Papers by Richard Krueger
The journal of the American Academy of Psychiatry and the Law, 1998
This article briefly reviews objective methods of assessing sexual interest and/or arousal and me... more This article briefly reviews objective methods of assessing sexual interest and/or arousal and mentions some of the disadvantages of penile plethysmography. Literature that supports the use of viewing time as a measurement of sexual interest is reviewed. A detailed description of a new system of assessing sexual interest, called the Abel Assessment, which has both subjective and objective components, is presented. A critique of this assessment system is then offered.
World Psychiatry, 2021
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic a... more In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM‐5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD‐11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD‐11 and DSM‐5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD‐DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is subs...
Aging Health, 2008
Electroconvulsive therapy (ECT) involves the induction of a generalized tonic–clonic seizure by m... more Electroconvulsive therapy (ECT) involves the induction of a generalized tonic–clonic seizure by means of an electric current applied to the head of the patient. The procedure is performed under general anesthesia with the use of muscle relaxants. The efficacy and safety of ECT has been controversial since the introduction of this treatment in the 1930s. Today, ECT is considered to be a safe and effective therapeutic option in treating a number of psychiatric illnesses. With recent technical advances, ECT has fewer adverse results, is safer even in the very old and is effective for a wider range of indications. Nevertheless, many physicians remain hesitant to refer their patients for ECT because of the mistaken belief that this form of treatment is primitive and barbaric. In this article, we review the use of ECT in the elderly.
Biological Psychiatry, 1993
Recent research has raised the possibility that electroconvulsive ,herapy (ECT) results in a pers... more Recent research has raised the possibility that electroconvulsive ,herapy (ECT) results in a persistent elevation of seizure threshold among males. In this study, seizure threshold, quantified by the method of limits procedure, was assessed at the first and last treatments of 148 consecutive depressed patients. Patients with and without a prior history of ECT did not differ in seizure threshold at the first treatment, seizure duration at the first treatment or averaged across all treatments, or in the magnitude of the seizure threshold increase over the ECT course. N.o evidence was obtained that history of ECT was associated with alterations of seizure threshold or seizure duration.
Dev. Mental Health L., 2006
... UL Rev. 788, 813 (1996); Terry, supra note 24, at 184. 50 Doron Teichman, Sex, Shame, and the... more ... UL Rev. 788, 813 (1996); Terry, supra note 24, at 184. 50 Doron Teichman, Sex, Shame, and the Law: An Economic Perspective on Megan's Laws, 42 Harv. J. LEGIS. 355, 357 (2005). 51 Adam Walsh Child Protection and Safety Act of 2006, Pub. L No. 109-248 (2006). 85 ...
Sexual Abuse: A Journal of Research and Treatment, 2006
The World Journal of Biological Psychiatry, 2020
World psychiatry : official journal of the World Psychiatric Association (WPA), 2018
CNS Spectrums, 2009
ABSTRACTObjective: This study was conducted to describe Axis I sexual diagnoses of 60 males arres... more ABSTRACTObjective: This study was conducted to describe Axis I sexual diagnoses of 60 males arrested for possession of child pornography obtained via the Internet and/or attempting to meet children via the Internet.Methods: Data was obtained from a chart review of evaluations conducted on 60 males referred for a psychosexual evaluation following an arrest for possession of child pornography and/or attempting to meet children. All crimes involved use of the Internet. Information obtained from the chart review was entered into SAS. All diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Simple descriptive statistics were computed and cross tabulations were tested for significance using χ2 or Fisher's Exact test.Results: Of the total sample, 40% had at least one paraphilia. Thirty-one percent had a diagnosis of pedophilia and 18% of a paraphilia not otherwise specified (NOS). Thirty-three percent had a sexual di...
Archives of sexual behavior, 2017
The World Health Organization is currently developing the 11th revision of the International Clas... more The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that inv...
The Israel journal of psychiatry and related sciences, 2012
Sexual offenders continue to occupy the public's attention; a significant proportion of this ... more Sexual offenders continue to occupy the public's attention; a significant proportion of this population is diagnosed with paraphilias. Cognitivebehavioral treatment has been the mainstay of treatment for sex offenders and for the paraphilias for the past three decades. This article will review the history of cognitivebehavioral therapy, its techniques, and its efficacy. A literature review was conducted of PubMed and PsychInfo Databases. A significant literature exists describing cognitive-behavioral therapy and presenting outcome studies and meta-analyses evaluating its efficacy. This study is based on a literature review and influenced by the knowledge and biases of the authors. Cognitive-behavioral therapy is the most prominent therapy for sexual offenders. Although reports from individual programs and meta-analyses support its efficacy, overall, the strength of the evidence base supporting this therapy is weak and much more empirical research is needed.
The Israel journal of psychiatry and related sciences, 2012
The DSM-5 has been under revision since 1999 and is scheduled for publication in 2013. This artic... more The DSM-5 has been under revision since 1999 and is scheduled for publication in 2013. This article will review the major proposed modifications of the Paraphilias. The information reviewed was obtained from PubMed, PsychInfo, the DSM-5.org website and other sources and reviewed. Pedohebephilia, Hypersexual Disorder and Paraphilic Coercive Disorder are new proposed diagnoses. Paraphilias have been assigned their own chapter in DSM- 5 and a distinction has been made between Paraphilias and Paraphilic Disorders. Victim numbers have been included in diagnosis of paraphilias that involve victims and remission and severity measures have been added to all paraphilias. Transvestic Disorder can apply to males or females, Fetishistic Disorder now includes partialism, and Sexual Masochism Disorder has Asphyxiophilia as a specifier. This study is based on a literature review and influenced by the knowledge and biases of the authors. The Paraphilic Disorders Section of the DSM-5 represents a si...
