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Treatment of Paraphilic Sex Offenders

  • Alessandra D. Fisher
  • Mario Maggi
Chapter

Abstract

Paraphilic disorders are characterized by recurrent, intense, sexually arousing fantasies, urges, or behaviors, over a period ≥6 months, generally involving nonhuman objects, suffering, or humiliation of oneself or one’s partner, children, or other non-consenting persons. These fantasies, urges, and behaviors produce clinically significant distress or impairments in social, occupational, and other important areas of functioning. Only a part of paraphilic behaviors may lead to sex offenses and vice versa; not all sex offenders suffer from a paraphilia. A sex offense, a major public health concern, is defined as any violation of established legal or moral codes of sexual behavior. Current treatment interventions of paraphilic sex offenders tend to integrate psychotherapy with pharmacological therapy, using psychotropic drugs and/or hormonal approaches.

Keywords

Androgen Deprivation Therapy Sexual Arousal Sexual Offense Cyproterone Acetate Surgical Castration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders, 5th edn: DSM-5 tm. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Thibaut F (2012) Pharmacological treatment of paraphilias. Isr J Psychiatry Relat Sci 49:297–305PubMedGoogle Scholar
  3. 3.
    Post L, Mezey N, Maxwell N, Wilbert W (2002) The rape tax: tangible and intangible costs of sexual violence. J Interpers Violence 17:773–782CrossRefGoogle Scholar
  4. 4.
    Birger M, Bergman-Levy T, Asman O (2011) Treatment of sex offenders in Israeli prison settings. J Am Acad Psychiatry Law 39:100–103PubMedGoogle Scholar
  5. 5.
    Craig LA, Browne KD, Stringer I, Hogue TE (2008) Sexual reconviction rates in the United Kingdom and actuarial risk estimates. Child Abuse Negl 32:121–138PubMedCrossRefGoogle Scholar
  6. 6.
    Hanson RK, Morton KE, Harris AJ (2003) Sexual offender recidivism risk: what we know and what we need to know. Ann NY Acad Sci 989:154–166PubMedCrossRefGoogle Scholar
  7. 7.
    Hanson RK, Morton-Bourgon KE (2005) The characteristics of persistent sexual offenders: a meta-analysis of recidivism studies. J Consult Clin Psychol 73:1154–1163PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia FD, Delavenne HG, Assumpção AF, Thibaut F (2013) Pharmacologic treatment of sex offenders with paraphilic disorder. Curr Psychiatry Rep 15:356PubMedCrossRefGoogle Scholar
  9. 9.
    Thibaut F, De la Barra F, Gordon H, Cosyns P, Bradford JM, WFSBP Task Force on Sexual Disorders (2010) The World Federation of Society of biological Psychiatry (WFSBP) Guidelines for the biological treatment of paraphilias. J Biol Psychiatry 11:604–655Google Scholar
  10. 10.
    Hall RC (2007) A profile of pedophilia: definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues. Mayo Clin Proc 82:457–471PubMedCrossRefGoogle Scholar
  11. 11.
    Kenworthy T, Adams CE, Bilby C, Brooks-Gordon B, Fenton M (2008) WITHDRAWN: psychological interventions for those who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 4, CD004858PubMedGoogle Scholar
  12. 12.
    Kaplan MS, Krueger RB (2012) Cognitive-behavioral treatment of the paraphilias. Isr J Psychiatry Relat Sci 49:291–296PubMedGoogle Scholar
  13. 13.
    Losel F, Schmucker M (2005) The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis. J Exp Criminol 1:117–146CrossRefGoogle Scholar
  14. 14.
    Kenworthy T, Adams CE, Bilby C, Brooks-Gordon B, Fenton M (2004) Psychological interventions for those who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 3:CD004858PubMedGoogle Scholar
  15. 15.
    Maletzki BM, Steinhauser C (2002) A 25-year follow-up of cognitive-behavioural therapy with 7,275 sexual offenders. Behav Modif 26:123–147CrossRefGoogle Scholar
  16. 16.
    Brooks-Gordon B, Bilby C, Wells H (2006) A systematic review of psychological interventions for sexual offenders I. Randomised control trials. J Forensic Psychiatry 17:442–466CrossRefGoogle Scholar
  17. 17.
    Belgian Advisory Commitee on Bioethics (2006) Opinion no. 39 of December 18th 2006 on hormonal treatment of sex offender. http://www.health.belgium.be/internet2Prd/groups/public/@public/@dg1/@legalmanagement/documents/ie2divers/18074794.pdf. Accessed 25 Jan 2014
