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Störung der Sexualpräferenz (Paraphilie)

Diagnostik, Ätiologie, Epidemiologie, Behandlung und präventive Aspekte

Paraphilia, sexual preference disorders. Diagnosis, etiology, epidemiology, treatment and prevention

  • Leitthema: Sexualmedizin
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die psychiatrische Diagnostik in der ICD- 10 (Störung der Sexualpräferenz) und in dem DSM-IV (Paraphilie) stellt als führendes Symptom die Beziehungsfeindlichkeit in den Vordergrund. Damit rückt die Störung nahe an stoffgebundene und nicht stoffgebundene lustvolle Selbststimulierungen, die progredient zwanghaft oder suchtartig zum Verlust der Selbstkontrolle führen können. Allerdings können die gleichen Symptome auch als Einzelereignisse oder episodisches Geschehen auftreten. Neben konstitutionellen Momenten spielen für die Entstehung dieser Störungen Probleme in der Entwicklung einer vertrauensvollen Beziehung zu den primären Bezugspersonen (Attachment) eine wesentliche Rolle. Als Auslöser sind besonders bei den episodischen Varianten der Störung Beziehungs- und Selbstwertkrisen von Bedeutung. In der Behandlung haben für die mit dem Gesetz in Konflikt gekommenen Betroffenen kognitiv-behaviorale Programme mit dem klaren Ziel, Selbsttäuschungen über die Effekte der paraphilen Handlungen für alle Beteiligten zu minimieren, stark an Bedeutung gewonnen. In der medikamentösen Behandlung nehmen neben der antihormonellen Therapie auch andere Prinzipien, wie die Beeinflussung der Serotonin-Transmission und die Therapie mit Naltrexon, die bei Süchten und chronischer Impulsivität ihre Effektivität schon erweisen konnten, einen zunehmenden Raum ein. Zur Prävention kann wenig Konkretes – eher allgemein Psychohygienisches (in der Gestaltung der Eltern-Kind-Beziehung) empfohlen werden.

Abstract

Hostility towards relationships is one prominent characteristic symptom for disorders of sexual preference (ICD-10) and paraphilias (DSM-IV). Paraphilic symptoms sometimes progress to obsessive or addictive- like forms leading to a loss of self-control but can occur also as single incidents or as episodic events. Besides constitutional aspects, problems in the development of close relationships to primary caregivers (attachment) play an important role in the development of these disorders. Actual relationship- and self-confidence prob lems often trigger the severity of disturbance, especially in the episodic forms of paraphilia. For patients who are in conflict with the law, cognitive-behavioral therapeutic approaches with the aim to minimize self-deception regarding the effects of the paraphilic behavior have become more and more relevant. Regarding the medical treatment, anti-hormonal therapy plays an important role, but also treatment with serotonergic agents and naltrexon are used. Only little can be advised in terms of prevention; general psycho-hygiene (regarding the parent-child relationship) is ecommended. Beside these general measures, institutions which offer special treatment for people in danger to become delinquents may be able to prevent serious harm for possible victims of abuse.

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Literatur

  1. Berner W (1996) Wann ist das Begehren krank? Z Sexualforsch 9:62–75

    Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington

  3. Dilling H, Mombour W, Schmidt MH, Schulte-Markwort E (2004) Internationale Klassifikation psychischer Störungen, 5. Aufl. Huber, Bern

  4. Stoller R (1991) The term perversion. In:Fogel GI, Myers WA (eds) Perversion and near perversion in clinical practice. University Press, New Haven London Yale; 35–55

  5. Hill A, Habermann N, Berner W, Briken P (2007) Single and multiple sexual homicide. Psychopathology 40, 22–28

    Article  PubMed  Google Scholar 

  6. Hill A, Habermann N, Berner W, Briken P (2007) Sexual sadism and sadistic personality disorder in sexual homicide. J Personality Disord 20(6) 672–685

    Google Scholar 

  7. v. Krafft-Ebing R (1890) Psychopathia sexualis, 5. Aufl. Ferdinand Enke, Stuttgart

