Organic Approaches to the Treatment of Paraphilics and Sex Offenders

Abstract

Emphasizing the power and fundamental nature—comparable to the basic mammalian drive for food—of sex drives and urges in almost everybody, including paraphilics and sex offenders, this article gives an overview of biologically-based, or “organic” approaches to the treatment of paraphilics and sex offenders. Organic treatment approaches for this population may be divided into surgical and pharmacotherapeutic categories. Surgical approaches include castration (orchiectomy), sterotactic (brain) surgery and estrogen implants, the latter two approaches are not used in the United States (U.S.). All surgical approaches act hormonally, in reducing or blocking the amount of circulating androgens in the subject. Pharmacotherapeutic approaches include: (1) Indirect-acting and direct-acting antiandrogen hormones, also intended to reduce or block the amount of circulating androgens in the subject. (2) Psychotropic medications for primary treatment of male aggressive hypersexuality, for treatment of co-occurring psychiatric symptomatology, or for both. (3) An experimental pharmacologic approach to the treatment of this population consists of the use of antiepileptic drugs, or “AED's” to stabilize the impulsivity/compulsivity of these subjects, in reducing the hypothesized “kindling” that may occur during impulsive/compulsive periods in these individuals. Whatever organic approach may be used for paraphilics and sex offenders, such an approach alone is not sufficient treatment for this population. Psychotherapeutic and cognitive/behavioral approaches must also be included in these individuals' treatment regimens. A companion piece to this article, giving an overview of psychotherapeutic and cognitive/behavioral treatment approaches to this population will be published in a future issue of this Journal.

Cognitive/Behavioral Approaches to the Treatment Adult Sex Offenders

“…In this article-a companion piece to "Organic Approaches to the Treatment of Paraphilics and Sex Offenders" published in a recent issue of this journal (Greenfield, 2006)-we will focus on the former-the "best of times"-by discussing current psychotherapeutic and cognitive/behavioral approaches to the treatment of sex offenders and by emphasizing that such treatment-often in conjunction with organic approaches, especially pharmacotherapy (Greenfield, 2006)-can be effective for sex offenders in a variety of ways.…”

Sexuality and psychotherapy.

“…Comorbidities (other paraphilias or other Axis I or II disorders) are also targeted for treatment as needed (e.g., Marvasti, 2004). Occasionally, especially when the paraphilia is experienced as significantly ego dystonic or has resulted in the client having engaged in an illegal act (e.g., child molestation), drugs are a component of treatment, particularly the anti-androgens, but also the phenothiazines, lithium, and antiepileptic and serotonergic medications (Abouesh & Clayton, 1999;Balon, 1998;Briken & Kafka, 2007;Corretti & Baldi, 2010;Greenfield, 2006). Although the jury is still out on the efficacy of contemporary psychological treatment approaches for men who have sexually offended against children (i.e., in reducing recidivism; Brooks-Gordon et al, 2006), particularly among those who are pedophilic, promising results have been reported for anti-androgen treatment (Briken & Kafka, 2007).…”

“…Of course, any of the drugs mentioned (the antiandrogens in particular) have risks and sometimes serious side effects that must be weighed against treatment effects. Even in the absence of empirical support for the position, most clinicians would likely agree that an organic treatment approach alone for any of the paraphilias would be less successful in the long term than combining pharmacology with psychotherapy (cognitive-behavioral techniques in particular; Greenfield, 2006).…”