This single case study demonstrates the effects of antiandrogen treatment on a subject with a very serious sexual deviation and a poor prognosis. It assesses the effects of cyproterone acetate (CPA) on an individual with a serious chronic organic brain syndrome combined with sadistic homosexual pedophilia. Furthermore, this individual had failed to respond to a behavioural treatment program and long-term milieu therapy. Finally, this case study is the first report of CPA differentially affecting penile responses to deviant and non-deviant stimuli.
References
1.
Uniform crime reporting statistics Canada and the provinces 1977–1981 sexual offences — Canadian Centre for Justice Statistics - StatisticsCanada August 1982.
2.
CormierBM, SimonsSPForensic psychiatry: the problem of the dangerous sexual offender.Can Psychiatr Assoc J1969; 14: 329–335.
3.
HolmesRMThe sex offender and the criminal justice system.Illinois: Charles C. Thomas,1983.
4.
JaffeAC, DynnesonL, BenselRWSexual assault on women and girls.Am J Dis Child1975; 129: 689–692.
5.
GreenFCIntroduction: child sexual abuse: the physicians responsibility.Pediatr Ann1979; 8: 286–288.
6.
MohrJW, TurnerRE, JerryMBPedophilia and exhibitionism.Toronto: University of Toronto Press,1964.
7.
AbelGG, MittelmanMS, BeckerJVSexual offenders: results of assessment and recommendations for treatment. In: Ben-AronMH, HuckerSJ, WebsterCD eds. Clinical criminology, the assessment and treatment of criminal behaviour.Toronto: M & M Graphics Ltd.,1985.
8.
WoodburyJ, SchwartzEThe silent sin.New York: New American Library,1971.
9.
AbelGG, BeckerJV, SkinnerLJBehavioural approaches to treatment of the violent sex offender. In: RothLH ed. Clinical treatment of the violent person.Rockville, Maryland: U.S. Department of Health and Human Services, Publication No. 85–1425, 1985.
10.
Summary of the report of the committee on sexual offences against children and youths. Sexual offences against children in Canada.Minister of Supply and Services, Canada, 1984.
11.
SoothillKL, GibbensT.C.N.Recidivism of sexual offenders: reappraisal.Br J Criminol1978; 18: 267–275.
12.
AbelGG, RouleauJ, Cunningham-RathnerJSexually aggressive behaviour. In: CurranW, McGarryAL, ShahSA eds. Modern legal psychiatry and psychology.Philadelphia: F.A. Davis Co., (in press).
13.
HeimN, HurschCJCastration for sex offenders: treatment or punishment? A review and critique of recent european literature.Arch Sex Behav1979; 8: 281–304.
14.
BremerJAsexualization: a follow-up study of 244 cases.New York: MacMillan,1959.
15.
StürupGKTreatment of sexual offenders in Herstedvéster Denmark: the rapists.Acta Psychiatr Scand1968; Suppl. 204.
16.
StürupGKCastration: the total treatment. In: ResnikH.L.P., WolfgangME eds. Sexual behaviours: social, clinical and legal aspects.Boston: Little Brown & Co., 1972: 361–382.
17.
LangelüddekeACastration of sexual criminals: de Gruyjér, Berlin: 1963 (In German).
18.
OrtmanJThe treatment of sexual offenders. Castration and antihormone therapy.Int J Law Psychiatry1980; 3: 443–451.
19.
MoneyJ, WiedekingC, WalkerPA, GainDCombined antiandrogenic and counselling program for treatment of 46 XY and 47 XYY sex offenders. In: SacharEJ ed. Hormones, behaviours and psychopathology.New York: Raven Press, 1976.
20.
BerlinFS, MeineckeCFTreatment of sex offenders with antiandrogenic medication: conceptualization, review of treatment modalities, and preliminary findings.Am J Psychiatry1981; 138: 601–607.
21.
LaschetUAntiandrogen in the treatment of sex offenders: mode of action and therapeutic outcome. In: ZubinJ, MoneyJ eds. Contemporary sexual behavior: critical issues in the 1970s.Baltimore: Johns Hopkins University Press, 1973: 331.
22.
LaschetU, LaschetLAntiandrogen therapie per pathologisch gesteigerten und abartigen Sexualitat des mannes.Klin Wschar1975; 45: 324–325.
23.
LaschetU, LaschetLAntiandrogens in the treatment of sexual deviations of men.J Steroid Biochem1975; 6: 821–826.
24.
LaschetU, LaschetLPsychopharmacotherapy of sex offenders with cyproterone acetate.Pharmakopsychiatrie Neuropsychopharmakologie1971; 4: 99–104.
25.
