Diagnóstico e intervenciones psicoterapéuticas acerca de los trastornos parafílicos: Una revisión sistemática
Diagnosis and psychotherapeutic interventions for paraphilic disorders: A systematic reviewContenido principal del artículo
Los Trastornos Parafílicos (TP) son aquellas conductas psicosexuales desadaptativas y aberrantes que constituyen una enfermedad mental, que necesitan un abordaje psicoterapéutico y psiquiátrico. Por lo tanto, el objetivo de este estudio fue evaluar los diagnósticos e intervenciones psicoterapéuticas más utilizadas en pacientes con trastornos parafílicos. La metodología empleada fue la revisión sistemática descriptiva, apoyada en PRISMA. La búsqueda se realizó en bases de datos como Scopus, Web of Science y PsycInfo, en cuanto a los controles de calidad se ejecutó una evaluación metodológica de los artículos empíricos con la Psychotherapy Outcome Study Methodology Rating Form (POMRF). Los resultados de búsqueda arrojaron 266 registros de los cuales siguiendo y cumpliendo con los criterios inclusión y exclusión fueron seleccionada 18 estudios acerca de la intervención psicoterapéutica de los TP. Se concluye que el DSM-V es una de las herramientas más utilizadas por profesionales de la salud mental para diagnosticar y clasificar el TP; en cuanto a las intervenciones terapéuticas más utilizadas para los TP corresponden al uso de fármacos (antilibidinal y antiandrógena) y la Terapia Cognitivo-Conductual (TCC).
Paraphilic Disorders (PD) are those maladaptive and aberrant psychosexual behaviors that constitute a mental illness, which need a psychotherapeutic and psychiatric approach. Therefore, the aim of this study was to evaluate the most commonly used diagnoses and psychotherapeutic interventions in patients with paraphilic disorders. The methodology used was a descriptive systematic review, supported by PRISMA. The search was carried out in databases such as Scopus, Web of Science and PsycInfo, and a methodological evaluation of the empirical articles was carried out using the Psychotherapy Outcome Study Methodology Rating Form (POMRF). The search results yielded 266 records of which 18 studies on the psychotherapeutic intervention of PT were selected according to the inclusion and exclusion criteria. It is concluded that the DSM-V is one of the tools most used by mental health professionals to diagnose and classify PT; the most commonly used therapeutic interventions for PT correspond to the use of drugs (antilibidinal and anti-androgen) and Cognitive-Behavioral Therapy (CBT).
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Antons, S., Engel, J., Briken, P., Krüger, T. H. C., Brand, M., y Stark, R. (2022). Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review. Journal of Behavioral Addictions, 11(3), 643-666. https://doi.org/10.1556/2006.2022.00061
Azizian, A., Hutton, S., Hughes, D., y Sreenivasan, S. (2016). Cognitional Impairment: Is There a Role for Cognitive Assessment in the Treatment of Individuals Civilly Committed Pursuant to the Sexually Violent Predator Act? Sexual Abuse: Journal of Research and Treatment, 28(8), 755-769. https://doi.org/10.1177/1079063215570757
Blanco, E. (2016). Trastorno parafílico: características clínicas de pacientes masculinos atendidos por Sexología Clínica Paraphilic Disorder: Clinical Characteristics of Male Patients Served by Clinical Sexology. 3. http://www.medigraphic.com/pdfs/revhospsihab/hph-2016/hph163i.pdf
Blanco, Elvia, Vasallo, C., Quintana, J., y Carnero, D. (2014). Parafilias: Un Estudio de Casos. Revista …, 12(30), 17-21. http://www.revsexologiaysociedad.sld.cu/index.php/sexologiaysociedad/article/download/325/379
Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T. W., y Potenza, M. N. (2019). The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors. Neuroscience and Biobehavioral Reviews, 104, 1-10. https://doi.org/10.1016/j.neubiorev.2019.06.032
Briken, P. (2015). Paraphilie und paraphile Störung im DSM-5. Forensische Psychiatrie, Psychologie, Kriminologie, 9(3), 140-146. https://doi.org/10.1007/s11757-015-0318-3
Briken, P., Boetticher, A., Krueger, R. B., Kismödi, E., y Reed, G. M. (2019). Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. Journal of Sexual Medicine, 16(10), 1615-1622. https://doi.org/10.1016/j.jsxm.2019.07.011
