Other Specified Paraphilic Disorder: Patterns of Use in Sexually Violent Predator Evaluations

Area of Science:

• Forensic Psychology
• Psychiatric Diagnosis
• Legal Psychiatry

Background:

• Sexually Violent Predator (SVP) legislation requires a mental abnormality causing difficulty controlling sexual behavior.
• Paraphilia Not Otherwise Specified (NOS) was a prevalent diagnosis in SVP evaluations.
• The DSM-5 revised paraphilia NOS into other specified paraphilic disorder (OSPD) and unspecified paraphilic disorder, requiring specifiers for OSPD.

Purpose of the Study:

• To explore the frequency and diagnostic reliability of paraphilic disorders post-DSM-5 revision in SVP evaluations.
• To examine the impact of DSM-5 changes on diagnoses within civil commitment proceedings.

Main Methods:

• Analysis of diagnostic data from 190 adult men evaluated for SVP civil commitment.
• Utilized DSM-5 criteria for diagnosing paraphilic disorders.
• Assessed inter-rater reliability for OSPD diagnoses.

Main Results:

• Other Specified Paraphilic Disorder (OSPD) was the second most common paraphilic disorder, following pedophilic disorder.
• Inter-rater agreement for OSPD diagnosis was poor to fair (kappa = 0.21).
• The most common OSPD specifiers were non-consent and hebephilia, despite their contested status in DSM-5, with varied terminology used.

Conclusions:

• The DSM-5 revision has led to OSPD being a frequent diagnosis in SVP evaluations, but with significant reliability issues.
• Vague diagnostic tendencies and the use of contested specifiers raise concerns about the validity of these diagnoses.
• Reliable and valid diagnostic practices are crucial for SVP commitment, given its constitutional basis on mental abnormality.