Skip to main content

Advertisement

SpringerLink
Log in

Pharmacologic Treatment of Sex Offenders With Paraphilic Disorder

  • Sexual Disorders (JP Fedoroff, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Sexual offending is both a social and a public health issue. Evidence demonstrates that a combination of pharmacological and psychotherapeutic approaches may reduce or even eliminate deviant sexual behavior in sex offenders with paraphilic disorders. In this article, we will review pharmacological treatment options for sex offenders with paraphilias. Both serotonin selective reuptake inhibitors (SSRIs) and antiandrogen treatments have been used with reported success in decreasing recidivism. SSRIs have been used in mild types of paraphilias and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe sex offenders with paraphilic disorders in order to reduce victimization. Combined pharmacological and psychotherapeutic treatment is associated with better efficacy. Imaging studies may improve the knowledge of paraphilic disorders and the mechanisms of action of current treatments. In spite of existing evidence, there is a need for independent, large-scale and good quality studies assessing the long-term efficacy and tolerance of treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Post L, Mezey N, Maxwell N, Wilbert W. The rape tax: tangible and intangible costs of sexual violence. J Interpers Violence. 2002;17(7):773–82.

    Article  Google Scholar 

  2. Birger M, Bergman-Levy T, Asman O. Treatment of sex offenders in Israeli prison settings. J Am Acad Psychiatry Law. 2011;39(1):100–3.

    PubMed  Google Scholar 

  3. Total sexual violence at the national level, number of police-recorded offences [database on the Internet]. United Nations Office on Drugs and Crime. 2012. Available from: http://www.unodc.org/documents/data-and-analysis/statistics/crime/CTS12_Sexual_violence.xls. Accessed 25 Dec 2012.

  4. Garcia FD, Thibaut F. Sexual addictions. Am J Drug Alcohol Abuse. 2010;36(5):254–60. doi:10.3109/00952990.2010.503823.

    Article  PubMed  Google Scholar 

  5. •• Garcia FD, Thibaut F. Current concepts in the pharmacotherapy of paraphilias. Drugs. 2011;71(6):771–90. doi:10.2165/11585490-000000000-00000. This paper, which complements Thibaut et al. [6], critically reviews the current literature concerning selective serotonin reuptake inhibitors (SSRI).

    Article  PubMed  CAS  Google Scholar 

  6. •• Thibaut F, De La Barra F, Gordon H, Cosyns P, Bradford JM. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias. World J Biol Psychiatry. 2010;11(4):604–55. doi:10.3109/15622971003671628. These guidelines review and critically analyze the available literature about paraphilia treatment.

    Article  PubMed  Google Scholar 

  7. Craig LA, Browne KD, Stringer I, Hogue TE. Sexual reconviction rates in the United Kingdom and actuarial risk estimates. Child Abuse Negl. 2008;32(1):121–38. doi:10.1016/j.chiabu.2007.09.002.

    Article  PubMed  Google Scholar 

  8. Hanson RK, Morton KE, Harris AJ. Sexual offender recidivism risk: what we know and what we need to know. Ann N Y Acad Sci. 2003;989:154–66. discussion 236-46.

    Article  PubMed  Google Scholar 

  9. Hanson RK, Morton-Bourgon KE. The characteristics of persistent sexual offenders: a meta-analysis of recidivism studies. J Consult Clin Psychol. 2005;73(6):1154–63. doi:10.1037/0022-006X.73.6.1154.

    Article  PubMed  Google Scholar 

  10. Hanson RK, Morton-Bourgon KE. The accuracy of recidivism risk assessments for sexual offenders: a metaanalysis of 118 prediction studies. Psychol Assess. 2009;21:1–21.

    Article  PubMed  Google Scholar 

  11. Harris AJR, Hanson RK. La récidive sexuelle: d'une simplicité trompeuse. In: civile Spep, editor. Ottawa, Canada2004.

  12. Prentky R, Burgess AW. Rehabilitation of child molesters: a cost-benefit analysis. Am J Orthopsychiatry. 1990;60(1):108–17.

    Article  PubMed  CAS  Google Scholar 

  13. Schmucker M, Losel F. Does sexual offender treatment work? A systematic review of outcome evaluations. Psicothema. 2008;20(1):10–9.

    PubMed  Google Scholar 

  14. McConaghy N. Paedophilia: a review of the evidence. Aust N Z J Psychiatr. 1998;32(2):252–65. discussion 66-7.

    Article  CAS  Google Scholar 

  15. Hall RC. A profile of pedophilia: definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues. Mayo Clin Proc. 2007;82(4):457–71.

