Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Judge at the German Federal Supreme Court of Justice (off-duty), Bremen, Germany.
J Sex Med. 2019 Oct;16(10):1615-1622. doi: 10.1016/j.jsxm.2019.07.011. Epub 2019 Aug 22.
Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published.
This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany.
A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization.
Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany.
Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system.
The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized.
STRENGTHS & LIMITATIONS: The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts.
A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders. Briken P, Boetticher A, Krueger RB, et al. Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. J Sex Med 2019;16:1615-1622.
最近，《国际疾病与相关健康问题统计分类》第十一次修订版（ICD-11）中的性欲倒错障碍诊断指南已经发布。
本文分析了德国性欲倒错障碍分类变化的潜在影响相关的法律、法规和政策问题。
德国的一名法医和法律专家与其他国际专家一起，使用世界卫生组织提供的评估指南，对这一评估进行了研究。
ICD-11 中性欲倒错障碍分类变化对德国法医实践、卫生系统、性犯罪个体的判决以及治疗的可能影响。
研究结果突出了德国卫生系统中医疗保密的特殊情况，这有助于为治疗恋童癖患者建立预防网络。ICD-11 指南将有助于澄清恋童癖和儿童性虐待犯罪之间的界限。这也将与其他性欲倒错诊断概念建立界限。我们描述了德国法律体系中与性欲倒错障碍相关的刑事责任的核心结构，专家证人的突出作用，以及医疗保密在医疗保健系统和法律体系中的概念化差异。
与 ICD-10 相比，ICD-11 性欲倒错障碍的建议在正常性行为的变异与涉及非自愿者或实体的性行为之间提供了更清晰的区分。特别的性偏好模式，如受虐狂和恋物癖，与公共卫生、卫生保健系统或法律系统无关，将不再被命名为精神障碍，因此将被视为私人行为，并消除污名。
评估结果显示了德国在性医学、精神病学和法律领域治疗性欲倒错患者的具体法律情况。然而，这只是由少数专家完成的。
分析的结论是，与 ICD-10 相比，ICD-11 诊断指南中更具体和更狭窄的定义，特别是对于恋童癖和强制性性施虐障碍，将导致假阳性诊断的减少。实施 ICD-11 性欲倒错障碍指南不太可能导致意外的和负面的影响。Briken P、Boetticher A、Krueger RB 等人。《国际疾病与相关健康问题统计分类》第十一次修订版（ICD-11）中性欲倒错障碍诊断指南对德国的当前法律状况及对性欲倒错障碍的影响。性医学杂志 2019;16:1615-1622.
