Bridging Exhibitionism and Internet Pornography: Is There A Link?

@#Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.

Research on the Etiology of Pedophilia through Monozygotic Twins with Pedophilia : A Case Report / 신경정신의학

Recent studies have suggested an association of genetic and neurodevelopmental factors with development of paraphilia. In this case report on monozygotic twins with pedophilia, we aim to offer additional evidence indicating that genetic vulnerability may be a significant risk factor along with environmental influences on development of pedophilia. These twin pairs, who have been arrested for sexual offenses against boys, had experienced emotional and physical abuse during their childhood, and the older twin brother is reported to have a history of sexual abuse. Both showed homosexual tendencies, and the younger twin brother was also diagnosed as exhibitionism. This case implies greater involvement of genetic factors and associated vulnerabilities in the etiology of paraphilia, including pedophilia, than environmental factors such as childhood abuse. In the future, conduct of research will be needed in order to determine the biological markers related to the etiology of pedophilia.

Effect of CORE Program on Cognitive, Social and Emotional Characteristics of Sex Offenders / 대한법의학회지

The purpose of this study was to develop the CORE Program for sex offenders and to determine its effectiveness. The CORE Program was designed with an aim to achieve cognitive restructuring, improve the ability to empathize in interpersonal relationships, and enhance self-esteem and intimacy. We conducted this program over 48 sessions for 28 sex offenders. The effectiveness of the program was evaluated using the Interpersonal Responsiveness Index (IRI), Self-esteem Questionnaire (SEQ), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI), Rape Myth Acceptance Scale (RMAS), and Wilson's Sex Fantasy Questionnaire (WSFQ). The data were analyzed using paired t-tests. Our results showed no significant changes in the SEQ, UCLALS, and IRI scores after the treatment program. However, the scores for the CUSI, RMAS, and WSFQ significantly improved after this program. In this paper, we demonstrate the effectiveness of the CORE Program for sex offenders. We also discuss the limitations of our study and provide suggestions for future research. Our findings indicate that this treatment program should be provided to sex offenders for preventing recidivism.

Preliminary Study of Effect of Leuprolide Acetate Treatment on Sexual Fantasy of Sex Offenders / 대한법의학회지

This study investigated the effect of leuprolide acetate treatment on sex offenders' sexual fantasies and behaviors, as well as on their criminogenic psychological character and the risk of second conviction. The study participants consisted of 22 sex offenders who were confined to the National Institute of Forensic Psychiatry. Among them, 9 patients were given off-label leuprolide acetate for three months to inhibit sexual impulses, whereas the others were not given any medication. All sex offenders underwent two psychological evaluations; the first evaluation was conducted before starting medication, and the second was conducted after medication. Wilson's Sex Fantasy Questionnaire (WSFQ), the Rape Myth Acceptance Scale (RMAS), and the Endorsement of Violence Scale (EVS) were used for evaluation. Leuprolide acetate-treated sex offenders showed a statistically significant decline in the total WSFQ score (p < 0.05). However, the RMAS and EVS scores did not differ after leuprolide acetate treatment, indicating that cognitive distortions like rape myth acceptance and endorsement of violence were unchanged after leuprolide medication. Leuprolide acetate may reduce deviant sexual impulses and fantasies, as suggested by previous research form Korea and other countries. However, it probably cannot alter cognitive distortion. On the basis of these findings, we recommend a combination of leuprolide medication and other therapies, like cognitive behavioral therapy, for the treatment of paraphilic sex offenders.

Psychiatric Diagnosis and Hypersexual Behavior Inventory, Sexual Addiction Screening Test, and Beck Depression Inventory/Beck Anxiety Inventory of the Sexual Offenders / 대한법의학회지

