to be unidimensional and moderately correlated but factorially distinct from sexual compulsivity. Also as expected, a Paraphilia diagnosis produced high SFS scores in a clinical role-play task. Correlational results suggest a tentative causal model wherein sensory processing sensitivity, social anxiety, and sexual compulsivity increase SFS motivation, which in turn prompts dissociation in sexual situations and expressive suppression – consistent with concealment strategies often attributed to putative sex addicts.

‘Counterfeit Deviance’ Revisited

BackgroundThe field has seen a renewed interest in exploring the theory of ‘counterfeit deviance’ for persons with intellectual disability who sexually offend. The term was first presented in 1991 by Hingsburger, Griffiths and Quinsey as a means to differentiate in clinical assessment a subgroup of persons with intellectual disability whose behaviours appeared like paraphilia but served a function that was not related to paraphilia sexual urges or fantasies. Case observations were put forward to provide differential diagnosis of paraphilia in persons with intellectual disabilities compared to those with counterfeit deviance. The brief paper was published in a journal that is no longer available and as such much of what is currently written on the topic is based on secondary sources.MethodThe current paper presents a theoretical piece to revisit the original counterfeit deviance theory to clarify the myths and misconceptions that have arisen and evaluate the theory based on additional research and clinical findings. The authors also propose areas where there may be a basis for expansion of the theory.ResultsThe theory of counterfeit deviance still has relevance as a consideration for clinicians when assessing the nature of a sexual offence committed by a person with an intellectual disability. Clinical differentiation of paraphilia from counterfeit deviance provides a foundation for intervention that is designed to specifically treat the underlying factors that contributed to the offence for a given individual.DiscussionCounterfeit deviance is a concept that continues to provide areas for consideration for clinicians regarding the assessment and treatment of an individual with an intellectual disability who has sexually offended. It is not and never was an explanation for all sexually offending behavior among persons with intellectual disabilities.

High-risk sexual offenders: An examination of sexual fantasy, sexual paraphilia, psychopathy, and offence characteristics

High-risk sexual offenders are a complex and heterogeneous group of offenders about whom researchers, clinicians, and law enforcement agencies still know relatively little. In response to the paucity of information that is specifically applicable to high-risk offenders, the present study investigated the potential influence of sexual fantasy, sexual paraphilia, and psychopathy on the offending behaviour of 139 of the highest risk sexual offenders in one province of Canada. The sample included 41 child molesters, 42 rapists, 18 rapist/molesters, 30 mixed offenders, and 6 “other” sexual offenders. Two offenders could not be categorized by type due to insufficient file information. Data analyses revealed significant differences between offender types for a number of criminal history variables including past sexual and nonsexual convictions, number of victims, weapon use, and age of offending onset. Further, there were significant differences between offender types for sexual fantasy themes, paraphilia diagnoses, and levels of psychopathy. For example, results revealed that offenders' sexual fantasies were significantly more likely to correspond with the specific type of index sexual offence that they had committed. Further, offenders scoring high in psychopathy were significantly more likely to have a sadistic paraphilia than offenders with either low or moderate psychopathy scores. Results from the current study provide a refined and informed understanding of sexual offending behaviour with important implications for future research, assessment, and treatment, as well as law enforcement practices when working with high-risk sexual offenders.

AS01-01 - Recent controversies in diagnosis and management of paraphilias

Paraphilias are defined as sexually arousing fantasies, urges, or behaviors involving either nonhuman objects; suffering or humiliation of oneself or one's partner; or children or other non-consenting persons. In the DSM classification, paraphilias are subsumed under sexual disorders, while in the ICD paraphilias are classified as disorders of adult personality and behavior (disorders of sexual preference). Historically, some have advocated eliminating paraphilias or radically revising their definitions, while others suggested adhering to their traditional definitions. The classification and definition of paraphilias is complicated by cultural and societal underpinning, and the unclear boundaries between “normal” and “abnormal” sexuality. The diagnostic criteria of some paraphilias (e.g., pedophilia) are also complicated by the differences between the medical and the legal concepts of these entities. The recent attempts to introduce two new diagnoses, hypersexual disorder and paraphilic coercive disorder, into the DSM system stirred passionate scientific discussions about those two diagnoses and about paraphilias in general. This presentation reviews the pros and cons of classifying paraphilias as sexual disorders and of including the new diagnoses of hypersexual disorder (unclear borders with “normality”) and paraphillic coercive disorder (unclear distinction between this entity and sexual sadism). In addition, this presentation reviews some of the more and/or less accepted methods of paraphilia management, such as pharmacotherapy and castration (chemical, surgical). Several aspects of the classification and diagnosis of paraphilias remain controversial and some of the proposed changes seem unwarranted. Resolving diagnostic and management controversies could be helped by large multicenter and international field trials.

