Assessment Methods and Management of Hypersexuality and Paraphilic Disorders

Daniel Turner; Daniel Schöttle; John Bradford; Peer Briken


Curr Opin Psychiatry. 2014;27(6):413-422. 

In This Article

Management of Paraphilic Disorders

Concerning the psychotherapeutic treatment of paraphilic disorders, no studies were published; however, three studies could be identified evaluating pharmacological treatment approaches.[36,37,38] However, we want to recommend a just recently published review and a meta-analysis about medical and psychological interventions for CSAs.[58,59] Different pharmacological agents have been introduced for the treatment of paraphilic disorders. Although these agents [e.g. SSRIs, cyproterone acetate (CPA), and gonadotropin-releasing hormone (GnRH) agonists] show different pharmacodynamic profiles, they all aim at a reduction of the sexual drive, sexual preoccupation or sexual impulsivity.

In a study evaluating the pharmacological treatment methods applied in German forensic–psychiatric institutions in sexual offenders (n = 611), it was found that SSRIs were used most frequently (12%), followed by GnRH agonists (11%), antipsychotics (10%), and CPA (5%).[38] Furthermore, in 75% of patients treated with GnRH agonists, a reduction in the frequency of sexual thoughts was reported.[38]

In two consecutive studies, Koo et al.[36,37] evaluated the effectiveness of GnRH agonist treatment (leuprolide acetate 3.75 mg subcutaneous depot injections every 3 months) of paraphilic-disordered sexual offenders in a South-Korean forensic–psychiatric hospital. Most patients were diagnosed with a pedophilia (45%), followed by a paraphilia not otherwise specified (23%), whereas the remaining offenders were diagnosed with voyeurism, fetishism, or exhibitionism. After 3 months of GnRH agonist treatment, 76% of the 38 included patients reported a reduction of sexual thoughts, 71% reported a reduction in the intensity of sexual thoughts, and 74% a reduction in masturbation frequency measured with Wilson's Sexual Fantasy Questionnaire (SFQ).[36] Most prevalent adverse effects were hot flushes (45%), weight gain (29%), testis size reduction (24%), and depressive symptoms (21%).[36]

In the second study, Koo et al.[37] compared the patients being treated with GnRH agonists for 3 months (n = 38, group A) with those being treated for 6 months (n = 18, group B). They found that 1 year after GnRH agonist treatment was stopped, sexual fantasies measured with Wilson's SFQ returned to the baseline levels in group A, whereas sexual fantasies remained at a lower level in group B. Furthermore, serum testosterone concentrations in group A showed a strong upsurge above the baseline level within the first 2 months after the therapy was ended, followed by a slow decrease until baseline levels were reached after about 10 months. In contrast, in group B, a stable increase of testosterone concentrations could be observed until baseline levels were reached after about 12 months.[37]