ABSTRACT
Históricamente la sociedad ha rechazado el abuso sexual de menores de 13 años, dictándose leyes al respecto. La justicia luego de un debido proceso condenaba al victimario con reclusión incluso hasta la década del 70-80, con orquiectomía. Los adelantos en neurobiología, endocrinología, sicofarmacología y sicología se consideraron las bases para tratar al pedófilo y someterlo a libertad condicional, ahorrándose el costo financiero de la reclusión de por vida. Diversos países dictaron leyes contra la conducta pedófila. En dicha legislación ejerció gran influencia la promulgación en EE.UU. (estado de Washington "sobre el ofensor sexual" y el dictamen de la Corte Suprema en 1997 en el juicio de Kansas vs Hendricks). En Chile en los 90 el caso del pedófilo apodado "Zacarach" sacó a la luz pública el tema que no se quería ver. En esa fecha se presentó al parlamento un proyecto de Ley para "curar" la pedofilia con acetato de Medroxiprogesterona imitando legislación de EE.UU. Causó sorpresa en el medio endocrinológico que se usara terapia hormonal como "cura" de la pedofilia. Se ha utilizado en varios países la castración química producida por gestágenos o agonístas del GnRH más antiandrógenos (acetato de Ciproterona), para inhibir la secreción y acción de la testosterona disminuyendo líbido y erección. No se ha demostrado que exista curación de la orientación pedófila y existen dudas de la prevención primaria y secundaria de la pedofilia. Pese al adelanto tecnológico en neurociencias para estudio de las zonas vinculadas a la sexualidad, aún no existen marcadores que permitan diagnosticar o pronosticar futuros resultados de la terapia. El tratamiento médico de la pedofilia no garantiza curación ni prevención del delito pedofílico.
Historically, society has rejected sexual abuse of children under 13, with there having been laws enacted in this regard. The judicial system, after a due process, condemned the perpetrator with reclusion and even up until the decades of the 70s and 80s with orchiectomy. Advances in neurobiology, endocrinology, psychopharmacology and psychology were considered the basis for treating the pedophile and putting them on probation, saving the financial cost of imprisonment for life. Multiple countries have enacted laws against pedophilic behaviour. Such legislation was greatly influenced by the enactment in the USA (state of Washington "on the sex offender" and the ruling of the Supreme Court in 1997 in the trial of Kansas against Hendricks). In Chile in the 90s, the case of a pedophile nicknamed "Zacarach" brought to light an issue that nobody wanted to see. Around that time, a bill was presented to Parliament to try and "cure" pedophilia with Medroxyprogesterone acetate, imitating US legislation. It was a surprise in the endocrinological world that hormonal therapy would be used as a "cure" for pedophilia. Chemical castration produced by gestagens or GnRH agonists plus antiandrogens (Cyproterone acetate) has been used in several countries to inhibit the secretion and action of testosterone, reducing libido and erection. It has not been proven that there is a cure for pedophile orientation and there are doubts about the primary and secondary prevention of pedophilia. Despite technological advances in neurosciences for the study of the zones pertaining to sexuality, there are still no indicators that allow for diagnosis or prediction of future results of therapy. The medical treatment of pedophilia does not guarantee cure or prevention of pedophilic crime.
Subject(s)
Humans , Male , Pedophilia/drug therapy , Castration/methods , Androgen Antagonists/therapeutic use , Pedophilia/diagnosis , Pedophilia/etiology , Pedophilia/therapy , Sex Offenses/legislation & jurisprudence , Testis/drug effects , Gonadotropin-Releasing Hormone/agonists , Medroxyprogesterone Acetate/therapeutic use , Cyproterone Acetate/therapeutic useABSTRACT
Todas as formas de violência contra a criança produzem consequências nefastas ao desenvolvimento infantil. Existe uma forte influência do trauma no progresso da arquitetura cerebral, da estruturação permanente da personalidade e dos padrões de relacionamento posteriores. Geralmente, os pedófilos iniciam suas atividades durante a adolescência, e a preferência pelo sexo masculino é duas vezes maior do que pelo feminino; sabe-se que as relações sexuais entre adultos e crianças ocorrem desde a antiguidade. Existem várias teorias para explicar a pedofilia: para alguns, a testosterona predispõe aos desvios de comportamento sexual; outros a explicam como resultado de fatores psicossociais. O diagnóstico é estabelecido preenchendo-se os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV-TR). O tratamento de escolha é a psicoterapia de longa duração, e o tratamento medicamentoso se baseia em três classes de drogas: hormônios femininos, agonistas do LHRH ou antiandrogênios. A castração cirúrgica é oferecida em casos especiais. A prisão remove os pedófilos da sociedade, mas não os modifica. Além dos dispositivos constitucionais que preveem, de forma ampla e integral, a proteção da criança e do adolescente, o Código Penal e o Estatuto da Criança e do Adolescente estabelecem um sistema de normas imperativas destinadas à repressão de abusos envolvendo a temática em comento. Frente a essas novas revelações, faz-se mister ao profissional da saúde receber noções médico-legais sobre a violência e suas aberrações.(AU)
All forms of violence against children produce disastrous consequences to the infantile development. There is a strong influence of the trauma in the progress of the cerebral architecture, the permanent structure of the personality and the standard of posterior relationships. Pedophiles usually begin their activities during adolescence, and the preference for males is twice as high as for females. It is known that sexual relations between adults and children have occurred since ancient times. There is a handful of theories to explain pedophilia: for some, testosterone predisposes the individual to sexually deviant behaviors; for others, it is the result of psychosocial factors. The diagnosis is established by comparison with the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), and the treatment of choice is long-term psychotherapy; drug therapy is based on three classes of drugs: female hormones, LHRH agonists or anti-androgens. Surgical castration is resorted in special cases only. Imprisonment removes pedophiles from society, but does not change or cure them. Along with the constitutional provisions that offer, in a broad and integral manner, the protection of children and adolescents, the Criminal Code and the Statute of the Child and Adolescent establish a system of mandatory regulations for the prosecution of those abusive individuals concerning the matter herein discussed. Due to these new revelations, it is important that health personnel receive medical legal notions about the violence and its aberrations.(AU)
Subject(s)
Humans , Child , Adolescent , Pedophilia/diagnosis , Pedophilia/history , Pedophilia/psychology , Pedophilia/drug therapy , Child Advocacy/legislation & jurisprudence , Pedophilia/etiology , Pedophilia/prevention & control , Prognosis , Brazil , Health Personnel , Constitution and Bylaws , Health Services Needs and Demand , Legislation as TopicABSTRACT
Diversos estudos investigaram a relação entre psicopatologia e parafilias, especialmente pedofilia. Transtornos de humor e ansiedade, seguidos de transtornos relacionados ao uso de substâncias, são as comorbidades mais prevalentes em pacientes com parafilias. Apresentou- se o caso de um paciente em tratamento para dependência de substâncias (álcool e heroína), transtorno bipolar e pedofilia. É importante frisar que poucos casos relatando comorbidades como essas foram descritos na literatura.
Many studies have investigated the relationship between psychopathology and paraphilias, specifically paedophilia. Mood disorders, anxiety disorders, followed by substance use were the most prevalent disorders comorbid in these patients. We present the case of a patient in treatment for substance misuse (alcohol and heroin), bipolar disorder and paedophilia. To our knowledge few cases were reported describing cases of comorbidity such as this.