    Article  PubMed  Google Scholar 

  16. Rosler A, Witztum E. Treatment of men with paraphilia with a long-acting analogue of gonadotropin-releasing hormone. N Engl J Med. 1998;338(7):416–22. doi:10.1056/NEJM199802123380702.

    Article  PubMed  CAS  Google Scholar 

  17. Murray JB. Psychological profile of pedophiles and child molesters. J Psychol. 2000;134(2):211–24.

    Article  PubMed  CAS  Google Scholar 

  18. Meston CM, Frohlich PF. The neurobiology of sexual function. Arch Gen Psychiatry. 2000;57(11):1012–30.

    Article  PubMed  CAS  Google Scholar 

  19. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res. 1998;92(2):111–8.

    Article  PubMed  CAS  Google Scholar 

  20. Virkkunen M, De Jong J, Bartko J, Goodwin FK, Linnoila M. Relationship of psychobiological variables to recidivism in violent offenders and impulsive fire setters. A follow-up study. Arch Gen Psychiatry. 1989;46(7):600–3.

    Article  PubMed  CAS  Google Scholar 

  21. Virkkunen M, Rawlings R, Tokola R, Poland RE, Guidotti A, Nemeroff C, et al. CSF biochemistries, glucose metabolism, and diurnal activity rhythms in alcoholic, violent offenders, fire setters, and healthy volunteers. Arch Gen Psychiatry. 1994;51(1):20–7.

    Article  PubMed  CAS  Google Scholar 

  22. Maes M, van West D, De Vos N, Westenberg H, Van Hunsel F, Hendriks D, et al. Lower baseline plasma cortisol and prolactin together with increased body temperature and higher mCPP-induced cortisol responses in men with pedophilia. Neuropsychopharmacology. 2001;24(1):37–46. doi:10.1016/S0893-133X(00)00177-9.

    Article  PubMed  CAS  Google Scholar 

  23. Baratta A, Javelot H, Morali A, Halleguen O, Weiner L. The role of antidepressants in treating sex offenders. Sexologies. 2012;21:106–8.

    Article  Google Scholar 

  24. Hill A, Briken P, Kraus C, Strohm K, Berner W. Differential pharmacological treatment of paraphilias and sex offenders. Int J Offender Ther Comp Criminol. 2003;47(4):407–21.

    Article  PubMed  Google Scholar 

  25. Adi Y, Ashcroft D, Browne K, Beech A, Fry-Smith A, Hyde C. Clinical effectiveness and cost-consequences of selective serotonin reuptake inhibitors in the treatment of sex offenders.2002 Contract No.: 28.

  26. Thibaut F. Pharmacological treatment of sex offenders. Sexologies. 2011;20:166–8.

    Article  Google Scholar 

  27. Fedoroff JP. Antiandrogens vs serotonergic medications in the treatment of sex offenders: a preliminary compliance study. Can J Hum Sex. 1995;4:111–23.

    Google Scholar 

  28. Simon NG, Cologer-Clifford A, Lu SF, McKenna SE, Hu S. Testosterone and its metabolites modulate 5HT1A and 5HT1B agonist effects on intermale aggression. Neurosci Biobehav Rev. 1998;23(2):325–36.

    Article  PubMed  CAS  Google Scholar 

  29. Rubinow DR, Schmidt PJ. Androgens, brain, and behavior. Am J Psychiatry. 1996;153(8):974–84.

    PubMed  CAS  Google Scholar 

  30. Wille R, Beier KM. Castration in Germany. Ann Sex Res. 1989;2:103–33.

    Google Scholar 

  31. Bradford JM. The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatr. 2001;46(1):26–34.

    CAS  Google Scholar 

  32. Guay DR. Drug treatment of paraphilic and nonparaphilic sexual disorders. Clin Ther. 2009;31(1):1–31.

    Article  PubMed  CAS  Google Scholar 

  33. Krueger RB, Hembree W, Hill M. Prescription of medroxyprogesterone acetate to a patient with pedophilia, resulting in Cushing's syndrome and adrenal insufficiency. Sex Abuse. 2006;18(2):227–8. doi:10.1007/s11194-006-9012-5.

    PubMed  Google Scholar 

  34. Jeffcoate WJ, Matthews RW, Edwards CR, Field LH, Besser GM. The effect of cyproterone acetate on serum testosterone, LH, FSH and prolactin in male sexual offenders. Clin Endocrinol. 1980;13(2):189–95.

    Article  CAS  Google Scholar 

  35. Neuman F. Pharmacology and potential use of cyproterone acetate. Horm Metab Res. 1977;9:1–13.

    Article  Google Scholar 

  36. Codispoti VL. Pharmacology of sexually compulsive behavior. Psychiatr Clin N Am. 2008;31(4):671–9. doi:10.1016/j.psc.2008.06.002.

