Pharmacological treatment of sex offenders

Determining Sexual Offender Profiles From Life Trajectories

To study qualitatively the development of a heteroaggressive behavior, we applied retrospective analytical method based on categorization of life events. The aim of this study was to establish the life trajectories of sexual offenders through interviews with second sources: the inmate's relatives and psychologists. The life trajectories of incarcerated sexual offenders were retraced to build individual life charts. These life charts grouped individual life events into four main domains: health, life events, the relational sphere, and the judicial and prison sphere. In a sample of 40 inmate participants, four different profiles of sex offenders and therefore life trajectories were identified according to the abovementioned domains: (a) "Early life events and behavior disorders" (n = 14), (b) "Abandonment issues" (n = 4), (c) "Behavior and socioaffective disorders" (n = 9), and (d) "Behavioral hyperadaptation and coldness" (n = 13). Expert judges classified the life trajectories with satisfactory interjudge agreement (k = 0.70). This research has clinical implications for integrating different life events into developmental trajectories and focusing psychological support for the individual.

A narrative review of research on clinical responses to the problem of sexual offenses in the last decade

Research on the treatment and programs for people who have committed sexual offenses has greatly increased in the past decade. The aim of this review is to discuss research that has been published over that period (2010-2019) that is relevant for treatment providers. The articles included in this review were found through PsycINFO and PubMed (Medline) using the keywords "treatment or therapy" and "sex offen*". The inclusion criteria were publications that discuss treatment of persons who have committed sexual offenses (written in the English language only). Any articles that examined only special populations were excluded, such as those that examined persons who committed sexual offenses who were female, had intellectual disabilities, deafness, juveniles, etc., because these groups will likely have needs and responsivity factors that differ from the "average" natal-born male sex offender. Results showed that several meta-analyses indicate that treatment is effective in reducing sexual recidivism. The most frequently used treatment for sex offenders is cognitive behavioral therapy, which is often provided in conjunction with pharmacological treatment to reduce sexual impulsivity and/or sex drive. This review is limited to the specific key search terms. The findings of this review support the use of treatment and a community reintegration approach when treating persons who have committed sexual crimes to prevent sexual recidivism.

[Deviant sexual behaviors, paraphilias, perversions]

OBJECTIVE

To know the new concept of paraphilias, their clinical presentation and their link with a personality disorder as perversion, the French legislation concerning them and the different therapeutic options.

MATERIAL AND METHODS

Review of guidelines published on this subject in the Medline database and a reflexion from our own clinical experience, especially in the judicial expertise.

RESULTS

Deviant sexual behavior is, in current classifications, known as paraphilia. This clinical entity corresponds to any sexual behavior considered "abnormal" compared with sexual acts in the society where the person lives. It means precisely, firstly, suffering caused by this disorder or deterioration of social, professional, or family life. Paraphilia such as pedophilia have strict age limits. The victim must be aged below 16 years, with an age difference of at least 5 years with the author of the act. Sexual acts which are illegal are crimes or offences according to the degree, and are sanctioned by the law. In ordinary terms, they are known as perverts, committing perversions. This concept is different from that of paraphilia, a pervert can have, or not have, paraphiliac behavior. In order to diagnose a personality disorder such as perversion, all the criteria must be included: narcissism, use of a person as an object for pleasure, with, primarily, mechanisms of denial and a split personality which removes any feeling of guilt from the perpetrator.

CONCLUSION

Medical treatment of paraphilia alone is not satisfactory for the denial mechanism is such that only the sex drive is affected with a high risk of recurrence. Only psychotherapy can modify the pathological element of a perverted personality.

Pharmacologic treatment of sex offenders with paraphilic disorder

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.