Paraphilic coercive disorder: Contagious virus?

I posted last week about a proposal to create a new mental disorder in the DSM-V for preferential rapists. A shocking news story out of Australia makes me think that if Coercive Paraphilic Disorder exists, it must be contagious. Not just contagious, but virulently contagious in certain all-male environments.

Of the 198 students at St Paul's College at the University of Sydney, a large proportion were apparently infected with a highly contagious form of the virus. If Paraphilic Coercive Disorder makes it into the next Diagnostic and Statistical Manual of Mental Disorders, St. Paul's will be Ground Zero for the epidemic.

According to an article in today's Sydney Morning Herald, men at the elite, all-male college proudly set up a pro-rape Facebook group called "Define Statutory" that promoted sexual aggression against women. But the elite students did not stop with words. They fostered an alcohol-fueled climate in which rapes were common, most sexual assaults went unreported, and women students felt so unsafe that they quit school, the story reports.

Reporter Ruth Pollard documented a series of rapes and sexual assaults, including one incident in which about 30 drunk, naked men broke into a college and surrounded a young woman, touching and taunting her.

The good news is that, if it's a contagious illness, there could be an immunization like the one for the H1N1 virus. So, while the DSM developers are frenetically creating new diagnoses, let's not forget to work on finding some cures, too.

The Sydney Morning Herald article is HERE.

Scientist razes proposed "Paraphilic Coercive Disorder"

Pedohebephilia. Hypersexuality. Coercive Paraphilic Disorder. How many new sexual disorders can fit into the DSM-V, the American Psychiatric Association diagnostic manual scheduled for publication in 2012?

Government evaluators in Sexually Violent Predator cases must be thrilled with the possibilities being generated by the prolific paraphilias subworkgroup of the DSM-V Sexual Disorders Workgroup. If these proposed diagnoses make it into the psychiatric bible, the task of establishing that sex offenders have bona fide mental disorders meriting hospitalization will suddenly get a whole lot easier.

But this will only happen if good science is not allowed to interfere with pragmatism and pretextuality. After all, the empirical support for some of these pseudoscientific categories is weak at best.

Now issuing a strong call of alarm is perhaps the premiere scientific researcher into the etiology of rape, Raymond Knight, the Mortimer Gryzmish Professor of Human Relations at Brandeis University.

In a forthcoming article in the Archives of Sexual Behavior, the respected scholar cautions against adoption of Coercive Paraphilic Disorder, which he says is not supported by empirical data and has a vast potential for misuse by the civil commitment industry.

Currently, the propensity to rape is not considered a mental illness. Proponents of adding a rapist diagnosis to the Diagnostic and Statistical Manual of Mental Disorders (DSM) claim it was only excluded the last time around due to pesky feminists' objections that it would excuse rapists from criminal consequences. However, that turns out to be something of a myth. The main reason it was excluded, says psychologist and lawyer Thomas Zander, who conducted primary research into the history, was because it was not scientifically supportable. And, according to Knight's article, it is even less supportable now than it was back then.

The fact that rape propensity is not a bona fide mental illness has proved a hurdle for the civil commitment industry. To be hospitalized on the basis of possible future dangerousness, sex offenders must be found to suffer from a mental disorder that reduces their volitional control. To get around this legal barrier against unconstitutional preventive detention, government evaluators have taken to assigning a de facto label of "Paraphilia Not Otherwise Specified - Nonconsent."

As Knight points out, if Coercive Paraphilic Disorder is introduced into the DSM-V, it will provide tacit support for the legitimacy of the bogus "NOS" diagnosis. This, he says, would be a travesty:

"The inclusion of PCD [Paraphilic Coercive Disorder] would inappropriately legitimize this 'disorder' and grant it the imprimatur of the DSM, which is almost universally cited by expert witnesses in civil commitment proceedings…. The diagnosis has little empirical support, and it would be a travesty to grant it a status that would perpetuate its misuse."

In his article, Knight discusses the evidence from a long line of research that suggests there is not a separate category of men with a propensity to rape. Rather than being a distinct "taxon," rape propensity exists along a continuum.