The current study evaluated DSM-IV psychiatric diagnoses and investigated the psychological characteristics of sexual offenders by using the Hypersexual Behavior Inventory(HBI), Sexual Addiction Screening Test (SAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Fifty male sexual offenders and 36 male healthy controls completed the psychiatric diagnosis and 30 of the 50 male sexual offenders completed the psychological tests listed above. Thirty-two of the 50 sexual offenders were patients with paraphilias, these sexual offenders had been admitted by the Ministry of Justice to the Institute for Forensic Psychiatry in Gongjui-si due to sexual violence. Participants displayed high lifetime rates of psychiatric disorders: 32 (64%) had paraphilias, 16 (32%) had depressive disorders, 10 (20%) had anxiety disorders, 9 (18%) had impulse control disorders, 6 (12%) had schizophrenia, 2 (4%) had bipolar disorders, and 16 (32%) had personality disorders or some other Axis II disorder. Scores for the sexual offenders were significantly higher both on the HBI and the SAST than the comparison group. Scores for the sexual offenders were also higher for the BDI and the BAI as compared to the control group, but this difference was not statistically significant. Results indicate that sexual offenders may have sexual addictions and be hypersexual. In addition to depressive and anxious psychopathologies, they also seem to have sexual psychopathologies. These results suggested that the psychopathology of sexual offenders may be different than that of a control group.

Psychotrophic Drug Therapy of the Sexual Offenders or Paraphilia / 대한정신약물학회지

Sexual violence crime causes severe trauma to victim's family as well as the victim, and its aftereffect which is hard to be healed can last for the entire lifetime. And thus plenty of social cost is incurred due to the crime. It has long been reported that paraphilia is associated with sexual offenders and sexual violence. In this study, the previous foreign data on the psychiatric medication used for sexual offender or paraphilia were summarized for the first time in Korea, and the possibility of medication in Korea was examined. As for the drugs used for sexual offender or paraphilia, SSRI was most frequently reported and besides that, tricyclic antidepressant, antipsychotics, antiepileptic drugs, mirtazapine, and naltrexone were reported.

Psychiatric and Psychological Characteristics of Sexual Offenders in Korea / 신경정신의학

OBJECTIVES: In an effort to increase understanding of the relationship between sexual violence and mental illness, we conducted an investigation of the prevalence of psychiatric illness and associated psychological features of sexual offenders. METHODS: Twenty-two male sex offenders were referred for psychiatric diagnosis from the prosecutor's office and admitted to the hospital between August 2010 and May 2011. In order to identify Axis I and II disorders, including sexual disorders, we conducted the Korean version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. All participants completed psychological assessment batteries, including the Korean-Wechsler Adult Intelligence Scale, and self-report scales, including the Barratt Impulsiveness Scale, State-Trait Anger Expression Inventory, and the Rape Myth Acceptance Scale. Information on participants' legal, personal, and psychiatric family histories was also gathered. RESULTS: Many of the participants received diagnosis of Axis I disorders : Eight subjects (36.4%) had paraphilia, and five (22.7%) had pedophilia. Two subjects (9.1%) had schizophrenia, five (22.7%) had depressive disorder, and three (13.6%) had alcohol dependence. Participants also showed high rates of Axis II disorders : four of them (18.2%) had mental retardation or borderline intellectual functioning and seven (31.8%) had cluster B personality disorders. Participants' serum free testosterone level showed statistically significant correlation with motor impulsiveness (p<0.05). CONCLUSION: Sex offenders included in this study displayed high rates of mental illness, including paraphilia and intellectual disability. On the basis of our findings, we asserted that sex offenders should undergo careful evaluation for mental illness, and that management programs for sex offenders should include psychiatric evaluation and intervention.

A Case of an Adolescent with Paraphilia with Depot GnRH Analogue (Goserelin) / 대한정신약물학회지

Paraphilia was a very treatment resistant psychiatric disorder. But new treatment strategies to paraphilia have been introduced recently. We report and review the effect of depot analogue (goserelin) administration in a 18 year-old adolescent with paraphilia. We administered goserelin 3.6 mg/month to him for 3 months, there were changes of scores in Clinical Global Improvement, Sex Addiction Screening Test, Freund Paraphilia Scales.

