A review of the pharmacological management of sexually offending behaviour in learning disabled offenders
| Pages | 166-175 |
| Date | 11 December 2017 |
| DOI | https://doi.org/10.1108/JIDOB-06-2017-0010 |
| Published date | 11 December 2017 |
| Author | Stephanie Sloan,Eleanor Brewster |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
A review of the pharmacological
management of sexually offending
behaviour in learning disabled offenders
Stephanie Sloan and Eleanor Brewster
Abstract
Purpose –The management of sexual offending is a major challenge, particularly in men who have an
intellectualdisability. Psychologicaltherapies havebeen shown beneficial, andprogrammes designed foruse in
the generalpopulation have been adaptedfor use in offenders who have an intellectualdisability. Thereis also a
role for pharmacological management,although the quality of evidence forthis is noticeably lacking, most likely
associatedwith the ethical and legal issuesencountered in conductingwell designed and controlledtrials in this
area. The purpose of this paperis to look at the pharmacological management optionsavailable.
Design/methodology/approach –A literature search of electronic databases was undertaken. Additionally,
the references lists for identified papers were examined for any further relevant publications.
Findings –The two main categories of drugs used in the management of inappropriate sexual behaviour are
the testosterone-lowering drugs and the psychotropic drugs. Most trials were open and utilised self-report
measures of drug effectiveness, limiting their usefulness. Most trials noted beneficial effect. Side effect profiles
and patient adherence can limit the effectiveness of anti-libidinal medication in practice.
Originality/value –There is very limited evidence available for the use of pharmacological agents in the
management of inappropriate sexual behaviour, owing to the lack of adequately controlled clinical trials. New
studies are therefore required, particularly of larger sample sizes, longer durations, and examining
characteristics of those who benefit from pharmacological treatment, although the ethical issues of
conducting such studies is duly acknowledged.
Keywords Intellectual disability, Sexual offending, Anti-libidinal, Inappropriate sexual behaviour,
Learning disabled, Pharmacological management
Paper type General review
Introduction
The purpose of this paper is to review the current literature in relation to the pharmacological
management of sexually offending behaviour in patients who have an intellectual disability, in the
larger context of the pharmacological management of sexually offending behaviour.
To this day, this continues to be an emerging field of application and study, with only a limited
number of controlled studies published.
Sexual behaviour is the fulfilment of a basic human drive, in the same way as eating fulfils the drive
of hunger. As such if the basic underlying drive is abnormal, so can the behaviours to achieve its
satisfaction. Some indi viduals who have an intell ectual disability may hav e particular
characteristics which make it challenging for them to control their normal or abnormal sexual
drive, which may become significant predisposing risk factors for sexual offending: lack of ability
to generate alternate solutions, limited insight, lack of ability to anticipate or understand
consequences, lack of or limited capacity for empathy, lack of ability to delay gratification,
impulsivity, poor affect regulation, and low frustration tolerance (Sherak, 2000).
Psychological therapies are the first-line treatment, and are directed at reducing the impact of
the predisposing factors identified above. O’Conner (1996) developed a problem-solving intervention
Received 22 June 2017
Revised 24 August 2017
Accepted 25 August 2017
Stephanie Sloan is a Doctor
and Eleanor Brewster is a
Consultant Psychiatrist, both at
the Department of Psychiatry of
Learning Disability, NHS
Tayside, Dundee, UK.
PAGE166
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 8 NO. 4 2017, pp.166-175, © Emerald Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-06-2017-0010
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