Peer Briken

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Papers by Peer Briken

Assessment, diagnosis, and management of hypersexual disorders

Current Opinion in Psychiatry, 2010

This review examines recent advances in conceptualizing and treating hypersexual disorders.

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A Relapse in Pedophilic Sex Offending and Subsequent Suicide Attempt During Luteinizing Hormone-Releasing Hormone Treatment

Journal of Clinical Psychiatry, 2004

Sexuelle Sucht: Diagnostik, Ätiologie, Behandlung 1

The Paraphilia-Related Disorders: An Investigation of the Relevance of the Concept in Sexual Murderers

Journal of Forensic Sciences, 2006

ABSTRACT: Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivi... more ABSTRACT: Paraphilic disorders (PAs) and sexual preoccupation are known risk factors for recidivism in sexual offenders. Nonparaphilic sexual excessive behaviors—so-called paraphilia-related disorders (PRDs), like paraphilias, are also characterized by sexual preoccupation and volitional impairment and can be diagnosed in paraphilic men. The prevalence and clinical significance of PRDs in sexual homicide perpetrators, however, is unknown. We investigated the relationship between PAs and PRDs retrospectively in a sample of 161 sexual murderers. Four groups were compared: men without a PA or a PRD diagnosis, men with at least one PRD but no PA, men with at least one PA but no PRD, and finally, those with a combination of both (PA+PRD). The PA+PRD group had the most lifetime cumulative sexual impulsivity disorders, more developmental problems, the highest persistent frequency of sexual activity, the highest number of previous sexual offences, more sexual sadism, and compulsive masturbation. Men of the PRD subsample had suffered more from childhood sexual abuse, showed more promiscuity, psychopathy, and alcohol problems. The use of the PRD concept in this special offender group should be further investigated with prospectively designed studies.

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Obszöne Telefonanrufe - Beziehungen zu Paraphilien, Paraphilie verwandten Störungen und Stalking

Psychiatrische Praxis, 2005

Selektive Serotoninwiederaufnahmehemmer (SSRI) in der Behandlung von Paraphilien

Fortschritte Der Neurologie Psychiatrie, 2007

For about 15 years selective serotonine reuptake inhibitors (SSRI) have been used in the treatmen... more For about 15 years selective serotonine reuptake inhibitors (SSRI) have been used in the treatment of paraphilias. In an open, uncontrolled, retrospective study, which was the first in the German speaking countries we investigated 16 male outpatients, who have been treated for different paraphilias with SSRI and psychotherapy. There was a marked reduction in paraphilic symptoms. Despite high rates of sexual side effects most patients reported a high overall treatment satisfaction. SSRI are an important addition in pharmacological treatment of paraphilic patients, especially with a risk of so called &quot;hands-off&quot; delinquency.