Transtornos parafílicos em pacientes com transtorno obsessivo-compulsivo: série de casos / Paraphilic disorders among patients with obsessive-compulsive disorder: case series

Com o intuito de elucidar a relação entre transtornos do controle de impulsos (TCI) e transtorno obsessivo-compulsivo (TOC), faz-se mister estudar subgrupos mais clinicamente homogêneos de transtornos impulsivos. Por meio do relato de quatro casos de pacientes com TOC e diferentes tipos de transtornos parafílicos (fetichismo transvético, sadismo, ginandromorfofilia e exibicionismo), são discutidos os conceitos de compulsividade, impulsividade e a relação temporal entre ambos. O estudo dos casos aqui descritos mostra que (1) pacientes com TOC e transtornos parafílicos tendem a desenvolver o TOC primeiro, (2) diante de desejos, fantasias ou atos sexuais parafílicos, pacientes com TOC podem lançar mão de comportamentos tipicamente compulsivos, (3) pacientes com TOC e obsessões sexuais egodistônicas podem desenvolver desejos, fantasias ou atos sexuais parafílicos de conteúdo semelhante ao das obsessões, (4) em um mesmo paciente, TOC e parafilias podem apresentar cursos independentes, e (5) pacientes com TOC e parafilias podem não apresentar obsessões sexuais. O sofrimento de pacientes com TOC e parafilias justifica a investigação continuada de tais condições no intuito de elucidar os mecanismos que subjazem esta associação e de criar estratégias que aumentem a adesão ao tratamento.

In order to elucidate the relationship between impulse control disorders and obsessive-compulsive disorder (OCD), it is essential to study more clinically homogenous subgroups of patients with impulsive disorders. Using four cases of patients with OCD and comorbid paraphilias (transvestic fetishism, sadism, gynandromorphophilia, and exhibitionism) as reference-points, we discuss the concepts of compulsivity, impulsivity, and the temporal relationship between them. The case studies here described suggest that (1) patients with OCD and comorbid paraphilias tend to develop OCD first, (2) once developing paraphilic fantasies, desires, or behaviors, patients with OCD can exhibit typical compulsive behaviors in an attempt to keep these phenomena under control, (3) patients with OCD and ego-dystonic sexual obsessions can develop paraphilic fantasies, desires, or behaviors with similar content to the first phenomenon, (4) OCD and paraphilias can follow independent courses in the same patient, and (5) patients with OCD and paraphilias may not present obsessions with sexual content. The distress presented by patients with OCD and paraphilias give good reason for the continuous investigation of this association, aiming at clarifying the neurobiological mechanisms underlying this association.

Exibicionismo e procedimentos baseados na Terapia de Aceitação e Compromisso (ACT): um relato de caso / Exhibitionism and Acceptance and Commitment Therapy (ACT) procedures: a case report

O presente artigo relata um tratamento de "comportamentos exibicionistas" por meio da aplicação de procedimentos baseados na Terapia de Aceitação e Compromisso (ACT). Atendeu-se um universitário com 24 anos de idade, que vinha apresentando o problema havia oito anos. O cliente procurou atendimento psicológico por decisão própria. A resposta de exibição pública ocorria aproximadamente uma vez ao dia, seguida freqüentemente de masturbação e sentimentos desagradáveis, conforme auto-registro realizado nos primeiros 20 dias de tratamento. Dezesseis sessões foram realizadas, ao longo das quais as respostas de masturbação, pensamentos parafilíacos e de exibição pública tiveram sua freqüência diminuída, de acordo com o auto-registro. Discute-se a contribuição dos procedimentos da ACT em casos de exibicionismo, assim como do envolvimento do cliente em um relacionamento afetivo significativo, na promoção das mudanças clínicas observadas

The objective of this paper is to describe some acceptance based procedures to the treatment ofexhibitionism. The client was a 24 years old student, who looked for psychotherapic treatmentspontaneously. He had been showing exhibitionists responses for eight years. His exhibitionistresponses used to occur once a day followed by masturbation and uncomfortable feelings of guilt -according to the self-records of the first twenty days in treatment. Sixteen sessions were conducted andat the end of them, the masturbation, the paraphiliac thoughts and the public exhibition had theirfrequency reduced to no occurrence in two weeks. This paper discusses the acceptance-basedprocedures to the treatment of exhibitionism, as well as the relevance of a friendship to promote thisparticular clinical change