Kenneth J. Zucker, Ph.D.,
Child and Adolescent Gender Identity Clinic, Child
Psychiatry Program,
Centre for Addiction and Mental Health Clarke Division,
250
College St., Toronto, Ontario M5T 1R8, Canada
(e-mail: Ken Zucker@camh.net )
[500]
Green reviewed some data on associated personality characteristics and the presence of other (my emphasis) mental disorders in pedophilic men. Green's read of these data is that
 | either they do not really distinguish pedophilic men in a particularly meaningful way |
| or that the direction-of-effect is arguable (e.g., a higher rate of depression or anxiety might be an understandable reaction in a person who engages in a sexual behavior pattern condemned by society rather than as inherently associated with pedophilia itself). |
[501]
They are irrelevant to the debate on whether or not pedophilia per se is a mental disorder. On this point, one must rely on the "rules of the game," i.e., whether or not pedophilia conforms to the DSM definition of a mental disorder
(Spitzer \& Endicott, 1978; Wakefield, 1992a, 1992b).
There is, however, an extremely interesting historical precedent to Green's consideration of associated features. One prominent factor in the removal of homosexuality per se from the DSM-II in 1973 was the emerging empirical database that homosexual adults were no more or less likely than heterosexual adults to have associated psychopathology (see Bayer, 1981).
A series of studies on non-patient homosexual and heterosexual subjects was particularly influential in this regard
(e.g., Saghir & Robins, 1973; Siegelman, 1972, 1974).
Green seems to want to run with this same pattern with regard to pedophilia.
Thirty years later, it is odd that associated features played such an important role in the debate over the de-listing of homosexuality. If, for example, homosexual men have a higher rate of major depressive disorder or if lesbian women have a higher rate of alcohol abuse, this should not bear on the question of whether or not homosexuality per se is a mental disorder. If it did, then homosexuality would have to be reinstated into the DSM because recent epidemiological studies have identified higher rates of mental disorders in both homosexual men and women
(e.g., Cochran, 2001; Sandfort, de Graaf, Bijl, & Schnabel, 2001).
It is clear, however, that this will not happen because associated features are just associated features.
Elevated rates of mental disorders in homosexual men and women are open to a wide variety of interpretations and explanations, but have nothing to do with defining the nature of mental disorder. It is likely that the data on associated features played such an important role 30 years ago because, in the earlier editions of DSM (American Psychiatric Association, 1952, 1968), homosexuality was conceptualized as a personality disorder.
Thus, in historical context, demonstrating that homosexuality per se was not necessarily associated with "other" psychopathology was important.
In my view, this argument will not fly with regard to the debate on pedophilia as mental disorder.