Pharmacological Therapy Case Study

As a therapist, how will you deal with a client who has disclosed that he (or she) is an exhibitionist?

If a client were to disclose their being an exhibitionist I would have many concerns beyond just this presentation. One such concern would be of the risk for developing other sexually offending behaviors (Kafka & Hennen, 1999) or their already engaged deviant behaviors that have not yet been revealed such as frottage or rape (Freund,1990) or voyeurism or child molestation (Abel & and Osborn,1992). Another secondary concern would be for any nonparaphilic disorders they may have such as mood disorders, dysthymic disorder, major depression disorder, anxiety disorder, substance use disorder, or attention-deficit/hyperactivity disorder (ADHD) (Kafka & Hennen, 2003). Furthermore, because the above paraphilic disorders are criminal acts there is cause for alarm for incarceration. An ethical dilemma also exists due to confidentiality and public safety.

2. What are treatment options

In pharmacological therapy, “more emotively known as chemical castration” (Harrison & Rainey, 2009, p. 47) the use of certain anti-androgens (e.g., Medroxyprogesterone Acetate (MPA) and Cyproterone Acetate (CPA)) and psychotropic medications (e.g., SSRIs) are utilized to suppress testosterone and reduce a person’s sexual drive, respectively. Likewise, a surgical intervention is the physical act of castration. Arguments exist on both sides for their usage (Besharov, 1992; Harrison & Rainey, 2009). The use of SSRIs as an intervention is not only because of their side effects for reducing sexual libido, but also because sexual addiction problems have a high comorbidity rate with other psychiatric disorders such as anxiety disorders, mood disorders, and substance abuse disorders (Kafka & Hennen,