United States v. Walter Wooden , 693 F.3d 440 ( 2012 )


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  •                        PUBLISHED
    UNITED STATES COURT OF APPEALS
    FOR THE FOURTH CIRCUIT
    UNITED STATES OF AMERICA,            
    Petitioner-Appellant,
    v.                          No. 11-7226
    WALTER WOODEN,
    Respondent-Appellee.
    
    Appeal from the United States District Court
    for the Eastern District of North Carolina, at Raleigh.
    Terrence W. Boyle, District Judge.
    (5:10-hc-02151-BO)
    Argued: May 17, 2012
    Decided: September 6, 2012
    Before TRAXLER, Chief Judge, and MOTZ and KEENAN,
    Circuit Judges.
    Reversed and remanded by published opinion. Chief Judge
    Traxler wrote the opinion, in which Judge Motz and Judge
    Keenan joined.
    COUNSEL
    ARGUED: Ian James Samuel, UNITED STATES DEPART-
    MENT OF JUSTICE, Washington, D.C., for Appellant. Eric
    Joseph Brignac, OFFICE OF THE FEDERAL PUBLIC
    2                  UNITED STATES v. WOODEN
    DEFENDER, Raleigh, North Carolina, for Appellee. ON
    BRIEF: Tony West, Assistant Attorney General, Mark B.
    Stern, UNITED STATES DEPARTMENT OF JUSTICE,
    Washington, D.C.; Thomas G. Walker, United States Attor-
    ney, Raleigh, North Carolina, for Appellant. Thomas P.
    McNamara, Federal Public Defender, G. Alan DuBois, Assis-
    tant Federal Public Defender, OFFICE OF THE FEDERAL
    PUBLIC DEFENDER, Raleigh, North Carolina, for Appellee.
    OPINION
    TRAXLER, Chief Judge:
    Approximately three months before Walter Wooden was to
    be released from federal prison, the government sought to
    commit him as a "sexually dangerous person," 
    18 U.S.C.A. § 4248
    (a) (West Supp. 2012), under the civil-commitment
    provisions of the Adam Walsh Child Protection and Safety
    Act of 2006 (the "Act"), Pub. L. No. 109–248, 
    120 Stat. 587
    (codified as amended in scattered sections of 18 and 42
    U.S.C.A.). After an evidentiary hearing, the district court held
    that the government failed to prove Wooden suffered from
    pedophilia and failed to prove he would have serious diffi-
    culty refraining from re-offending. The court therefore dis-
    missed the government’s petition and ordered Wooden
    released. The government appeals. For the reasons set forth
    below, we reverse the district court’s order and remand for
    reconsideration of the government’s petition on the existing
    record.
    I.
    The Act authorizes the government to civilly commit "sex-
    ually dangerous" federal inmates after the expiration of their
    sentences. 
    18 U.S.C.A. § 4248
    (a). An inmate is a "sexually
    dangerous person" if he has a prior act or attempted act of
    UNITED STATES v. WOODEN                    3
    child molestation or sexually violent conduct and is "sexually
    dangerous to others." 
    Id.
     § 4247(a)(5). An inmate is sexually
    dangerous to others if he "suffers from a serious mental ill-
    ness, abnormality, or disorder as a result of which he would
    have serious difficulty refraining from sexually violent con-
    duct or child molestation if released." Id. § 4247(a)(6).
    The Act’s mental illness and serious-difficulty-refraining
    requirements ensure that commitment is limited to inmates
    with a volitional impairment — inmates "whose mental ill-
    ness renders them dangerous beyond their control." United
    States v. Francis, ___ F.3d ___, ____, 
    2012 WL 2877668
    , at
    *8 (4th Cir. July 16, 2012); see also United States v. Hall, 
    664 F.3d 456
    , 463 (4th Cir. 2012) ("[T]he serious difficulty prong
    of § 4248’s certification proceeding refers to the degree of the
    person’s volitional impairment, which impacts the person’s
    ability to refrain from acting upon his deviant sexual inter-
    ests." (internal quotation marks omitted)). As the Supreme
    Court has explained, the requirement that the inmate suffer
    from a volitional impairment is of "constitutional importance"
    because it works to "distinguish[ ] a dangerous sexual
    offender subject to civil commitment from other dangerous
    persons who are perhaps more properly dealt with exclusively
    through criminal proceedings. That distinction is necessary
    lest civil commitment become a mechanism for retribution or
    general deterrence — functions properly those of criminal
    law, not civil commitment." Kansas v. Crane, 
    534 U.S. 407
    ,
    412 (2002) (citation & internal quotation marks omitted).
    II.
    A.
    Wooden was born in March 1956 in Washington, D.C.
    Wooden’s intellectual capacity is somewhat limited. He
    repeated the third grade and was expelled from school in the
    eighth grade. See J.A. 112. A 1978 evaluation classified
    Wooden’s intellectual functioning as within the "dull normal
    4                 UNITED STATES v. WOODEN
    range," J.A. 75, and his I.Q. has been measured at 70, which
    qualifies as "borderline retarded," J.A. 502.
    When Wooden was eight or nine years old, he was sexually
    assaulted by a man in his neighborhood. Wooden did not
    report the abuse.
    In January 1972 and again in April 1972, Wooden was
    adjudicated delinquent for committing rectal sodomy on a
    minor. In October 1973, Wooden again was adjudicated delin-
    quent after sexually molesting a minor. A sentencing report
    prepared in connection with this offense indicated that
    Wooden had been arrested for sexual offenses against chil-
    dren at least six times since January 1972. In 1974, Wooden
    was charged as an adult and pleaded guilty to taking indecent
    liberties with a four-year-old child. Wooden was sentenced to
    ten years’ imprisonment, but he was paroled into the commu-
    nity in 1980. In 1984, after separate incidents involving an
    eight-year-old boy and a twelve-year-old boy, Wooden was
    convicted of various charges, including sodomy, and was sen-
    tenced to 25 years’ imprisonment. Wooden was paroled in
    2000, but his parole was revoked in 2001 for failure to coop-
    erate with the supervising officers. On July 25, 2002, Wooden
    was again paroled, and he was ordered to undergo long-term
    sex-offender treatment and testing.
    Dr. Ronald Weiner supervised Wooden’s court-ordered sex
    offender treatment. Wooden responded well enough to treat-
    ment that after about six months, Dr. Weiner recommended
    reducing the frequency of their sessions from once a week to
    once every other week. After about a year of treatment, Dr.
    Weiner recommended monthly sessions.
    In May 2005, probation officer John Taberski was assigned
    to Wooden’s case. Taberski called and introduced himself to
    Wooden and told Wooden that he had a "maintenance" poly-
    graph examination coming up. J.A. 452. Wooden repeatedly
    told Taberski that he would refuse to take the polygraph.
    UNITED STATES v. WOODEN                    5
    Wooden would not explain his concerns about the polygraph,
    and Taberski encouraged Wooden to discuss his apprehen-
    sions with Dr. Weiner. Taberski reported Wooden’s reluc-
    tance to Paul Brennan, Taberski’s supervisor. In
    conversations with the probation agents, Wooden admitted
    that he had had contact with children in the community and
    that children visited Wooden’s apartment while he was alone
    there. See J.A. 452-54. When Taberski pressed Wooden about
    whether he was following the plans and using the relapse-
    avoidance skills developed in his treatment sessions, Wooden
    became angry, saying, "‘What do you expect me to do; there’s
    nowhere for me to go.’" J.A. 455. Taberski called Dr. Weiner
    immediately after the home visit to report that Wooden had
    admitted to being around children not only in the community,
    but also in his apartment.
    Dr. Weiner met with Wooden on June 3, 2005, for a coun-
    seling session. Wooden told Dr. Weiner that he had been
    "placing himself in high risk situations" by hiring himself out
    as a babysitter and that he had been having "deviant sexual
    thoughts about children." J.A. 67. Wooden eventually told Dr.
    Weiner that, months earlier, he had had sexual contact with a
    seven-year-old boy he knew from the neighborhood. Wooden
    told Dr. Weiner that the boy had followed him to the laundry
    room in the basement of his apartment building. After
    Wooden pulled down his pants and showed the boy his penis,
    the boy also took off his pants, and Wooden placed his penis
    against the boy’s buttocks without making any attempt to pen-
    etrate. Wooden reported that he then became upset with him-
    self and changed his mind about engaging in sexual activity
    with the boy, who left after Wooden gave him five dollars.
    On June 7, 2005, Wooden, Dr. Weiner, and probation offi-
    cers Brennan and Taberski met for an emergency meeting
    convened by Dr. Weiner. At the meeting, Dr. Weiner
    explained to the others that Wooden had admitted to molest-
    ing the seven-year-old boy, and Wooden agreed. Wooden
    6                 UNITED STATES v. WOODEN
    refused to provide the boy’s full name, but he did provide the
    boy’s address.
    At a June 9 counseling session with Lesley Stamm, an
    associate of Dr. Weiner’s, Wooden said that he had met the
    boy about a year earlier and that "the boy initiated their
    encounters because the boy wanted to have sex with him."
    J.A. 152. Wooden told Stamm that he fought an "internal bat-
    tle" over whether he should touch the boy and that he "en-
    tertain[ed] fantasies" about sodomizing the boy. J.A. 152.
