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Paraphilic disorders, psychopathy, and those who sexually offend: a narrative review of treatment modalities

Abstract

Despite its critical importance, the treatment of paraphilic disorders remains an often-overlooked domain both in clinical research and practice. Challenges have arisen in the morphing understanding of paraphilias and paraphilic disorders, now considered separate concepts, and efforts at developing a more nuanced understanding of these conditions is ongoing, resulting in a muddled history that can frustrate efforts at study and treatment. These populations are by nature more heterogeneous than may first be obvious—particularly among those with comorbid psychopathic traits—and may require a more nuanced and individualized approach based on risk, needs, and responsivity to treatment. Until recently, there were few guidelines to assist clinicians when confronted with these complicated clinical pictures and a sea of discrete studies investigating various biological and non-biological interventions. Treatments range from several variations of psychotherapy and behavioral therapies to SSRIs, anti-androgenic medications, to orchiectomy, all displaying varying degrees of effectiveness and evidence across decades of research. Fortunately, recent efforts to collate these studies supported by a task force of the World Federation of Societies of Biological Psychiatry (WFSBP) have helped form a better-focused and better-evidenced picture of effective treatments and the unique challenges faced by (and with) these populations.

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Fig. 1: Simplified WFSBP algorithm for treatment of paraphilic disorders.

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J.N.S. gathered and reviewed materials for the article and wrote and edited substantial portions of the manuscript. S.H.S. gathered and reviewed materials for the article, wrote, edited, and collated references and designed figures. F.M.S. initiated this project and provided guidance, editing, expert insight, and acted as the corresponding author.

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Correspondence to Seo Ho Song.

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Nicholas Shumate, J., Song, S.H. & Saleh, F.M. Paraphilic disorders, psychopathy, and those who sexually offend: a narrative review of treatment modalities. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00816-z

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