Psych Vivas · Specialty psychiatry — clinical paraphilic disorders
Paraphilic disorders (clinical) — structured clinical viva
Fellowship viva on clinical exhibitionistic disorder: interest vs disorder, risk, WFSBP ladder, ethics of drive-reduction requests.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in outpatient clinic. A 41-year-old man reports 2 years of exhibitionistic urges on public transport, two episodes of exposing himself while intoxicated, intense shame, and a request for 'medication to kill my sex drive.' He has no known child-related interests. Partner is distressed. Discuss classification, differential, risk, assessment, WFSBP-aligned management including when SSRIs versus antiandrogens/GnRH are considered, monitoring, and communication about goals of care.
Interpretation
Reveal interpretationShowHide
This is exhibitionistic disorder (preferred atypical interest with acts involving nonconsenting persons plus distress), with alcohol as facilitator, partner impact, and a request for extreme drive reduction. Priorities: public risk management, substance work, psychological treatment, stepped pharmacology rather than jumping straight to GnRH, and ethical framing of goals.[1][2][7]
References7ShowHide
- [1]Krueger RB, Reed GM, First MB, et al. Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) Arch Sex Behav, 2017.PMID 28210933
- [2]Thibaut F, De La Barra F, Gordon H, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias World J Biol Psychiatry, 2010.PMID 20459370
- [3]Thibaut F, Cosyns P, Fedoroff JP, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders World J Biol Psychiatry, 2020.PMID 32452729
- [4]Assumpção AA, Garcia FD, Garcia HD, et al. Pharmacologic treatment of paraphilias Psychiatr Clin North Am, 2014.PMID 24877704
- [5]Garcia FD, Thibaut F Pharmacologic treatment of sex offenders with paraphilic disorder Curr Psychiatry Rep, 2013.PMID 23572328
- [6]Turner D, Briken P Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review J Sex Med, 2018.PMID 29289377
- [7]Seto MC The Motivation-Facilitation Model of Sexual Offending Sex Abuse, 2019.PMID 28715948