Briken, P., Bourget, D., y Dufour, M. (2014). Sexual Sadism in Sexual Offenders and Sexually Motivated Homicide. Psychiatric Clinics of North America, 37(2), 215-230. https://doi.org/10.1016/j.psc.2014.03.003
Briken, P., y Häßler, F. (2016). Medikamentöse Behandlung von Adoleszenten mit paraphiler Symptomatik und einem Risiko für die Begehung von Sexualstraftaten. Forensische Psychiatrie, Psychologie, Kriminologie, 10(2), 122-126. https://doi.org/10.1007/s11757-016-0363-6
Briken, P., y Krueger, R. B. (2018). From Atypical Sexual Interests to Paraphilic Disorders: The Planned ICD Revisions Related to Paraphilic Disorder. Journal of Sexual Medicine, 15(6), 807-808. https://doi.org/10.1016/j.jsxm.2018.02.001
Calleja, N. G. (2013). Integrating research into practice: The Forward-Focused Model of adolescent sexual behavior treatment. Aggression and Violent Behavior, 18(6), 686-694. https://doi.org/10.1016/j.avb.2013.07.023
Castellini, G., Rellini, A. H., Appignanesi, C., Pinucci, I., Fattorini, M., Grano, E., Fisher, A. D., Cassioli, E., Lelli, L., Maggi, M., y Ricca, V. (2018). Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students. Journal of Sexual Medicine, 15(9), 1322-1335. https://doi.org/10.1016/j.jsxm.2018.07.015
Chan, O., y Lam, S. (2018). Combination of psychiatric and psychological approaches in the assessment and treatment of sexual offenders. East Asian Archives of Psychiatry, 28(4), 129-133. https://doi.org/10.12809/eaap1828
Chopin, J., y Beauregard, E. (2021). Sadistic juvenile offenders: identifying clinical intervention dimensions based on sadism manifestations and criminogenic factors. Journal of Forensic Psychiatry and Psychology, 32(6), 792-807. https://doi.org/10.1080/14789949.2021.1909105
Dhuffar, M. K., y Griffiths, M. D. (2015). A Systematic Review of Online Sex Addiction and Clinical Treatments Using CONSORT Evaluation. Current Addiction Reports, 2(2), 163-174. https://doi.org/10.1007/s40429-015-0055-x
Eher, R., Rettenberger, M., y Turner, D. (2019). The prevalence of mental disorders in incarcerated contact sexual offenders. Acta Psychiatrica Scandinavica, 139(6), 572-581. https://doi.org/10.1111/acps.13024
Farré, J., y Lasheras, M. (2012). Trastornos de la inclinación sexual. Del estigma a la clínica: las parafilias. Tratado de Psiquiatría, 1979(4), 543-559. https://psiquiatria.com/tratado/cap_30.pdf
Gerwinn, H., Weiß, S., Tenbergen, G., Amelung, T., Födisch, C., Pohl, A., Massau, C., Kneer, J., Mohnke, S., Kärgel, C., Wittfoth, M., Jung, S., Drumkova, K., Schiltz, K., Walter, M., Beier, K. M., Walter, H., Ponseti, J., Schiffer, B., y Kruger, T. H. C. (2018). Clinical characteristics associated with paedophilia and child sex offending – Differentiating sexual preference from offence status. European Psychiatry, 51, 74-85. https://doi.org/10.1016/j.eurpsy.2018.02.002
Greaves, J. R., y Salloum, A. (2015). Evaluation of a Youth with Sexual Behavior Problems (YSBP) Outpatient Treatment Program. Child and Adolescent Social Work Journal, 32(2), 177-185. https://doi.org/10.1007/s10560-014-0348-2
Hall, P., Dix, J., y Cartin, C. (2020). The Effectiveness of Psycho-Educational Group Work in Treating Compulsive Sexual Behavior Disorder (CSBD): Clinical Outcomes Using CORE OM and Supplement at Three-Month and Six-Month Follow up. Sexual Addiction and Compulsivity, 27(1-2), 12-22. https://doi.org/10.1080/10720162.2020.1751364
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Jokinen, J., y Öberg, K. G. (2019). A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men. Journal of Sexual Medicine, 16(5), 733-745. https://doi.org/10.1016/j.jsxm.2019.03.005
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., y Öberg, K. G. (2017). A Cognitive-Behavioral Therapy Group Intervention for Hypersexual Disorder: A Feasibility Study. Journal of Sexual Medicine, 14(7), 950-958. https://doi.org/10.1016/j.jsxm.2017.05.004
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Piwowar, M., Jokinen, J., y Öberg, K. G. (2020). Internet-Administered Cognitive Behavioral Therapy for Hypersexual Disorder, With or Without Paraphilia(s) or Paraphilic Disorder(s) in Men: A Pilot Study. Journal of Sexual Medicine, 17(10), 2039-2054. https://doi.org/10.1016/j.jsxm.2020.07.018
