Pharmacological Treatments for Compulsive Sexual Behaviors Among Offending Individuals

Even if the prevalence of hypersexuality in paraphiliacs or paraphilic disorders is close to the prevalence reported in the general population, it remains a risk factor for sexual offense for many authors. We will review common risk factors between hypersexuality and paraphilic disorders as well as the comorbidity between both disorders, especially in sexual offenders. Then, we will report pharmacological treatment studies conducted in paraphilic disorders with hypersexuality and make some treatment recommendations.

Although the neurobiology and neuropharmacology of sexual behavior remain unclear, there has been significant research that aims to highlight the neuronal circuits and neurotransmitters involved in sexual disorders such as paraphilic disorders and hypersexuality.

Pharmacological treatment of sex offenders with paraphilic disorders should follow the principles of the risk-needs responsivity model, meaning that the higher the risk, the more intensive the proposed therapeutic approach. The criminogenic needs addressed by pharmacological treatments are paraphilias/paraphilic disorders (mostly pedophilic and sadistic disorders) and hypersexuality. Pharmacological treatment of sex offenders with paraphilic disorders should be part of a more comprehensive treatment plan including psychotherapy (mostly behavior therapy). In this review, we will propose treatment guidelines for patients with comorbid paraphilic disorders and hypersexuality. The challenge for future research is to improve our understanding of these disorders and their complex relationships in order to propose new pharmacological targets or new techniques such as non-invasive brain stimulation. The ultimate goal of clinicians is to prevent sexual offenses in these patients.