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The Federal Constitutional Court has emphasized the necessity of psychotherapy for offenders. Little is known about the actual situation of this field of work. Thus, an online survey was initiated.The survey was conducted through an online portal. The heads of forensic psychiatric facilities have been asked to participate by completing a questionnaire.The elicitation provided data from 27 institutions. A large part of patients receive psychotherapeutic treatment. Psychotherapy is predominantly shaped by psychologists. The majority of institutions apply approaches derived from behavioral therapy. To a large extent, manualized and modular procedures are being used; most of them in group settings. One problem stems from personnel deficiencies, leading to psychotherapy not taking place on a regular basis or not being performed in accordance to the guidelines of treatment programs.The prior allegation - impositions of forensic measures being characterized by custodial detention - is no longer valid for a high number of forensic psychiatric services., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Different clinical guidelines suggest using testosterone-lowering medications (TLM) in sex offender treatment in addition to psychotherapy. Within Germany, there are two officially approved agents. So far, no current data exist about the routine use of TLM in a clinical context., Aim: The present observational study evaluates the frequency of the prescription of TLM and other medications in sex offender treatment in German forensic-psychiatric institutions. Experts are asked about the observed effects and side effects of TLM., Method: The heads of all 69 German forensic-psychiatric hospitals and outpatient clinics were asked to fill out a questionnaire assessing offender characteristics and treatment methods in use., Main Outcome Measures: Main outcome measures were the number of patients being treated with TLM and other pharmacological agents for reducing sexual drive. Further effects and side effects of the agents were evaluated., Results: Thirty-two participating institutions reported on 3,963 patients, 611 of them being sex offenders (15.4%). Most sex offenders had been convicted for child sexual abuse (39.8%) or a sexual assault/rape (37.6%). Almost all sex offenders were treated psychotherapeutically and 37% were receiving an additional pharmacological treatment. Of all the sex offenders, 15.7% were treated with TLM; 10.6% were treated with a gonadotropin-releasing hormone agonist; and 5.1% were treated with cyproterone acetate. Of these, 26.0-75.4% showed improvements in such outcomes as reduction of frequency and/or intensity of sexual thoughts. The remaining 21.3% of sex offenders who received a pharmacological agent were treated with selective serotonin reuptake inhibitors (11.5%) or antipsychotic medications (9.8%)., Conclusions: TLM are a frequently used addition to psychotherapy in sex offenders. In light of the lack of controlled clinical trials and the many side effects, benefits and risks should always be thoroughly assessed., (© 2012 International Society for Sexual Medicine.)

The authors differentiates deviant (paraphilic) and non-deviant forms of a sexual addictive symptomatology. For the non-deviant forms, the diagnostic term paraphilia-related disorder is used. According to etiological factors, the authors discuss an interaction of a biological vulnerability, attachment and relationship problems, disorders of affect regulation as well as disinhibition of sexual excitation. Some individuals react to negative emotions, like depression or anxiety, with an increased sexual arousal. They may try to cope with negative emotions by being sexually active. However, the importance of the sexual stimulus itself should not be ignored. The authors describe specific psychotherapy, the attendance of self-help groups, and pharmacological treatment, especially with selective serotonin reuptake inhibitors.