Mapmedicalism

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Mapmedicalism is an ideological stance in MAP discourse. It denotes the belief that being a MAP is a mental disorder.

History

The first documented usage of the term or something adjacent was by the medicalist MAP Lo on NNIA.space in February 2021[1]. The conversation went as follows:

@[email protected]: I'm a MAPmed

@[email protected] does it mean you believe being a map is a medical condition, or..?

@[email protected] I see it as a disordered sexual orientation.

@[email protected] why disordered?

@[email protected] if acted on its inherently damaging. If not acted on it leaves the person with a lifetime of never truly being sexually or romantically satisfied. You can get laid elsewhere if course, and you can still find love (obvs I mean I'm married), but there will always be that lacking.

@[email protected] an unfortunate life situation is not inherently a medical issue.

A few other NNIA users have occasionally used the term in discussions about the medicalization of mapness as well. Unfortunately, records of these posts cannot be retrieved at this time. MAP blogger Ethan Edwards has expressed being favorable to classifying pedophilia as a mental disorder[2].

Other people have attempted to define mapness as a mental disorder both to justify stigmatizing MAPs[3][4][5][6] as well as to justify destigmatizing MAPs[7][8][9][10][11][12][13].

Roots

Presumably, the terms "mapmed," "mapmedicalist," and "mapmedicalism" were inspired by their parallels to transmedicalism, an ideology denoting the belief that being transgender inherently constitutes a mental disorder (and thus a medical issue condition) because one must have a specific mental "disorder" (gender dysphoria) to be "actually trans." The suffix -medicalism has been used to name other ideologies since then, such as system medicalism or "sysmedicalism," an ideology in part centered around the belief that being a system inherently constitutes a mental disorder because one must have a specific mental disorder (Dissociative Identity Disorder, Other Specified Dissociative Disorder subtype 1, or Unspecified Dissociative Disorder) to be "actually a system."

Academic precedents

The World Health Organization's International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) classified "paedophilia" ("a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age") as a "disorder of sexual preference."[14] The ICD-11 changed the category to "paraphilic disorders."[15]

Paraphilic Disorders are characterized by persistent and intense patterns of atypical sexual arousal, manifested by sexual thoughts, fantasies, urges, or behaviours, in which the focus of the arousal pattern involves others whose age or status renders them unwilling or unable to consent (e.g., pre-pubertal children, an unsuspecting individual being viewed through a window, an animal). Paraphilic Disorders may also involve other atypical sexual arousal patterns if they cause marked distress to the individual or involve significant risk of injury or death.


Paraphilic Disorders include the following:

6D30 Exhibitionistic Disorder
6D31 Voyeuristic Disorder
6D32 Pedophilic Disorder
6D33 Coercive Sexual Sadism Disorder
6D34 Frotteuristic Disorder
6D35 Other Paraphilic Disorder Involving Non-Consenting Individuals


In order for the above Paraphilic Disorders to be diagnosed, the individual must have acted on the arousal pattern or be markedly distressed by it.

In addition, the following diagnosis may be assigned to describe persistent and intense patterns of atypical sexual arousal—manifested by sexual thoughts, fantasies, urges, or behaviours—that involve consenting adults or solitary behaviours, as long as either: 1) the person is markedly distressed by the nature of the arousal pattern and the distress is not simply a consequence of rejection or feared rejection of the arousal pattern by others; or 2) the nature of the paraphilic behaviour involves significant risk of injury or death (e.g., asphyxophilia or achieving sexual arousal by restriction of breathing).


6D36 Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals

Atypical patterns of sexual arousal that do not involve actions towards others whose age or status renders them unwilling or unable to consent or that are not associated with marked distress or significant risk of injury or death are not considered to be Paraphilic Disorders.

Many sexual crimes involve actions or behaviours that are not associated with a sustained underlying paraphilic arousal pattern. Rather, these behaviours may be transient and occur impulsively or opportunistically, or in relation to substance use or intoxication. A diagnosis of a Paraphilic Disorder should not be assigned in such cases.

Its entry on "Pedophilic disorder":[16]

Pedophilic disorder is characterised by a sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children. In addition, in order for Pedophilic Disorder to be diagnosed, the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them. This diagnosis does not apply to sexual behaviours among pre- or post-pubertal children with peers who are close in age.

Diagnostic Requirements


Essential (Required) Features:

A sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children. The individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them.

The diagnosis does not apply to sexual arousal and accompanying behaviour between pre- or post-pubertal children who are close in age.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), a publication by the American Psychiatric Association (APA) for the classification of mental disorders, made similar changes which depathologized pedophilia and other paraphilias in recent versions. Page 5 of Malon (2012) gives an quick organized overview of the how the DSM's diagnosis of pedophilia has evolved[17].

