Diagnostic criteria DSM-5 Generally, for each of the specific paraphilic disorders listed in DSM-5, the first diagnostic criterion specifies the qualitative nature of the paraphilia eg, an erotic focus on children or on exposing the genitals to strangerswhereas the second criterion specifies the negative consequences of the paraphilia see below. Both criteria must be satisfied to establish a diagnosis of a paraphilic disorder. An individual who meets the first criterion but not the second is considered to have a paraphilia but not a paraphilic disorder.
Especially in the treatment of sexually aggressive paraphilic individuals, multimodal treatment approaches, including individual, cognitive-behavioral, group, psychoeducational, and pharmacological treatments, are commonly prescribed and are tailored to the specific needs of the offender Maletzky This outcome literature, however, is based on skewed samples collected by surveys of self-selected Step attendees.
H is a year-old married man who had repetitively molested his stepdaughter. When referred for treatment, he was diagnosed with current major depression; dysthymic disorder, early-onset subtype; social phobia, generalized subtype; and alcohol abuse.
His social phobia and substance abuse were in remission. In addition to pedophilia, Mr. H had a history of compulsive masturbation and pornography dependence.
He had been molested by a neighbor during his own childhood and described his mother as intrusive, anxious, and overprotective. H greatly benefited from individual psychotherapy, which helped him to understand and then change his hostile-dependent relationship with his spouse.
Group Psychotherapies, Including Relapse Prevention Treatment Professionally facilitated cognitive-behavioral-oriented group therapies are the most common treatment modalities for confronting denial in sex offenders and exploring the developmental antecedents that may have contributed Theoretical perspectives on paraphilias treatment symptom formation.
Such groups may include modules or feature separate therapy groups for learning the principles and practice of relapse prevention, victim empathy, anger management, or social skills Laws Relapse prevention is an integrated cognitive-behavioral and group therapy treatment approach that originally evolved from a theoretical understanding of, and treatment for, addictive disorders such as alcohol abuse, nicotine dependence, and overeating Marlatt and Gordon The techniques developed were based on the clinical observation that although habitual behaviors i.
Following identification of recurrent affective and behavioral chains preceding paraphilic behavior, behavioral rehearsal of new, comprehensive problem-solving techniques and social and sexual skills training are implemented Laws Individual and group therapies can be enhanced by providing homework and specialized workbooks Bays and Freeman-Longo ; Bays et al.
Although long-term outcome studies i.
As mentioned previously in this chapter, the relapse prevention model of treatment has predominated in specialized sex offender treatment programs in North America Freeman-Longo et al. Men with PRDs have also been treated with professionally administered group psychotherapy.
Other clinicians have reported on the use of group therapy for PRDs Earle and Crow ; Turner but have not discussed outcome results. These programs can have a profound effect on the process of recovery, especially if the program is zealously adhered to. For example, Step recovery programs commonly require daily attendance at a Step meeting for the first 3 months of recovery from alcoholism Galanter et al.
Naditch and Barton and Carnes noted a positive long-term outcome associated with Step sexual addiction programs in conjunction with individual psychotherapy in a retrospective survey of men and women recovering from nonviolent PAs and PRDs.
In many respects, the program based on zealous adherence to the Step recovery model for PRDs bears some resemblance to a cognitive-behavior therapy-based relapse prevention program for the treatment of sex-offending paraphilic individuals Carnes ; Laws J was a year-old married man who was referred for treatment of persistent low self-esteem, anxiety, and continued paraphilia-related sexual behaviors.
He met DSM-IV diagnostic criteria for dysthymic disorder early-onset subtype and cocaine abuse in remissionand he had subclinical obsessive-compulsive disorder.
There was no developmental history of physical, sexual, or emotional abuse. Several months of intensive treatment with individual psychotherapy and near-daily attendance in Step sexual addiction groups resulted in substantial amelioration of Mr.
Behavior Therapies Behavior therapy techniques are used frequently in treatment centers specializing in the assessment and treatment of sexually aggressive paraphilic individuals, and these techniques can be applied to nonviolent PAs and PRDs as well Maletzky b.
Although these techniques have a different theoretical approach than relapse prevention, they are sometimes integrated with cognitive-behavioral therapy treatments Maletzky Aversive techniques, for example, can be applied to a wide range of human behaviors, including sexual behaviors, when accompanied by the voluntary consent and understanding of the patient.
The use of imagined but highly detailed aversive consequences interrupting the arousal inherent in specific imagined sexually arousing scenarios represents a palatable form of aversion therapy when the technique is applied repetitively Cautela Despite its common use in treatment programs, however, this technique has not produced robust treatment effects Maletzky Olfactory aversion is designed to reduce unconventional sexual arousal with aversive smells, utilizing foul odors such as ammonia Colson or rotting animal or human tissue Maletzky a.
The advantage of olfactory aversion derives from the immediacy of a powerful aversive odor paired repetitively with conditioned sexually arousing fantasies.
For example, ammonia aversion involves encapsulated ammonia ampoules that are portable and can be broken and inhaled in conjunction with both behavioral homework and in vivo practice, as well as in situations that trigger sexual impulses.
Theoretical support exists for the use of smells that produce nausea e.Discussion Question 1 Post your response to the following: Summarize the theoretical perspective on paraphilias assigned by your instructor. How would this theoretical perspective approach possible treatment of paraphilias?
· Respond to your classmates’ posts by stating whether you think a particular treatment would be effective.
Scientists are not sure what causes paraphilias, but there are many theories. For example, behavioral theory suggests that if a person becomes conditioned to believe a nonsexual object (like a shoe) is sexually stimulating, his or her body may react in a sexual way.
Many people with paraphilias have personality or anxiety disorders. Dec 03, · Family education is of particular importance in the treatment of paraphilic disorders.
The family should receive education about the disorder, medications, side effects, and medication compliance, the importance of psychotherapy, and what to do in case of an emergency.
The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the biological treatment of paraphilias FLORENCE THIBAUT1, FLORA DE LA BARRA 2, HARVEY GORDON 3,4, PAUL COSYNS 5, JOHN M.
W subject to evolving changes of social perspective.
Empathy training involves helping the offender take on the perspective of the victim and in identification with the victim, understand the harm that has been done.
Theoretical Perspectives. Given the limited empirical research on paraphilias and atypical sexual behavior among girls, there are no theories explaining its etiology and maintenance.
However, some theories that have been .