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PubMed1981

[On co-operation of the child-specialist of neuropsychiatry in prevention and control of dissocial and criminal behaviour (author's transl)].

There is an increasing win of recognition of polycausality in the development of social deviates. Therefore the today's organization of control of criminality is representing a complicated course of socioeconomical, ideological, legal, educational and other measures. Author points to diagnostic and therapeutic possibilities of the children's neuropsychiatry. They could serve for early recognition of an incipient social deviate development. This would make possible a therapy of partial causes in the right moment.

Adolescent↗
PubMed1995

Body dysmorphic disorder, pathological gambling, and sexual compulsions.

This article focuses on body dysmorphic disorder (BDD), pathological gambling, and sexual compulsions within the realm of obsessive-compulsive spectrum disorders. These three disorders affect sizable numbers of the population, have an early age at onset and chronic courses, and seem to have a preferential response to serotonin reuptake inhibitors (SRIs). They also have a high comorbidity with obsessive-compulsive disorder, depression, and other impulse control disorders. BDD patients lie more toward the compulsive/risk-aversive end of the dimensional model of obsessive-compulsive spectrum disorder and often have poor insight. Pathological gambling patients lie more toward the impulsivity/novelty-seeking end of the OCD spectrum and often have features of inattention. Sexual obsessions and/or compulsions encompass a heterogeneous group of disorders, as exhibited by differential response to SRIs within this group. These three disorders fall within a new and evolving field that requires further investigation and reconceptualization. This concept may have far-reaching consequences and yield more significant treatment outcomes.

Adolescent↗
PubMed1995

Compulsive sexual behaviors.

CSBs constitute a wide range of complex sexual behaviors that clinicians are increasingly encountering. This article has set forth four models of CSBs: compulsive, affective, addictive, and impulsive. Some of the CSBs appear to fit rather neatly into one of the models, whereas others have features of two or more of them. The identification of these various features has important treatment implications. Although a scientific demarcation of these sexually compulsive disorders awaits further research, clinicians should be aware of the growing number of assessment and treatment approaches for these disorders, as well as of the specialists in the field who can be turned to for consultation and referral depending upon the complexities and dangerousness of the case.

Adult↗
PubMed1994

Psychotherapists who transgress sexual boundaries with patients.

The causes of therapist-patient sex are complex and multidetermined. Efforts to understand why psychotherapists transgress sexual boundaries are hampered by the lure of reductionism and oversimplification. Most of those who examine this issue would prefer to categorize all such therapists as "bad" and "corrupt" as a way of distancing themselves and disavowing any similarities between these therapists and themselves. The pathology of therapists who commit sexual boundary violations generally falls into four broad categories: (1) psychotic disorders, (2) predatory psychopathy and paraphilias, (3) lovesickness, and (4) masochistic surrender. Although a variety of individual psychodynamic factors are involved within each group, this classification is highly useful for informed treatment planning.

Antisocial Personality Disorder↗
PubMed1993

A fundamental dilemma of psychoanalytic technique: reflections on the analysis of a perverse paranoid patient.

The work refers to the general topic of the traumatic effects of transference in the analytic situation. The author defines the fundamental dilemma of interpretive technique as the technical difficulty, sometimes insurmountable, faced by the therapist in the treatment of severely ill patients, particularly in the case of narcissistic, self-centred disorders, where the interpretive action itself often produces negative side effects that are not countered by the curative effect of the insight achieved through interpretation. In a brief theoretical introduction, this dilemma is described as a longstanding problem in psychoanalysis that has been systematically concealed by the protracted discussion on the subject of 'analysability' and which has still not been resolved by the theory of technique. Clinical case material on a perverse patient is then presented to illustrate the dilemma described and to demonstrate some general strategies by which it may be overcome.

Adult↗
PubMed1993

The perverse attitude toward reality.

Freud's (1940a) tentative distinction between the defensive maneuvers in neurosis and those in perversion can be extended to good clinical effect. In general, neurotic defenses may be thought of as directed against wishes, whereas perverse defenses are directed against perceived reality. It is suggested that the perverse approach to reality is not limited to frank sexual perversions; it defines a class of operations that involve taking certain liberties with reality. Clinical material is used to demonstrate the perverse attitude and some of its implications for technique. The role of the superego is considered.

Adult↗
PubMed1995

Sexual abuse experiences of psychiatric patients.

By interviewing 200 male psychiatric patients and 150 female psychiatric patients, we found that 17.1% of the respondents had experienced sexual victimization during their childhood. Only 11% of a control group of 50 males and 50 females, who had never received psychiatric treatment, reported similar victimization. The incidence of intrafamilial sexual victimization was greater among females than males. The group that had suffered the most sexual victimization was that of female psychiatric patients diagnosed with neuroses. Sexual victimization linked to aggressive behaviour and threats of violence was more common in the case of male and female psychiatric patients than in the control groups. Only 4% of the sexual victimization cases were investigated by the police.

Adult↗
PubMed1998

Homicidal sex offenders: psychological, phallometric, and diagnostic features.