The first version of the DSM to discuss paraphilias was the DSM-III (1980)[18].

PARAPHILIAS

The essential feature of disorders in this subclass is that unusual or bizarre imagery or acts are necessary for sexual excitement. Such imagery or acts tend to be insistently and involuntarily repetitive and generally involve either: (1) preference for use of a nonhuman object for sexual arousal, (2) repetitive sexual activity with humans involving real or simulated suffering or humiliation, or (3) repetitive sexual activity with nonconsenting partners. In other classifications these disorders are referred to as Sexual Deviations. The term Paraphilia is preferable because it correctly emphasizes that the deviation (para) is in that to which the individual is attracted (philia).

The imagery in a Paraphilia, such as simulated bondage, may be playful and harmless and acted out with a mutually consenting partner. More likely it is not reciprocated by the partner, who consequently feels erotically excluded or superfluous to some degree. In more extreme form, paraphiliac imagery is acted out with a nonconsenting partner, and is noxious and injurious to the partner (as in severe Sexual Sadism) or to the self (as in Sexual Masochism).

Since paraphiliac imagery is necessary for erotic arousal, it must be included in masturbatory or coital fantasies, if not actually acted out alone or with a partner and supporting cast or paraphernalia. In the absence of paraphiliac imagery there is no relief from nonerotic tension, and sexual excitement or orgasm is not attained. The imagery in a paraphiliac fantasy or the object of sexual excitement in a Paraphilia is frequently the stimulus for sexual excitement in individuals without a Psychosexual Disorder. For example, women's undergarments and imagery of sexual coercion are sexually exciting for many men; they are paraphiliac only when they become necessary for sexual excitement.

The Paraphilias included here are, by and large, conditions that traditionally have been specifically identified by previous classifications. Some of them are extremely rare; others are relatively common. Because some of these disorders are associated with nonconsenting partners, they are of legal and social significance. Individuals with these disorders tend not to regard themselves as ill, and usually come to the attention of mental health professionals only when their behavior has brought them into conflict with society. The specific Paraphilias described here are: (1) Fetishism, (2) Transvestism, (3) Zoophilia, (4) Pedophilia, (5) Exhibitionism, (6) Voyeurism, (7) Sexual Masochism, and (8) Sexual Sadism. Finally, there is a residual category, Atypical Paraphilia, for noting the many other Paraphilias that exist but that have not been sufficiently described to date to warrant inclusion as specific categories.

The DSM-III labeled attraction to children alone as sufficient to constitute a disorder, even without any additional specifiers of distress[19]

302.20 Pedophilia

The essential feature is the act or fantasy of engaging in sexual activity with prepubertal children as a repeatedly preferred or exclusive method of achieving sexual excitement. The difference in age between the adult with this disorder and the prepubertal child is arbitrarily set at ten years or more. For late adolescents with the disorder, no precise age difference is specified; and clinical judgment must be used, the sexual maturity of the child as well as the age difference being taken into account.

Isolated sexual acts with children do not warrant the diagnosis of Pedophilia. Such acts may be precipitated by marital discord, recent loss, or intense loneliness. In such instances the desire for sex with a child may be understood as a substitute for a preferred but unavailable adult.


Diagnostic criteria for Pedophilia

    1. The act or fantasy of engaging in sexual activity with prepuhertal children is a repeatedly preferred or exclusive method of achieving sexual excitement.
    2. If the individual is an adult, the prepubertal children are at least ten years younger than the individual. If the individual is a late adolescent, no precise age difference is required, and clinical judgment must take into account the age difference as well as the sexual maturity of the child.

The DSM-III-R (1987) added to the criteria distress and/or offending[20].

302.20 Pedophilia

The essential feature of this disorder is recurrent, intense, sexual urges and sexually arousing fantasies, of at least six months' duration, involving sexual activity with a prepubescent child. The person has acted on these urges, or is markedly distressed by them.


Diagnostic criteria for 302.20 Pedophilia

    1. Over a period of at least six months, recurrent intense sexual urges and sexually arousing fantasies involving sexual activity with a prepubescent child or children (generally age 13 or younger).
    2. The person has acted on these urges, or is markedly distressed by them.
    3. The person is at least 16 years old and at least 5 years older than the child or children in A.

The DSM-IV (1994) labeled "pedophilia" as a disorder, but its criteria technically excluded non-distressed pedophiles who had never offended[21]

Paraphilias

Diagnostic Features

The essential features of a Paraphilia are recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one's partner, or 3) children or other nonconsenting persons, that occur over a period of at least 6 months (Criterion A). For some individuals, paraphiliac fantasies or stimuli are obligatory for erotic arousal and are always included in sexual activity. In other cases, the paraphiliac preferences occur only episodically (e.g., perhaps during periods of stress), whereas at other times the person is able to function sexually without paraphiliac fantasies or stimuli. The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion B).