  8. Briere J, Runtz M (1989) Males'sexual interest in children:predicting potential indices of "pedophilia" in a nonforensic sample. Child Abuse Negl 13:65–75

    Article  PubMed  CAS  Google Scholar 

  9. Templeman TL, Stinnett RD (1991) Patterns of sexual arousal and history in a „normal“ sample of young men. Arch Sex Behav 20:137–150

    Article  PubMed  CAS  Google Scholar 

  10. Finkelhor D (1994) The international epidemiology of child sexual abuse. Child Abuse Negl 18:409–417

    Article  PubMed  CAS  Google Scholar 

  11. McConaghy N (1998) Paedophilia. A review of the evidence. Aust NZ J Psychiatry 32:252–265

    CAS  Google Scholar 

  12. Hunt MM (1974) Sexual behavior in the 1970’s. Playboy Press, Chicago

  13. Rathbone J (2001) Anatomy of masochism. Kluwer Academic/Plenum Publishers, New York

  14. Berner W, Briken P, Hill A (2006) Female sex offenders. In:Saleh F, Bradford J (eds) Sex offenders:identification, risk assessment, treatment, and legal issues. (in press)

  15. Marshall WL, Barbaree HE (1990) An integrated theory of the etiology of sexual offending. In:Marshall WL, Laws RD, Barbaree HE (eds) Handbook of sexual assault:issues, theories, and treatment of offender. Plenum Press, New York, pp 257–275

  16. Mustanski BS, Chivers ML, Bailey JM (2002) A critical review of recent biological research on human sexual orientation. Annu Rev Sex Res 13:89–141

    PubMed  Google Scholar 

  17. Berner W, Hill A (2004) Pädophilie – eine sexuelle Orientierung? In:Richter-Appelt H, Hill A (Hrsg) Geschlecht zwischen Spiel und Zwang. Psychosozial- Verlag, Gießen, S 153–177

  18. Gaffney GR, Lurie SF, Berlin FS (1984) Is there familial transmission of pedophilia. J Nerv Ment Dis 172:546–548

    Article  PubMed  CAS  Google Scholar 

  19. Ben Zion IZ, Tessler, R, Cohen L et al. (2006) Polymorphisms in the dopamine D4 receptor gene (DRD4) contribute to individual differences in human sexual behavior:desire, arousal and sexual function. Mol Psychiatry 11:782–786

    Article  PubMed  CAS  Google Scholar 

  20. Kim-Cohen J, Caspi A, Taylor A et al. (2006) MAOA, maltreatment, and gene-environment interaction predicting children's mental health:new evidence and a meta-analysis. Mol Psychiatry 11; doi:10.1038/sj.mp.4001851

  21. Marshall WL, Anderson D, Fernandez Y (1999) Cognitive behavioural treatment of sexual offenders. Wiley, Chichester

  22. Briken P, Habermann N, Berner W, Hill A (2005) The influence of brain abnormalities on psychosocial development, criminal history and paraphilias in sexual murders. J Forensic Sci 50:1204-1208

    Article  PubMed  Google Scholar 

  23. Briken P, Hill A, Berner W (2006) Sexualstörungen – Störungen der Sexualpräferenz, Paraphilien. In:Förstl H, Hautzinger M, Roth G (Hrsg) Neurobiologie psychischer Störungen. Springer, Berlin Heidelberg New York Tokyo, S 827–851

  24. Schiffer B (2006) Neuronale Systeme in der Steuerung von normalem und deviantem Sexualverhalten. Centaurus, Herbolzheim

  25. Cooper AJ, Cernovovsky Z (1992) The effects of cyproterone acetate on sleeping and waking penile erections in pedophiles:possible implications for treatment. Can J Psychiatry 37:33–39

    PubMed  CAS  Google Scholar 

  26. Bradford JMW, Pawlak A (1993) Double-bind-placebo- crossover-study of cyproterone-acetate in the treatment of paraphilias. Arch Sex Behav 22:383–402

    Article  PubMed  CAS  Google Scholar 

  27. Bradford JMW (1999) The paraphilias, obsessive compulsive spectrum disorder, and the treatment of sexual deviant behaviour. Psychiatric Quart 70:209–219

