More developments on the sex offender front

Study finds problems with real-world reliability of Static-99

Evaluators differ almost half of the time in their scoring of the most widely used risk assessment instrument for sex offenders, the Static-99, according to a report in the current issue of Criminal Justice and Behavior. Even a one-point difference on the instrument can have substantial practical implications, both for individual sex offenders and for public policy. In by far the largest and most ecologically valid study of interrater agreement in Static-99 scoring, the research examined paired risk ratings for about 700 offenders in Texas and New Jersey. The findings call into question the typical practice of reporting only a single raw score, without providing confidence intervals that would take into account measurement error. The study, the latest in a line of similar research by Marcus Boccaccini, Daniel Murrie and colleagues, can be requested HERE.

California reining in SVP cowboys

Psychiatrist Allen Frances has more news coverage of a memorable state-sponsored training at which Sexually Violent Predator (SVP) evaluators were cautioned to be more prudent in their diagnostic practices. Ronald Mihordin, MD, JD, acting clinical director of the Department of Mental Health program, warned evaluators against cavalierly diagnosing men who have molested teenagers with “hebephilia” and rapists with “paraphilias not otherwise specified-nonconsent,” unofficial diagnoses not found in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. California evaluators have come under fire in the past for billing upwards of $1 million per year conducting SVP evaluations of paroling prisoners. The PowerPoints of the 3-day training are now available online, at the DMH's website.

The neuroscience of sex offending

In preventive detention trials of sex offenders, forensic evaluators often testify about whether an offender lacks volitional control over his conduct. But how much do we really know about this? In the current issue of Aggression and Violent Behavior, forensic psychologist John Matthew Fabian explores the neuroscience literature on sex offending as it applies to civil commitment proceedings. The article can be viewed online, or requested from the author HERE.

Challenge to sex offender registry

Although the sex offender niche is by far the most partisan and contentious in forensic psychology, one thing that just about all informed professionals agree about is that sex offender registration laws do more harm than good. By permanently stigmatizing individuals, they hamper rehabilitation and reintegration; as Elizabeth Berenguer Megale of the Barry University School of Law explores in an essay in the Journal of Law and Social Deviance (full-text available HERE), they lead to a form of “social death.” Now, the California Coalition on Sexual Offending (CCOSO) and the Association for the Treatment of Sexual Abusers (ATSA) have filed a joint amicus brief in a challenge to California's "Jessica's Law," which bars registered sex offenders from living within 2,000 feet of any school or park. The amicus contends that the restriction is punishment without any rational purpose, in that it does not enhance public safely or deter future criminality. The challenge was brought by Steven Lloyd Mosley. After a jury found Mosley guilty of misdemeanor assault, a non-registerable offense, the sentencing judge ordered him to register anyway, ruling that the assault was sexually motivated. The 4th District Court of Appeal granted Mosley’s appeal, and the California Department of Corrections has appealed to the state's supreme court. We'll have to wait and see whether the high court will tackle the issue of registration laws directly, or will sidestep with a narrow, technical ruling.

Hebephilia hopes hidey-hole will help it slip into DSM-5

Jean Broc: The Death of Hyacinthos

Hebephilia, the controversial faux disorder proposed for the upcoming DSM-5, has been repackaged in the hopes that no one will notice its presence. Unfortunately for its survival, two newly published journal articles may make it harder to hide.

The proposed label of "pedohebephilia” has been quietly discarded. Instead, hebephilia – defined as sexual attraction to young pubescents – has been buried in the text of revamped criteria for pedophilia. Presumably hoping it will go unnoticed, the web page authors do not mention the change.

The questionable diagnosis is the brainchild of a Canadian sex offender clinic with inordinate influence on the Sexual Disorders Workgroup of the American Psychiatric Association’s DSM-5 revision committee.

It is the last of three quacky sexual paraphilia proposals still standing. Overwhelming opposition derailed paraphilic coercive disorder (which would have turned rape into a mental disorder) and hypersexuality.

These victories notwithstanding, the developers of the DSM-5, due out in 2013, have been remarkably deaf to an ever-increasing roar of concern from allied professions in the United States and internationally. The revision process steamrollers on despite a mushrooming petition by a coalition of psychology organizations, a scathing critique by the British Psychological Society and, most recently, public statements of concern by the 154,000-member American Psychological Association and the 120,000-strong American Counseling Association. 

More costly and ineffective civil detentions

Following on the heels of my historical review of hebephilia in Behavioral Sciences and the Law, the Journal of the American Academy of Psychiatry and Law has just published two new critiques.

In an article focusing on the legal ramifications, forensic psychologist and attorney John Fabian warns that the primary result of adding this scientifically unproven diagnosis to the DSM-5 will be an increase in civil commitments of sex offenders.

Fabian outlines the inconsistent federal case interpretations of hebephilia, including the only federal court of appeals ruling, by the U.S. Court of Appeals for the First District in the case of Todd Carta (the case I led off with in my review):

The court in Carta focused on the offender's behavior as causing him distress, impairment, and dysfunction in his life. However, the question of whether hebephilia is a type of paraphilia NOS, depends on whether it is considered deviant and abnormal to have a sexual attraction and to engage in subsequent sexual behaviors toward pubescent adolescents and postpubescent minors. To this date, neither the case law nor clinical research on sex offenders has clearly supported classifying hebephilia as an abnormal pathology.

As we can see through this psycholegal analysis, both clinicians and the courts disagree as to whether hebephilia is a pathological sexual deviance disorder. Given the fact that the U.S. Supreme Court recently denied certiorari in hearing McGee, Michael L. v. Bartow, Dir., WI Resource Center, addressing whether a rape paraphilia NOS, nonconsent, meets the constitutional threshold for legal mental abnormality for civil commitment, it is unlikely that the Court will hear such a case addressing hebephilia. More likely, the DSM-5 will provide guidance for clinicians, attorneys, and judges who evaluate and litigate this issue in civil commitment proceedings.

Focus on clinical impairment

In a commentary on Fabian's article, sex offender researchers Robert Prentky and Howard Barbaree try to take a middle road in the contentious debate. At the outset, they acknowledge the questionable nature of diagnosing a condition that is hard-wired in heterosexual men:

Brooke Shields was only 12 years old when she played a child prostitute in Pretty Baby, three years before she modeled Calvin Klein jeans, asking, "Want to know what gets between me and my Calvin's? Nothing." Klein's young teenage models were so provocative that the Justice Department investigated whether the ads violated federal child pornography and child exploitation laws. Penelope Cruz was only 13 years old when she played a child prostitute in the French soap opera Série Rose. Jodie Foster was 14 years old when she played a child prostitute in Taxi Driver. The model Maddison Gabriel, the official "face" of Australia's Gold Coast Fashion Week in 2007, was only 12 years old. Highly sexualized young girls would not be used in advertising, in movies, and on catwalks unless a great many adult males were paying close attention. It appears that heterosexual human males are hard wired to respond sexually to young females with secondary sexual characteristics.

But, they continue, men with an "exclusive sexual preference for young teenagers" (if such men can be found) may indeed be sufficiently impaired so as to meet the mental disorder requirement of "clinically significant deficits in social and interpersonal skills."