Differential Diagnosis

A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviors, or objects are paraphiliac only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere with social relationships).

Diagnostic criteria for 302.2 Pedophilia

    1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
    2. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    3. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

Some slight changes in the DSM-IV-TR (2000):[22]

Diagnostic criteria for 302.2 Pedophilia

    1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
    2. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
    3. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

The DSM-V, however, distinguished between paraphilias and paraphilic disorders, and pedophilia and pedophilic disorder[23]

The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, phys­ically mature, consenting human partners. In some circumstances, the criteria "intense and persistent" may be difficult to apply, such as in the assessment of persons who are very old or medically ill and who may not have "intense" sexual interests of any kind. In such circumstances, the term paraphilia may be defined as any sexual interest greater than or equal to normophilic sexual interests. There are also specific paraphilias that are gen­erally better described as preferential sexual interests than as intense sexual interests. A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic dis­order, and a paraphilia by itself does not necessarily justify or require clinical intervention.

Pedophilic Disorder

Diagnostic Criteria

    1. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sex­ual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
    2. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
    3. The individual is at least age 16 years and at least 5 years older than the child or chil­dren in Criterion A.
    If individuals also complain that their sex­ual attractions or preferences for children are causing psychosocial difficulties, they may be di­agnosed with pedophilic disorder. However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic im­pulses (according to self-report, objective assessment, or both), and their self reported and le­gally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder[24].

Several months later, the APA recanted their words after pressure from public outrage:[25]

APA Statement on DSM-5 Text Error

Pedophilic disorder text error to be corrected

The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has recently been published after a comprehensive multi-year research and review of all of its diagnostic categories. In the case of pedophilic disorder, the diagnostic criteria essentially remained the same as in DSM-IV-TR. Only the disorder name was changed from “pedophilia” to "pedophilic disorder" to maintain consistency with the chapter’s other disorder listings.

“Sexual orientation” is not a term used in the diagnostic criteria for pedophilic disorder and its use in the DSM-5 text discussion is an error and should read “sexual interest.” In fact, APA considers pedophilic disorder a “paraphilia,” not a “sexual orientation.” This error will be corrected in the electronic version of DSM-5 and the next printing of the manual.

APA stands firmly behind efforts to criminally prosecute those who sexually abuse and exploit children and adolescents. We also support continued efforts to develop treatments for those with pedophilic disorder with the goal of preventing future acts of abuse.

A revised version of the statement remains on their website:[26]

A news release sent Oct. 30 on behalf of the American Family Association mischaracterized the position of the American Psychological Association with respect to pedophilia. The American Psychological Association does not classify mental disorders or publish the Diagnostic and Statistical Manual, as the release incorrectly stated. The American Psychological Association maintains that pedophilia is a mental disorder; that sex between adults and children is always wrong; and that acting on pedophilic impulses is and should be a criminal act. The American Psychological Association has worked for many years to prevent child sexual abuse and will continue to do so.

The decision was criticized by Berlin (2014):[27]

In the face of significant criticism of its inclusion in the DSM-5, the American Psychiatric Association (APA) has stated its intention to remove the term Pedophilic Sexual Orientation from the diagnostic manual. Removing that term in response to public criticism would be a mistake. Experiencing ongoing sexual attractions to prepubescent children is, in essence, a form of sexual orientation, and acknowledging that reality can help to distinguish the mental makeup that is inherent to Pedophilia, from acts of child sexual abuse.

Other academics have argued in favor of classifying pedophilia and/or hebephilia as mental disorders [28][29][30].

Implications

The diagnosis of pedophilia, paraphilias, or other associated disorders is used to justify involuntarily committing sex offenders to psychiatric facilities after their prison sentences have been served[31]. The belief that paraphilias such as biastophilia, pedophilia, or hebephilia constitute mental disorders leads to a belief that they can or should be "cured," or that we should attempt to devise "cures" for them. The belief that paraphilias can be removed through conditioning has led to attempts at conversion therapy[32], physical assault and abusive psychotherapy[33], encouraging chemical castration as a necessity[34], sexual assault of adult sex offenders who are paraphilic[35][36] or perceived to be paraphilic[37], and sexual assault of minors who are paraphilic or perceived to be paraphilic at psychiatric facilities[38] by medical professionals.

