Search

Maladaptive personality traits, such as 'dark personalities' are found to result in a diverse set of negative outcomes, including paraphilic interests and associated (illegal) behaviors. It is however unclear how these are exactly related, and if related, if then only those individuals higher on dark personality traits and higher impulsivity engage in paraphilic behaviors. In the current study, 50 participants were recruited to investigate the relationship between Dark Tetrad personality traits (i.e., narcissism, psychopathy, Machiavellianism and everyday sadism), paraphilic interests (arousal and behavior) and the moderating role of impulsivity. Personality and paraphilic interests were investigated through self-report questionnaires. Impulsivity was measured both through self-reported dysfunctional impulsivity and the P3 event related potential using electroencephalography during the Go/No-Go task (i.e. response inhibition). The results showed that there was a positive association between psychopathy, sadism and paraphilic interests. Whereas everyday sadism was associated with paraphilic (self-reported) arousal, psychopathy was associated with paraphilic behavior. Although P3 amplitude was not associated with paraphilic interests, self-reported dysfunctional impulsivity was associated with paraphilic behavior specifically. However, there was no moderating role of dysfunctional impulsivity and response inhibition (P3) in the relationship between psychopathy and paraphilic behavior. Findings indicate that the relation between specific dark personalities and paraphilic interests may be more complex than initially thought. Nevertheless, risk assessment and intervention approaches for paraphilia and related behavior both may benefit from incorporating Dark Tetrad and impulsivity measurements., (© 2024. The Author(s).)

Background: Accumulating evidence suggests that deficits in decision-making and judgment may be involved in several psychiatric disorders, including addiction. Behavioral addiction is a conceptually new psychiatric condition, raising a debate of what criteria define behavioral addiction, and several impulse control disorders are equivalently considered as types of behavioral addiction. In this preliminary study with a relatively small sample size, we investigated how decision-making and judgment were compromised in behavioral addiction to further characterize this psychiatric condition., Method: Healthy control subjects (n = 31) and patients with kleptomania and paraphilia as behavioral addictions (n = 16) were recruited. A battery of questionnaires for assessments of cognitive biases and economic decision-making were conducted, as was a psychological test for the assessment of the jumping-to-conclusions bias, using functional near-infrared spectroscopy recordings of prefrontal cortical (PFC) activity., Results: Although behavioral addicts exhibited stronger cognitive biases than controls in the questionnaire, the difference was primarily due to lower intelligence in the patients. Behavioral addicts also exhibited higher risk taking and worse performance in economic decision-making, indicating compromised probability judgment, along with diminished PFC activity in the right hemisphere., Conclusion: Our study suggests that behavioral addiction may involve impairments of probability judgment associated with attenuated PFC activity, which consequently leads to higher risk taking in decision-making., (© The Author(s) 2020. Published by Oxford University Press on behalf of CINP.)

Background and Aims: Compulsive Sexual Behavior Disorder (CSBD) is characterized by a persistent failure to control intense and recurrent sexual impulses, urges, and/or thoughts, resulting in repetitive sexual behavior that causes a marked impairment in important areas of functioning. Despite its recent inclusion in the forthcoming ICD-11, concerns regarding its assessment, diagnosis, prevalence or clinical characteristics remain. The purpose of this study was to identify participants displaying CSBD through a novel data-driven approach in two independent samples and outline their sociodemographic, sexual, and clinical profile., Methods: Sample 1 included 1,581 university students (females = 56.9%; Mage = 20.58) whereas sample 2 comprised 1,318 community members (females = 43.6%; Mage = 32.37). First, we developed a new composite index to assess the whole range of CSBD symptoms based on three previously validated scales. Based on this new composite index, we subsequently identified individuals with CSBD through a cluster analytic approach., Results: The estimated occurrence of CSBD was 10.12% in sample 1 and 7.81% in sample 2. Participants with CSBD were mostly heterosexual males, younger than respondents without CSBD, reported higher levels of sexual sensation seeking and erotophilia, an increased offline and especially online sexual activity, more depressive and anxious symptoms, and poorer self-esteem., Conclusions: This research provides further evidence on the occurrence of CSBD based on an alternative data-driven approach, as well as a detailed and nuanced description of the sociodemographic, sexual, and clinical profile of adults with this condition. Clinical implications derived from these findings are discussed in detail.

There is no accepted definition of the term paraphilia despite its being listed as an essential feature of a class of mental disorders known as the paraphilic disorders. The origin of the term, history of its inclusion as a diagnosis, and logical flaws inherent in the various definitions are discussed in this review. We examine the basis for pathologizing individuals with paraphilias, consider what paraphilias can tell us about how humans develop their sexual interests, and question the usefulness of dividing sexual interests into paraphilias and normophilias. The construct of the paraphilias appears to be poorly conceived and has outlived its usefulness.

