Presentation in Sexpo's international seminar "Sex Offending: Preventive Interventions and Recidivism" 2013

1. Centre for Andrology & Sexualmedicine
Stefan Arver, Associate professor, Director
Katarina Öberg, PhD, psychologist
Elin Zamore, RND, psychotherapist, coordinator
Cecilia Dhejne, psychiatrist
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Centre for Andrology and
Sexualmedicine

2. 2 Föreläsningens namn
Centre for Andrology and Sexual Medicine
Andrology and Sexual Medicine
Investigation and treatment
Andrological Endocrinology
Male infertility
Sexual dysfunction
Paraphilias
Hypersexuality
Gender Dysphoria
Sexual dysfunction
Centre for Andrology and
Sexualmedicine

3. • Endocrinolgy/internal medicine
• Urology, gynaecology
• Psychiatry, Forensic Psychiatriy
• Psychology
• Psychotherapy
• Specialist Nurse
• Administration
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4. • Intake patients
◦ Hypersexuality
◦ Paraphilias
◦ Persons at risk of becoming sexual
offenders
◦ Sexual offenders
• General Sexual Medicine; sexual
dysfunctions
• Problems related to sexual orientation and
gender identity
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5.  42% referral psychiatric care
 46% self referral
 4% correctional system
 8% other; police,
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Self admission:
Telephone
Letters
Mail
Referals
psychiatry, GP
Prevention program
Center for Andrology
and
Sexual Medicine
Pris
on
Forensic
psychiatr
ic care
Probition
with
mandatory
treatment
Probition
Forensic
psychiat
ric
evaluati
on
Court
Judge
Sex
offen
der
police
Consultations

7.  Purpose
• Assessment for diagnosis and indvidulaised
treatment
• Research; systematic data regarding sexual
paraphilias and hypersexuality disorder.
• Assessmentof treatment efficacy and outcome
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Centre for Andrology and
Sexualmedicine

8.  Main diagnos
 Co-morbidity: Axis-I and II
 Personality disorder
 Risk assessment for relapse in sexual offending
 Screening for alcohol- och substansabuse, ADHD, Asperger
 Exposure to trauma, pornography, offending behav, sexual
impulsivity & compulsivity, sexual sensation seeking behav,
hypersexual disorder
 Sexual interests & experiences, sexual function
 Cognitive level
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Centre for Andrology and
Sexualmedicine

9.  95% men
 50% in relation
 31% have children
 85% born in Sweden
 76% work or studied
 35% university education
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Centre for Andrology and
Sexualmedicine

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Diagnosis
Antal
n=158
Procent
%
Pedophilia 29 18
Sexual highrisk behaviour 27 17
Hypersexuality 61 39
Exhibitionism 6 4
Fetishism 1 1
Voyeurism 1 1
Frotteurism 2 1
Other : psychiatric diagnos,
31 19
Totalt 158 100
Main diagnosis at first visit

11.  68% Depression (15% on-going)
18% Social anxiety, phobia
 17% Personality disorder, 10% Anti social
personality disorder
 14% Anxiety disorder (GAD, panic syndrom)
 13% Obessive compulsive disorder
 10% Neuro psychiatric disorder, Aspergers
Syndrom, ADHD
 10% Alcohol- substance abuse

 3% Suicidal (on-going)
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Centre for Andrology and
Sexualmedicine

12. 
Harassment or bullying
86 %
 Physical abuse
35 %
 Sexual abuse
18 %
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Centre for Andrology and
Sexualmedicine

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Previous conviction
sexual offences 16%
physical assualt 4%
other (incl childpornography use) 19%
Self reported
sexual offences 34%
physical assault 2%
other (incl childpornography use) 25%
Conviction
N=123
Centre for Andrology and
Sexualmedicine

14.  Motivation on different levels, but always
 Voluntary in cooperation with the patient
 Group, individual, couple
 Individualized based on assement,
 Manually-based cognitive behavioural therapy programme in
progress
 Evidence based
 Farmacology and/or psychotherapy
 Booster
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15.  Motivational Interviewing
 Focus on eliminating offender behav; identify of risksituations and
riskbehav
 Treating co-morbidity
 Identify “triggers” & maintaining factors of behav
 Consequences of behavior, short- and longterm
 Identify cognitive destortions; denial
 Social skill training; self-esteem and confidence, listening, regulation of
affects
 Empathy for the victim
 Social skills. Develop alternative sexual relations and sexuality: psycho-
education/pedagogic, and/or sextherapy with partner
 Riskfactors for relapse
 Evidence-based treatment!
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