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Journal of the National Medical... Sep 1960
Topics: Exhibitionism; Humans; Paraphilic Disorders
PubMed: 13736482
DOI: No ID Found -
Personality and Individual Differences Jul 2021Narcissism can manifest in a grandiose form - admiration-seeking, exhibitionism, and dominance - or a vulnerable form - anxiety, withdrawal, and hypersensitivity. While...
Narcissism can manifest in a grandiose form - admiration-seeking, exhibitionism, and dominance - or a vulnerable form - anxiety, withdrawal, and hypersensitivity. While grandiose narcissism is conceptually in line with an independent self-construal, as prevalent in Western countries, the vulnerable form can be assumed to relate more to an interdependent self-construal, as prevalent in Eastern countries. We studied both forms of narcissism in Germany and Japan (s = 258, 280), which differ fundamentally in their independent and interdependent self-construal, yet are similar regarding global developmental standards. We tested whether (1) mean differences in both narcissism forms would conform to the predominant self-construal, (2) self-construal would explain variance in narcissism beyond broad personality traits, and (3) there would be stronger mental health tradeoffs for culturally incongruent forms of narcissism. Our results largely confirm these expectations for vulnerable narcissism, which is (1) more prevalent in Japan than Germany, (2) related to self-construal beyond broad traits, and, (3) more strongly related to mental health problems in Germany than Japan. For grandiose narcissism, data analyses indicated that construct equivalence can only be assumed for the entitlement factor, and internal structure and nomological networks differ substantially between cultural contexts.
PubMed: 34285424
DOI: 10.1016/j.paid.2021.110716 -
The Israel Journal of Psychiatry and... 2012The psychiatrist's main role is to provide care to the paraphilic patient and to reduce personal distress. However, in cases of paraphilia associated with sexual... (Review)
Review
BACKGROUND
The psychiatrist's main role is to provide care to the paraphilic patient and to reduce personal distress. However, in cases of paraphilia associated with sexual offences, reducing paraphilic behavior is critical in an approach to preventing sexual violence and reducing victimization. This review will focus on this specific population.
METHOD
We discuss the recently published recommendations for the treatment of paraphilias of the World Federation of Societies of Biological Psychiatry which were based on a review of the available literature about pharmacological treatment of paraphilias (1970-2010).
RESULTS AND CONCLUSION
Antiandrogens, and mostly GnRH analogues, significantly reduce the intensity and frequency of deviant sexual arousal and behavior, although informed consent is necessary in all cases. GnRH analogue treatment constitutes the most promising treatment for sex offenders at high risk of sexual violence, such as pedophiles or serial rapists. SSRIs remain an interesting option in adolescents, in patients with depressive or OCD disorders, or in mild paraphilias such as exhibitionism. Pharmacological interventions should be part of a more comprehensive treatment plan including psychotherapy and, in most cases, behavior therapy.
Topics: Adolescent; Adult; Gonadotropin-Releasing Hormone; Humans; Paraphilic Disorders; Practice Guidelines as Topic; Selective Serotonin Reuptake Inhibitors; Sex Offenses
PubMed: 23585467
DOI: No ID Found -
Self and Identity : the Journal of the... 2021Previous research has shown that narcissistic traits such as exploitativeness, exhibitionism, and entitlement are associated with delinquency and aggression in childhood...
Previous research has shown that narcissistic traits such as exploitativeness, exhibitionism, and entitlement are associated with delinquency and aggression in childhood and adolescence. However, there is a paucity of longitudinal research examining these associations, and virtually no research examining other problem behaviors such as drug use and early sexual behavior. In this study, we extended previous research by testing whether two facets of narcissism, exploitativeness and superiority, assessed at age 14, predicted problem behaviors at age 16, while controlling for problem behaviors at age 14. We applied two-part count models to data from a longitudinal study of 674 Mexican-origin adolescents living in the United States followed over a two-year period from age 14 to 16. Adolescents with higher exploitativeness levels at age 14 were more likely to engage in drug use, commit delinquent acts, have sexual intercourse, and exhibit symptoms of conduct disorder at age 16, compared to adolescents with lower exploitativeness levels. Superiority had almost no associations with problem behaviors. Thus, exploitativeness may be one personality risk factor that underlies the development of multiple forms of problem behaviors in adolescence.