Criticism in academia

Various academics have asserted that pedophilia, hebephilia, and/or paraphilias in general, should not be considered mental disorders[39][40][41], or otherwise criticized the DSM's conceptualization of "pedophilic disorder"[42][43][44].

Moser & Kleinpatz (2005) argue for the removal of the DSM-IV-TR's "paraphilias" category:[45]

Although a radical solution, we now favor removal of the entire category from the DSM as the most appropriate remedy for the problems outlined. There are individuals now diagnosed with a paraphilia who seek psychotherapy. We believe that other psychological characteristics describe these individuals and their concerns more accurately than their sexual interests do. It is not their sexual interests, but the manner in which they are manifest that can be problematic at times and is a more appropriate focus for therapy. A guiding principle in medicine is the dictum “First, do no harm.” The confusion of variant sexual interests with psychopathology has led to discrimination against all “paraphiliacs.” Individuals have lost jobs, custody of their children, security clearances, become victims of assault, etc., at least partially due to the association of their sexual behavior with psychopathology. This is not a new problem for psychiatry. Within the last 100 years, the labeling of other sexual behaviors as pathological (e.g., masturbation, “nymphomania,” homosexuality) has caused untold misery. Judgments should be made on the basis of science, rather than the morality that is popular at the time of a given edition. It is time to reevaluate rigorously the Paraphilia section of the DSM.

Malon (2012) calls to depathologize pedophilia entirely:[46]

The past depathologization of homosexuality is the strongest argument available to those who take the position that pedophilia and other paraphilias should not be treated as mental disorders (Culver & Gert, 2006; Moser, 2001). Culver and Gert and Moser both claim that the subject’s personal suffering is a necessary condition to define a mental disorder and their main argument is that paraphilias, including pedophilia, do not cause any particular distress in the majority of those who experience them. Where such distress is present, they add, itis better explained by the presence of a conflict with society (stigmatization, condemnation, persecution, etc.) than by the condition itself (Vogt, 2006). Indeed, some people are quite capable of integrating it into their lives and personalities with reasonably satisfactory results (Moser, 2001; Suppe, 1987; Wilson & Cox, 1983). Moser (2001) asserted that homosexuality was not deleted from the DSM for scientific reasons but on political and social grounds, and other paraphilias should also have been eliminated. Bieber, an advocate of treating homosexuality as a pathology, once raised this question regarding the elimination of other paraphilias from the DSM with Spitzer. According to Bieber (1987), Spitzer replied to him that "…these conditions should perhaps also be removed from DSM-II, and that if the group so affected were to organize as did the gay activists, they, too, might find that their conditions would be removed as a diagnostic entity"(p. 433). This point was also made by others (e.g., Silverstein, 2009; Suppe, 1987), but it did not win much support. Any attempt to question the legitimacy of the psychiatric apparatus, including the DSM as a whole, was rejected as a political strategy by homosexual activists (see Silverstein, 2009, Footnote 3), because it would have jeopardized the goal of excluding homosexuality from the DSM.

Münch et al (2020) argue for more moderate alterations to be made to the DSM-V criteria of Pedophilic Disorder:[47]

Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield’s "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others.

Generally, diseases are primarily harmful to the diseased individual herself either by being directly life-threatening or at least life-shortening, or by causing pain or suffering, or by impairing her ability to live in human symbiotic communities. Harm to others, however, may or may not be a secondary effect of diseases. A typical example are infectious diseases which harm the infected individual and possibly others as well. A mere infection, however, is not called a disease as long as it is not and will not be harmful to the infected individual herself, even if it poses a risk to others as a secondary effect. This is evident from the example of asymptomatic carriers of pathogens. Although they may transmit the pathogen to others and harm particularly vulnerable, e.g. immunosuppressed people, medicine does not regard them as ill. Therefore, such persons should be described as being ‘disease-causing’ for others, rather than as being ‘diseased’ themselves.

If this is true for diseases in general, that they are primarily harmful to the individual herself, it should also be true for mental disorders as long as they are viewed as a subset of diseases. This is reflected in frequently cited attempts to formulate a general definition of mental disorder, like the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the "harmful dysfunction" model by Wakefield. Both definitions characterize a mental disorder by, broadly speaking, a dysfunction in mental processes that is associated with harm to the affected individual.

For some psychiatric diagnoses, however, it is questionable whether the presupposition of harm to the individual really applies. We will show that several diagnoses essentially rely on behavior that is harmful to others, but not necessarily to the individual herself. This is especially true for the diagnoses "Antisocial Personality Disorder" (ASPD) in DSM-5 (or "Dissocial Personality Disorder" in ICD-10) and "Pedophilic Disorder" in DSM-5 and ICD-11. Instead, as we will show, another disease criterion comes in here: the criterion of "harm to others."

