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In-depth interviews and psychometric tests were conducted with 20 young, South African male, hands-on sex offenders, between the ages of seven and 15 years. These offenders were referred by both the legal system and the welfare and health system. The data was gathered for the purpose of drawing up a descriptive profile of salient psychological and sociological characteristics of this population group, the patterns of offenses, the circumstances under which the offenses occurred and victims selected. Results showed that half the sample had committed prior sex offenses. The majority of young sex offenders had a history of consenting sexual interactions, had committed a non-sexual offense and engaged in a range of other antisocial behaviours. Half the sample reported a history of physical or sexual abuse (under-reporting of such victimization experiences was suspected). Typically, the young sex offender w:~s sexually naive and had not received any suitable sex education. He was usually a scholar although his school attendance was often infrequent and he was likely to have failed one or more standards. His intelligence quotient was most likely to fall in or below the borderline range of functioning. He tended to be either socially isolated and socially anxious or alternatively reported having a number of friends and appeared to have adequate social skills. His home environment was typically characterized by overcrowding, alcohol abuse and domestic violence. A significant male relative of his was likely to have committed a criminal offense. In his community environment, he regularly witnessed violence and sexual activity. The sex offenses were usually carried out with a co-perpetrator in a variety of venues. The victim was usually known and younger (mean age = seven years) than the perpetrator (mean age = 12 years). The overall results suggest that young sex offenders commit an array of sexual offenses that do not represent sexual experimentation, but rather indicate a developing pattern of sexual deviance. Comparisons between the above profile and the literature findings are explored. Finally, recommendations for structural changes, assessment procedures, additional future research pessibilities and guidelines for the development of appropriate - treatment programmes are outlined.

INTRODUÇÃO: A literatura apresenta estudos sobre parafilias, transtornos relacionados às parafilias e compulsão sexual, mas não contém pesquisas sobre a freqüência destas práticas sexuais na população em geral. Este estudo investiga a associação destas práticas a parâmetros sócio- demográficos e de saúde física, mental e sexual, em amostra da população do Brasil. MÉTODOS: O Estudo da Vida Sexual do Brasileiro (EVSB) é um estudo transversal, de 7.022 indivíduos (45,4% de mulheres) realizado através de um questionário auto-responsivo de 87 itens sobre aspectos sócio-demográficos e de hábitos e comportamento sexuais. Com a amostra desse estudo, foi realizada a comparação entre indivíduos com referência a pelo menos um comportamento sexual não convencional - sexo grupal, sexo a três, troca de casais, incesto, sexo com animais, com fetiches, com troca de insultos ou agressões, com recebimento de dinheiro, com componentes exibicionistas ou voyeuristas - (grupo 1) e indivíduos sem referência a qualquer uma destas práticas (grupo 2). RESULTADOS: 1. Os comportamentos sexuais não convencionais foram mais freqüentes entre os homens (52,3%) do que entre as mulheres (30,4%); p<0,001. 2. Comportamento fetichista (13,4%), voyeurista (13,0%) e incesto (11,3%) foram os mais freqüentes, enquanto receber dinheiro por sexo (4,8%), relação sexual com animais (3,2%) e troca de casais (3,1%), os menos freqüentes. 3. O grupo 1 teve média de idade menor que o grupo 2, tanto para mulheres (35,0 vs 35,9 anos; p<0,05) como para homens (36,5 vs 37,8 anos; p<0,05). 4. O modelo final de regressão logística multivariado mostrou associação de comportamento sexual não convencional com as seguintes variáveis: gênero masculino (O.R.=2,3; IC95%=2,0 -2,6; p<0,001); estado civil: casado (O.R.=1,0; referência), solteiro (O.R.