Hypersexuality in the DSM: A threat to constitutional rights

The controversial proposal of adding Hypersexual Disorder to the DSM must be seen against so-called Sexually Violent Predator (SVP) commitment, in which 20 US states and US Federal Government label some sex offenders as “sexually violent predators”, (or a similar term) in order to detain them after completing their prison sentences, although no violent behavior is actually required for this designation. If this were further punishment, it would be unconstitutional, so these people are being held not for anything they have done, but for some future crime they may or may not commit if released. SVP commitment is extremely expensive, does little to decrease sexual violence and our ability to predict future crime is not very good.

The US Supreme Court narrowly upheld these laws in Kansas v. Hendricks in a 5-4 decision, where the majority of the Court accepted Kansas' claim that this is not punishment. Part of its alleged constitutionality is that some “mental disorder” is necessary for a person to be detained under these laws. However, many people that zealous prosecutors and forensic evaluators want to lock up are not diagnosable with anything widely recognized as a mental disorder. The result has been making up disorders to detain people. Often the only “evidence” that the person has a “mental disorder” is that they committed crimes. In a recent editorial by Drs. Martin Kafka and Richard Krueger, both members of the DSM-5 Paraphilias Subworkgroup, they essentially admitted that this is a primary aim for adding Hypersexual Disorder to the DSM.

During the past 35 years…sexual crimes have been substantively demonized, civil commitment proceedings for sexual crimes have been reinstituted in 20 states in the U.S. and periods of incarceration have increased as a result (Mears, 2010). During this time frame, hypersexuality as a dimensional measure of sexual behavior associated with paraphiliashas been identified as an important factor associated with recidivistic sexual offending (Hanson & Morton- Bourgon, 2004). We would argue that the absence of an operationalized categorical diagnosis incorporating specific components of dimensional hypersexuality has significantly contributed to the problematic misuse of Not Otherwise Specified (NOS) sexual diagnoses during civil commitment hearings (Becker, Stinson, Tromp,&Messer, 2003; Levenson, 2004; Zander, 2008). Rather than attorneys encouraging sexual offenders to conform to the diagnosis of HD as a mitigating factor or behavioral "excuse", we would contend that introducing an operationalized, polythetic and evidence-based ‘‘disorder’’ category could also reduce the misuse of Sexual Disorder NOS designations in both court and non-forensic clinical settings (Prentky et al., 2006).

To read between the lines (or just read the lines themselves)?: People believing themselves to be protecting society who do not mind violating basic constitutional rights in the process (and need some sort of "mental disorder" diagnosis to do this) have just been making stuff up (NOS diagnoses) to do this. Krueger and Kafka suggest that the reason that they're just making stuff up is because there is not anything presently in the DSM to get the job done and that adding Hypersexual Disorder to the DSM would reduce this. Essentially: if we give crusading prosecutors and forensic evaluators a bogus diagnosis that's actually in the DSM to use to lock up people in the SVP prison-like facilities, then they won't make up bogus ones that aren't in the DSM! While some defenders of the Subworkgroup’s proposals dismiss such claims as “conspiracy theories”, it seems to me the only sensible interpretation of Kafka and Krueger’s comment.

The Paraphilias Subworkgroup has decided not to include Hypersexual Disorder in the DSM and now the Sexual Dysfunction Subworkgroup is considering adding it to the appendix, under conditions deserving further research. Even this would be giving too much ground, as it would legitimatize its use as a Sexual Disorder: NOS and contribute to depriving people of constitutional rights to lock them up in SVP money-pits.

Andrew Hinderliter runs the Asexual Explorations web site and the Asexual Explorations blog. Asexual Explorations provides in-depth analsysis of the Academic Issues surrounding Asexuality.

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