Cyproterone acetate is a powerful antiandrogen used in the treatment of the paraphilias for at least a decade. Studies have reported it effective in reducing the recidivism rates of sexual crimes perpetrated by men. It acts through competitive inhibition of the androgen receptors blocking the effects of testosterone and dihydrotestosterone. Systematic clinical study of its effectiveness and its clinical effects on sexual behavior is lacking, however. In the current study 19 paraphilic men who had also recidivated in a variety of sexual crimes were treated with cyproterone acetate and placebo in a double-blind crossover design. The use of active drug was associated with a significant reduction of some aspects of sexual behavior, particularly sexual fantasies. There were also significant effects on levels of circulating sex hormones and some effects on physiological measurements and self-reports of sexual arousal.
The DSM-II and DSM-III both allow for multiple diagnoses. The DSM-III acknowledges that a patient may have multiple paraphilias but the true nature and extent of the multiplicity has only been documented recently. In order to study the degree of crossover between the various paraphiliac acts, a study of men who admitted to at least one paraphilia was conducted. A proportional index of multiple deviation was obtained. In addition, the mean number of admitted sexually deviant incidents per paraphilic category was computed as an estimate of the extent of deviant acts committed by this population. The results indicated that paraphiliacs tend to have multiple types of sexual aberrations as well as a high frequency of deviant acts per individual.
The antiandrogen treatment of sexual offenders has been shown to reduce the recidivism rate. The mechanism of action has been assumed to be through asexualization with its secondary effects on sexual behavior. This study shows that the mechanism may be more complex and may involve a differential effect on sexual arousal patterns. Treatment responses may differ in high and low plasma testosterone groups.
Three experiments assessed the hypothesis that suggested amnesia for a previously learned word list is a function of subjects' interpretations of the ambigous aspects of the amnesia testing situation. By manipulating preliminary instructions concerning interpretations of this situation, subjects who were unselected with respect to hypnotic susceptibility were induced to show either substantial increments or decrements in amnesia. However, subjects high on hypnotic susceptibility ignored preliminary instructions and therefore could not be induced to show decrements in amnesia. Previous findings of more amnesia in hypnotic than in task-motivated subjects were both replicated and reversed by varying subjects' interpretations of the amnesia task. Analyses on the combined data from the three experiments confirmed earlier findings that partial amnesics tend to recall list items in a relatively disorganized fashion. All of these findings are consistent with an inattention hypothesis of suggested amnesia. Theoretical implications for hypnosis research are discussed.
Sexual offenders who had been referred for a forensic evaluation were assessed in terms of their deviant sexual arousal by means of standard penile plethysmographic procedures. The sample was divided into Rapist and Nonrapist groups according to their sexual history and criminal charges. Penile circumference responses (PCR) and self-reported arousal to consenting sex, sexual assault, and physical assault were monitored. The assessments were repeated following subject instructions to suppress their arousal and following the ingestion of alcohol. The overall correlation between PCR and self-reported arousal was .65. An Alcohol-by-Offender Type interaction revealed that the lowering effect of alcohol on PCR occurred only among the Nonrapists. The suppression instruction increased Rapists' PCRs to Rape and Physical Assault presentations relative to consenting sexual narrations. When the data were examined in relation to intelligence, low IQ Rapists displayed greater responses to rape than high IQ Rapists. Under the influence of alcohol, low IQ Rapists displayed greater arousal regardless of the stimulus, while high IQ Rapists showed no change, and Nonrapists responded less than they did without alcohol. Comments concerning the accurate assessment of deviant sexual arousal and the identification of precursors to deviant sexual behaviour are made in view of the current findings.
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