This study examined qualitative data on 1,795 male, 139 female, and 78 transgender members of the adult baby/diaper lover (ABDL) online community. Using grounded theory, the analyses examined a description of ABDL practices, explored evidence of subgroups within the ABDL community, and examined the degree to which ABDL behavior involves sexual motivations. Overall, the data suggest there is a fair amount of diversity within the ABDL community. Most participants enjoy wearing diapers or engaging in age regression (as babies or children), and the importance of incontinence may vary. ABDL practices can reflect bondage play for some individuals and a way to cope with medical problems for others. Overall, there is modest evidence of more than two ABDL subgroups. Although a large number of individuals do not see their ABDL practices as sexual in nature, there is a clear contingent that describes sexual motivations. For some, sex during ABDL activity violates conceptions of baby play. Nonsexual motivations include a desire to relax or be carefree as well as a desire to be nurtured. Some diaper lovers and adult babies have the same goals but achieve them in different ways. ABDL practices may be as diverse as seemingly typical sexual behaviors.

Aim: To investigate serotonin and catecholamine levels in people with paraphilic disorders and identify correlations between transmitter dysfunction and clinical signs of paraphilic disorders., Material and Methods: Fifteen men with paraphilic disorders were studied using clinical-psychopathological, sexological, biochemical and statistical methods., Results: There were an increase in the levels of serotonin and norepinephrine and a decrease in the concentration of DOPAC (3,4-dihydroxyphenylacetic acid) in the urine of patients with paraphilic disorders. The concentrations of serotonin and norepinephrine are correlated with obsessive disturbances. The level of DOPAC was associated with affective and dissociative disorders., Conclusion: The relationships between biochemical and psychopathological signs suggest a role of biological mechanisms in the organization of abnormal sexual behavior. Correlations between psychopathological phenomena and DOPAC indicate a key role of central dopamine in the pathogenesis of paraphilic disorders and disturbances of conscious regulation of behavior.

Purpose of Review: This paper reviews recent research into four different approaches to the assessment of offense-related sexual deviance., Recent Findings: Two of these approaches, structured rating scales and phallometry, have a sufficient basis in research for clinical use but have undergone significant refinements in recent years. One approach, the use of cognitive tasks to indirectly assess sexual deviance, is approaching the point where it has a sound research basis for clinical use though too many promising tasks have yet to make the transition from laboratory to clinical practice. This approach has however begun to map the earlier stages of sexual response including preconscious processes. The final approach, assessment through neuroimaging, is at the earliest stage of development with research findings having yet to reach sufficient stability for clinical application. Existing assessment technologies, despite their limitations, allow professionals to assess offense-related sexual deviance. New approaches, currently being developed, potentially allow a better understanding of underlying processes and, when sufficiently mature, will be more therapeutically useful.

Objective: Zoophilia is a rare paraphilic disorder with intense sexual urges involving animals. Autism is characterised by impairments in social communication and repetitive, restricted behaviours (RRB). Reported cases of zoophilia are limited worldwide, and zoophilia in autism is rarer., Method: This is a case report describing this unique and relatively unrecognised association in a male adolescent from Sri Lanka., Results: A 17-year-old boy diagnosed with autism has average intelligence and academic capabilities. He had spent increasing time at his grandparents' cattle house. First, he was found masturbating near the cows and later having penetrative intercourse with a heifer. The shocked parents first sought traditional healing in the form of 'thovil', a demonic ritual of exorcist nature. Later, clinical evaluation found intense sexual urges towards cattle, which had led to marked distress and academic impairment. Sex hormone profile was normal. The adolescent was treated with a combination of cognitive-behaviour therapy and a selective serotonin reuptake inhibitor., Conclusion: We postulate that his persistent social difficulties contributed to the development of a paraphilic disorder. Unlike with his RRBs, he was markedly distressed about this sexual behaviour. Further research is required to explore this rarely reported, potential association.

To date there are few treatment options to reduce high sexual drive or sexual urges in paraphilic patients with a risk for sexual offending. Pharmacological therapy aims to reduce sexual drive by lowering testosterone at the cost of severe side effects. We hypothesize that high sexual drive could also be reduced with deep brain stimulation (DBS) of circuits that generate sexual drive. This approach would help to avoid systemic side effects of antiandrogenic drug therapies. So far the best investigated target to reduce sexual drive is the ventromedial hypothalamus, which was lesioned unilaterally and bilaterally by stereotaxic interventions in paraphilic patients in the 1970s. Here, we discuss DBS as a treatment strategy in patients with severe paraphilic disorders with a serious risk of sexual offending. There are profound ethical and practical issues associated with DBS treatment of paraphilic patients that must be solved before considering such a treatment approach.