He also challenges the contention of a Canadian research group that rapists are sexually aroused by the coercive aspects of sexual assault. A more likely scientific explanation for why some men rape is that the coercive elements of the situation fail to inhibit their sexual arousal, he writes.

This dimensional model coincides with a large body of sociological and anthropological research, which suggests that men in certain environments -- most notably wars -- are much more likely to commit rape. Indeed, research has found that even on the same college campus, some fraternity environments promote a "rape culture" among men, whereas others do not. (I discuss this environmental aspect of rape in an article I wrote a few years back on the theatrical elements of group rape.)

Knight's scientifically grounded critique is a refreshing change from the pseudoscientific tenor of many of the DSM diagnostic proposals. More scientific rebuttals to some of the shaky studies in the sex offender field are currently in press, and I will try to stay attuned and alert you readers as soon as they become publicly available.

Further resources:

Knight, Raymond. (2009). Is a diagnostic category for Paraphilic Coercive Disorder defensible? Archives of Sexual Behavior. This article is online, but requires a subscription. The abstract is visible HERE, along with the email address of the author (from whom copies may be requested).

Zander, T. K. (2008). Commentary: Inventing Diagnosis for Civil Commitment of Rapists. Journal of the American Academy of Psychiatry & the Law , 36, 459-469.

Zander, T.K. (2005). Civil Commitment Without Psychosis: The Law’s Reliance on the Weakest Links in Psychodiagnosis. Journal of Sexual Offender Civil Commitment: Science and the Law, 1, pp.17-82.

Franklin, Karen. (2004). Enacting Masculinity: Antigay Violence and Group Rape as Participatory Theater. Sexuality Research and Social Policy, 1 (2), pp. 25–40.

Asperger’s: Here today, gone tomorrow?

Would erasure from DSM impact forensic use?

It was just a few years ago that Asperger's Disorder exploded into the public consciousness. But just as suddenly, if the DSM-V authors have their way, it may disappear, absorbed back into the spectrum of autism disorders from whence it came.

An intriguing story in today's New York Times describes the controversy that is heating up as the DSM-V work groups prepare to issue their final diagnostic proposals in January.

As Times reporter Claudia Wallis notes, Asperger's is "one of the most intriguing labels" in the diagnostic book:

"Children with Asperger's syndrome, a mild form of autism, are socially awkward and often physically clumsy, but many are verbal prodigies, speaking in complex sentences at early ages, reading newspapers fluently by age 5 or 6 and acquiring expertise in some preferred topic -- stegosaurs, clipper ships, Interstate highways -- that will astonish adults and bore their playmates to tears."

The sudden rise of this "once obscure diagnosis," diagnosed four times more often in boys than girls, accounts for much of the apparent rise in autism, which now has a prevalence rate of about 1 percent among U.S. children.

Although self-described "Aspies" and their families distinguish Asperger's from the more stigmatized label of autism, experts quoted by the Times say the distinctions are confusing and not scientifically based.

Asperger's in the forensic context

At the same time that it faces formal extinction, Asperger's is seeing ever-escalating use in the criminal courts, in cases ranging from violent crime to computer hacking and child pornography possession.

Typically, the diagnosis is proposed by defense attorneys seeking to mitigate the mental state required for a crime. A hallmark of the disorder is severe problems understanding social rules and nuances, and therefore navigating social situations. Sometimes, the profound deficit in social reasoning explains crimes that otherwise are simply bizarre, and lacking in rational motivation. Consider this scenario, adopted from a case I worked on:

You’re on an excursion with a recreational group, walking through a downtown area. The group encounters a red light. Seeing no traffic, everyone jaywalks. All except the young man with Asperger’s, whose can’t break a rule. No one notices as he gets left behind. When he finally finds the group again, he is furious, and punches the group leader in the face.

In this case, the defendant had a particularly severe and clearcut case that had been diagnosed and treated at a specialty clinic from the time he was a toddler. Thus, it could not be argued that the diagnosis was being manufactured with a pretextual goal in the legal context.