Homicidal sex offenders represent an understudied population in the forensic literature. Forty-eight homicidal sex offenders assessed between 1982 and 1992 were studied in relation to a comparison group of incest offenders. Historical features, commonly used psychological inventories, criminal histories, phallometric assessments, and DSM diagnoses were collected on each group. The homicidal sex offenders, compared with the incest offenders, self-reported that they had more frequently been removed from their homes during childhood and had more violence and forensic psychiatric contact in their histories. On the self-report psychological inventories, the homicidal sex offenders portrayed themselves as functioning significantly better in the areas of sexuality (Derogatis Sexual Functioning Inventory) and aggression/hostility (Buss-Durkee Hostility Inventory). However, on the Psychopathy Checklist-Revised (PCL-R), researchers rated the homiciders significantly more psychopathic than the incest offenders on Factor 1 (personality traits) and Factor 2 (antisocial history). Police records revealed the homicidal subjects also had been charged or convicted of more violent and nonviolent nonsexual offenses. The phallometric assessments indicated that the homicidal sex offenders demonstrated higher levels of response to pedophilic stimuli and were significantly more aroused to stimuli depicting assaultive acts to children, relative to the incest offenders. Despite the homiciders' self-reports of fairly good psychological functioning, DSM-III diagnoses reliably discriminated between the groups. A large number of homicidal sex offenders were diagnosed as suffering from psychosis, antisocial personality disorder, paraphilias, sexual sadism, sexual sadism with pedophilia, and substance abuse. Seventy-five percent of the homicidal sex offenders had three or more diagnoses compared with six percent of the incest offenders. The article addresses the role of "hard" versus "soft" measures in the assessment and treatment of violent sex offenders. In addition, the usefulness of phallometric assessments and the PCL-R and its subscales are considered.

Adolescent↗
PubMed2002

Behavioral and psychopharmacological treatment of the paraphilic and hypersexual disorders.

In this article, the second of a two-part series, the authors present information on the clinical assessment of individuals with paraphilias and hypersexual disorders. They review ethical considerations in the assessment and treatment of individuals with paraphilias. The role of interview and subjective and objective instruments in the assessment of individuals with paraphilias and hypersexual disorders is discussed. The authors discuss the use of penile plethysmography or phallometry, polygraphy, and viewing time assessments. Risk assessment of sexual offenders is reviewed. The authors then discuss behavioral, environmental, and psychopharmacological treatments for paraphilias and hypersexual disorders. Cognitive-behavioral therapy appears to be the most effective nonpharmacological strategy. The authors describe cognitive-behavioral techniques for decreasing and/or controlling sexual urges (e.g., satiation, covert sensitization, fading, cognitive restructuring, victim empathy therapy) as well as methods for enhancing appropriate sexual interest and arousal (e.g., social skills training, assertiveness skills training, sex education, couples therapy). The authors also discuss the role of relapse prevention therapy and 12-step programs, as well as other nonbiological therapies such as surveillance networks. The importance of providing appropriate treatment for comorbid conditions (e.g., depression, substance abuse or dependence) is stressed. The authors then review psychopharmacological treatments, including serotonin reuptake inhibitors (SRIs) and antiandrogens, in particular, the use of gonadotropin-releasing hormone (GNRH) agonists. SRIs have been studied in these disorders in an uncontrolled way and appear promising. Earlier antiandrogens (e.g., estrogen, progesterone, and cyproterone acetate) have demonstrated efficacy in the treatment of paraphilias. The newer GNRH agonists have the advantage over the earlier treatments of being available in long-acting depot formulations and having fewer side effects. Preliminary studies and case reports with these agents appear promising. Further study of both the SRIs and GNRH agonists in these disorders is needed. The article concludes with a treatment algorithm, in which the authors suggest beginning with less restrictive treatments (e.g., behavioral or verbal therapies), if possible, and moving to more restrictive alternatives (e.g., biological therapies, institutionalization) as needed. A guide for clinicians and patients about where and how to find appropriate clinicians and treatment resources in the United States is provided.

Journal Article↗
PubMed2004

Understanding sexual offending in schizophrenia.

BACKGROUND: Studies have found an elevated incidence of violent sexual offences in males with schizophrenia. The relationship between sexual offending and psychiatric illness is, however, complex and poorly defined. AIMS: The aim of the present article is to delineate possible mechanisms that underlie offensive sexual behaviour in schizophrenia that can be used as a framework for assessing and treating these behaviours. A review of research pertaining to the aetiology of sexual deviance in schizophrenia was conducted, focusing in particular on the role of early childhood experiences, deviant sexual preferences, antisocial personality traits, psychiatric symptomatology and associated treatment effects, the impact of mental illness on sexual and social functioning, and other potential contributory factors. TOWARDS A TYPOLOGY: It is proposed that schizophrenic patients who engage in sexually offensive activities fall into four broad groups: (1) those with a pre-existing paraphilia; (2) those whose deviant sexuality arises in the context of illness and/or its treatment; (3) those whose deviant sexuality is one manifestation of more generalized antisocial behaviour, and (4) factors other than the above. This classification provides a useful framework for evaluating and treating sexually offensive behaviours in schizophrenic patients.

Brain↗