Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil

Abstract

Introduction The World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories. Aim Analyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders. Methods A forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries. Main Outcome Measure The most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil. Results Because Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing. Clinical Implications Although ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria. Strengths & Limitations The study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible. Conclusion In the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country.

The Influence of Clinician Gender and Attitudes on Judgments Related to Forensic Considerations in ICD-11 Paraphilic Disorders: An Internet-based Field Study

“…There is nothing in the ICD-11 diagnostic requirements for paraphilic disorders that suggests that individuals with paraphilic disorders who commit sexual crimes associated with their paraphilic arousal pattern should not be considered to be criminally responsible for their behavior (Krueger et al, 2017). Legal analyses of the impact of the ICD-11 classification of paraphilic disorders in four of the five countries where they were conducted-Brazil (Abdalla-Filho et al, 2019), Lebanon (Makhlouf et al, 2020), Mexico (Martínez-López et al, 2019, and South Africa (Artz et al, 2021)-found no basis for such a claim in any of their respective legal systems. In most countries, having a paraphilic arousal pattern or disorder is not a criminal offense; however, an action that a person takes in response to their sexual arousal may be punishable by law (Makhlouf et al, 2020).…”

“…In many countries, the diagnosis and treatment of paraphilic disorders are extensively entangled with the criminal justice systems and policies that regulate sexual behaviour and criminal status (First & Halon, 2008;Saleh et al, 2009). It is generally established that an individual's state of awareness of the nature or quality of their actions is a assigning factor for establishing criminal responsibility for individuals diagnosed with a mental disorder, and paraphilic disorders are not an exception (Abdalla-Filho et al, 2019;Briken & Muller, 2014;Briken et al, 2019;Dobbrunz et al, 2020;Makhlouf et al, 2020;Martínez-López et al, 2019). Although sexual crimes may occur in the context of a paraphilic disorder, particularly when the individual acts upon the paraphilic arousal, many sexual crimes involving non-consenting individuals reflect transient, impulsive, or opportunistic acts rather than sustained, persistent patterns of sexual arousal.…”