Pornographie und sexuelle Gewalt im Internet

Bundesgesundheitsblatt-gesundheitsforschung-gesundheitsschutz, 2007

Die Frage, ob Pornographie im Internet sexuelle Gewalt fördert oder eher als Sicherheitsventil di... more Die Frage, ob Pornographie im Internet sexuelle Gewalt fördert oder eher als Sicherheitsventil dient, ist ein gesundheits-, medien- und kriminalpolitisch wichtiges Thema. Studien zur Wirkung von Pornographie generell zeigen, dass Softcore-Pornographie und gewaltfreie Pornographie als harmlos gelten, während gewaltfreie Hardcore und Gewaltpornographie Aggressivität steigern können. Personen mit hohem Risiko für sexuelle Gewalt haben mehr Interesse an gewalttätiger Pornographie und werden durch diese stärker negativ beeinflusst. An 2 Fallbeispielen werden die besonderen Merkmale von Internetpornographie und Cybersex veranschaulicht: leichter Zugang von zu Hause, Anonymität, niedrige Kosten, Mannigfaltigkeit und Devianz des Materials, grenzenloser Markt, Auflösung der Grenzen zwischen Konsument und Produzent, interaktive Kommunikation, Experimentierraum zwischen Fantasie und realem Verhalten, virtuelle Identitäten, leichte Kontaktaufnahme zwischen Täter und Opfer bzw. verschiedenen Tätern sowie niedriges Entdeckungsrisiko. Dem Phänomen sexueller Sucht (oder Paraphilie-verwandte Störung) kommt beim problematischen Umgang mit Internetpornographie eine besondere Bedeutung zu. Neben präventiven Maßnahmen zum Schutz potenzieller Opfer werden für die Täterseite Behandlungsstrategien vorgestellt, die außer einer Beschränkung des Zugangs zu Internetsexualität die Therapie komorbider psychischer Störungen und Probleme (soziale Isolation, Trauerprozesse, Stress- und Wutmanagement, Schuld und Scham, Kindheitstraumata, kognitive Verzerrungen, Opferempathie), eventuell auch medikamentöse Behandlung und die Förderung einer integrativeren und beziehungsreicheren Sexualität umfassen. Internet pornography has been regarded as either stimulating sexual aggression and abuse or as serving as a safety valve. This controversy is an important issue in health, media and legal politics. According to empirical studies on pornography in general, soft-core pornography and nonviolent pornography can be regarded as harmless, whereas non-violent hard-core pornography and violent pornography may increase aggression. Individuals with a high risk for sexual aggression show more in terest in violent pornography and are stimulated more strongly through such material. Two case histories illustrate the characteristics of internet pornography and "cybersex": easy access, anonymity, affordability, wide range and deviancy of the material, unlimited market, blurring the borders between consumer and producer, interactive communication, space for experi menting between fantasy and in- reallife behavior, virtual identities, easy contact between offender and victim or among offenders, and low risk of apprehension. The phenomenon of "sexual addiction" (or paraphilia- related disorder) is particularly relevant for the problematic use of internet pornography. Preventive measures to protect possible victims are presented as well as treatment strategies for offenders. Beside limiting access to the internet, these include therapy of comorbid psychiatric disorders and psychological problems (social isolation, bereavement, stress- and anger-management, guilt and shame, childhood traumata, cognitive distortion, victim empathy), psychopharmacotherapy and the enhancement of a more integrative and relationshiporiented sexuality.

Pornography and sexual abuse in the Internet

Bundesgesundheitsblatt-gesundheitsforschung-gesundheitsschutz, 2007

Sexualstörungen — Störungen der Sexualpräferenz, Paraphilien

... sexuell gestörtes Verhalten han-delt. Ein Problem aller Studien zur Bildgebung sind sehr klei... more

Antihormonal treatment of paraphilic patients in German forensic psychiatric clinics

European Psychiatry, 2002

The aim of this study was to investigate which antihormonal treatment strategies are used in Germ... more The aim of this study was to investigate which antihormonal treatment strategies are used in German forensic psychiatric institutions. Forensic clinics were asked about the number of treated patients. Four hundred seventy-four patients were committed for sex offences; 12% received either CPA (n = 29) or LHRH-agonists (n = 29). Differences in efficacy were small. Several side effects confirm the importance of a protocol for minimizing medical complications. © 2002 Éditions scientifiques et médicales Elsevier SAS cyproterone acetate / forensic psychiatry / GnRH-agonists / LHRH-agonists / paraphilia

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Sexuelle Deviationen

Psychiatrie Und Psychotherapie Up2date, 2009

The Influence of Brain Abnormalities on Psychosocial Development, Criminal History and Paraphilias in Sexual Murderers

Journal of Forensic Sciences, 2005

The aim of this study was to investigate the number and type of brain abnormalities and their inf... more The aim of this study was to investigate the number and type of brain abnormalities and their influence on psychosocial development, criminal history and paraphilias in sexual murderers. We analyzed psychiatric court reports of 166 sexual murderers and compared a group with notable signs of brain abnormalities (N = 50) with those without any signs (N = 116). Sexual murderers with brain abnormalities suffered more from early behavior problems. They were less likely to cohabitate with the victim at the time of the homicide and had more victims at the age of six years or younger. Psychiatric diagnoses revealed a higher total number of paraphilias: Transvestic fetishism and paraphilias not otherwise specified were more frequent in offenders with brain abnormalities. A binary logistic regression identified five predictors that accounted for 46.8% of the variance explaining the presence of brain abnormalities. Our results suggest the importance of a comprehensive neurological and psychological examination of this special offender group.

