Hebephilia

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Hebephilia Audio file "LL-Q1860 (eng)-Flame, not lame-hebephilia.wav" not found is the strong, persistent sexual interest by adults in pubescent children who are in early adolescence, typically ages 11–14 and showing Tanner stages 2 to 3 of physical development.[1] It differs from pedophilia (the primary or exclusive sexual interest in prepubescent children), and from ephebophilia (the primary sexual interest in later adolescents, typically ages 15–18).[1][2][3] While individuals with a sexual preference for adults may have some sexual interest in pubescent-aged individuals,[2] researchers and clinical diagnoses have proposed that hebephilia is characterized by a sexual preference for pubescent rather than adult partners.[2][4] Hebephilia is approximate in its age range because the onset and completion of puberty vary.[1] On average, girls begin the process of puberty at age 10 or 11 while boys begin at age 11 or 12.[5] Partly because puberty varies, some definitions of chronophilias (sexual preference for a specific physiological appearance related to age) show overlap between pedophilia, hebephilia and ephebophilia.[2] For example, the DSM-5 extends the prepubescent age to 13,[6] and the ICD-10 includes early pubertal age in its definition of pedophilia.[1][7] Proposals for categorizing hebephilia have argued that separating sexual attraction to prepubescent children from sexual attraction to early-to-mid or late pubescents is clinically relevant.[2][3] According to research by Ray Blanchard et al. (2009), male sex offenders could be separated into groups by victim age preference on the basis of penile plethysmograph response patterns. Based on their results, Blanchard suggested that the DSM-5 could account for these data by subdividing the existing diagnosis of pedophilia into hebephilia and a narrower definition of pedophilia.[3] Blanchard's proposal to add hebephilia to the DSM-5 proved controversial,[1][2][8] and was not adopted.[9] It has not been widely accepted as a paraphilia or mental disorder, and there is significant academic debate as to whether it should be classified as either.[1]

Etymology, definitions and history

The term hebephilia is based on the Greek goddess and protector of youth Hebe, but, in Ancient Greece, also referred to the time before manhood in Athens (depending on the reference, the specific age could be 14, 16 or 18 years old). The suffix -philia is derived from -phil-, implying love or strong friendship.[10] Hebephilia is defined as a chronophilia in which an adult has a strong and persistent sexual interest in pubescent children, typically children aged 11–14, although the age of onset and completion of puberty vary.[1][2] Although sexologist Ray Blanchard and others who proposed the hebephilia diagnosis have focused on pubescents in Tanner stages 2 and 3 (centering on children who have begun to show signs of pubertal development of sex characteristics but are not at or near the end of this process), discussion of hebephilia has also concerned attraction to pubescents and adolescents in general, which has contributed to confusion among those who have debated the topic.[1] The DSM-5's diagnostic criteria for pedophilia and the general medical literature define pedophilia as a disorder of primary or exclusive sexual interest in prepubescent children, thus excluding hebephilia from its definition of pedophilia.[11][12] However, the DSM-5's age criteria extends to age 13.[6] Although the ICD-10 diagnostic code for the definition of pedophilia includes a sexual preference for children of prepubertal or early pubertal age,[1][7] the ICD-11 states that "pedophilic disorder is characterized by a sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children."[13] Because of some inconsistencies in definitions and differences in the physical development of children and adolescents, there is overlap between pedophilia, hebephilia and ephebophilia.[2] The term hebephilia was first used in 1955, in forensic work by Hammer and Glueck.[14] Anthropologist and ethno-psychiatrist Paul K. Benedict used the term to distinguish pedophiles from sex offenders whose victims were adolescents.[15] Although hebephilia is distinct from pedophilia, the term pedophilia is commonly used by the general public and the media, at least in the English-speaking world, to refer to any sexual interest in minors below the local age of consent and/or age of majority, regardless of their level of physical or mental development.[12]