This was the approach taken by the appellate court in upholding the civil commitment of Todd Carta, and it is a tactic being used by government experts in sexually violent predator civil commitment proceedings. In a circular rationale, once the pseudo-diagnosis of “Paraphilia Not Otherwise Specified-Hebephilia” is assigned, clinically significant impairment can be inferred from the mere fact of an arrest and criminal prosecution.

To their credit, Prentky and Barbaree do admit that the research base for hebephilia is insufficient at the present time:

The bright line in the sand should be the clinical and empirical integrity of the proposed diagnosis…. Examined in isolation, there does not appear to be adequate empirical evidence that sexual arousal in response to young adolescents constitutes a paraphilia…. Clearly, this is an area that warrants further research.

Let's just hope the DSM-5 gods tune in to the controversy in time to pull the plug on yet another half-baked idea that will only bring further embarrassment to the profession.

Both articles are freely available online:

• John Fabian: Diagnosing and Litigating Hebephilia in Sexually Violent Predator Civil Commitment Proceedings

• Robert Prentky and Howard Barbaree: Commentary: Hebephilia—A Would-be Paraphilia Caught in the Twilight Zone Between Prepubescence and Adulthood

The DSM-5 petition, spearheaded by the Society for Humanistic Psychology, is HERE.

"Invasion of the Hebephile Hunters," my oldie but goodie from 2007 (before all this hoopla got started), is HERE.

"Abandon ethics, all ye who enter here"

Special ethics exemption sought for SVP work

Concern is mounting among many in the fields of forensic psychology, forensic psychiatry, and law about ethical violations by some practitioners in the Sexually Violent Predator (SVP) arena. But instead of calling for greater adherence to ethical practice, some are floating a radically different idea: Abandon professional ethics altogether.

[A] good-faith, case-by-case, consequential ethics approach should be used that balances the greatest good for the greatest number without trampling unduly on individual rights and each citizen’s constitutionally protected liberty interests.

This "consequential" approach will eliminate bias and give the civil commitment process "ethical authenticity," contend Shoba Sreenivasan, Allen Frances, and Linda Weinberger in the current issue of the Journal of the American Academy of Psychiatry and the Law.

Sexually Violent Predator evaluations lend themselves to ethical slippage because of the laws' requirement that in order to be eligible for civil commitment, a convicted sex offender must suffer from a "mental abnormality" that makes him "likely" (interpreted in most states other than California to mean a risk of 51 percent or more) to commit another sexually violent offense.

These legal requirements create a slippery slope when an offender does not have a bona fide mental disorder and/or does not score high on risk assessment instruments, but the evaluator still believes the offender needs to be civilly committed to protect the public.

But this is no "puzzling ethics quandary." It's no different from such pulls in other forensic arenas. For example, a forensic practitioner might opine that:

• a young man who experienced a brief, drug-induced psychotic break meets the M'Naghten standard of insanity, because the prosecutor and the defense attorney have worked out a deal in which he won't have to go to prison

• a victim of an industrial accident meets the criteria for posttraumatic stress disorder because she needs counseling and the corporation has deep pockets

• a mother in a child custody dispute has "parental alienation syndrome" because she appears angry and vindictive toward her husband

Each of these evaluators is overstepping, and usurping the role of the trier of fact (the judge or jury). It is not the expert's job to decide whether Sexually Violent Predator laws are morally just. It is not our job to balance the goals of public protection with individual civil liberties. Those duties fall to courts, legislatures, and voters.

As I teach my students in Forensic Psychology 101, when we enter the courtroom our job is a simple one: To assist the trier of fact in understanding the psychological science of relevance to the case at hand. Nothing more, nothing less.

The authors complain that the courts have given us insufficient guidance in this task. But, welcome to the forensic world. Statutory and case law is often intentionally vague, to allow for unique situations or changing circumstances. The law's inherent vagueness about mental abnormality and risk does not create an ethics quandary, much less one that merits abandonment of our ethics codes.

It is ludicrous to think that the solution to problems in SVP practice is an anything-goes approach that essentially rests upon the good intentions of individual evaluators. Most of us probably do have good intentions. But self-serving blinders make it hard to be objective. That is precisely why professionals have established deontological, or rule-based, ethics standards (which the authors refer to as "normative ethics").

Indeed, these authors reveal their implicit bias through their choice of examples. Instead of focusing on the widespread exaggeration of risk or manufacturing of bogus psychiatric diagnoses, they condemn "long and confusing discussions of Bayes' theorem" and label as biased the evaluator who emphasizes limitations in our ability to accurately predict risk.

Actually, that is precisely our job. We are ethically obligated to present the limitations of our models, which are significant. To fail to do so is to succumb to what an Australian judge described as gross product enthusiasm:

Amongst the many factors which may lead an expert witness into error is a malady which, if encountered in a new car salesperson, might be described as gross product enthusiasm. Some witnesses seem to become so fervid about the potential of their chosen discipline that they lose sight of its limitations and are borne by their enthusiasm into making claims that could not be supported by more sober and objective assessment of the available evidence.*

As this judge implies, the testimony of expert witnesses should be given little weight when it amounts to confirmatory bias in disguise, resting on a paper-thin layer of exploratory or contradictory research that has not been peer reviewed, published, or replicated, and is of unknown reliability or validity.

I will say it once again: Our only role in court is to assist the trier of fact to accurately apply reliable and valid science to the case at hand. And that includes acknowledging the science's limitations.

Science in principle is distinguished from the law, religion, and politics by its allegiance to scientific inquiry, or the search for replicable cause-effect relationships. The ethics of our discipline therefore rely upon the principles of objectivity and transparency. In contrast, Sreenivasan et al’s ethics of "consequentialism" elevate expedience. This might be fine in the fields of law or religion. But, as a learned colleague said, "expedience is the bane of Science."

SVP trials pit David against Goliath. The dice are loaded against sex offenders facing civil commitment, due to the onerous nature of their past crimes, inequalities in legal resources, and even the very label of predator, which conjures a beastly monster. Condemning as "biased" efforts by the defense to point out the scientific weaknesses of the state's evidence would only increase this monumental power imbalance.

But that's no "puzzling ethics quandary." Any more than psychologists are faced with a puzzling ethics quandary when they decide to participate in government torture for the greater good.

Because we have professional rules, or ethics codes, the psychologists who allegedly tortured detainees at Guantanamo now await licensing board actions in their respective states of Ohio and New York.

That's the way it is, and the way it should remain.

Acknowledgment: In crafting this essay, I consulted with more than a dozen learned colleagues, who helped me to ponder these critical issues of ethics. Thanks to all of you, and a special thanks to Robert Halon, who gave the matter a great deal of thought. It’s a privilege to count such wise individuals among my professional colleagues.

Photo credit (Creative Commons license): Klearchos Kapoutsis, Baba Vida fortress, Bulgaria, the place of the hangings.

*R. v. Hiller, ACTSC 50, 25 (Australia, 2003), as cited in Psychological Science in the Courtroom, Consensus and Controversy, page 255.

