Disinhibited sexual desire, clinically manifested as hypersexual desire disorders, can be operationally defined by considering three behavioral domains associated with sexual motivation or appetitive behavior: (a) sexual preoccupation (time/day consumed by fantasies, urges, and activities), (b) the repetitive frequency of enacted sexual behavior (total sexual outlet/week), and (c) adverse consequences associated with repetitive sexual behavior. Data are presented suggesting that clinical samples of males with paraphilias, paraphilia-related disorders, and sexual coercion may be associated with disinhibited sexual appetite. These conditions need to be addressed by an integrated combination of psychotherapeutic and psychopharmacologic interventions that specifically target disinhibited sexual appetitive behaviors, their antecedents, and consequences. Although combination therapies (empirically based specific psychotherapies in conjunction with psychopharmacological treatments) have demonstrated superior efficacy in many Axis I psychiatric disorders, such combination therapies to reduce paraphilias, paraphilia-related disorders, and adult sexual coercion are currently underutilized in both North and South America and Europe.
Get full access to this article
View all access options for this article.
References
1.
Abouesh, A., & Clayton, A. (1999). Compulsive voyeurism and exhibitionism: A clinical response to paroxetine . Arch Sex Behav, 28, 23-30 .
2.
American Psychiatric Association. (1994). Sexual and gender identity disorders. In Diagnostic and statistical manual of mental disorders (4th ed., pp. 493-538). Washington, DC: Author .
3.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR (4th ed., text revision). Washington DC: Author .
4.
Atwood, J.D., & Gagnon, J.(1987). Masturbatory behavior in college youth . J Sex Educ Ther, 13, 35-42 .
5.
Beach, F.A.(1942). Analysis of factors involved in the arousal, maintenence and manifestation of sexual excitement in male animals . Psychosom Med, 4, 173-198 .
6.
Berlin, F. S., & Meinecke, C. F. (1981). Treatment of sex offenders with antiandrogenic medication: Conceptualization, review of treatment modalities, and preliminary findings . Am J Psychiatry, 138, 601-607 .
7.
Bianchi, M.(1990). Fluoxetine treatment of exhibitionism [Letter] . Am J Psychiatry, 147, 1089-1090 .
8.
Bradford, J. M. W. (1995). An open pilot study of sertraline in the treatment of outpatients with pedophilia .Paper presented at the 148th annual meeting of the American Psychiatric Association, Miami FL.
9.
Bradford, J.M.W.(2001). The neurobiology, neuropharmacology, and pharmacological treatment of paraphilias and compulsive sexual behavior . Can J Psychiatry, 46, 26-33 .
10.
Bradford, J.M.W., & Pawlak, A.(1993a). Double-blind placebo crossover study of cyproterone acetate in the treatment of the paraphilias . Arch Sex Behav, 22, 383-402 .
11.
Bradford, J.M.W., & Pawlak, A.(1993b). Effects of cyproterone acetate on sexual arousal patterns of pedophiles . Arch Sex Behav, 22, 629-640 .
12.
Brotherton, J. (1974). Effect of oral cyproterone acetate on urinary and serum FSH and LH levels in adult males being treated for hypersexuality . J Reprod Fertil, 36, 177-187 .
13.
Burton, D.L., & Smith-Darden, J.P.(1996). 1996 nationwide survey: A survey of treatment programs & models serving children with sexual behavior problems, adolescent sex offenders, and adult sex offenders. Brandon, VT: Safer Society .
14.
Burton, D. L., & Smith-Darden, J. (2000). North American survey of sexual abuser treatment and models summary data. Brandon, VT: Safer Society .
15.
Cooper, A. J. (1981). A placebo-controlled trial of the antiandrogen cyproterone acetate in deviant hypersexuality . Compr Psychiatry, 22, 458-465 .
16.
Cooper, A. J., Sandhu, S., Losztyn, S., & Cernovsky, Z. (1992). A double-blind placebo controlled trial of medroxyprogesterone acetate and cyproterone acetate with seven pedophiles . Can J Psychiatry, 37, 687-693 .
17.
