Olfactory aversion: notes on procedure, with speculations on its mechanism of effect

Olfactory Aversion and Directed Masturbation in the Modification of Deviant Preferences

A description is provided of the use of olfactory aversion and directed masturbation with a chronic child molester. Evidence of changes assessed by phallometry demonstrated the effectiveness of these procedures in reducing deviant sexual interests and in enhancing the sexual attractiveness of consensual sex with an adult partner. Attitude change procedures were also employed to facilitate the client's ability to act on these changed sexual preferences. Follow-up data revealed the enduring nature of the changed preferences and there was no evidence of further sexual misconduct.

Rape Treatment: An Overview of Current Knowledge

Sexual offending is frequently seen by the lay person as being a result of an innate abnormality that is relatively fixed and unchangeable. Accordingly, sexual offenders are seen as more likely to recidivate than other types of offenders. In fact, this is not the case, and most sexual offenders do not re-offend. Also, contemporary research has shown that treatment programs driven by cognitive behaviour therapy significantly reduce rates of sexual offender recidivism. Nevertheless, while there has been a great deal of research on the treatment of child sexual offenders, the treatment of rapists has received comparatively less attention. Thus, the main aim of this article is to summarise current knowledge of sexual offender treatment, paying specific attention to the needs of rapists. In particular, we pay attention to the content of sexual offender treatment programs, and the relevance of this content to rape. We also discuss therapeutic issues of relevance for rapist treatment that are typically ignored or underestimated in the research literature. Finally, based upon our analysis of the literature, we present a schematic overview of rape treatment and identify important areas for further research.

The development of the interest in child molestation scale

Although numerous research studies have been conducted to investigate apprehended child molesters' sexual interest in children and associated concepts, very little research has been conducted to investigate community males' sexual interest in children. In this article, the authors describe the development and preliminary validation of a new measure--the Interest in Child Molestation Scale--to assess community male's sexual arousal, behavioral propensity toward, and enjoyment of child sexual abuse. Preliminary results show that the Interest in Child Molestation Scale holds some promising psychometric properties, representing a reasonably reliable measure of community males' sexual interest in children. Using this scale, the authors find that a good proportion of community males (57%) did not emphatically reject an interest in child sexual abuse. The authors also find that self-reported sexual arousal to child sexual abuse that is relatively low in forcefulness was significantly related to implicit child sexualization as measured via a pen-and-paper implicit association test. The authors discuss these results with reference to possible future uses of the measure for theory and research development.

A new hypnotic technique for treating combat-related posttraumatic stress disorder: a prospective open study

Many combat veterans with posttraumatic stress disorder (PTSD) have an olfactory component to their traumatic memories that might be utilized by a technique called hypnotherapeutic olfactory conditioning (HOC). Thirty-six outpatients with chronic PTSD, featuring resistant olfactory-induced flashbacks, were treated with six 1.5-hour sessions using hypnosis. The authors used the revised Impact of Events Scale (IES-R), Beck Depression Inventory, and Dissociative Experiences Scale as outcome measures. Significant reductions in symptomatology were recorded by the end of the 6-week treatment period for the IES-R, as well as for the Beck Depression Inventory and the Dissociative Experiences Scale; 21 (58%) of the subjects responded to treatment by a reduction of 50% or more on the IES-R. Improvement was maintained at 6-month and 1-year follow-ups. Use of medication was curtailed. HOC shows potential for providing benefit to individuals suffering from PTSD with olfactory components.

Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation

Sexually intrusive behaviour, which may range from inappropriate commentary to rape, is often observed following a traumatic brain injury. It may represent novel behaviour patterns or an exacerbation of pre-injury personality traits, attitudes, and tendencies. Sexually intrusive behaviour poses a risk to staff and residents of residential facilities and to the community at large, and the development of a sound assessment and treatment plan for sexually intrusive behaviour is therefore very important. A comprehensive evaluation is best served by drawing on the fields of neuropsychology, forensic psychology, and cognitive rehabilitation. The paper discusses the types of brain damage that commonly lead to sexually intrusive behaviour, provides guidance for its assessment, and presents a three-stage treatment model. The importance of a multidisciplinary approach to both assessment and treatment is emphasized. Finally, a case example is provided to illustrate the problem and the possibilities for successful management.

The sense of smell, its signalling pathways, and the dichotomy of cilia and microvilli in olfactory sensory cells

Smell is often regarded as an ancillary perception in primates, who seem so dominated by their sense of vision. In this paper, we will portray some aspects of the significance of olfaction to human life and speculate on what evolutionary factors contribute to keeping it alive. We then outline the functional architecture of olfactory sensory neurons and their signal transduction pathways, which are the primary detectors that render olfactory perception possible. Throughout the phylogenetic tree, olfactory neurons, at their apical tip, are either decorated with cilia or with microvilli. The significance of this dichotomy is unknown. It is generally assumed that mammalian olfactory neurons are of the ciliary type only. The existence of so-called olfactory microvillar cells in mammals, however, is well documented, but their nature remains unclear and their function orphaned. This paper discusses the possibility, that in the main olfactory epithelium of mammals ciliated and microvillar sensory cells exist concurrently. We review evidence related to this hypothesis and ask, what function olfactory microvillar cells might have and what signalling mechanisms they use.

Behavioral and psychopharmacological treatment of the paraphilic and hypersexual disorders

In this article, the second of a two-part series, the authors present information on the clinical assessment of individuals with paraphilias and hypersexual disorders. They review ethical considerations in the assessment and treatment of individuals with paraphilias. The role of interview and subjective and objective instruments in the assessment of individuals with paraphilias and hypersexual disorders is discussed. The authors discuss the use of penile plethysmography or phallometry, polygraphy, and viewing time assessments. Risk assessment of sexual offenders is reviewed. The authors then discuss behavioral, environmental, and psychopharmacological treatments for paraphilias and hypersexual disorders. Cognitive-behavioral therapy appears to be the most effective nonpharmacological strategy. The authors describe cognitive-behavioral techniques for decreasing and/or controlling sexual urges (e.g., satiation, covert sensitization, fading, cognitive restructuring, victim empathy therapy) as well as methods for enhancing appropriate sexual interest and arousal (e.g., social skills training, assertiveness skills training, sex education, couples therapy). The authors also discuss the role of relapse prevention therapy and 12-step programs, as well as other nonbiological therapies such as surveillance networks. The importance of providing appropriate treatment for comorbid conditions (e.g., depression, substance abuse or dependence) is stressed. The authors then review psychopharmacological treatments, including serotonin reuptake inhibitors (SRIs) and antiandrogens, in particular, the use of gonadotropin-releasing hormone (GNRH) agonists. SRIs have been studied in these disorders in an uncontrolled way and appear promising. Earlier antiandrogens (e.g., estrogen, progesterone, and cyproterone acetate) have demonstrated efficacy in the treatment of paraphilias. The newer GNRH agonists have the advantage over the earlier treatments of being available in long-acting depot formulations and having fewer side effects. Preliminary studies and case reports with these agents appear promising. Further study of both the SRIs and GNRH agonists in these disorders is needed. The article concludes with a treatment algorithm, in which the authors suggest beginning with less restrictive treatments (e.g., behavioral or verbal therapies), if possible, and moving to more restrictive alternatives (e.g., biological therapies, institutionalization) as needed. A guide for clinicians and patients about where and how to find appropriate clinicians and treatment resources in the United States is provided.