    When discussing his interactions with the boy, however,
    Wooden vacillated between admitting to actual sexual contact
    with the boy and claiming that he had only dreamed about
    having sexual contact with the boy. See J.A. 152. In the ear-
    lier conversations with Dr. Weiner and the probation officers,
    Wooden never claimed that he had dreamed the encounter.
    During a polygraph examination administered on June 20,
    2005, Wooden admitted to having "deviant sexual thoughts
    about children in the past year" and to being sexually aroused
    in the presence of children in the past year. J.A. 68. Wooden
    acknowledged that he had engaged in sexual activity with a
    child in the past year and that he had attempted to engage in
    sexual activity with a different child. See J.A. 68, 153.
    According to the officer administering the polygraph, Wood-
    en’s answers to those questions were "non-deceptive." J.A.
    153. In a session with Dr. Weiner the next day, Wooden
    acknowledged that he was not being completely truthful about
    his sexual contacts with children. He told Dr. Weiner that, a
    couple of years earlier, he had lured a boy into the basement
    for sexual purposes but changed his mind and did not go
    through with the offense. See J.A. 152, 529-30.
    Police officers investigating the incident interviewed
    Wooden, who told them the same story he had first told Dr.
    Weiner — that he placed his penis against the boy’s buttocks
    but did not attempt penetration. The officers also interviewed
    the seven-year-old boy identified by Wooden. The presence
    UNITED STATES v. WOODEN                           7
    of the police scared the boy, who worried that Wooden was
    "real mad because he told on him." J.A. 373. The boy would
    not explain why Wooden might be mad at him, and he denied
    that Wooden touched or molested him. The boy told the offi-
    cers, however, that he was afraid to be around Wooden, even
    though Wooden sometimes gave him money. The boy told the
    officers that one of his friends thought Wooden was "gay and
    told [the boy] not to go around him." J.A. 373.
    In July 2005, Wooden was charged with violating the terms
    of his parole by having contact with minors and by having
    sexual contact with the seven-year-old boy. At his parole
    revocation hearing, Wooden testified that he had not actually
    molested the seven-year-old boy, but had only dreamed about
    the molestation. The hearing officer revoked Wooden’s
    parole, concluding (under a preponderance-of-the-evidence
    standard) that Wooden did in fact have sexual contact with the
    boy.
    Wooden served the parole-revocation sentence at the Fed-
    eral Correctional Institute in Butner, North Carolina.1 While
    at Butner, Wooden sent a Christmas card to the seven-year-
    old boy. Wooden’s message on the card read, "Merry Christ-
    1
    The Act authorizes the government to seek commitment of inmates "in
    the custody of the Bureau of Prisons." 
    18 U.S.C.A. § 4248
    (a). Although
    Wooden’s crimes all involved violations of the laws of the District of
    Columbia, defendants convicted in the District are committed to the cus-
    tody of and serve their sentences at the place designated by the Attorney
    General of the United States, see 
    D.C. Code § 24-201.26
    , and are "subject
    to any law or regulation applicable to persons committed for violations of
    laws of the United States consistent with the sentence imposed," 
    id.
     § 24-
    101(a). The district court concluded that, by virtue of these statutes,
    Wooden was in the legal custody of the Bureau of Prisons and thus subject
    to commitment under the Act. See United States v. Joshua, 
    607 F.3d 379
    ,
    388 (4th Cir. 2010) ("[U]nder § 4248 the word ‘custody’ refers not to
    physical custody or some qualified derivative but rather to legal custody.
    The statutory language ‘in the custody of the Bureau of Prisons’ therefore
    requires the BOP to have ultimate legal authority over the person’s deten-
    tion."). Wooden does not challenge that ruling on appeal.
    8                   UNITED STATES v. WOODEN
    mas to you [name redacted], and if I was out there I would do
    a whole lot for you. Because it is Christmas and you are my
    friend. So have a very, very happy Christmas, and a happy
    New Year too." J.A. 68. The card was signed, "Your Friend
    Walter." J.A. 68.
    B.
    Approximately three months before Wooden’s scheduled
    release date, the government initiated commitment proceed-
    ings by filing a certification that Wooden was a sexually dan-
    gerous person within the meaning of the Act. The certification
    automatically stayed Wooden’s release pending the district
    court’s final determination, after an evidentiary hearing, of
    whether commitment was warranted. See 
    18 U.S.C.A. § 4248
    (a); Hall, 
    664 F.3d at 459
    .
    The hearing took place over two days in July 2011. Testify-
    ing at the hearing were Wooden himself, Wooden’s parole
    officer, and three expert witnesses — government experts Dr.
    Hy Malinek and Dr. Heather Ross, clinical psychologists spe-
    cializing in forensic psychology and risk assessment for sex-
    ual offenders, and defense expert Dr. Terence Campbell, a
    psychologist specializing in forensic psychology.
    Wooden was one of the first witnesses called by the gov-
    ernment; his direct examination began on the first day of the
    hearing and continued into the second day. On the first day,
    Wooden was a difficult and recalcitrant witness. There were
    often long pauses before Wooden answered a question, see
    J.A. 20, and Wooden frequently claimed he could not remem-
    ber details of the crimes or tried to invoke his right to remain
    silent, see J.A. 386 ("I plead the Fifth. I ain’t tryin’ to go back
    to that."). Nonetheless, the government was able to elicit
    some testimony from Wooden about his prior crimes, and that
    testimony also shed light on Wooden’s thought processes.
    Wooden testified that the victims of his crimes, who were as
    young as four, wanted to have sex with him and that they
    UNITED STATES v. WOODEN                      9
    came to him asking for sex. See J.A. 393-95, 406, 426-27. He
    testified that his victims asked him for money and that these
    young children "understood" that they would have to have sex
    with Wooden before he would give them any money. J.A.
    397. When Wooden was asked if, after reflecting on his early
    crimes, he had any thoughts about how he should have
    reacted, his response was, "I should have told all of them no."
    J.A. 407.
    The testimony Wooden gave on the first day of the hearing
    was similar to the testimony he had given two weeks earlier,
    when he was deposed by the government. For example,
    Wooden testified at the deposition that "[a] whole lot of boys
    came up to me and wanted me to have sex with them back
    then. That’s the God honest truth, and my brothers and sis-
    ters—my brothers will tell you that, too." J.A. 347. Wooden
    also testified that, at the time he committed his prior offenses,
    he believed the young boys wanted to have sex with him, and
    he testified that he still believed that to be true at the time of
    the deposition. See J.A. 345. And when asked in the deposi-
    tion about a prior conviction involving a four-year-old boy,
    Wooden testified that the boy laid down on his stomach on his
    own, without Wooden touching or guiding him, because "he
    knew. I guess he knew that’s what I wanted." J.A. 422.
    When Wooden retook the stand on the second day of the
    hearing, his demeanor was markedly improved. He did not
    claim memory lapses or assert a right to remain silent as he
    did on the first day, and he was much more responsive to the
    government’s questions. When the government asked
    Wooden about the disputed 2005 incident with the seven-
    year-old boy, Wooden responded:
    I told him it was a dream. I told Dr. Weiner that I
    had this dream. I had this dream about [name
    redacted], and I told Dr. Weiner, I said, I want him
    to find out was it a dream or not, because sometimes
    I have blackout spells. I wanted him to find out was
    10                 UNITED STATES v. WOODEN
    it a dream or not because I didn’t want to hurt the
    boy. So the next thing I know he had me to go see—
    had me to go see the police investigator, had me to
    go see the investigator. I talked to the investigator,
    and the investigator asked me the same questions. I
    told the investigator the same thing. I said, I didn’t
    want to hurt the boy. I wanted them to find out was
    it a dream or not, because I didn’t know.
    J.A. 437 (emphasis added). Wooden testified that he sent the
    Christmas card to the boy because the boy was his friend. J.A.
    442.
    The government asked Wooden if he felt he had changed
    as a person. Wooden responded that he had changed because
    he no longer thinks about boys and because he realized that
    he was at fault. See J.A. 446 ("Once before I was thinking that
    they wanted it, but it was something that I really wanted
    myself. I wanted that. I wanted to have sex with them kids.").
    The government pointed out Wooden’s testimony from the
    day before that all of his victims wanted to have sex with him
    and asked Wooden why his testimony had changed. Wooden
    answered,
    I had nightmares all night. I couldn’t sleep. I
    couldn’t sleep. I couldn’t sleep. I kept tossing and
    turning and tossing and turning and tossing and turn-
    ing. I couldn’t sleep. It kept on coming up to me. In
    my mind it kept coming up to me that it was my
    fault. I couldn’t sleep. I didn’t get no sleep. I
    couldn’t sleep.
    J.A. 446. The district court interjected, asking Wooden if he
    was saying that "because you want to get out" or "because
    you actually have a conscience now that you didn’t have
    before?" J.A. 446-47. Wooden explained:
    I didn’t want to really answer them questions,
    because every time — every time when I hear about
    UNITED STATES v. WOODEN                    11
    these boys my heart get to pounding. I get scared and
    it hurts. My heart pounds all the time when I hear
    about them boys. I was trying not to hear about them
    no more. I’m trying to do something positive. That’s
    why I didn’t want to answer his questions because I
    didn’t want to be up here on the stand crying,
    because it hurts.
    J.A. 447-48. After prompting by the district court, Wooden
    specifically acknowledged that it was wrong for him to have
    "molested them boys." J.A. 448.
