Is a separate diagnostic category defensible for paraphilic coercion?

AbstractPurpose 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. s ical, 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. s 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. sions plications of these results for the DSM-5, legal decisions, and research strategies are discussed.