Research

General

Multiple research studies have investigated the sexual attraction patterns of hebephilic and pedophilic men. The sexual attraction to children appears to fall along a continuum instead of being dichotomous.[16] The attractions of hebephiles and pedophiles are less focused on the child's sex than are the attractions of teleiophiles (people who sexually prefer adults)—i.e., much larger proportions of hebephiles and pedophiles than teleiophiles report being attracted to both males and females.[16] Hebephilia, together with pedophilia and some other paraphilias, has been found to be an important motivator of sexual offending. It also has a high degree of overlap with pedophilia, as well as with similar correlates of sexual offending.[17] The Prevention Project Dunkelfeld is an effort founded in Germany to provide therapy and abuse prevention techniques to adults attracted to children. In a study of 222 men contacting the Dunkelfeld project for help, roughly two-thirds had a sexual interest in pubertal children. These men also reported experiencing high levels of psychological distress, at clinically relevant levels. Both the hebephiles and the pedophiles showed greater distress than teleiophiles, but they did not differ from each other.[18]

Correlates

Researchers from the Centre for Addiction and Mental Health in Toronto conducted a series of studies on neurological and psychological correlates of hebephilia, including brain structure,[19][20] handedness,[21][22] intelligence quotient,[22] lesser educational attainment or greater probability of repeating a year in primary education,[23][24] height,[25][26] and other markers of atypical physical development.[27] These findings suggest that problems during prenatal development play a significant role in the development of hebephilia.[1] In some cases, head trauma during pre-pubertal childhood, or experiencing sexual abuse during puberty, could also be contributing factors.[1] Differences in brain structure may mean that hebephilic interests result from disconnections in the brain networks that recognize and react to sexual cues.[1]

Prevalence

The prevalence of hebephilia within the general population is unknown. There is evidence suggesting that within clinical and correctional samples,[28][29] as well as anonymous surveys of people sexually interested in children, there are more individuals with an erotic interest in pubescent rather than in prepubescent children.[30][31]

DSM-5 debate

Proposal

The DSM-5's diagnostic criteria for pedophilia specifies it as a disorder of sexual interest in prepubescent children generally age 13 years or younger.[6] A 2009 research paper by Ray Blanchard and colleagues indicated that, based on penile plethysmographs, sex offenders could be grouped according to the sexual maturity of individuals they found most attractive (because ages are not a specific indication of adolescent sexual development, Blanchard used stimuli with a Tanner scale rating of 1 on essentially all measures to evaluate hebephilic offenders while adult control stimuli all had a Tanner rating of 5).[3] Blanchard noted that the most common age of victims for sexual offenders was 14 years, and suggested there were qualitative differences between offenders who preferred pubertal sex-objects and those with a prepubertal preference. The paper concluded that the DSM-5 could better account for those data if it split the DSM-IV-TR's existing criteria for pedophilia, which focuses on sexual attraction to prepubescent children, but sets the age range at generally 13 or younger.[3]