    Counsel for Wooden asked him three questions on cross-
    examination — whether Wooden had "any desire to have sex
    with young boys now"; whether Wooden believed that a
    young boy who asked him for money wanted to have sex with
    him; and whether Wooden believed "grown men should have
    sex with young boys." Wooden answered, "No, ma’am," to
    each question. J.A. 449-50.
    The government’s experts, Dr. Malinek and Dr. Ross, both
    testified that Wooden met the criteria for commitment under
    the Act. Prior to the hearing, the experts had submitted reports
    setting out their conclusions and recommendations in detail.
    Although Wooden refused to be interviewed by the govern-
    ment’s experts, they had access to extensive information
    about Wooden, including a transcript of the government’s
    deposition of Wooden taken two weeks before the hearing;
    court records and other information about his crimes; his
    prison disciplinary file; and his mental health records, includ-
    ing the treatment records and notes from Dr. Weiner’s sex-
    offender treatment program.
    Dr. Malinek testified that Wooden met the diagnostic
    criteria for pedophilia, which qualifies as a serious mental ill-
    ness under the Act. When determining whether Wooden
    would have serious difficulty refraining from further sexual
    offenses, Malinek scored Wooden under several actuarial
    12                     UNITED STATES v. WOODEN
    risk-assessment models and considered various "dynamic"
    risk factors that focus on the individual circumstances of the
    defendant under evaluation.2 Wooden’s scores on the actuarial
    models all indicated either a high risk or very high risk of
    recidivism. And of the dynamic factors considered by
    Malinek, all but one (Wooden’s age) suggested that Wooden
    would have difficulty refraining from re-offense. Malinek
    therefore concluded that Wooden’s mental illnesses would
    cause him to have serious difficulty refraining from re-
    offending if released and that Wooden met the criteria for
    commitment under the Act. Dr. Malinek’s conclusions and
    recommendations were premised in large part on Malinek’s
    determination that Wooden had, in fact, molested the seven-
    year-old boy in 2005. See, e.g., J.A. 103 ("[F]actoring heavily
    into my decision making in this case is the fact that Mr.
    Wooden molested a young boy . . . while participating in sex
    offender treatment, and after he has been incarcerated for
    years due to similar crimes in the past. He admitted to sexual
    fantasies and arousal around children during 2005. This fail-
    ure to stop himself speaks to a powerful volitional impair-
    ment.").
    2
    The actuarial models consider risk factors that have been shown to be
    predictive of recidivism. Sex offenders are scored under the model based
    on the presence or absence of the risk factors in that offender’s crimes, and
    the offender’s risk of recidivism is determined by reference to the known
    recidivism rates of released sex-offenders who received the same score
    under the model. See United States v. Hunt, 
    643 F. Supp. 2d 161
    , 170-71
    (D. Mass. 2009). The actuarial models, however, "only gauge a risk of
    recidivism based upon the statistics of the particular group of sex offend-
    ers selected for comparison." United States v. Hall, 
    664 F.3d 456
    , 464 (4th
    Cir. 2012). "[K]nowing the recidivism rate of a particular group does not
    mean that the individual under consideration poses the same chance of
    recidivism in the same time frame; his risk could be higher or lower than
    that of the group based upon the unique circumstances of his case." 
    Id.
    Accordingly, experts using these risk-assessment models also consider
    dynamic factors such as "the age of the particular offender, his participa-
    tion in treatment, his compliance with such treatment, his history of reof-
    fending after treatment, and his commitment to controlling his deviant
    behavior." 
    Id.
    UNITED STATES v. WOODEN                   13
    Dr. Ross’s conclusions were consistent with those of Dr.
    Malinek. Dr. Ross concluded that Wooden suffered from
    pedophilia, and her assessment of Wooden under two risk
    assessment models also showed that he was at high risk of
    reoffending. Dr. Ross testified that the mental illnesses would
    make it difficult for Wooden to refrain from reoffending if
    released and that Wooden therefore qualified as a sexually
    dangerous person within the meaning of the Act. Like those
    of Dr. Malinek, Dr. Ross’s recommendations were premised
    on her view that the 2005 incident actually occurred. See J.A.
    119-20, 123.
    Wooden’s expert, Dr. Terence Campbell, testified that
    Wooden did not meet the criteria for commitment under the
    Act. Although Campbell agreed that the pedophilia diagnosis
    may have been proper in the past, he testified that Wooden no
    longer satisfied the diagnostic criteria for pedophilia. Dr.
    Campbell also testified that Wooden was not impulsive,
    which Campbell viewed as foreclosing any possibility that
    Wooden had a volitional impairment. See J.A. 500
    ("[I]mpulsiveness is a necessary condition for volitional
    impairment. . . . If there’s no impulsiveness, there’s no voli-
    tional impairment."). Because Wooden was not impulsive and
    thus was not volitionally impaired, Dr. Campbell testified that
    Wooden would not have serious difficulty refraining from fur-
    ther offenses if released.
    Dr. Campbell’s determination that Wooden could no longer
    be considered a pedophile was premised in large part on
    Wooden’s age, which was 55 at the time of the hearing. As
    Dr. Campbell testified, research has shown that "the preva-
    lence and incidence of criminal behavior by adults decreases
    steadily with increasing age." Robert A. Prentky et al., Sexu-
    ally Violent Predators in the Courtroom: Science on Trial, 12
    Psychol. Pub. Pol’y & L. 357, 375 (2006); see Testimony of
    Dr. Malinek, J.A. 573 ("[Q]uite a few age related studies
    [have] documented an inverse relationship between age and
    recidivism."). Dr. Campbell testified that only Wooden’s
    14                 UNITED STATES v. WOODEN
    behavior, not his thoughts or feelings, was relevant to whether
    Wooden still suffered from pedophilia. See J.A. 498 ("Are we
    going to focus on what someone thinks? Are we going to
    focus on what someone feels? Or are we going to focus on
    what someone does. And in a legal proceeding, such as this
    one, diagnostic considerations dictate that we focus on what
    the Respondent does. What is his overt behavior."). Campbell
    noted that there was no evidence of sexual misconduct by
    Wooden in prison since 2005, that Wooden had not been col-
    lecting child pornography or non-explicit pictures of children
    while in prison, and that, with the "one exception" of the
    Christmas card, J.A. 498, Wooden had not attempted to corre-
    spond with children. In Dr. Campbell’s view, the absence of
    these problematic and symptomatic behaviors
    is consistent with the relevant diagnostic data . . .
    that the vast majority of previously convicted sexual
    offenders do not reoffend. Therefore, whatever psy-
    chopathology drove the original offending behavior
    resolves itself with the passage of time. . . . [S]ooner
    or later practically all offenders stop offending. So
    age becomes a very important consideration, and Mr.
    Wooden’s age of 55 indicates that he’s at the point
    where he is beyond his pedophilia and he is not at a
    risk to reoffend.
    J.A. 498-99.
    Under questioning from the district court, Campbell
    acknowledged that there was no evidence that Wooden had
    ever collected or shown any interest in child pornography, but
    he still found the absence of a pornography cache significant,
    because "child molesters serving time who have no history of
    pornography possession out in the street [frequently] acquire
    their own collection while they’re behind bars because it
    affords them some kind of gratification for their sexual devi-
    ancy." J.A. 558. After the district court observed that "the
    empirical evidence is that that’s not him[, b]ecause there are
    UNITED STATES v. WOODEN                     15
    no incidents of him ever viewing or collecting child pornogra-
    phy," J.A. 559, Campbell responded, "Correct. And he’s not
    doing it now. If he were doing it now then I would revise my
    opinion about pedophilia applying to him as a diagnosis
    now." J.A. 559.
    Dr. Campbell testified that he had drawn no conclusion
    about whether Wooden actually molested the seven-year-old
    boy in 2005. Noting that there was evidence supporting either
    conclusion, Dr. Campbell explained that he was "not a trier of
    fact" and that it would be "inappropriate for [him] to assume
    that position." J.A. 517. Dr. Campbell’s opinion and recom-
    mendation to the court nonetheless were premised on the
    assumption that the incident did not happen; Campbell agreed
    that civil commitment would be warranted if Wooden had
    molested the boy in 2005. See J.A. 522.
    C.
    The district court in a written opinion rejected the govern-
    ment’s petition. The district court first held that application of
    the Act to Wooden violated the Due Process and Equal Pro-
    tection Clauses of the Constitution. And on the merits of the
    certification question, the court concluded that the govern-
    ment had not proven by clear and convincing evidence that
    Wooden suffered from a serious mental illness or that he
    would have serious difficulty refraining from further acts of
    child molestation if he were released. The court thus ordered
    Wooden released.
    The district court agreed that Wooden had suffered from
    pedophilia "at some point in the past," J.A. 39, but the court
    found that the government had not proven that Wooden still
    suffered from pedophilia at the time of the hearing. Relying
    on Dr. Campbell’s testimony, the district court explained that
    "under the proper circumstances," pedophilia can "abate with
    time," J.A. 39, and the district court ultimately concluded that
    16                 UNITED STATES v. WOODEN
    pedophilia was "no longer a controlling and debilitating part
    of Mr. Wooden’s psychological makeup." J.A. 39.
    Critical to this conclusion was the court’s determination
    that Wooden did not molest the seven-year-old boy in 2005.
    The court acknowledged that Wooden had initially admitted
    that he molested the boy, but the court gave "little weight" to
    that admission given Wooden’s "obvious and undisputed
    intellectual deficits." J.A. 40. The court noted that the alleged
    victim of the 2005 incident, after being specifically and
    directly asked about the incident, denied that Wooden had
    touched him, which the court found significant in light of Dr.