Antisaccade task performance and mean amplitudes of slow cortical potentials (contingent negative variation--CNV) were investigated in 19 healthy volunteers, 16 schizophrenic patients (SP), and 12 patients with stereotyped form of paraphilia (PP). Compared with healthy subjects, schizophrenic and paraphilic patients committed significantly more erroneous saccades. The clear between-group CNV differences were observed during the early CNV stage that is associated with cognitive aspects of preparatory set. In SP, as compared to controls, the significant decline of CNV amplitude was found at frontal-central area. PP have demonstrated the lack of CNV over central and parietal regions, but their CNV amplitudes in frontal area did not differ from values of control group. Thus, two distinct types of CNV abnormalities have been found. The SP results have been interpreted as support for frontal dysfunction in schizophrenia. The disconnection between prefrontal cortex, sensorimotor cortex, and related subcortical structures is hypothesized in paraphilia group., (© 2013 American Academy of Forensic Sciences.)

Introduction: Antiandrogen therapy has been used for 30 years to treat paraphilic patients and sexual offenders. Yet the therapeutic success of antiandrogens is uncertain. Furthermore, there is still a lack of comprehensive knowledge about the effects of androgen-lowering therapy in paraphilic patients., Aim: We discuss endocrinological, neurobiological, and therapeutic aspects of paraphilia with the aim of integrating these on the basis of the current neurobiological and clinical knowledge on testosterone that was set out in Part I of this review., Methods: Our review of the human literature comprises the current knowledge about the neurobiology of paraphilia and the known endocrinological, pathophysiological, and genetic aspects of this disorder. The role of testosterone is discussed. A survey of antiandrogen therapy and its outcome in paraphilic patients and sex offenders is provided., Results: Although not all data are consistent, current imaging research suggests that structural and functional changes in pedophilia appear for the most part in brain regions also involved in sexual functions. Not exclusively testosterone but also some other endocrinological and neurochemical parameters could be disturbed in pedophilic patients and child molesters; these include changes in hypothalamic-pituitary function, prolactin levels, and dopaminergic or serotonergic functions. There appears to be a sex-steroid-related genetic influence on antisocial traits, externalizing behavior, and sexual behavior. Most of the studies in which antiandrogen therapy in paraphilic patients and sex offenders have been examined were case reports, or observational or open-label studies, and many did not include adequate control groups. Only a few placebo-controlled double-blind studies have been published with inconsistent results concerning treatment effects. Outcome measures differ between the studies and do not seem ideally suited to their purpose., Conclusions: On the basis of the current knowledge about testosterone and its effects on brain and behavior as described in Part I, and of available results on the relationship between testosterone and paraphilia as well as antiandrogen therapy, we present from a neurobiological perspective an extended scientific proposal for design features to investigate the effects of antiandrogen treatment in large clinical trials., (© 2011 International Society for Sexual Medicine.)

There is a proposal to establish a paraphilic coercive disorder as a new paraphilia in the DSM-V. The empirical data do not, however, support the hypothesis that a distinct syndrome exists that comprises males who are sexually aroused by the coercive elements of rape per se. Purported evidence for this syndrome has centered on the results of phallometric studies. Higher plethysmographic responses of rapists to coercive rape scenarios may, however, be better explained by the failure of coercive elements to inhibit arousal to sexual aspects of the stimuli rather than by arousal specifically to the coercive elements. In addition, sexual fantasies about forcing sex and about struggling victims are highly correlated with sadistic fantasies and have not been shown to identify a syndrome that can be discriminated from sadism. Finally, taxometric evidence strongly supports the hypothesis that the underlying components of rape are distributed as dimensions and do not constitute a separate taxon. Consequently, the criteria purported to categorize rapists into the proposed syndrome would have to be arbitrarily determined. Not only does there seem to be little empirical justification for the creation of this new syndrome, the inclusion of this disorder among the paraphilias would have serious potential for misuse. It would imply endorsement of Paraphilia, NOS, nonconsent, which is currently inappropriately employed in civil commitment proceedings to justify commitment.

