The Neurobiology, Neuropharmacology, and Pharmacological Treatment of the Paraphilias and Compulsive Sexual Behaviour

Abstract

There has been in creas ing in ter est in the treat ment of sex ual dis or ders in re cent years. Sex ual dis or ders are clas si fied in DSM-IV as sex ual dysfunctions, paraphilias, and gen der iden tity dis or ders. The sex ual dysfunctions are nondeviant or nonparaphillic. The sex ual dys func tion dis or ders should in clude “hy per ac tive sex ual de sire dis or der” un der sex ual de sire dis or ders. Fur ther, there should be a speci fier for paraphilias of “with hypersexuality” or “with out hypersexuality.” There is still in com plete un derstand ing of the neurobiology of sex ual dis or ders al though func tional neuroanatomy and neoropharmcological re search has e xposed the neurotransmitters, receptors, and hormones that are in volved in sex ual de sire. Vari ous pharmacological agents in clud ing se ro to nin reuptake in hib i tors, antiandrogens, LHRH agonists, and oth ers have been doc u mented as re duc ing sex ual de sire. An al go rithm for the use of these drugs in the treat ment of the paraphilias as well nonparaphilic hypersexuality is out lined. The modes of ac tion, dos ages, aims of treat ment, and usual meth ods of pre scrib ing these agent s is re viewed in this ar ti cle. Some fu ture di rec tions of re search in phar ma co log i cal treat ment is also dis cussed.