Current Concepts in the Pharmacotherapy of Paraphilias

Abstract

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.

Rethinking responsibility in offenders with acquired paedophilia: Punishment or treatment?

“…Inappropriate treatment may put both the offender (e.g., in case of specific medical conditions) and society at risk (e.g., in case of severe co-morbid psychopathy). Paraphilias are chronic disorders and a minimal duration of 3-5 years of treatment is recommended for severe paraphilia with a high risk of violence (del Busto & Harlow, 2011;Garcia & Thibaut, 2011;Hall & Hall, 2007;Thibaut et al, 2010).…”

“…Moreover, Garcia and Thibaut (2011) report that between 33-52% of paraphiliac individuals suffer from personality disorders such as borderline or antisocial personality disorders. Raymond, Coleman, Ohlerking, Christenson, and Miner (1999) found that 22.5% of sex offenders with paedophilia suffer from antisocial personality disorders.…”

A Case of Mental Retardation with Paraphilia Treated with Depot Leuprorelin

“…In the late 19th century, Freud suggested that the cause of sexual perversion involves biological and developmental factors, as well as psychoanalytic factors (1). In recent years, researchers defined paraphilia as the addictive, impulsive, and compulsive expression of excessive sexual desire (2).…”

Impacto da psicoterapia sobre a escolha dos parceiros sexuais de parafílicos em tratamento medicamentoso

“…Pacientes informados e motivados são aqueles que melhor respondem ao tratamento (Assumpção et al, 2014). (Rösler;Witztum, 1998;Kafka, 2007;Thibaut, 2011;Assumpção et al, 2014). …”

“…O tratamento dos casos de parafilias moderadas a graves respondem melhor ao uso de terapias de deprivação androgênica, associadas à psicoterapia de base cognitivocomportamental (Rösler;Witztum, 1998;Briken et al 2003;Kafka, 2007;Thibaut, 2011). Neste caso, o uso de medicações antiandrogênicas -proscrito no Brasil para os casos de parafilias -impediria a realização de estudos com desenhos que incluíssem estas medicações.…”