From the Research
The most effective treatment for paraphilia typically involves a combination of psychotherapy and medication, with cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) being the primary approaches. According to the most recent and highest quality study available, 1, the gold standard treatment of severe paraphilias in adult males is antiandrogen treatment with cognitive behavioral therapy.
Treatment Approaches
- Cognitive-behavioral therapy (CBT) helps individuals identify and change harmful thought patterns and behaviors.
- Other effective therapies include relapse prevention strategies, empathy training, and social skills development.
- For medication, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, or paroxetine may reduce sexual urges and compulsive behaviors.
- In more severe cases, particularly for paraphilias involving high risk of harm, anti-androgen medications such as medroxyprogesterone acetate or leuprolide acetate might be prescribed to reduce testosterone levels and decrease sexual drive.
Key Considerations
- Treatment is typically long-term, often continuing for years, and works best when tailored to the individual's specific needs and when the person is motivated to change.
- The goal is not only to prevent harmful behaviors but also to help the person develop healthy sexual interests and relationships.
- Success rates improve when treatment addresses co-occurring mental health conditions like anxiety, depression, or substance use disorders, as noted in studies such as 2, 3, and 4.
Medication Options
- SSRIs have been shown to be effective in reducing paraphilic symptoms, with studies like 2 and 4 supporting their use.
- Antiandrogen treatments, as discussed in 1, are particularly effective in severe paraphilic subjects committing sexual offenses.
- Psychostimulants, as explored in 3, can be cautiously and effectively combined with SSRIs to ameliorate paraphilias and paraphilia-related disorders for specific indications.