=1,2; IC 95%=1,0 - 1,4; p<0,05), divorciado ou separado (O.R.=1,4; IC95%=1,1 - 1,8; p<0,01); raça: branca (O.R.=1,0; referência), negra (O.R.=1,4; IC95%=1,0 - 1,9; p<0,05), parda (O.R.=1,4; IC95%=1,1 - 1,7; p<0,01); nível educacional: superior (O.R.=1,0; referência), médio (O.R.=1,2; IC95%=1,1 - 1,5; p<0,01), fundamental (O.R.=1,7; IC95%=1,3 - 2,3; p<0,001); tratamento para transtorno do estresse pós-traumático (O.R.=1,4; IC95%=1,1 - 1,8; p<0,05); tratamento para dependência por álcool (O.R.=2,0; IC95%=1,1 - 3,8; p<0,05); contracepção de emergência (O.R.=1,8; IC95%=1,4 - 2,2; p<0,001); dificuldades no início da vida sexual (O.R.=1,3; IC95%=1,2 - 1,5; p<0,001); violência sexual sofrida (O.R.=2,2; IC95%=1,5 - 3,2; p<0,001); orientação sexual: heterossexual (O.R.=1,0; referência), bissexual (O.R.=3,6; IC95%=1,9 - 6,6; p<0,001); realizar sexo anal (O.R.=2,0; IC95%=1,7 - 2,3; p<0,001); realizar sexo oral (O.R.=1,2; IC95%=1,1 - 1,5; p<0,01). CONCLUSÕES: estes comportamentos devem ser valorizados na clínica uma vez que os indivíduos que os referiram apresentaram indicativos negativos de condições sócio-econômicas e de saúde física, mental e sexual. / INTRODUCTION: The literature presents studies about paraphilias, upsets related to paraphilias and sexual compulsion, but does not contain researches on the frequency of the current sexual practices in non-clinical samples. This study investigated the association of these practices for social- demographic and physical, mental and sexual health parameters, in a populational sample of Brazil. METHODS: The Brazilian Sexual Life Study (BSLS) is a transversal study, of 7.022 individuals (45.4% of women) accomplished through a self-responsive questionnaire of 87 items regarding social-demographic aspects and sexual behavior habits. With this study sample was performed a comparison between individuals with reference to at least one unconventional sexual behavior - pertaining to a group sex, sex to three, couples´ switch, incest, sex with animals, with fetishes, with insults or aggressions exchange, with money receiving, with exhibitionists or voyeuristic components - (Group 1) and individuals without reference to any of these practices (Group 2). RESULTS: 1. Unconventional sexual behaviors (USB) were more frequent among men (52.3%) than among women (30.4%); p<0.001. 2. Fetishist behavior (13.4%), voyeurism (13.0%) and incest (11.3%) were the most frequent ones, while receiving money for sex (4.8%), sexual intercourse with animals (3.2%) and couples\' switch (3.1%) the least frequent. 3. Group 1 had a lower average age than Group 2, so much for women 35.0 vs. 35.9 years (p<0.05) as well as for men 36.5 vs. 37.8 years (p<0.05). 4. The final model of multivariate logistics regression showed an association of unconventional sexual behavior with the next variables: masculine gender (O.R. = 2.3; IC 95% = 2.0 - 2.6 (p<0.001); marital status: married (O.R. = 1.0; Reference), single (O.R. = 1.2; IC 95% = 1.0 - 1.4; p<0.05), divorced or separated (O.R. = 1.4; IC 95% = 1.1 - 1.8; p<0,01); race: white (O.R. = 1.0; Reference), black (O.R. = 1.4; IC 95% = 1.0 - 1.9; p<0,05), mulatto (O.R. = 1.4; IC 95% = 1.1 - 1.7; p<0,01); educational level: superior (O.R. = 1.0; Reference), medium (O.R. = 1.2; IC95% = 1.1 - 1.5; p<0.01), fundamental (O.R. = 1.7; IC 95% =1.3 - 2.3; p<0,001); post- traumatic stress disorder (PTSD) treatment (O.R. = 1.4; IC 95%=1.1 - 1.8; p<0.05); alcohol dependence treatment (O.R. = 2.0; IC 95% = 1.1 - 3.8; p<0.05); emergency contraception (O.R. = 1.8; IC 95% =1.4 - 2.2; p<0.001); difficulty at the beginning of the sexual life (O.R. = 1.3; IC 95 % = 1.2 - 1.5; p<0.001); sexual violence (O.R. = 2.2; IC 95% = 1.5 - 3.2; p<0.001); sexual orientation: heterosexual (O.R. = 1.0; Reference), bisexual (O.R. = 3.6; IC 95 % = 1.9 - 6.6; p<0.001); performance of anal (O.R. = 2.0; IC 95 % = 1.7 - 2.3; p<0,001) or oral intercourse (O.R. = 1.2; IC 95 % = 1.1 -1.5; p<0.01). CONCLUSIONS: These behaviors should be clinically prized because individuals who presented them showed negative indicative of socioeconomic terms and of physical, mental and sexual health.

