Sexual Impulsivity Disorders
What are Sexual Disorders?
According to Harvard Medical School Associate Professor of Clinical Psychiatry, Martin P. Kafka, M.D., psychiatry in the United States often overlooks sexual disorders, although these conditions can be quite serious. In fact, these conditions are commonly acknowledged by individuals under emergency situations, such as during impending marital divorce or when legal charges are brought against them for inappropriate sexual behaviors.1 Sexual disorders include paraphilias (PAs) and Paraphilia related disorders (PRDs). Kafka states that PAs are defined as being intense and recurring expressions of sexually deviant behavior that may cause individual distress or other significant adverse consequences.1 The DSM-IV lists the most common PA disorders as exhibitionism, voyeurism, fetishism, frotteurism, sexual sadism, sexual masochism, and pedophilia.1 PRDs, on the other hand, are defined as compulsive masturbation, pornography dependence, promiscuity, and severe sexual desire.1 While they are more common than PAs, Kafka states that they do not have diagnostic criteria listed in the DSM-IV, but are being considered for the DSM 5.1 It is rare for persons with these sexual disorders to discuss their impulses with intimate partners, family, friends, and clinicians, as the consequences can be serious, including incarceration, restrictions on personal liberty, and personal endangerment due to vigilantes.1
Treatment for Sexual Disorders
Treatments for individuals with PAs and PRDs vary. For the treatment of PAs, a combination of medicines and cognitive-behavioral therapy is typical. Medicines may include antiandrogens, gonadotropin-releasing hormone agonists, or SSRIs.1 PDRs are considered to be compulsive disorders and are treated with 12 step programs based upon Alcoholics Anonymous or with individual psychotherapy.1 According to Kafka, research regarding treatment of sexual disorders is, unfortunately, lacking.1
While clinicians are too familiar with complaints of diminished sexual interest in individuals with mood disorders, they also understand that an increased sexual drive may be associated with the same disorders.1 Therefore, it is important for clinicians to look for symptoms of sexual disorders in persons with mood disorders, attention-deficit/hyperactivity disorder (ADHD), substance use disorders, and fetal alcohol-spectrum disorders. Dysthymic disorder, a more common unipolar condition with sexual impulsivity compared with major depression, may have a comorbid relationship with sexual disorders.1 Persons with dysthymic disorder often externalize their behavior, which may include sexual impulsivity and eating disorders.1 Bipolar disorder also is commonly comorbid with sexual disorders, as a symptom of hypomania is commonly sexual indiscretions.1 According to Kafka, there is a well-known association between sexual offending and alcohol abuse, as well as marijuana dependence and cocaine abuse.1 There is also research stating that the combined subtype of ADHD may be more so associated with paraphilic sexual offending, while the inattentive subtype may be more likely associated with PRDs.1 Regarding sexual disorders in persons with fetal alcohol effects (FAE) or fetal alcohol syndrome (FAS), sexual impulsivity is less likely planned as it may be with the average person with PA.1
Awareness for Sexual Disorders Should be Increased
Kafka states that clinicians should be more aware of sexual impulsivity disorders, understanding what disorders may be frequently comorbid with PAs and PRDs.1 As described above, persons with mood disorders, ADHD, substance use disorders, and developmental disabilities are more likely to have a sexual disorder, and men are more likely than woman to develop one.1 Kafka states that forming a therapeutic alliance with the patient may allow for the identification of the disorder, leading to treatment as necessary.1
 Kafka, M.P. (2007, December 1). Sexual Impulsivity Disorders: Psychiatric “Orphans.” Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/masochism/content/article/10168/54691
 Hill A, Briken P, Kraus C, et al. Differential pharmacological treatment of paraphilias and sex offenders. Int J Offender Ther Comp Criminol. 2003;47:407-421.
 Kafka MP, Hennen J. A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders. Sex Abuse. 2002;14:349-366.
 Fago DP. Comorbidity of attention deficit hyperactivity disorder in sexually aggressive children and adolescents. In: Null GA, Schwartz BA, eds. The Sex Offender: Theoretical Advances, Treating Special Populations and Legal Developments. Vol 3. Kingston, NJ: Civic Research Institute; 1999:16.11-16.15.
 Raymond NC, Coleman E, Ohlerking F, et al. Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry. 1999;156:786-788.
 Baumbach J. Some implications of prenatal alcohol exposure for the treatment of adolescents with sexual offending behaviors. Sex Abuse. 2002;14:313-327. Sexual disorders.