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International Journal of Offender Therapy and Comparative Criminology
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Sex Offending and Sexual Appetite: The Clinical and Theoretical Relevance of Hypersexual Desire

Martin P. Kafka, M.D.

McLean Hospital

Disinhibited sexual desire, clinically manifested as hypersexual desire disorders, can be operationally defined by considering three behavioral domains associated with sexual motivation or appetitive behavior: (a) sexual preoccupation (time/day consumed by fantasies, urges, and activities), (b) the repetitive frequency of enacted sexual behavior (total sexual outlet/week), and (c) adverse consequences associated with repetitive sexual behavior. Data are presented suggesting that clinical samples of males with paraphilias, paraphilia-related disorders, and sexual coercion may be associated with disinhibited sexual appetite. These conditions need to be addressed by an integrated combination of psychotherapeutic and psychopharmacologic interventions that specifically target disinhibited sexual appetitive behaviors, their antecedents, and consequences. Although combination therapies (empirically based specific psychotherapies in conjunction with psychopharmacological treatments) have demonstrated superior efficacy in many Axis I psychiatric disorders, such combination therapies to reduce paraphilias, paraphilia-related disorders, and adult sexual coercion are currently underutilized in both North and South America and Europe.

Key Words: sexual offender • rape • paraphilia • paraphilia-related disorder • hypersexual • medical therapy • antidepressant

International Journal of Offender Therapy and Comparative Criminology, Vol. 47, No. 4, 439-451 (2003)
DOI: 10.1177/0306624X03253845
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[Abstract] [PDF]