In this guest blog, Dr Deirdre D'Orazio responds to a recent commentary by Dr Allen Frances on conducting evaluations of potential sexually violent predators.

Accurate diagnosis is absolutely crucial in SVP hearings because the potential outcome is so consequential—involuntary incarceration in a psychiatric hospital that may well last a lifetime. In no other clinical or forensic situation does so much ride on the presence or absence of a psychiatric diagnosis.

During the past year, I have been involved as an expert witness for the defense in 14 SVP cases (tried in California, Washington, and Iowa). My role has been to clarify what is meant by the wording of the Paraphilia section in DSM-IV. And it certainly does badly need explaining.