THE WITNESS: He’s not interested in prepubescent children.
Id. at 169. Indeed, Dr. Demby acknowledged that “individually, [puberty] can happen at different ages for different children,” and she frankly admitted that it would “be possible for somebody who is say, 12 years old to be pubescent.” Id. at 209. Dr. Demby nonetheless diagnosed Caporale with “pedophilia, sexually attracted to males exclusive type, and personality disorder not otherwise specified of dependent traits.” Id. at 207.
Dr. Zinik, having ruled out pedophilia, concluded that Caporale suffers from “paraphilia ... not otherwise specified” (“paraphilia/NOS”). J.A. 161. Dr. Zinik testified that paraphilia is characterized by “recurrent, intense sexual fantasies, urges or behaviors that ... last at least six months and ... cause a significant impairment or disability in the individual’s life.” Id. at 167. Dr. Zinik occasionally referred to Caporale’s affliction as “hebephilia,” which is not a listed diagnosis in the DSM, but a colloquial term understood by mental health professionals to describe the proclivity of “men whose erotic interest centers on pubescents.” Ray Blanchard et ak, Pedophilia, Hebephilia, and the DSM-V, 38 Archives of Sexual Behavior 335, 336 (2009).
Only eight specific manifestations of paraphilia — pedophilia, transvestic fetishism, exhibitionism, fetishism with respect to inanimate objects, voyeurism, sexual masochism, sexual sadism, and frotteurism (sexual rubbing against non-consenting persons, often in crowded areas) — are documented in the Fourth Edition of the DSM, a treatise accepted as authoritative by all the testifying experts. More generally, however, the DSM lists paraphilia/NOS, which, Dr. Zinik explained, “is a residual category in which really all — any other paraphilia could be included.” J.A. 167. According to Dr. Zinik, a paraphilia’s inclusion within the catch-all should not depend on whether it is diagnosed with a frequency similar to those specifically listed, but should merely consider whether it impairs normal functioning to a similar extent. See id.
In Dr. Zinik’s opinion, Caporale’s paraphilia “has caused serious impairment and dysfunction in his life, because he keeps getting arrested and ... he’s never really done much with his life, because of this obsession.” J.A. 161. Dr. Demby agreed with Dr. Zinik that impairment is the hallmark of a mental infirmity, explaining that “[t]he mere presence of sexual attraction to pubescent children in and of itself does not qualify as a mental disorder. The disorder comes when it causes one to have significant impairment in major spheres of functioning in one’s life.” See id. at 210.
In opposition to the government’s experts, Dr. Plaud opined that Caporale suffers from no qualifying illness, abnormality, or disorder under § 4247(a). Dr. Plaud observed that Caporale’s sexual liaisons with pubescent males “is illegal to a certain extent ... upwards, depending on the jurisdiction. But it is not disordered.” J.A. 251. Emphasizing the lack of a discrete DSM listing for Caporale’s affliction, Dr. Plaud reasoned that “if it’s ... truly a disorder, it should have its own diagnostic criteria. [I]f you have something that’s high frequency and it’s truly considered by the professional community to be a disorder, then you’ve got to have a diagnosis for it.” Id. at 252.
Dr. Plaud took issue with Dr. Zinik’s conclusion that, for purposes of the Walsh Act, hebephilia can be shoehorned into the DSM-listed diagnosis of paraphilia/NOS, explaining that “[fit’s only more recently that this has become something, I think, as a consequence of what’s going on in the larger civil commitment world.... And I