In other cases, especially when an alternate and rational motivation is at least equally plausible, the defense has met with less success. For example, as I blogged about last year, it was unsuccessfully advanced in the case of Hans Reiser, the oddball computer programmer who killed his wife and buried her body in the hills of Oakland, California.

In an article on "the geek defense" in Slate magazine, science writer Erica Westly gives other examples of Asperger's recent deployment in court, some successful and some not.

• Astonishingly, a jury in Galveston, Texas acquitted billionaire real estate heir Robert Durst in the murder and dismemberment of his neighbor under the theory that Asperger's made him incapable of premeditating the crime.

• Lisa Brown of the United Kingdom was not so lucky. The 22-year-old woman was sentenced to life in prison in the murder of her mother after a judge ruled that her lack of empathy did not mitigate the gravity of the crime.

Explanation for collecting child porn

The compulsive behaviors and zealous collecting of many individuals with Asperger's is being invoked to explain certain types of criminal conduct, such as computer misconduct or child pornography collecting.

Computer hacker Gary McKinnon

The Slate article features the high-profile case of Gary McKinnon, the British computer geek who hacked into U.S. military and NASA computers looking for proof that the U.S. government had covered up evidence of UFO landings. He claims Asperger's made him compulsively driven to search for evidence of alien spacecraft.

This type of defense is ready-made for compulsive collecting of child pornography images. In an Iowa case this year, a judge reduced a pornography possession sentence after concluding that Asperger's "might very well explain the number of images" the man had acquired. Similarly, across the Atlantic a 21-year-old student in the United Kingdom was sentenced to just four months in jail for possession of 922 pornographic images of children. Other courts have been less sympathetic to this version of a diminished capacity defense.

Anecdotally, I have heard of Asperger's arguments backfiring. Introduced as mitigation in cases of violent and/or sexual offending, Asperger's may become aggravating by increasing jurors' fear of a defendant because he is perceived as strange and therefore more unpredictable.

At risk in prison

In a final forensic angle, the extreme social awkwardness of Asperger's sufferers puts them at risk in prison, where social interactions are highly scripted and regulated. In one case I was involved in, a prisoner incurred new criminal charges stemming from a bizarre fight triggered by his misperception of social cues.

Indeed, computer hacker McKinnon is raising this issue in an attempt to avoid extradition to the United States. Given his condition, incarceration in a U.S. prison would amount to torture, he contends. As evidence, he cites a 2007 study by psychiatrist David Allen finding that imprisonment is extremely stressful and confusing for men with Asperger's, who find it hard to successfully interact with guards and other prisoners and thus spend much of their time hiding out in fear.

No one knows whether or how exclusion from the upcoming DSM-V, due to be published in 2012, might affect deployment of the diagnosis in court. After all, even if it is not a separate diagnosis, Asperger's will still presumably exist as a condition on the autism spectrum. And, as regular readers of this blog know, plenty of less valid diagnoses are invoked in court despite their absence from the DSM.

Although I understand the logic of the DSM-V work group, I cannot help but wonder -- given the massive influence of the pharmaceutical industry in shaping and perpetuating psychiatric diagnoses -- whether they would be proposing Asperger's for elimination if a money-making drug was available to treat it.

Somehow, I think not.

Further resource:

Barry-Walsh, J.B., & Mullen, P.E. (2004). Forensic aspects of Asperger's Syndrome. Journal of Forensic Psychiatry and Psychology, 15, 96-107.

Halloween "security theater" endures

Ho-hum. Another Halloween, another senseless roundup of sex offenders. This is the third year in a row that I have posted about the sex offender hysteria on All Hallows Eve that seems completely impervious to logic, common sense, and -- now -- even research.

What's new this year is that a Florida professor has done the empirical research to prove what people in the field already knew: Sex offenders aren't out snatching and molesting children on Halloween.

Jill Levenson, a professor at Lynn University, studied a 9-year period and found no spikes in sex crimes against children on Halloween. Her study was just published in Sexual Abuse: A Journal of Research and Treatment.

