Does the APA consider hebephilia to be normal?

That question is being asked by Ray Blanchard in a letter to the editor (read entire letter here) of the Archives of Sexual Behavior. Blanchard is the former chair of the Paraphilias Subworkgroup of the APA’s DSM V Sexual and Gender Identity Disorders Workgroup. DSM stands for Diagnostic and Statistical Manual of the American Psychiatric Association. The new 5th edition is slated to be released any day now and has attracted much controversy for a variety of reasons.

Generally, there is no more controversial area of the DSM than the section on sexual disorders. Blanchard’s subworkgroup recommended including reference to hebephilia in the section on paraphilias in the new edition. Hebephilia is defined as primary sexual interest in children who are in early puberty (i.e., at Tanner Stages 2 and 3, often corresponding to development between ages 11 and 14). Blanchard begins his letter by noting that “on December 1, 2012, the American Psychiatric Association (APA) announced that its Board of Trustees (BOT) had voted to reject the changes to the diagnostic criteria for pedophilic disorder proposed by the Paraphilias Subworkgroup for DSM-5 and to retain the diagnostic criteria published in DSM-IV-TR [i.e., a sexual preference for prepubertal, i.e., Tanner Stage 1, children, nowadays about age 10 or younger].”

Blanchard believes the proposed change would have allowed more precise diagnosis and research of people who have sexual preferences for early pubescent children but not younger, pre-pubescent children or adults. However, for reasons that are not clear, the APA Board of Trustees did not accept the recommended changes.

The fact that the APA did not make this change raises questions. Blanchard asks if the APA wants to discourage research on hebephilia. Furthermore, Blanchard wonders if the current DSM allows for hebephilia to be diagnosed under the category “other specified paraphilic disorder.” In other words, can clinicians and researchers use the “other” category to give label to individuals with hebephilia.  Ultimately, according to Blanchard, the answers to these questions may provide insight into the APA’s stance on normal sexual preferences. He writes

It remains to be seen how the BOT [board of trustees] will respond to these questions when they start to arise in real-life settings, which they will. It seems to me that there are only two possibilities. If the BOT denies that it meant to assert that the sexual preference for children in early puberty is normal, then it has to allow the diagnosis of ‘other specified paraphilic disorder (hebephilia).’ If the BOT, or someone officially speaking on behalf of the BOT or the whole APA, states or testifies that the BOT intended to prohibit the diagnosis of ‘other specified paraphilic disorder (hebephilia),’ then that is tantamount to stating that the APA’s official position is that the sexual preference for early pubertal children is normal.

Elsewhere in his letter, Blanchard states that sexual preference for early pubertal children doesn’t “square with the average layperson’s concept of sexual normalcy and probably does not square with the average clinician’s either.” I agree and believe Blanchard raises some important issues which I hope the APA will address.

Note: On May 16, I asked the APA PR dept for comment on Blanchard’s letter. No response as of today (May 17). I will post anything I get.

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  • StraightGrandmother

    I just feel sorry for people who research in this area. It is so creepy.

    • Nick

      That actually says more about you than “this area” or the people researching “it”.

  • Patrocles

    The idea seems to be: If something isn’t normal, it’s a disorder: if it isn’t a disorder, it’s normal.

    There are some other words which might be relevant for the debate: From the view of a sociologist/anthropologist: “usual”vs.”unusual” or “deviant”. From the view of the medical profession: “”healthy” vs. “ill/sick” or possibly “handicapped”. From the viewpoint of ethics: “good” vs. “bad”.

    All those three viewpoints are clearly different and all are clear and logical in itself.

    Is the psychiatrical viewpoint more than a rather unclear and illogical mix of sociological, medical and ethical aspects?

  • David Blakeslee

    Warren you may remember the study which sought to underscore that some forms of sexual contact with minors did not result in “harm.” It created quite an uproar…

    I know you are trying to do your best to be fair and scientific, but do your realize that science really can’t comment on moral good…only utilitarianism?

  • carole

    And it doesn’t seem to square with biology either —male attraction to females in early puberty (no matter what age that puberty is or has been throughout human history or from culture to culture or race to race) can produce pregnancy, pregnancies that don’t end well for either the girl or the fetus.

