psychiatric disorders
Pedophilic Disorder
Treatment of Pedophilic Disorder
Individual and/or group psychotherapy Treatment of comorbid disorders Pharmacologic therapy (eg, antiandrogens, selective serotonin reuptake inhibitors [SSRIs]) Long-term individual or group psychotherapy, particularly cognitive-behavioral therapy, is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and psychiatric disorders, and pharmacologic therapy. Treatment of pedophilia is less effective when court ordered, although many adjudicated sex offenders have benefited from treatments, such as group psychotherapy plus antiandrogens. Some clinics that have treated self-referred and court-ordered patients have accumulated long-term follow-up studies using phallometric monitoring. They have reported substantial improvements with treatment over the long term with low recidivism rates ( Treatment references ). Some pedophiles who are committed to treatment and monitoring can refrain from pedophilic activity and can be reintegrated into society. These results are more likely when no other psychiatric disorders, particularly Overview of Personality Disorders , are present. In the United States, the treatment of choice for pedophilia is Depotmedroxyprogesteroneacetate By blocking pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH),medroxyprogesteronereducestestosteroneproduction and thus reduces libido. ( Treatment references ). However, the cost is usually considerably higher. Cyproterone acetate, which blockstestosteronereceptors, is used in Europe. Serumtestosteroneshould be monitored and maintained in the normal female range (<62 ng/dL [2.15 nmol/L]) in male patients. Treatment is usually long-term because pedophilic fantasies usually recur weeks to months after treatment is stopped. Liver tests should be done, and blood pressure, bone mineral density, and complete blood count should be monitored as required. The usefulness of antiandrogens in female pedophiles is less well established. In addition to antiandrogens, limited data suggest that SSRIs may be useful ( Treatment references ). Medications are most effective when used as part of a multimodal treatment program that involves cognitive-behavioral therapy. 1.Federoff JP: Pedophilia: Interventions that work.Psychiatric Times33(7): 2016. 2.Hall RCW, Hall RCW: A profile of pedophilia: Definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues.Mayo Clin Proc82(4):457-471, 2007. doi: 10.4065/82.4.457 