Reliability and validity of the DSM-IV-TR and proposed DSM-5 criteria for pedophilia: Implications for the ICD-11 and the next DSM

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• 作者：Michael C. Seto^a ; ^b ; ^{Michael.Seto@theroyal.ca" class="auth_mail" title="E-mail the corresponding author} ; J. Paul Fedoroff^a ; ^b ; John M. Bradford^a ; ^b ; ³ ; Natasha Knack^a ; Nicole C. Rodrigues^a ; ^b ; Susan Curry^a ; Brad Booth^b ; Jonathan Gray^b ; Colin Cameron^b ; Dominique Bourget^a ; ^b ; Sarina Messina^b ; ¹ ; Elizabeth James^b ; ² ; Diane Watson^b ; Sanjiv Gulati^b ; Rufino Balmaceda^b ; Adekunle G. Ahmed^a ; ^b
• 关键词：Pedophilia ; Diagnosis ; DSM-5 ; DSM-IV-TR ; Inter-rater reliability ; Criterion-related validity ; ICD-11
• 刊名：International Journal of Law and Psychiatry
• 出版年：2016
• 出版时间：September-December 2016
• 年：2016
• 卷：49
• 期：part_PA
• 页码：98-106
• 全文大小：267 K

文摘

We tested the inter-rater reliability and criterion-related validity of the DSM-IV-TR pedophilia diagnosis and proposed DSM-5 pedohebephilia diagnosis in a sample of 79 men who had committed child pornography offenses, contact sexual offenses against children, or who were referred because of concerns about whether they had a sexual interest in children. Participants were evaluated by two independent psychiatrists with an interview and questionnaire regarding demographic characteristics, sexual history, and self-reported sexual interests; they also completed phallometric and visual reaction time testing. Kappa was .59 for ever meeting DSM-IV-TR criteria for pedophilia and .52 for ever meeting the proposed DSM-5 criteria for pedohebephilia. Ever meeting DSM-IV-TR diagnosis was significantly related to self-reported index of sexual interest in children (highest AUC = .81, 95% CI = .70–.91, p < .001) and to indices of sexual interest in children from phallometric testing (AUC = .70; 95% CI = .52–.89; p < .05) or a computerized assessment based on visual reaction time and self-report (AUC = .75; 95% CI = .62–.88; p < .005). Ever meeting the proposed DSM-5 “diagnosis” was similarly related to self-report (AUC = .84, 95% CI = .74–.94, p < .001) and to the two objective indices, with AUCs of .69 (95% CI = .53–.85; p < .05) and .77 (95% CI = .64–.89; p < .001), respectively. Because the pDSM-5 criteria did not produce significantly better reliability or validity results and users are more familiar with the current DSM-5 criteria, we believe these results suggest the revision of DSM-5 and development of ICD-11 could benefit from drawing on the current DSM-5 criteria, which are essentially the same as DSM-IV-TR except for a distinction between having a paraphilia (the interest) and a paraphilic disorder (the paraphilia plus clinically significant distress or impairment).