Misuse of Diagnostic and Statistical Manual Diagnosis in Sexually Violent Predator Cases

Supreme Court rulings supporting the constitutionality of sexually violent predator (SVP) statutes require that evaluators determine whether the rapist has a mental disorder (which justifies psychiatric commitment) or is just a common criminal (who cannot be preventively detained psychiatrically), but they offer no guidelines on making this crucial distinction. Until recently, state evaluators ignored the crucial fact that rape as a mental disorder has been roundly rejected by the Diagnostic and Statistical Manual of Mental Disorders (DSM) four times in the past 45 years (in DSM-III, DSM-III-R, DSM-IV, and DSM-5). The most common diagnosis in SVP cases was "other specified paraphilia, nonconsent," which was based on a misunderstanding and misuse of the DSM definition of "paraphilia." Sreenivasan and colleagues suggest antisocial personality disorder as an appropriate standalone diagnosis to replace "paraphilia" and report it has been allowable in 19 states, although it has been disallowed in New York state courts and in the federal courts. My contrasting view is that antisocial personality disorder is not an appropriate diagnosis in SVP cases because it overlaps almost completely with common criminality, holds only a very marginal place in psychiatric diagnosis, never serves as grounds for civil psychiatric commitment, and is never considered a valid psychiatric excuse to avoid prison for rape and therefore is not a legitimate psychiatric excuse for preventive incarceration after the criminal sentence has been served.