"The wide net cast by Halloween laws places some degree of burden on law enforcement officers whose time would otherwise be allocated to addressing more probably dangerous events," Levenson noted.

Unfortunately, her research seems to be falling on deaf ears.

Last year, when some of the sillier Halloween restrictions were ridiculed by late-night TV pundits and at least one was struck down by a U.S. district judge as overly broad, I naively thought the pendulum might be swinging. But even studies by experts such as Dr. Levenson seem incapable of bringing common sense to bear. Probation officers and others are continuing to implement ridiculous roundups and other once-a-year restrictions on sex offenders, instead of focusing on the real threat to children, which I'll get to in a moment.

Around the nation this year, more parole and probation officers than ever are ordering convicted sex offenders not to answer their doors, decorate their porches, or wear costumes on Halloween. More sex offenders are being ordered to post "NO CANDY HERE" signs on their doors. Others are being required to attend special Halloween "counseling sessions" or "movie nights" where they will be monitored (and, incidentally, protected from false accusations). The restrictions are so widespread and so varied that I no longer have the time or energy to catalog them as I have done in the past. If you are interested, just do a Google news search for "Halloween sex offender roundup."

The farcical crackdowns are a prime example of what Scott Henson over at Grits for Breakfast has labeled "security theater," that is, "hyping (and pretending to solve) a threat that in reality is extremely remote, even to the point of diverting resources from policing activities like DWI enforcement that would protect more people and save more lives."

Why Halloween, we might ask? After all, most sex offenders target people they know, not children off the street. And the crackdowns on registered sex offenders miss the mark anyway, because the broad majority of new sex offenses are committed by men who have never been caught for a past sex offense. Furthermore, registered sex offenders feel so branded and ostracized that most are ducking and hiding today.

But the scare plays off of a deep-rooted cultural fear of the bogeyman stranger, as memorialized in the timeworn Halloween legend of tainted candy, which has endured despite myriad attempts at correction. As Benjamin Radford of the Skeptical Enquirer pointed out a few years ago about the persistence of that stranger-danger myth: "Despite e-mail warnings, scary stories, and Ann Landers columns to the contrary, there have been only two confirmed cases of children being killed by poisoned Halloween candy, and in both cases the children were killed not in a random act by strangers but intentional murder by one of their parents."

The sad part of both myths is that children are taught a message of fear: Strangers, or even their own neighbors, might try to poison or molest them.

Oh, yes. What is the real danger facing children this Halloween? It's one your mama always warned you about: Getting hit by a speeding car while crossing a dark street. Car accidents kill about 8,000 children every year in the United States, and children are more than twice as likely to be killed by a car while walking on Halloween night than at any other time of the year.

Related blog posts:

• Beware the Halloween bogeyman (October 30, 2008)
• Pendulum swing on Halloween hype? (October 31, 2008)

Photo credit: Kaushik Gopal (Creative Commons license)

Adolescent immaturity reduces culpability, say researchers

APA amicus brief in two upcoming high court cases
on life without parole for juveniles

Adolescents may not possess the maturity to be held to adult levels of responsibility for violent crimes, according to an article in the current issue of American Psychologist by Laurence Steinberg, a professor of developmental psychology at Temple University, and colleagues.

"Adolescents likely possess the necessary intellectual skills to make informed choices about terminating a pregnancy but may lack the social and emotional maturity to control impulses, resist peer pressure and fully appreciate the riskiness of dangerous decisions," Steinberg was quoted in Science Daily as saying. "This immaturity mitigates their criminal responsibility."

The researchers studied the differences in various cognitive and psychosocial capacities among 935 research participants, ages 10 to 30. Significant differences in mature decision-making were found between the 16- to 17-year-olds and people just four or five years older.

"It is very difficult for a 16-year-old to resist peer pressure in a heated, volatile situation," Steinberg said. "Most times, there is no time to talk to an adult to inject some reason and reality to the situation. Many crimes committed by adolescents are done in groups with other teens and are not premeditated."

