Vol. 3, No. 4, 1997 Page 5


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:

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:

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."


"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.

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