Commentary: inventing diagnosis for civil commitment of rapists.

In the past two decades, public fear and antipathy toward sexual offenders have led to public registries of their names and addresses, longer prison sentences, consideration of the death penalty, and civil commitment laws that allow potentially lifetime preventive detention after these offenders complete prison sentences. Twenty states and the federal government have enacted such civil commitment laws. Some forensic evaluators of rapists base findings supporting such commitment on the diagnosis of paraphilia not otherwise specified, using this miscellaneous category as a substitute for a proposed diagnosis that was rejected for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1986. Despite the deliberate rejection of such a hypothesized rape paraphilia for DSM, and despite a continued lack of research supporting the validity or interrater reliability of such a diagnosis, it is widely used as a basis for confining rapists. This article discusses the history and ethics-related implications of this forensic practice.