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Leuprolide Acetate Suppresses Pedophilic Urges and Arousability

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Abstract

Cognitive–behavioral psychotherapy was compared with cognitive–behavioral psychotherapy augmented by leuprolide acetate (LA) for suppression of pedophilic behavior. Five male pedophiles (M age, 50 years; range, 36–58) were administered LA by Depo injection for 12 months, followed by saline placebo for 12 months. Testosterone levels, sexual interest preference by visual reaction time (Abel Assessment), penile tumescence (Monarch Penile Plethysmography, PPG), as well as strong sexual urges toward children and masturbatory frequency involving thoughts of children (polygraph), were measured every 3 months. On LA, testosterone decreased to castrate levels. Penile tumescence was significantly suppressed compared with baseline, but sufficient response remained to detect pedophilic interest. Pedophilic interest was also detected by visual reaction times. When asked about having pedophilic urges and masturbating to thoughts of children, all subjects self-reported a decrease. Polygraph responses indicated subjects were not deceptive. On placebo, testosterone and physiologic arousal eventually rose to baseline. As noted by polygraph, at baseline and on placebo, subjects were deceptive regarding increased pedophilic urges and masturbatory frequency. Interest preference, as measured by Abel Assessment and Monarch PPG, was generally unchanged throughout the study. Cognitive–behavioral psychotherapy augmented with LA significantly reduced pedophilic fantasies, urges, and masturbation; however, pedophilic interest did not change during 1 year of therapy. Deceptive responses by polygraph suggested that self-report was unreliable. Follow-up utilizing objective measures is essential for monitoring efficacy of treatment in pedophilia. Our study supports the premise that suppression of pedophilic behavior is possible. LA may augment cognitive–behavioral psychotherapy and help break the sequence leading to a re-offense.

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References

  • Abel, G. G., Huffman, J., Warberg, B., & Holland, C. L. (1998). Visual reaction time and plethysmography as measures of sexual interest in child molesters. Sexual Abuse: A Journal of Research and Treatment, 10, 81–95.

    Article  Google Scholar 

  • Abel, G. G., & Osborn, C. (1992). The paraphilias: The extent and nature of sexually deviant and criminal behavior. Psychiatric Clinics of North America, 15, 675–687.

    PubMed  Google Scholar 

  • American Psychiatric Association. (1994). Diagnosis and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Bambino, T. H., Schreiber, J. R., & Hsueh, A. J. (1980). Gonadotropin-releasing hormone and its agonist inhibit testicular luteinizing hormone receptor and steroidogenesis in immature and adult hypophysectomized rats. Endocrinology, 107, 908–917.

    Article  PubMed  Google Scholar 

  • Barbaree, H. E., & Mewhort, D. J. (1994). The effects of the z-score transformation on measures of relative erectile response strength: A re-appraisal. Behaviour Research and Therapy, 32, 547–558.

    Article  PubMed  Google Scholar 

  • Belchetz, P. E., Plant, T. M., Nakai, Y., Keogh, E. J., & Knobil, E. (1978). Hypophysial responses to continuous and intermittent delivery of hypopthalamic gonadotropin-releasing hormone. Science, 202, 631–633.

    PubMed  Google Scholar 

  • Berger, P., Berner, W., Bolterauer, J., Gutierrez, K., & Berger, K. (1999). Sadistic personality disorder in sex offenders: Relationship to antisocial personality disorder and sexual sadism. Journal of Personality Disorders, 13, 175–186.

    PubMed  Google Scholar 

  • Bergquist, C., Nillius, S. J., & Wide, L. (1979). Intranasal gonadotropin-releasing hormone agonist as a contraceptive agent. Lancet, 2, 215–217.

    Article  PubMed  Google Scholar 

  • Berlin, F. S. (1983). Sex offenders: A biomedical perspective and a status report on biomedical treatment. In J. C. Greer & I. R. Stuart (Eds.), The sexual aggressor: Current perspectives on treatment (pp. 82–123). New York: Van Nostrand Reinhold Company.

    Google Scholar 

  • Bradford, J. M. (1983). The hormonal treatment of sexual offenders. Bulletin of the American Academy of Psychiatry and the Law, 11, 159–169.

    PubMed  Google Scholar 

  • Bradford, J. M., & Pawlak, A. (1993). Double-blind placebo crossover study of cyproterone acetate in the treatment of the paraphilias. Archives of Sexual Behavior, 22, 383–402.

    Article  PubMed  Google Scholar 

  • Briken, P. (2002). Pharmacotherapy of paraphilias with luteinizing hormone-releasing hormone agonists [Letter]. Archives of General Psychiatry, 59, 469–470.

