The Management of Sex Offenders: Perspectives for Psychiatry

Abstract

In the effort to identify and manage sex offenders, the differences between legal and medical/psychiatric terminology and approaches are readily apparent. This article discusses the different definitions and approaches of the two fields and considers both the behaviors that create risk to others and the strategies for reducing that risk. Particular attention is paid to the subcategory of paraphilic sex offenders. Treatment goals, modalities, and efficacies are discussed, as are evolving legal strategies for risk control and the need for interaction between law and medicine/psychiatry in order to accomplish common goals of risk management.

Understanding service users’ and therapists’ experiences of pharmacological treatment for sexual preoccupation and/or hypersexuality in incarcerated sex offenders

“…The increased effectiveness of this combination in comparison to mono-therapy, is supported in the literature (e.g. Saleh et al, 2010;Guay, 2009).…”

“…Furthermore, if sexual urges or thoughts are particularly intense, this can impact upon individuals' ability to focus/participate in treatment programmes, and their ability to apply techniques to manage their sexual preoccupation (Marshall et al, 2006;Saleh, Grudzinskas, Malin & Dwyer, 2010). …”

“…This treatment 'gap' has spawned the use of pharmacological interventions in the treatment of sexual offenders to diminish deviant sexual fantasies, urges and behaviours (Bourget & Bradford, 2008), and facilitate learning within psychological treatment programmes (Saleh et al, 2010). In 2007, protocols were established within the UK to allow the pharmacological treatment of sexual offenders (within the care of the prison or probation service) on a voluntary basis.…”

Combination of Psychiatric and Psychological Approaches in the Assessment and Treatment of Sexual Offenders

“…9 Anti-androgen has been used to reduce deviant sexual thoughts or fantasies and to aid engagement in psychological programmes. 10 It serves to lower testosterone and hence sexual drive, aggression, violent behaviour, and recidivism in sexual offending. 11,12 There is a threshold level of testosterone below which sexual arousal is substantially reduced.…”

Prolonged flare‐up of testosterone after administration of a gonadotrophin agonist to a sex offender: an under‐recognised risk?

“…The main treatment for paraphilias is psychotherapy, with androgen suppression in certain patients, variously using steroidal or non‐steroidal anti‐androgens, GnRH analogues or GnRH antagonists (Saleh et al, ; Gooren, ). An infrequent but potentially lethal side effect of GnRH analogues is pituitary apoplexy, a clinical syndrome caused by infarction and/or haemorrhage of the pituitary gland.…”