Archives of Sexual Behavior

, Volume 28, Issue 1, pp 23–30 | Cite as

Compulsive Voyeurism and Exhibitionism: A Clinical Response to Paroxetine

  • Ahmed Abouesh
  • Anita Clayton
Article

Abstract

The compulsive behaviors seen in sexualparaphilias may be related to those ofobsessive-compulsive disorder (OCD). Based primarilyupon case reports as well as studies indicating theeffectiveness of serotonin reuptake inhibitors in the treatment of sexualparaphilias, it has been speculated that sexualparaphilias lie within the obsessive-compulsivespectrum. There have been no reports of the use ofparoxetine in the treatment of sexual paraphilias. This isa report of two patients, the first a voyeur and thesecond an exhibitionist, both of whom responded totreatment with paroxetine. The discussion addresses the need for further comparative studiesinvestigating the role of the serotonin system in thepathogenesis of sexual paraphilias and OCD as well asthe effect of serotonin reuptake inhibitors incomparison to other pharmacologic modalities used in thetreatment of paraphilias.

VOYEURISM EXHIBITIONISM PARAPHILIAS OBSESSIVE-COMPULSIVEDISORDER SEROTONIN REUPTAKE INHIBITORS 

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REFERENCES

  1. Barr, L. C., Goodman, W. K., Price, L. H., McDougle, C. J., and Charney,D S. The serotonin hypothesis of obsessive-compulsive disorder: Implications of pharmacologic challenge studies. J. Clin. Psychiat. 53(4, Suppl.): 17-28.Google Scholar
  2. Baxter, L. R., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Guze, B. H., Mazziotta, J. C., Alazraki, A., Selin, C. E., Ferng, H., Munford, P., and Phelps, M. E. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive compulsive disorder. Arch. Gen. Psychiat. 49: 681-689.Google Scholar
  3. Behar, D., Rapoport, J. L., Berg, C. J. (1984). Computerized tomography and neuropsychological measures in adolescents with obsessive-compulsive disorder. Am. J. Psychiat. 141: 363-369.Google Scholar
  4. Bradford, J. M. W. (1995). Pharmacologic Treatment of the Paraphilias, In Oldham, J. M., and Riba, M. B. (eds.), American Psychiatric Press Review of Psychiatry, Vol. 14, American Psychiatric Press, Washington, DC.Google Scholar
  5. Chouinard, R., Goodman, W., Greist, J., Jenike, M., Rasmussen, S., White, K., Hackett, E., Gaffney, M., and Bick, P. A. (1990). Results of a double blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive compulsive disorder. Psychopharm acol. Bull. 26: 279-284.Google Scholar
  6. Clompipramine Collaborative Study Group. (1991). Clomipramine in the treatment of patients with obsessive-compulsive disorder. Arch. Gen. Psychiat. 48: 730-738.Google Scholar
  7. Clayton, A. H. (1993). Fetishism and Clomipramine. Am. J. Psychiat. 150: 673-674.Google Scholar
  8. Gessa, G. L., Tagliamonte, A., and Brodie, B. B. (1970). Essentail role ot testosterone on the sexual stimulation induced by p-Chlorophenylalanine in male animals. Nature 227: 616-617.Google Scholar
  9. Gitlin, M. J. (1994). Psychotropic medication and their effects on sexual function: Diagnosis, biology and treatment approaches. J. Clin. Psychiat. 55: 406-413.Google Scholar
  10. Greenburg, D. M., and Bradford, J. M. W. (1997). Treatment of the paraphilia disorders: A review of the role of the selective serotonin reuptake inhibitors. Sexual abuse: J. Res. Treat. 9: 349-360.Google Scholar
  11. Greenburg D. M., Bradford, J. M. W., Curry S., and O'Rourke, A. B. (1996). A comparison of treatment of paraphilias with three serotonin reuptake inhibitors: A retrospective study. Am Acad. Psychiat. Law, 24: 525-532.Google Scholar
  12. Jacobsen, F. M. (1992). Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J. Clin. Psychiat. 53: 119-122.Google Scholar