INTRODUÇÃO: A literatura apresenta estudos sobre parafilias, transtornos relacionados às parafilias e compulsão sexual, mas não contém pesquisas sobre a freqüência destas práticas sexuais na população em geral. Este estudo investiga a associação destas práticas a parâmetros sócio- demográficos e de saúde física, mental e sexual, em amostra da população do Brasil. MÉTODOS: O Estudo da Vida Sexual do Brasileiro (EVSB) é um estudo transversal, de 7.022 indivíduos (45,4% de mulheres) realizado através de um questionário auto-responsivo de 87 itens sobre aspectos sócio-demográficos e de hábitos e comportamento sexuais. Com a amostra desse estudo, foi realizada a comparação entre indivíduos com referência a pelo menos um comportamento sexual não convencional - sexo grupal, sexo a três, troca de casais, incesto, sexo com animais, com fetiches, com troca de insultos ou agressões, com recebimento de dinheiro, com componentes exibicionistas ou voyeuristas - (grupo 1) e indivíduos sem referência a qualquer uma destas práticas (grupo 2). RESULTADOS: 1. Os comportamentos sexuais não convencionais foram mais freqüentes entre os homens (52,3%) do que entre as mulheres (30,4%); p<0,001. 2. Comportamento fetichista (13,4%), voyeurista (13,0%) e incesto (11,3%) foram os mais freqüentes, enquanto receber dinheiro por sexo (4,8%), relação sexual com animais (3,2%) e troca de casais (3,1%), os menos freqüentes. 3. O grupo 1 teve média de idade menor que o grupo 2, tanto para mulheres (35,0 vs 35,9 anos; p<0,05) como para homens (36,5 vs 37,8 anos; p<0,05). 4. O modelo final de regressão logística multivariado mostrou associação de comportamento sexual não convencional com as seguintes variáveis: gênero masculino (O.R.=2,3; IC95%=2,0 -2,6; p<0,001); estado civil: casado (O.R.=1,0; referência), solteiro (O.R.=1,2; IC 95%=1,0 - 1,4; p<0,05), divorciado ou separado (O.R.=1,4; IC95%=1,1 - 1,8; p<0,01); raça: branca (O.R.=1,0; referência), negra (O.R.=1,4; IC95%=1,0 - 1,9; p<0,05), parda (O.R.=1,4; IC95%=1,1 - 1,7; p<0,01); nível educacional: superior (O.R.=1,0; referência), médio (O.R.=1,2; IC95%=1,1 - 1,5; p<0,01), fundamental (O.R.=1,7; IC95%=1,3 - 2,3; p<0,001); tratamento para transtorno do estresse pós-traumático (O.R.=1,4; IC95%=1,1 - 1,8; p<0,05); tratamento para dependência por álcool (O.R.=2,0; IC95%=1,1 - 3,8; p<0,05); contracepção de emergência (O.R.=1,8; IC95%=1,4 - 2,2; p<0,001); dificuldades no início da vida sexual (O.R.=1,3; IC95%=1,2 - 1,5; p<0,001); violência sexual sofrida (O.R.=2,2; IC95%=1,5 - 3,2; p<0,001); orientação sexual: heterossexual (O.R.=1,0; referência), bissexual (O.R.=3,6; IC95%=1,9 - 6,6; p<0,001); realizar sexo anal (O.R.=2,0; IC95%=1,7 - 2,3; p<0,001); realizar sexo oral (O.R.=1,2; IC95%=1,1 - 1,5; p<0,01). CONCLUSÕES: estes comportamentos devem ser valorizados na clínica uma vez que os indivíduos que os referiram apresentaram indicativos negativos de condições sócio-econômicas e de saúde física, mental e sexual. / INTRODUCTION: The literature presents studies about paraphilias, upsets related to paraphilias and sexual compulsion, but does not contain researches on the frequency of the current sexual practices in non-clinical samples. This study investigated the association of these practices for social- demographic and physical, mental and sexual health parameters, in a populational sample of Brazil. METHODS: The Brazilian Sexual Life Study (BSLS) is a transversal study, of 7.022 individuals (45.4% of women) accomplished through a self-responsive questionnaire of 87 items regarding social-demographic aspects and sexual behavior habits. With this study sample was performed a comparison between individuals with reference to at least one unconventional sexual behavior - pertaining to a group sex, sex to three, couples´ switch, incest, sex with animals, with fetishes, with insults or aggressions exchange, with money receiving, with exhibitionists or voyeuristic components - (Group 1) and individuals without reference to any of these practices (Group 2). RESULTS: 1. Unconventional sexual behaviors (USB) were more frequent among men (52.3%) than among women (30.4%); p<0.001. 