Responses

General

Researchers at the German Dunkelfeld project supported the explicit mention of hebephilia in DSM-5: "Concerning the update of the DSM (DSM-5) a category called 'hebephilic disorder' would have been appropriate, especially considering the given data which shows that in men with a hebephilic preference, who seek treatment, the disorder criteria of the DSM-5 (psychological distress, behavior endangering others) are given in many cases. In this respect there would be men with hebephilia as well as men with a 'hebephilic disorder.'"[18] In a letter to the editor, Thomas Zander argued there would be serious consequences from expanding the definition of pedophilia to include hebephilia, and stated that there are problems in distinguishing between prepubescent versus pubescent victims and thus in classifying offenders, and concluded that it required more research and consideration of implications before the DSM was changed.[32] Blanchard agreed that distinguishing between pedophiles and hebephiles may present difficulties, but stated that in the case of a repeat sexual offender, these fine distinctions would be less important; he noted that other objections raised by Zander's letter were addressed in the original article.[33] In another letter to the editor, physician Charles Moser agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia.[4] Karen Franklin stated that she believes the concept is largely the result of the Centre for Addiction and Mental Health,[34] although CAMH scientist and pedophilia researcher James Cantor challenged her factual accuracy, citing the existence of the concept in the ICD-10,[35] the use of the word in 100 scholarly texts from a variety of disciplines and time periods, and the existence of 32 peer reviewed papers researching the concept.[36] Psychologist Skye Stephens and sexologist Michael C. Seto also argue that because the ICD-10 includes "prepubertal or early pubertal age" in its classification of pedophilia, it includes both pedophilic and hebephilic sexual interests.[1][37] At a 2009 meeting of the American Academy of Psychiatry and the Law, concern was raised that the criteria could have produced both false positives and false negatives, and that hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, while excluding offenders who had committed serious offences on only one or two victims.[38] During academic conferences for the American Academy of Psychiatry and Law and International Association for the Treatment of Sexual Offenders, symbolic votes were taken regarding whether the DSM-5 should include pedohebephilia, and in both cases an overwhelming majority voted against this.[39] In a letter to the editor, clinical psychologist Joseph Plaud criticized the study for lacking control groups for post-pubescent and normal patterns of male sexual arousal, overlap between groups Blanchard believed were separate, and lack of specificity in the data.[40] Blanchard replied that the initial publication used sex offenders who had committed crimes against post-pubescent adults as a control group, and that the results supported victim age preferences being a continuous rather than categorical variable.[33] In separate letters to the editor, forensic psychologist Gregory DeClue and mathematician Philip Tromovitch agreed the term would be valuable for research purposes and to subdivide the current diagnosis of pedophilia into victim age preferences, but expressed concern over the term's potential to dramatically expand the number of people diagnosed with a paraphilia without an adequate research base to support it, and that the article did not include a definition of "mental disorder" and thus lacked the ability to distinguish the pathological from the non-pathological.[41][42] Blanchard stated in a reply that his paper was written under the assumptions that the DSM-5's definition of mental disorder and pathologizing of sexual activity with underaged individuals would be similar to the one found in the DSM-IV.[33]

Attraction as normal or abnormal

Commenting on Blanchard et al.'s proposal, psychologists Robert Prentky and Howard Barbaree stated that examples of highly sexualized young girls appear frequently in advertising, fashion shows, television programs, and films, making it questionable whether sexual attraction to pubescents is abnormal.[2] Psychiatrist Allen Frances argued that attraction to pubescent individuals is within the normal range of human behavior and thus could not be considered sexually deviant, though acting on such attraction could be considered a crime.[43][44] Thomas Zander also expressed concern about the degree to which the potential diagnosis genuinely reflected normal versus abnormal sexual desire.[32] Some authors have argued that dysfunction is culturally relative or a social construct, such as by pointing to historical societies where marriage between pubescent girls and older men was practiced.[1] Anthropologist David Ryniker wrote that cultures that practiced marriage between adult men and pubescent girls did so for economic and social reasons, not due to any sexual preference.[1][45] He argued that, based on the biological evidence, humans did not evolve a strategy of early fertility, and that a sexual focus on pubescents would be maladaptive.[45] Anthropologist Raymond Hames and Blanchard argued that in most cultures, pubescent girls did not begin sexual activity until they were at or near the end of puberty.[1][46] Stephens and Seto argue that hebephilia can be considered dysfunctional, stating that "conceptually, hebephilia is a paraphilia, reflecting an atypical (statistically rare) sexual age interest in pubescent children."[1] They state that hebephilia is a malfunction of the biological mechanism which drives males to be attracted to sexually mature females, and that while typical men are attracted to youthfulness, they are also interested in cues of sexual maturity (adult size, fully developed breasts, and a waist-to-hip ratio of around 0.70).[1] Hebephiles, by contrast, respond positively to cues of youthfulness but negatively to cues of sexual maturity.[1] Penile plethysmography results show that heterosexual men are preferentially attracted to adult women, with lower responses to pubescent girls and then prepubescent girls, and then males of all ages causing the least response.[1] Stephens and Seto also argue that hebephilia is dysfunctional because it causes significant distress or impairment in those who have it, perhaps via legal issues or disrupted adult relationships, because hebephilic behavior violates social norms or is even illegal in most contemporary cultures.[1]