  • Tom Van Dyke

    Blakeslee: Warren you may remember the study which sought to underscore that some forms of sexual contact with minors did not result in “harm.” It created quite an uproar…

    I know you are trying to do your best to be fair and scientific, but do your realize that science really can’t comment on moral good…only utilitarianism?

    This is the modern theo-philosophical conundrum vs. modernity, “science.”

    I respect that Warren’s between a rock and a hard place. You certainly can’t let your religion or philosophical principles deny reality, that leads to doom. And If “science” says there’s no harm, theology or philosophy are excluded from the question of “is it good?” [Or bad, or abnormal, or whatnot. Who's to say?]

    It’s a hard case to even begin to make, that “neutrality” isn’t neutral, because “science” sets the rules of “neutrality.” Ed Feser is a great thinker, but I’m not sure even here gets very far.

    http://www.edwardfeser.com/unpublishedpapers/libertarianimpartiality.html

  • Zoe Brain

    Dr. Ray Blanchard answering a question:

    Do you think autoandrophelia, where a woman is aroused by the thought of herself as a man, is a real paraphelia?

    No, I proposed it simply in order not to be accused of sexism, because there are all these women who want to say, “women can rape too, women can be pedophiles too, women can be exhibitionists too.” It’s a perverse expression of feminism, and so, I thought, let me jump the gun on this. I don’t think the phenomenon even exists.

    After that admission, I don’t see a reason for taking anything he says seriously.

  • ken

    As previously mentioned, simply because something may not be considered “normal” does not automatically make it a “disorder.” Further, there really is no clear cut definition of what constitutes a psychological disorder.

  • Warren

    Zoe – Because a person says something odd does not automatically disqualify everything else they say. Blanchard has inside information and knows the process well. I think he asks reasonable questions in this case, ones I hope the APA will address (I have written them to ask).

    ken – Establishing the definition of a disorder was Spitzer’s contribution to the DSM, although most would not consider his approach perfect. However, there are criteria involving distress and hindrance to self that are in place. Bottom line is that it is inexact and the DSM has erred on many points. I don’t think that fact can invalidate Blanchard’s key question about the normalcy of primary sexual interest in stage 2-3 children.

  • ken

    Warren says:

    May 17, 2013 at 6:57 am

    “I don’t think that fact can invalidate Blanchard’s key question about the normalcy of primary sexual interest in stage 2-3 children.”

    I wouldn’t call what Spitzer contributed a “definition.” Mostly he suggested some guidelines/criteria to examine. Determining whether something should be considered a psychological disorder is still more of an art than a science.

    However, Blanchard’s “key question” sets up a false dichotomy, either it is “normal” or “disorder.” Just because the APA BOT may not have thought hebephilia was significant enough to be listed in the DSM-5 as a disorder, does not mean they consider it “normal.’

  • Richard Willmer

    As an educator, I think clarity on this area is incredibly important. I’m no expert in this field, and have no inclination to offer any kind of assessment of Blanchard’s proposal.

    I would like to offer a perspective from my own experience. I used to head up a multi-disciplinary programme for learners aged 16 to 19, and was very conscious of those learners arriving as ones who often functioned as children and leaving as adults (I remember a progress review with one learner who was approaching the end of the programme – at the end of the dialogue of I suddenly thought to myself “My goodness, N, you’re a man now!”).

    I’m sure that what is being discussed here is important, but I’m also convinced that what many call ‘the invisible change’ is also worthy of very serious consideration.

  • Zoe Brain

    Warren –

    Because a person says something odd does not automatically disqualify everything else they say.

    As the chair of the Paraphilias subgroup, proposing a diagnosis he doesn’t believe exists for purely political reasons pretty much does disqualify him.

    That’s not just “something odd”, it means the process is corrupt.

    Then he says:

    I don’t think we should promulgate untruths for the sake of political agendas, even if they are worthwhile political agendas.

    http://motherboard.vice.com/blog/heres-how-the-guy-who-wrote-the-manual-on-sex-talks-about-sex

    I have issues with Blanchard in the way that he has little understanding of how fraught the concept of “biological sex” is – he apparently defines it by whatever was written on a birth certificate, certainly not anything to do with biology or anatomy. But that’s another matter.

