Evidence Regarding the Need for a Diagnostic Category for a Coercive Paraphilia

Evidence relevant to a potential diagnosis of Paraphilic Coercive Disorder is reviewed. Salient cues indicating that their partner is feeling coerced normally at least partially inhibit male sexual arousal while cues indicating mutual interest heighten arousal. However, for a minority of males, this pattern reverses with salient coercion cues leading to heightened arousal. This unusual pattern of arousal and fantasy is associated with a self-reported willingness to rape among non-convicted samples and is more common among convicted rapists than in other offender groups. It is inconsistently associated with Sadism as defined by the DSM-IV-TR and only weakly associated with psychopathy or general criminality. Evidence for it as an abnormal and persistent sexual interest comes from behavioral patterns, self-reported sexual fantasy, and laboratory tests. Two possible ways of incorporating it into a future version of the DSM are outlined.