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Sahithya BR, Kashyap RS. Sexual Addiction Disorder— A Review With Recent Updates. JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221081080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sexual addiction, hypersexuality, sexual compulsivity, and sexual impulsivity are all terms that describe a psychological disorder that is characterized by a person’s inability to control his or her sexual behavior. This spectrum of symptoms are often referred to as sexual addiction disorder. Whether excessive sexual behavior should be regarded as an addiction, or a compulsion, or an impulse control disorder is arguable, as each label indicates a specific etiological model and treatment plan. Sexual addiction disorder has been largely ignored by the clinicians, although it causes significant emotional and behavioral problems among the patients. Fortunately, in the recent years, this disorder is gaining recognition, and attempts have been made to understand it through research. The present article aims to systematically review and summarize the recent understanding and research on phenomenology, clinical characteristics, etiology, assessment, and management of sexual addiction disorder.
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Affiliation(s)
- B. R. Sahithya
- Department of Clinical Psychology, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| | - Rithvik S. Kashyap
- Department of Clinical Psychology, JSS Medical College & Hospital, Mysuru, Karnataka, India
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Klapilová K, Demidova LY, Elliott H, Flinton CA, Weiss P, Fedoroff JP. Psychological treatment of problematic sexual interests: cross-country comparison. Int Rev Psychiatry 2019; 31:169-180. [PMID: 31090478 DOI: 10.1080/09540261.2019.1591353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs.
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Affiliation(s)
- Kateřina Klapilová
- a Laboratory of Evolutionary Sexology and Psychopathology , National Institute of Mental Health , Klecany , Czech Republic.,b Faculty of Humanities , Charles University , Prague , Czech Republic
| | - Liubov Y Demidova
- c Laboratory of Forensic Sexology, Department for Forensic Psychiatric Assessment in Criminal Proceedings , V. Serbsky National Medical Research Centre for Psychiatry and Narcology , Moscow , Russia
| | | | | | - Petr Weiss
- a Laboratory of Evolutionary Sexology and Psychopathology , National Institute of Mental Health , Klecany , Czech Republic.,f Institute of Sexology, 1st Faculty of Medicine , Charles University , Prague , Czech Republic
| | - J Paul Fedoroff
- g Sexual Behaviours Clinic , The Royal and University of Ottawa , Ottawa , Canada
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Vella-Zarb RA, Cohen JN, McCabe RE, Rowa K. Differentiating Sexual Thoughts in Obsessive-Compulsive Disorder From Paraphilias and Nonparaphilic Sexual Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lippi G, van Staden PJ. The use of cyproterone acetate in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning. S Afr J Psychiatr 2017; 23:982. [PMID: 30263177 PMCID: PMC6138062 DOI: 10.4102/sajpsychiatry.v23i0.982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/12/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cyproterone acetate (CPA) is a steroidal anti-androgenic medication used in the field of psychiatry for the treatment of paraphilic disorders, hypersexuality, and inappropriate sexual behaviour which may be present in patients with disorders such as mild and major neurocognitive disorders. In the forensic psychiatric population, it is prescribed for these indications especially for patients with a history of committing a sexual offence or who are at moderate to high risk of recidivism. OBJECTIVES To investigate the use of CPA in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning. METHODS Seventy-six forensic psychiatric patients from Weskoppies Hospital in Pretoria, South Africa, participated in the study which measured their sexual functioning. A specifically designed questionnaire was used to capture relevant background information. The use of CPA was studied. The Changes in Sexual Functioning Questionnaire, Male Clinical Version (CSFQ-M-C) was used to measure sexual functioning of participants. The CSFQ-M-C scores, and those of all its subscales, of participants on CPA were compared to those not on the drug. Relevant statistical analyses were performed. RESULTS Thirteen out of the 76 participants were being treated with CPA (17.11%). In total, 53.85% of the participants on CPA and 65.08% not on CPA had scores indicating the presence of sexual dysfunction. The total CSFQ-M-C scores for participants on CPA (mean = 40.54; median = 42) were not statistically significantly lower than those not on the drug (mean = 41.22; median = 41). More notable is that the use of CPA in this population was associated with lower levels of desire, frequency of and pleasure from sexual activity. There was an association between having intellectual disability and being treated with CPA. CONCLUSION That all the participants were being treated with psychotropic medication could account for the high percentage of sexual dysfunction in any or all areas of sexual functioning and contribute to the small difference in CSFQ-M-C scores between the two groups. Only a tentative conclusion can be made that CPA may be more effective in decreasing levels of desire, frequency and pleasure related to sexual activity than other areas of sexual functioning. The indication for the use of CPA in this population should be assessed clinically according to patient circumstances and risk assessment.