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Pharmacotherapy of Paraphilias With Long-Acting Agonists of Luteinizing Hormone–Releasing Hormone: A Systematic Review

Journal of Clinical Psychiatry, 2003

In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, e... more In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) are commonly used but can have serious side effects. Selective serotonin reuptake inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that luteinizing hormone-releasing hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients. MEDLINE was searched for clinical trials, case-control studies, case reports, and other clinically and theoretically important literature published between 1980 and November 2002 on the treatment of paraphilia with LHRH agonists. Keywords included LHRH agonists, GnRH- agonists, antiandrogens, paraphilia, pedophilia, and sex offenders. We found 4 case reports, 1 case- control study, 7 open uncontrolled studies, and 1 study comparing patients receiving CPA with those receiving LHRH agonist treatment in forensic hospitals. In total, the studies reported on a sample of 118 treated patients with different forms of paraphilias (sadism, pedophilia, exhibitionism, voyeurism). Nearly all of the studies used self-reports to measure the effects of medication. Duration of follow-up was between 6 months and 7 years and revealed that there were no relapses if patients remained under treatment. Patients previously treated with other agents like CPA, MPA, or SSRIs reported better effects when taking LHRH agonists. Although there is a need for further research, LHRH agonists offer a treatment option for patients with severe paraphilia. We propose a differentiated pharmacologic treatment regarding side effects, symptomatology, and severity.

Criminal Recidivism in Sexual Homicide Perpetrators

International Journal of Offender Therapy and Comparative Criminology, 2008

Forensic psychiatric reports on 166 sexual homicide perpetrators in Germany were retrospectively ... more Forensic psychiatric reports on 166 sexual homicide perpetrators in Germany were retrospectively analyzed for criminal risk factors. Follow-up information about release and reconvictions from federal criminal records was available for 139 offenders; 90 (64.7%) had been released. The estimated recidivism rate (Kaplan-Meier analyses) for 20 years at risk was 23.1% for sexual and 18.3% for nonsexual violent reoffences. Three men (3.3%) were reconvicted for attempted or completed homicide. Only young age at the time of sexual homicide resulted in higher sexual recidivism, whereas increased nonsexual violent recidivism was related to previous sexual and nonsexual delinquency, psychopathic symptoms, and higher scores in risk assessment instruments. Increased recidivism with any violent reoffence was associated with age-related factors: young age at first sexual offence, at homicide, and at release and duration of detention. The impacts of the results for risk assessment, relapse prevention, and supervision are discussed.

Syndrome sexueller Sucht

Dieser Beitrag befasst sich mit Ausdrucksformen von Sexualität, die durch ihren exzessiven, sucht... more Dieser Beitrag befasst sich mit Ausdrucksformen von Sexualität, die durch ihren exzessiven, suchtähnlichen Charakter zu schwerwiegenden Konsequenzen für den Betroffenen selbst oder andere führen. Dabei wird es weniger um Formen sexueller Devianz (z.B. sexuellen Sadismus; Übersicht dazu z.B. bei Berner et al. 2007) gehen, sondern um so genannte nicht deviante Verhaltensweisen, die durch die ihnen zugrunde liegenden Motive, ihre Intensität und ihre Konsequenzen Störungscharakter bekommen.

Differential Pharmacological Treatment of Paraphilias and Sex Offenders

International Journal of Offender Therapy and Comparative Criminology, 2003

This article gives an overview of current pharmacological treatment of paraphilias and sex offend... more This article gives an overview of current pharmacological treatment of paraphilias and sex offenders focusing on the situation in Germany. Information about selective serotonin reuptake inhibitors (SSRI) is followed by data about established antihormonal substances (cyproterone acetate/CPA, and medroxyprogesterone acetate/MPA), as well as a more detailed account on luteinizing hormone-releasing hormone agonists (LHRH agonists). The results of open, uncontrolled clinical studies with SSRIs (n = 16) and LHRH agonists (n = 11) in paraphilic outpatients confirm the positive effects of these substances. A survey about the use of CPA and LHRH agonists in forensic hospitals in Germany shows that half of the patients treated with any kind of (anti-) hormonal agents received an LHRH agonist. The authors present a protocol on side effects, contraindications, and monitoring of CPA and LHRH agonists and develop an algorithm for differential pharmacotherapy of paraphilias.

