Sexual Violence: Pharmacological Treatment
Surgical Castration
Biological basis = Sex offending dependent on sexual fantasies, sex drive, sexual
arousal and sexual functioning (Grubin, 2018)
Castration (orchidectomy) used for centuries in controlling animal sexual behaviour
and aggressive tendencies
- Evidence of use with sex offenders in Texas and Czech Republic, but abolished in
Germany in 2017 (Grubin, 2018)
Pharmacological Treatment
Recommendation = to be use as part of a comprehensive treatment plan, often inc.
psychological therapies (Thibaut et al., 2016)
- Although successful treatment requires psychological change, medication that
helps an individual to manage their arousal can be an important adjunct to
psychological therapies (Grubin, 2018)
Implementation somewhat unclear (see Turner et al., 2019 for a review).
- Few countries/states have legislation for this
- Can be mandatory/voluntary – and sometimes a condition of parole
- None specific should be using in conjunction with treatment – or arrangements
for monitoring side effects
World Federation of Societies of Biological Psychiatry (WFSBP)
- Hierarchy of drugs to be used with individuals with ‘paraphilic interests’ who are
deemed risky (Thibaut et al., 2016)
st
1 = Selective serotonin-reuptake inhibitors (SSRIs)
2nd = Steroidal antiandrogens (cyproterone acetate (CPA) or medroxyprogesterone
acetate (MPA))
3rd = Gonadotropin-releasing hormone agonists (GnRH agonists).
- Steroidal antiandrogens and GnRH agonists lead to a considerable decrease in
serum testosterone - collectively referred to as androgen-deprivation therapy
(ADT)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Increases concentration of serotonin in brain
- Neurotransmitter related to mood, impulsivity, eating, sleeping and sexual
activity (amongst other things)
- Commonly prescribed for depression, anxiety, OCD, etc.
In sex offenders, SSRIs reduce sex drive in some (not predictable)
- Aim is to reduce intensity of sexual fantasies (not physical arousal)
- Enabling offender to control them better, e.g. by using skills learnt in
psychological therapies
Anti-Libidinal Medication
Reduce testosterone levels to those found in pre-pubescent boys
Mostly affects libido/interest rather than sexual function
- There is less spontaneous interest in sex but most (not all) can experience
physical arousal with stimulation.
Surgical Castration
Biological basis = Sex offending dependent on sexual fantasies, sex drive, sexual
arousal and sexual functioning (Grubin, 2018)
Castration (orchidectomy) used for centuries in controlling animal sexual behaviour
and aggressive tendencies
- Evidence of use with sex offenders in Texas and Czech Republic, but abolished in
Germany in 2017 (Grubin, 2018)
Pharmacological Treatment
Recommendation = to be use as part of a comprehensive treatment plan, often inc.
psychological therapies (Thibaut et al., 2016)
- Although successful treatment requires psychological change, medication that
helps an individual to manage their arousal can be an important adjunct to
psychological therapies (Grubin, 2018)
Implementation somewhat unclear (see Turner et al., 2019 for a review).
- Few countries/states have legislation for this
- Can be mandatory/voluntary – and sometimes a condition of parole
- None specific should be using in conjunction with treatment – or arrangements
for monitoring side effects
World Federation of Societies of Biological Psychiatry (WFSBP)
- Hierarchy of drugs to be used with individuals with ‘paraphilic interests’ who are
deemed risky (Thibaut et al., 2016)
st
1 = Selective serotonin-reuptake inhibitors (SSRIs)
2nd = Steroidal antiandrogens (cyproterone acetate (CPA) or medroxyprogesterone
acetate (MPA))
3rd = Gonadotropin-releasing hormone agonists (GnRH agonists).
- Steroidal antiandrogens and GnRH agonists lead to a considerable decrease in
serum testosterone - collectively referred to as androgen-deprivation therapy
(ADT)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Increases concentration of serotonin in brain
- Neurotransmitter related to mood, impulsivity, eating, sleeping and sexual
activity (amongst other things)
- Commonly prescribed for depression, anxiety, OCD, etc.
In sex offenders, SSRIs reduce sex drive in some (not predictable)
- Aim is to reduce intensity of sexual fantasies (not physical arousal)
- Enabling offender to control them better, e.g. by using skills learnt in
psychological therapies
Anti-Libidinal Medication
Reduce testosterone levels to those found in pre-pubescent boys
Mostly affects libido/interest rather than sexual function
- There is less spontaneous interest in sex but most (not all) can experience
physical arousal with stimulation.