Loi du 17 juin 1998 : bilan de l’expérience des médecins coordonnateurs de Haute Normandie

Most people recognize that incarceration alone will not solve sexual violence. Treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. The Law of June 17, 1998, on the prevention and repression of sexual offences, as well as the protection of minors, makes a provision for the possibility of medical and psychological monitoring adapted to these particular individuals. Sex offenders may well be constrained, after their incarceration, to social and judicial follow-up, which may include coerced treatment in order to reduce the risk of recidivism. In order to control this follow-up, the legislature has created the position of medical coordinator, who acts as an interface between justice and care in conjunction with the treating physician. This study is the first attempt to evaluate the activity of physician coordinators conducted in France since the implementation in 2004 of the 1998 law on monitoring sex offenders. An interview of all the physician coordinators in Upper Normandy was conducted. The files of all sex offenders subjected to coerced treatment were studied. In our sample of 100 sex offenders who were subjected to coerced treatment (any kind of treatment) (99% men, 60% of sexual assaults on minors, 14% of cases of indecent exposure), minor victims of sexual assault were: 78% females; in 90% of cases the victim was aged under 14 years (under 10 in 52% of cases), 60% of cases were intrafamilial incest; the victim was an unknown aggressor in only one case out of 60. The constraint follow-up contributed to reducing the risk of recidivism (three cases of recidivism in 100 individuals over an average duration of follow-up of five years), although it remains difficult to assess the recidivism over a duration of time as short as five years. A diagnosis of paraphilia was only applied in 19% of cases (in 10 cases pedophilia, exhibitionism in nine cases). Only six subjects were receiving antiandrogen treatment. A diagnosis based on Axis I DSM was established in 57% of cases. Personality disorders were mentioned in the medical records in 65% of cases. An antisocial personality disorder was not prominent (20%). In 56 cases, the individuals had been victims of physical, psychological or sexual abuse. Nearly half of the individuals had a past history of sexual or non sexual offences, among those, 16 subjects had previously been convicted at least three times. The seniority of the prior conviction was more than 10 years in 43% of cases. Physician coordinators interviewed were satisfied with their work and felt they had contributed to improving the care of patients who had committed sexual offences. However, this study shows the need to create a national reference centre, which could enable a multidisciplinary evaluation of difficult cases and could also boost the development of research in this area where many questions remain unanswered, particularly regarding the determinants of deviant sexual behaviour and risk factors for recidivism.

A Brief History of Field Trials of the DSM Diagnostic Criteria for Paraphilias

Some of these critiqueshave argued, implicitly or explicitly, that the proposed criteriawould represent a disimprovement over the current ones (e.g.,First, 2010). The casual reader would suppose that such com-parisons must be based on a solid foundation of knowledgeabout the performance of the current criteria. It is thereforeinstructive to review one of the most important sources of infor-mation about the reliability and v alidity of DSM diagnoses—thefield trials conducted as ‘‘[a]n i mportant step’’ (American Psy-chiatric Association, 1980, p. 467) in each major revision. ThepurposeoftheDSMfieldtrialshasbeensummarizedbyKraemer,Kupfer,Narrow,Clarke,andRegier(2010)inlayterms:‘‘Afieldtrialisanevaluationofaproductinthecontextinwhichitwillbeused’’(p. 1158).Oneofthefirstquestionsonemightaskaboutthefieldtrialscon-ductedfortheDSMrevisionsishowmanypatientswithdiagnosesof paraphilia were studied. The field trials for DSM-III, whichwere sponsored by the National Institute of Mental Health,included three patients with paraphilias (Appendix F, Tables1and 2, pp. 470–471).That’s it. Paraphilia diagnoses were not included in the fieldtrials for DSM-III-R (American Psychiatric Association, 1987,Appendix F, pp. 493–495) or for DSM-IV (see O’Donohue,Regev,H some, for example, were incarcerated sex offenderswhereas otherswerereferredas outpatients(see Blanchard etal.,2007). The sample sizes were comparable to the numbers ofpatients used to study all of the psychiatric disorders targeted inthe field trials for DSM-III (American Psychiatric Association,1980, Appendix F, Tables1 and 2, pp. 470–471) and DSM-III-R(AmericanPsychiatric Association,1987,Appendix F,pp. 493–495).