  • Zoe Brain

    Then there’s this:

    Do you think that classifying transgender people as having a disorder does contribute to stigma against the trans community?

    No. I mean how many people who make a joke about trannies consult the DSM first?

    Such obtuseness is remarkable.

    Good that the security was on the ball. There could have been children in there.

    Just because you have the officially classed mental disease Gender Dysphoria does not entitle you to actually use opposite sex facilities such as changing rooms or toilets, especially where there are children.

    Lycanthropics have a mental disease where they actually think they are wild beasts. Such illnesses should be treated with psychiatry, not accommodation.

    Source:

    http://www.pinknews.co.uk/2013/05/17/scotland-trans-woman-threatened-with-ban-from-shopping-centre-for-using-ladies-toilets/comments/#comment-441308

    So in a way psychiatric research is inherently gender normative?

    I would say medical research is inherently gender normative.

    With results like this….

    The Southern Poverty Law Center and Advocates for Informed Choice have filed a lawsuit against the South Carolina Department of Social Services (SCDSS), Greenville Hospital System, the Medical University of South Carolina, and several medical personnel for allowing physicians to remove the atypical genitals of a 16-month-old toddler because that child, in the state’s custody at the time, was born with an intersex condition. M.C. had been identified male at birth, but his genitals were sufficiently indeterminate that surgeons removed his ambiguous phallus, a testis, and testicular tissue on one gonad, and surgically created an ostensible approximation of female genitals. The suit asserts that there was no medical need for this surgery, which was meant to permanently “fix” this child and turn him into an unequivocal girl, but it did him more harm than good. M.C., now eight years old, feels more like a boy, lives as a boy, and heartbreakingly has asked his mother, “When will I get my penis?”

    “Even though the doctor admitted that John seemed happily male, he still wondered about ovary implantation to force John to live as Frances against his own wishes. The mistake of the excised penis would then be negated, but at the expense of John’s inclination….”

    Source:

    http://nursingclio.org/2013/05/17/do-no-harm-intersex-surgeries-and-the-limits-of-certainty/

  • Richard Willmer

    I can see why you might have issues with B’s treatment of sex and gender, Zoe. I certainly do, in part because I find the style of some of his answers on the link you posted rather crass and diminishing (eg. he uses the phrases such as “making jokes about trannies” – which strikes me as inappropriate in the context of a serious interview). Perhaps he’s trying to be ‘cool’; I think it’s just poor taste. I don’t like it at all.

  • Boo

    There’s also the issue that under Blanchard’s view, a disorder can be defined by the reactions of other people, despite DSM IV clearly stating that social noncomformity is not to be taken as evidence of mental disorder (else once upon a time, and even in many cultures today, Christianity could be labelled a mental disorder) and that his bizarre views on sex and reproduction makes a Quiverfull couple more “normal” (unless they live in a neighborhood where everyone else thinks they’re weirdos? I guess?) than a couple that uses contraception. His “scientific” views seem almost totally subjective.

  • Zoe Brain

    I have a comment in moderation that addresses other difficulties too, but I think Boo’s one really hits the bullseye.

    There is no objective standard. It’s about “obnoxiousness” to others, not based on objective criteria such as informed consent.

    We saw this in some of the early discussions, where it was proposed that anyone who was attracted to a Trans or Intersex person should be regarded as “mentally ill” because most people found that icky, and because it went against “healthy reproduction”. Even if it was an attraction to a particular individual, and not Trans or Intersex people in general.

    I’m on record as saying there’s more to Love (eros) than just sex. Well there’s more to sex than just reproduction. The minor criterion he uses – that of reproductive ability – is hopelessly narrow, even eccentric. The major criterion – that of social acceptability – goes against any rational definition of pathology.

    It’s this subjectivity that makes me distrust anything Blanchard has to say on Hebephilia, or indeed, anything else.

  • Zoe Brain

    One point I agree with Blanchard on: Reality wins in the end. I’ve had no end of criticism from those who say my research results are harming the cause of social justice, and asking what my agenda is.

