This paper examines the taxonomic adequacy of the Diagnostic and Statistical Manual, 4th ed., DSM-IV (American Psychiatric Association, 1994) diagnostic category of pedophilia. This diagnosis, as well as the other sexual disorders, have been ignored in DSM field trials. There is no empirical information about the reliability or validity of this diagnosis. Moreover, because the vagueness of the diagnostic criteria, clinicians would need to make inferences that would likely lead to reliability problems in diagnosis. Further, the DSM diagnostic criteria include constructs that are not intersubjectively verifiable and for which there are no valid measures. This can also lead to lack of diagnostic reliability and accuracy. Most problematical however, there are aspects of the diagnostic criteria, most notably the presence of an "ego dystonic sexual attraction to children," that are incorrect exclusion criteria. Suggestions for improvement are provided.
Sexually inappropriate behaviors in clinical settings are relatively common occurrences that may negatively affect the therapeutic process. For example, more than half of female psychologists have reported at least 1 incident in which a client responded in a sexually inappropriate manner. Thus, it is important for clinicians to understand inappropriate behaviors and respond in a manner that is both personally satisfying and helpful to the client. A framework for conceptualizing these behaviors is proposed, as well as components for, and examples of, therapeutic responses. Recommendations are provided for preventive measures to decrease the likelihood of inappropriate behaviors and for systemic approaches to benefit professional training in regards to these issues. Our aim is to stimulate further discussion of sexually inappropriate behaviors specifically by facilitating psychotherapists' ability to address clients' within-session sexual behavior, facilitating speculation of the antecedents of and motivations behind such behaviors, and facilitating discussion of such behaviors within supervision and, more broadly, within training programs.
This paper examines the taxonomic adequacy of the Diagnostic and Statistical Manual, 4th ed., DSM-IV (American Psychiatric Association, 1994) diagnostic category of pedophilia. This diagnosis, as well as the other sexual disorders, have been ignored in DSM field trials. There is no empirical information about the reliability or validity of this diagnosis. Moreover, because the vagueness of the diagnostic criteria, clinicians would need to make inferences that would likely lead to reliability problems in diagnosis. Further, the DSM diagnostic criteria include constructs that are not intersubjectively verifiable and for which there are no valid measures. This can also lead to lack of diagnostic reliability and accuracy. Most problematical however, there are aspects of the diagnostic criteria, most notably the presence of an "ego dystonic sexual attraction to children," that are incorrect exclusion criteria. Suggestions for improvement are provided.
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