Introduction: As Parkinson's disease progresses, its non-motor manifestations become increasingly more apparent to the point where, in advances phases of the disease, they are the most important clinical symptoms. A very wide range of non-motor symptoms can appear in Parkinson's disease. Impairment of the urinary function and the sexual function (understood as the capacity to carry out sexual activity) can be seen as belonging to the dysautonomic disorders. Hypersexuality would be included within the group of impulse control disorders., Development: This study reviews the epidemiology, phenomenology and treatment of urinary disorders, sexual dysfunction and hypersexuality as non-motor symptoms of Parkinson's disease., Conclusions: Urinary disorders are the most frequent non-motor symptom in Parkinson's disease. They usually present as nocturia, urgency and increased mictional frequency (pollakiuria). Preferred treatment is with anticholinergic agents. Sexual dysfunction is a frequent complaint in patients with Parkinson. It has a multifactorial aetiology and is more frequent in males than in females. In males it manifests mainly as incapacity to achieve an erection, premature ejaculation or loss of the capacity to ejaculate, whereas in females the predominant signs are decreased libido, lowered arousal and difficulty in reaching an orgasm. Hypersexuality affects young males above all and has been related to the use of dopamine agonists.

Previous studies have identified sexual deviance as a particularly strong predictor of sexual recidivism in sex offenders. The present study examined the construct validity (i.e., convergent and discriminant validity) of the three dynamic factor domains (Sexual Deviance, Criminality, Treatment Responsivity) of the Violence Risk Scale- Sexual Offender version (VRS-SO) as well as the Screening Scale for Pedophilic Interests (SSPI; for comparison purposes) with respect to phallometric measures of sexual deviance. VRS-SO and phallometric data were collected from 124 federally incarcerated sex offenders from a maximum security forensic psychiatric facility. The Sexual Deviance factor and SSPI were positively correlated to varying degrees with computed arousal indexes (Percent Full Erection, difference scores) for child stimuli but were not significantly correlated with nondeviant arousal, supporting the convergent and discriminant validity of these measures, respectively. Convergent validity also appeared stronger for sex offender subtypes with child victims. Criminality and Treatment Responsivity did not correlate with male stimuli, although they were positively correlated with arousal to female profiles. The VRS-SO Sexual Deviance factor and some phallometric indexes of deviant arousal (e.g., female children) were predictive of sexual recidivism whereas the SSPI was not. The pattern of findings across analyses broadly supports the construct validity of the VRS-SO in assessing sexual deviance.

Apotemnophilia straddles the boundary between neurology and psychiatry. It is a condition in which individuals experience the strong and specific desire for amputation of a healthy limb. Research suggests this disorder may be of neurological origin, specifically that the body image centers of the brain lack a cortical representation for a particular limb. A curious aspect of this condition is that sufferers often report an attraction to amputees in addition to desiring their own limb be removed. We postulate that sexual 'aesthetic preference' for certain body morphology is dictated in all individuals in part by the cortical representation of one's body image.

Although sex offender risk assessment has progressed greatly over the past decade and a half since most states implemented the sexually violent predator/sexually dangerous person (SVP/SDP) laws, there continues to be limited applicability of such models to intellectually disabled sex offenders because there has been no empirical validation. However, SVP/SDP civil commitment programs have reported increased admission of developmentally disabled sex offenders. Differentiating sexual deviance, the primary factor predisposing most individuals to criminal sexual violence, from impulsive, immature, and inappropriate behavior stemming from cognitive deficits presents yet another challenge to the clinician tasked with performing such evaluations. This article reviews actuarial risk models and their limited applicability to mentally retarded sex offenders and offers a conceptual method of assessing the risk of recidivism in intellectually disabled sex offenders under SVP/SDP evaluation.

A unique challenge posed by advancing scientific knowledge about the biology of human behavior is how to integrate that understanding with the desire to hold ourselves--and one another--morally accountable. As human beings, we are something more than just passive agents whose behavior is the sum product of biologic determinism. Because of the existence of the mind, we are also active agents with the capacity to influence, at least to some extent, our own destinies. Behavior may be determined, but it is not predetermined. We are one of its determinants. Misconduct by a person of sound mind should not be attributed improperly to brain pathology. On the other hand, suffering, legitimate mental disorder, and associated impairments should not be trivialized. Historically, persons who once were labeled "lazy" are often more appropriately understood by modern standards as clinically depressed. Frequently they are more in need of pharmacologic treatments that alter brain chemistry than "a kick in the behind." Gluttony, one of the original cardinal sins, is often more properly understood as morbid obesity, a condition that deserves appropriate medical care. Persons who have alcoholism, once judged morally as "bums in the gutter," are more frequently referred to treatment facilities, such as The Betty Ford Clinic. One should not approach the issue of human sexual behavior without at least some appreciation of moral values and scientific research. Although clearly some persons choose to act in a sexually selfish and self-indulgent fashion with wanton disregard, others seem to be more genuinely burdened and struggle to integrate their sexual desires into an otherwise healthy and fully responsible lifestyle. When a person, whether male or female, seems to be so driven that it becomes difficult to master erotic desires and he or she experiences difficulty serving his or her own best longterm interests, the concept of sexual compulsivity seems to be relevant. Ultimately, a better understanding of any associated neuropathologies may help to facilitate future treatments and public acceptance. The possibility exists, at least in some instances, that a sexually compulsive individual is less an example of a bad person deserving of punishment than a "broken mind" in need of repair. In time, increased knowledge about the precise workings of the brain in reciprocally initiating and sustaining the sexual interests of the mind may facilitate a much clearer appreciation of the issues at hand.