In the case of Pedophilic Disorder, harm to others is a sufficient criterion. In the case of ASPD, it is a necessary one and, as we will argue, practically also a sufficient one. In addition to the harm criterion, getting another meaning, we will argue that the criterion of a mental dysfunction is unclear in these diagnoses. Thus, the diagnoses of ASPD and Pedophilic Disorder fall out of the general concept of diseases and even out of the general concept of mental disorders. Are they accordingly rather "moral disorders" than clinical disorders? If this is true, psychiatry contributes to a "medicalization" of morally wrong behavior. The conceptual problems of ASPD and Pedophilic Disorder lead to the fundamental question which criteria define a mental disorder.

The aim of this paper is to discuss whether behavior harmful to others should be a sufficient criterion of mental disorder as it is the case in the diagnoses of ASPD and Pedophilic Disorder. If we come to the conclusion that this should not be the case, the question arises whether ASPD and Pedophilic Disorder should be eliminated from the diagnostic manuals.

With regard to pedophilia, one could argue under an evolutionary account of dysfunction, that it is a form of a sexual dysfunction, assuming that the biologically defined function of sexual arousal (i.e. the reason the mechanism of sexual arousal was selected for) lies in its contribution to (potential) reproduction, which is clearly not the case in pedophilic sexual behavior. This, however, is an insufficient model of the function of human sexuality. Human sexuality has important functions beyond reproduction, particularly promoting pair bonding and fulfilling emotional needs. Many forms of sexuality that do not pursue reproduction are broadly accepted, e.g. sexual intercourse of infertile people, under birth control, or homosexuality. Furthermore, there is no reason not to use a certain function for other, possibly purely hedonistic purposes that have nothing to do with its evolutionary function. The fact that a function is used for other than the alleged evolutionary purposes does not mean that this is dysfunctional.

Some pedophilic men actually state that they are not only interested in sexual contact with children but also look for romantic relationships with them. The dysfunction in Pedophilic Disorder thus cannot simply stem from the fact that the sexual arousal is not associated with (potential) reproduction. The concept of a dysfunction in an evolutionary sense falls too short here.

According to DSM-5 and ICD-11, a pedophilic sexual interest is only deemed a mental disorder when it leads to subjective distress or impairment, or has been acted upon.

To assume that having certain sexual fantasies or urges is not pathological but acting according to them is, seems inconsistent. It might be explained by the implicit assumption that there is another dysfunction involved, namely an impaired ability to control one’s behavior. To illustrate this point: if a heterosexual teleiophilic man (i.e. a man sexually attracted to physically mature individuals) sexually assaults a woman, it is not generally supposed that he must be mentally disordered because he couldn’t control his sexual urges. For it is just as possible that he thought the assault was justified, e.g. because the woman dressed “lewdly”. There is no reason to regard the case of the heterosexual teleiophilic sexual offender differently from the case of a pedophilic sexual offender who is convinced that his behavior is morally justified, or who just does not respect the rights of children.

Conclusions

Diagnoses that primarily rely on behavior harmful to others, like Pedophilic Disorder and ASPD, fall out of the general disease concept. They even do not meet the general criteria of mental disorders as defined by DSM-5 or the “harmful dysfunction” model by Wakefield. Neither the criterion of harm to the individual himself, nor the criterion of a dysfunction are met in these two diagnoses.15 Instead, they rely on another disease criterion: the criterion of harm to others. Psychiatry brings itself into great conceptual difficulties by making behavior harmful to others/criminal behavior a central part of the definition of some mental disorders, while at the same time lacking a clear concept of dysfunction in these cases. When diagnoses are formulated in a way that makes it possible to apply them to mere antisocial and criminal behavior, psychiatry is at risk of confounding the medical and the moral.

In the case of Pedophilic Disorder, we think that the diagnosis should be kept but reformulated in accordance with the general definition of mental disorder in DSM-5 in order to make it consistent with a medical model of mental disorder. This means it should only be applicable to individuals that are distressed or impaired by it so that they can get treatment within the health system. It should not be possible to make the diagnosis solely based on behavior harmful to others. Therefore, we suggest reformulating Criterion B of Pedophilic Disorder as follows: “The sexual urges or fantasies cause marked distress or interpersonal difficulty (e.g. in the context of occupation, family life, friendships, intimate life).” That means, the criterion “The individual has acted on these sexual urges” is cancelled.

