Treatment outcome with sex offenders

Objectives. The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. Methods. The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990–2009 for SSRIs) (1969–2009 for antiandrogen treatments), supplemented by other sources, including published reviews. Results. Each trea...

/pdf/the-world-federation-of-societies-of-biological-psychiatry-48pzecae5s.pdf

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias.

Sexual deviation disorders, or paraphilias, are diagnosable psychiatric syndromes manifested by 1) recurrent fantasies about deviant sex, 2) intense associated cravings, and 3) stereotypic behavioral responses. Pedophiles seek out children in response to their erotic thoughts and urges, whereas exhibitionists expose themselves. Paraphiliac syndromes ordinarily follow a chronic course and may be associated with biological pathology, but etiological factors are poorly understood. Treatment becomes a consideration when the well-being or rights of others are compromised. Proposed treatments have included psychotherapy, behavior therapy, surgery, and medication. Medroxyprogesterone acetate, which reduces testosterone, may diminish sexual preoccupation and urges, making self-control easier.

Treatment of Sex Offenders with Antiandrogenic Medication: Conceptualization, Review of Treatment Modalities, and Preliminary Findings

There has been in creas ing in ter est in the treat ment of sex ual dis or ders in re cent years. Sex ual dis or ders are clas si fied in DSM-IV as sex ual dysfunctions, paraphilias, and gen der id...

https://journals.sagepub.com/doi/pdf/10.1177/070674370104600104

The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour.

The effects of cyproterone acetate and ethinyl oestradiol on sexual behaviour of sexual offenders was assessed using a combination of behavioural, attitudinal and physiological measures. There was no significant difference between the drugs on any measure. They were equally effective in reducing frequency of sexual thoughts and sexual activity, whereas only cyproterone acetate produced a weak effect in reducing erectile and subjective responses to erotic stimuli. The possibility of a placebo effect cannot be excluded. On the dosages used, neither drug produced troublesome side effects. Further work is needed to assess the effects of longer administration and varying dose levels.

The control of deviant sexual behaviour by drugs. I. Behavioural changes following oestrogens and anti-androgens.

1. A psychopathic male with uncontrollable and deviant sexual behaviour (homosexuality, attempted incest, fetishism, transvestism) was treated with the antiandrogen using cyproterone acetate 100 mg per day—for three weeks. After four days plasma testosterone levels (basal 9 a.m. and 6 p.m. and during masturbation—pre, immediate post, and 30 mins. post) had dropped by approximately 50 per cent; clinically both erectile and ejaculatory capacity and `libido' (sexual feelings, tension, fantasies, etc.) were reduced, the former to a much greater extent than the latter. Both clinical and endocrine effects were completely reversible eight weeks after discontinuing the drug.

2. Two other cases (a homosexual and a \` hypersexual') studied clinically showed complete suppression of sexual responsiveness (\`physiological' and `libido') on doses ranging from 50 mg/day–150 mg/day; the effects were reversible on stopping the drug.

3. In addition to the action on sexual feelings and functioning, all patients noted a general tranquillizing effect.

Antiandrogen (cyproterone acetate) therapy in deviant hypersexuality

SUMMARY i.A psychopathicmale with uncontrollableand deviant sexual behaviour (homosexuality,attempted incest, fetishism, transvestism) wastreatedwiththeantiandrogenusingcyproterone acetate 000 mg per dayâ€”for three weeks. After four days plasma testosteronelevels(basal 9 a.m. and 6 p.m. and during masturbationâ€”pre, immediate post, and 30 mins. post)had dropped by approximately 50 per cent;clinically both erectile and ejaculatory capacityand â€˜?libido'(sexualfeelings,tension,fantasies,etc.) were reduced, the former to a much greaterextent than the latter. Both clinical and endocrine effects were completely reversible eightweeks after discontinuing the drug. 2. Two other cases (a homosexual and a â€˜?hypersexual')studied clinically showed complete suppression of sexual responsiveness(â€˜physiological' and â€˜?libido')on doses ranging from 50 mg/dayâ€”i 50 mg/day; the effects were reversible on stopping the drug.3. In addition to the action on sexual feelingsand functioning,allpatientsnoted a generaltranquillizing effect.

D. L. Love

Papers

Antiandrogen (cyproterone acetate) therapy in deviant hypersexuality

Hypersexuality(Cyproterone Acetate) Therapy in Deviant