Davies, T. S. (1974). Cyproterone acetate for male hypersexuality . J Int Med Res, 2, 159-163 .
18.
Ellis, L. (1989). Theories of rape: Inquiries into the causes of sexual aggression. New York: Hemisphere .
19.
Ellis, L. (1991). A synthesized (biosocial) theory of rape . J Consult Clin Psychol, 59, 631-642 .
20.
Emmanuel, N. P., Lydiard, R. B., & Ballenger, J. C. (1991). Fluoxetine treatment of voyeurism [Letter] . Am J Psychiatry, 148, 950 .
21.
Everitt, B.J.(1990). Sexual motivation: A neural and behavioral analysis of the mechanisms underlying appetitive and copulatory responses of the male rat . Neurosci Biobehav Rev, 14, 217-232 .
22.
Everitt, B.J.(1995). Neuroendocrine mechanisms underlying appetitive and consummatory elements of masculine sexual behavior. In J. Bancroft (Ed.), The pharmacology of sexual function and dysfunction (pp. 15-31). Amsterdam: Elsevier .
23.
Federoff, J. P., Wisner-Carlson, R., Dean, S., & Berlin, F. S. (1992). Medroxy-progesterone acetate in the treatment of paraphilic sexual disorders . J Offender Rehabil, 18, 109-123 .
24.
Firestone, P., Bradford, J. M., McCoy, M., Greenberg, D. M., Larose, M. R., & Curry, S. (1999). Prediction of recidivism in incest offenders . J Interpersonal Viol, 14, 511-531 .
25.
Gabbard, G. O., & Kay, J. (2001). The fate of integrated treatment: Whatever happened to the biopsychosocial psychiatrist . Am J Psychiatry, 158, 1956-1963 .
26.
Gagné, P. (1981). Treatment of sex offenders with medroxyprogesterone acetate . Am J Psychiatry, 138, 644-646 .
27.
Geaudreau, P., Little, T., & Goggin, C. (1996). The meta-analysis of predictors of adult offender recidivism: What works? Criminology, 34, 575-607 .
28.
Greenberg, D.M., & Bradford, J.M.W.(1997). Treatment of the paraphilic disorders: A review of the role of the selective serotonin reuptake inhibitors . Sexual Abuse: Journal of Treatment and Research, 9, 349-360 .
29.
Greenberg, D.M., Bradford, J.M.W., Curry, S., & O'Rourke, A.(1996). A comparison of treatment of paraphilias with three serotonin reuptake inhibitors: A retrospective study . Bull Am Acad Psychiatry Law, 24, 525-532 .
30.
Hall, G.C.N.(1995). Sexual offender recidivism revisited: A meta-analysis of recent treatment studies . J Consult Clin Psychol, 63, 802-809 .
31.
Hall, G.C.N., & Hirschman, R.(1991). Toward a theory of sexual aggression: A quadripartite model . J Consult Clin Psychology, 59, 662-669 .
32.
Hanson, R.K., & Bussiere, M.T.(1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies . J Consult Clin Psychol, 66, 348-362 .
33.
Hanson, R., & Harris, A. (2000). Where should we intervene? Dynamic predictors of sexual offense recidivism . Crim Justice Behav, 27, 6-35 .
34.
Hudson, S. M., & Ward, T. (1997). Rape: Psychopathology and Theory. In D. R. Laws & W. O'Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp.332-355). New York: Guilford .
35.
Kafka, M. P. (1991a). Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men . J Clin Psychiatry, 52, 60-65 .
36.
Kafka, M. P. (1991b). Successful treatment of paraphilic coercive disorder (a rapist) with fluoxetine hydrochloride . Br J Psychiatry, 158, 844-847 .
Kafka, M.P.(1994b). Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders; an open trial . Ann Clin Psychiatry, 6, 189-195 .
39.
Kafka, M.P.(1997). Hypersexual desire in males: An operational definition and clinical implications for men with paraphilias and paraphilia-related disorders . Arch Sex Behav, 26, 505-526 .
40.