The etiology of anomalous, or paraphilic, sexual preferences in men is unclear although a growing literature points to their prenatal neurodevelopmental ontogenesis. The present study explored whether this was also apparent in a community sample of 200 heterosexual men by examining their sexual fantasies using the Wilson Sex Fantasy Questionnaire (WSFQ) and several demographic and somatic neurodevelopmental markers, including sibling sex composition, handedness, maternal and paternal age at birth, second to fourth finger length ratios, and fluctuating asymmetry of finger lengths and wrist widths. Responses to the WSFQ were used to quantify the extent of paraphilic interest by computing a variance-quotient (or VQ) previously shown to differentiate paraphilic from conventional heterosexual males. High paraphilic scorers had a significantly greater number of older brothers, higher right-hand 2D:4D, and a trend for lower Edinburgh Handedness Inventory (EHI) scores compared to low-paraphilic scorers. Correlational analysis revealed a significant positive association of VQ scores with number of older brothers and significant negative associations with number of younger brothers and EHI scores (elevated paraphilic interests were correlated with elevated non-right handedness). Correlations between VQ scores and other variables were not significant. It is suggested that processes such as developmental instability and maternal immunity may play a role in variant sexual preferences among otherwise healthy heterosexual men.

A sample of 404 adult men underwent assessment following illegal or clinically significant sexual behaviors or interests. Patients' assessments included: administration of a modified version of the Edinburgh Handedness Inventory; recording of patients' phallometric (penile) responses to erotic stimuli depicting adults, pubescent children, and prepubescent children of both sexes; and a tabulation of the numbers of patients' victims, ages 0-11, 12-14, 15-16, and 17 and older, of both sexes. In Study 1, patients' right-handedness scores correlated negatively with their phallometric responses to stimuli depicting prepubescent children and positively with stimuli depicting adults, replicating the pattern described in a previous report (Cantor et al., 2004). Unlike the previous study, however, patients' handedness scores did not significantly correlate with their numbers of prepubescent victims. To explore this discrepancy, Study 2 combined the patients from this replication sample with those in the previously reported sample, categorizing them by the sex and age group of greatest erotic interest to them. The odds of non-right-handedness in men offending predominantly against prepubescent children were approximately two-fold higher than that in men offending predominantly against adults and three-fold higher after eliminating those men with intrafamilial (i.e., incest) offenses. Handedness differences between men erotically interested in males versus females were not statistically significant. These results indicate that the rates of non-right-handedness in pedophilia are much larger than previously suggested and are comparable to the rates observed in pervasive developmental disorders, such as autism, suggesting a neurological component to the development of pedophilia and hebephilia.

This paper describes what is currently known about attachment from the development, social-cognitive and biological literatures and outlines the impact on organisms given adverse development experiences that can have an effect upon attachment formation in childhood across these three literatures. We then describe the effects that 'insecure' attachment styles arising in childhood can affect brain chemistry and brain function and subsequently adult social/romantic relationships. In the paper, we note that a number of sexual offenders report adverse childhood experiences and that they possess attachment styles that, taken together, make it likely that they will either seek out intimate attachments in ways where they will have sex with children, perhaps confusing sex with intimacy or in aggressive ways as particularly happens with men who sexually assault adult women. The last section of the paper describes chemical treatment for sexual offenders, focusing on the use of selective serotonin re-uptake inhibitors (SSRIs). We note evidence for the role of SSRIs in promoting more social/affiliative behaviors and speculate on the effects that SSRIs have in the treatment of sexual offenders by targeting areas of the social brain. Here, we would argue that it would be useful to carry out treatment where there is a combination of SSRI treatment (to promote more prosocial feelings and behaviors) in conjunction with therapy that typically addresses thoughts and behaviors, i.e., cognitive-behavioral therapy/schema-focused therapy.

This paper investigates the way in which the sexuality of women has been posited in relation to rats as experimental subjects, exploring the stakes of a scientific debate that takes the social world of female sexuality as its focus and as a political problem. Studies that purport to understand female sexuality by investigating rat behavior rely on problematic assumptions about sovereign agents motivating sexual behavior. Such studies also aim to do away with so-called deviant sexual behaviors and, as a consequence, gay people. Theories of agential realism and hybridity serve as counterforces to these inherently repressive perspectives by insisting on the multiple determinations of sexuality and subjectivity among women.