    Campbell’s testimony that "studies of children’s response pat-
    terns to investigatory questions indicate that if they are
    directly asked, they do not deny, but tell." J.A. 40 (internal
    quotation marks and alteration omitted). In the district court’s
    view, the government simply failed to present "sufficient
    credible evidence to sustain a finding that the 2005 alleged
    assault occurred." J.A. 41.
    After concluding that the 2005 incident did not happen, the
    district court found the evidence of current or ongoing
    pedophilia wanting. The court observed that Wooden had
    been free in the community for three years without re-
    offending, that Wooden had been making good progress in his
    treatment with Dr. Weiner before he reported the 2005 inci-
    dent, and that Wooden cooperated with the investigation of
    the 2005 incident, and the court believed that these facts sup-
    ported a finding that Wooden’s pedophilia had "subsided with
    time." J.A. 42. The court took note of Dr. Campbell’s testi-
    mony that Wooden’s failure to collect child pornography in
    prison indicated that Wooden’s pedophilia had abated and of
    Dr. Malinek’s testimony "that some molesters are simply not
    interested in child pornography." J.A. 42. Although the court
    found Malinek’s point to be "well taken," the court explained
    that after
    considering that [Wooden’s] last act of child moles-
    tation occurred in 1983, that he was free in the com-
    UNITED STATES v. WOODEN                    17
    munity for three years without re-offending, that
    during the last six years while incarcerated there
    have not been any infractions involving any type of
    sexual deviancy, this Court finds that the Govern-
    ment has not shown by clear and convincing evi-
    dence that Mr. Wooden continues to suffer from
    pedophilia.
    J.A. 42.
    Although the district court could have rested its rejection of
    the government’s petition solely on its determination that
    Wooden was not a pedophile, see Francis, 
    2012 WL 2877668
    at *9, the court also addressed the Act’s other requirements.
    In the district court’s view, proof of a volitional impairment
    that would make it seriously difficult for the inmate to refrain
    from reoffending, as required by § 4247(a)(6), is not enough
    for commitment under the Act. Instead, the court concluded
    that "[a] finding of dangerousness is also constitutionally
    required," which the court viewed as requiring proof that
    Wooden "poses a risk of re-offense that is significant enough
    to justify a finding that [Wooden] is sexually dangerous and
    therefore can be preventively detained." J.A. 18.
    Noting the conflicting expert testimony and choosing to
    credit Dr. Campbell’s testimony that Wooden had no voli-
    tional impairment because he was not impulsive, the district
    court held that the government had not proven that Wooden
    "currently manifests a serious mental illness, abnormality or
    disorder that impairs his volitional control such that he would
    have serious difficulty refraining from sexually violent con-
    duct or child molestation if released." J.A. 50. As to "danger-
    ousness," the district court stated that because none of the
    actuarial risk-assessments models showed a five-year recidi-
    vism rate of 50% or more, "the actuarial instrument scores
    alone cannot possibly satisfy the statutory threshold of clear
    and convincing evidence that Mr. Wooden would have seri-
    ous difficulty refraining from engaging in sexually violent
    18                    UNITED STATES v. WOODEN
    conduct or child molestation." J.A. 52. The district court
    therefore concluded that Wooden was not a sexually danger-
    ous person as defined by the Act, and the court dismissed the
    government’s petition and ordered Wooden released. This
    appeal followed.
    III.
    The government first challenges the district court’s consti-
    tutional rulings, arguing that application of the Act to Wooden
    is consistent with the Equal Protection and Due Process
    Clauses of the Constitution.
    These constitutional issues need not detain us long. The
    district court’s ruling on the constitutional issues rested
    entirely on its analysis of those issues in an earlier civil-
    commitment case, United States v. Timms, 
    799 F. Supp. 2d 582
     (E.D.N.C. 2011). This court, however, has since rejected
    the district court’s constitutional analysis and reversed its
    decision in Timms. See United States v. Timms, 
    664 F.3d 436
    ,
    456 (4th Cir. 2012), petition for cert. filed (U.S. June 4, 2012)
    (No. 11-10654). Because the district court’s constitutional
    analysis is foreclosed by our opinion in Timms, we reverse the
    district court’s determination that application of the Act to
    Wooden violated the Due Process and Equal Protection
    Clauses of the United States Constitution.
    IV.
    We turn now to the government’s challenges to the district
    court’s determination that Wooden did not qualify as a "sexu-
    ally dangerous person" under the Act. The government first
    contends that the district court erred by concluding that
    Wooden no longer suffered from pedophilia.3 The government
    3
    The government’s experts concluded that Wooden also suffered from
    antisocial personality disorder. The district court held that the government
    had not proven that Wooden still suffered from the disorder or that the dis-
    order was a "serious" mental illness as required by the Act. The govern-
    ment does not challenge those rulings on appeal.
    UNITED STATES v. WOODEN                    19
    also contends that the district court improperly interpreted the
    Act’s serious-difficulty element as requiring proof that
    Wooden was more likely than not to reoffend in the future if
    released.
    "[W]e review the district court’s factual findings for clear
    error and its legal conclusions de novo." Hall, 
    664 F.3d at 462
    . A court reviewing for clear error may not "reverse a
    lower court’s finding of fact simply because [it] would have
    decided the case differently. Rather, a reviewing court must
    ask whether, on the entire evidence, it is left with the definite
    and firm conviction that a mistake has been committed." Eas-
    ley v. Cromartie, 
    532 U.S. 234
    , 242 (2001) (citation and inter-
    nal quotation marks omitted). "If the district court’s account
    of the evidence is plausible in light of the record viewed in its
    entirety, the court of appeals may not reverse it even though
    convinced that had it been sitting as the trier of fact, it would
    have weighed the evidence differently." Anderson v. Besse-
    mer City, 
    470 U.S. 564
    , 573-74 (1985).
    A.
    Persuaded by the testimony of Dr. Campbell, the district
    court held that although Wooden may have suffered from
    pedophilia in the past, the government had not proven by
    clear and convincing evidence that Wooden, at the time of the
    hearing, continued to suffer from pedophilia. The government
    contends that the record is replete with evidence showing that
    Wooden still suffered from pedophilia, and the government
    argues that the district court committed clear error by ignoring
    the substantial amount of contradictory evidence. See, e.g.,
    Francis, 
    2012 WL 2877668
     at *6 ("A court commits clear
    error when it makes findings without properly taking into
    account substantial evidence to the contrary." (internal quota-
    tion marks omitted)).
    Wooden, however, notes that expert opinion is critical
    when a court is called upon to determine whether an individ-
    20                 UNITED STATES v. WOODEN
    ual suffers from a mental illness. See Addington v. Texas, 
    441 U.S. 418
    , 429 (1979) ("Whether the individual is mentally ill
    and dangerous to either himself or others . . . turns on the
    meaning of the facts which must be interpreted by expert psy-
    chiatrists and psychologists."). Because there was conflicting
    expert testimony about whether Wooden continued to suffer
    from pedophilia, Wooden argues that the district court’s deci-
    sion to credit Dr. Campbell’s testimony over that of the gov-
    ernment’s experts cannot be clearly erroneous. See, e.g.,
    Anderson, 
    470 U.S. at 575
     ("[W]hen a trial judge’s finding is
    based on his decision to credit the testimony of one of two or
    more witnesses, each of whom has told a coherent and
    facially plausible story that is not contradicted by extrinsic
    evidence, that finding, if not internally inconsistent, can virtu-
    ally never be clear error.").
    As Wooden notes, a court reviewing for clear error "should
    be especially reluctant to set aside a finding based on the trial
    court’s evaluation of conflicting expert testimony." Hall, 
    664 F.3d at 463
     (internal quotation marks omitted). Nonetheless,
    while clear-error review is "deferential, it is not toothless." In
    re Agnew, 
    144 F.3d 1013
    , 1014 (7th Cir. 1998) (per curiam);
    accord Jiminez v. Mary Washington Coll., 
    57 F.3d 369
    , 379
    (4th Cir. 1995) (district court’s factual findings are not "so
    sacrosanct as to evade review"). And as we will explain, our
    careful review of the evidence has left us "with the definite
    and firm conviction that a mistake has been committed."
    United States v. United States Gypsum Co., 
    333 U.S. 364
    , 395
    (1948).
    (1)
    Pedophilia is a serious disorder characterized by "recurrent,
    intense sexually arousing fantasies, sexual urges, or behaviors
    involving sexual activity with a prepubescent child or chil-
    dren." American Psychiatric Association, Diagnostic & Sta-
    tistical Manual of Mental Disorders § 302.2, at 572 (4th ed.,
    Text Revision 2000) ("DSM"). This definition, which "reflec-
    UNITED STATES v. WOODEN                              21
    t[s] a consensus of current formulations of evolving knowl-
    edge in [the] field," id. at xxxvii, makes it clear that
    pedophilia is characterized not only by child-centered sexual
    behavior, but also by child-centered sexual fantasies and urges.4
    As the government argues, the record contains substantial
    evidence showing that Wooden was still having intense and
    recurrent sexually arousing fantasies and sexual urges about
    prepubescent children, including Wooden’s admission to Dr.
    Weiner that he was having sexual thoughts about being
    around children, his admissions in the 2005 polygraph exami-
    nation that he had been having deviant sexual thoughts about
    children and had been sexually aroused while in the presence
    of children, and his acknowledgement during his deposition
    that he had been having sexual thoughts about children.