2. Fetishist behavior (13.4%), voyeurism (13.0%) and incest (11.3%) were the most frequent ones, while receiving money for sex (4.8%), sexual intercourse with animals (3.2%) and couples\' switch (3.1%) the least frequent. 3. Group 1 had a lower average age than Group 2, so much for women 35.0 vs. 35.9 years (p<0.05) as well as for men 36.5 vs. 37.8 years (p<0.05). 4. The final model of multivariate logistics regression showed an association of unconventional sexual behavior with the next variables: masculine gender (O.R. = 2.3; IC 95% = 2.0 - 2.6 (p<0.001); marital status: married (O.R. = 1.0; Reference), single (O.R. = 1.2; IC 95% = 1.0 - 1.4; p<0.05), divorced or separated (O.R. = 1.4; IC 95% = 1.1 - 1.8; p<0,01); race: white (O.R. = 1.0; Reference), black (O.R. = 1.4; IC 95% = 1.0 - 1.9; p<0,05), mulatto (O.R. = 1.4; IC 95% = 1.1 - 1.7; p<0,01); educational level: superior (O.R. = 1.0; Reference), medium (O.R. = 1.2; IC95% = 1.1 - 1.5; p<0.01), fundamental (O.R. = 1.7; IC 95% =1.3 - 2.3; p<0,001); post- traumatic stress disorder (PTSD) treatment (O.R. = 1.4; IC 95%=1.1 - 1.8; p<0.05); alcohol dependence treatment (O.R. = 2.0; IC 95% = 1.1 - 3.8; p<0.05); emergency contraception (O.R. = 1.8; IC 95% =1.4 - 2.2; p<0.001); difficulty at the beginning of the sexual life (O.R. = 1.3; IC 95 % = 1.2 - 1.5; p<0.001); sexual violence (O.R. = 2.2; IC 95% = 1.5 - 3.2; p<0.001); sexual orientation: heterosexual (O.R. = 1.0; Reference), bisexual (O.R. = 3.6; IC 95 % = 1.9 - 6.6; p<0.001); performance of anal (O.R. = 2.0; IC 95 % = 1.7 - 2.3; p<0,001) or oral intercourse (O.R. = 1.2; IC 95 % = 1.1 -1.5; p<0.01). CONCLUSIONS: These behaviors should be clinically prized because individuals who presented them showed negative indicative of socioeconomic terms and of physical, mental and sexual health.

High risk offenders are a complex and heterogeneous group of offenders about whom researchers, clinicians, and society still know relatively little. In response to the paucity of information that is specifically applicable to high risk offenders, the present study examined RCMP Integrated Sexual Predator Intelligence Network (ISPIN) data to investigate the relationship between sexual paraphilias, sexual fantasy, and psychopathy among 139 of the highest risk sexual offenders in British Columbia. The sample included 41 child molesters, 42 rapists, 18 rapist/molesters, 30 mixed offenders, and 6 “other” sexual offenders. The majority of offenders in this sample were diagnosed with one primary paraphilia (67%). Data analysis revealed significant differences between offender types for criminal history variables including past sexual and nonsexual convictions, number of victims, and age of offending onset. For example, offenders who victimized children (i.e., exclusive child molesters & rapist/molesters) had a greater number of past sexual convictions than did offenders who victimized adults exclusively. Further, there were significant differences between offender types for paraphilia diagnoses, sexual fantasy themes, and levels of psychopathy. For example, exclusive child molesters were significantly more likely to receive a paraphilia diagnosis, were more likely to report having sexual fantasies, and had lower Psychopathy Checklist Revised (PCL-R) scores than other offender types. Results from the current study will serve to facilitate a more refined and informed understanding of sexual offending behaviour, with important implications for future research, assessment, and treatment issues, as well as law enforcement practices when working with high risk sexual offenders.

