Is a separate diagnostic category defensible for paraphilic coercion?

PurposeIt has been hypothesized that paraphilic coercive disorder (PCD) constitutes a distinct sexual preference for the coercive elements of sexual interactions and that this preference can be discriminated from a sexual preference for violence, harm, and injury. This article critically reviews the evidence that has been marshaled to support this hypothesis in the recent debates about admission of PCD to the DSM-5. It then tests the validity of an alternative model—a single dimension Agonistic Continuum that encompasses both PCD and sadism.MethodsA critical, selective review of plethysmographic (PPG) and self-report studies attempting to differentiate coercion and harm is presented. The validity of the hypothesis that there is a single, Agonistic Continuum rather than distinct disorders was tested using exploratory factor analysis, Item Response Theory, and taxometrics.ResultsIt is argued that PPG studies that have purported to discriminate PCD from sadism have rather supported the linkage of the two constructs. The review and empirical analyses converge on a single dimension, anchored by coercive fantasies on the lower end and extreme sadism on the upper end and labeled the Agonistic Continuum.ConclusionsThe implications of these results for the DSM-5, legal decisions, and research strategies are discussed.

► MIDSA self-report responses were gathered from 529 sex offenders in MA and MN
► EFA, IRT, and taxometrics explored the structure of an Agonistic Continuum
► This Continuum is distributed as a dimension, ranging from noncoercion through sadism
► No data in the review or analyses supported PCD and sadism as separate disorders
► Implications discussed for DSM-5, legal decisions, research, and clinical utility