Kafka, M.(2001).Paraphilias and paraphilia-related disorders. In G. O. Gabbard (Ed.), Treatments of psychiatric disorders (Vol.2, pp.1951-1979). Washington, DC: American Psychiatric Publishing .
41.
Kafka, M. P., & Hennen, J. (1999). The paraphilia-related disorders: An empirical investigation of nonparaphilic hypersexuality disorders in 206 outpatient males . J Sex Marital Ther, 25, 305-319 .
42.
Kafka, M., & Hennen, J. (2002). A DSM IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders . Sexual Abuse, 14, 349-366 .
43.
Kafka, M.P., & Hennen, J.(2003). Hypersexual desire in males: Are males with paraphilias different from males with paraphilia-related disorders. Manuscript submitted for publication.
44.
Kafka, M. P., & Prentky, R. (1992). Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men . J Clin Psychiatry, 52, 351-358 .
45.
Kafka, M. P., & Prentky, R. A. (1998). Attention Deficit Hyperactivity Disorder in males with paraphilias and paraphilia-related disorders: A comorbidity study . J Clin Psychiatry, 59, 388-396 .
46.
Kaplan, H. S. (1988). Anxiety and sexual dysfunction . J Clin Psychiatry, 49 (Suppl. 10), 21-25 .
47.
Kaplan, H.S.(1995). The sexual desire disorders: Dysfunctional regulation of sexual motivation. New York: Brunner/Mazel .
48.
Kinsey, A.C., Pomeroy, W.B., & Martin, C.E.(1948).Total sexual outlet. In Sexual behavior in the human male (pp. 193-217). Philadelphia: W. B. Saunders .
49.
Knight, R., & Cerce, D. (1999). Validation and revision of the Multidimensional Assessment of Sex and Aggression . Psycholigica Belgica, 39, 135-161 .
50.
Knight, R., & Prentky, R. A. (1987). The developmental antecedants and adult adaptations of rapist subtypes . Crm Justice Behav, 14, 403-426 .
51.
Knight, R.A., & Prentky, R.A.(1990).Classifying sex offenders: The development and corroboration of taxonomic models. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and the treatment of offenders (pp. 23-52). New York: Plenum .
52.
Knight, R. A., & Prentky, R. A. (2002). The role of sexual motivation in sexually coercive behavior. Manuscript submitted for publication.
53.
Kravitz, H. M., Haywood, T. W., Kelly, J., Liles, S., & Cavanaugh, J. L. (1996). Medroxyprogesterone and paraphiles: Do testosterone levels matter? Bull Am Acad Psychiatry Law, 24, 73-83 .
54.
Krueger, R.B., & Kaplan, M.S.(2001). Depot-leuprolide for treatment of paraphilias: A report of 12 cases . Arch Sex Behav, 30, 409-422 .
55.
Kruesi, M. J. P., Fine, S., Valladares, L., Phillips, R. A., & Rapoport, J. L. (1992). Paraphilias: A double-blind crossover comparison of clomipramine versus desipramine . Arch Sex Behav, 21, 587-593 .
56.
Langevin, R., Paitich, D., Hucker, S., Newman, S., Ramsay, G., Pope, S., et al. (1979). The effect of assertiveness training, provera and sex of therapist in the treatment of genital exhibitionism . J Behav Ther Exp Psychiatry, 10, 275-282 .
57.
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press .
58.
Levin, R.J.(1994).Human male sexuality: Appetite and arousal, desire and drive. In C. R. Legg & D. Booth (Eds.), Appetite: neural and behavioral bases (pp.128-164). Oxford, UK: Oxford University Press .
59.
Lieblum, S.R., & Rosen, R.C.(1988).Introduction: Changing perspectives on sexual desire. In S. R. Lieblum & R. C. Rosen (Eds.), Sexual desire disorders (pp. 1-20). New York: Guilford .
60.
Lorefice, L. S. (1991). Fluoxetine treatment of a fetish [Letter] . J Clin Psychiatry, 52, 41 .
61.
MacPhee, D.C., Johnson, S.M., & Van Der Ver, M.M.C.(1995). Low sexual desire in women: The effects of marital therapy . J Sex Marital Ther, 21, 159-182 .