  18. 18.
    Khan O, Ferriter M, Huband N, Smailagic N (2009) Pharmacological interventions for those who have sexually offended or are at risk of offending (Protocol). The Cochrane Library, Issue 3Google Scholar
  19. 19.
    Guay DRP (2009) Drug treatment of paraphilic and nonparaphilic sexual disorders. Clin Ther 31:1–31PubMedCrossRefGoogle Scholar
  20. 20.
    Adi Y, Ashcroft D, Browne K, Beech A, Fry-Smith A, Hyde C (2002) Clinical effectiveness and cost-consequences of selective serotonin reuptake inhibitors in the treatment of sex offenders. Health Technol Assess 6:1–66PubMedGoogle Scholar
  21. 21.
    Thibaut F (2011) Pharmacological treatment of sex offenders. Sexologies 20:166–168CrossRefGoogle Scholar
  22. 22.
    Fedoroff JP (1995) Antiandrogens vs serotonergic medications in the treatment of sex offenders: a preliminary compliance study. Can J Hum Sex 4:111–123Google Scholar
  23. 23.
    Meston CM, Frohlich PF (2000) The neurobiology of sexual function. Arch Gen Psychiatry 57:1012–1030PubMedCrossRefGoogle Scholar
  24. 24.
    Hill A, Briken P, Kraus C, Strohm K, Berner W (2003) Differential pharmacological treatment of paraphilias and sex offenders. Int J Offender Ther Comp Criminol 47:407–421PubMedCrossRefGoogle Scholar
  25. 25.
    Garcia FD, Thibaut F (2011) Current concepts in the pharmacotherapy of paraphilias. Drugs 71:771–790PubMedCrossRefGoogle Scholar
  26. 26.
    Giltay EJ, Gooren LG (2009) Potential side effects of androgen deprivation treatment in sex offenders. J Am Acad Psychiatry Law 37:53–58PubMedGoogle Scholar
  27. 27.
    Jeffcoate WJ, Matthews RW, Edwards CR, Field LH, Besser GM (1980) The effect of cyproterone acetate on serum testosterone, LH, FSH and prolactin in male sexual offenders. Clin Endocrinol 13:189–195CrossRefGoogle Scholar
  28. 28.
    Neuman F (1997) Pharmacology and potential use of cyproterone acetate. Horm Metab Res 9:1–13CrossRefGoogle Scholar
  29. 29.
    Dunsieth NW, Nelson EB, Brusman-Lovins LA, Holcomb JL, Beckman D, Welge JA et al (2004) Psychiatric and legal features of 113 men convicted of sexual offenses. J Clin Psychiatry 65:293–300PubMedCrossRefGoogle Scholar
  30. 30.
    Bradford JM (2001) The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatry 6:26–34Google Scholar
  31. 31.
    Raymons NC, Coleman E, Ohlerking F, Christenson GA, Miner M (1999) Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry 156:786–788Google Scholar
  32. 32.
    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ III, Spack NP, Tangpricha V, Montori VM (2009) Endocrine Society. Endocrine treatment of transsexuals persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94:3132–3154PubMedCrossRefGoogle Scholar
  33. 33.
    Rosler A, Witztum E (2000) Pharmacotherapy of paraphilias in the next millennium. Behav Sci Law Behav Sci 18:43–56CrossRefGoogle Scholar
  34. 34.
    Thibaut F, Cordier B, Kuhn JM (1993) Effect of a long-lasting gonadotrophin hormone-releasing hormone agonist in six cases of severe male paraphilia. Acta Psychiatr Scand 87:445–450PubMedCrossRefGoogle Scholar
  35. 35.
    Thibaut F, Cordier B, Kuhn JM (1996) Gonadotrophin hormone releasing hormone agonist in cases of severe paraphilia: a lifetime treatment? Psychoneuroendocrinology 21:411–419PubMedCrossRefGoogle Scholar
  36. 36.
    Thibaut F, Kuhn JM, Cordier B, Petit M (1998) Hormone treatment of sex offenses. Encéphale 24:132–137PubMedGoogle Scholar
  37. 37.
    Schober JM, Kuhn PJ, Kovacs PG, Earle JH, Byrne PM, Fries RA (2005) Leuprolide acetate suppresses pedophilic urges and arousability. Arch Sex Behav 34:691–705PubMedCrossRefGoogle Scholar
  38. 38.
    Krueger RB, Kaplan MS (2001) Depot-Leuprolide Acetate for treatment of paraphilias: a report of twelve cases. Arch Sex Behav 30:409–422PubMedCrossRefGoogle Scholar
  39. 39.
    Czerny JP, Briken P, Berner W (2002) Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics. Eur Psychiatry 17:104–106PubMedCrossRefGoogle Scholar
  40. 40.
    Brahams D (1988) Voluntary chemical castration of a mental patient. Lancet 1:1291–1292PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical SciencesUniversity of FlorenceFlorenceItaly

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