The treatment of sexual paraphilias: A review of the outcome research

Abstract

Studies which investigate the impact of treatment on subjects with singular and multiple sexual paraphilias (exhibitionism, fetishism, pedophilia, transvestism, voyeurism) are reviewed. A methodological evaluation was conducted with attention to six categories: design, subjects, therapists, treatment, time periods, and outcome measures. Subjects included sexual offenders and non‐offenders. Most of the studies were single‐case reports. The methodological shortcomings in the literature included the failure to control for social desirability factors, especially in the case of sex offenders, and the reliance upon verbal self‐reports in the evaluation of outcome. Almost all of the studies found positive treatment effects, either immediately after treatment or at various follow‐up periods. However, periodic booster treatment sessions sometimes were necessary with paraphilias of long duration. Across the paraphilias reviewed, the literature offered tentative support for the efficacy of a multiple behavioral treatment package specifically tailored to aspects of the patient's sexual arousal pattern. The elimination of variant sexual responses in conjunction with fostering appropriate, non‐variant sexual behavior is a relevant treatment strategy in some cases. Future research should use homogeneous experimental and control subjects, obtain a pre‐therapy assessment of sexual and social functioning, specify treatment goals, and use multiple outcome measures. The importance of specifying subject variables for the goal of successful subject‐treatment matches is also suggested. As a step in that direction, a checklist which noted the psychological and situational correlates of the five predominant sexual paraphilias was derived from the literature.