Our suggested reformulation of Criterion B is indeed consistent with the form it already had in DSM-IV. As De Block et al. note, the DSM-IV diagnostic criteria were “by far the most consistent vis-à-vis the DSM’s own definition of mental disorder.”. It was, however, criticized that this criteria set leads to the situation that someone acting on his pedophilic interests without feeling distressed would not be considered mentally ill. O’Donohoe et al. argue that rather the lack of experiencing subjective distress when being sexually attracted to children than the experience of distress is a sign of psychological problems. They do not accept that, according to DSM-IV, a “contended pedophile” does not meet the criteria of a mental disorder. They argue that a person sexually interested in children must be considered in some way socially impaired “because societal norms dictate that it is abnormal for a person to be sexually interested in children.” They clearly want to classify pedophilia as a mental disorder for social and forensic rather than for medical reasons. Their postulation that “a single instance of sexual behavior with a child should be sufficient to label someone as having a disorder” confounds criminal behavior with mental disorder.

If pedophilia by itself is not a mental disorder according to DSM-5, then acting according to it cannot be a mental disorder unless there is clear evidence of a dysfunction of volitional control. Impairment of volitional control, however, is not implied in the diagnosis of a paraphilic disorder. If we assume that sometimes such impairment is given, then it probably stems from another disease (like e.g. dementia, a brain tumor or mental retardation). If there is no such impairment, we have to assume that this person acted deliberately, and it is not clear why this should be a sign of a mental disorder rather than simply a criminal act.

The DSM-5 warns of the dangers of using a diagnostic manual developed for clinical purposes in the forensic context. For assigning mental disorder in the legal sense “additional information is usually required beyond that contained in the DSM-5 diagnosis, which might include information about the individual’s functional impairments and how these impairments affect the particular abilities in question.”

It is important to note that there is a difference between a mental disorder and the US-American legal concept of "mental abnormality.”

We suggest that it should be possible to diagnose a “mental abnormality” in the forensic sense for a person with pedophilia who is neither distressed nor impaired by his pedophilic condition (i.e., who fulfills criterion A but not B according to our suggestion). Even though this person does not meet the criteria of a mental disorder as suggested by us, he might still meet the concept of “mental abnormality” if there is evidence of a high risk of reoffending. We thus suggest that this difference in clinical and forensic use is clearly annotated in the diagnostic criteria of Pedophilic Disorder in DSM. This suggestion is important with regard to other countries than the USA. The DSM is used worldwide for research, and therefore its diagnostic criteria should not be distorted in order to adapt them to the US legal system. In Germany, for example, no diagnosis of a mental disorder is required to order preventive detention after imprisonment; rather the assessment of danger and the prognosis of the probability of recidivism is decisive.

Our intention is not to protect the “contented pedophile”, as long as he is dangerous, from preventive detention or to downplay the harm that child molesters do to their victims in any sense. On the other hand, our suggestion is not meant to preclude the detained child molester from getting treatment if at some point he starts to show insight into his problems and wants to get treated. Rather, we want to separate the medical aspects of Pedophilic Disorder from the societal and forensic implications.

To summarize, our suggestion is as follows. We agree with the differentiation between Pedophilia and Pedophilic Disorder in DSM-5 and suggest adding a category “Pedophilia with mental abnormality” for forensic purposes. Thus, we suggest defining Pedophilia as pedophilic preference without distress/impairment; Pedophilic Disorder as pedophilic preference with distress/impairment; and Pedophilia with mental abnormality as pedophilic preference with sexual offending and high risk of re-offending with or without distress/impairment.

Criticism from anti-MAPs

The position that mapness is a mental illness and thus worthy of stigmatization is popular among anti-MAPs who are more openly ableist[48]. Antis who claim to be supportive of destigmatizing mental illness, however, face a conundrum: either they betray their principles of all disorders being supposedly worthy of destigmatization, or they decide that mapness is in fact not an actual disorder. The latter proclaim that calling mapness a mental disorder is offensive to actually disordered individuals[49][50]. Some other antis, not necessarily mental illness activists, also loudly proclaim that mapness is not a mental illness and that saying it is one is deeply offensive[51][52][53][54][55]. This usually arises from a capitulation to the popular notion that mentally ill people should be offered help with kindness and compassion, something they do not wish to give to MAPs[56][57]. Another possibility is belief that a harmful behavior being caused by mental illness means that person is absolved of agency or responsibility, but they dislike the idea of letting off people who commit "actually harmful crimes," so as a compromise they pick offending MAPs alone to ascribe self-aware evil and purposeful abuses to[58][59][60].

Criticism from MAPs and MAP allies

Pro-MAP activists such as Comrade Lecter[61][62], Fiction Is Not Reality[63], Virtuous Pedophiles[64], and B4U-ACT[65], among others, have also said that it is inaccurate to classify mapness as a mental illness or disorder.