    Article  PubMed  Google Scholar 

  • Briken, P., Hill, A., & Berner, W. (2003). Pharmacotherapy of paraphilias with long-acting agonists of luteinizing hormone-releasing hormone: A systematic review. Journal of Clinical Psychiatry, 64, 890–897.

    Article  PubMed  Google Scholar 

  • Briken, P., Nika, E., & Berner, W. (2001). Treatment of paraphilia with luteinizing hormone-releasing hormone agonists. Journal of Sex and Marital Therapy, 27, 45–55.

    Article  PubMed  Google Scholar 

  • Brogden, R. N., & Clissold, S. P. (1989). Flutamide: A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in advanced prostatic cancer. Drugs, 38, 185–203.

    PubMed  Google Scholar 

  • Brotherton, J., & Harcus, A. W. (1973). Effect of oral cyproterone acetate on urinary FSH and LH levels in adult males being treated for hypersexuality. Journal of Reproduction and Fertility, 33, 256–257.

    PubMed  Google Scholar 

  • Byrne, P. M. (2000). The reliability and validity of a less explicit audio and “clothed” visual penile plethysmograph set with child molesters and nonoffenders. Unpublished doctoral dissertation, University of Utah, Salt Lake City, Utah.

  • Clarke, D. J. (1989). Antilibidinal drugs and mental retardation: A review. Medicine, Science, and the Law, 29, 136–146.

    PubMed  Google Scholar 

  • Cooper, A. J. (1986). Progestogens in the treatment of male sex offenders: A review. Canadian Journal of Psychiatry, 31, 73–79.

    Google Scholar 

  • Cooper, A. J., & Cernovsky, Z. Z. (1994). Comparison of cyproterone acetate (CPA) and leuprolide acetate (LHRH agonist) in a chronic pedophile: A clinical subject study. Biological Psychiatry, 36, 269–271.

    Article  PubMed  Google Scholar 

  • Epperson, D. L., Kaul, J. D., Huot, S. J., Hesselton, D., Alesander, W., & Goldman, R. (1999). Minnesota Sex Offender Screening Tool Revised (MnSOST-R). St. Paul, MN: Minnesota Department of Corrections.

    Google Scholar 

  • Fagan, P. J., Wise, T. N., Schmidt, C. W., & Berlin, F. S. (2002). Pedophilia. Journal of the American Medical Association, 288, 2458–2465.

    Article  PubMed  Google Scholar 

  • Gagne, P. (1981). Treatment of sex offenders with medroxyprogesterone acetate. American Journal of Psychiatry, 138, 644–646.

    PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.

    PubMed  Google Scholar 

  • Hanson, R. K., Gordon, A., Harris, A. J., Marques, J. K., Murphy, W., Quinsey, V. L., et al. (2002). First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders. Sexual Abuse: A Journal of Research and Treatment, 14, 169–197.

    Article  Google Scholar 

  • Hanson, R. K., & Thornton, D. (1999). Static 99: Improving actuarial risk assessments for sex offenders 1999-02 (National Institute of Corrections Report, Accession Number 015355/Kutak VF 1920.44, pp. 1–23). Ottawa, ON: Canada, Solicitor General of Canada.

  • Hare, R. D. (1998). The PCL-R assessment of psychopathy: Some issues and concerns. Legal and Criminological Psychology, 3, 99–119.

    Google Scholar 

  • Harris, J. T., Rice, M. E., Quinsey, V. L., Chaplin, T. C., & Earls, C. (1992). Maximizing the discriminant validity of phallometric assessment data. Psychological Assessment, 4, 502–511.

    Article  Google Scholar 

  • Heil, P., Ahlmeyer, S., Simons, D., & English, K. (1999). The impact of polygraphy on admissions of crossover offending behavior in adult sexual offenders. Paper presented at the meeting of the ATSA Research and Treatment Conference, Lake Buena Vista, FL.

  • Hirsch, D., Kovatz, S., Bernheim, J., & Shenkman, L. (1994). Fatal fulminant hepatitis from cyproterone acetate. Israel Journal of Medical Sciences, 30, 238–240.

    PubMed  Google Scholar 

  • Ichikawa, T., Akimoto, S., & Shimazaki, J. (1988). Effect of leuprolide on growth of rat prostatic tumor (R 3327) and weight of male accessory sex organs. Endocrinologia Japonica, 35, 181–187.

    PubMed  Google Scholar 

  • Kafka, M. (2000). Psychopharmacologic treatments for nonparaphilic compulsive sexual behaviours. CNS Spectrums, 5, 49–59.

