Fred S. Berlin

Chemical castration for sex offenders.

To the Editor: California recently enacted legislation requiring either surgical castration or “chemical castration” — a misnomer — for persons convicted of repeated sexual crimes against children....

Treatment of sexual paraphilias: A review of the 1999-2000 literature

Treatment research on the paraphilias is limited and confounded by the larger treatment literature on sex offenders. Research suggests that sex offenders can benefit from treatment. Anti-androgen and cognitive-behavioural techniques appear to have the best likelihood of reducing recidivism. Data regarding the effectiveness of selective serotonin reuptake inhibitors and other psychotropic medication are too limited for allowing conclusions to be made.

Androgen Deprivation Treatment of Sexual Behavior

Gonadotropin-releasing hormone agonists are underutilized in patients seeking diminution of problematic sexual drives. This chapter reviews the literature on surgical castration of sex offenders, anti-androgen use and the rationale for providing androgen deprivation therapy, rather than selective serotonin reuptake inhibitors or more conservative interventions, for patients with paraphilias and excessive sexual drive. Discussions of informed consent, side effects, contraindications and case examples are provided.

The eroticized violent crime: A psychiatric perspective with six clinical examples

Abstract Rape and a variety of other sexual offenses are defined by statute as criminal acts. Understandably, from the victims perspective, such acts, especially sexual assault, are experienced as aggressive and hostile traumas. Descriptions of the perpetrators actions, and of their consequences, do not necessarily help to elucidate motivation. Sexual offenses can be enacted out of a variety of motivations. In some cases, the behaviors in question may be a manifestation of a psychiatric disorder with accompanying severe impairment. This paper reviews the clinical cases of six convicted sexual offenders in an attempt to explore motivational factors. The cases presented include 1) a sociopathic opportunistic rapist; 2) an angry rapist; 3) a developmentally-impaired offender; 4) a psychotic rapist; 5) a paraphiliac, or sexually-driven rapist; and 6) a rare case of sexual assault associated with voyeurism. Substance abuse as an additional contributory factor is discussed as well. The behaviors of some sexua...