Use in court

Forensic psychologist Charles Patrick Ewing criticized the diagnosis, saying it is a transparent attempt to ensure that sex offenders who target pubescent teenagers may be subject to involuntary civil commitment.[47] DSM-IV editors Michael First and Allen Frances expressed concern that hebephilia could be misused in civil commitment hearings, and questioned the need and evidence for the inclusion.[43] Frances wrote that the diagnosis of hebephilia "has no place in forensic proceedings."[48] Charles Moser argued against what he saw as the problematic use of paraphilic labels to pathologize unusual sexual interests and incarcerate individuals on the basis of their paraphilia rather than their behavior. He also questioned the usefulness of paraphilias in general when the real issue may be criminal behaviors or stigmatization of unusual but benign sexual acts.[4] Of hebephilia in civil commitment, Prentky and Barbaree wrote, "Hence, for self-serving reasons, it is applauded by those who generally work for the prosecution and criticized by those who generally work for the defense. This is an admittedly cynical, if unfortunately accurate, commentary on the influence of adversarial litigation on clinical deliberation."[2] Psychologist Douglas Tucker and lawyer Samuel Brakel stated that civil commitment as a sexually violent predator does not require a DSM diagnosis, so long as the clinicians who testify in courts do so in good faith and they identify a conceptually and empirically meaningful mental abnormality that is predictive of future sexual violence, irrespective of the term used.[49] Some courts have accepted the hebephilia diagnosis while others have not.[47] In court cases where the term hebephilia is used, it is placed within the DSM category of paraphilia, not otherwise specified (NOS).[34] The diagnosis of hebephilia was rejected in one United States federal court in 2009 for being a label, not a "generally accepted mental disorder", and because a mere attraction to pubescent adolescents is not indicative of a mental disorder. Although the court rejected the government's claim that hebephilia is a mental disorder, the government argued that hebephilia may at times fall within a DSM-IV category of NOS. The court was also unconvinced by this.[47]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 Stephens S, Seto MC (2015). Phenix A, Hoberman H (eds.). Sexual Offending: Predisposing Antecedents, Assessments and Management. Springer. pp. 29–41. ISBN 978-1493924165.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 Prentky, R.; Barbaree, H. (2011). "Commentary: Hebephilia--a would-be paraphilia caught in the twilight zone between prepubescence and adulthood". The Journal of the American Academy of Psychiatry and the Law. 39 (4): 506–510. PMID 22159978.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Blanchard, R.; Lykins, A. D.; Wherrett, D.; Kuban, M. E.; Cantor, J. M.; Blak, T.; Dickey, R.; Klassen, P. E. (2009). "Pedophilia, Hebephilia, and the DSM-V". Archives of Sexual Behavior. 38 (3): 335–350. doi:10.1007/s10508-008-9399-9. PMID 18686026. S2CID 14957904.
  4. ↑ 4.0 4.1 4.2 Moser, C. (2009). "When is an Unusual Sexual Interest a Mental Disorder? (letter to the editor)". Archives of Sexual Behavior. 38 (3): 323–325. doi:10.1007/s10508-008-9436-8. PMID 18946730. S2CID 43363957.
