Pharmacological Treatments for Paraphilic Patients and Sexual Offenders

Peer Briken; Martin P. Kafka

Disclosures

Curr Opin Psychiatry. 2007;20(6):609-613. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: This review addresses testosterone-lowering and other psychotropic medications for the treatment of paraphilic patients or sexual offenders.
Recent findings: Randomized controlled studies are still lacking, and only a few new studies were reported during the past year. On the other hand, there is substantial scientific knowledge about the wide range of psychiatric comorbidity associated with paraphilias and in sexual offenders. Empirically based treatment of these patients, especially of impulsivity, anxiety and mood disorders, may also ameliorate sexual impulsivity.
Summary: Medication interventions, either substantially lowering serum testosterone or treating axis I comorbidities, show definite promise as a significant component of the management of sexual offenders. Pharmacotherapy should be combined with other therapeutic treatment modalities, most commonly cognitive-behaviour based psychotherapy and intensive community supervision.

Introduction

Sexual offences, especially those against children, invoke a public outcry for methods to control offenders, ranging from effective psychotherapeutic treatment modalities to stricter community supervision (including global position monitoring) and even to lifetime incarceration. A recent meta-analytic report[1] examining the effectiveness of sexual offender treatments including 'biological' interventions, such as surgical castration and testosterone-lowering hormonal treatments, reported that such treatments may significantly reduce sexual offender recidivism to an extent greater than that with psychosocial treatments. Despite these data, pharmacologically based treatment interventions are not well integrated into cognitive-behavioural treatment programmes.

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