  13. Jenike, M. A., Hyman, S., Baer, L., Holland, A., Minichiello, W. E., Buttolph, L., Summergrad, P., Seymour, R., and Ricciardi, J. (1990). A controlled trial of fluvoxamine in obsessive-compulsive disorder. Am. J. Psychiat. 147: 1209-1215.Google Scholar
  14. Kafka, M. P. (1991). Successful antidepressant treatment of non-paraphilic sexual addictions and paraphilias in men. J. Clin. Psychiat. 52: 60-65.Google Scholar
  15. Kafka, M. P. (1994). Sertraline pharmacotherapy for paraphilias and paraphilia related disorders. An open trial. Ann. Clin. Psychiat. 6: 189-195.Google Scholar
  16. Kafka, M. P., and Prentky, R. (1992). Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. J. Clin. Psychiat. 53: 351-358.Google Scholar
  17. Lucey, J. V., Butcher, G., Clare, A. W., and Dinan, T. G. (1993). The anterior pituitary responds normally to protirelin in obsessive-compulsive disorde r: Evidence to support a neuroendocrine serotonergic deficit. Acta Psychiat. Scand. 87: 384-388.Google Scholar
  18. Marazitti, D., Hollander, E., Lensi, P., Ravagli, S., and Cassano, G. B. Peripheral markers of serotonin and dopamine function in obsessive-compulsive disorder. Psychiat. Res. 42: 41-51.Google Scholar
  19. Perilstein, R. D., Lipper, S., and Freidman, L. J. Three cases of pedophilia responsive to fluoxetine treatment. J. Clin. Psychiat. 52: 169-170.Google Scholar
  20. Rapoport, J., Wise, S., Lauffer, M., Munitz, H. (1988). Obsessive-compulsive disorder: A basal ganglia disease? In Rapoport, J. (e d.), Obsessive Compulsive Disorder in Children and Adolescents, APPI Press, Washington, DC: pp. 327-344.Google Scholar
  21. Risch, C. S., and Nemeroff, C. B. (1992). Neurochemical alteration of serotonergic neuronal systems in depression. J. Clin. Psychiat. 53(10, Suppl.).Google Scholar
  22. Swedo S. E., Pietrini, P., Leonard, H. L., Schapiro, M. B., Rettew, D. C., Goldberger, E. L., Rapoport, S. I., Rapoport, J. L., and Grady, C. L. (1992). Cerebral glucose metabolism in childhood onset obsessive compulsive disorder: Revisualization during pharmacotherapy. Arch. Gen. Psychiat. 49: 690-694.Google Scholar
  23. Stein, D. J., Hollander, E, Anthony, D. T., Scheier, F. R., Fallon, B. A., Liebowitz, M. R., and Klein, D. F. (1992). Serotonergic medications for sexual obsessions, sexual addictions and paraphilias. J. Clin. Psychiat. 53: 267-271.Google Scholar
  24. Tagliamonte, A., Tagliamonte, P., Gessa, G. L., and Brodie, B. B. (1969). Compulsive sexual activity induced by p-Chlorophenylalanine in normal and pinealectomized male rats. Science 166: 1433-1435.Google Scholar
  25. Tollefson, G. D., Rampey, A. H., Potvin, J. H., Jenike, M. A., Rush, A. J., Dominguez, R. A., Koran, L. M., Shear, M. K., Goodman, W., and Grenduso, L. A. (1994). A multicenter investigation of fixed dose fluoxetine in the treatment of obsessive compulsive disorder. Arch. Gen. Psychiat. 51: 559-567.Google Scholar
  26. Zajecka, J., Fawcett, J., Schaff, M., Jeffriess, H., and Guy, C. (1991). The role of serotonin in sexual dysfunction: Fluoxetine associated dysfunction. J. Clin. Psychiat. 52: 66-68.Google Scholar
  27. Zohar, J., and Judge, R. (1996). Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. OCD Paroxe tine study investigators. Br. J. Psychiat. 169: 468-474.Google Scholar
  28. Zohar, J., Klein, E. M., Maeller, A., Insel, T. R., Uhde, T. W., Murphy, D. L. (1987). 5-HT, obsessive-compulsive disorder and anxiety. In Proceedings of the Ame rican Psychiatric Association, Chicago, p. 175.Google Scholar

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© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Ahmed Abouesh
  • Anita Clayton

There are no affiliations available

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