    Article  Google Scholar 

  37. Meyer JW, Cole CM. Physical and chemical castration of sex offenders. J Off Rehab. 1997;25(3–4):1–18.

    Article  Google Scholar 

  38. Laschet U, Laschet L. Antiandrogens in the treatment of sexual deviations of men. J Steroid Biochem. 1975;6(6):821–6.

    Article  PubMed  CAS  Google Scholar 

  39. Hansen H, Lykke-Olesen L. Treatment of dangerous sexual offenders in Denmark. J Forensic Psychiatr. 1997;8:195–9.

    Article  Google Scholar 

  40. Czerny JP, Briken P, Berner W. Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics. Eur Psychiatry. 2002;17(2):104–6.

    Article  PubMed  Google Scholar 

  41. Thibaut F, Cordier B, Kuhn JM. Effect of a long-lasting gonadotrophin hormone-releasing hormone agonist in six cases of severe male paraphilia. Acta Psychiatr Scand. 1993;87(6):445–50.

    Article  PubMed  CAS  Google Scholar 

  42. Thibaut F, Cordier B, Kuhn JM. Gonadotrophin hormone releasing hormone agonist in cases of severe paraphilia: a lifetime treatment? Psychoneuroendocrinology. 1996;21(4):411–9.

    Article  PubMed  CAS  Google Scholar 

  43. Thibaut F, Kuhn JM, Cordier B, Petit M. Hormone treatment of sex offenses. Encephale. 1998;24(2):132–7.

    PubMed  CAS  Google Scholar 

  44. Schober JM, Kuhn PJ, Kovacs PG, Earle JH, Byrne PM, Fries RA. Leuprolide acetate suppresses pedophilic urges and arousability. Arch Sex Behav. 2005;34(6):691–705. doi:10.1007/s10508-005-7929-2.

    Article  PubMed  Google Scholar 

  45. Brahams D. Voluntary chemical castration of a mental patient. Lancet. 1988;1(8597):1291–2.

    Article  PubMed  CAS  Google Scholar 

  46. Ward T, Gannon TA, Birgden A. Human rights and the treatment of sex offenders. Sex Abuse. 2007;19(3):195–216. doi:10.1007/s11194-007-9053-4.

    PubMed  Google Scholar 

  47. Berlin FS. Sex offender treatment and legislation. J Am Acad Psychiatry Law. 2003;31(4):510–3.

    PubMed  Google Scholar 

  48. Silverman WA. The myth of informed consent: in daily practice and in clinical trials. J Med Ethics. 1989;15(1):6–11.

    Article  PubMed  CAS  Google Scholar 

  49. Belgian Advisory Commitee on Bioethics. Opinion no. 39 of December 18th 2006 on hormonal treatment of sex offender. 2006. In: http://www.health.belgium.be/internet2Prd/groups/public/@public/@dg1/@legalmanagement/documents/ie2divers/18074794.pdf. Accessed 16 Feb 2011.

  50. Moulier V, Fonteille V, Pelegrini-Issac M, Cordier B, Baron-Laforet S, Boriasse E, et al. A pilot study of the effects of gonadotropin-releasing hormone agonist therapy on brain activation pattern in a man with pedophilia. Int J Offender Ther Comp Criminol. 2012;56(1):50–60. doi:10.1177/0306624X10392191.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

F.D. Garcia declares that he has no conflict of interest.

H.G. Delavenne declares that she has no conflict of interest.

A.F.A. Assumpção declares that she has no conflict of interest.

F. Thibaut declares that she has no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry, INCT - de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil

    Frederico Duarte Garcia, Heloise Garcia Delavenne & Alessandra de Fátima Almeida Assumpção

  2. Inserm Unit 1073, Rouen University, Rouen, France

    Frederico Duarte Garcia

  3. Rouen University Hospital, Faculty of Medicine, INSERM U675, Rouen, France

    Florence Thibaut

Authors
  1. Frederico Duarte Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heloise Garcia Delavenne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra de Fátima Almeida Assumpção
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florence Thibaut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florence Thibaut.

Additional information

This article is part of the Topical Collection on Sexual Disorders

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garcia, F.D., Delavenne, H.G., Assumpção, A.F.A. et al. Pharmacologic Treatment of Sex Offenders With Paraphilic Disorder. Curr Psychiatry Rep 15, 356 (2013). https://doi.org/10.1007/s11920-013-0356-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-013-0356-5

Keywords

Search

Navigation