Serial sexual homicide has been the object of intensive study from forensic psychiatric, criminological, developmental, and sociological perspectives. In contradistinction to these approaches, neuropsychiatric concepts and methods have received relatively little attention in this area. In this article we adopt a neuropsychiatric developmental perspective and undertake a review of the psychiatric literature on violence and autism spectrum disorders. Our analysis of this literature suggests the presence of an association between autism spectrum psychopathology and serial homicidal behavior. Recommendations for further research to help clarify the nature of this association are briefly discussed., (Copyright 2004 John Wiley & Sons, Ltd.)

Phallometric testing is a procedure that has enjoyed considerable popularity as an objective component in the assessment of sexual offenders. The value of this procedure may be most notably compromised in the realm of interpretation, and problems in interpretation are particularly acute for those participants where full arousal is not obtained during testing. The calculation of Percent Full Erection (PFE) scores has of necessity involved a speculative component in such cases. Eliminating this speculation through empirical investigation was the purpose of the current research. Circumferential change scores (from flaccidity to full erection) were obtained for 724 respondents at nine North American correctional facilities, allowing for the calculation of descriptive statistics and a determination of the distribution characteristics of these scores. The results provide an empirical basis for calculating PFE scores and interpreting phallometric data in those cases where full arousal is not obtained, and specific confidence levels associated with interpretation are offered. It is suggested that only through a more rigorous application of the principles of science will the procedure of phallometric assessment fulfill its true potential.

A monoamine hypothesis for the pathophysiology of paraphilic disorders was first articulated in 1997 by Kafka. This hypothesis was based on four converging lines of empirical evidence. First, the monoamine neurotransmitters, dopamine, norepinephrine, and serotonin serve a modulatory role in human and mammalian sexual motivation, appetitive, and consummatory behavior. Second, the sexual effects of pharmacological agents that affect monoamine neurotransmitters can have both significant facilitative and inhibitory effects on sexual behavior. Third, paraphilic disorders appear to have Axis I comorbid associations with nonsexual psychopathologies that are associated with monoaminergic dysregulation. Last, pharmacological agents that enhance central serotonergic function in particular, have been reported to ameliorate paraphilic sexual arousal and behavior. Contemporary data supporting or refuting a monoaminergic hypothesis as a biological component associated with paraphilic sex offending behaviors will be reviewed. Particular attention will be given to pharmacological-metabolic probe studies, reports of Axis I comorbidity, the proposed role of disinhibited sexual motivation or sexual appetitive behavior, and cumulative pharmacological treatment data sets.

Contingent negative variation and evoked potentials to visual erotic stimuli were recorded from 8 brain sites in a sample of 62 right-handed men aged 20-50, half of whom declared paraphilic interests and half claimed "normal" heterosexual interests. To quantify erotic preferences, a "variance quotient" (VQ) was calculated from scores on the Wilson Sex Fantasy Questionnaire using the formula VQ = Impersonal + Sadomasochistic fantasies/Intimate + Exploratory fantasies. Stimuli consisted of 57 paraphilic slides (depicting fetishistic and sadomasochistic themes), 57 heterosexual erotic slides (explicit pictures of nude women, coitus, and oral sex), and 57 neutral slides (landscapes and street scenes). The P600 response appeared to be the best indicator of erotic preferences, butthe locus of maximum arousal was different for paraphilic and heterosexual stimuli. The primary brain site for heterosexual arousal was P4 (right parietal), where there was a -.34 (p < .01) correlation between VQ and P600 (i.e., nonvariant males showed greater responses to normal erotic stimuli at this location). For paraphilic stimuli, there was a correlation of .26 (p < .05) between the VQ and P600 response at the F3 (left frontal) site (i.e., paraphilic men showed greater responses to paraphilic stimuli than normal men at this brain location). Dividing the sample into groups of 23 paraphilics and 23 heterosexual controls on the basis of their VQs showed that "normals" differentiated between stimulus types more at the P4 than paraphilics. Theoretical and clinical implications of these findings are discussed.

Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social embarrassment to the afflicted patient but also to the targets of their paraphilic focus. The primary objective of this article is to examine and review data on the efficacy and tolerability of the testosterone-lowering agents medroxprogesterone acetate, cyproterone acetate, and leuprolide acetate. The secondary goal is to review data on less conventional and more innovative pharmacological treatments, particularly the serotonin-specific reuptake inhibitors.

