Cases That Test Your Skills

Nothing more than feelings?

Current Psychiatry. 2005 July;4(7):77-91

References

1. Elliott M, Browne K, Kilcoyne J. Child sexual abuse prevention: what offenders tell us. J Sex Marital Ther 2002;28:211-8.

2. Conte JR, Wolf S, Smith T. What sexual offenders tell us about prevention strategies. Child Abuse Negl 1989;13:293-301.

3. Wasyliw OE, Grossman LS, Haywood TW. Denial of hostility and psychopathology in the evaluation of child molestation. J Pers Assess 1994;63:185-90.

4. Kempe CH. Sexual abuse, another hidden pediatric problem: the 1977 C. Anderson Aldrich lecture. Pediatrics 1978;62:382-9.

5. Ringel C. Criminal victimization 1996: changes 1995-96 with trends 1993-96. BJS Bulletin, NCJ 165812, November 1997.

6. Snyder HN. Sexual assault of young children as reported to law enforcement: victim, incident, and offender characteristics. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, July 2000. Available at: http://www.ojp.usdoj.gov/bjs/cvict_c.htm#relate. Accessed June 3, 2005.

7. Gabbard GO. Psychodynamic psychiatry in clinical practice (3rd ed). Washington, DC: American Psychiatric Press; 2000.

8. Hall GC. Sexual arousal as a function of physiological and cognitive variables in a sexual offender population. Arch Sex Behav 1991;20:359-69.

9. Heim N. Sexual behavior of castrated sex offenders. Arch Sex Behav 1981;10:11-19.

10. Stone TH, Winslade WJ, Klugman CM. Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure. Behav Sci Law 2000;18:83-110.

11. Freund K. Therapeutic sex drive reduction. Acta Psychiatr Scand Suppl 1980;287:5-38.

12. Rosler A, Witztum E. Pharmacotherapy of paraphilias in the next millennium. Behav Sci Law 2000;18:43-56.

13. Winslade W, Stone TH, Smith-Bell M, Webb DM. Castrating pedophiles convicted of sex offenses against children: new treatment or old punishment? SMU Law Rev 1998;51:349-411.

14. Power DJ. Paedophilia. Practitioner 1977;218:805-11.

Stone et al¹⁰ draw several germane conclusions:

Sentencing laws are often unclear or do not take into account scientific research on pedophilia. For example, psychological testing often is not ordered before a treatment is mandated, even though knowing the patient’s psychological profile and the nature of his predilections are crucial to treatment and prognosis.¹²
Many laws do not suggest an instrument of implementation. For example, most laws that mandate a patient evaluation do not specify whether a licensed psychiatrist, psychologist, or other clinician should evaluate the patient.
Many laws directed against pedophilia are punitive in nature. Mandated treatment—or the informed consent that precedes it—is often inadequate,¹⁰ and physicians can be held liable in either case. However, we could not determine the liability that could result from enhancing a convicted pedophile’s libido.

REFERRAL: TREATMENT ADVICE

We referred Mr. V back to his primary care physician and advised the doctor to:

discuss the testosterone treatment request with physicians who treated Mr. V at the state prison
call our hospital’s attorney to investigate the legal implications of treating Mr. V.

We also recommended against enhancing Mr. V’s libido, given his poor insight and denial and the primary care physician’s lack of expertise in this treatment. A recent check of Mr. V’s electronic record indicated that he was not given medication to enhance sexual performance.

Related resources

Sex offenders get Medicaid-paid Viagra. Associated Press May 22, 2005. http://msnbc.msn.com/id/7946129/.
Conte JR, Wolf S, Smith T. What sexual offenders tell us about prevention strategies. Child Abuse Negl 1989;13:293-301.
U.S. Department of Justice, Bureau of Justice Statistics. Statistics on sex offenders and victims. www.ojp.usdoj.gov/bjs/abstract/saycrle.htm.

Drug brand names

Goserelin • Zoladex
Leuprolide • Eligard, others
Medroxyprogesterone acetate • Depo-Provera, others
Nafarelin • Synarel
Sildenafil • Viagra
Triptorelin • Trelstar Depot

Acknowledgment

The authors thank Cynthia Meyer, chief librarian, VA Hospital, Fresno, CA, for her help with researching this article.

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Nothing more than feelings?

References

Pages

Recommended Reading