    My agenda is to determine the truth, however imperfectly. When facts change, I change my opinions. I don’t conceal evidence “harmful to my cause”, and if I find it sufficiently compelling, I change my cause to accommodate it. I make no apology for that.

    I’ve had rather more critics attack me (not my work, me) as being part of some worldwide evil-utionist conspiracy. All I can do in such cases is quote the evidence, ask for contradictory evidence, or a better interpretation of it than my own.

    This isn’t new.

    “Those who assert that ‘the earth moves and turns’…[are] motivated by ‘a spirit of bitterness, contradiction, and faultfinding;’ possessed by the devil, they aimed ‘to pervert the order of nature.’”

    - John Calvin, sermon no. 8 on 1st Corinthians, 677, cited in John Calvin: A Sixteenth Century Portrait by William J. Bouwsma (Oxford Univ. Press, 1988), A. 72

    I get a lot of that.

  • Richard Willmer

    “I think Boo’s [comment] really hits the bullseye.” – Zoe

    I agree (you got there first, Zoe!). I’m not an expert on what rightfully constitutes ‘pathology’, but – as a layman – I would have thought that it concerns a degree actual or harmful material EFFECT on self or others. If people find the reality of the existence of transgendered or transsexual persons a ‘problem’, then it is ‘their problem’, not that of the transgendered or transsexual person. If someone is harmed by, say, a paedophile, then it should be understood that the problem is with the paedophile.

    However, I agree with what I think Warren is saying that as Blanchard’s ideas relating to hebephilia should, at least in the first instance, be assessed on their own merits. (Perhaps the APA shares [some of] Zoe’s concerns regarding other aspects, and is therefore wary about giving credence to what he [Blanchard] is saying on this particular matter? I could understand such a thing.)

  • Zoe Brain

    I guess it doesn’t matter who says something. If it’s true, it’s true, if false, false. I think that’s what Warren was trying to convey.

    My concern is that the whole “social acceptability” thing is dangerous.

    Viz: http://www.mohabatnews.com/index.php?option=com_content&view=article&id=4923:iran-seeks-to-legalise-marriage-for-girls-under-10&catid=35:inside-iran&Itemid=278

    Ray Blanchard’s views are based on very conservative religious values, traditional ones one might say. So are those of Mohammad Ali Isfenani.

    I prefer more objective standards, regarding harm and consent, not “Ick” factors. Otherwise we have situations where one man’s Mede is another man’s Persian, and there are no limits other than cultural ones.

  • Zoe Brain

    I also have real difficulty regarding the use of Tanner stages.

    Is attraction to an 8 year old at Tanner stage IV pathological? What about to a 21 year old at Tanner stage II? (That latter describes me pretty well as of 1979 BTW)

    See

    Rosenbloom AL, Tanner, JM (1998). “Misuse of Tanner Puberty Stages to Estimate Chronologic Age”. Pediatrics 102 (6): 1494.

    Is it all about appearance? Knowledge of the person’s age? Knowledge of their ability to consent? What about those who are physically mature, but mentally incompetent? Mentally and chronologically mature, but physically undeveloped?

    Blanchard’s letter seemed very confused to me. I can see why the APA decided not to open this can of very wriggly worms, though I think they should have.

  • Richard Willmer

    Agreed, Zoe – “social acceptablitiy” as a criterion as about as relativistic as one can get!

    There is a indeed a ‘can of worms’ here: while there are clear ‘patterns’ that apply to many people, there are also a good many exceptions. This is one of the things that makes ‘public policy’ (on more or less anything) such a involved matter. And whether something is effectively ‘sociopathic’ can also depend on circumstances: it was IMO a good thing that the UK Sexual Offences (Amendment) Act 2000 (which is best known for doing away with discriminatory laws against lesbians and gay men), that the concept of ‘abuse of a position of trust’ was introduced and, with it, differientated ages of consent. (One might argue about what those ages should be, but the principle is an important one.)

  • Boo
  • Patrocles

    There’s something which I find most disinquieting. Psychiatry began as a part of the medical profession, which helps people from pains or harms they themselves have. But by and by, people began to think that psychiatrists should treat people who inflict harm on others. (Which made psychiatry a rival to penal law and education and which has led to the excesses of political psychiatry.)

