Overview of Treatment

Reasons for Treatment
Individuals may seek treatment for several reasons. The most common reasons to seek treatment are : 1. To decrease or eliminate problematic sexual behaviors in order to regain control of one’s life. 2. To answer a legal question posed by the courts. 3. To comply with treatment conditions imposed by an outside agency such as probation or parole.

Treatment Duration
Responses to treatment may occur in a short period of time, such as 4-6 weeks, or in a longer intervals such as 4-6 months. Individuals who have commorbid psychiatric disorders respond best to concomitant treatment of both disorders. For example, an individual with Major Depression and Exhibitionism will have the best response to treatment if the depression and exhibitionism is treated.

Confidentiality
Confidentiality is a term used to describe a physician’s obligation to keep a patient’s care private. Information about our patients is not transmitted unless a patient has signed a specific consent form which permits the exchange of information. If a patient has been court ordered for treatment, the patient must sign a waiver which allows the exchange of information between treaters and correctional staff.

Understanding Sexual Disorders

Paraphilias are defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. Paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others (Criterion B).  DSM-5 describes 8 specific disorders of this type (Criterion A) along with other specified and unspecified paraphilic disorders. The list, however, is not exhaustive. The disorders are defined as:

Exhibitionism: sexual arousal from exposing one’s genitals to an unsuspecting person.

Fetishism: the use of non-sexual or nonliving objects or part of a person’s body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.

Frotteurism: recurrent urges or behavior of touching or rubbing against a non-consenting person.

Pedophilia: sexual attraction to prepubescent individuals.

Sexual Masochism: sexual arousal to the being the object of to humiliation, being bound, beaten or otherwise made to suffer.

Sexual Sadism: sexual arousal to acts in which the pain or humiliation is inflicted on another the victim is sexually exciting.


Transvestic Fetishism: sexual attraction to wearing garments or clothing of the opposite gender.


Voyeurism: sexual arousal to observing an unsuspecting person who is naked, disrobing or engaging in sexual activities.

Other rarer paraphilias are grouped together under Specified Paraphilic Disorder or Unspecificed Paraphilic Disorder and include telephone scatalogia (obscene phone calls), necrophilia (corpses), partialism (exclusive focus on one part of the body), zoophilia (animals), coprophilia (feces), klismaphilia (enemas), urophilia (urine), emetophilia (vomit).

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington:American Psychiatric Publishing. 2013.

Glossary

Bone density study
An xray which produces a picture of the skeleton and evaluates the health of bones.

Cognitive distortion
A belief that is inaccurate based on the cultural and moral beliefs of society. (example: sex with children is ok.)

Flutamide
A medication used to block the testosterone surge which occurs during the first 14 days following Lupron administration.

Fosomax
A medication used to prevent bone loss that is caused by prolonged hormonal treatment. This medication is typically taken once a week.

Hormones
chemicals produced by the body that control the activity of certain organs.

Intramuscular injection
An injection (shot) given in the muscle (typically deltoid – arm or gluteus – buttocks)

Lupron/Luprolide
A synthetic hormone that can be used to decrease testosterone production.

Medroxyprogesterone acetate
A progestin that is commonly used in hormonal contraception.

OsCal
A medication which consists of vitamin C and Vitamin D. OsCal is used to maintain healthy, strong bones.

Osteoporosis
Thinning of the bones

Osteopenia
A decrease in the amount of calcium and phosphorous in the bones.

Provera
A synthetic preparation of medroxyprogesterone acetate.

Relapse prevention
Therapy that aims to teach individuals strategies that will prevent future symptoms.

SSRIs/Selective Serotonin Reuptake Inhibitors
A psychotropic medication that acts in the brain to block the reuptake of serotonin (a neurotransmitter) by the neurons.

Sexual appetite
Desire for sex, “libido”.

Sexual dysfunction
Impairment in physiologic sexual functioning

Sexual deviance
Sexual arousal to objects or individuals that are judged to be deviant by societal mores.

Sexual arousal
The physiologic and emotional changes which occur to prepare for sexual activity.

Sexual fantasy
An imagined thought that is sexual in content

Testosterone
A hormone produced predominantly in the testes that prompts the development of male sex characteristics.

Total sexual outlet (TSO)
The sum of orgasms in a 24 hour period.

Triggers
An entity that initiates an action.

Men's Sexual Addiction Screening Test

By Patrick Carnes, Ph.D. and Robert Weiss, LCSW, CAS

The Male Sexual Addiction Screening Test (G-SAST) is designed to assist the assessment of sexually compulsive or “addictive” behavior. The G-SAST provides a profile of responses which help to identify men with sexually addictive disorders. Check each response as appropriate.

1 – 3 “yes” responses may indicate an area of concern and should be openly discussed with a clinician.

4 – 6 positive answers would indicate a possible problem with sexual addiction, leading to consideration of a clinical evaluation and possible treatment such as group or individual therapy.

6 or more “yes” responses clearly describe a problem with potentially self abusive and/or dangerous consequences. Should seriously consider treatment with a counselor trained in the area of sexual addiction.

Women's Sexual Addiction Screening Test

By Patrick Carnes, Ph.D. and Sharon O’Hara, MA

The Women’s Sexual Addiction Screening Test (W-SAST) is a set of questions to help you see your sexual activity more clearly. It is an assessment of sexually compulsive or addictive behavior. A high number of YES answers may be a sign of some issues with sex addiction.

A high number of YES answers may be a sign of some issues with sex addiction. After using this questionnaire, please consult our staff to discuss these issues further.