The management of self-inflicted lesions requires an understanding of the dynamics of the act of self-mutilation. The overview of practical techniques allows the non-psychiatrist physician to deal with self-inflicted disorders more effectively. The efficacy of behavioral and psychotherapeutic techniques is enhanced when combined with psychopharmaca.
The high frequency of recidivism with convicted sexual perverts is mainly due to the compulsive character of perversion. The classical methods of treatment are seldom satisfactory: Surgery provokes ethical objections, psychopharmaca and oestrogens lead to disagreeable side effects, psychotherapy of any kind is unlikely to be efficacious because of the unfavourable atmosphere the nature of perversion causes it to take place in. However, the climate of both psychoanalytical treatment and suggestive and directive psychotherapy can be enhanced by a combination with an anti-androgen treatment, which eliminates the patient's fear of conviction by inhibiting his sexual urge. Two cases illustrate this combined method. On the basis of a positive disposition, which arises from the improved climate, sublimation of the sex drive and the achievement of a feeling of social responsibility is aimed at. The advantages of the combined therapy are then discussed in comparison with the existing treatments. It is concluded that this combined treatment, next to social guidance and an attempt at solving the fundamental problem of loneliness, can promote the social reintegration of the convicted sexual pervert.
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