Fast Five Quiz: Sexual Interest Disorders (Paraphilias)

Steve Soreff, MD


December 19, 2022

In the treatment of paraphilic disorders, behavioral techniques and dynamic psychotherapy, chemical approaches, and surgical interventions produce mixed results. Ongoing monitoring and lifelong maintenance are often the most realistic approach. Patients with pedophilic disorder must be willing to acknowledge the problem and participate in treatment. When patients are invested in their recovery, the physician can help them develop coping strategies and reduce the intensity of the fantasies. It is important to understand the patient's social context in order to appreciate sources of stress and support.

Pharmacologic interventions may be used to suppress sexual behavior. These treatments may offer genuine help to various patients with paraphilic disorders; however, numerous adverse effects have been reported. Additionally, ethical, medical, and legal questions have been raised regarding issues of informed consent, especially in hospital and prison settings. Medications that may be considered in the treatment of paraphilic disorders include:

  • Antidepressants, such as lithium and various SSRIs;

  • Long-acting gonadotropin-releasing hormones (ie, medical castration), such as leuprolide acetate and triptorelin;

  • Antiandrogens (to lower sex drive), such as medroxyprogesterone acetate (10 mg every 12 hours, with the dosage doubled every 3 days to a maximum of 200 mg/d, then maintained for 1 month and adjusted as necessary);

  • Phenothiazines, such as fluphenazine; and

  • Mood stabilizers.

SSRIs may be prescribed specifically to treat associated compulsive sexual disorders or to induce libido-lowering sexual side effects, or both. The dosages used are higher than those typically administered for depression. Usual dosage ranges for several SSRIs commonly employed in this setting are:

  • Sertraline: 150-200 mg/d

  • Fluoxetine: 20-80 mg/d

  • Fluvoxamine: 200-300 mg/d

  • Citalopram: 20-80 mg/d (caution needed in doses > 40 mg/d given risk for QTc prolongation)

  • Escitalopram: 10-40 mg/d (caution needed in doses > 20 mg/d given risk for QTc prolongation)

  • Paroxetine: 20-60 mg/d

Learn more about treating paraphilias.

This Fast Five Quiz was excerpted and adapted from the Medscape articles Paraphilic Disorders and Sexual Criminality, Paraphilic Disorders, DSM-5 Update: What's New?, Paraphilias, and Assessment Methods and Management of Hypersexuality and Paraphilic Disorders.

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