    Moreover, Wooden’s testimony at his deposition and at the
    hearing was full of cognitive distortions5 or "thinking errors"
    common to sex offenders. For example, Wooden testified that
    the victims of his crimes wanted to have sex with him and that
    children who ask adults for money are really asking to have
    sex and will retaliate if rejected. See J.A. 406-07 ("It’s just
    4
    The DSM is widely recognized as "the authoritative reference used in
    diagnosing mental disorders." Young v. Murphy, 
    615 F.3d 59
    , 61 n.1 (1st
    Cir. 2010); see also J.A. 321 (testimony of Dr. Malinek describing the
    DSM as "[t]he universally accepted manual for diagnosing mental disor-
    ders" and the "Bible of diagnosis"). Although the DSM’s description of
    pedophilia is not controlling, it is persuasive. See Kansas v. Crane, 
    534 U.S. 407
    , 413 (2002) ("[T]he science of psychiatry . . . informs but does
    not control ultimate legal determinations. . . ."); see 
    id. at 411
    , 414 (citing
    the DSM authoritatively); McGee v. Bartow, 
    593 F.3d 556
    , 575 (7th Cir.
    2010) ("Despite its limitations in a non-medical setting, the DSM is a
    highly influential and useful tool.").
    5
    Cognitive distortions allow "sex offenders [to] explain their actions in
    a way to manage the impressions of others and in a way to make them-
    selves more socially palatable." United States v. Mitchell, 
    706 F. Supp. 2d 1148
    , 1217 (D. Utah 2010) (internal quotation marks omitted). Such dis-
    tortions "are an established, well understood phenomenon among sex
    offenders." 
    Id.
     (internal quotation marks omitted).
    22                    UNITED STATES v. WOODEN
    like this. If a little kid tryin’ to get some money out of you
    and want to have sex with and you don’t have sex with him,
    [he] can go to anybody and say you did something . . . .").
    Wooden’s testimony about the 2005 incident likewise pro-
    vides compelling evidence of the existence and power of his
    sexual fantasies and urges. Wooden testified that the incident
    was only a dream, but he also testified that he told Dr. Weiner
    about it because he was not completely certain it really was
    a dream: "[S]ometimes I have blackout spells. I wanted him
    to find out was it a dream or not because I didn’t want to hurt
    the boy. . . . I wanted them to find out was it a dream or not,
    because I didn’t know." J.A. 437 (emphasis added). Assuming
    that Wooden was being truthful when he claimed that the inci-
    dent was only a dream,6 this testimony reveals that Wooden’s
    fantasies about sexually assaulting a seven-year-old boy were
    so strong that he was unable to distinguish his dreams from
    6
    The district court’s conclusion that the 2005 incident did not happen
    was based not on a determination that Wooden was telling the truth, but
    on the court’s view that the government had not carried its burden of prov-
    ing that the incident happened. The district court did not make any explicit
    factual findings about the truth of Wooden’s statements, but the court’s
    dismissive reference to Wooden’s "shadowy admission" about the incident
    perhaps suggests the court found Wooden’s denial more credible than his
    admission.
    From our review of the record, it seems likely that Wooden was not
    being truthful and that he came up with the dream story in a futile attempt
    to get himself out of trouble—Dr. Weiner’s contemporaneous treatment
    notes present Wooden’s story as a factual admission of actual sexual con-
    tact with the boy and do not indicate that Wooden claimed he dreamed the
    incident, see J.A. 67-68; Wooden’s probation agent testified that during
    the emergency meeting on June 7, Wooden did not claim to have dreamed
    the incident, see J.A. 459; and the treatment notes of the session with
    Weiner’s associate show that even after he first claimed it was a dream,
    Wooden still vacillated between admitting the incident occurred and
    claiming it was only a dream, see J.A. 152. Nonetheless, our determination
    that the district court committed clear error is not dependent on whether
    Wooden was being truthful or whether the 2005 incident in fact occurred,
    and we therefore accept, for purposes of resolving this appeal, the district
    court’s factual conclusion that the 2005 incident did not occur.
    UNITED STATES v. WOODEN                   23
    his actions. The possibility that he might have hurt the boy
    was so real and so troubling to Wooden that he voluntarily
    told Dr. Weiner about the dream, despite the consequences he
    might face.
    The district court, however, did not account for this evi-
    dence when considering whether Wooden was a pedophile. In
    fact, very little of this evidence is even mentioned in the dis-
    trict court’s order. The court did not mention Wooden’s
    admission that he was having sexually deviant thoughts about
    children or his admission of an attempted assault on another
    child. Moreover, while the district court when recounting
    Wooden’s testimony generally described the difficult and
    often non-responsive nature of Wooden’s testimony on the
    first day of the hearing, the court did not mention the sub-
    stance of Wooden’s testimony that day. The court described
    Wooden’s second-day testimony that he was no longer inter-
    ested in having sex with young boys and no longer believed
    that boys asking for money are really asking for sex. See J.A.
    21-22. The court, however, did not acknowledge in any way
    that Wooden’s second-day testimony was completely contrary
    to his first-day testimony and his deposition testimony,
    despite the court’s observations on the first day of the hearing
    that Wooden was "trying to reconcile profound guilt and
    sense of confrontation about his own behavior with doing
    something that detracts from his position," J.A. 431, and that
    Wooden was "not telling the truth and . . . not being candid"
    because he was "trying to assess the danger and the risk
    involved in being forthcoming," J.A. 432.
    Although the district court might not have been required to
    accept that the evidence recounted above proved Wooden’s
    ongoing pedophilia, the court was required to at least consider
    the evidence, and account for it, when concluding otherwise.
    See Miller v. Mercy Hosp., Inc., 
    720 F.2d 356
    , 361 (4th Cir.
    1983) ("[T]he conviction of mistake may properly be based
    upon a conclusion that, without regard to what the ‘actual’
    facts may be, the findings under review . . . were made with-
    24                UNITED STATES v. WOODEN
    out properly taking into account substantial evidence to the
    contrary."); accord Doe v. Menefee, 
    391 F.3d 147
    , 164 (2d
    Cir. 2004) (Sotomayor, J.) ("We have found a district court’s
    factual findings to be clearly erroneous where the court has
    failed to synthesize the evidence in a manner that accounts for
    conflicting evidence or the gaps in a party’s evidentiary pre-
    sentation."). The need to acknowledge and account for this
    contradictory evidence is particularly acute given the district
    court’s observation (during a break from the government’s
    questioning of Wooden) that "[i]t is well established, prong
    one, that he is a pedophile." J.A. 428. We do not suggest that
    the district court was somehow bound by this statement, but
    the statement does indicate that the court at least initially
    viewed the evidence as pointing toward a finding of
    pedophilia. Under these circumstances, the district court’s
    failure to acknowledge its initial views or explain why it dis-
    regarded the extensive evidence of Wooden’s continuing
    pedophilic fantasies and urges casts real doubt on the propri-
    ety of the district court’s determination Wooden no longer
    suffered from pedophilia. See Taylor v. Maddox, 
    366 F.3d 992
    , 1007-08 (9th Cir. 2004) ("The process of explaining and
    reconciling seemingly inconsistent parts of the record lays
    bare the judicial thinking process, enabling a reviewing court
    to judge the rationality of the fact-finder’s reasoning. . . .
    [F]ailure to take into account and reconcile key parts of the
    record casts doubt on the process by which the finding was
    reached, and hence on the correctness of the finding.").
    (2)
    As Wooden notes, the district court repeatedly explained in
    its opinion that it found Dr. Campbell’s testimony more credi-
    ble than that of the government’s experts, and the court
    explicitly relied on Dr. Campbell’s opinion when concluding
    that Wooden was not a pedophile. Contrary to Wooden’s
    argument, however, that does not make the district court’s
    factual findings unreviewable. As the Supreme Court has
    explained,
    UNITED STATES v. WOODEN                    25
    the trial judge may [not] insulate his findings from
    review by denominating them credibility determina-
    tions, for factors other than demeanor and inflection
    go into the decision whether or not to believe a wit-
    ness. Documents or objective evidence may contra-
    dict the witness’ story; or the story itself may be so
    internally inconsistent or implausible on its face that
    a reasonable factfinder would not credit it. Where
    such factors are present, the court of appeals may
    well find clear error even in a finding purportedly
    based on a credibility determination.
    Anderson, 
    470 U.S. at 575
     (emphasis added). In our view, Dr.
    Campbell’s testimony was internally inconsistent and was
    otherwise deficient or problematic in so many respects that
    his opinion provides no safe harbor for the district court’s fac-
    tual findings.
    Dr. Campbell testified that the proper way to determine
    whether Wooden "at this point in time, here and now," quali-
    fied for a pedophilia diagnosis was to "focus on what
    [Wooden] does. What is his overt behavior." J.A. 498.
    Attempting to correspond with children was one of the overt
    behaviors that Campbell believed would evidence ongoing
    pedophilia, but Campbell attached no significance to the
    Christmas card Wooden sent to the boy involved in the 2005
    incident and did not explain why this evidence of relevant
    overt behavior was not relevant after all.
    Dr. Campbell also ignored the evidence that Wooden, while
    on parole, was engaging in high-risk behavior by babysitting
    children. An important part of Wooden’s treatment under Dr.