High risk offenders are a complex and heterogeneous group of offenders about whom researchers, clinicians, and society still know relatively little. In response to the paucity of information that is specifically applicable to high risk offenders, the present study examined RCMP Integrated Sexual Predator Intelligence Network (ISPIN) data to investigate the relationship between sexual paraphilias, sexual fantasy, and psychopathy among 139 of the highest risk sexual offenders in British Columbia. The sample included 41 child molesters, 42 rapists, 18 rapist/molesters, 30 mixed offenders, and 6 “other” sexual offenders. The majority of offenders in this sample were diagnosed with one primary paraphilia (67%). Data analysis revealed significant differences between offender types for criminal history variables including past sexual and nonsexual convictions, number of victims, and age of offending onset. For example, offenders who victimized children (i.e., exclusive child molesters & rapist/molesters) had a greater number of past sexual convictions than did offenders who victimized adults exclusively. Further, there were significant differences between offender types for paraphilia diagnoses, sexual fantasy themes, and levels of psychopathy. For example, exclusive child molesters were significantly more likely to receive a paraphilia diagnosis, were more likely to report having sexual fantasies, and had lower Psychopathy Checklist Revised (PCL-R) scores than other offender types. Results from the current study will serve to facilitate a more refined and informed understanding of sexual offending behaviour, with important implications for future research, assessment, and treatment issues, as well as law enforcement practices when working with high risk sexual offenders.

High risk offenders are a complex and heterogeneous group of offenders about whom researchers, clinicians, and society still know relatively little. In response to the paucity of information that is specifically applicable to high risk offenders, the present study examined RCMP Integrated Sexual Predator Intelligence Network (ISPIN) data to investigate the relationship between sexual paraphilias, sexual fantasy, and psychopathy among 139 of the highest risk sexual offenders in British Columbia. The sample included 41 child molesters, 42 rapists, 18 rapist/molesters, 30 mixed offenders, and 6 “other” sexual offenders. The majority of offenders in this sample were diagnosed with one primary paraphilia (67%). Data analysis revealed significant differences between offender types for criminal history variables including past sexual and nonsexual convictions, number of victims, and age of offending onset. For example, offenders who victimized children (i.e., exclusive child molesters & rapist/molesters) had a greater number of past sexual convictions than did offenders who victimized adults exclusively. Further, there were significant differences between offender types for paraphilia diagnoses, sexual fantasy themes, and levels of psychopathy. For example, exclusive child molesters were significantly more likely to receive a paraphilia diagnosis, were more likely to report having sexual fantasies, and had lower Psychopathy Checklist Revised (PCL-R) scores than other offender types. Results from the current study will serve to facilitate a more refined and informed understanding of sexual offending behaviour, with important implications for future research, assessment, and treatment issues, as well as law enforcement practices when working with high risk sexual offenders. / Graduate Studies, College of (Okanagan) / Graduate

Child sexual abuse (CSA) has been recognized as a widespread and devastating problem in our society. Definitional challenges result in a broad range of prevalence rates for CSA varying from 60/0 to 62% for females and 30/0 to 31 % for males (Finkelhor, Araji, Baron, Browne, Peters, & Wyatt, 1986). Although CSA affects our nation's children in epidemic proportions, researchers have found little conclusive evidence regarding CSA precursors. One promising area for exploring the etiology of CSA may be the differential patterns of sexual fantasies in juvenile and adult sex offenders. Abel, Becker, Mittleman, Cunningham-Rathner, Rouleau and Murphy (1987) found that more than 40% of non-familial child molesters reported the development of deviant sexual fantasies prior to sexually offending. Despite variations in offender subgroups, Marshall, Barbaree and Eccles (1991) found that 22% of the offenders experienced deviant fantasies prior to their first sexual offense. Unfortunately, the literature in this area has been quite limited despite its