Individuals who engage in sexual offenses may be afflicted with a paraphilic disorder or sexual deviation syndrome. Paraphilias are psychiatric disorders characterized by deviant and culturally non-sanctioned sexual fantasies, thoughts, and/or behaviors. A proportion of these individuals may also suffer from symptoms of mental illness that can go unrecognized. Although the etiology and pathophysiology of paraphilic disorders continue to be under investigation, data from empirical, biomedical, and psychopharmacological studies suggest abnormalities at a biological level. This article will discuss and review clinical and neurobiological characteristics of the paraphilias. To this end, we will begin with a general exploration and overview of basic principles that are germane to the subject matter and will conclude with an examination of the most recent relevant research findings.

There has been increasing interest in the treatment of sexual disorders in recent years. Sexual disorders are classified in DSM-IV as sexual dysfunctions, paraphilias, and gender identity disorders. The sexual dysfunctions are nondeviant or nonparaphillic. The sexual dysfunction disorders should include "hyperactive sexual desire disorder" under sexual desire disorders. Further, there should be a specifier for paraphilias of "with hypersexuality" or "without hypersexuality." There is still incomplete understanding of the neurobiology of sexual disorders although functional neuroanatomy and neoropharmcological research has exposed the neurotransmitters, receptors, and hormones that are involved in sexual desire. Various pharmacological agents including serotonin reuptake inhibitors, antiandrogens, LHRH agonists, and others have been documented as reducing sexual desire. An algorithm for the use of these drugs in the treatment of the paraphilias as well nonparaphilic hypersexuality is outlined. The modes of action, dosages, aims of treatment, and usual methods of prescribing these agents is reviewed in this article. Some future directions of research in pharmacological treatment is also discussed.

A monoamine pathophysiological hypothesis for paraphilias in males is based on the following data: (i) the monoamines norepinephrine, dopamine, and serotonin are involved in the appetitive dimension of male sexual behavior in laboratory animals; (ii) data gathered from studying the side effect profiles of antidepressant psychostimulant, and neuroleptic drugs in humans suggest that alteration of central monoamine neurotransmission can have substantial effects on human sexual functioning, including sexual appetite; (iii) monoamine neurotransmitters appear to modulate dimensions of human and animal psychopathology including impulsivity, anxiety, depression, compulsivity, and pro/antisocial behavior, dimensions disturbed in many paraphiliacs; (iv) pharmacological agents that ameliorate psychiatric disorders characterized by the aforementioned characteristics, especially central serotonin enhancing drugs, can ameliorate paraphilic sexual arousal and behavior.

Interhemispheric interactions were examined in individuals with abnormal sexual behaviour by means of method of evaluation of coherent EEG properties in symmetric points of two hemispheres in different levels of awakening and in elaboration of cognitive tests related with preferential activation of one of two hemispheres. It was determined that EEG of the individuals who had committed sexual deliquency and had the signs of paraphilia was characterized by diffuse elevation of the degree of interhemispheric coherence in alpha-activity in the state of both passive and active awakening and by its local elevation in theta-activity. The results obtained might testify to the disorders either in cortical-subcortical interactions and in the cortical processes and permitted to suppose the decrease of degree of functional hemispheric lateralization in persons with paraphilias.

Some studies have suggested that phallometrically derived rape indices can differentiate groups of rapists and non-offenders. There are other studies however which cast doubt on this assertion, at least in so far as it applies to all but those few rapists who are sadistic. These studies have used rape indices which are derived from rapists' sexual responses to audiotaped descriptions of mutually consenting sex and brutal sexual assaults. It was hypothesized however, that stimuli which put more emphasis on the degrading and humiliating elements of rape would improve discriminability. Stimuli were compiled to test this hypothesis. The results indicate that neither rape indices derived from the physically brutal elements nor the degrading elements of rape were able to discriminate between rapists and non-offenders. Furthermore, these indices were not related to offence histories. The results are discussed in terms of their implications for the assessment of rapists and theoretical considerations of their behaviour.

The current study examined the relationship between clinical characteristics and a phallometrically derived deviance quotient index in two samples of 44 and 54 juvenile sex offenders. Results support an association between higher measured deviant arousal and having a male victim only, consistent with the literature on adult child molesters. However, results reflected greater fluidity in the offense patterns of the juvenile offenders, and generally less correspondence between measured arousal and offense histories than what has been cited for adults. The authors review whether there is empirical support for a conditioning model of deviant arousal onset in juveniles, and suggest caution in the interpretation of phallometric data with this population.

