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Current Concepts in the Pharmacotherapy of Paraphilias

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Abstract

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3–5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.

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Acknowledgements

The authors declare that: (1) they have received no financial support for the submitted work from anyone other than their employer; (2) Prof. Thibaut was consultant for Debiopharm; (3) they have no spouses, partners or children who have relationships with commercial entities that might have an interest in the submitted work; (4) they have no non-financial interests that may be relevant to the submitted work. The authors are grateful to Richard Medeiros, Rouen University Hospital Medical Editor, for editing the manuscript.

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  1. ADEN Laboratory EA4311, Rouen University Hospital, Biomedical Research Institute, IFR 23, Rouen, France

    Frederico D. Garcia

  2. Department of Psychiatry, Rouen University Hospital, INSERM U 614, Faculty of Medicine, Rouen University, Rouen, France

    Florence Thibaut

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  1. Frederico D. Garcia
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  2. Florence Thibaut
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Correspondence to Florence Thibaut.

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Garcia, F.D., Thibaut, F. Current Concepts in the Pharmacotherapy of Paraphilias. Drugs 71, 771–790 (2011). https://doi.org/10.2165/11585490-000000000-00000

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