  5. ↑ Kail, RV; Cavanaugh JC (2013). Human Development: A Lifespan View (6th ed.). Cengage Learning. pp. 292. ISBN 9781111835545.
  6. ↑ 6.0 6.1 6.2 "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition". American Psychiatric Publishing. 2013. Retrieved July 25, 2013.
  7. ↑ 7.0 7.1 See section F65.4 Paedophilia. "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010". ICD-10. Retrieved November 17, 2012.
  8. ↑ Wakefield, J. C. (2011). "The DSM-5's Proposed New Categories of Sexual Disorder: The Problem of False Positives in Sexual Diagnosis". Clinical Social Work Journal. 40 (2): 213–223. doi:10.1007/s10615-011-0353-2. S2CID 143666677.
  9. ↑ Singy, Patrick (18 April 2015). "Hebephilia: A Postmortem Dissection". Archives of Sexual Behavior. 44 (5): 1109–1116. doi:10.1007/s10508-015-0542-0. PMID 25894647. S2CID 8004856.
  10. ↑ Powell, A (2007). Paedophiles, Child Abuse and the Internet: A Practical Guide to Identification, Action and Prevention. Radcliffe Publishing. pp. 4–5. ISBN 978-1857757743.
  11. ↑ Seto, Michael (2008). Pedophilia and Sexual Offending Against Children. Washington, DC: American Psychological Association. p. vii.
  12. ↑ 12.0 12.1 Gavin H (2013). Criminological and Forensic Psychology. SAGE Publications. p. 155. ISBN 978-1118510377. Archived from the original on March 30, 2019. Retrieved July 7, 2018.
  13. ↑ "ICD-11 for Mortality and Morbidity Statistics". World Health Organization/ICD-11. 2018. See section 6D32 Pedophilic disorder. Retrieved 2018-07-07. Pedophilic disorder is characterized 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.
  14. ↑ Janssen, D.F. (2015). ""Chronophilia": Entries of Erotic Age Preference into Descriptive Psychopathology". Medical History. 59 (4): 575–598. doi:10.1017/mdh.2015.47. ISSN 0025-7273. PMC 4595948. PMID 26352305.
  15. ↑ Hammer, E. F.; Glueck, B. C. (1957). "Psychodynamic patterns in sex offenders: A four-factor theory". The Psychiatric Quarterly. 31 (2): 325–345. doi:10.1007/BF01568731. PMID 13465890. S2CID 25200895.
  16. ↑ 16.0 16.1 Bailey, J. M.; Hsu, K. J.; Bernhard, P. A. (2016). "An Internet study of men sexually attracted to children: Sexual attraction patterns". Journal of Abnormal Psychology. 125 (7): 976–988. doi:10.1037/abn0000212. PMID 27732027.
  17. ↑ Moss S, Simmons M, Trendell S, Stephens S (2018). Ternes M, Magaletta PR, Patry MW (eds.). The Practice of Correctional Psychology. Springer. p. 201. ISBN 978-3-030-00452-1.
  18. ↑ 18.0 18.1 Beier, K.; Amelung, T.; Kuhle, L.; Grundmann, D.; Scherner, G.; Neutze, J. (2015). "Hebephilia as a Sexual Disorder". Fortschritte der Neurologie · Psychiatrie. 83 (2): e1–e9. doi:10.1055/s-0034-1398960. ISSN 0720-4299. PMID 25723776. S2CID 22739711.
  19. ↑ Cantor, James M.; Kabani, Noor; Christensen, Bruce K.; Zipursky, Robert B.; Barbaree, Howard E.; Dickey, Robert; Klassen, Philip E.; Mikulis, David J.; Kuban, Michael E.; Blak, Thomas; Richards, Blake A.; Hanratty, M. Katherine; Blanchard, Ray (2008). "Cerebral white matter deficiencies in pedophilic men". Journal of Psychiatric Research. 42 (3): 167–183. doi:10.1016/j.jpsychires.2007.10.013. ISSN 0022-3956. PMID 18039544.
  20. ↑ Cantor, James M.; Blanchard, Ray (2012). "White Matter Volumes in Pedophiles, Hebephiles, and Teleiophiles". Archives of Sexual Behavior. 41 (4): 749–752. doi:10.1007/s10508-012-9954-2. ISSN 0004-0002. PMID 22476520. S2CID 207090545.