    Article  CAS  Google Scholar 

  28. Everaerd W, Laan E, Both S, Spiering M (2001) Sexual motivation and desire. In:Everaerd W, Laan E, Both S (eds) Sexual appetite, desire and motivation:energetics of sexual systems. Royal Netherlands Academy of Arts and Sciences, Amsterdam, pp 95–111

  29. Ward T, Hudson SM, Marshall WL (1996) Attachment- style in sex offenders:a preliminary study. J Sex Res 33:17–26

    Google Scholar 

  30. Marshall WL (2001) Attachment problems in the etiology and treatment of sexual offenders. In:Everaerd W, Laan W, Both S (eds) Sexual appetite, desire and motivation:energetics of sexual systems. Royal Netherlands Academy of Arts and Sciences, Amsterdam, pp 135–145

  31. Marsa F, O'Reilly G, Carr A et al. (2004) Attachment styles and psychological profiles of child sex offenders in Ireland. J Interpers Violence 19:228–251

    Article  PubMed  Google Scholar 

  32. Beech AR, Mitchell IJ (2005) A neurobiological perspective on attachment problems in sexual offenders and the role of selective serotonin re-uptake inhibitors in the treatment of such problems. Clin Psychol Rev 25:153–182

    Article  PubMed  Google Scholar 

  33. Smallbone SW, McCabe BA (2003) Childhood attachment, childhood sexual abuse, and onset of masturbation among adult sexual offenders. Sex Abuse 15:1–9

    Article  PubMed  Google Scholar 

  34. Salter D, McMillan D, Richards M et al. (2003) Development of sexual abusive behaviour in sexually victimised males:a longitudinal study. Lancet 361:471–476

    Article  PubMed  Google Scholar 

  35. Kafka MP, Hennen J (1999) The paraphilia-related disorders:an empirical investigation of nonparaphilic hypersexuality disorders in outpatient males. J Sex Marital Ther 25:305–319

    Article  PubMed  CAS  Google Scholar 

  36. Briken P, Hill A, Berner W (2005) Sexuelle Sucht:Diagnostik, Ätiologie, Behandlung. Z Sexualforsch 18:185–197

    Article  Google Scholar 

  37. Briken P, Habermann N, Kafka MP et al. (2006) The paraphilia-related disorders:an investigation of the relevance of the concept in sexual murderers. J Forensic Sci 51:683–688

    Article  PubMed  Google Scholar 

  38. Fiedler P (2004) Sexuelle Orientierung und sexuelle Abweichung. Beltz, Weinheim Basel

  39. Berner W, Karlick-Bolten E (1986) Verlaufsformen bei Sexualkriminalität. Enke, Stuttgart

  40. Lösel F, Schmucker M (2005) The effectiveness of treatment for sexual offenders:a comprehensive meta-analysis. J Experim Criminol 1:117–146

    Article  Google Scholar 

  41. Hanson R, Morton-Bourgon K (2004) Predictors of sexual recidivism:an update meta-analysis 2004-02. Public Safety and Emergency Preparedness Canada. Public Works and Government Services Canada. Cat.No:PS3 – 1/2004-2E-PDF

  42. Marques JK, Wiederanders M, Day DM et al. (2005) Effects of a relapse prevention program on sexual recidivism:final results from California’s sex offender treatment and evaluation project (SOTEP). Sex Abuse 17:79–107

    Article  PubMed  Google Scholar 

  43. Mann RE, Thornton D (1998) The evolution of a multisite sexual offender treatment program. In:Marshall WL, Fernandez JM, Hudson SM, Ward T (eds) Sourcebook of treatment programs for sexual offenders. Plenum, New York, pp 47–58

  44. Pithers WD, Marques JK, Gibat CC, Marlatt GA (1983) Relapse prevention with sexual aggressives:a self-control model of treatment and maintenance of change. In:Greer JG, Stuart IR (eds) The sexual aggressor:current perspectives on treatment. Van Nostrand Reinholt, New York, pp 214–239