Verläufe bei sexuellen Tötungen

Forensische Psychiatrie, Psychologie, Kriminologie, 2008

In einer Untersuchung an 166 in der Zeit zwischen 1963 und 1991 verurteilten Straftätern, deren S... more In einer Untersuchung an 166 in der Zeit zwischen 1963 und 1991 verurteilten Straftätern, deren Sexualdelikt für die Opfer tödlich endete, ergaben sich zunächst beim Vergleich von Einfach- mit Mehrfachtätern ähnliche Verhältnisse, wie aus Voruntersuchungen mit kleineren Stichproben bekannt war. Bei den Mehrfachtätern wurden häufiger sexueller Sadismus und andere Störungen der Sexualpräferenz sowie antisoziale, schizoide und sadistische Persönlichkeitsstörungen gefunden. Katamnestische Daten aus dem Bundeszentralregister lagen von 139 Tätern vor. Während die Entlassenen (n=90) durchschnittlich 12,2 Jahre in Gewahrsam verbrachten, waren die Nicht-Entlassenen (n=49) bis zur Erstellung der Bundeszentralregister-Auszüge im Durchschnitt seit 20,6 Jahren ununterbrochen in Haft oder im Maßregelvollzug. Bei den Nicht-Entlassenen waren signifikant mehr Störungen der Sexualpräferenz und mehr antisoziale und sadistische Persönlichkeitsstörungen zu verzeichnen. Störungen der Sexualpräferenz und Antisozialität stellen ein empirisch gut belegtes besonderes Risiko für einschlägige Rückfälligkeit bei Sexualstraftätern dar. Außerdem zeigten sämtliche angewandten Prognose-Instrumente (PCL-R, HCR-20, SVR-20, Static-99) bei den Nicht-Entlassenen höhere Werte. Vor diesem Hintergrund muss es gesehen werden, dass bei den entlassenen Tätern nur 1,1% (n=1) Rückfälligkeit in vollendeten und 2,2% (n=2) Rückfälligkeit in versuchten Tötungsdelikten gefunden wurde. Die Rückfälligkeit mit Sexual- und Gewaltdelikten war mit den Ergebnissen der Metaanalyse von Hanson und Morton-Bourgon (4) vergleichbar. Nachdem die bekannten Risikofaktoren offensichtlich schon bei der Entscheidung für oder gegen eine Entlassung „verbraucht“ worden waren, blieben in der Katamnese nur mehr das Alter beim Delikt und das Alter bei der Entlassung als weitere Risikofaktoren zur Erklärung von Rückfälligkeit mit Sexual- und anderen Gewaltdelikten über. Das heißt, je jünger der Täter beim sexuellen Tötungsdelikt und je jünger bei der Entlassung, umso wahrscheinlicher ist ein Rückfall im Katamnese-Zeitraum. This article summarizes main results of studies on forensic psychiatric court reports on 166 men who had been persecuted between 1963 and 1991 for a sexual offence leading to the death of the victim. Comparing perpetrators with a single victim and those with multiple victims we found similar results as in two previous studies with smaller samples: Multiple sexual homicide perpetrators showed more often sexual sadism and other paraphilias, as well as antisocial, schizoid and sadistic personality disorders. Follow-up data from the federal criminal records could be obtained for 139 offenders. Ninety perpetrators had been released after a mean detention of 12.2 years, whereas the 49 offenders who were still in prison or forensic psychiatric hospitals had been detained for a mean period of 20.6 years. The non-released offenders showed more often paraphilias as well as antisocial and sadistic personality disorders than the released perpetrators. Paraphilias and antisocial personality traits are empirically well proven risk factors for criminal recidivism with sexual reoffences. In addition, the non-released sexual homicide perpetrators had higher scores in all applied risk assessment instruments (PCL-R, HCR-20, SVR-20, Static-99). Among the released offenders only 1.1% (n=1) reoffended with a completed homicide and 2.2% (n=2) with attempted homicide. The recidivism rates with sexual and other violent reoffences in this sample of sexual homicide perpetrators were similar to those in a large meta-analysis on recidivism in sexual offenders by Hanson and Morton-Bourgon (4). Since well established risk factors had apparently been “used-up” for the decisions about release or non-release, in the follow-up data about the released offenders only age at the sexual homicide and age at the time of release were found as risk factors for recidivism with any violent (sexual or non-sexual) reoffence, i.e. the younger the offender at the time of the homicide and the younger at the time of release, the more likely is the risk of violent reoffending.

