J Psychiatry Neurosci 2015;40(6):429-431
Johannes Fuss, MD; Matthias K. Auer, MD; Sarah V. Biedermann, MD; Peer Briken, MD; Werner Hacke, MD, PhD
To date there are few treatment options to reduce high sexual drive or sexual urges in paraphilic patients with a risk for sexual offending. Pharmacological therapy aims to reduce sexual drive by lowering testosterone at the cost of severe side effects. We hypothesize that high sexual drive could also be reduced with deep brain stimulation (DBS) of circuits that generate sexual drive. This approach would help to avoid systemic side effects of antiandrogenic drug therapies. So far the best investigated target to reduce sexual drive is the ventromedial hypothalamus, which was lesioned unilaterally and bilaterally by stereotaxic interventions in paraphilic patients in the 1970s. Here, we discuss DBS as a treatment strategy in patients with severe paraphilic disorders with a serious risk of sexual offending. There are profound ethical and practical issues associated with DBS treatment of paraphilic patients that must be solved before considering such a treatment approach.
Submitted Jan. 6, 2015; Revised Feb. 19, 2015; Accepted Feb. 25, 2015; Early-released June 9, 2015.
Affiliations: From the Institute for Sex Research and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany (Fuss, Briken); the RG Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany (Auer); the Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany (Biedermann); and the Department of Neurology, University of Heidelberg, Germany (Hacke).
Competing interests: P. Briken is a consultant at Dr. Pfleger GmbH, Bamberg, Germany. No other competing interests declared.
Contributors: All authors contributed substantially to the conception, writing and review of this commentary and approved the final version for publication.
Correspondence to: J Fuss., Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; firstname.lastname@example.org