    Perhaps we must honestly accept the idea that psychiatrists are to treat persons for inflicting harm on others.

    However, Dr. Throckmorton above relies on Spitzer’s definition of disorder which implies criteria like “distress and hindrance to self”. The danger I see is that psychiatrists have to be intellectually dishonest – meaning actually that the hebephilist or whoever does harm to others, but acting under the pretext that he is distressed and a hindrance to himself. Intellectual dishonesty is a hindrance to psychiatry!!

  • Richard Willmer

    Boo : It certainly shows up the limits of ‘law’ as a means of dealing with consensual sexual relations, as well as the differences between different jurisdictions (assuming no ‘abuse of a position of power’, this situation would have been entirely ‘legal’ in France, Germany, Spain, Estonia, Sweden, Slovenia …).

    The sad thing about a situation like this is that all the hullabaloo generated by bringing charges etc is probably going to be far more damaging to both of these students than would be a more flexible, discreet and ‘pastoral’ approach. The 15 yo’s parents have IMO made a bad mistake by making an ‘public issue’ of the relationship.

  • Richard Willmer

    (No comments about ‘immoral Europeans’, please – or I might wheel out some statistics!!! And we wouldn’t want that now, would we?! :-) )

  • Boo

    Which one is mentally ill? The older girl or the more developed girl?

  • Richard Willmer

    The parents perhaps?! (Just a thought.)

  • ken

    Boo says:

    May 19, 2013 at 3:17 pm

    “Which one is mentally ill?”

    The story you cited isn’t a matter of mental illness, it is a matter of law. Big difference.

  • Zoe Brain

    Note that the age of the suspect doesn’t make a difference.

    Even if she was 14, not 17, she could have been charged with one of the offences.

    Florida state law was pretty good – lots of appropriate penalties for actual paedophilia in section 794 if memory serves.

    e.g.

    http://www.flsenate.gov/Laws/Statutes/2012/794.05

    Then they added section 800, which made any “sexual contact” by anyone of any age with a 15 year old a class II felony, something far worse than mere rape or kidnapping.

    http://www.flsenate.gov/Laws/Statutes/2012/800.04

  • Boo

    Ken- but Blanchard would make one or both of them mentally ill. If we go by age, then the older one. If we go by development, possibly the younger one. Which do you pick?

  • ken

    Boo says:

    May 19, 2013 at 11:03 pm

    “but Blanchard would make one or both of them mentally ill. ”

    No, I doubt he would. Hebephilia isn’t based n a single relationship but a pattern of desire.

    “Which do you pick?”

    neither, and I suspect Blanchard would say the same thing.

  • Zoe Brain

    Boo – you hit the bullseye again. That encapsulates the issue exactly.

    I think this brings into disrepute the whole concept of “mental illness”. I’d even call it insane :)

  • Boo

    Ken- I suspect the 18 year old has a regular pattern of being attracted to girls the age of her girlfriend, and I suspect the 15 year old has a regular pattern of being attracted to girls at the developmental stage of her girlfriend. So yeah, you kinda dodged it.

    Zoe- I wouldn’t go that far, I’d just say that highlights the danger of using the mental health profession as an instrument of social control, and that Blanchard is too arrogant to recognize his biases and too hung up on his own subjective definition of “normal.”

  • ken

    Boo says:

    May 20, 2013 at 8:50 am

    “I suspect the 18 year old has a regular pattern of being attracted to girls the age of her girlfriend, and I suspect the 15 year old has a regular pattern of being attracted to girls at the developmental stage of her girlfriend. ”

    You can determine a pattern from a single data point?

    “I’d just say that highlights the danger of using the mental health profession as an instrument of social control,”

    Except your article isn’t an example of “using the mental health profession” for social control. The case in question has nothing to do with whether hebephilia is a disorder or not (or whether either of the girls in question could be diagnosed with it).

  • buddyglass

    Maybe this means I’m a hebephile, but I can say with some certainty that I’ve been attracted to 13 year olds before. Not least of which when I was that age myself. That would have been 7th-8th grade. By that age (many of) the girls at my school had developed visible sexual characteristics, the existence of which I was keenly aware (as, I expect, are most thirteen year old boys). Not coincidentally, that’s approximately the age (if not a year or two earlier) at which I started masturbating regularly, often while fantasizing about my female classmates. In hindsight I see this for what it is: lust, and therefore sin. But I also recognize that it’s fairly “normal” behavior.