BLOGGER RESPONSES:

Steve Erickson @ Crime & Consequences

Mark Bennett @ Defending People

Emma B. @ Psychology & Crime News (UK)

Hebephilia flunks Frye test

Photo credit: NY Law Journal

In a strongly worded rejection of hebephilia, a New York judge has ruled that the controversial diagnosis cannot be used in legal proceedings because of “overwhelming opposition” to its validity among the psychiatric community.

Judge Daniel Conviser heard testimony from six experts (including this blogger) and reviewed more than 100 scholarly articles before issuing a long-awaited opinion this week in the case of “Ralph P.,” a 72-year-old man convicted in 2001 of a sex offense against a 14-year-old boy. The state of New York is seeking to civilly detain Ralph P. on the basis of alleged future dangerousness.

State psychologist Joel Lord had initially labeled Ralph P. with the unique diagnosis of sexual attraction to “sexually inexperienced young teenage males,” but later changed his diagnosis to hebephilia, a condition proposed but rejected for the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Under the Frye evidentiary standard, designed to bar novel scientific methods that are not sufficiently validated, a construct must be “generally accepted” by the relevant scientific community before it can be relied upon in legal proceedings.

Judge Conviser found that hebephilia (generally defined as sexual attraction to children in the early stages of puberty, or around the ages of 11 or 12 to 14) is being promoted by a tiny fringe of researchers and in practice is used almost exclusively as a tool to civilly commit convicted sex offenders. Under U.S. Supreme Court rulings, such offenders must have a mental disorder in order to qualify for prolonged detention after they have served their prison terms.

“It is not an accident, as Dr. Franklin outlined, that hebephilia became a prominent diagnosis only with the advent of SVP laws,” the judge wrote in his 75-page opinion. “It is also not a coincidence that each of the three expert witnesses who testified for the State at the instant hearing either work or formerly worked for state [Sexually Violent Predator] programs.”

Conviser’s ruling analyzed both the practical problems in reliably identifying hebephilia and the political controversies swirling around it: Without any standardized criteria, “clinicians are free to assign hebephilia diagnoses in widely disparate ways, many of which are just plainly wrong.” Using age as a proxy for pubertal stage is no guarantee of reliability because pubertal onset is highly variable. Ultimately, he concluded, whether erotic interest in pubescent minors is deemed "pathological" is more about moral values than science.

APA secrecy faulted

The judge was harshly critical of the American Psychiatric Association for its refusal to publicly explain why it rejected hebephilia from the DSM-5 in 2013. The diagnosis was aggressively promoted by a Canadian psychologist, Ray Blanchard, and fellow researchers from Canada’s Centre for Addiction and Mental Health (CAMH), who dominated the DSM-5 subcommittee on paraphilias.

Blanchard rewrote the DSM section on paraphilias (sexual deviances) in a broad way such that virtually all sexual interests other than a narrowly defined “normophilic” pattern became pathological. However, the APA rejected Blanchard’s proposal to expand pedophilia to pathologize adult sexual attractions to pubescent-aged (rather than just prepubescent) minors.

“The proposal was apparently rejected because it was greeted with a firestorm of criticism by the sex offender psychiatric community, which was communicated to the APA board…. As best as this Court can surmise, the APA rejected the pedohebephilia proposal because it was opposed by most of the psychiatrists and psychologists who worked in the field.”

“[S]trikingly,” wrote Judge Conviser, “the process through which proposed new diagnoses are approved or rejected is shrouded in a degree of secrecy which would be the envy of many totalitarian regimes…. With respect to hebephilia, the APA board’s actions will have a direct impact on both public safety and the fundamental liberty interests of hundreds or thousands of people.”

The APA forces those involved in the DSM revision process to sign nondisclosure contracts. That policy came in the wake of a series of published exposes – including Christopher Lane’s Shyness: How Normal Behavior Became a Sickness, Jonathan Metzl's The Protest Psychosis, and Ethan Watters’s Crazy Like Us (to name just a few of my favorites) -- that embarrassed the world’s largest psychiatric organization by shining a light inside the often subjective and political process of diagnosis creation and expansion.

“Overwhelming” opposition

Blanchard and his CAMH colleagues’ 2009 proposal to expand pedophilia into a new “pedohebephilia” diagnosis in the DSM-5 spawned a massive outcry, which mushroomed into at least five dozen published critiques.

In preparation for my testimony at this and similar Frye hearings in New York, I expanded on my 2010 article in Behavioral Sciences and the Law tracing hebephilia’s rise from obscurity, to produce an updated chart containing all 116 articles addressing the construct. If one tallies only those articles that take a position (pro or con) on hebephilia and are not written by members of the CAMH team, fully 83% are critical as compared to only 17% that are favorable. This, Judge Conviser noted, is strong evidence against the government’s position that hebephilia is “generally accepted” by the relevant scientific communities.

“The thrust of the evidence at the hearing was … clear: there was overwhelming opposition to the pedohebephilia proposal in the sex offender psychiatric community,” he wrote. “There is overwhelming opposition to the hebephilia diagnosis today.”

Courts scrutinizing nouveau diagnoses

With the APA’s rejection of hebephilia as well as two other proposed sexual disorders (one for preferential rape and another for hypersexuality), government evaluators continue to shoehorn novel, case-specific diagnostic labels into the catchall DSM-5 category of “other specified paraphilic disorder” (OSPD) as a basis for civil commitment.

Under a 2012 New York appellate court ruling in the case of State v. Shannon S., upon a defense request, a Frye evidentiary hearing must be held on any such attempt to introduce an OSPD diagnosis into a Sexually Violent Predator (SVP) case. That has triggered a spate of Frye hearings in the Empire State, affording greater scrutiny and judicial gatekeeping of scientifically questionable diagnoses.

Ironically, although the Shannon S. court upheld hebephilia by a narrow 4-3 margin, Shannon S. would not have met diagnostic criteria under the narrower definitions presented by the government experts at Ralph P.’s Frye hearing four years later, because his victims were older than 14.

“Assuming hebephilia is a legitimate diagnosis, Shannon S., like many SVP respondents, was apparently diagnosed with the condition not based on evidence he was preferentially attracted to underdeveloped pubescent body types but because he offended against underage victims,” Judge Conviser observed in his detailed summary of prior New York cases.

The three dissenting judges in Shannon S. were adamant that hebephilia was “absurd,” and an example of “junk science,” deployed with the pretextual goal of “locking up dangerous criminals” who had committed statutory rapes.

The opening of the Frye floodgates has led to a flurry of sometimes-competing opinions.

In 2015, in State v. Mercado, Judge Dineen Riviezzo ruled against “OSPD--sexually attracted to teenage females” as a legitimate diagnosis. However, she declined to rule on the general acceptance of hebephilia because it was not specifically diagnosed in that case.

A year later, relying on similar evidence, a judge in upstate New York ruled in State v. Paul V. that hebephilia was generally accepted, in large part because it was backed by the APA’s paraphilias sub-workgroup. Judge Conviser found that reasoning unpersuasive, pointing out that the subworkgroup was dominated by the very same CAMH researchers who were hebephilia’s primary advocates; it was therefore “not a valid proxy" for the scientific community.