  21. ↑ Cantor, J. M.; Klassen, P. E.; Dickey, R.; Christensen, B. K.; Kuban, M. E.; Blak, T.; Williams, N. S.; Blanchard, R. (2005). "Handedness in Pedophilia and Hebephilia". Archives of Sexual Behavior. 34 (4): 447–459. doi:10.1007/s10508-005-4344-7. PMID 16010467. S2CID 6427342.
  22. ↑ 22.0 22.1 Cantor, J. M.; Blanchard, R.; Christensen, B. K.; Dickey, R.; Klassen, P. E.; Beckstead, A. L.; Blak, T.; Kuban, M. E. (2004). "Intelligence, Memory, and Handedness in Pedophilia". Neuropsychology. 18 (1): 3–14. doi:10.1037/0894-4105.18.1.3. PMID 14744183.
  23. ↑ Fazio, Rachel L.; Lykins, Amy D.; Cantor, James M. (2014). "Elevated rates of atypical handedness in paedophilia: Theory and implications". Laterality: Asymmetries of Body, Brain and Cognition. 19 (6): 690–704. doi:10.1080/1357650X.2014.898648. ISSN 1357-650X. PMC 4151814. PMID 24666135.
  24. ↑ Cantor, J. M.; Kuban, M. E.; Blak, T.; Klassen, P. E.; Dickey, R.; Blanchard, R. (2006). "Grade Failure and Special Education Placement in Sexual Offenders' Educational Histories". Archives of Sexual Behavior. 35 (6): 743–751. doi:10.1007/s10508-006-9018-6. PMID 16708284. S2CID 24164499.
  25. ↑ Cantor, J. M.; Kuban, M. E.; Blak, T.; Klassen, P. E.; Dickey, R.; Blanchard, R. (2007). "Physical Height in Pedophilic and Hebephilic Sexual Offenders". Sexual Abuse: A Journal of Research and Treatment. 19 (4): 395–407. doi:10.1007/s11194-007-9060-5. PMID 17952597. S2CID 322977.
  26. ↑ Fazio, R. L.; Dyshniku, F.; Lykins, A. D.; Cantor, J. M. (2015). "Leg Length Versus Torso Length in Pedophilia: Further Evidence of Atypical Physical Development Early in Life". Sexual Abuse: A Journal of Research and Treatment. 29 (5): 500–514. doi:10.1177/1079063215609936. ISSN 1079-0632. PMID 26459491. S2CID 24580367.
  27. ↑ Dyshniku, Fiona; Murray, Michelle E.; Fazio, Rachel L.; Lykins, Amy D.; Cantor, James M. (2015). "Minor Physical Anomalies as a Window into the Prenatal Origins of Pedophilia". Archives of Sexual Behavior. 44 (8): 2151–2159. doi:10.1007/s10508-015-0564-7. ISSN 0004-0002. PMID 26058490. S2CID 25667170.
  28. ↑ Gebhard, PH; Gagnon JH; Pomeroy WB; Christenson CV (1965). Sex offenders: An analysis of types. New York: Harper & Row.
  29. ↑ Studer, L. H.; Aylwin, A. S.; Clelland, S. R.; Reddon, J. R.; Frenzel, R. R. (2002). "Primary erotic preference in a group of child molesters". International Journal of Law and Psychiatry. 25 (2): 173–180. doi:10.1016/s0160-2527(01)00111-x. PMID 12071103.
  30. ↑ Bernard, F (1975). "An enquiry among a group of pedophiles". The Journal of Sex Research. 11 (3): 242–255. doi:10.1080/00224497509550899. JSTOR 3811479.
  31. ↑ Wilson, G. D.; Cox, D. N. (1983). "Personality of paedophile club members". Personality and Individual Differences. 4 (3): 323–329. doi:10.1016/0191-8869(83)90154-X.
  32. ↑ 32.0 32.1 Zander, T. K. (2008). "Adult Sexual Attraction to Early-Stage Adolescents: Phallometry Doesn't Equal Pathology". Archives of Sexual Behavior. 38 (3): 329–330, author 330 331–330. doi:10.1007/s10508-008-9428-8. PMID 18931899. S2CID 20198549.
  33. ↑ 33.0 33.1 33.2 Blanchard, R. (2008). "Reply to Letters Regarding Pedophilia, Hebephilia, and the DSM-V (letter to the editor)". Archives of Sexual Behavior. 38 (3): 331–334. doi:10.1007/s10508-008-9427-9. S2CID 143846500.
