Commentary: muddy diagnostic waters in the SVP courtroom.

In this brief commentary, we address several of the points raised by Drs. First and Halon on the abuses of DSM diagnoses (APA, 2000) in civil commitment hearings of sex offenders. We discuss each of the elements in the three-step process proposed by First and Halon for reforming the diagnosis of paraphilias in SVP proceedings, paying particular attention to the role of volitional impairment. Both in spirit and in substance, we fundamentally agree with First and Halon, concluding that the misuse of science, inclusive of the misuse of the DSM, in the SVP courtroom is a variation of pretextuality. We commend First and Halon for drawing attention to a serious problem, one that undermines the integrity of the legal system in general and the SVP adjudicatory process in particular. We conclude with a warning that without firmer control from the courts, expert opinions will remain opaque and of questionable probative value.