The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

Abstract

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.

Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990−2018 for SSRIs) (1969−2018 for hormonal treatments), supplemented by other sources, including published reviews.

Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.

Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

Keywords:

• Paraphilic disorder; sex offender; antiandrogen treatment; SSRI; GnRH agonist

Acknowledgements

The authors wish to thank H. Gordon for his contribution to the manuscript; P. Mazeau for his help in bibliographical research; N. Thiounn (Professor of Urology, University Hospital G. Pompidou, University of Paris, France); R. Jouin (CRDS Tournai, Belgique) and the anonymous reviewers for their helpful comments.

Statement of interest

Prof. Thibaut: Editor-in-Chief of Dialogues in Clinical Neuroscience (the journal receives a grant from Servier). Other authors: none declared.