DSM 5 Tries to Sneak in Hebephilia

The DSM 5, Sexual Disorders work group has originated three off-the-wall proposals. Fortunately two have already been shot down--rape will not be a mental disorder in DSM 5 and there will not be a DSM 5 diagnosis for hypersexuality (AKA sex addiction). But the work group has not yet given up on its third equally discredited pet idea and persists in trying to find new ways to sneak Hebephilia into DSM 5. The term was invented to describe men with persistent sexual urges for pubescent youngsters--in contrast to Pedophilia which is restricted to urges for prepubescent children.

The concept of Hebephilia has been widely and vigorously opposed, both by the experts in sexual disorders (aware of how weak the supporting science is) and by the forensic experts (aware of how it would be misused in Sexually Violent Predator court hearings). The work group tried the back door approach of inventing an omnibus term, Pedohebephilia to nest Hebephilia within the already authorized Pedophilia category--a trick that didn't fool anyone. The DSM-5 web site has recently been revised with a new slight of hand. The term Pedohebephilia disappears altogether, but the concept of Hebephilia secretly lives on--the definition of Pedophilia has now been inflated to include pubescent children. The rationale section of the website doesn't even bother to mention the change and is derelict in its duty to discuss the highly controversial issues involved and their enormous forensic consequences.

Hebephilia (however it is disguised) is a simply terrible idea. The basic issue is that sexual attraction to pubescent youngsters is not the slightest bit abnormal or unusual. Until recently, the age of consent was 13 in most parts of the world (including the U.S.) and it remains 14 in many places. Evolution has programmed humans to lust for pubescent youngsters--our ancestors did not get to live long enough to have the luxury of delaying reproduction. For hundreds of thousands of years, sex followed closely behind puberty. Only recently has society chosen to protect the moratorium of adolescence and to declare as inappropriate and illegal a sexual interest in the pubescent. This is a wonderful idea, but you can't change human nature by fiat. Surveys show that sexual interest in pubescent youngsters remains very common and anyone who doubts the numbers should do a study of Calvin Klein ads.

It is natural and no sign of mental illness to feel sexual attraction to pubescent youngsters. But to act on such impulses is, in our society, a reprehensible crime deserving severe punishment. The proper disposition for those who break the law and selfishly violate the innocence of the vulnerable is prison, not a mental hospital.

And the scientific literature offered in support of Hebephilia is a laughable jumble of very few and very poorly conducted studies--not coincidentally mostly done by the people associated with the DSM 5 work group. There are no data at all on how best to define hebephilia, whether it can be diagnosed reliably, or its predictive validity. Hebephilia having been created out of thin air is now secretly being dropped into the definition of Pedophilia with no scientific support and no consideration of risks.

This parochial carelessness is not a good way to create a diagnostic manual that has such a huge impact in the legal system. The potential consequences to forensic psychiatry are terribly unsettling. Hebephilia is already being misused in SVP hearings as an excuse to justify lifelong involuntary psychiatric hospitalization. This constitutes an abuse of psychiatry and a questionably constitutional form of preventive detention--a slippery slope that should definitely be avoided.

How did we get here. The problem started with the composition of the Sexual Disorders work group, unduly dominated by individuals with ties to one institution. They were then given too much freedom to pursue their own idiosyncratic proposals and to overvalue their own very incomplete research. And this tightly sealed in-group has been remarkably insensitive to universal opposition coming from the field.

Time is short, final decisions on DSM 5 will be made soon. It is frightening that hebephilia (in its new disguise) is so close to being made official, but there is reasonable hope that good sense will eventually prevail. This in-group has been twice forced previously to back down (on rape and sex addiction) and can probably be forced now to back down again on hebephilia. But it will doubtless take continued, concerted, and organized opposition from the field.