Life threatening eroticizing behavior, asphyxiophilia (sexual asphyxia) is practiced in women, as in men, in order to heighten sexual excitement and to achieve orgasm, which is in some women accompanied by expulsions of fluid (ejaculation) from the urethra. The relatively easily achieved orgasm induced by the mechanism of asphyxia is hypothesized to be the common reason for repetitive deviant asphyxiophilic behavior. Moreover, in women of the ejaculatory type (female ejaculators), the desire to induce ejaculatory orgasm by asphyxia may also come into play as this kind of orgasm is usually assessed as sensation of greater delight than orgasm without ejaculation.

The hypothalamic - pituitary - gonadal axis was evaluated in men with paedophilia and non-paedophilic paraphilia, and in normal male controls, by infusion of 100 mcg. of synthetic luteinising hormone-releasing hormone (LHRH). There were no significant differences among groups in age, height, weight, testosterone, baseline luteinising hormone (LH) and follicle stimulating hormone (FSH), and FSH response to LHRH. However, there was a significant difference between the paedophilic group and the other two groups in the LH response to LHRH. The paedophiles responded with a marked elevation of LH, when compared with the non-paedophilic paraphiliacs and controls. These data indicate a hypothalamic - pituitary - gonadal dysfunction in paedophiles.

The hypothesis that the preferential rape pattern belongs among the courtship disorders like voyeurism, exhibitionism, and toucheurism was tested. The study consisted of two experiments. The first compared 11 rape-prone males, who were most likely afflicted with the preferential rape pattern, with 11 sexually normal controls on penile response to narratives that depicted scenes in which the individual engaged in behavior typical of voyeurs, exhibitionists, or toucheurs. Narratives depicting normal tactile interaction (short of intercourse) with a genuinely participating woman, normal intercourse, and sexually neutral scenes were also presented. The rape-prone males responded more to the voyeuristic situations than did the controls. The standing of the normal intercourse situations on the scale of erotic value, relative to the other above-mentioned situations, was lower for the rape-prone males than for the normal controls. A second experiment compared 12 rape-prone males, who most likely demonstrated the preferential rape pattern, with 12 males with (other) courtship disorders and 12 sexually normal controls. Penile response to narratives depicting the individual involved in pretactile erotic activity, in tactile sexual activity short of intercourse, or in having intercourse was compared. Each situation was presented in two modalities depicting either a genuinely participating woman or a woman fearful of the individual. The penile responses of the rape-prone males, as well as those of males with other courtship disorders, differentiated less between sexual interaction with a fearful woman and such interaction with a participating woman than did the penile responses of normal controls. There was no significant difference in this respect between the rape-prone males and males with other courtship disorders.

The literature on the progestogens, medroxyprogesterone acetate (MPA) and cyproterone acetate (CPA), which are currently used in the treatment of deviant male hypersexuality, is reviewed. There are few adequately controlled trials, but clinical observations suggest that the drugs are reasonably effective in suppressing libido and sexual arousal in men. They are approximately equipotent and equivalent in this respect, but differ somewhat in their pharmacology. When used in conjunction with other measures, especially psychotherapy, they may benefit some sex offenders. The best results are likely in self-referred, nonrecidivist hypersexuals, with good social supports and who are motivated for treatment. The need for long-term placebo and comparison trials is stressed.

The use of erection measurement studies is proliferating in the assessment and treatment of sexual deviants. Because of the nature of sexual offense, there are many inherent legal complications with the implementation of this technology, specifically its use as evidence. The authors present data from a study of 185 sex offenders in an attempt to illustrate the appropriate utility of erection measurements in treatment and its potential for abuse in the legal context.

Sexuality includes eroticism. Though its determinants are multivariate and developmentally sequential, most current biological theories arbitrarily exclude social determinants, and vice versa. Developmentally, masculinization is not necessarily synonymous with defeminization, nor feminization with demasculinization. In the development of brain and behavior, behavior that appears to be either male or female may actually be sex-shared but sex-different in the threshold for its expression. Parent-child bonding is a precursor of subsequent erotosexual pair-bonding. Suppression of erotosexual rehearsal play in childhood is a precursor of postpubertal and adult erotosexual pathology. The criterion defining the heterosexual, bisexual, and homosexual conditions is the sex of the partner with whom a limerent (falling-in-love) pairbond is possible; and there is no evidence that pubertal sex steroids, per se, are responsible for which of the three it will be. The phases of an erotosexual encounter are proception, acception, and conception. The disorders of proception, manifested in both imagery and practice, are the paraphilic syndromes (formerly known as perversions). The disorders of acception may be either hypophilic deficiencies, or hyperphilic increases. The disorders of conception are those of infertility. There is a nonsystematic relationship of erotosexualism to the hormonal cycle of the menses and to gerontological hormonal changes.