Androgen deprivation treatment of sexual behavior.

Gonadotropin-releasing hormone agonists are underutilized in patients seeking diminution of problematic sexual drives. This chapter reviews the literature on surgical castration of sex offenders, anti-androgen use and the rationale for providing androgen deprivation therapy, rather than selective serotonin reuptake inhibitors or more conservative interventions, for patients with paraphilias and excessive sexual drive. Discussions of informed consent, side effects, contraindications and case examples are provided.

Sexual risk assessment for people with intellectual disabilities.

Given that sexually offensive behavior on the part of people with intellectual disabilities has been identified as a significant problem, we developed a risk assessment questionnaire, that takes not only various static and dynamic factors into account but also environmental risk variables. Psychologists and staff members completed this Risk Inventarization Scale on Sexually Offensive Behavior of Clients with Intellectual Disabilities for 56 intellectually disabled clients with sexually offensive behavior problems. The scale contains static client variables (rated using two- or five-point likert scales and open questions) and both dynamic client and environmental variables (rated using a five-point Likert scale). Factor analyses of the dynamic client and environmental variables revealed three subscales: quality of supervision, offending behavior and emotional and social stability. Reliability analyses showed sufficient to good reliability for both the total scale (r=0.82) and the identified subscales (quality of guidance r=0.94; offending behavior r=0.75, and emotional and social stability r=0.58). Correlational analyses of the quality of guidance subscale showed high positive correlations with such static variables as values and norms, living conditions, and criminal offenses in early youth. Because both dynamic and environmental variables can be altered, the implications for treatment of the sexually offensive behavior of clients with intellectual disabilities are discussed further.

The DSM diagnostic criteria for exhibitionism, voyeurism, and frotteurism.

I reviewed the empirical literature for 1980-2008 on exhibitionism, voyeurism, and frotteurism for the American Psychiatric Association's Sexual and Gender Identity Disorders Work Group in preparation for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Very limited empirical support was found for major changes of the current DSM-IV-TR criteria sets for these paraphilias. Some of the criticism of current criteria and the balancing of false negatives and false positive diagnoses are examined. The report concludes with suggestions for possible diagnostic criteria changes for the DSM-V.

Clinical characteristics and psychiatric comorbidity in males with exhibitionism.

BACKGROUND: This study was constructed to detail the demographic and phenomenological features of males with exhibitionism. METHOD: Male subjects with DSM-IV exhibitionism were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, and associated features of the disorder. Subjects also underwent structured clinical interviews to assess both Axis I and Axis II comorbidities. Data were collected from September 2003 to March 2005. RESULTS: Twenty-five males with exhibitionism (mean +/- SD age = 35.0 +/-13.1 years [range, 14-68 years]) were studied. The majority of subjects were single (60% [N = 15]) and heterosexual (80% [N = 20]). The mean +/- SD age at onset for exhibitionism was 23.4 +/-13.1 years. All subjects reported urges to expose themselves with little control over these urges. Exposing oneself while driving was the most common expression of the disorder. Twenty-three (92%) suffered from a current comorbid Axis I disorder (major depressive disorder, compulsive sexual behavior, and substance use disorders were most common), and 40% (N = 10) suffered from a personality disorder. Suicidal thoughts were common (52% [N = 13]), and many (36% [N = 9]) had been arrested for exhibitionism. CONCLUSION: Exhibitionism appears to be associated with high rates of psychiatric comorbidity and impairment. Research is needed to optimize patient care for men with this disorder.

[Stalking--a modern manifestation of erotomania?]. / Stalking--eine moderne Erscheinungsform der Erotomanie?

Stalking is the technical term for the systematic, excessive and sometimes offensive molestation in order to seek personal contact with a target person, mostly of the contrary sex. This phenomenon seems to have increased recently and concerns above all celebrities of several kinds. In some cases, stalking behavior can culminate in acts of violence. However, the pathological fixation onto an often unattainable person is not a modern phenomenon, since it was studied and described under the term erotomania in former centuries. The author presents and discusses the case of a young man, who displayed his stalking behavior exclusively by telephone calls.

Recognition and management of addictive sexual disorders: guide for the primary care clinician.

