Use of DSM paraphilia diagnoses in sexually violent predator commitment cases

There is legitimate concern in the psychiatric community about the constitutionality of sexually violent predator (SVP) commitment statutes. Such constitutionality depends on the requirement that a sexual offender have a mental abnormality that makes him commit violent predatory sex offenses and reflects almost exclusively a concern for public safety, with little regard for notions of clinical sensibility or diagnostic accuracy. However, given that mental health experts ’ diagnostic opinions are, and will continue to be, important to the triers of fact in regard to the application of the SVP statutes, we describe valid means of making a DSM-IV-TR paraphilic diagnosis. We also provide a three-step approach for the judicious application of the diagnosis in the context of SVP commitment evaluations that emphasizes the importance of not making a paraphilia diagnosis based solely on the sexual offenses themselves. Finally, we discuss the appropriate use of a paraphilia NOS diagnosis in SVP cases. J Am Acad Psychiatry Law 36:443–54, 2008 In 1990, the state of Washington passed the first sexually violent predator (SVP) involuntary commit-ment statute, which was designed to allow for the civil commitment of sex offenders to mental hospi-tals after they complete mandatory prison sentences