Aggression · Sex-related issues · Uncategorized

Paraphilia: sexuality gone wrong

The term “paraphilia” is a psychiatric term used to describe abnormal sexual impulses that are socially deviant or harmful.  Paraphilias aren’t just taboo.  They’re disruptive.  They’re problematic.  There are many different types, including fetishism (unhealthy interest in nonsexual objects), masochism (arousal through injury), sadism (arousal by hurting others against their will), exhibitionism (flashing), voyeurism (peeping tom), pedophilia (interest in children), and others.

I work at a state psychiatric facility, and most state facilities house forensic patients.  Not all  my patients are “criminally insane,” if that’s what you want to call them, but the number is quite high.  We have murderers.  We have rapists too.  Whether they’re pre-trial or Not Guilty by Reason of Insanity (NGRI), it’s my job to meet the individual where they are and help them find the right direction.  I need to treat them.

Aberrant sexual behaviors are perhaps the one crime that isn’t forgivable.  Society is willing to look past theft, drug trafficking, assault, even murder.  However, once you’re a registered sex offender, you’re marked as a “bad person,” and the task is to keep the world safe from you. 

But can sex offenders be treated?  Can people with paraphilias change their ways?  I talked to a forensic psychiatrist a few days ago about this issue; she specializes in helping people with sexual deviance, and her response was an absolute and informed “yes.”  People can be rehabilitated, she insisted. 

Whether you’re convinced treatment is effective or not, the typical question that follows usually addresses the nature of treatment.   How do you rehabilitate a rapist?  Here’s an overview:

1-LEGAL PRESSURE JUMPSTARTS AND MAINTAINS TREATMENT – Legal pressure is often the only motivating factor to ensure treatment participation.  Most sex offenders don’t seek help until they’re legally bound by probation or prison sentence.  

2-MEDICATIONS INHIBIT LIBIDO – Treatment for sex offenders includes medications to blunt the sex drive.  Antidepressants like Prozac, Zoloft, Effexor, or a tricyclic are effective at decreasing libido and causing erectile dysfunction. Other medications we frequently choose include antipsychotics like Haldol or Risperidone, anti-androgenous treatment (birth control pills and injections), and Naltrexone.  Sometimes it takes very high doses to get good effect. Medications are usually combined with therapy.


AVERSIVE CONDITIONING –Aversive conditioning is a kind of punishment.  It’s a therapy that links people’s “demon” with a painful or negative experience.  Because of the negative association, the patient learns to avoid this part of themselves.  Zapping someone with electricity each time they think about inappropriate sexual behaviors eventually teaches the person not avoid those thoughts.  

POSITIVE CONDITIONING – this is the opposite of aversive conditioning.  People are taught new, healthier ways of dealing with their urges.  They learn how to separate their sexuality from the paraphilia.

EMPATHY TRAINING – this involves teaching sex offenders to identify with and understand their victims; that is, to understand the harm that has been done.

       OTHER THERAPIES – Cognitive therapy and insight-oriented therapy have also been suggested to be helpful in treating paraphilias.   

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