PubMed: 33716582
DOI: 10.1080/15298868.2019.1609573 -
Contrast Media & Molecular Imaging 2022In order to solve the problem of sports medical image in basketball training, a sports medical image modeling research method based on injury prevention in basketball...
In order to solve the problem of sports medical image in basketball training, a sports medical image modeling research method based on injury prevention in basketball training was proposed. By the method, the current situation of sports injury in university basketball was investigated. At the same time, the injury factors were analyzed on four occasions, including basketball class, extracurricular activities, competition, and training. In order to reduce the occurrence of injury and enhance the security of basketball sports for nonbasketball students of physical education, combined with the problems and reasons, the corresponding suggestions were put forward. Through the experiment, it was found that the incidence of basketball injury for nonbasketball male university students was as high as 90.7%. The results of the experiment showed that it was necessary to enhance the awareness of self-protection, control emotions and exhibitionism, strengthen physical training, attach importance to basic skills training, do warm-up activities, stay focused, pay attention to exercise load, and prevent excessive fatigue.
Topics: Athletic Injuries; Basketball; Humans; Male; Sports Medicine
PubMed: 35992544
DOI: 10.1155/2022/5742543 -
The Cochrane Database of Systematic... Feb 2015Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence... (Review)
Review
BACKGROUND
Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence levels and it is accepted that there is a high proportion of hidden sexual victimisation. Surveys report high levels of psychiatric morbidity in survivors of sexual offences.Biological treatments of sex offenders include antilibidinal medication, comprising hormonal drugs that have a testosterone-suppressing effect, and non-hormonal drugs that affect libido through other mechanisms. The three main classes of testosterone-suppressing drugs in current use are progestogens, antiandrogens, and gonadotropin-releasing hormone (GnRH) analogues. Medications that affect libido through other means include antipsychotics and serotonergic antidepressants (SSRIs).
OBJECTIVES
To evaluate the effects of pharmacological interventions on target sexual behaviour for people who have been convicted or are at risk of sexual offending.
SEARCH METHODS
We searched CENTRAL (2014, Issue 7), Ovid MEDLINE, EMBASE, and 15 other databases in July 2014. We also searched two trials registers and requested details of unidentified, unpublished, or ongoing studies from investigators and other experts.
SELECTION CRITERIA
Prospective controlled trials of antilibidinal medications taken by individuals for the purpose of preventing sexual offences, where the comparator group received a placebo, no treatment, or 'standard care', including psychological treatment.
DATA COLLECTION AND ANALYSIS
Pairs of authors, working independently, selected studies, extracted data, and assessed the risk of bias of included studies. We contacted study authors for additional information, including details of methods and outcome data.
MAIN RESULTS
We included seven studies with a total of 138 participants, with data available for 123. Sample sizes ranged from 9 to 37. Judgements for categories of risk of bias varied: concerns were greatest regarding allocation concealment, blinding of outcome assessors, and incomplete outcome data (dropout rates in the five community-based studies ranged from 3% to 54% and results were usually analysed on a per protocol basis).Participant characteristics in the seven studies were heterogeneous, but the vast majority had convictions for sexual offences, ranging from exhibitionism to rape and child molestation.Six studies examined the effectiveness of three testosterone-suppressing drugs: cyproterone acetate (CPA), ethinyl oestradiol (EO), and medroxyprogesterone acetate (MPA); a seventh evaluated two antipsychotics (benperidol and chlorpromazine). Five studies were placebo-controlled; in two, MPA was administered as an adjunctive treatment to a psychological therapy (assertiveness training or imaginal desensitisation). Meta-analysis was not possible due to heterogeneity of interventions, comparators, study designs, and other issues. The quality of the evidence overall was poor. In addition to methodological issues, much evidence was indirect.
