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.

American Psychiatric Association representatives issue statement against Uganda's Anti-Homosexuality Bill

Earlier this evening, the American Psychiatric Association’s legislative body formally condemned the Anti-Homosexuality Bill in Uganda. Their action will now go to the APA Board of Trustees where it is expected to become official APA policy.
Although the bill appears to be finished for this Parliament, it may be back during the next one. The APA reps wanted to make clear to mental health professionals in Uganda that the proposed bill was counter to professional guidance. Here is the action paper:

Action Paper  
Title: Ugandan Anti-homosexuality Bill
Whereas:  The Hon. David Bahati, a member of the Ugandan Parliament, has introduced an Anti-Homosexuality Bill in the Ugandan Parliament calling for:

  1. Seven years of imprisonment for anyone who attempts to engage in homosexual contact
  2. Life imprisonment for anyone who engages in sexual penetration of a member of the same gender;
  3. Death for “aggravated homosexuality” which includes repeated offenses of homosexuality or engaging in a homosexual act while HIV-positive.
  4. Imprisonment of up to three years for failing to report violations of the statute within 24 hours of awareness of the offense

Whereas:  The bill is based on a misguided attempt to “protect” the traditional heterosexual family from corruption and to prevent the corruption of traditional Ugandan concepts of morality by Western influences;
Whereas: the bill is predicated on the assertion that “same-sex attraction is not an innate and immutable characteristic” and that Ugandans can be seduced into homosexuality if Western thought takes hold;
Whereas:  the Ugandan National Association of Social Workers has issued a position paper supporting the concept that homosexuality is pathological drawing from religious concepts and from “scientific” studies of 50 years ago that have long since been discredited by the scientific community;
Whereas:  the death penalty is mandated for HIV positive gay people who engage in same sex contact but a similar penalty is not mandated for HIV positive heterosexual people who engage in sexual relations despite the fact that, in Africa, the primary mode of HIV transmission is through heterosexual sexual contact;
Whereas:  the Ugandan tabloid, the Rolling Stone, called for gays to be lynched and published a list of people alleged to be gay;
Whereas:  at least one gay activist in Uganda has been murdered after being listed in the Rolling Stone — which Ugandan police have attributed to a robbery;
Be It Resolved: That the American Psychiatric Association reaffirms its position that there is no credible scientific evidence that same sex attraction is pathological, chosen, needs “cure,” or entails threat to heterosexual families or to children;
That the American Psychiatric Association condemns societal scapegoating and stigmatization of gay, lesbian, and bisexual people anywhere in the world;
That the American Psychiatric Association condemns criminalization of homosexual behavior and calls upon the Ugandan legislature to reject the Anti-Homosexuality Bill.
Refer to:  Council on Minority Mental Health and Health Disparities
Author or Authors:
David L. Scasta, M.D., DFAPA, AAOL for the Association of Gay and Lesbian Psychiatrists

I helped work on this paper and believe that, once official policy, the APA will use this statement to reach out to Uganda’s mental health and medical communities in the coming months.

APA issues statement regarding GID and the DSM-V

The American Psychiatric Association released a statement on Friday regarding some “inquiries about the DSM-V process.” I suspect many of those inquiries have focused on the disputes over treatment highlighted by the recent NPR broadcast on gender identity, often involving Dr. Ken Zucker. I asked Ken Zucker and Michael Bailey for their reactions to this press release from a transgender advocacy group. Dr. Zucker declined to comment, but sent the following APA statement. Dr. Bailey’s comment follows.

May 9, 2008
The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.
The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.
The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.
There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.
All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.
The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:
– Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
– Paraphilias, chaired by Ray Blanchard, Ph.D.
– Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.
Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.

Regarding the Transactive organization’s statement about the DSM-V, Dr. Bailey took strong exception to this statement:

“Zucker has stated that a secure gender identity possibly prevents the development of later homosexuality. This raised several red flags for those of us who work with gender non-conforming children, youth and their families. TransActive’s position is that “prevention of homosexuality” should not be the concern of childhood gender identity specialists.”

To which, Bailey said:

This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.

I agree with Bailey, I have seen nothing which would suggest Zucker has a stake in the eventual sexual orientation of children. And I certainly agree with the last sentence which has some special significance to me in light of the cancellation of the APA symposium.
In my opinion, there are some advocates who implore various audiences to trust science but really do not want this unless the outcome suits their advocacy goals.

The APA symposium on homosexuality, therapy and religion has been cancelled

What a difference a day makes.

The American Psychiatric Association program Homosexuality and Therapy: The Religious Dimension has been pulled by chair David Scasta. My understanding is that he was asked (by whom, I am still not clear) to pull the program because of increasing concerns about it. I am still hearing more about the reasons and hope to know something more clearly soon.

Dr. Scasta did tell me that the APA’s position is that the program was not pulled because gay activists were unhappy with it. At this moment, I am skeptical.

More to come…

American Psychiatric Association symposium on religion, therapy and homosexuality

I am looking forward to the May 5th symposium in Washington DC, hosted by the APA at their annual conference involving Bishop Gene Robinson, Southern Baptist Theological Seminary President, Al Mohler, Past-President of the Association of Gay and Lesbian Psychiatrists, David Scasta, Harvard psychiatrist John Peteet and me. Here is a rebuttal to a critical article from Wayne Besen about the symposium and brief coverage of the event by Citizenlink.