Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA.
J Am Acad Psychiatry Law. 2011;39(4):555-61.
Sexually violent predators (SVP) constitute a serious potential risk to public safety, especially when they are released after too short a prison sentence. Twenty states and the federal government have developed a seemingly convenient way to reduce this risk. They have passed statutes that allow for the involuntary (often lifetime) psychiatric commitment of mentally disordered sexual offenders after prison time is up. In three separate cases, the Supreme Court has accepted the constitutionality of this procedure, but only if the offender's dangerousness is caused by a mental disorder and is not a manifestation of simple criminality. The idea that paraphilic rape should be an official category in the psychiatric diagnostic manual has been explicitly rejected by Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, DSM-IV, and, recently, DSM-5. Despite this, paraphilia NOS, nonconsent, is still frequently used by mental health evaluators in SVP cases to provide a mental disorder diagnosis that legitimizes psychiatric commitment and makes it appear constitutional. This commentary will show how the diagnosis paraphilia NOS, nonconsent, is based on a fundamental misreading of the original intent of the DSM-IV Paraphilia Workgroup and represents a misuse of psychiatry, all in the admittedly good cause of protecting public safety.
性暴力掠夺者（SVP）对公共安全构成严重潜在风险，尤其是在他们服刑时间过短而被释放之后。二十个州和联邦政府已经制定了一种看似方便的方法来降低这种风险。他们通过了法规，允许在服刑期满后，对有精神障碍的性犯罪者进行非自愿（通常是终身）的精神科强制住院治疗。在三个单独的案件中，最高法院接受了这一程序的合宪性，但前提是犯罪者的危险性是由精神障碍引起的，而不是单纯犯罪行为的表现。《精神障碍诊断与统计手册》（DSM）-III、DSM-III-R、DSM-IV 以及最近的 DSM-5 都明确拒绝将恋物性强奸作为精神病学诊断手册中的一个正式类别。尽管如此，非特定性恋物癖，不同意，仍然经常被心理健康评估人员在 SVP 案件中使用，以提供精神障碍诊断，使精神科强制住院治疗合法化，并使其看起来符合宪法。本评论将展示非特定性恋物癖，不同意，这一诊断是如何基于对 DSM-IV 性癖工作组原意的根本性误解，并代表了对精神病学的滥用，所有这些都是在保护公共安全这一无可非议的良好理由下进行的。