62.
Malamuth, N., Knight, R., & Prentky, R. (1995, October 11-14). A unified developmental theory of sexual aggression: Models in the making .Paper presented at the 14th annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, New Orleans, LA.
63.
Malamuth, N.M., Sockloskie, R.J., Koss, M.P., & Tanaka, J.S.(1991). Characteristics of aggressors against women: Testing a model using a national sample of college students . J Consult Clin Psychol, 59, 670-681 .
64.
Maletzky, B. M. (1991). The use of medroxyprogesterone acetate to assist in the treatment of sexual offenders . Ann Sex Res, 4, 117-129 .
65.
Marshall, W.L., & Barbaree, H.E.(1990).An integrated theory of the etiology of sexual offending. In W. L. Marshall, D. R. Laws, & H. E. Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 257-275). New York: Plenum .
66.
Mas, M.(1995). Neurobiological correlates of masculine sexual behavior . Neurosci Biobehav Rev, 19, 261-277 .
67.
McKenna, K.(1999). The brain is the master organ in sexual function: Central nervous system control of male and female function . Int J Impotence Res, 11 (Suppl. 1), S48-S55 .
68.
Meyer, W. J., Collier, C., & Emory, E. (1992). Depoprovera treatment for sex offending behavior: An evaluation of outcome . Bull Am Acad Psychiatry Law, 20, 249-259 .
69.
Orford, J.(1978). Hypersexuality: Implications for a theory of dependence . Brit J Addiction, 73, 299-310 .
70.
Perilstein, R. D., Lipper, S., & Friedman, L. J. (1991). Three cases of paraphilias responsive to fluoxetine treatment . J Clin Psychiatry, 52, 169-170 .
71.
Pfaus, J. G. (1996). Homologies of animal and human sexual behaviors . Hormones Behav, 30, 187-200 .
72.
Prentky, R. A. (1997). Arousal reduction in sexual offenders: A review of antiandrogenic interventions . Sexual Abuse: A Journal of Research and Treatment, 9, 335-348 .
73.
Prentky, R.A., & Burgess, A.W.(2000). Prediction. In Forensic management of sexual offenders (pp. 99-142). New York: Plenum .
74.
Prentky, R.A., & Knight, R.A.(1991). Identifying critical dimensions for discriminating among rapists . J Clin Consult Psychol Forensic Management of Sexual Offenders, 59, 643-661 .
75.
Quinsey, V.(1995). The prediction and explanation of criminal violence . Int J Law Psychiatry Forensic Management of Sexual Offenders, 18, 117-127 .
76.
Rosler, A., & Witztum, E. (1998). Treatment of men with paraphilia with a long-acting analogue of gonadotropin-releasing hormone . New England Journal of Medicine, 338, 416-422 .
77.
Schiavi, R.C.(1992). Interview, psychometric, and psychophysiologic strategies to assess sexual disorders . J Clin Psychiatry, 53(Monograph 10).
78.
Schreiner-Engel, P.(1989).Low sexual desire: Biological implications. In A. J. Stunkard & A. Baum (Eds.), Perspectives in behavioral medicine: Eating, sleeping, sex (pp. 195-202). Hillsdale, NJ: Lawrence Erlbaum .
79.
Schreiner-Engel, P., & Schiavi, R.C.(1986). Lifetime psychopathology in individuals with low sexual desire . J Nerv Ment Dis, 174, 646-651 .
80.
Seto, M. C., & Barbaree, H. E. (1997). Sexual aggression as antisocial behavior. In D. M. Stoff, J. Breiling, & J. D. Maser (Eds.), Handbook of antisocial behavior (pp.524-533). New York: John Wiley .
81.
White, P., Bradley, C., Ferriter, M., & Hatzipetrou, L. (2000). Managements for people with disorders of sexual preference and for convicted sexual offenders . Cochrane Database Syst Rev, 2, CD000251 .
82.
Zohar, J., Kaplan, Z., & Benjamin, J. (1994). Compulsive exhibitionism successfully treated with fluvoxamine: A controlled case study . J Clin Psychiatry, 55, 86-88 .