    Weiner was learning "avoidance and escape techniques
    designed to help [Wooden] get away from problematic situa-
    tions and high risk situations." J.A. 317. The fact that
    Wooden, while in treatment, not only was spending unsuper-
    vised time around children but also was hiring himself out as
    a babysitter is highly relevant to the question of whether
    26                UNITED STATES v. WOODEN
    Wooden was a pedophile. Yet Dr. Campbell, who believed
    that behavior was all that mattered, ignored this evidence of
    highly relevant behavior.
    Dr. Campbell likewise failed to address the significance of
    another powerful piece of evidence of ongoing pedophilia —
    Wooden’s admission that, in addition to molesting the seven-
    year-old boy in 2005, he had previously attempted to engage
    in sexual activity with a different child. Given Campbell’s
    acknowledgement that commitment would be warranted if
    Wooden had molested the seven-year-old boy, the evidence of
    an additional attempted assault would seem to be highly rele-
    vant to Campbell’s opinion. Dr. Campbell, however, never
    explained why he disregarded it.
    Moreover, Dr. Campbell placed great weight on the fact
    that Wooden was not collecting child pornography, even
    though there was no evidence that Wooden had ever been
    interested in child pornography and even after acknowledging
    that some "hands-on" sex offenders "never look at pornogra-
    phy because they get no gratification from [it]." J.A. 558. Dr.
    Campbell thus concluded that Wooden was no longer a
    pedophile by ignoring evidence of very troubling affirmative
    behavior by Wooden while at the same time emphasizing
    Wooden’s failure to engage in behavior he had never engaged
    in.
    Because Campbell insisted that behavior is all that matters,
    but then ignored, without explanation, all evidence of prob-
    lematic behavior, his opinion was internally inconsistent, if
    not entirely implausible. Under these circumstances, the dis-
    trict court’s explicit crediting of Campbell’s testimony does
    not shield the court’s factual findings from our review. See
    Anderson, 
    470 U.S. at 575
    .
    (3)
    The district court determined that Wooden was not a
    pedophile by relying exclusively on the opinion of Dr. Camp-
    UNITED STATES v. WOODEN                     27
    bell. As discussed above, however, Dr. Campbell largely
    ignored all contradictory evidence, and his analysis was inter-
    nally inconsistent, and the district court’s analysis of the issue
    suffers from the same deficiencies.
    The record in this case contains substantial evidence show-
    ing that Wooden’s pedophilia had not abated with age and
    that Wooden at the time of the hearing was still afflicted with
    and engaging in the child-focused sexually arousing fantasies,
    sexual urges, and behaviors that are characteristic of
    pedophilia. The district court did not account for or otherwise
    explain why it disregarded all evidence of Wooden’s thoughts
    and thought-processes, nor did the court account for or other-
    wise explain why it disregarded the evidence of Wooden’s
    problematic conduct. Dr. Campbell, the expert whose opinion
    the district court found credible, testified that the evidence of
    Wooden’s continuing thoughts about offending against chil-
    dren and his abandoned attempt to carry out those thoughts
    would qualify Wooden as a pedophile under the DSM. See
    J.A. 556. The district court did not acknowledge this portion
    of Campbell’s testimony, nor did it explain why it rejected the
    consensus view of pedophilia reflected in the DSM.
    We fully understand that, as a reviewing court, we may not
    reverse the district court’s factual findings "even though con-
    vinced that had [we] been sitting as the trier of fact, [we]
    would have weighed the evidence differently," as long as the
    court’s "account of the evidence is plausible in light of the
    record viewed in its entirety." Anderson, 
    470 U.S. at 574
    .
    Nonetheless, we have painstakingly reviewed the entire
    record, and the district court’s account of the evidence in this
    regard simply is not plausible. We are "definite[ly] and firm-
    [ly]" convinced that the district court made a mistake by con-
    cluding that Wooden was not a pedophile. United States
    Gypsum Co., 
    333 U.S. at 395
    ; see Mercy Hosp., 
    720 F.2d at
    361 n.5 (explaining that a factual finding is clearly erroneous
    if it is "against the great preponderance of the evidence"
    (internal quotation marks omitted)). Accordingly, we reverse
    28                 UNITED STATES v. WOODEN
    as clearly erroneous the district court’s determination that
    Wooden did not suffer from pedophilia and thus did not have
    a serious mental illness as required for commitment under the
    Act.
    B.
    In an alternate holding, the district court explained that
    even if it could conclude that Wooden still suffered from
    pedophilia, the government nonetheless had not proven that
    Wooden would have serious difficulty refraining from re-
    offense if released.
    In reaching this conclusion, the district court discounted the
    testimony of the government’s experts because their opinions
    were based in part on their conclusions that the 2005 incident
    in fact occurred, a factual premise the district court had
    already rejected. The district court instead credited Dr. Camp-
    bell’s testimony on the issue, finding his analysis more per-
    suasive because
    Dr. Campbell analyzed Mr. Wooden’s volitional
    capacity in an individualized and tailored manner,
    addressing the statutory issue head-on with the Bar-
    ratt Impulsiveness scale. But Dr. Malinek, on the
    other hand, applied a more wooden historical analy-
    sis of Mr. Wooden’s volition, an analysis based
    largely on decades-old criminal convictions and an
    alleged 2005 sexual offense that the Court finds as
    a matter of fact did not occur.
    J.A. 49-50. The district court thus accepted Campbell’s view
    that Wooden was not volitionally impaired because he was
    not impulsive, and the court concluded that the government
    had not proven that Wooden "currently manifests a serious
    mental illness, abnormality or disorder that impairs his voli-
    tional control such that he would have serious difficulty
    refraining from sexually violent conduct or child molestation
    UNITED STATES v. WOODEN                     29
    if released." J.A. 50. The district court also held that the gov-
    ernment failed to prove Wooden’s dangerousness, which the
    court defined as requiring proof that Wooden "poses a risk of
    re-offense that is significant enough to justify a finding that
    [Wooden] is sexually dangerous and therefore can be preven-
    tively detained." J.A. 18. The district court concluded that the
    government could not make the required showing of danger-
    ousness because none of the risk-assessment models showed
    a five-year recidivism rate of more than 50%.
    On appeal, the government argues that the district court’s
    error in concluding that Wooden does not suffer from
    pedophilia prevented the court from properly assessing the
    serious-difficulty question. Moreover, the government con-
    tends that the district court’s analysis, like its analysis of the
    pedophilia question, failed to acknowledge or account for the
    substantial body of evidence showing that Wooden would
    have serious difficulty refraining from re-offense if released.
    The government argues that the court compounded those
    errors with its demand for proof of dangerousness that could
    only be satisfied by proof that Wooden was more likely than
    not to reoffend. The government therefore argues that the dis-
    trict court’s conclusion that Wooden would not have serious
    difficulty refraining from re-offending if released must be set
    aside as clearly erroneous.
    We agree. Although the district court based its conclusions
    on Dr. Campbell’s testimony, which the court again found to
    be more credible than that of the government’s experts, the
    deference generally due such decisions is not appropriate in
    this case. For reasons mirroring those discussed above, the
    many deficiencies in Dr. Campbell’s testimony and the dis-
    trict court’s analysis of the issue again leave us firmly and
    definitely convinced that the district court’s factual findings
    were mistaken.
    (1)
    Dr. Campbell concluded that Wooden was not impulsive
    based solely on Wooden’s score on the "Barratt Impulsive-
    30                 UNITED STATES v. WOODEN
    ness Scale," a "self-report measure" that used Wooden’s
    answers to various questions to assess his level of impulsive-
    ness. J.A. 541. And because Campbell found that Wooden
    was not impulsive, Campbell concluded that Wooden did not
    have a volitional impairment:
    So at this point in time if we ask does Mr. Wooden
    exhibit volitional control or volitional impairment,
    the answer would be no. Because impulsiveness is a
    necessary condition for volitional impairment.
    Remembering the old distinction of oxygen is neces-
    sary for human life but in and of itself it’s not suffi-
    cient. Impulsiveness is necessary for volitional
    impairment. If there’s no impulsiveness, there’s no
    volitional impairment.
    J.A. 500.
    As the district court recognized during the hearing, not all
    child molesters are impulsive or opportunistic; many are care-
    ful and deliberate, "grooming" their victims to gain their trust
    and affection before attempting to make sexual contact. See,
    e.g., United States v. Brand, 
    467 F.3d 179
    , 203 (2d Cir. 2006)
    (explaining that "[c]hild sexual abuse is often effectuated fol-
    lowing a period of grooming and the sexualization of the rela-
    tionship" and that the defendant’s "sharing pictures, flirting,
    and attempting to gain affection . . . constituted classic
    grooming behavior in preparation for a future sexual encoun-
    ter" (internal quotation marks omitted)); J.A. 567 (district
    court asking Dr. Malinek if grooming behavior was
    "[p]lanned or anticipated behavior, rather than impulsive
    behavior"). Under Campbell’s view, sex offenders who groom
    their victims would be categorically excluded from the Act
    because they are not impulsive and therefore could not possi-
    bly have any level of volitional impairment. Dr. Malinek
    flatly disagreed with this proposition, see J.A. 568-69, and the
    district court’s questions during the hearing suggested that it
    was likewise troubled by the premise of Campbell’s opinion,
    UNITED STATES v. WOODEN                    31
    see J.A. 567-68. The district court, however, ultimately
    accepted Campbell’s view that volitional impairment was
    dependent on impulsiveness, without explaining how it had
    resolved its earlier questions or even acknowledging the exis-
    tence of those earlier questions.