PRIMARY OUTCOME
recividism. Two studies reported recidivism rates formally. One trial of intramuscular MPA plus imaginal desensitisation (ID) found no reports of recividism at two-year follow-up for the intervention group (n = 10 versus one relapse within the group treated by ID alone). A three-armed trial of oral MPA, alone or in combination with psychological treatment, reported a 20% rate of recidivism amongst those in the combined treatment arm (n = 15) and 50% of those in the psychological treatment only group (n = 12). Notably, all those in the 'oral MPA only' arm of this study (n = 5) dropped out immediately, despite treatment being court mandated.Two studies did not report recidivism rates as they both took place in one secure psychiatric facility from which no participant was discharged during the study, whilst another three studies did not appear directly to measure recividism but rather abnormal sexual activity alone.
SECONDARY OUTCOMES
The included studies report a variety of secondary outcomes. Results suggest that the frequency of self reported deviant sexual fantasies may be reduced by testosterone-suppressing drugs, but not the deviancy itself (three studies). Where measured, hormonal levels, particularly levels of testosterone, tended to correlate with measures of sexual activity and with anxiety (two studies). One study measured anxiety formally; one study measured anger or aggression. Adverse events: Six studies provided information on adverse events. No study tested the effects of testosterone-suppressing drugs beyond six to eight months and the cross-over design of some studies may obscure matters (given the 'rebound effect' of some hormonal treatments). Considerable weight gain was reported in two trials of oral MPA and CPA. Side effects of intramuscular MPA led to discontinuation in some participants after three to five injections (the nature of these side effects was not described). Notable increases in depression and excess salivation were reported in one trial of oral MPA. The most severe side effects (extra-pyramidal movement disorders and drowsiness) were reported in a trial of antipsychotic medication for the 12 participants in the study. No deaths or suicide attempts were reported in any study. The latter is important given the association between antilibidinal hormonal medication and mood changes.
AUTHORS' CONCLUSIONS
We found only seven small trials (all published more than 20 years ago) that examined the effects of a limited number of drugs. Investigators reported issues around acceptance and adherence to treatment. We found no studies of the newer drugs currently in use, particularly SSRIs or GnRH analogues. Although there were some encouraging findings in this review, their limitations do not allow firm conclusions to be drawn regarding pharmacological intervention as an effective intervention for reducing sexual offending.The tolerability, even of the testosterone-suppressing drugs, was uncertain given that all studies were small (and therefore underpowered to assess adverse effects) and of limited duration, which is not consistent with current routine clinical practice. Further research is required before it is demonstrated that their administration reduces sexual recidivism and that tolerability is maintained.It is a concern that, despite treatment being mandated in many jurisdictions, evidence for the effectiveness of pharmacological interventions is so sparse and that no RCTs appear to have been published in two decades. New studies are therefore needed and should include trials with larger sample sizes, of longer duration, evaluating newer medications, and with results stratified according to category of sexual offenders. It is important that data are collected on the characteristics of those who refuse and those who drop out, as well as those who complete treatment.
Topics: Adolescent; Adult; Aged; Androgen Antagonists; Antipsychotic Agents; Child; Child Abuse, Sexual; Desensitization, Psychologic; Exhibitionism; Humans; Libido; Male; Middle Aged; Randomized Controlled Trials as Topic; Rape; Recurrence; Sex Offenses; Sexual Behavior
PubMed: 25692326
DOI: 10.1002/14651858.CD007989.pub2 -
The Israel Journal of Psychiatry and... 2012Axis I non-sexual psychopathology, especially if associated with other manifestations of impulsivity, could be important to consider during the assessment and... (Review)
Review
BACKGROUND
Axis I non-sexual psychopathology, especially if associated with other manifestations of impulsivity, could be important to consider during the assessment and pharmacological treatment of paraphilic sexual offenders.
