Editing Paraphilia (section)

==Paraphilic disorders==
Most clinicians and researchers believe that paraphilic sexual interests cannot be altered,<ref name="SetoAhmed2014">{{cite journal|first1=Michael C.|last1=Seto|authorlink1=Michael C. Seto|first2=AG|last2=Ahmed|title=Treatment and management of child pornography use|journal=Psychiatric Clinics of North America|volume=37|issue=2|pages=207–214|year=2014|pmid=24877707|doi=10.1016/j.psc.2014.03.004}}</ref> although evidence is needed to support this.<ref name="SetoAhmed2014"/> Instead, the goal of therapy is normally to reduce the person's discomfort with their paraphilia and limit the risk of any harmful, anti-social, or criminal behavior.<ref name="SetoAhmed2014"/> Both [[psychotherapeutic]] and [[Chemical castration|pharmacological methods]] are available to these ends.<ref name="SetoAhmed2014"/> [[Cognitive behavioral therapy]], at times, can help people with extreme paraphilic disorders develop strategies to avoid acting on their interests.<ref name="SetoAhmed2014" /> Patients are taught to identify and cope with factors that make acting on their interests more likely, such as stress.<ref name="SetoAhmed2014" /> It is currently the only form of psychotherapy for paraphilic disorders supported by randomized [[double-blind]] trials, as opposed to case studies and consensus of expert opinion.<ref name="thibaut2010" /><!-- p. 646 -->

===Medications===
[[Pharmacological]] treatments can help people control their sexual behaviors, but do not change the content of the paraphilia.<ref name="thibaut2010"/> They are typically combined with [[cognitive behavioral therapy]] for best effect.<ref name="assumpcao2014">{{cite journal|last1=Assumpção|first1=Alessandra Almeida|last2=Garcia|first2=Frederick Duarte|last3=Garcia|first3=Heloise Delavenne|last4=Bradford|first4=John M.W.|last5=Thibaut|first5=Florence|title=Pharmacologic treatment of paraphilias|journal=[[Psychiatric Clinics of North America]]|publisher=[[Elsevier]]|location=Amsterdam, Netherlands|volume=37|issue=2|pages=173–181|date=June 2014|pmid=24877704|doi=10.1016/j.psc.2014.03.002}}</ref>

====SSRIs====
[[Selective serotonin reuptake inhibitor]]s (SSRIs) have been well received and are considered an important pharmacological treatment of severe paraphilic disorders.<ref>{{Cite journal|last1=Kraus|first1=Christoph|last2=Strohm|first2=Kate|last3=Hill|first3=Andrew|last4=Habermann|first4=Niels|last5=Berner|first5=Wolfgang|last6=Briken|first6=Peer|date=June 2007|title=Selective serotonine reuptake inhibitors (SSRI) in the treatment of paraphilia|journal=Fortschritte der Neurologie-Psychiatrie|location=Melbourne, Australia|publisher=[[University of Melbourne]]|volume=75|issue=6|pages=351–356|doi=10.1055/s-2006-944261|issn=0720-4299|pmid=17031776}}</ref> They are proposed to work by reducing sexual arousal, [[compulsivity]], and depressive symptoms. They have been used with exhibitionists, non-offending pedophiles, and compulsive masturbators.<ref name="assumpcao2014"/>

====Antiandrogens====
[[Antiandrogen]]s are used in more extreme cases.<ref name="assumpcao2014"/> Similar to physical [[castration]], they work by reducing [[androgen]] levels, and have thus been described as [[chemical castration]].<ref name="assumpcao2014"/> The antiandrogen [[cyproterone acetate]] has been shown to substantially reduce sexual fantasies and offending behaviors.<ref name="assumpcao2014"/> [[Medroxyprogesterone acetate]] and [[gonadotropin-releasing hormone agonist]]s (such as [[leuprorelin]]) have also been used to lower sex drive.<ref name="assumpcao2014"/> Due to the side effects, the World Federation of Societies of Biological Psychiatry recommends that hormonal treatments only be used when there is a serious risk of sexual violence, or when other methods have failed.<!-- p. 647 --><ref name="thibaut2010">{{cite journal|vauthors=Thibaut F, De La Barra F, Gordon H, Cosyns P, Bradford JM|title=The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias|journal=The World Journal of Biological Psychiatry|volume=11|issue=4|pages=604–655|year=2010|pmid=20459370|doi=10.3109/15622971003671628|s2cid=14949511}}</ref> Surgical [[castration]] has largely been abandoned because these pharmacological alternatives are similarly effective and less invasive.<ref>{{cite book|first=Michael C.|last=Seto|authorlink=Michael C. Seto|date=2008|title=Sexual Deviance: Theory, Assessment, and Treatment|edition=2nd|publisher=[[The Guilford Press]]|location=New York City|pages=199–200|chapter=Pedophilia: Assessment and Treatment|editor1-first=D. Richard|editor1-last=Laws|editor2-first=William T.|editor2-last=O'Donohue}}</ref>

===Legality===
{{Citation style|section|reason=Cited court cases appear inside parentheses, which is a deprecated style.|date=May 2025}}
In the United States, since 1990 a significant number of states have passed [[sexually violent predator law]]s.<ref name="First 2014">{{cite journal|last=First|first=Michael B.|title=DSM-5 and paraphilic disorders.|journal=The Journal of the American Academy of Psychiatry and the Law|volume=42|issue=2|year=2014|issn=1093-6793|pmid=24986346|pages=191–201|url=http://jaapl.org/content/42/2/191}}</ref> Following a series of landmark cases in the [[Supreme Court of the United States]], persons diagnosed with extreme paraphilic disorders, particularly pedophilia (''[[Kansas v. Hendricks]]'', 1997) and others that cause serious difficulty controlling behavior (''[[Kansas v. Crane]]'', 2002), can be held indefinitely in [[civil confinement]] under various state legislation generically known as [[sexually violent predator laws]]<ref>{{cite journal|last1=First|first1=M. B.|last2=Halon|first2=R. L.|title=Use of DSM paraphilia diagnoses in sexually violent predator commitment cases|journal=The Journal of the American Academy of Psychiatry and the Law|volume=36|issue=4|pages=443–454|year=2008|pmid=19092060|url=http://www.jaapl.org/cgi/reprint/36/4/443.pdf}}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{Cite book|publisher=Jones & Bartlett Learning|pages=[https://books.google.com/books?id=6MQj-mjHgBIC&pg=PA248 248]|title=Legal aspects of corrections management|isbn=978-0-7637-2545-7|last1=Cripe|first1=Clair A|last2=Pearlman|first2=Michael G|year=2005}}</ref> and the federal [[Adam Walsh Act]] (''[[United States v. Comstock]]'', 2010).<ref name="apabc">JESSE J. HOLLAND, [https://abcnews.go.com/Politics/wireStory?id=10666088 Court: Sexually dangerous can be kept in prison], [[Associated Press]]. Retrieved 16 May 2010.</ref><ref>{{cite web|url=http://capcentral.org/civil/svpa/svpa_article_USsupreme.asp|title=Civil: SVPA – CCAP|publisher=Capcentral.org|access-date=2013-03-14|archive-date=29 June 2013|archive-url=https://web.archive.org/web/20130629163853/http://capcentral.org/civil/svpa/svpa_article_USsupreme.asp|url-status=dead}}</ref>