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PubMed2001

Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases.

A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise in the treatment of the paraphilias, with substantially less side effects than medroxyprogesterone acetate or cyproterone acetate. This paper reports the results of treatment using a depot suspension of leuprolide acetate on 12 patients with paraphilic disorders or with sexual disorders not otherwise specified to suppress or help these individuals control their deviant sexual behavior or impulses. The method involved uncontrolled observations of individuals treated with depot-leuprolide acetate for various lengths of time, from 6 months to 5 years, with the follow-up intervals ranging from 6 months to 6 years. Leuprolide acetate resulted in a significant suppression of deviant sexual interests and behavior as measured by self-report and was well tolerated. However, the three patients who were on long-term therapy developed bone demineralization, suggesting that this is a significant side effect of prolonged therapy. Leuprolide acetate shows promise as a treatment for the paraphilias.

Adult↗
PubMed2001

The paraphilic and hypersexual disorders: an overview.

In this article, the first of a two-part series, the authors present reasons for considering the paraphilic and hypersexual disorders together and provide an overview of these disorders. The DSM-IV diagnostic criteria for paraphilias are reviewed, and proposed criteria for hypersexual disorders are presented. The question of whether the paraphilic and hypersexual disorders should be considered within the spectrum of obsessive-compulsive disorders is considered. The authors then review the epidemiology of these disorders, and discuss some implications of recent sexual predator legislation. The authors discuss the etiology of the paraphilias and hypersexual disorders, and consider the role of endocrinological function, findings from brain imaging and neuropsychological testing, findings from primate research, the monoamine hypothesis, the imprinting hypothesis, social learning theory, the concept of courtship disorder, the role of obsessive-compulsive elements, psychodynamic theories, and genetic factors. The phenomenology of the paraphilias and hypersexual disorders is discussed, including the tendency for multiple paraphilias to co-occur, the lack of a specific offender profile, the predominance of males among those with paraphilias, the incidence of a history of victimization in individuals with paraphilias and compulsive sexual disorders, the onset and course of both types of disorders, and the lack of internal motivation for change in individuals with paraphilias and hypersexual disorders. The authors then discuss disorders that commonly co-occur with paraphilias and compulsive sexual disorders, including mood disorders, substance abuse and dependence disorders, attention-deficit/hyperactivity disorder, anxiety and impulse control disorders, and personality disorders. The second article in the series will discuss the clinical assessment and the behavioral and psychopharmacological treatment of these disorders. A guide for clinicians and patients on where and how to find specialized clinicians and treatment resources in the United States will also be provided.

Journal Article↗
PubMed1975

Psychodynamic changes in untreated neurotic patients. II. Apparently genuine improvements.

This work is part of a study of 45 neurotic patients who were seen for consultation at the Tavistock Clinic but who never received treatment, and who, by the time they were asked to come for follow-up, had never been interviewed by a psychiatrist more than twice in their whole lives. In a previous report, we described 13 patients who were at least "improved" on purely symptomatic criteria but whom we did not regard as improved on dynamic criteria. Here, we describe 11 patients who were judged to be improved on dynamic criteria. These patients are of extraordinary interest, providing not only direct evidence of therapeutic mechanisms in everyday lifeān answer to a question posed by Strupp and Bergin in 1969but also, quite unexpectedly, evidence about the therapeutic effects of single interviews.

Adult↗
PubMed1979

Sex offenders: three personality types.

Analyzed by a Q-type factor analysis MMPI profiles of 92 sex offenders institutionalized for psychiatric evaluation, which yielded three basic MMPI profile types. Altogether 88 of the 92 Ss coult be categorized into one of three types characterized by profile peaks on F,Sc; Pd,MA; or D,PD. Analysis of background information, social history items, nature of present crime, primary diagnosis, and ward observations revealed significant differences among the types. Of particular interest was the finding that the primary diagnosis for 85% of the "F,Sc" MMPI type was "no mental disorder" in spite of the fact that this group showed significantly more disturbed behavior on the ward (anxiety, depression, suspicion, and manic excitement) and had uniquely degraded their victims. The fact that two-thirds of these persons who had F scores greater than or equal to 80 and 50% denied the crime may have inadvertently affected diagnostic decisions.

Adult↗
PubMed2003

Problematic internet use: proposed classification and diagnostic criteria.

Since the mid-1990s, there have been frequent reports of individuals whose use of the computer and internet is problematic. Given the recent expansion and the expected increase in internet availability and usage in the coming years, it is important that healthcare professionals be informed about this behavior and its associated problems. Recently, psychological and psychiatric literature has described individuals that exhibit problematic internet use who often suffer from other psychiatric disorders. In the face of this comorbidity, it is essential to evaluate whether these individuals represent a distinct class of disorder, or a manifestation/coping mechanism related to other underlying diagnosis. In either event, problematic internet use negatively impacts social and emotional functioning. Based on the current limited empirical evidence, problematic internet use may best be classified as an impulse control disorder. It is therefore imperative that problematic internet use be appropriately identified among symptomatic individuals. For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior.

Adult↗
PubMed2006

Perverse dreams and dreams of perversion.

This paper (1) posits the occurrence of perverse dreams as a type of mental phenomenon in the constellation of perverse processes; (2) considers manifest dreams of frank perversion as a type of perverse dream within the class of perverse dreams as a whole; (3) relates the subtype of perverse dreams without manifest perversions to the occurrence of perverse defenses and the development of a perverse transference; and (4) suggests that consideration to perverse dreams in the psychoanalytic process finds application in identifying and differentiating perverse defenses from neurotic and other characterologic patterns; in identifying and tracing the vicissitudes of difficult perverse transference-countertransference constellations; and in furthering perverse patients' recognition and understanding of particularly troublesome and seemingly intractable issues in their psychic makeup. Clinical material illustrates perverse dreams and their usefulness in the often arduous process of analyzing perverse defenses.

Countertransference↗
PubMed1978

Diagnosis and chronic mental illness.

This paper describes the occurrence of chronicity in varying psychiatric illnesses. There is not an unequivocal definition of chronicity, but with the exception of the illnesses that will be described below and that lead directly or indirectly to death from CNS complications of the illness, chronicity will require a duration of a minimum of five years without a significant remission. Chronicity is further differentiated into four different kinds of chronicity: chronic--death, chronic--self-limited, chronic--remission, and chronic--recurrent. The illnesses that may be considered as possibly fulfilling the criteria for chronic will be noted and a method for deciding whether an illness qualifies will be outlined.

Alcoholism↗