In July, another court rejected both hebephilia and “OSPD--underage males” as valid diagnoses, in the cases of Hugh H. and Martello A. The court noted that hebephilia is inconsistently defined, was rejected for the DSM-5, and is primarily advanced by one research group; further, attraction to pubescent minors is not intrinsically abnormal.

Cynthia Calkins, a professor at John Jay College of Criminal Justice in New York, echoed those points in her testimony at Ralph P.'s hearing. She noted that in the United States, the main psychologists advocating for hebephilia are government-retained evaluators in SVP cases, who make up only perhaps one-fourth of one percent of psychologists and psychiatrists in the U.S. and so cannot be a proxy for “general acceptance” in the scientific community.

The government’s choice of experts illustrated Calkins’ point: Testifying for the government were Christopher Kunkle, director of New York’s civil management program for sex offenders, David Thornton of Wisconsin’s civil commitment center, and Robin Wilson, formerly of Florida’s civil commitment center and a protégé of Ray Blanchard’s.

The third expert called by Ralph P.’s attorneys was Charles Ewing, a distinguished professor at the University at Buffalo Law School who is both an attorney and a forensic psychologist and has authored several books on forensic psychology.

Defense attorneys Maura Klugman and Jessica Botticelli of Mental Hygiene Legal Service represented Ralph P. Assistant New York Attorney General Elaine Yacyshyn represented the state.

Ultimately, New York State’s highest court may have to weigh in to resolve once and for all the question of whether novel psychiatric diagnoses like hebephilia are admissible for civil commitment purposes. But that could be years down the road.

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The ruling in State v. Ralph P. is HERE. The subsequent order of Sept. 28, 2016 granting Ralph P.'s motion for summary judgment and dismissal of the civil commitment petition is HERE.

A New York Law Journal report on the case, "judge Rejects Diagnosis for Civil Confinement," is HERE.

A search of this blog site using the term hebephilia will produce my reports on this construct dating all the way back to my original post from 2007, "Invasion of the Hebephile Hunters."

Another forensic psychology sex scandal

A psychologist in North Dakota who conducted sex offender evaluations for the state has resigned over a self-admitted child pornography compulsion. Joseph Belanger had run the state's Sexually Dangerous Individual (SDI) civil commitment program. In that capacity, he evaluated sex offenders and testified in court that they were sexually dangerous and should remain hospitalized.

It was unknown what triggered the investigation against Dr. Belanger, but Homeland Security officials recently seized his home computer, according to the Forum newspaper in Fargo, ND.

Dr. Belanger, who worked for the state hospital for more than 20 years, was reportedly a protege of Dennis Doren, a prominent psychologist for the state in sex offender civil commitment proceedings (I've mentioned Doren previously here and here).

Belanger is at least the second forensic psychologist this year to be tarnished by accusations of sexual deviancy.

In July, prominent forensic psychologist Stuart Greenberg killed himself after being arrested on suspicion of voyeurism; he had allegedly secretly videotaped a woman in his office bathroom. Greenberg was known for his expertise in child custody evaluations, but he was also a consultant for the Archdiocese of Seattle in sex abuse cases.

A commonality in these cases in that both men allegedly used modern technology to further their deviant interests - Greenberg using a concealed video camera and Belanger using the Internet.

While reporting on this news, I hasten to point out that two men out of the countless forensic psychologists in the United States certainly doesn't represent a pattern. Rather, the similar scandals cropping up in other professions suggest that such cases may be more a sign of the times than a reflection on any particular line of work.

What is relevant to the field, however, is that the revelations will likely cause scrutiny of cases in which the two men were involved as expert psychologists. This scrutiny is already occurring in Greenberg's case, with parents protesting unfavorable child custody court decisions that were based in part upon his opinions. In King County (Seattle), the presiding judge anticipated a flurry of legal challenges to cases in which Greenberg was a court-appointed evaluator. Although Greenberg's arrest would not be sufficient to reopen a case, a parent could argue bias if Greenberg's custody recommendations hinged on a parent's sexuality. I would anticipate similar challenges by civilly committed sex offenders evaluated or treated by Belanger in North Dakota.

As evidenced by the numerous venomous posts at the websites of Washington newspapers that covered the Greenberg case as well as websites devoted to parental rights in custody cases, these scandals also provide ready ammunition to critics of forensic psychology and expert witnesses more generally.

Putting the Cart Before the Horse: The Forensic Application of the SRA-FV

As the developers of actuarial instruments such as the Static-99R acknowledge that their original norms inflated the risk of re-offense for sex offenders, a brand-new method is cropping up to preserve those inflated risk estimates in sexually violent predator civil commitment trials. The method introduces a new instrument, the “SRA-FV,” in order to bootstrap special “high-risk” norms on the Static-99R. Curious about the scientific support for this novel approach, I asked forensic psychologist and statistics expert Brian Abbott to weigh in.

Guest post by Brian Abbott, PhD*

NEWS FLASH: Results from the first peer-reviewed study about the Structured Risk Assessment: Forensic Version (“SRA-FV”), published in Sexual Abuse: Journal of Research and Treatment (“SAJRT”), demonstrate the instrument is not all that it’s cracked up to be.

Promotional material for an SRA-FV training

For the past three years, the SRA-FV developer has promoted the instrument for clinical and forensic use despite the absence of peer-reviewed, published research supporting it validity, reliability, and generalizability. Accordingly, some clinicians who have attended SRA-FV trainings around the country routinely apply the SRA-FV in sexually violent predator risk assessments and testify about its results in court as if the instrument has been proven to measure what it intends to assess, has known error rates, retains validity when applied to other groups of sexual offenders, and produces trustworthy results.

Illustrating this rush to acceptance most starkly, within just three months of its informal release (February 2011) and with an absence of any peer-reviewed research, the state of California incredibly decided to adopt the SRA-FV as its statewide mandated dynamic risk measure for assessing sexual offenders in the criminal justice system. This decision was rescinded in September 2013, with the SRA-FV replaced with a similar instrument, the Stable-2007.

The SRA-FV consists of 10 items that purportedly measure “long-term vulnerabilities” associated with sexual recidivism risk. The items are distributed among three risk domains and are assessed using either standardized rating criteria devised by the developer or by scoring certain items on the Psychopathy Checklist-Revised (PCL-R). Scores on the SRA-FV range from zero to six. Some examples of the items from the instrument include: sexual interest in children, lack of emotionally intimate relationships with adults, callousness, and internal grievance thinking. Patients from the Massachusetts Treatment Center in Bridgewater, Massachusetts who were evaluated as sexually dangerous persons between 1959 and 1984 served as members of the SRA-FV construction group (unknown number) and validation sample (N = 418). It was released for use by Dr. David Thornton, a co-developer of the Static-99R, Static-2002R, and SRA-FV and research director at the SVP treatment program in Wisconsin, in December 2010 during training held in Atascadero, California. Since then, Dr. Thornton has held similar trainings around the nation where he asserts that the SRA-FV is valid for predicting sexual recidivism risk, achieves incremental validity over the Static-99R, and can be used to choose among Static-99R reference groups.