METHOD
The author performed a Medline literature search using combinations of the following terms "sexual offender," "paraphilia," "Axis I," and "comorbid." In addition, individual paraphilic disorders including "exhibitionism," "voyeurism," "frotteurism," "sexual sadism" and "pedophilia" were searched with the terms "Axis I" and "comorbid." From the literature retrieved, 18 relevant specific articles and additional references were reviewed that utilized either a comprehensive prospective methodology to ascertain Axis I psychopathology or a specific diagnosis not typically included in structured diagnostic instruments was ascertained with validated rating instruments.
RESULTS
Unipolar and bipolar mood disorders, social anxiety disorder, attention deficit hyperactivity disorder and other neurodevelopmental conditions (mental retardation, fetal alcohol spectrum disorder, Asperger's disorder) are Axis I psychopathologies reported as co-associated with paraphilic sexual offending. The aforementioned Axis I psychiatric disorders typically manifest during childhood or adolescence, the same age of onset as paraphilic disorders. Alcohol abuse is prevalent among paraphilic offenders as well and its presence serves as an additional disinhibitor. Research supporting the concurrent pharmacological treatment of Axis I comorbidities is modest but offers support that such treatment could mitigate paraphilic behavior.
LIMITATIONS
This review was organized to emphasize positive findings. Studies reviewed varied in both sample types and settings as well as ascertainment and diagnostic methodologies. The literature reviewed is modest in size and additionally limited by small samples.
CONCLUSIONS
A subset of males with Axis I diagnoses of mood disorders, social anxiety disorder, substance use disorders, and ADHD or other childhood neurodevelopmental disabilities may be co-associated with sexual disinhibition and aggression manifested as paraphilias. Pharmacological treatments addressing Axis I comorbidites and paraphilias have been reported to mitigate both sets of disorders but the treatment data should be regarded as preliminary.
Topics: Comorbidity; Humans; Mental Disorders; Paraphilic Disorders; Sex Offenses
PubMed: 23585462
DOI: No ID Found -
Sexual Abuse : a Journal of Research... Jun 2023Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the...
Little is known about distinct factors linked with acting on paraphilic interests or refraining from engaging in paraphilic behaviors. Participants from Canada and the United States ( = 744), aged 19-42 years ( = 29.2; = 3.18), were recruited through Amazon's Mechanical Turk. Participants completed questionnaires about their paraphilic interests and behaviors, as well as potential key factors linked to behavioral engagement (i.e., perceptions of consent, sexual excitation/inhibition, impulsivity, moral disengagement, empathy). Results indicated that higher moral disengagement and impulsivity, lower sexual control (i.e., high sexual excitation, low sexual inhibition), and maladaptive understandings of consent were best able to differentiate individuals who reported highly stigmatized (e.g., hebephilia, pedophilia, coprophilia) or Bondage and Dicipline, Dominance and Submission, Sadism and Masochism(BDSM)/Fetish paraphilic interests and engagement in the paraphilic behaviours associated with these interests relative to individuals who did not report such paraphilic interests or behaviors. Moreover, higher moral disengagement, impulsivity, and maladaptive perceptions of consent were best able to differentiate non-consensual paraphilic interests and behaviours (e.g., voyeurism, exhibitionism) compared to individuals who did not report these paraphilic interests or behaviours. These results provide future directions for the exploration of mechanisms that may contribute to engagement in paraphilic behaviors and may be targets for intervention aimed at preventing engagement in potentially harmful paraphilias.
Topics: Humans; Sexual Behavior; Paraphilic Disorders; Sadism; Masochism; Pedophilia
PubMed: 35699951
DOI: 10.1177/10790632221108949