    After accepting Campbell’s view that impulsiveness was
    the determinative question, the district court concluded that
    Wooden was not impulsive by relying on Campbell’s testi-
    mony that Wooden’s Barratt score of 48 was "far below the
    cutoff score of 74 for impulsiveness." J.A. 499-500. In con-
    cluding that Wooden was not impulsive, however, the district
    court failed to account for the substantial evidence in the
    record showing Wooden’s impulsiveness. Wooden’s impul-
    siveness is apparent from the nature of his prior crimes, which
    were crimes of opportunity where Wooden took his victims to
    "the first place that he could find," J.A. 337, without concern
    for whether he could be identified by his victims, who were
    all from his neighborhood. Wooden’s "abominabl[e]" adjust-
    ment to institutionalization, J.A. 81, likewise provides com-
    pelling evidence of his impulsiveness. Wooden committed a
    "record high number of institutional rule violations," J.A. 337,
    and was sanctioned for conduct including insolence towards
    staff members, work refusal, possession of gambling para-
    phernalia, destroying government property, stealing, threaten-
    ing bodily harm, assault, and threatening to kill staff
    members, to list a very few. See J.A. 81-82. Wooden’s con-
    duct led to serious sanctions, including administrative deten-
    tion and multiple disciplinary transfers, but the conduct
    continued throughout his institutional career, including his
    time at FCI Butner serving the parole-revocation sentence.
    And as Dr. Malinek and Dr. Ross testified, Wooden’s disci-
    plinary history was strong evidence of his impulsiveness.
    To the extent that the district court addressed this evidence
    at all, it was in the course of its rejection of the diagnosis of
    antisocial personality disorder made by the government’s
    experts. In that portion of the opinion, the district court sug-
    32                  UNITED STATES v. WOODEN
    gested that Wooden’s criminal history was a "stale historical
    factor[ ]" entitled to little weight, J.A. 43, and the court men-
    tioned Wooden’s prison disciplinary history only to note that
    the frequency of the infractions declined as Wooden aged, see
    J.A. 44. The nature of Wooden’s prior crimes may well be a
    historical factor, but it is by no means a stale or irrelevant one.
    When the question is whether an inmate suffering from
    pedophilia will have serious difficulty refraining from re-
    offending if released, consideration of the nature of his prior
    crimes provides a critical part of the answer. And while the
    decreasing frequency of Wooden’s prison infractions is also
    relevant, so too is the nature of those infractions. The district
    court’s failure to take this evidence into account substantially
    undermines the court’s factual determination that Wooden
    was not impulsive.
    (2)
    There is, moreover, an even more fundamental problem
    with the district court’s analysis. The district court ignored
    extensive evidence that, while perhaps not directly relevant to
    the question of impulsiveness, was directly relevant to the
    question actually posed by the statute: whether Wooden
    would have serious difficulty refraining from re-offense if
    released.
    Much of the previously discussed evidence ignored by the
    district court when concluding that Wooden was not a
    pedophile was also relevant to the serious-difficulty inquiry.
    And just as it did when answering the pedophilia question, the
    district court ignored this evidence when answering the
    serious-difficulty question. For example, the district court
    interrupted Wooden’s cross-examination of Dr. Ross to say,
    "[t]he fact that he’s sending a Christmas card to somebody
    that he has molested is a pretty strong indication of reoffend-
    ing; don’t you think?" J.A. 490. The district court in its writ-
    ten opinion, however, did not mention the Christmas card in
    its serious-difficulty analysis, did not acknowledge its previ-
    UNITED STATES v. WOODEN                    33
    ous view of the significance of the evidence, and did not
    explain why it no longer believed the evidence was relevant
    to the question of whether Wooden would have serious diffi-
    culty refraining from re-offense. The district court also failed
    to account for Wooden’s admissions that he was having devi-
    ant sexual thoughts about children, was sexually aroused in
    the presence of children, was placing himself in high-risk situ-
    ations by hiring himself out as a babysitter, and had attempted
    to assault a child other than the seven-year-old involved in the
    2005 incident. Whether or not this evidence speaks to impul-
    siveness, it speaks directly to the serious-difficulty prong, and
    it should have been considered and accounted for by the dis-
    trict court.
    The district court likewise failed to acknowledge or con-
    sider the significance of Wooden’s dream about the 2005 inci-
    dent. As previously discussed, Wooden testified that he told
    Dr. Weiner about the dream because he "want[ed] him to find
    out was it a dream or not, because sometimes I have blackout
    spells. I wanted him to find out was it a dream or not because
    I didn’t want to hurt the boy." J.A. 437. The facts revealed by
    this explanation—that Wooden has blackout spells and has
    dreams about sexually assaulting a seven-year-old boy that
    are so vivid he cannot distinguish them from reality—are
    quite obviously relevant to the question of whether Wooden
    would have serious difficulty refraining from re-offense. The
    district court, however, simply ignored this evidence.
    The district court also failed to consider Wooden’s own tes-
    timony when determining whether Wooden would have seri-
    ous difficulty refraining from re-offense. In our view,
    Wooden’s deposition testimony and his testimony on the first
    day of the hearing, and the cognitive distortions that testi-
    mony revealed, were highly relevant to the serious-difficulty
    inquiry. Those portions of Wooden’s testimony indicated that
    when Wooden committed his prior crimes, he believed that
    very young children were appropriate sexual partners, and
    that he continued to believe that at least through the first day
    34                    UNITED STATES v. WOODEN
    of the hearing. As Dr. Malinek testified, "[t]he way people
    think often mediates their conduct. If he thinks that this is
    appropriate sexual activity or [that a young child is an appro-
    priate] intimacy partner, then that certainly affects his behav-
    ior." J.A. 323 (emphasis added).
    When considering the serious-difficulty prong, however,
    the district court declined to consider Wooden’s testimony.
    Wooden’s performance on the witness stand had led the dis-
    trict court and Dr. Malinek to believe that Wooden’s cognitive
    limitations were more significant than indicated in Wooden’s
    record.7 Dr. Malinek testified that Wooden’s limited intellec-
    tual functioning increased his risk of recidivism, given Wood-
    en’s inability to learn from his experiences and his persistent
    belief that children are appropriate sex partners. The district
    court disagreed:
    Mr. Wooden’s cognitive limitations merely com-
    pel this Court to discount Mr. Wooden’s testimony.
    Having thoroughly observed Mr. Wooden on the
    witness stand, the Court finds that Mr. Wooden is a
    poor historian, that his cognition is markedly
    impaired, and that he has difficulty in understanding
    and adequately responding to complex questioning.
    Mr. Wooden’s testimony, as a whole, is not entitled
    to significant weight.
    7
    Although previous testing pegged Wooden’s I.Q. at 70, the district
    court, drawing from its experience with Social Security cases involving
    claims of intellectual deficits, J.A. 543, believed Wooden’s I.Q. was more
    likely to be in the 60s and that Wooden "manifests signs of mild retarda-
    tion." J.A. 571. In the government’s rebuttal case, Malinek testified that
    after observing Wooden’s testimony on the first day of the hearing, he
    thought Wooden "was clearly retarded based on how he presented . . . .
    Today he was much more relevant and focused. He obviously is
    impaired." J.A. 574. Malinek thought Wooden’s I.Q. was likely to be in
    the 70s, J.A. 574, but he agreed that it was likely below the "dull normal"
    range "identified in the 1978 evaluation." J.A. 570.
    UNITED STATES v. WOODEN                   35
    J.A. 48.
    Although Wooden is clearly cognitively impaired, that
    impairment cannot justify the district court’s decision to sim-
    ply disregard Wooden’s testimony. Determining whether an
    inmate will have serious difficulty refraining from re-
    offending requires the court to "evaluate[ ] the individual’s
    present mental condition and the likely prospective effect of
    that mental condition on his volitional control." Francis, 
    2012 WL 2877668
     at *8. This forward-looking inquiry, which
    attempts to predict the inmate’s "ability to refrain from acting
    in accord with his deviant sexual interests," 
    id.,
     requires con-
    sideration of the grip strength of the mental illness on the
    inmate—the extent to which the inmate is controlled by the
    illness. Whether or not Wooden was a poor historian or was
    confused by complex questions, his testimony provided pow-
    erful evidence of his then-current thought processes, which
    provided critical insight into the degree to which Wooden
    would be able to control his deviant sexual interests should he
    be released.
    Determining the credibility of witnesses and the weight to
    be accorded their testimony, of course, is a matter for the dis-
    trict court as factfinder. And while Wooden’s cognitive limi-
    tations would provide a rational basis for the court to discount
    certain portions of Wooden’s testimony — for example, his
    claims that he enrolled in Howard University when he was 15
    and went to business school when he was released from
    prison, J.A. 379, or his testimony that he learned about anal
    sex at a very young age by watching his brothers and sisters,
    J.A. 398, the district court went much farther here. The dis-
    trict court refused to consider Wooden’s testimony, which
    provided important evidence about the extent of Wooden’s
    cognitive impairments, and also refused to consider how
    Wooden’s cognitive impairments would affect Wooden’s
    ability to refrain from re-offending if released. The district
    court thus did not simply assign little weight to Wooden’s tes-
    timony, it assigned little weight to the fact of Wooden’s cog-
    36                    UNITED STATES v. WOODEN
    nitive impairment. Because the district court did not consider
    this critical evidence or the other evidence showing the inten-
    sity and persistence of Wooden’s child-focused sexual fanta-
    sies, thoughts, and urges, the court’s account of the evidence
    is not "plausible in light of the record viewed in its entirety,"
    Anderson, 
    470 U.S. at 574
    , and the court’s factual findings are
    not entitled to the deference typically required under clear-
    error review, see Menefee, 
    391 F.3d at 164
     (explaining that a
    factual finding is clearly erroneous "where the court failed to
    weigh all of the relevant evidence before making its factual
    findings"); Taylor, 
    366 F.3d at 1007
     ("Fact-finding is . . . a
    dynamic, holistic process that presupposes for its legitimacy
    that the trier of fact will take into account the entire record
    before it.").