A primary focus of the trainings is a novel system in which the total score on the SRA-FV is used to select one Static-99R “reference group” among three available options. The developer describes the statistical modeling underlying this procedure, which he claims increases predictive validity and power over using the Static-99R alone. However, reliability data is not offered to support this claim. In the December 2010 training, several colleagues and I asked for the inter-rater agreement rate but Dr. Thornton refused to provide it.

I was astounded but not surprised when some government evaluators in California started to apply the SRA-FV in sexually violent predator risk assessments within 30 days after the December 2010 training. This trend blossomed in other jurisdictions with sexually violent predator civil confinement laws. Typically, government evaluators applied the SRA-FV to select Static-99R reference groups, invariably choosing to compare offenders with the “High Risk High Needs” sample with the highest re-offense rates. A minority of clinicians stated in reports and court testimony that the SRA-FV increased predictive accuracy over the Static-99R alone but they were unable to quantify this effect. The same clinicians have argued that the pending publication of the Thornton and Knight study was sufficient to justify its use in civil confinement risk assessments for sexually violent predators. They appeared to imply that the mere fact that a construction and validation study had been accepted for publication was an imprimatur that the instrument was reliable and valid for its intended purposes. Now that the research has been peer-reviewed and published, the results reflect that these government evaluators apparently put the proverbial cart before the horse.

David Thornton and Raymond Knight penned an article that documents the construction and validation of the SRA-FV. The publication is a step in the right direction, but by no means do the results justify widespread application of the SRA-FV in sexual offender risk assessment in general or sexually violent predator proceedings in particular. Rather, the results of the study only apply to the group upon which the research was conducted and do not generalize to other groups of sexual offenders. Before discussing the limitations of the research, I would like to point out some encouraging results.

The SRA-FV did, as its developer claimed, account for more sources of sexual recidivism risk than the Static-99R alone. However, it remains unknown which of the SRA-FV’s ten items contribute to risk prediction. The study also found that the combination of the Static-99R and SRA-FV increased predictive power. This improved predictive accuracy, however, must be replicated to determine whether the combination of the two instruments will perform similarly in other groups of sexual offenders. This is especially important when considering that the SRA-FV was constructed and validated on individuals from the Bridgewater sample from Massachusetts who are not representative of contemporary groups of sexual offenders. Thornton and Knight concede this point when discussing how the management of sexual offenders through all levels of the criminal justice system in Massachusetts between 1959 and 1984 was remarkably lenient compared to contemporary times. Such historical artifacts likely compromise any reliable generalization from patients at Bridgewater to present-day sexual offenders.

Training materials presented four months before
State of California rescinded use of the SRA-FV

Probably the most crucial finding from the study is the SRA-FV’s poor inter-rater reliability. The authors categorize the 64 percent rate of agreement as “fair.” It is well known that inter-rater agreement in research studies is typically higher than in real-world applications. This has been addressed previously in this blog in regard to the PCL-R. A field reliability study of the SRA-FV among 19 government psychologists rating 69 sexually violent predators in Wisconsin (Sachsenmaier, Thornton, & Olson, 2011) found an inter-rater agreement rate of only 55 percent for the SRA-FV total score, which is considered as poor reliability. These data illustrate that 36 percent to 45 percent of an SRA-FV score constitutes error, raising serious concerns over the trustworthiness of the instrument. To their credit, Thornton and Knight acknowledge this as an issue and note that steps should be taken to increase reliable scoring. Nonetheless, the current inter-rater reliability falls far short of the 80 percent floor recommended for forensic practice (Heilbrun, 1992). Unless steps are taken to dramatically improve reliability, the claims that the SRA-FV increases predictive accuracy either alone or in combination with the Static-99R, and that it should be used to select Static-99R reference groups, are moot.

It is also important to note that, although Thornton and Knight confuse the terms validation and cross validation in their article, this study represents a validation methodology. Cross-validation is a process by which the statistical properties found in a validation sample (such as reliability, validity, and item correlations) are tested in a separate group to see whether they hold up. In contrast, Thornton and Knight first considered the available research data from a small number of individuals from the Bridgewater group to determine what items would be included in the SRA-FV. This group is referred to as the construction sample. The statistical properties of the newly conceived measure were studied on 418 Bridgewater patients who constitute the validation sample. The psychometric properties of the validation group have not been tested on other contemporary sexual offender groups. Absent such cross-validation studies, we simply have no confidence that the SRA-FV works at it has been designed for groups other than the sample upon which it was validated. To their credit, Thornton and Knight acknowledge this limitation and warn readers not to generalize the validation research to contemporary groups of sexual offenders.

The data on incremental predictive validity, while interesting, have little practical value at this point for two reasons. One, it is unknown whether the results will replicate in contemporary groups of sexual offenders. Two, no data are provided to quantify the increased predictive power. The study does not provide an experience table of probability estimates at each score on the Static-99R after taking into account the effect of the SRA-FV scores. It seems disingenuous, if not misleading, to inform the trier of fact that the combined measures increase predictive power but to fail to quantify the result and the associated error rate.

In my practice, I have seen the SRA-FV used most often to select among three Static-99R reference groups. Invariably, government evaluators in sexually violent predator risk assessments assign SRA-FV total scores consistent with the selection of the Static-99R High Risk High Needs reference group. Only the risk estimates associated with the highest Static-99R scores in this reference group are sufficient to support an opinion that an individual meets the statutory level of sexual dangerousness necessary to justify civil confinement. Government evaluators who have used the SRA-FV for this purpose cannot cite research demonstrating that the procedure works as intended or that it produces a reliable match to the group representing the individual being assessed. Unfortunately, Thornton and Knight are silent on this application of the SRA-FV.

In a recently published article, I tested the use of the SRA-FV for selecting Static-99R reference groups. In brief, Dr. Thornton used statistical modeling based solely on data from the Bridgewater sample to devise this model. The reference group selection method was not based on the actual scores of members from each of the three reference groups. Rather, it was hypothetical, presuming that members of a Static-99R reference group will exhibit a certain range of SRA-FV score that do not overlap with any of the other two reference groups. To the contrary, I found that the hypothetical SRA-FV reference group system did not work as designed, as the SRA-FV scores between reference groups overlapped by wide margins. In other words, the SRA-FV total score would likely be consistent with selecting two if not all three Static-99R reference groups. In light of these findings, it is incumbent upon the developer to provide research using actual subjects to prove that the SRA-FV total score is a valid method by which to select a single Static-99R reference group and that the procedure can be applied reliably. At this point, credible support does not exist for using the SRA-FV to select Static-99R reference groups.

