Abstract
A relationship has been suggested between clinical presentation of paraphilias and obsessive-compulsive disorder (OCD) with respect to the unwanted repetitive nature and insight into the irrationality of the paraphiliac behavior. This has led to speculation that paraphiliac disorders might belong to an “obsessive compulsive spectrum.” To address this issue, and because of the striking selective benefit of serotonin reuptake blocking antidepressants (such as clomipramine) in the treatment of OCD, 15 paraphiliacs entered a doubleblind crossover comparison of clomipramine vs. desipramine preceded by a 2-week single-blind placebo period. Four subjects responded to placebo and were dropped from the study. Three others failed to complete the study. Although the study is limited by the small number of patients and the heterogeneity of the paraphilias, the observed benefit from both tricyclics (over the initial placebo) encourages further study. For the 8 subjects completing the protocol, there was no preferential response to the more specific serotonin reuptake inhibitor suggesting a difference in underlying pathophysiology between paraphilia and OCD.
Similar content being viewed by others
References
Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., and Rouleau, J. (1988). Multiple paraphilic diagnoses among sex offenders.Bull. Am. Acad. Psychiat. Law 16: 153–168.
Cooper, J. (1970). The Leyton Obsessional Inventory.Psychol. Med. 1: 48–64.
Coryell, W., and Noyes, R. (1988). Placebo response in panic disorder.Am. J. Psychiat. 145: 1138–1140.
Endicott, J., and Spitzer, R. L. (1978). A diagnostic interview. The schedule for affective disorders and schizophrenia.Arch. Gen. Psychiat. 35: 837–844.
Fichten, C. S., Libman, E., Rothenberg, I., and Davis, M. B. (1988). Sexual Self-Efficacy Scale—Erectile Functioning. In Davis, C. M., Yarber, W. L., and Davis, S. L. (eds.),Sexuality-Related Measures C. M. Davis, W. L. Yarber, and S. L. Davis, Syracuse, NY.
Gordon, C. T., Rapoport, J. L., Hamburger, S. D., State, R. C., and Mannheim, G. B. (1992). Differential response of seven subjects with autistic disorder to clomipramine and desipramine.Am. J. Psychiat. 149: 3, 363–366.
Insel, T. (1990). New pharmacologic approaches to obsessive compulsive disorder.J. Clin. Psychiat. 51: 47–51.
Jenike, M. A. (1989). Obsessive-compulsive and related disorders: A hidden epidemic.New Engl. J. Med. 321: 539–41.
Kafka, M. P. (1991). Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men.J. Clinic. Psychiat. 52: 60–65.
Knoop, F. H. (1984).Retraining Adult Sex Offenders: Models and Methods Safer Society Press, Orwell, VT.
Langevin, R., Bain, J., Wortzman, G., Hucker, S., Dickey, R., and Wright, P. (1988). Sexual sadism: Brain, blood, and behavior.Ann. N. Y. Acad. Sci. 528: 163–171.
Leonard, H. L., Swedo, S. E., Rapoport, J. L., Koby, E., Lenane, M., Cheslow, D., and Hamburger, S. (1989). Treatment of obsessive compulsive disorder in children and adolescents: A double blind crossover comparison.Arch. Gen. Psychiat. 46: 1088–1092.
Leonard, H. L., and Rapoport, J. L. (1989). Pharmacotherapy of childhood obsessive compulsive disorder.Psychiat. Clin. N. Am. 12(4): 963–970.
Magnan, V. (1886–1887). Considerations generales sur la folie des hereditaries ou degeneres.Le Progres Medical 14: 1089–1090, 1108–1112; 15: 187–190, 209–213.
Mavissakalian, M. R., Jones, B., and Olson, S. (1990). Absence of placebo response in obsessive-compulsive disorder.J. Nerv. Ment. Dis. 178: 268–270.
Mavissakalian, M. R. (1987). The placebo effect in agoraphobia.J. Nerv. Ment. Dis. 175: 95–99.
Mavissakalian, M. R. (1988). The placebo effect in agoraphobia. II.J. Nerv. Ment. Dis. 176: 446–448.
Monteiro, W. O., Noshirvani, H. F., Marks, I. M., and Lelliott, P. T. (1987). Anorgasmia from clomipramine in obsessive-compulsive disorder: A controlled trial.Br. J. Psychiat. 151: 107–112.
Murphy, D. L., Pickar, D., and Alterman, I. S. (1982). Methods for the quantitative assessment of depressive and manic behavior. In Burdock, E. L., Sudilovsky, A., and Gershon, S. (eds.),The Behavior of Psychiatric Patients Marcel Dekker, New York, pp. 355–392.
Swedo, S. E., Leonard, H. L., Rapoport, J. L., Lenane, M. C., Goldberger, E. L., and Cheslow, D. L. (1989). A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling).New Engl. J. Med. 321: 497–501.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kruesi, M.J.P., Fine, S., Valladares, L. et al. Paraphilias: A double-blind crossover comparison of clomipramine versus desipramine. Arch Sex Behav 21, 587–593 (1992). https://doi.org/10.1007/BF01542257
Issue Date:
DOI: https://doi.org/10.1007/BF01542257