Vol. 3, No. 4, 1997 Page 5 |
SEXUAL DEVIANCY: NEW CLUES ABOUT
CAUSES, TREATMENTS
Prisoners arrested for pedophilia, exhibitionism or other sexually
deviant acts often receive psychotherapy-an approach which
unfortunately does little to stop them from re-offending. A new report
on paraphilias (socially deviant, repetitive, arousing sexual
fantasies, urges, and activities) suggests that medical approaches may
be far more effective in treating sexual deviancy.
Martin Kafka, who notes that individuals with paraphilias generally
exhibit multiple sexual impulsivity disorders, theorizes that such
disorders involve abnormalities of the brain chemicals serotonin,
dopamine, and norepinephrine, collectively known as monoamines. Among
the evidence he cites:
- Depleting central [brain] serotonin in rats causes them to exhibit
"compulsive" sexual behavior.
- The sexual behavior of castrated male rats can be restored with a
combination of low-dose testosterone and a serotonin-reducing drug,
while low doses of testosterone alone fail to restore sexual activity.
- Yohimbine and idozoxan, drugs that enhance norepinephrine's
activity, facilitate the sexual behavior of rats, while drugs that
reduce norepinephrine's activity have the opposite effect.
- Drugs that blockade dopamine receptors can abolish all sexual
behavior in male rats, while drugs that increase dopamine's effects
enhance copulatory behavior in male rats.
While it's easier to study sexual behavior in rats than in humans,
Kafka says that existing human research also points to monoamines as a
factor in paraphilias. For instance, he notes, Prozac and other
serotonin-enhancing drugs "have been reported to produce a high
frequency of human sexual dysfunction side effects including the
cluster of loss of sexual desire and impaired copulatory response in
males"-an indication that high serotonin levels in the brain can
inhibit sexual desire and performance. Drugs that blockade dopamine
receptors decrease sexual appetite, while dopamine enhancing drugs such
as L-DOPA can lead to increased sexual desire.
Because testosterone and other sex hormones affect levels of
monoamines, Kafka says, "it is most likely that hormones and monoamine
neurotransmitters interact in a dynamic fashion that determines the
form and intensity of drive behaviors, including sexual behavior."
Pointing to the high incidence of depression, anxiety, impulsivity,
compulsiveness, and aggression in paraphilics, Kafka notes that reduced
serotonin levels are linked to all of these behavior abnormalities. He
also notes that alterations in norepinephrine have been reported in
sensation-seeking individuals.
If Kafka's theory is correct, drug therapies that alter monoamine
levels should lead to changes in paraphilic behavior. Indeed, Kafka
says, studies show that drugs that alter monoamine levels can alter
sexually deviant behavior. Among research findings:
- A double-blind, placebo-controlled crossover study found that both
clomipramine (a serotonin-enhancing drug) and desipramine (a
norepinephrine-enhancing drug) helped reduce paraphilic behavior.
- Several case studies and two open trial studies indicate that Prozac
reduces paraphilic behavior. While Prozac is most often used to treat
depression, and many of the treated paraphilics had co-existing
depression, Kafka says that "a positive treatment response was
independent of baseline depression rating."
- In a 12-week open trial of sertraline, another serotonin-enhancing
drug, researchers reported decreased pedophilic fantasies and other
deviant behaviors among personality disordered pedophiles taking the
drug.
While Kafka says more research is needed, he believes "the most
recent data [suggest] that serotonergic agents may represent a
contemporary advance in the treatment of deviant sexuality."
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"A monoamine hypothesis for the pathophysiology of paraphilic
disorders," Martin P. Kafka, Archives of Sexual Behavior, Vol. 26, No. 4, 1997. Address: Martin P. Kafka, McLean Hospital, 115 Mill Street,
Belmont, MA 02178.