BriggsM, BriggMHTreatment of male hypersexual conditions by nonoestrogenic antiandrogen.Med J Zambia1971; 125–129.
26.
DaviesTSCyproterone acetate in sexual misbehavior.Med Sci Law1970; 10: 237–242.
27.
DaviesTSCyproterone acetate for male hypersexuality.J Int Med Res1974; 2: 159–163.
MoneyJUse of androgen-depleting hormone in the treatment of male sex offenders.J Sex Res1970; 6: 165–172.
30.
RivarolaMA, CamachoAM, MigeonCJEffect of treatment with medroxyprogesterone acetate.J Clin Endocrinol1968; 29: 506–513.
31.
GagnePTreatment of sex offenders with medroxyprogesterone acetate.Am J Psychiatry1981; 138: 644–646.
32.
FreundKA laboratory method for diagnosing predominance of homo or hetero erotic interest in the male.Behav Res Ther1963; 1: 85–93.
33.
FreundKDiagnosing heterosexual paedophilia by means of a test for sexual interest.Behav Res Ther1965; 3: 229–234.
34.
FreundKDiagnosing homo-heterosexuality and erotic age preference by means of a psychophysiological test.Behav Res Ther1967; 5: 209–228.
35.
FreundKErotic preference in paedophilia.Behav Res Ther.1967; 5: 339–348.
36.
FreundK, McKnightC, LangevinRThe female child as a surrogate object.Arch Sex Behav1972; 2: 190–233.
37.
QuinseyVLA personal communication reported to Abel GG, Becker JV, Skinner LJ. Aggressive behaviour and sex. In: MeyerJK ed. Symposium on sexuality. Psychiatr Clin North Amer1980; 3: 133–151.
38.
AbelGG, BeckerJV, SkinnerLJAggressive behaviour and sex. In: MeyerJK ed. Symposium on sexuality. Psychiatr Clin North Amer1980; 3: 133–153.
39.
GuzeSCriminality and psychiatric disorders.London: Oxford University Press,1976.
40.
WolfgangMEPatterns in criminal homicide.Philadelphia: University of Pennsylvania Press,1958.
41.
VossHL, HepburnJRPatterns of criminal homicide in Chicago.J Crim Law Criminol Pol Science1968; 59: 499–508.
42.
ShupeIMAlcohol and crime: a study of the urine alcohol concentration found in 882 persons arrested during or immediately after the commission of a felony.J Crim Law Criminol1954; 44: 661.
43.
RadaRTAlcoholism and forcible rape.Am J Psychiatry1975; 132: 444–446.
44.
AmirMAlcohol and forcible rape.Br J Addict1967; 62: 219–232.
45.
BarbareeHE, MarshallWL, YatesE, LightfootLOAlcohol intoxication and deviant sexual arousal in male social drinkers.Behav Res Ther1983; 21: 365–373.
46.
BriddellDW, RimmDC, CaddyGR, KrawitzGEffects of alcohol and cognitive set on sexual arousal to deviant stimuli.J Abnorm Psychol1978; 87: 418–430.
47.
LanskyD, WilsonGTAlcohol expectations and sexual arousal in males: an information processing analysis.J Abnorm Psychol1981; 90: 35–45.
48.
WilsonGT, LawsonDMExpectancies alcohol and sexual arousal in male social drinkers.J Abnorm Psychol1976; 85: 587–594.
49.
WilsonGT, LawsonDM, AbramsDMEffects of alcohol on sexual arousal in male alcoholics.J Abnorm Psychol1978; 87: 609–616.
50.
BradfordJMcDW., McLeanDSexual offenders, violence and testosterone: a clinical study.Can J Psychiatry1984; 29: 335–343.
51.
WormithJS, BradfordJMcDW, PawlakA, BorzeckiM, ZoharAThe assessment of deviant sexual arousal as a function of intelligence, instructional set and alcohol ingestion. In final preparation for publication.
52.
BradfordJ.M.cD.W.The hormonal treatment of sexual offenders.Bull Am Acad Psychiatry Law1983; 11: 159–169.
53.
BradfordJ.M.cD.W.Research on sex offenders.Psychiatr Clin North Amer1983; 6: 715–731.
54.
FreundKTherapeutic sex drive reduction.Acta Psychiatr Scand1980; 62: 1–38, Suppl. 287.
55.
MartiniL, MottaMAndrogens and antiandrogens.New York: Raven Press,1977.
56.
DavidsonJM, SmithER, DamassaDAComparative analysis of the roles of androgen in feedback mechanisms and sexual behaviour. In: MartiniL, MottaM eds. Androgens and antiandrogens.New York: Raven Press, 1977: 137–161.