The design, development, validation, and replication of psychological instruments is guided by the Standard for Educational and Psychological Testing (“SEPT” -- American Educational Research Association et al., 1999). When comparing the Thornton and Knight study to the framework provided by SEPT, it is apparent the SRA-FV is in the infancy stage of development. At best, the SRA-FV is a work in progress that needs substantially more research to improve its psychometric properties. Aside from its low reliability and inability to generalize the validation research to other groups of sexual offenders, other important statistical properties await examination, including but not limited to:

1. standard error of measurement
2. factor analysis of whether items within each of the three risk domains significantly load in their respective domains
3. the extent of the correlation between each SRA-FV item and sexual recidivism
4. which SRA-FV items add incremental validity beyond the Static-99R or may be redundant with it; and proving each item has construct validity. 

It is reasonable to conclude that at its current stage of development the use of the SRA-FV in forensic proceedings is premature and scientifically indefensible. In closing , in their eagerness to improve the accuracy of their risk assessments, clinicians relied upon Dr. Thornton’s claim in the absence of peer-reviewed research demonstrating that the SRA-FV achieved generally accepted levels of reliability and validity. The history of forensic evaluators deploying the SRA-FV before the publication of the construction and validation study raises significant ethical and legal questions:

• Should clinicians be accountable to vet the research presented in trainings by an instrument’s developer before applying a tool in forensic practice? 

• What responsibility do clinicians have to rectify testimony where they presented the SRA-FV as if the results were reliable and valid?

•  How many individuals have been civilly committed as sexually violent predators based on testimony that the findings from the SRA-FV were consistent with individuals meeting the legal threshold for sexual dangerousness, when the published data does not support this conclusion?

Answers to these questions and others go beyond the scope of this blog. However, in a recent appellate decision, a Washington Appeals Court questions the admissibility of the SRA-FV in the civil confinement trial of Steven Ritter. The appellate court determined that the application of the SRA-FV was critical to the government evaluator’s opinion that Mr. Ritter met the statutory threshold for sexual dangerousness. Since the SRA-FV is considered a novel scientific procedure, the appeals court reasoned that the trial court erred by not holding a defense-requested evidentiary hearing to decide whether the SRA-FV was admissible evidence for the jury to hear. The appeals court remanded the issue to the trial court to hold a Kelly-Frye hearing on the SRA-FV. Stay tuned!

References

Abbott, B.R. (2013). The Utility of Assessing “External Risk Factors” When Selecting Static-99R Reference Groups. Open Access Journal of Forensic Psychology, 5, 89-118.

American Educational Research Association, American Psychological Association and National Council on Measurement in Education. (1999). Standards for Educational and Psychological Testing. Washington, DC: American Educational Research Association.

Heilbrun, K. (1992). The role of psychological testing in forensic assessment. Law and Human Behavior, 16, 257-272. doi: 10.1007/BF01044769.

In Re the Detention of Steven Ritter. (2013, November). In the Appeals Court of the State of Washington, Division III. 

Sachsenmaier, S., Thornton, D., & Olson, G. (2011, November). Structured risk assessment forensic version (SRA-FV): Score distribution, inter-rater reliability, and margin of error in an SVP population. Presentation at the 30th Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Toronto, Canada.

Thornton, D. & Knight, R.A. (2013). Construction and validation of the SRA-FV Need Assessment. Sexual Abuse: A Journal of Research and Treatment. Published online December 30, 2013. doi: 10.1177/ 1079063213511120. 

* * *

*Brian R. Abbott is licensed psychologist in California and Washington who has evaluated and treated sexual offenders for more than 35 years. Among his areas of forensic expertise, Dr. Abbott has worked with sexually violent predators in various jurisdictions within the United States, where he performs psychological examinations, trains professionals, consults on psychological and legal issues, offers expert testimony, and publishes papers and peer-reviewed articles.

(c) Copyright 2013 - All rights reserved

Miracle of the day: 80-year-old man recaptures long-lost youth

(Or: How committing a new sex crime can paradoxically LOWER risk on the Static-99R)

"How old is the offender?"

 Age is an essential variable in many forensic contexts. Older people are at lower risk for criminal recidivism. Antisocial behaviors, and even psychopathic character traits, diminish as criminals reach their 30s and 40s. Men who have committed sex offenses become at considerably lower risk for further such misconduct, due to a combination of decreased testosterone levels and the changes in thinking, health, and lifestyle that happen naturally with age.

Calculating a person's age would seem very straightforward, and certainly not something requiring a PhD: Just look up his date of birth, subtract that from today's date, and -- voila! Numerous published tests provide fill-in-the-blank boxes to make this calculation easy enough for a fourth-grader.

One forensic instrument, however, bucks this common-sense practice. The developers of the Static-99R, the most widely used tool for estimating the risk of future sexual recidivism, have given contradictory instructions on how to score its very first item: Offender age.

In a new paper, forensic evaluator Dean Cauley and PsyD graduate student Michelle Brownfield report that divergent field practices in the scoring of this item are producing vastly different risk estimates in legal cases -- estimates that in some cases defy all logic and common sense.

Take Fred. Fred is 80 years old, and facing possible civil commitment for the rapes of two women when he was 18 years old. He served 12 years in prison for those rapes. Released from prison at age 30, he committed several strings of bank robberies that landed him back in prison on six separate occasions.

At age 80 (and especially with his only known sex offenses committed at age 18), his risk for committing a new sex offense if released from custody is extremely low -- something on the order of 3 percent. But evaluators now have the option of using any of three separate approaches with Fred, with each approach producing quite distinct opinions and recommendations.

Procedure 1: Age is age (the old-fashioned method)

The first, and simplest, approach, is to list Fred's actual chronological age on Item 1 of the Static-99R. Using this approach, Fred gets a three-point reduction in risk for a total of one point, making his actuarial risk of committing a new sex offense around 3.8 percent.

Evaluators adopting this approach argue that advancing age mitigates risk, independent of any technicalities about when an offender was released from various periods of incarceration. These evaluators point to the Static-99R's coding manuals and workbook, along with recent publications, online seminars, and sworn testimony by members of the Static-99 Advisory Committee. Additionally, they point to a wealth of age-related literature from the fields of criminology and psychology to support their scoring.

Procedure 2: Reject the Static-99R as inappropriate

A second approach is not to use the Static-99R at all, because Fred's release from prison for his "index offenses" (the rapes) was far more than two years ago, making Fred unlike the members of the samples from which the Static-99R's risk levels were calculated. Evaluators adopting this approach point to publications by members of the Static-99 Advisory Committee, generally accepted testing standards and actuarial science test standards to support their choice to not use the test at all.

Procedure 3: The amazing elixir of youth

But there is a third approach. One that magically transports Fred back to his youth, back to the days when a career in bank robbing seemed so promising. (Bank robbery is no longer alluring; it is quietly fading away like the career of a blacksmith.) The last five decades of Fred's life fade away, and he becomes 30 again -- his age when he was last released from custody on a sex offense conviction.

Now Fred not only loses his three-point age reduction, but he gains a point for being between the ages of 18 and 34.9. A four point difference! The argument for this approach is that it most closely conforms to the scoring methods used on the underlying samples of sex offenders, who were scored based on their date of release from their index sexual offense. These evaluators can correctly point to information imparted at training seminars, advice given by some members of the Static-99R Advisory Committee, and sworn testimony by developers of the test itself. They can also point to an undated FAQ #27 on the Static-99 website to support their opinion.