potential. Understanding offender similarities and differences in adult and juvenile populations may be important due to the large proportion of the offender population who begin sexually offending as juveniles and due to the treatment modalities that may be implemented for developmentally different offenders. As many as 500/0 of adult sex offenders have reported sexually deviant behavior beginning in adolescence (Becker, 1988; Ferhenbach, Smith, Monastersky & Deisher, 1986; Marshall, Barbaree, & Eccles, 1991). Juveniles have also been identified as perpetrators in more than half of all cases (Fehrenbach, Smith, Monastersky, & Deisher, 1986). This study investigates the relationship between offenders' sexual fantasies and their use of physical force to sexually offend. This investigation was also designed to examine the similarities and differences between adult and adolescent sexual offenders on these dimensions. Findings reveal an empirical relationship between offenders' fantasies and behaviors in sexual offending. It is anticipated that additional knowledge regarding potential relationships between fantasies and behaviors will assist in assessing and intervening with accused and convicted sexual offenders. Potential implications for clinical assessment and intervention into sexual abuse are discussed as well as the potential for understanding maintenance factors in the continuation of sexual abuse.

INTRODUÇÃO: Pacientes com diagnóstico de parafilias e de transtornos relacionados às parafilias ocupam a atenção pública e clínica por se tratarem de indivíduos potencialmente inconvenientes, causadores de problemas à sociedade e a si próprios. Caracteristicamente, apresentam padrões invulgares de comportamento sexual e distinguem-se pela escolha de parcerias ou de contextos sexuais incomuns. JUSTIFICATIVA: O tratamento atual leva em consideração comportamentos, fantasias e necessidades sexuais parafílicas e procura modificá-los por meio de psicoterapia cognitivocomportamental, medicação antidepressiva e antiandrogênica. Apenas a supressão destes comportamentos tem se mostrado insatisfatória e ainda apresenta altas taxas de reincidência. Não há resultados publicados sobre a efetividade de um novo tratamento psicoterapêutico, cujo foco esteja voltado para a identificação e a reestruturação da identidade sexual e cujo principal objetivo seja o de promover maior contato destes pacientes com parcerias sexuais convencionais. MÉTODO: A intervenção foi testada por meio de ensaio clínico de tratamento, randomizado, placebo controlado e unicego, realizado com dois grupos paralelos: experimental (N=6) e controle (N=8). Todos os pacientes apresentavam diagnóstico de parafilias e foram medicados com inibidores seletivos da recaptação de serotonina. As intervenções psicoterapêuticas duraram dezesseis semanas com frequência de uma sessão por semana. As mudanças comportamentais foram monitoradas por meio de um diário e as comorbidades psiquiátricas, a qualidade de vida e a adequação social foram avaliadas por meio de escalas psicométricas, nos três períodos do estudo: início, término e seguimento pósintervenção. RESULTADOS: Não houve melhora estatisticamente significante dos escores de depressão, qualidade de vida e adequação social para ambos os grupos. O grupo experimental apresentou tendência de melhor resposta para depressão ao se tomar esta variável de forma categorial. Ambos os grupos apresentaram: maior incapacidade de adequação social (comparados a populações não clínicas); tendência de aumento do estado de ansiedade; melhora clínica global e redução dos índices de gravidade das parafilias. Houve diferenças estatisticamente significantes entre os grupos. Para o grupo experimental: aumento de fantasias e masturbações normofílicas; maior procura por contatos eróticos normofílicos e diminuição de fantasias parafílicas. Porém, houve diminuição de contatos íntimos normofílicos (beijos, abraços e carícias) para este grupo. Houve diferenças estatisticamente significantes intragrupos. Para o grupo experimental: redução de contatos íntimos parafílicos e totais (parafílicos e normofílicos). Para o grupo placebo: aumento de relações sexuais parafílicas e da totalidade das fantasias sexuais (parafílicas e normofílicas). CONCLUSÕES: Os defechos favoráveis observados no grupo de intervenção evidenciaram a importância em se identificar e trabalhar psicoterapeuticamente o impedimento que os parafílicos apresentam de se relacionar com parcerias sexuais normofílicas, uma vez que para o grupo experimental as mudanças positivas observadas no comportamento, fantasias e necessidades sexuais caminharam em direção a padrões convencionais / INTRODUCTION: