German Dunkelfeld project supported the explicit mention of hebephilia in DSM-5: "Concerning the update of the DSM (DSM-5) a category called 'hebephilic disorder' would have been appropriate, especially considering the given data which shows that in men with a hebephilic preference, who seek treatment, the disorder criteria of the DSM-5 (psychological distress, behavior endangering others) are given in many cases. In this respect there would be men with hebephilia as well as men with a 'hebephilic disorder.'" In a letter to the editor, Thomas Zander argued there would be serious consequences from expanding the definition of pedophilia to include hebephilia, and stated that there are problems in distinguishing between prepubescent versus pubescent victims and thus in classifying offenders, and concluded that it required more research and consideration of implications before the DSM was changed. Blanchard agreed that distinguishing between pedophiles and hebephiles may present difficulties, but stated that in the case of a repeat sexual offender, these fine distinctions would be less important; he noted that other objections raised by Zander's letter were addressed in the original article. In another letter to the editor, physician Charles Moser agreed with Blanchard et al.'s premise that there was a distinction between sex offenders who preferred pubescent versus prepubescent victims and supported the term's usefulness in conducting research, but questioned whether hebephilia would represent a true paraphilia. Karen Franklin stated that she believes the concept is largely the result of the Centre for Addiction and Mental Health, although CAMH scientist and pedophilia researcher James Cantor challenged her factual accuracy, citing the existence of the concept in the ICD-10, the use of the word in 100 scholarly texts from a variety of disciplines and time periods, and the existence of 32 peer reviewed papers researching the concept. Psychologist Skye Stephens and sexologist Michael C. Seto also argue that because the ICD-10 includes "prepubertal or early pubertal age" in its classification of pedophilia, it includes both pedophilic and hebephilic sexual interests. At a 2009 meeting of the American Academy of Psychiatry and the Law, concern was raised that the criteria could have produced both false positives and false negatives, and that hebephilia as a DSM diagnosis could pathologize sex offenders who have opportunistically preyed on pubescent victims but do not have a paraphilic attachment to a specific age of victim, while excluding offenders who had committed serious offences on only one or two victims. During