    Is the expectation, then, that at some point a developing male will cease to find attractive the same females he formerly found intensely sexually attractive? Not sure that’s realistic. Especially given the wide variation in sexual development at that age. (Some thirteen year olds could pass for sixteen, if not older.)

    What I do affirm is that it’s pathological for an adult male to *prefer* thirteen year olds over older girls/women. And it’s definitely pathological for an adult male to *act* on any attraction he might feel toward a thirteen year old. In that case, though, the pathology isn’t the attraction per se, but the lack of good judgment and impulse control.

  • Boo

    Ken- you think that teenagers aren’t usually attracted to other teenagers? And I’m not talking about the article by itself as an example, but how Blanchard’s expressed views and those of the mental health profession in general) would apply to the girls in the article.

  • ken

    Boo says:

    May 20, 2013 at 10:20 am

    “you think that teenagers aren’t usually attracted to other teenagers?”

    No, I don’t think that. What I think is that that is NOT an example of hebephilia.

    “Blanchard’s expressed views and those of the mental health profession in general) would apply to the girls in the article.”

    How have you determined that Blanchard would say the case you cited was an example of hebephilia?

  • Zoe Brain

    Note that in this case, the15 yr old was at a later Tanner stage, and in the same school class. If you see the two together, she looks the older of the two.

  • Boo

    Ken- I’m basing it on what Blanchard already has said, not on what he or you would say. By his own previously expressed criteria, one or both of those girls must be mentally ill.

  • ken

    Boo says:

    May 21, 2013 at 10:01 am

    “I’m basing it on what Blanchard already has said, not on what he or you would say. By his own previously expressed criteria, one or both of those girls must be mentally ill.”

    Can you give me a citation for where you got what Blanchard said? I’d like to read it for myself. Because I doubt very much he said that a single instance of attraction would qualify. And more importantly how you determined the tanner staging for these girls?

    It seems to me Boo, that you are deliberately exaggerating this case to put words in Blanchard’s mouth.

  • Boo

    So once again, Ken, are you seriously trying to claim that it is even plausible that this is the only time either of those teenaged girls had ever been attracted to another teenager? Or are you deliberately just going around in circles?

  • ken

    Boo says:

    May 21, 2013 at 2:00 pm

    “are you seriously trying to claim that it is even plausible that this is the only time either of those teenaged girls had ever been attracted to another teenager? ”

    I never suggested any such thing. In fact I explicitly said that situation DOES NOT MATTER. Teenagers being attracted to other teenagers is NOT an example of hebephilia. And until you can cite a direct quote from Blanchard where he said it was an example of it, I stand by my assertion you are just exaggerating this case for your own purposes.

  • Christopher Doyle

    Warren,

    Any update on this?

    Best,

    Christopher Doyle

  • Warren Throckmorton

    No update on this but I see you have updated your position. In a comment here you said

    have stopped writing such articles a couple of years ago, after I had a change of heart and mind regarding the LGBT community. I apologized for my insensitive remarks, a couple of times: http://www.christianpost.com/news/day-of-silence-revisited-73597 and also once in our IHF newsletter in 2011.

    Then I saw where you are dragging in Jerry Sandusky to your opposition to the New Jersey bill on reparative therapy for minors.

    Since the New Jersey bill does not forbid treatment for sexually abused youth, your only purpose has to be to make a spurious link between SSA and childhood sexual abuse. Casting gays as sexual predators is about as offensive and insensitive as it gets. So you certainly haven’t stopped writing such articles.

  • Boo

    Ken- but one teenager is considered an adult.

  • Patrocles

    Dear Dr. Throckmorton,

    “Casting gays as sexual predators is about as offensive and insensitive as it gets.”

    You wouldn’t call Jerry Sandusky gay? Or you wouldn’t think that there are more men like Sandusky? And how would you then explain the fact that there are tons of man-boy porn videos in the Internet, mostly between other porn videos about man-man sex?

    I may have misread you, but at this moment I simply don’t understand your position.


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