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A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm or risk of harm to others (American Psychiatric Association, 2013). Paraphilias are defined as ‘any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.’ Paraphilic disorders in individuals are a significant risk factor in sexual offending, with at least one paraphilic disorder being found in approximately 50% of sexual offenders.
The Diagnostic Criteria for Paraphilic disorders
According to the American Psychiatric Association, DSM-5 criteria, the diagnosis of the paraphilic disorder occurs when there are recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting persons that occur over at least 6 months (American Psychiatric Association, 2013).
Evidenced-based psychotherapy and psychopharmacologic treatment for the paraphilic disorders
According to the guidelines, clinicians should first use selective serotonin reuptake inhibitors (SSRIs), followed by steroidal antiandrogens (cyproterone acetate (CPA) or medroxyprogesterone acetate (MPA) and finally gonadotropin-releasing hormone agonists (GnRH agonists) to treat the paraphilic disorder. On the basis that both steroidal antiandrogens and GnRH agonists lead to a considerable decrease in serum testosterone levels, they are referred to as androgen deprivation therapy (ADT). Factors that clinicians usually consider when deciding whether or not ADT should be used include a history of previous treatment failures and sexual violations while either in detention or under community supervision (Turner, Petermann, Harrison, Krueger & Briken, 2019).
Psychotherapeutic and psychosocial interventions are an integral part of treatment for individuals with problematic sexual interests. Historically, many psychotherapeutic approaches were conceptualized as management of paraphilic interests, as opposed to treatment. Psychoanalytic approaches began parallel to behavioral therapies, which were replaced by cognitive-behavioral and modified psychodynamic-oriented treatments. (Klapilová, Demidova, Elliott, Flinton, Weiss & Fedoroff, 2019). The therapeutic methods of individual and group therapy have been used with individuals experiencing various personal concerns (sexual and non-sexual), with little empirical evidence comparing their efficacy. Group therapy allows individuals to overcome isolation, increase social and communication skills, and facilitate emotional connections. Groups offer the opportunity of positive role modeling and assist patients in overcoming feelings of shame (Klapilová et al.,2019).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®) (5th ed.). American Psychiatric Pub.
Klapilová, K., Demidova, L. Y., Elliott, H., Flinton, C. A., Weiss, P., & Fedoroff, J. P. (2019).
Psychological treatment of problematic sexual interests: a cross-country
comparison. International Review of Psychiatry (Abingdon, England), 31(2), 169–180.
Turner, D., Petermann, J., Harrison, K., Krueger, R., & Briken, P. (2019). Pharmacological
treatment of patients with paraphilic disorders and risk of sexual offending: An
international perspective. The World Journal of Biological Psychiatry, 20(8), 616–625.