eMedicine Specialties > Psychiatry > Adult

Paraphilias: Follow-up

Author: Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Coauthor(s): Kimberly S Carroll, MA, Clinical Research Coordinator, Brentwood Research Institute
Contributor Information and Disclosures

Updated: Feb 14, 2008

Follow-up

Further Inpatient Care

Patients may require further inpatient care if they represent a danger to themselves, to others, or if they are gravely disabled.

Further Outpatient Care

For the best results, patients require medication management and psychotherapy.

Inpatient & Outpatient Medications

If the patient began medication therapy in the hospital, continue the same therapy and adjust as needed. If not, select medications and discuss the risks, benefits, adverse effects, and alternatives with the patient. Obtain informed consent before starting medication therapy.

Transfer

If patients are charged with a crime or have been arrested, they may be incarcerated.

Deterrence/Prevention

  • Education
  • Legal ramifications

Complications

  • Adverse medication effects
  • Noncompliance with medications and therapy
  • Pedophilia on the Internet

Prognosis

  • Patients with a good prognosis have the following characteristics:
    • Cooperative attitude
    • Normal sex life
    • Motivated outlook, with a desire to change
    • Voluntary approach to treatment
  • Patients with a poor prognosis have the following characteristics:
    • Early onset of paraphilia
    • Legal charges pending
    • Unmotivated attitude
    • Uncooperative attitude
    • Paraphilia as the only sexual activity or outlet
    • Comorbidity
    • Lack of remorse over acts

Patient Education

  • Sex education and social skills training
  • Both the patient and the family should be educated regarding paraphilias. The family may need to be involved in a support group (eg, church). If the patient is on medication the family needs to be informed of potential problems such as side effects and drug interations. If the patient is married, marital counceling needs to be part of the treatment plan. The family also needs to be aware of local laws in regard to paraphilas. If the patient is on probation, the family needs to be aware of court dates, if appicable, probation, and if the patient will need to be listed on the sexual offenders listing the community.
  • Community notification of a sex offender may be required for some patients with paraphilas. It is important to point out that many patients with paraphilias have no legal charges and even health care workers are not required to report all paraphilias while others require mandatory reporting such as pedophilia. Some patients may find this notification as a deterrent to the paraphila while others may not. Some experts suggest that, while required, it may hamper some patients who are tring to obtain help for there illness. This will continue to be a matter of community concern and debate for the unforseeable future. The patient should address these concerns with the treatment team.

Miscellaneous

Medicolegal Pitfalls

  • Failure to be familiar with the laws regarding illegal acts
  • Failure to maintain or break patient confidentiality (ie, reporting patients to the proper authorities)

Special Concerns

Physicians must be aware that not every therapist treats people with paraphilias.

 


More on Paraphilias

Overview: Paraphilias
Differential Diagnoses & Workup: Paraphilias
Treatment & Medication: Paraphilias
Follow-up: Paraphilias
References
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Further Reading

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Keywords

sexual urges, sexual fantasies, masturbation, voyeurism, frotteurism, zoophilia, exhibitionism, fetishism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, scopophilia, scatologia, necrophilia, partialism, coprophilia, klismaphilia, urophilia, autogynephilia, asphyxiophilia, hypoxyphilia, autoerotic asphyxiation, infantophilia, video voyeurism

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Contributor Information and Disclosures

Author

Guy E Brannon, MD, Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company
Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association
Disclosure: AstraZeneca Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Janssen Honoraria Speaking and teaching

Coauthor(s)

Kimberly S Carroll, MA, Clinical Research Coordinator, Brentwood Research Institute
Disclosure: Nothing to disclose.

Medical Editor

Mohammed A Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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