Therapie mit dem LHRH-Agonisten Leuprorelinacetat bei Paraphilien und sexuell aggressiven Impulshandlungen

Nervenarzt, 2000

Bisher gibt es im deutschsprachigem Raum keine publizierten Erfahrungen in der Therapie von Parap... more Bisher gibt es im deutschsprachigem Raum keine publizierten Erfahrungen in der Therapie von Paraphilien (Pädophile, Sadismus) und sexuell aggressiven Impulshandlungen mit LHRH-(Lutein-Releasing-Hormon-)Agonisten. In dieser Untersuchung beschreiben wir 11 Patienten, die in einem Untersuchungszeitraum von 12 Monaten mit dem LHRH-Agonisten Leuprorelinacetat behandelt wurden. Im Behandlungszeitraum kam es zu keinen weiteren sexuell aggressiven Handlungen und nach Angaben der Patienten zu einer deutlichen Reduktion von Erektion, Ejakulation, Masturbation, sexuell devianten Drangzuständen und Fantasien. Ein Patient verstarb durch Suizid. Insgesamt scheinen LHRH-Agonisten in Kombination mit anderen therapeutischen Verfahren eine viel versprechende Alternative zum Cyproteronacetat mit seinen möglichen karzinogenen Effekten zu sein. Up to now there are no published results of therapy of paraphilia (Pedophilia, Sadism) and sexual aggressive impulsiveness with LHRH-(luteinizing hormone-releasing hormone) Agonists in the Germanspeaking countries. In this report we describe 11 patients which were treated with the LHRH-Agonist Leuprolide Acetate in a period of 12 months. The patients showed no tendency of sexuell aggressive behaviour and reported an evident reduction of penile erection, ejaculation, masturbation, sexual deviant impulsiveness and phantasies. One patient died from suicide. In combination with other treatments LHRH-Agonist seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.

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Diagnosis and Treatment of Sexual Addiction: A Survey among German Sex Therapists

Sexual Addiction & Compulsivity, 2007

Controversies exist about the diagnostic concept of "sexual addiction." The aim of this study was... more Controversies exist about the diagnostic concept of "sexual addiction." The aim of this study was to investigate if German specialized sex therapists are confronted with patients who possess sexual addiction symptoms and to obtain information about diagnoses, comorbidity and treatment. A 12-item questionnaire was sent to all members of the German Society of Sex Research asking them about diagnoses, comorbidity and treatment of patients who experienced sexual addiction problems. Forty-three out of 149 members (28.9%) responded to the survey and reported about 97 patients with sexual addiction symptoms. Most common were pornography dependence, compulsive masturbation, and protracted promiscuity. Using ICD-10 definition "excessive sexual drive" was diagnosed more often in women while "disorder of sexual preference" was mainly diagnosed in men. In women neurotic (e.g., anxiety disorders) and eating disorders were most commonly diagnosed as comorbid disorders, while in men substance disorders were most commonly diagnosed. Most patients were treated by individual psychotherapy. We discuss the difficulties of the "sexual addiction" concept critically and propose an algorithm to facilitate the diagnostic process. This algorithm differentiates between the paraphilic and non-paraphilic (we use the term paraphilia-related disorder) types of excessive sexual behavior first. As a second step it includes a dynamic perspective differentiating between a progressive and a non-progressive course.

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XYY chromosome abnormality in sexual homicide perpetrators

American Journal of Medical Genetics Part B-neuropsychiatric Genetics, 2006

In a retrospective investigation of the court reports about sexual homicide perpetrators chromoso... more In a retrospective investigation of the court reports about sexual homicide perpetrators chromosome analysis had been carried out in 13 of 166 (7.8%) men. Three men (1.8%) with XYY chromosome abnormality were found. This rate is much higher than that found in unselected samples of prisoners (0.7–0.9%) or in the general population (0.01%). The three men had shown prepubescent abnormalities, school problems, and had suffered from physical abuse. The chromosome analysis in all cases had been carried out in connection with the forensic psychiatric court report due to the sexual homicide. However, two men had earlier psychiatric referrals. All were diagnosed as sexual sadistic, showed a psychopathic syndrome or psychopathy according to the Psychopathy Checklist-Revised [Hare RD, 1991, The Hare Psychopathy Checklist-Revised, Toronto, Ontario, Canada: Multi-Health Systems]. Two were multiple murderers. Especially forensic psychiatrists should be vigilant of the possibility of XYY chromosome abnormalities in sexual offenders. © 2006 Wiley-Liss, Inc.