    (3)
    In addition to these clear errors of omission, the district
    court erred by insisting that the government prove Wooden’s
    "dangerousness,"8 which the court believed required proof of
    8
    As support for its view that "dangerousness" was a separate and neces-
    sary element of the government’s case, the district court relied on the
    Supreme Court’s observation in Kansas v. Crane that involuntary commit-
    ment statutes generally have been upheld when, among other things,
    "there is a finding of dangerousness either to one’s self or to others, and
    . . . proof of dangerousness is coupled with the proof of some additional
    factor, such as a mental illness or mental abnormality." Crane, 
    534 U.S. at 409-10
     (emphasis added; internal alteration and quotation marks omit-
    ted); see Kansas v. Hendricks, 
    521 U.S. 346
    , 257-58 (1997). "Dangerous-
    ness" in this context is simply shorthand for the danger posed "to the
    public health and safety" by "people who are unable to control their
    behavior." 
    Id. at 409
     (internal quotation marks omitted). The Kansas stat-
    ute at issue in Crane satisfied the dangerousness requirement by limiting
    commitment to persons suffering from a mental illness that makes the per-
    son "likely to engage in the predatory acts of sexual violence." 
    Id. at 352
    (internal quotation marks omitted). The Adam Walsh Act’s requirement of
    proof that the inmate "would have serious difficulty in refraining from
    sexually violent conduct or child molestation if released," 
    18 U.S.C.A. § 4247
    (a)(6), likewise satisfies the dangerousness requirement referred to
    in Crane. The district court therefore erred by requiring the government
    to separately prove Wooden’s "dangerousness."
    UNITED STATES v. WOODEN                     37
    a greater-than-50% risk that Wooden would re-offend within
    five years. See J.A. 52 (rejecting government’s evidence of
    Wooden’s actuarial risk of recidivism because "[n]one of the
    recidivism rates within the five-year window reaches or
    exceeds 50%."). The district court’s insistence on proof of a
    greater than 50% risk of recidivism finds no support in the
    language of the Act. The Act requires the government to
    prove that the inmate will have serious difficulty refraining
    from re-offense, see 
    18 U.S.C.A. § 4247
    (a)(6), but it "does
    not ask the finder of fact to determine exactly how likely [the
    inmate] is to reoffend." United States v. Hunt, 
    643 F. Supp. 2d 161
    , 180 (D. Mass. 2009).
    Recidivism rates are circumstantially relevant to the
    serious difficulty inquiry because offenders who
    continually expose themselves to punishment may be
    presumed to have the most difficulty refraining from
    sexual reoffending. But the ultimate question called
    for by the Act concerns the self-control of an indi-
    vidual, not the statistical rearrest patterns of a given
    population.
    
    Id.
     The court’s greater-than-50% requirement is likewise
    inconsistent with the Supreme Court’s refusal to give "lack of
    control a particularly narrow or technical meaning," Crane,
    
    534 U.S. at 413
     (internal quotation marks omitted), and with
    the Court’s recognition that "in cases where lack of control is
    at issue, ‘inability to control behavior’ will not be demonstra-
    ble with mathematical precision," 
    id.
    (4)
    After a careful review of the entire record, we again are
    "left with the definite and firm conviction that a mistake has
    been committed." Easley, 532 U.S. at 242 (internal quotation
    marks omitted). The district court reached its conclusion that
    Wooden would not have serious difficulty refraining from re-
    offense by relying on a flawed expert opinion, by ignoring or
    38                     UNITED STATES v. WOODEN
    otherwise failing to account for the substantial body of contra-
    dictory evidence,9 and by disregarding perhaps the most rele-
    vant evidence on this issue—Wooden’s own testimony. See
    Mercy Hosp., 
    720 F.2d at 361
     ("[T]he conviction of mistake
    may properly be based upon a conclusion that . . . the findings
    under review . . . were made without properly taking into
    account substantial evidence to the contrary.").
    Moreover, it appears to us that the weight of the evidence
    in the record indicates that Wooden’s pedophilia would cause
    him to have serious difficulty refraining from re-offense if
    released. See United States v. Martinez-Melgar, 
    591 F.3d 733
    ,
    738 (4th Cir. 2010) ("[C]lear error occurs when a district
    court’s factual findings are against the clear weight of the evi-
    dence considered as a whole." (internal quotation marks omit-
    ted)); Mercy Hosp., 720 F.2d at n.5 (explaining that a district
    court’s factual finding is clearly erroneous if "the finding is
    against the great preponderance of the evidence" (internal
    quotation marks omitted)). The evidence established Wood-
    en’s long history of acting on his pedophilic urges. He has
    9
    In the instances where the district court did explain why it declined to
    credit contrary evidence, the reasons given by the court cannot withstand
    scrutiny. For example, when considering whether Wooden suffered from
    antisocial personality disorder, the district court indicated that the govern-
    ment’s experts failed to consider the relevance of Wooden’s age to the
    recidivism question. The government’s experts, however, acknowledged
    the relevance of age and considered Wooden’s age in their reports, see
    J.A. 92-93, 120-22, and Dr. Malinek in his testimony specifically identi-
    fied Wooden’s age as a "protective" risk factor—one that mitigates the
    risk of recidivism. See J.A. 340, 573-74. The court also rejected the views
    of the government experts because their opinions were erroneously based
    on their views that Wooden actually molested the seven-year-old boy in
    2005. Neither Dr. Ross nor Dr. Malinek, however, based their opinions
    solely on their belief that the 2005 incident occurred; both experts gave
    multiple reasons to support their conclusion that Wooden still suffered
    from pedophilia and would have serious difficulty refraining from re-
    offense if released. Under these circumstances, the district court’s dis-
    agreement with one of their factual conclusions cannot justify the court’s
    refusal to consider the balance of their testimony.
    UNITED STATES v. WOODEN                   39
    been convicted (or adjudicated delinquent) five times, and by
    his own admission he offended many more times than he was
    caught. Each re-offense occurred within a relatively short
    time after Wooden returned to the community, which demon-
    strates that the threat of detection and incarceration have lim-
    ited deterrent effect on Wooden. The evidence likewise
    establishes Wooden’s resistance to treatment. While he was
    undergoing intensive sex-offender treatment with Dr. Weiner,
    Wooden engaged in high-risk behavior by being alone with
    children, giving children money, and even hiring himself out
    as a babysitter. He continued to have deviant sexual thoughts
    about children, including the seven-year-boy at the center of
    the 2005 incident, and he admitted to Dr. Weiner that he came
    close to acting on these thoughts but changed his mind after
    luring a different boy into the basement. Wooden’s cognitive
    distortions and thinking errors about the appropriateness of
    children as sexual partners continued through the time of the
    hearing, as evidenced by his testimony that all of his victims
    initiated the contact and wanted to have sex with him. More-
    over, the actuarial risk-assessment models all indicate that
    Wooden is at high risk of re-offending. Of the relevant
    dynamic factors, only one—Wooden’s age—indicates that
    Wooden’s risk might be lower. In this case, however, the gen-
    erally observed inverse relationship between age and recidi-
    vism does little to overcome the evidence of Wooden’s
    continuing struggle with the child-focused fantasies, urges,
    and behaviors characteristic of pedophilia.
    Accordingly, after careful consideration of the record as a
    whole, we are constrained to reverse as clearly erroneous the
    district court’s determination that Wooden would not have
    serious difficulty refraining from re-offense if released.
    SeeMartinez-Melgar, 
    591 F.3d at 738
    ; Mercy Hosp., 720 F.2d
    at n.5.
    V.
    To summarize, we hold that the district court erred in its
    conclusion that the application of the Act to Wooden violated
    40                 UNITED STATES v. WOODEN
    the Due Process and Equal Protection Clauses of the United
    States Constitution. We also conclude that the record does not
    support the district court’s determination that Wooden does
    not "suffer[ ] from a serious mental illness, abnormality, or
    disorder" because he no longer suffers from pedophilia, 
    18 U.S.C.A. § 4247
    (a)(6), nor does the record support the district
    court’s determination that Wooden would not have "serious
    difficulty refraining from sexually violent conduct or child
    molestation if released," 
    id.,
     and we hereby reverse those fac-
    tual findings as clearly erroneous.
    Accordingly, we reverse the district court’s judgment dis-
    missing the government’s petition seeking to commit
    Wooden, and we remand the matter to the district court for
    reconsideration. On remand, the district court shall reconsider,
    on the basis of the existing record and in light of the questions
    about the district court’s original analysis and the concerns
    about the existing evidence raised in this opinion, whether
    Wooden is a sexually dangerous person within the meaning of
    the Act.
    REVERSED AND REMANDED