Medications may be used in conjunction with psychotherapy. Such medications include antiandrogens (to lower sex drive), medroxyprogesterone acetate (Provera) and leuprolide acetate (Lupron). Selective serotonin reuptake inhibitors (SSRIs) may be prescribed to treat associated compulsive sexual disorders and/or to gain benefit from libido-lowering sexual side effects. Higher doses than are typically administered for depression are usually used. These include sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), and paroxetine (Paxil).
Intensity of sex drive is not consistently related to the behavior of paraphiliacs and high levels of circulating testosterone do not predispose a male to paraphilias. Hormones such as medroxyprogesterone acetate and cyproterone acetate decrease the level of circulating testosterone thereby reducing sex drive and aggression. These hormones reduce the frequency of erections, sexual fantasies, and initiations of sexual behaviors including masturbation and intercourse. Hormones are typically used in tandem with behavioral and cognitive treatments. Antidepressants such as fluoxetine have also successfully decreased sex drive but have not effectively targeted sexual fantasies.
Research suggests that cognitive-behavioral models are effective in treating paraphiliacs. Such models may include aversive conditioning, confrontation of cognitive distortions which is especially effective in groups, victim empathy (show videos of victims and consequences to victims), assertiveness training (social skills training, time management, structure), relapse prevention (identifying antecedents to the behavior [high-risk situations] and how to disrupt antecedents), surveillance systems (family associates who help monitor patient behavior) and lifelong maintenance.
Aversive conditioning involves using negative stimuli to reduce or eliminate a behavior. One such therapy is covert sensitization which involves the patient relaxing and visualizing scenes of deviant behavior followed by a negative event such as getting his penis stuck in the zipper of his pants. Assisted aversive conditioning is similar to covert sensitization except the negative event is real, such as in the form of a foul odor pumped in the air by the therapist. The goal is for the patient to associate the deviant behavior with the foul odor. Aversive behavioral reversal is commonly known as "shame therapy;" the goal is to humiliate the offender into ceasing the deviant behavior. For example, the offender might watch videotapes of their crime with the goal that the experience will be distasteful and offensive to the offender.
There are positive conditioning approaches that center on social skills training and alternate, more appropriate behaviors. Reconditioning, for example, is giving the patient immediate feedback, which may help him change his behavior. For instance, a person might be connected to a biofeedback machine connected to a light, he is taught to keep the light within a specific range of color while he is exposed to sexually stimulating material.
Cognitive therapies include restructuring cognitive distortions and empathy training. Restructuring cognitive distortions involves correcting a pedophile's thoughts that the child wishes to be involved in the activity. A pedophile observing a young girl wearing shorts may erroneously think, "she wants me." Empathy training involves helping the offender take on the perspective of the victim and to identify with the victim and understand the harm.
The prognosis for pedophilia is difficult to determine. For pedophiles, these longstanding sexual fantasies about children can be very difficult to change. The practitioner can attempt to reduce the intensity of pedophiliac fantasies and develop coping strategies for the abuser but they must be willing to recognize that a problem exists and be willing to participate in treatment which is not always the case. Dynamic psychotherapy, behavioral techniques, chemical approaches, and surgical interventions yield mixed results. Lifelong maintenance may be a pragmatic and realistic approach.
Pedophilia. Last reviewed 06/06/2010
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