Patients diagnosed with paraphilia and paraphilia-related disorders have public and medical attention drawn to them because they are potentially disturbing individuals who cause problems to society and to themselves. Typically, they show unusual patterns of sexual behavior and make unusual choices related to sexual partners or sexual contexts. RATIONALE: Current treatment considers paraphilic behaviors, fantasies, and urges, trying to change these symptoms using cognitive-behavioral psychotherapy, antidepressants, and anti-androgen medication. The elimination of these behaviors has proved unsatisfactory and still has high recurrence rates. We could not find in the literature any studies on the effectiveness of a new psychotherapeutic treatment focused on identifying and restructuring the patients\' sexual identity to allow for the promotion of contact between these patients and conventional sexual partners. METHOD: We conducted a randomized, placebo-controlled, single-blind clinical trial with two groups: experimental (N = 6) and control (N = 8). All patients were diagnosed with paraphilia and were treated with selective serotonin reuptake inhibitors. The psychotherapeutic interventions lasted sixteen weeks, and its frequency was one session a week. Behavioral changes were monitored using a diary, whereas psychiatric comorbidities, quality of life, and social adequacy were assessed using psychometric scales in the three study periods: baseline, end, and post-intervention follow-up. RESULTS: There was no significant improvement of depression, quality of life, and social adequacy scores for both groups. The experimental group showed a trend toward better response to depression when we considered this as categorical variable. Both groups showed higher inability of social adequacy (when compared with non-clinical populations); tendency of increased state of anxiety; improvement of overall clinical status, and reduced levels of paraphilia severity. There were statistically significant differences between the groups. The experimental group showed increased frequency of normophilic fantasies and masturbation; increased demand for normophilic erotic contact, and decreased paraphilic fantasies. However, there was a decrease in normophilic intimate contact (kisses, hugs, and caresses) in this group. There were statistically significant intragroup differences. The experimental group had reduced paraphilic and total (paraphilic and normophilic) intimate contact. The placebo group had increased paraphilic sexual intercourse and higher frequency of sexual fantasies (paraphilic and normophilic). CONCLUSIONS: The positive outcomes found in the intervention group showed the importance of psychotherapy in identifying and treating the paraphilic patients\' impediments that prevent them from having relationships with normophilic sexual partners. This was reinforced by the finding that the experimental group showed positive changes in terms of sexual behaviors, fantasies, and urges, which were closer to conventional standards

INTRODUÇÃO: Pacientes com diagnóstico de parafilias e de transtornos relacionados às parafilias ocupam a atenção pública e clínica por se tratarem de indivíduos potencialmente inconvenientes, causadores de problemas à sociedade e a si próprios. Caracteristicamente, apresentam padrões invulgares de comportamento sexual e distinguem-se pela escolha de parcerias ou de contextos sexuais incomuns. JUSTIFICATIVA: O tratamento atual leva em consideração comportamentos, fantasias e necessidades sexuais parafílicas e procura modificá-los por meio de psicoterapia cognitivocomportamental, medicação antidepressiva e antiandrogênica. Apenas a supressão destes comportamentos tem se mostrado insatisfatória e ainda apresenta altas taxas de reincidência. Não há resultados publicados sobre a efetividade de um novo tratamento psicoterapêutico, cujo foco esteja voltado para a identificação e a reestruturação da identidade sexual e cujo principal objetivo seja o de promover maior contato destes pacientes com parcerias sexuais convencionais. MÉTODO: A intervenção foi testada por meio de ensaio clínico de tratamento, randomizado, placebo controlado e unicego, realizado com dois grupos paralelos: experimental (N=6) e controle (N=8). Todos os pacientes apresentavam diagnóstico de parafilias e foram medicados com inibidores seletivos da recaptação de serotonina. As intervenções psicoterapêuticas duraram dezesseis semanas com frequência de uma sessão por semana. As mudanças comportamentais foram monitoradas por meio de um diário e as comorbidades psiquiátricas, a qualidade de vida e a adequação social foram avaliadas por meio de escalas