Mentally ill MAP activist chronic takes a far more radical approach: that not only should pedophilia itself be demedicalized, but also that adjacent concepts such as "pedophilic disorder," even when they do not claim pedophilia itself is a disorder, should nevertheless be abolished entirely as well. One such conversation, occurring on a suspended Tumblr account of theirs[66], went as follows:

smol-paw:

As there is a post going around I want to clarify-

This blog DOES NOT support; beastiality, SA or CSA, "pro contact" zoo/map, those who engage in illegal/dangerous paraphilias, nor does it support the toxic "Zoo pride" community.

This blog DOES support; no-contact paraphiles, recovering zoos/maps, paraphiles who are seeking support and treatment, and the effort to understand and respect those with paraphilias.

chronic:

What if we aren’t seeking “support and treatment,” hmm? Our paraphilias aren’t something we need support or treatment for. Many of us are mentally ill (something that can actually be “recovered” from). But what if we don’t want to recover from our mental illnesses? What if we’re not actively trying to recover? Does that make us any less valid, any less deserving of community and support?

proship-menhera

You don’t have to chose treatment if you don’t want to it just helps as long as your non offending/non contact I don’t understand why “no contact” is an anti term it means the same thing as “non offending”.

harmful paraphilias are attractions but they can be harmful if acted upon such as zoophilia pedophilia that’s why it’s ADVISED to get help and treatment so that you find coping mechanism so that it’s easier to not bother the person who has it and so it’s easier for them to not act or get frustrated with it.

No one is saying that you have to as long as you are non offending you are fine.

paraphilia is something a lot people need help with bc it frustrates and or is hard for the user to deal with it and it benefits them to cope with their attraction but no you don’t have to seek treatment as long as you aren’t acting on it.

mental illness is not something to be cured but people DO need recovery anyone does not seeking to recover can literally be deadly for people with mental illness not seeking help is one thing not wanting to recover from your negative symptoms/symptoms that harm you is another that doesn’t mean you aren’t deserving of support but anyone should want to recover and learn to cope with their symptoms.

recover doesn’t mean “cure” or “treated” it means coping and trying not to fall into negative symptoms that harm you not wanting to get better is symptom of mental illness and these people DO need help and support like anyone else but it’s important that they do feel the need to recover and GET BETTER.

chronic:

There is no such thing as a “harmful paraphilia.” The thoughts themselves are never harmful to others. The potential actions being harmful doesn’t make the paraphilia itself harmful.

chronic followed with a screenshot of one of their NNIA posts:

"Pedophilic disorder" is arguably not a particularly useful diagnosis, even when eliminating distress caused purely by social stigma, and acts of offending.

Some people experience distress from their pedophilia only because pedophilic thoughts are a PTSD trigger. But then the problem isn't the pedophilia, it's the PTSD. You don't say someone's suffering from [random object] disorder if [random object] is a PTSD trigger. The PTSD needs to be treated, not the connection between pedophilia and triggers, because by only treating the latter you're not actually treating the root cause, only separating it from a current other factor/trait.

Some pedophiles (me, hello!) have ASPD, and thus experience violent urges + lack of impulse control when it comes to acting on those violent urges, and some of their violent urges manifest in the form of fantasizing about committing CSA. In treatment, we don't try to cut the connection between our pedophilia and ASPD; we try to treat the ASPD as a whole.

Idk, I probably worded this very poorly, but this is an approximate reason for why I'm not going to claim pedophilic disorder as a label, because pedophilia is not inherently disordered nor is it causative of the listed related disordered factors (i.e. urges & lack of control over those urges)[67].

I think the closet analogy is hypersexuality/sex addiction and why it was rejected as a diagnosis for the DSM-V:[68] for one, because sex [or sex-related behavior] isn't inherently disordered nor more disordered than other [nonsexual] things [just because it is sexual], nor sexuality/porn [inherently, directly] causative of sex addiction; trauma[69][, religious guilt[70], and preexisting] predisposition for addiction[71] are.

chronic then attached a screenshot of a Reddit thread where they had discussed the topic:

chronic:

Pedophilia is not a mental illness, as it does not inherently cause the individual distress.

un-lovable:

Yeah if you want to get technical, the mental illness form of pedophilia is called "pedophilia disorder" or PD. In my comment I used the term mental illness loosely, as it tends to be an effective way of communicating the unchosen and subconscious nature of the attractions. Of course not all pedophiles agree with this usage, but I would at the very least argue that our attractions are not an optimal to find ourselves in. Given that we cannot fully express them and as such it often DOES cause us some degree of distress, I feel as though it is at the very least a dead end and unfortunate sexual orientation. I don't personally have any qualms with using the term mental illness to describe it, though the dsm doesn't classify it as such.

chronic:

> an effective way of communicating the unchosen and subconscious nature of the attractions
> Of course not all pedophiles agree with this usage,

Of course we don't. The entire community of neurodivergent &/or mentally ill pedophiles will eat you alive for this.