  34. ↑ 34.0 34.1 Cite error: Invalid <ref> tag; no text was provided for refs named Franklin
  35. ↑ Cantor in his 2012 rebuttal in the International Journal of Forensic Mental Health states "The current version of the International Classification of Diseases (ICD-10) contains code F65.4, which defines paedophilia as 'A sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age' (World Health Organization, 2007; emphasis added). That is, people with a sexual preference for early pubescent children do indeed receive a diagnosis in the ICD system. In Franklin's defense, one could claim that the word 'hebephilia' does not appear in the ICD; however, the people with hebephilia would receive a diagnosis nonetheless."
  36. ↑ Cantor, J. M. (2012). "The Errors of Karen Franklin's Pretextuality". International Journal of Forensic Mental Health. 11 (1): 59–62. doi:10.1080/14999013.2012.672945. PMC 3382737. PMID 22745581.
  37. ↑ Seto, M. C. (2009). "Pedophilia". Annual Review of Clinical Psychology. 5: 391–407. doi:10.1146/annurev.clinpsy.032408.153618. PMID 19327034. S2CID 241202227.
  38. ↑ Frieden, J (2009-12-01). "DSM-V work on paraphilias begins in earnest" (PDF). Clinical Psychiatry News. 37 (12): 21. doi:10.1016/S0270-6644(09)70438-2. Archived from the original (PDF) on 2014-12-21. Retrieved 2013-01-07.
  39. ↑ Franklin, K (2011). "Forensic Psychiatrists Vote No on Proposed Paraphilias". Psychiatric Times. 27 (12). (subscription required)
  40. ↑ Plaud, J. (2009). "Are there "hebephiles" among us? A response to Blanchard et al. (2008) (letter to the editor)". Archives of Sexual Behavior. 38 (3): 326–327, author 327 331–327. doi:10.1007/s10508-008-9423-0. PMID 18923892. S2CID 5062770.
  41. ↑ Declue, G. (2008). "Should Hebephilia be a Mental Disorder? A Reply to Blanchard et al. (2008)". Archives of Sexual Behavior. 38 (3): 317–318, author 318 331–318. doi:10.1007/s10508-008-9422-1. PMID 18925429. S2CID 207089458.
  42. ↑ Tromovitch, P. (2008). "Manufacturing Mental Disorder by Pathologizing Erotic Age Orientation: A Comment on Blanchard et al. (2008)". Archives of Sexual Behavior. 38 (3): 328, author reply 331–4. doi:10.1007/s10508-008-9426-x. PMID 18923890.
  43. ↑ 43.0 43.1 Cite error: Invalid <ref> tag; no text was provided for refs named Frances
  44. ↑ Frances, Allen "DSM 5 Needs to Reject Hebephilia Now" Psychology Today, 15.06.2011, retrieved 27.07.18
  45. ↑ 45.0 45.1 Ryniker, DC (August 2012). "Hebephilia and male fertility". Archives of Sexual Behavior. 41 (4): 741–3. doi:10.1007/s10508-012-9977-8. PMID 22695643. S2CID 31148218.
  46. ↑ Hames, R; Blanchard, R (August 2012). "Anthropological data regarding the adaptiveness of hebephilia". Archives of Sexual Behavior. 41 (4): 745–7. doi:10.1007/s10508-012-9972-0. PMID 22644593. S2CID 9910627.
  47. ↑ 47.0 47.1 47.2 Ewing, CP (2011). Justice Perverted:Sex Offense Law, Psychology, and Public Policy: Sex Offense Law, Psychology, and Public Policy. Oxford University Press. pp. 28–32. ISBN 978-0199732678.
  48. ↑ Frances, Allen (2013). Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5. Guilford Publications. p. 174. ISBN 978-1462513499.
  49. ↑ Tucker, D.; Brakel, S. J. (2012). "DSM-5 Paraphilic Diagnoses and SVP Law". Archives of Sexual Behavior. 41 (3): 533. doi:10.1007/s10508-011-9893-3. PMID 22218789.

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