Two friend-of-the-court briefs filed by the American Psychological Association in cases heard by the U.S. Supreme Court spurred questions about differences between cognitive and interpersonal maturity and the apparent inconsistency between APA's positions in the two cases. In its amicus brief filed in Roper v. Simmons (2005), the case that abolished the juvenile death penalty, APA presented research showing that adolescents are developmentally immature in ways that are relevant to their criminal culpability. In an earlier brief filed in Hodgson v. Minnesota (1990), which upheld adolescents' right to seek an abortion without parental approval, APA presented research regarding cognitive abilities that bear on medical choices, showing that adolescents are as mature as adults.

The APA differentiated these two scenarios by looking at the decision-making processes required for each situation. In the Hodgson case, APA described adolescents as being competent to make informed and sound health care decisions. In the Roper case, APA characterized adolescents as too short-sighted and impulsive to warrant capital punishment, no matter what the crime.

These issues are likely to be at the forefront of two U.S. Supreme Court cases -- the cases of Joe Sullivan and Terrance Graham -- slated to be heard this month, involving the constitutionality of sentencing juveniles to life without the possibility of parole. Sullivan, now 33, was 13 years old when he and two older boys broke into a home, where they robbed and raped an elderly woman. After a one-day trial, Sullivan was sentenced to life in prison with no chance for parole. The APA has filed an amicus brief presenting relevant research, including Steinberg's most recent study, to the court.

Adolescents' legal rights, said Steinberg, should be guided by accurate and timely scientific evidence on the nature and course of psychological development. "It is crucial to understand that brain systems responsible for logical reasoning and basic information processing mature earlier than systems responsible for self-regulation and the coordination of emotion and thinking," he said.

Further resources:

Laurence Steinberg, Elizabeth Cauffman, Jennifer Woolard, Sandra Graham, Marie Banich. Are Adolescents Less Mature than Adults? Minors' Access to Abortion, the Juvenile Death Penalty, and the Alleged APA 'Flip-Flop'. American Psychologist, 2009; Vol. 64, No. 7.

Supreme Court to consider juvenile 'lifers': Does life without parole for minors who didn't kill constitute cruel and unusual punishment? By David Savage, Los Angeles Times (Sept. 28, 2009)

FRONTLINE: When Kids Get Life.

U.S. depression: Children hitting the streets

MEDFORD, Ore. -- Dressed in soaked green pajamas, Betty Snyder, 14, huddled under a cold drizzle at the city park as several older boys decided what to do with her. Betty said she had run away from home a week earlier after a violent argument with her mother. Shivering and sullen-faced, she vowed that she was not going to sleep by herself again behind the hedges downtown, where older homeless men and methamphetamine addicts might find her.

The boys were also runaways. But unlike them, Betty said, she had been reported missing to the police. That meant that if the boys let her stay overnight in their hidden tent encampment by the freeway, they risked being arrested for harboring a fugitive.

"We keep running into this," said one of the boys, Clinton Anchors, 18. Over the past year, he said, he and five other teenagers living together on the streets had taken under their wings no fewer than 20 children -- some as young as 12 -- and taught them how to avoid predators and the police, survive the cold and find food.

"We always first try to send them home,” said Clinton, who himself ran away from home at 12. "But a lot of times they won't go, because things are really bad there. We basically become their new family."

That's the lead-in to a poignant New York Times story, subtitled "Running in the shadows," chronicling the surge in youth homelessness across the United States. Each year, more than 1.6 million children in the United States either run away or are thrown out of their homes. With the harsh economy, the number of children living on their own has more than doubled, according to a federal survey of schools. At the same time, fewer public services are available to help them. Harkening back to Dickensonian London, reporter Ian Urbina found children as young as 12 hiding out from abusive families who did not want them or could no longer afford to feed them. Too young to sign contracts or get legitimate employment, young runaways survive by selling drugs, panhandling, or selling their bodies. They remain hidden in the shadows because their families did not report them missing or, if they did, police failed to enter their names into the national database of missing children. Many of these invisible children will be victimized on the streets; others will be our clients. Read the heartbreaking story HERE.

Hat tip: Jane
Photo credit: "Motherless Brooklyn" by Shrued (Creative Commons license)