Fred could rape someone to reduce his risk!

Back-dating age to the time of the last release from a sex offense-related incarceration allows for a very bizarre twist:

Let's say that after Fred was released from prison on his most recent robbery stint, back when he was a vigorous young man of 61, he committed another rape. Being 60 or over, Fred would now get the four-point reduction in risk to which his age entitles him. This would cut his risk by two-thirds -- from 11.4 percent (at a score of 5) all the way down to a mere 3.8 percent (at a score of 1)!

While such a scenario might seem far-fetched, it is not at all unusual for an offender to be released from prison at, say, age 58 or 59, but to not undergo a civil commitment trial for a couple of years, until age 60 or 61. Such an offender's score will vary by two points (out of a total of 12 maximum points) depending upon how the age item is scored. And, as Cauley and Brownfield describe, the members of the Static-99R development team have, at different times, given contradictory advice on how to score the age item.

By completely negating the very substantial body of research on age and crime, this technocratic method creates other very concerning -- and paradoxical -- implications, Cauley and Brownfield argue: As the risk estimate for a more persistent offender is lowered, the offender who does not reoffend is stuck with a risk score that is forever jacked up.

Back-dating an offender's age is also at odds with the research that generated the test itself, they say, because the offenders in the samples used to construct the Static-99R had finished serving their sentences on their index sexual offenses within two years of being studied. In other words, none of the offenders had been released many years earlier, and there was none of this curious time-travel business in regard to their ages. As the instrument's developers noted in a publication just last year, the Static-99 "was developed on, and intended for, sexual offenders with a current or recent sexual offense."

So, if you are evaluating an old geezer in the local pen and he tells you that he is only 30 years old, don't assume that he has a delusional belief that he has discovered the elixir of youth -- or that he's pulling your leg. He just might be reciting the age that he was just assigned by a technocratic Static-99R evaluator.

The paper, "Static-99R: Item #1 -- What is the Offender's Age? A lack of consensus leads to a defective actuarial," is available for download both HERE and HERE.

Sex Offender Laws: Failed Policies, New Directions

Here's an important new book for you folks who work with sex offenders:

In response to many high-profile cases of sexual assault, federal and state governments have placed a number of unique criminal sanctions on sex offenders. These include residency restrictions, exclusionary zones, electronic monitoring, and chemical castration. However, the majority of sex offender policies are not based on empirical evidence, nor have they demonstrated any significant reductions in offender recidivism. In fact, some of these policies have unintended consequences, which actually increase the likelihood of sexual offenses.

In this book, Richard Wright critically analyzes existing policies, and assesses the most effective approaches in preventing sex offender recidivism. This provocative and timely book draws from the fields of criminal justice, law, forensic psychology, and social work to examine how current laws and policies are enacted and what to-date is known about their efficacy. In response to the failed policies of sex offender laws, this book presents alternative models and approaches to sex offense laws and policies.

Topics include:

• History and politics of sex offender laws
• Internet sex stings
• Registration and community notification laws
• GPS monitoring
• Residency restrictions
• Chemical and surgical castration
• Civil commitment
• Death penalty
• Containment approach
• Sexual violence and restorative justice
• Victim impact

Richard G. Wright is a criminal justice professor at Bridgewater State College in Massachusetts and a nationally known expert on sex offender laws.

Two new texts in forensic psychology

Joining an increasingly crowded forensic psychological arena comes Rebecca Jackson's Learning Forensic Assessment. I haven't read it so I can't endorse it, but it's got some great chapter authors and is being advertised as more practical than many texts, providing both didactic information and discussions of specific assessment instruments and techniques. At 600-plus pages, it includes topical coverage of:

• Competency to Stand Trial
• Insanity
• Psychopathy
• Violence Risk
• Civil Commitment of Sex Offenders
• Capital Sentencing
• Competency for Execution
• Juvenile Assessment Issues
• Civil Assessment
• Child Custody
• and more ...

For other forensic psychology texts, check out my Forensic Psychology book list at Amazon.

And from Oxford University Press comes Stalking: Psychiatric Perspectives and Practical Approaches, edited by Debra A. Pinals, Director of the Forensic Psychiatry Fellowship and Training Program at the University of Massachusetts Medical School.

It's written by a committee of nationally recognized forensic psychiatrists for use by mental health professionals, judges, lawyers, law enforcement officials, journalists, and anyone else with an interest in this increasingly high-profile topic. Topics covered include classification of stalking behaviors, risk assessment and risk management, the victim's perspective, celebrity stalking, forensic assessment, juvenile and adolescent stalking, and the emerging topic of cyberstalking.

The American Journal of Psychiatry has an online review by Sibel Cakir, MD.

Study: Actuarials fail to predict sexually violent recidivism

In a new prospective study out of Austria, none of the actuarial instruments commonly used to predict sex offender recidivism were able to predict sexually violent recidivism among a group of sex offenders released from prison after treatment.

The interesting study, just published in the International Journal of Offender Therapy and Comparative Criminology, was designed to validate German versions of commonly used actuarial tools, including the Static-99, RRASOR, SORAG, and SVR-20. It followed about 400 Austrian prisoners for an average of three years in the community.

The main problem obtaining significant results was that recidivism was so rare. Obviously, the less likely an event is to occur, the harder it is to accurately predict. Only seven offenders in the entire sample committed a new hands-on offense during the followup period, and most of those were extrafamilial child molesters. Recidivism base rates were especially low for rapists and incest offenders.

The results echoed findings in two other recent studies in which the actuarials failed to demonstrate good predictive validity for predicting sexually violent reoffending.

Most of the instruments did better when recidivism was defined more broadly, to include all sexual reconviction, even hands-off offenses such as voyeurism or exhibitionism that is not typically defined as sexually violent under civil commitment laws. Even including these lesser offenses, the overall base rate for all sexual recidivism among this sample was still quite low, 4.3% (12% among extrafamilial child molesters, 1.7% among rapists, and about 1% among incest offenders).

When extrafamilial child molesters -- the group most likely to reoffend -- were examined separately, all of the instruments except the RRASOR had some predictive utility, with the SVR-20 doing the best. Still, neither the Static-99 (the most widely used actuarial tool) nor the RRASOR could significantly predict sexually violent reoffenses even for that relatively higher-risk group.

"From the results of these studies and of the present study, the actuarial prediction of some reoffence categories in at least some offender subtypes is less accurate than generally assumed,” the authors concluded. "One major aim of most criminal justice systems is to calculate risk by predicting the probability of severe sexual crimes. This goal obviously is not yet achieved satisfactorily by actuarial risk assessment, because results are far from ideal, especially when time-at-risk periods are relatively short."

An important implication of this study is that evaluators need to consider offender subgroups separately, rather than lumping all types of sex offenders together. Recidivism varies tremendously by type of offender (e.g., rapists versus child molesters) and by how recidivism is defined, with the various instruments doing better at some types of predictions than others. Furthermore, so little outcome research exists on certain groups (such as hands-off offenders, juveniles, the intellectually disabled, and offenders with only adult male victims) that the actuarials may be inappropriate to use at all.