With greater awareness of sexual exploitation, professional sexual misconduct, and the sexual issues of public figures, a growing awareness of the problem of sexual addiction is emerging. As a result of public awareness, more cases will be brought to the attention of primary care providers. When primary care providers are confronted by problematic sexual behavior that fits the parameters of addictive illness, they should know what the implications are in order to make appropriate clinical decisions and to evaluate treatment approaches. The purpose of this article is to summarize the nature of the problem, to review critical issues in assessment, to provide treatment options, and to suggest critical factors for monitoring progress.

Disease, disorder, or deception? Latah as habit in a Malay extended family.

Thirty-seven cases of latah are examined within the author's Malay extended family (N = 115). Based on ethnographic data collected and a literature review, cases are readily divisible into two broad categories: habitual (N = 33) and performance (N = 4). The first form represents an infrequent, culturally conditioned habit that is occasionally used as a learned coping strategy in the form of a cathartic stress response to sudden startle with limited secondary benefits (i.e., exhibiting brief verbal obscenity with impunity). In this sense, it is identical to Western swearing. Performers are engaged in conscious, ritualized social gain through the purported exploitation of a neurophysiological potential. The latter process is essentially irrelevant, akin to sneezing or yawning. It is concluded that latah is a social construction of Western-trained universalist scientists. The concept of malingering and fraud in anthropology is critically discussed.

The treatment of exhibitionists: a focus on sexual deviance versus cognitive and relationship features.

Two studies compared treatment of exhibitionists aimed at either: (1) modifying deviant sexual preferences; or (2) changing cognitions, enhancing relationship and interpersonal skills, and improving awareness of relapse prevention issues. Recidivism rates of these two programs were compared with each other and with the rates observed in untreated offenders. Results supported the focus on broader cognitive and social issues. Clearly exhibitionists can be treated effectively.

[Clinico-pathogenetic characteristics of exhibitionism]. / Kliniko-patogeneticheskie osobennosti exhibitionism.

The author relates the results of ++clinico-psychopathological and sexological studies carried out in 61 men with the signs of exhibitionism. With the nosological qualification of the mental status of exhibitionists being diverse, the four uniform ++clinico-pathogenetic groups were distinguished: with the hypothalamic and temporal syndromes, ++non-processual autism syndromes, and schizophrenic defect. The involvement of biological factors in the genesis of pathological inclination is demonstrated to be of uncertain degree, depending on the classifying with the groups indicated. Heterogeneity dysontogenesis of the psychosexual development was discovered with the aid of sexological examination. At the same time the author proves the common character of the pathogenetic components of exhibitionism, lying in the unity of the constitutional basis for their individual characteristics.

[Principles of the forensic psychiatric assessment of exhibitionism]. / Printsipy sudebno-psikhiatricheskoi otsenki éksgibitsionizma.

Incompetence of the existing approach to forensic psychiatric assessment of exhibitionism as well as the necessity for conducting the analysis of direct manifestations of perverse behaviour are shown. Dissimilar clinical manifestations of this kind of paraphilias are presented and its fixed, compulsive and impulsive variants are described. The necessity for singling out differential forensic psychiatric criteria depending on psychopathologic characteristics of exhibitionism is stressed.

The Clarke SHQ: a clinical sex history questionnaire for males.

The development of a 225-item sexual history questionnaire is reported. The frequency, desire for, and disgust for a wide range of sexual behaviors, including anomalous behavior, were examined. Twenty-four scales were derived from factor analysis of the items. The scales were represented by modest unitary factors but were relatively free of bias from age, education, intelligence, social desirability, and defensiveness. The scales generally discriminated clinically relevant groups from control subjects and therefore meet a clinical need in the assessment of anomalous sexual behavior. The instrument also appears to be useful in examining hypotheses for research. Among these observations was the continuity between exhibitionism and heterosexual pedophilia and the apparent bisexuality of some homosexual males. The scale allows for the assessment of the preferences of sexually inexperienced males as well.

Hand Test characteristics of marijuana-experienced and multiple-drug-using college students.

Three matched groups of 30 college student (17 males, 13 females) categorized as marijuana users, multiple-drug users, and complete abstainers were compared across 24 Hand Test scores. Both drug-using groups were characterized by significantly lower scores on Acquisition, Active, and Environmental responses. Results were interpreted as supporting the amotivational hypothesis that drug-users display a lessened interest in environmental accomplishment. The marijuana group also proved to be slightly higher on the Exhibition score.