Holas, P., Draps, M., Kowalewska, E., Lewczuk, K., y Gola, M. (2021). A pilot study of mindfulness-based relapse prevention for compulsive sexual behaviour disorder. Journal of Behavioral Addictions, 9(4), 1088-1092. https://doi.org/10.1556/2006.2020.00075
Honeycutt, D. R., y Rickard, G. K. (2021). Treatment of Students with Sexual Deviant or Offending Behaviors: Should College Counseling Centers Go There? Journal of College Student Psychotherapy, 35(2), 136-151. https://doi.org/10.1080/87568225.2019.1650682
Hsu, S. (2019). Fanon and the New Paraphilias: Towards a Trans of Color Critique of the DSM-V. Journal of Medical Humanities, 40(1), 53-68. https://doi.org/10.1007/s10912-018-9531-3
Hurtado, F. (2017). Rasgos de personalidad y características descriptivas de los ofensores sexuales en base a la evidencia científica. Siglantana PSICOSOMÁTICA Y PSIQUIATRÍA, 1(1), 37-40. https://doi.org/10.34810/PsicosomPsiquiatrnum0305
Keeley, J. W., Briken, P., Evans, S. C., First, M. B., Klein, V., Krueger, R. B., Matsumoto, C., Fresán, A., Rebello, T. J., Robles, R., Sharan, P., y Reed, G. M. (2021). Can Clinicians Use Dimensional Information to Make a Categorical Diagnosis of Paraphilic Disorders? An ICD-11 Field Study. Journal of Sexual Medicine, 18(9), 1592-1606. https://doi.org/10.1016/j.jsxm.2021.06.016
Khan, O., Ferriter, M., Huband, N., Powney, M. J., Dennis, J. A., y Duggan, C. (2015). Pharmacological interventions for those who have sexually offended or are at risk of offending. Cochrane Database of Systematic Reviews, 2015(2). https://doi.org/10.1002/14651858.CD007989.pub2
Kingston, D. A., Graham, F. J., y Knight, R. A. (2017). Relations Between Self-Reported Adverse Events in Childhood and Hypersexuality in Adult Male Sexual Offenders. Archives of Sexual Behavior, 46(3), 707-720. https://doi.org/10.1007/s10508-016-0873-5
Landgren, V., Malki, K., Bottai, M., Arver, S., y Rahm, C. (2020). Effect of gonadotropin-releasing hormone antagonist on risk of committing child sexual abuse in men with pedophilic disorder: A randomized clinical trial. JAMA Psychiatry, 77(9), 897-905. https://doi.org/10.1001/jamapsychiatry.2020.0440
Lett, T. A., Mohnke, S., Amelung, T., Brandl, E. J., Schiltz, K., Pohl, A., Gerwinn, H., Kärgel, C., Massau, C., Tenbergen, G., Wittfoth, M., Kneer, J., Beier, K. M., Walter, M., Ponseti, J., Krüger, T. H. C., Schiffer, B., y Walter, H. (2018). Multimodal neuroimaging measures and intelligence influence pedophile child sexual offense behavior. European Neuropsychopharmacology, 28(7), 818-827. https://doi.org/10.1016/j.euroneuro.2018.05.002
Mora-Montes, J., y Mora-Encinas, M. (2020). Una mejor comprensión de la sexualidad humana a través del estudio de la asexualidad. Revista de la Asociación Española de Neuropsiquiatría, 40(138), 115-132. https://doi.org/10.4321/S0211-573520200020007
Öst, L. G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), 296-321. https://doi.org/10.1016/j.brat.2007.12.005
Sánchez-Hernández, H. (2018). Hallazgos neurobiológicos recientes de la pedofilia. Archivos de Criminologia, seguridad Privada y Criminalística, XI, 38-43. www.acspyc.es.tl
Sánchez-Herrero, N., Lopez-Perez, R. M., y Domínguez-Muñoz, A. (2018). Parafilias: una revisión comparativa desde el DSM-5 y la CIE-10. Behavior & Law Journal, 4(1), 41-49. https://doi.org/10.47442/blj.v4.i1.58
Turner, D., y Briken, P. (2018). Treatment of paraphilic disorders with GnRH agonists under special consideration of ethical and legal aspects. Forensische Psychiatrie, Psychologie, Kriminologie, 12(4), 344-351. https://doi.org/10.1007/s11757-018-0503-2
Urrútia, G., y Bonfill, X. (2010). Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis.
Von Franqué, F., Klein, V., y Briken, P. (2015). Which techniques are used in psychotherapeutic interventions for nonparaphilic hypersexual behavior? Sexual Medicine Reviews, 3(1), 3-10. https://doi.org/10.1002/smrj.34
Winder, B., Fedoroff, J. P., Grubin, D., Klapilová, K., Kamenskov, M., Tucker, D., Basinskaya, I. A., y Vvedensky, G. E. (2019). The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence. International Review of Psychiatry, 31(2), 159-168. https://doi.org/10.1080/09540261.2019.1577223