Störung der Sexualpräferenz (Paraphilie)

Diagnostik, Ätiologie, Epidemiologie, Behandlung und präventive Aspekte
Leitthema: Sexualmedizin

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.

Schlüsselwörter

Paraphilie Störung der Sexualpräferenz Kognitiv-behaviorale Programme Rückfallvermeidung Antihormonelle Therapie SSRI LHRH-Agonisten Naltrexon 

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

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.

Keywords

paraphilia disturbances of sexual preference cognitive-behavioral programs prelaps prevention antihormonal therapy SSRI LHRH-agonists naltrexon 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Universitätsklinikum Hamburg-EppendorfHamburg-EppendorfBRD
  2. 2.Institut für Sexualforschung und Forensische Psychiatrie, Zentrum für Psychosoziale MedizinUniversitätsklinikum Hamburg-EppendorfHamburgBRD

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