The Development of In Vivo Measures to Assess the Impact of Sex-Drive Reducing Medications in an Offender with an Intellectual Disability

Abstract

The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

“…PPG (using audio stimuli or nocturnal PPG) was used as an outcome measurement in 2 cases. In all cases, except for two, paraphilic sexual behavior and fantasies disappeared within 3 weeks; in the remaining cases, erectile response to audio sexual stimuli was increased with MPA (Cooper et al, 1987) or treatment was not successful (one case of exhibitionism with intellectual disability, duration of follow up 31 months) (fluoxetine plus MPA) (Rea et al, 2017). Testosterone levels decreased to 10 to 20% of baseline levels.…”

“…• Case reports Thirteen case reports including 24 subjects were found (Berlin and Coyle 1981;Berlin and Meinecke, 1981;Cordoba and Chapel 1983;Bourget and Bradford 1987;Cooper et al, 1987Cooper et al, , 1990Ross et al, 1987;Cooper, 1988;Weiner et al, 1992;Stewart 2005;Light and Holroyd 2006;Krueger et al, 2006;Rea et al, 2017). All participants were males, aged from 17 to 85 years (in 13 cases, subjects were aged above 65 years, and exhibitionism or hypersexuality was associated with dementia).…”

Tratamento Medicamentoso Dos Transtornos Parafílicos

“…Um oligofrênico que faz carícias íntimas numa criança é muito diferente de indivíduos sem esse quadro que realizam o mesmo ato, tornando as abordagens psicoterápicas e medicamentosas muito importantes (KEELING et al, 2005;REA et al, 2017). Um esquizofrênico que também é agressor sexual precisa usar antipsicóticos, que diminuem a libido pelo efeito antidopaminérgico (GARCIA et al, 2011;STAHL, 2013).…”

Risk Factors for Sexual Offenses Committed by Men With or Without a Low IQ: An Exploratory Study

“…Children victimization from MIQSO may also be due to a lower sexual selectivity, both for age and gender, instead of genuine pedophilia ( 38 , 50 ). The functional age of the offender may also be causally involved (i.e., attractiveness toward children), as well as general hypersexuality ( 61 ) and sexual preoccupations ( 62 ). Rates of child sexual offenses or pedophilia may also be inflated in MIQSO due to referential bias (child sexual abuse being more likely to be reported; 19).…”