> but I would at the very least argue that our attractions are not an optimal to find ourselves in.

Because we are oppressed, not by any inherent factor in them.


> Given that we cannot fully express them and as such it often DOES cause us some degree of distress, I feel as though it is at the very least a dead end and unfortunate sexual orientation.

It is almost equally unfortunate to be allo then, because allos are often attracted to those who do not consent to them, and thus cannot fully express their attractions. But not every mildly unpleasant feeling constitutes a disorder.

The aforementioned distress only comes from comorbidities, or societal stigma[72], not any inherent trait of the attraction itself. When the distress from not being able to engage in a relationship with the target of attraction becomes significant/severe as to be unmanageable, there is almost certainly a comorbidity (such as BPD or the like)[73].


> I don't personally have any qualms with using the term mental illness to describe it, though the dsm doesn't classify it as such.

I do, as I am mentally ill with also some nondisordered neurodivergences and other traits, and I would greatly appreciate it if I could maintain accurate language to describe my separate experiences, thanks.

It's unfortunate that we're not particularly familiar nor especially not off-platform, because everyone who knows me knows that I go with a "fuck the DSM" approach when it comes to neurodivergency or mental health. I do not personally believe that "pedophilic disorder" exists as an independent phenomenon in which disorder is caused by pedophilia itself, rather than separate comorbidities which happen to interfere and which coexisting pedophilia alters the presentation thereof.

chronic further elaborated on their arguments in a blog post:[74]

According to the APA, a mental disorder is a “health condition involving significant changes in thinking, emotion and/or behavior, and distress and/or problems functioning in social, work or family activities.”[75] The connotation of the term “disorder” is that disorders are bad for us, that curing disorders or treating their symptoms is necessary for us to improve in certain ways health-wise, etc. I use "disorder" as synonymous with "illness," as the APA agrees, and I have yet to see a source or convincing argument as to why they should be distinguished; connotation-wise they seem to carry similar meanings too.

Other marginalized people (POC[76], gay/lesbian/bi/aspec people[77], etc.) have argued against pathologizing our distress from society’s bigoted treatment of us as “disordered.” The connotation of the label “disorder” implies that we or something within us is the primary problem, rather than society. That to eliminate our distress activists should prioritize “treating” us rather than changing society to treat us better.

Are abuse victims “disordered” for experiencing distress from being abused? Similar to the previous paragraph’s example, I think not: claiming we are “disordered” implies it is optimal to try to minimize our currently experienced distress with medication or therapy, rather than simply removing our abusers.

Whereas if an abuse survivor has left their abusive situation, but still experiences PTSD (nightmares, flashbacks, now-excessive preemptive risk assessment, etc.), that distress is not going to go away just by environmental changes anymore. The symptoms themselves must be targeted for treatment.

This conversation becomes a bit more difficult when we consider that none of us, if we are marginalized, can truly (yet) escape the bigoted society, arguably the ultimate abuser. But like how abuse victims in ongoing abusive situations are capable of recognizing that we are experiencing PTSD which will continue even after we escape, so can marginalized people know that we are experiencing disorders because of society's past treatment of us, which require treatment rather than merely social change to alleviate.

I think from this it is reasonable to conclude that a “disorder” is a condition (i.e. set of traits) which causes significantly severe and persistent (i.e. ongoing, not one-off) distress, the complete alleviation of which requires the removal of the condition’s traits, rather than merely accommodation which does not remove the traits themselves but rather makes it easier and less distressing to live with them by changing the way in which their environment interacts with them.

The problem with incorrect pathologization

Telling those of us with nondisordered neurodivergences, disabilities, and other divergent/non-normative characteristics that we are actually disordered is a denial of our agency. You are like every gaslighting psychiatrist who tells us we aren’t distressed when we actually are[78], except in reverse; you think you know better than us what we think and what we feel, as if we cannot know that for ourselves because we are too freaky, too insane[79] You are speaking over us. You are implying that our feelings require "cures" rather than accommodation[80]

Pathologization also subjects us to misdirected anti-mental-illness stigma. It makes it easier for the psych industry to research how to "cure" us[81]; it lends further legitimacy to attempts at conversion therapy[82][83] Even for actual disorders, treatment and/or cures should be voluntary and only provided with informed consent[84] (Disclaimer: no, I do not believe we should attempt to destigmatize the above at the expense of actual disorders.)