Reliability and validity of the DSM-IV-TR and proposed DSM-5 criteria for pedophilia: Implications for the ICD-11 and the next DSM.
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).
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada. Electronic address: Michael.Seto@theroyal.ca.
Michael C
MC
Seto
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
J Paul
JP
Fedoroff
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
John M
JM
Bradford
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Natasha
N
Knack
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Nicole C
NC
Rodrigues
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Susan
S
Curry
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Brad
B
Booth
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Jonathan
J
Gray
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Colin
C
Cameron
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Dominique
D
Bourget
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Sarina
S
Messina
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Elizabeth
E
James
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Diane
D
Watson
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Sanjiv
S
Gulati
Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Rufino
R
Balmaceda
Forensic Research Unit, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Integrated Forensic Program, Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
Adekunle G
AG
Ahmed
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D038801:International Classification of Diseases; D010378:Pedophilia / Q000175:diagnosis* / Q000523:psychology; D015203:Reproducibility of Results; D012725:Sexual Behavior; D055815:Young Adult
Criterion-related validity; DSM-5, DSM-IV-TR; Diagnosis; ICD-11; Inter-rater reliability; Pedophilia