Civil commitment of mentally disordered persons in the United States was generally limited to persons who were clinically and judicially determined to have psychotic disorders, until 2 U.S. Supreme Court decisions in 1997 and 2002 sanctioned the commitment of nonpsychotic sex offenders who had completed their prison sentences. Such commitments are based on diagnoses of paraphilias and personality disorders – often using the miscellaneous “not otherwise specified” designations for these diagnostic categories. These diagnoses have poor conceptual validity and low interrater reliability. Accordingly, civil commitments that are based on diagnoses of such nonpsychotic disorders have a weak foundation.
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