psicométricas, nos três períodos do estudo: início, término e seguimento pósintervenção. RESULTADOS: Não houve melhora estatisticamente significante dos escores de depressão, qualidade de vida e adequação social para ambos os grupos. O grupo experimental apresentou tendência de melhor resposta para depressão ao se tomar esta variável de forma categorial. Ambos os grupos apresentaram: maior incapacidade de adequação social (comparados a populações não clínicas); tendência de aumento do estado de ansiedade; melhora clínica global e redução dos índices de gravidade das parafilias. Houve diferenças estatisticamente significantes entre os grupos. Para o grupo experimental: aumento de fantasias e masturbações normofílicas; maior procura por contatos eróticos normofílicos e diminuição de fantasias parafílicas. Porém, houve diminuição de contatos íntimos normofílicos (beijos, abraços e carícias) para este grupo. Houve diferenças estatisticamente significantes intragrupos. Para o grupo experimental: redução de contatos íntimos parafílicos e totais (parafílicos e normofílicos). Para o grupo placebo: aumento de relações sexuais parafílicas e da totalidade das fantasias sexuais (parafílicas e normofílicas). CONCLUSÕES: Os defechos favoráveis observados no grupo de intervenção evidenciaram a importância em se identificar e trabalhar psicoterapeuticamente o impedimento que os parafílicos apresentam de se relacionar com parcerias sexuais normofílicas, uma vez que para o grupo experimental as mudanças positivas observadas no comportamento, fantasias e necessidades sexuais caminharam em direção a padrões convencionais / INTRODUCTION: Patients diagnosed with paraphilia and paraphilia-related disorders have public and medical attention drawn to them because they are potentially disturbing individuals who cause problems to society and to themselves. Typically, they show unusual patterns of sexual behavior and make unusual choices related to sexual partners or sexual contexts. RATIONALE: Current treatment considers paraphilic behaviors, fantasies, and urges, trying to change these symptoms using cognitive-behavioral psychotherapy, antidepressants, and anti-androgen medication. The elimination of these behaviors has proved unsatisfactory and still has high recurrence rates. We could not find in the literature any studies on the effectiveness of a new psychotherapeutic treatment focused on identifying and restructuring the patients\' sexual identity to allow for the promotion of contact between these patients and conventional sexual partners. METHOD: We conducted a randomized, placebo-controlled, single-blind clinical trial with two groups: experimental (N = 6) and control (N = 8). All patients were diagnosed with paraphilia and were treated with selective serotonin reuptake inhibitors. The psychotherapeutic interventions lasted sixteen weeks, and its frequency was one session a week. Behavioral changes were monitored using a diary, whereas psychiatric comorbidities, quality of life, and social adequacy were assessed using psychometric scales in the three study periods: baseline, end, and post-intervention follow-up. RESULTS: There was no significant improvement of depression, quality of life, and social adequacy scores for both groups. The experimental group showed a trend toward better response to depression when we considered this as categorical variable. Both groups showed higher inability of social adequacy (when compared with non-clinical populations); tendency of increased state of anxiety; improvement of overall clinical status, and reduced levels of paraphilia severity. There were statistically significant differences between the groups. The experimental group showed increased frequency of normophilic fantasies and masturbation; increased demand for normophilic erotic contact, and decreased paraphilic fantasies. However, there was a decrease in normophilic intimate contact (kisses, hugs, and caresses) in this group. There were statistically significant intragroup differences. The experimental group had reduced paraphilic and total (paraphilic and normophilic) intimate contact. The placebo group had increased paraphilic sexual intercourse and higher frequency of sexual fantasies (paraphilic and normophilic). CONCLUSIONS: The positive outcomes found in the intervention group showed the importance of psychotherapy in identifying and treating the paraphilic patients\' impediments that prevent them from having relationships with normophilic sexual partners. This was reinforced by the finding that the experimental group showed positive changes in terms of sexual behaviors, fantasies, and urges, which were closer to conventional standards