  45. Allam J, Middleton D, Browne K (1997) Different clients, different needs? Practice issues in comunity- based treatment for sex offenders. Crim Behav Mental Health 7:69–84

    Article  Google Scholar 

  46. Berner W, Becker KH (2001) Sex offender Treatment Programme (SOTP) in der Sozialtherapeutischen Abteilung Hamburg-Nesselstraße. In:Rehn GB, Wischka B, Lösel F, Walter M (Hrsg) Behandlung gefährlicher Straftäter. Grundlagen, Konzepte, Ergebnisse. Centaurus, Herbolzheim, S 206–218

  47. Berner W, Preuss WF (2002) Gruppentherapie für Männer mit pädosexuellen Tendenzen. Gruppentherapie Grupppendynamik 38:255–280

    Google Scholar 

  48. Berner W, Kleber R, Lohse R (2004) Psychotherapie bei sexueller Delinquenz. In:Strauß B (Hrsg) Psychotherapie der Sexualstörungen. Krankheitsmodelle und Therapiepraxis – störungsspezifisch und schulenübergreifend. Thieme, Stuttgart, S 135–155

  49. Berner W, Preuss WF, Hill A, Lietz K (2004) Tiefenpsychologisch- integrative Tätertherapie am Beispiel von Gruppentherapie für Patienten mit pädosexueller Präferenz. Psychotherapie Dialog 5:128–134

    Article  Google Scholar 

  50. Rösler A, Witztum E (1998) Treatment of men with paraphilia with a long-acting analogue of gonadotropine- releasing hormone. New Eng J Med 338:416–422

    Article  PubMed  Google Scholar 

  51. Briken P, Berner W, Noldus J et al. (2000) Therapie mit dem LHRH-Agonisten Leuprorelinacetat bei Paraphilien und sexuell aggressiven Impulshandlungen. Nervenarzt 71:380–385

    Article  PubMed  CAS  Google Scholar 

  52. Czerny JP, Briken P, Berner W (2001) Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics. Eur Psychiatry 17:104–106

    Article  Google Scholar 

  53. Moore TM, Scarpa A, Raine A (2002) A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior. Aggressive Behavior 28:299–316

    Article  CAS  Google Scholar 

  54. Stein JD, Hollander E, Anthony DT et al. (1992) Serotonergic medications for sexual obsessions, sexual addictions and paraphilias. J Clin Psychiatry 53:267–271

    PubMed  CAS  Google Scholar 

  55. Kafka MP, Prentky R (1992) A comparative study on non paraphilic sexual addiction and paraphilias in men. J Clin Psychiatry 53:345–350

    PubMed  CAS  Google Scholar 

  56. Kafka MP, Prentky R (1992) Fluoxetine treatment of non paraphilic sexual addiction and paraphilias in men. J Clin Psychiatry 53:350–358

    Google Scholar 

  57. Ryback RS (2004) Naltrexone in the treatment of adolescent sexual offenders. J Clin Psychiatry 65:982–986

    Article  PubMed  CAS  Google Scholar 

  58. Schorsch E (1988) Affekttaten und sexuelle Perversionstaten im strukturellen und psychodynamischen Vergleich. Recht Psychiatrie 6:10–19

    Google Scholar 

  59. Hansen H, Lykke-Olesen L (1977) Treatment of dangerous sexual offenders in Denmark. J Forensic Psychiatry 8:195–199

    Google Scholar 

  60. Massie H, Szajnberg (1997) The ontogeny of a sexual fetich from birth to age 30 and memory processes. Int J Psychoanalysis 78:755–771

    Google Scholar 

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Authors and Affiliations

  1. Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, BRD

    Wolfgang Berner & P. Briken

  2. Institut für Sexualforschung und Forensische Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, BRD

    Wolfgang Berner

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Correspondence to Wolfgang Berner.

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Berner, W., Briken, P. Störung der Sexualpräferenz (Paraphilie). Bundesgesundheitsbl. 50, 33–43 (2007). https://doi.org/10.1007/s00103-007-0108-y

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