Archives of Sexual Behavior, 2001
A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise ... more A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise in the treatment of the paraphilias, with substantially less side effects than medroxyprogesterone acetate or cyproterone acetate. This paper reports the results of treatment using a depot suspension of leuprolide acetate on 12 patients with paraphilic disorders or with sexual disorders not otherwise specified to suppress or help these
Journal of Sex Research, 2010
This article may be used for research, teaching, and private study purposes. Any substantial or s... more This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
Journal of Psychiatric Practice, 2001
In this article, the first of a two-part series, the authors present reasons for considering the ... more In this article, the first of a two-part series, the authors present reasons for considering the paraphilic and hypersexual disorders together and provide an overview of these disorders. The DSM-IV diagnostic criteria for paraphilias are reviewed, and proposed criteria for hypersexual disorders are presented. The question of whether the paraphilic and hypersexual disorders should be considered within the spectrum of obsessive-compulsive disorders is considered. The authors then review the epidemiology of these disorders, and discuss some implications of recent sexual predator legislation. The authors discuss the etiology of the paraphilias and hypersexual disorders, and consider the role of endocrinological function, findings from brain imaging and neuropsychological testing, findings from primate research, the monoamine hypothesis, the imprinting hypothesis, social learning theory, the concept of courtship disorder, the role of obsessive-compulsive elements, psychodynamic theories, and genetic factors. The phenomenology of the paraphilias and hypersexual disorders is discussed, including the tendency for multiple paraphilias to co-occur, the lack of a specific offender profile, the predominance of males among those with paraphilias, the incidence of a history of victimization in individuals with paraphilias and compulsive sexual disorders, the onset and course of both types of disorders, and the lack of internal motivation for change in individuals with paraphilias and hypersexual disorders. The authors then discuss disorders that commonly co-occur with paraphilias and compulsive sexual disorders, including mood disorders, substance abuse and dependence disorders, attention-deficit/hyperactivity disorder, anxiety and impulse control disorders, and personality disorders. The second article in the series will discuss the clinical assessment and the behavioral and psychopharmacological treatment of these disorders. A guide for clinicians and patients on where and how to find specialized clinicians and treatment resources in the United States will also be provided.
Journal of Child Custody, 2013
Use of the Internet has been increasingly associated with sexual behaviors. Referred to as online... more Use of the Internet has been increasingly associated with sexual behaviors. Referred to as online sexual activity, these sexual behaviors include cybersexual behavior and pornography usage. Child custody evaluators are increasingly being asked to assess the impact of these behaviors on child custody and visitation determinations. In this article, we review the Internet-related sexual behaviors of cybersex and pornography usage, which have been associated with an increased risk of compulsive sexual behavior. Gender di erences, general e ects of pornography, and the e ects of cybersex on the family are reviewed. Healthy sexuality and normative sexual behaviors in children are described. Legal issues and case law are comprehensively reviewed.
Archives of Sexual Behavior, 2009
I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexu... more I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexual and Gender Identity Disorders Workgroup for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Sadism, the assessment of Sexual Sadism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Sadism using the DSM in non-forensic populations. I conclude that the diagnosis of Sexual Sadism should be retained, that minimal modifications of the wording of this diagnosis are warranted, and that there is a need for the development of dimensional and structured diagnostic instruments.
Archives of Sexual Behavior, 2010
I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Masochism for the S... more I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Masochism for the Sexual and Gender Identity Disorders Work Group for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Masochism, the assessment of Sexual Masochism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Masochism using the DSM in nonforensic populations. I concluded that the diagnosis of Sexual Masochism should be retained, that minimal modifications of the wording of this diagnosis were warranted, and that there was a need for the development of dimensional and structured diagnostic instruments. It should be noted that this summary reflects my original literature review. Subsequently, interactions with other members of the workgroup and advisors have resulted in modification of these initial suggestions.
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, Jan 17, 2017
The present study aims to evaluate existing policy and practice relating to the use of pharmacolo... more The present study aims to evaluate existing policy and practice relating to the use of pharmacological treatments with patients suffering from paraphilic disorders who are at risk of committing further sexual offences. A systematic literature search was conducted to document current legal policies across 26 different countries. In addition, a questionnaire assessing the practice of pharmacological treatment was sent to practitioners involved in the treatment of patients with paraphilic disorders. Legal policies concerning the preconditions of using pharmacological treatments differ considerably between countries, and for most jurisdictions do not exist. Drawing on the responses of 178 practitioners, pharmacological agents are a useful addition to psychotherapeutic interventions, especially with those patients classified as medium or high risk for sexually violent behaviours. It would appear that most patients are medically examined, are informed of the risks and possible side effect...
The journal of the American Academy of Psychiatry and the Law, 2011
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Papers by Richard Krueger