Depathologizing Consensual Sexual Sadism, Sexual Masochism, Transvestic Fetishism, and Fetishism

The DSM-V Paraphilias Subworkgroup's suggested revision to differentiate between paraphilias and Paraphilic Disorders appears to be a step forward in depathologizing unusual sexual interests. Paraphilia diagnoses are regularly misused in criminal and civil proceedings as an indication that individuals cannot control their behavior; these individuals turn for assistance to the National Coalition for Sexual Freedom (NCSF), a national advocacy organization that advances the rights of, and advocates for, consenting adults in the BDSM-leather-fetish, swing, and polyamory communities.One recent child custody case referred to NCSF illustrates the common misunderstanding that legal and social service professionals have with the DSM-IV-TR, and is the first documented reaction to the proposal to differentiate between paraphilias and Paraphilic Disorders. The children were removed in July 2009 while psychological evaluations were performed on the mother and the children, which concluded there was... Language: en

When Is an Unusual Sexual Interest a Mental Disorder?

Blanchard et al.’s (2008) excellent article distinguishing Hebephilia (erotic arousal to pubescent children) from Pedophilia (erotic arousal to prepubescent children) raises an important issue. In the article, Blanchard et al. specifically advocate incorporating Hebephilia into the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA). I am not challenging their conclusion that sexual interests in pubescent and prepubescent minors are distinct entities (albeit with some overlap) or that the distinction may have utility for research purposes, but it is not clear that a sexual interest in pubescent minors implies that the individual suffers from a mental disorder, specifically a Paraphilia. Blanchard et al. may assume that Hebephilia will meet the other criteria required for a Paraphilia diagnosis and a mental disorder, but that is neither obvious nor necessarily true. To be crystal clear, the following comments should not be construed as supportive of any sexual activity between adults and minors in any way. Having sex with a minor is a crime and should be punished as such, but it is not clear that this behavior constitutes a mental disorder. How we conceptualize a problem is important. Are the problems associated with an unusual sexual interest primarily sexual, related to another mental disorder, or are they social rather than psychiatric? There is no doubt that some people experience problems related to their sexual interests or behavior, but the sex can be a manifestation of another disorder rather than the cause of the problem. Compulsively washing one’s hands can be a symptom of Obsessive-Compulsive Disorder, but it is not a hand washing disorder. The treatment and conceptualization of unusual sexual interests as Paraphilias have not led to greater understanding of, or more effective treatment for, individuals with these interests; some would argue that pathologizing unusual sexual interests has led to more discrimination and discouraged individuals from seeking treatment for any problem (see Klein & Moser, 2006; Kleinplatz & Moser, 2004; Kolmes, Stock, & Moser, 2006). Paraphilia diagnoses have been misused in criminal and civil proceedings as an indication that these individuals cannot control their behavior. Although there is some indication in the DSM (see APA, 2000, p. 663) that the Paraphilias are Impulse Control Disorders, impulse control is not mentioned in the Paraphilia diagnostic criteria. At least from my experience, most individuals with unusual sexual interests are quite capable of controlling their behavior and, in fact, do so. Those individuals who cannot control their sexual impulses may qualify for another diagnosis based upon their inability to control their impulses, but not based upon the specific sexual behavior. The DSM specifically notes the ‘‘...Paraphilias... are not considered to be compulsions...’’ (APA, 2000, p. 462); ‘‘compulsive masturbators’’ and ‘‘compulsive homosexuals’’ began to disappear once those behaviors were no longer seen as signs or symptoms of psychopathology. I have been quite critical of the Paraphilias diagnostic category in the past (Kleinplatz & Moser, 2005; Moser, 2001, 2002; Moser & Kleinplatz, 2002, 2005a, 2005b) and will not repeat those criticisms here. I will question another aspect of Editor’s note: This letter was submitted to the Journal after Blanchard’s reply to the other letters about the Blanchard et al. (2008) article was in production; hence, the reply by Blanchard (2008) does not refer to the content of this letter.