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Affiliation(s)
- Gian Lippi
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, South Africa
- Forensic Unit, Weskoppies Hospital, South Africa
| | - Paul J. van Staden
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa
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Coshway L, Broussard J, Acharya K, Fried K, Msall ME, Lantos JD, Nahata L. Medical Therapy for Inappropriate Sexual Behaviors in a Teen With Autism Spectrum Disorder. Pediatrics 2016; 137:peds.2015-4366. [PMID: 26936858 DOI: 10.1542/peds.2015-4366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/24/2022] Open
Abstract
Teens with autism spectrum disorder often exhibit sexual behaviors in public that are disturbing to parents, teachers, and peers. Some have proposed that such behaviors can be curtailed with hormonal suppression. There is information on the Internet suggesting that such medications work, and some reports in the peer-reviewed medical literature support these claims. Such medications can have serious side effects. In this paper, we present a case in which parents requested such treatment of their teenage son with autism spectrum disorder.
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Affiliation(s)
- Loyal Coshway
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
| | - Julia Broussard
- Children's Mercy Hospital-Kansas City, Kansas City, Missouri
| | - Kruti Acharya
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois
| | - Karen Fried
- Advocate Health Care System, Chicago, Illinois; and
| | | | - John D Lantos
- Children's Mercy Hospital-Kansas City, Kansas City, Missouri;
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
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Knott V, Impey D, Fisher D, Delpero E, Fedoroff P. Pedophilic brain potential responses to adult erotic stimuli. Brain Res 2015; 1632:127-40. [PMID: 26683083 DOI: 10.1016/j.brainres.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022]
Abstract
Cognitive mechanisms associated with the relative lack of sexual interest in adults by pedophiles are poorly understood and may benefit from investigations examining how the brain processes adult erotic stimuli. The current study used event-related brain potentials (ERP) to investigate the time course of the explicit processing of erotic, emotional, and neutral pictures in 22 pedophilic patients and 22 healthy controls. Consistent with previous studies, early latency anterior ERP components were highly selective for erotic pictures. Although the ERPs elicited by emotional stimuli were similar in patients and controls, an early frontal positive (P2) component starting as early as 185 ms was significantly attenuated and slow to onset in pedophilia, and correlated with a clinical measure of cognitive distortions. Failure of rapid attentional capture by erotic stimuli suggests a relative reduction in early processing in pedophilic patients which may be associated with relatively diminished sexual interest in adults.
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Affiliation(s)
- Verner Knott
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Danielle Impey
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Emily Delpero
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Paul Fedoroff
- Forensic Research Unit, University of Ottawa, Institute of Mental Health Research, Ottawa, ON, Canada
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Garcia FD, Delavenne HG, Assumpção ADFA, Thibaut F. Pharmacologic treatment of sex offenders with paraphilic disorder. Curr Psychiatry Rep 2013; 15:356. [PMID: 23572328 DOI: 10.1007/s11920-013-0356-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sexual offending is both a social and a public health issue. Evidence demonstrates that a combination of pharmacological and psychotherapeutic approaches may reduce or even eliminate deviant sexual behavior in sex offenders with paraphilic disorders. In this article, we will review pharmacological treatment options for sex offenders with paraphilias. Both serotonin selective reuptake inhibitors (SSRIs) and antiandrogen treatments have been used with reported success in decreasing recidivism. SSRIs have been used in mild types of paraphilias and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe sex offenders with paraphilic disorders in order to reduce victimization. Combined pharmacological and psychotherapeutic treatment is associated with better efficacy. Imaging studies may improve the knowledge of paraphilic disorders and the mechanisms of action of current treatments. In spite of existing evidence, there is a need for independent, large-scale and good quality studies assessing the long-term efficacy and tolerance of treatments.
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Affiliation(s)
- Frederico Duarte Garcia
- Department of Psychiatry, INCT - de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Abstract
Although shame and facets of neuroticism have independently been linked to hypersexuality, the present study extends these findings by exploring pathways among these variables, using structural equation modeling in a patient sample of hypersexual adult men (N = 95). Results suggested that the domain of neuroticism, as represented by the NEO Personality Inventory-Revised, was a significant direct predictor of hypersexuality, with specific variance from the facet of impulsivity adding additional predictive power. Shame's bivariate association with hypersexuality was also significant, but in a predictive path model the effect of shame on hypersexuality was indirectly mediated through neuroticism and was not an independently significant predictor. Implications for treatment suggest that clinicians working with this population should evaluate precipitating risk factors to consider whether shame is activating neurotic coping or if other stressors might be influencing emotional instability that can trigger hypersexuality. Independent of the general distress associated with neuroticism, the literature on impulsivity might provide other valuable insights and direction for working with hypersexual men.
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Aggrawal A. A new classification of zoophilia. J Forensic Leg Med 2011; 18:73-8. [DOI: 10.1016/j.jflm.2011.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 11/24/2010] [Accepted: 01/05/2011] [Indexed: 11/24/2022]
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