The study is:

Rettenberger, M., Matthes, A., Boer, D.P., & Eher, R. (2010). Prospective Actuarial Risk Assessment: A Comparison of Five Risk Assessment Instruments in Different Sexual Offender Subtypes. International Journal of Offender Therapy and Comparative Criminology, 54 , 169-186.

Hat tip: Jeffrey Singer

FURTHER READING: For those of you interested in the actuarials, I also recommend "More prejudicial than probative?," a stastical critique by David J. Cooke, a forensic psychology professor in Glasgow who is an expert scholar and trainer on violence risk assessment. Cooke argues that the actuarials are compelling because they are simple to use by paraprofessionals and have a scientific veneer, but "the scientific basis for actuarial scales, as applied to individuals, may be more illusory than real." The article, in the journal of the Law Society of Scotland, is available online. It also includes useful references to other sources.

Psychiatry rejects new rape disorder for DSM-5

Regular blog readers will be familiar with the heated battle over a controversial proposed mental condition of "Paraphilic Coercive Disorder" for rapists. Now, the American Psychiatric Association has issued its latest draft of the DSM-5 diagnostic manual, with the condition relegated to the appendix. The proposal was favored by psychologists working for the government in Sexually Violent Predator (SVP) civil commitment cases, as it would have made it far easier to testify that sex offenders are mentally ill. It had met with strong opposition from scientists, including premier rape researcher Raymond Knight of Brandeis University.

Among other outspoken opponents was psychiatrist Allen Frances, an emeritus professor from Duke University who chaired the DSM-IV Task Force. In blog posts soon to go live at the Psychiatric Times and Psychology Today, he cautions that the battle is not over: The current attempt to place the pseudoscientific condition into the appendix of the DSM 5 as a condition warranting further study is still a mistake.

"Important message"

Dr. Frances said the rejection should send a strong message to those involved in the SVP civil commitment industry:

Dr. Allen Frances

The evaluators, prosecutors, public defenders, judges, and juries must all recognize that the act of being a rapist almost always is an indication of criminality, not of mental disorder. This now makes four DSM's (DSM III, DSM IIIR, DSM IV, DSM 5) that have unanimously rejected the concept that rape is a mental illness. Rapists need to receive longer prison sentences, not psychiatric hospitalizations that are constitutionally quite questionable.

This DSM 5 rejection has huge consequences both for forensic psychiatry and for the legal system. If "coercive paraphilia" had been included as a mental disorder in DSM 5, rapists would be routinely subject to involuntary psychiatric commitment once their prison sentence had been completed. While such continued psychiatric incarceration makes sense from a public safety standpoint, misusing psychiatric diagnosis has grave risks that greatly outweigh the gain…. Preventive psychiatric detention is a slippery slope with possibly disastrous future consequences for both psychiatry and the law. If we ignore the civil rights of rapists today, we risk someday following the lead of other countries in abusing psychiatric commitment to punish political dissent and suppress individual difference.

This DSM 5 rejection of rape as mental disorder will hopefully call attention to, and further undercut, the widespread misuse in SVP hearings of the fake diagnosis "Paraphilia Not Otherwise Specified, nonconsent". Mental health evaluators working for the state have badly misread the DSM definition of Paraphilia and have misapplied it to rapists to facilitate their psychiatric incarceration. They have disregarded the fact that we deliberately excluded rape as an example of Paraphilia NOS in order to avoid such backdoor misuse. Not Otherwise Specified diagnoses are included in DSM only for clinical convenience and are inherently too idiosyncratic and unreliable to be used in consequential forensic proceedings.

Exclude coercive paraphilia from appendix

All along, promoters of this new diagnosis have conceded that this would be a tough sell, given its lack of scientific foundation. Indeed, they said publicly that they would consider it a victory if they could even get paraphilic coercive disorder included in the appendix of the upcoming diagnostic manual (due out in mid-2013), as a condition meriting further study. But as Dr. Frances points out, even that would be a major error:

The sexual disorders work group proposes placing "coercive paraphilia" in an appendix for disorders requiring further research. We created such an appendix for DSM IV. It was meant as a placement for proposed new mental disorders that were clearly not suitable for inclusion in the official body of the manual, but might nonetheless be of some interest to clinicians and researchers….

If "Coercive Paraphilia" were like the average rejected DSM suggestion, it would similarly make sense to park it in the appendix -- as has been suggested by the DSM 5 sexual disorders work group. This might facilitate the work of researchers and also provide some guidance to clinicians....

But "coercive paraphilia" is not the average rejected DSM diagnosis. It has been, and is continuing to be, badly misused to facilitate what amounts to an unconstitutional abuse of psychiatry. Whether naively or purposefully, many SVP evaluators continue to widely misapply the concept that rape signifies mental disorder and to inappropriately use NOS categories where they do not belong in forensic hearings.

Including "Coercive Paraphilia" in the DSM 5 appendix might confer some unintended and undeserved back-door legal legitimacy on a disavowed psychiatric construct. Little would be gained by such inclusion and the risks of promoting continued sloppy psychiatric diagnosis and questionable legal proceedings are simply not worth taking. The rejection of rape as grounds for mental disorder must be unequivocal in order to eliminate any possible ambiguity and harmful confusion. We did not include any reference to "coercive paraphilia" in DSM IV and it should not find its way in any form, however humble and unofficial, into DSM 5. 

If you agree that this pseudoscientific condition needs to be placed in the wastebasket once and for all, now is the time to speak up. The current public comment period ends June 15. While you’re at it, you might want to state your opposition to a couple of the other controversial proposals with potential for profound negative consequences in the forensic realm – pedohebephilia and hypersexuality.

Postscript: Thanks to the suggestion of an alert reader, I have added the direct links to the DSM-5 comments pages. You must register in order to submit a comment.

• Click HERE to comment on the proposed diagnosis of Pedohebephilia.
• Click HERE to comment on the proposed diagnosis of Paraphillic Coercive Disorder.

Related posts:

• Psychiatrists ramp up opposition to forensic misuse of DSM: "Pedohebephilia" would make bad situation worse, they warn (March 10, 2011)
• Europeans first to shoot down controversial paraphilia (Oct 26, 2010)
• Psychiatrists vote no on controversial paraphilias (Oct. 24, 2010)
• Rape as psychiatric illness: Battle heats up (June 24, 2010)
• Latest hebephilia critiques: Point-counterpoint (March 12, 2010)
• More prominent voices join chorus of DSM-5 critics (March 1, 2010)
• DSM-V: Will shoddy manual implode years before launch date? (Feb. 20, 2010)
• New Scientist expose of psychiatry’s "civil war" (Dec. 10, 2009)
• Scientist razes proposed "Paraphilic Coercive Disorder" (Nov. 6, 2009)
• Hebephilia struck by third blow: Down but not out? (June 5, 2009)
• Wrangling over psychiatry's bible (Nov 16, 2008)
• DSM makeover: What will they come up with next? (Oct 13, 2008)
• Invasion of the hebephile hunters (Oct 31, 2007)