    PubMed  Google Scholar 

  • Kuban, M., Barbaree, H. E., & Blanchard, R. (1999). A comparison of volume and circumference phallometry: Response magnitude and method agreement. Archives of Sexual Behavior, 28, 345–359.

    Article  PubMed  Google Scholar 

  • Letourneau, E. J. (2002). A comparison of objective measures of sexual arousal and interest: Visual reaction time and penile plethysmography. Sexual Abuse: A Journal of Research and Treatment, 14, 207–223.

    Article  Google Scholar 

  • Linde, R., Doelle, G. C., Alexander, N., Kirchner, F., Vale, W., Rivier, J., et al. (1981). Reversible inhibition of testicular steroidogenesis and spermatogenesis by a potent gonadotropin-releasing hormone agonist in normal men: An approach toward the development of a male contraceptive. New England Journal of Medicine, 305, 663–667.

    Article  PubMed  Google Scholar 

  • Marshall, W. L., & Barbaree, H. E. (1990). Outcome of comprehensive cognitive–behavioral treatment programs. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories and treatment of the offender (pp. 363–385). New York: Plenum Press.

    Google Scholar 

  • McEvoy, G. K. (1990). AHFS drug information 90. Bethesda, MD: American Society of Hospital Pharmacists.

    Google Scholar 

  • Miner, M. H., & Coleman, E. (2001). Advances in sex offender treatment and challenges for the future. Journal of Psychology and Human Sexuality, 13, 5–24.

    Article  Google Scholar 

  • Murphy, W. D., & Barbaree, H. E. (1994). Assessments of sex offenders by measures of erectile response: Psychometric properties and decision making. Brandon, VT: The Safer Society Press.

    Google Scholar 

  • Raymond, N. C., Grant, J. E., Kim, S. W., & Coleman, E. (2002). Treatment of compulsive sexual behavior with naltrexone and serotonin reuptake inhibitors: Two case studies. International Clinical Psychopharmacology, 17, 201–205.

    Article  PubMed  Google Scholar 

  • Raymond, N., Robinson, B., Kraft, C., Rittberg, B., & Coleman, E. (2001). Treatment of pedophilia with leuprolide acetate: A case study. Journal of Psychology and Human Sexuality, 13, 79–88.

    Article  Google Scholar 

  • Rosler, A., & Witztum, E. (1998). Treatment of men with paraphilia with a long-acting analogue of gonadotropin-releasing hormone. New England Journal of Medicine, 338, 416–422.

    Article  PubMed  Google Scholar 

  • Stein, D. J., Hollander, E., Anthony, D. T., Schneier, F. R., Fallon, B. A., Liebowitz, M. R., et al. (1992). Serotonergic medications for sexual obsessions, sexual addiction and paraphilias. Journal of Clinical Psychiatry, 53, 267–271.

    PubMed  Google Scholar 

  • Vance, M. A., & Smith, J. A. (1984). Endocrine and clinical effects of leuprolide in prostatic cancer. Clinical Pharmacology and Therapeutics, 36, 350–354.

    PubMed  Google Scholar 

  • Vilchez-Martinez, J. A., Coy, D. H., Arimura, A., Coy, E. J., Hirotsu, Y., & Schally, A. V. (1974). Synthesis and biological properties of (Leu-6)-LH-RH and (D-Leu-6,desGly-NH210)-LH-RH ethylamide. Biochemical and Biophysical Research Communications, 59, 1226–1232.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hamot Medical Center, Erie, Pennsylvania

    Justine M. Schober (M.D) & Ruth A. Fries B.S. (C.I.P.)

  2. Lake Erie Research Institute, Erie, Pennsylvania

    Phyllis J. Kuhn Ph.D.

  3. Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania

    Paul G. Kovacs Ph.D.

  4. JHE Consultant Group Inc., Colorado Springs, Colorado

    James H. Earle Ph.D.

  5. Behavioral Technology Inc., Salt Lake City, Utah

    Peter M. Byrne Ph.D.

  6. 333 State Street, Suite 201, Erie, Pennsylvania, 16507

    Justine M. Schober (M.D)

Authors
  1. Justine M. Schober
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  2. Phyllis J. Kuhn Ph.D.
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  3. Paul G. Kovacs Ph.D.
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  4. James H. Earle Ph.D.
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  5. Peter M. Byrne Ph.D.
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  6. Ruth A. Fries B.S.
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Correspondence to Justine M. Schober.

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Schober, J.M., Kuhn, P.J., Kovacs, P.G. et al. Leuprolide Acetate Suppresses Pedophilic Urges and Arousability. Arch Sex Behav 34, 691–705 (2005). https://doi.org/10.1007/s10508-005-7929-2

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  • DOI: https://doi.org/10.1007/s10508-005-7929-2

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