Five cases of sexual addiction under Short-term Psychodynamic Group Psychotherapy

Scanavino, Marco de Tubino; Kimura, Cintia Mayumi Sakurai; Messina, Bruna; Abdo, Carmita Helena Najjar; Tavares, Hermano

doi:10.1590/S0101-60832013000500007

LETTER TO THE EDITOR

Marco de Tubino Scanavino; Cintia Mayumi Sakurai Kimura; Bruna Messina; Carmita Helena Najjar Abdo; Hermano Tavares

Department and Institute of Psychiatry, Clínicas' Hospital, University of São Paulo Medical School (FMUSP), São Paulo, Brazil

Dear Editor,

Sexual addicts searching for treatment usually present severe sexual compulsivity (SC) in Brazil^1,2. Stressful events in childhood, which are common in Brazil³, are often reported by sex addicts⁴, and because of this, psychodynamic psychotherapy is a good choice of treatment. We aim to report the evolution of five sex addicts, who underwent short-term psychodynamic group psychotherapy (STPGP). Our specific goal is investigate the effect of the STPGP on SC.

The five patients also had impulse control disorder or drug/alcohol dependence, and were all Brazilian men over 18 years of the Institute of Psychiatry at Clinicas' Hospital of University of São Paulo Medical School (HC-FMUSP). All of them met the Goodman's criteria for sex addiction⁴, and also reached scores up of the cut-off of the Sexual Compulsivity Scale (SCS) (= 24)⁵.

The inventories employed were: 1) Mini International Neuropsychiatric Interview (MINI)⁶; 2) Structured Clinical Interview for DSM-IV Axis I Disorders - Clinical Version (SCID-CV)⁷; 3) SCS⁵.

The study was approved by the Ethics Committee of HCFMUSP. After signing the consent form, the patients were submitted to psychiatric evaluation, and they responded to instruments 1 and 2. Psychiatric assessment was introduced with intervals of two to four weeks before the beginning of the STPGP, and with 40 days of interval on average, during the STPGP. The same doctor consulted all patients during the study period. The patients had the medication introduced since three to six months before the beginning of the STPGP. All the patients achieved the therapeutic dose of their medication, and responded to instrument 3 before initiating the program of 16 sessions of STPGP. After the 16^th session, they responded to SCS again.

Sociodemografic and clinical data and the results of the inventories can be seen in table 1. All patients reported good adherence to the medication. The mean and standard error on SCS were 27.5, 2.17 before the intervention, and 16.25, 2.09 after the intervention. All patients reported a decrease in the SC during the treatment. Patient D. reported some worsening in his pathologic gambling behavior. His dose of topiramate was increased and he improved.

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In the 8^th session, E. got a job, and had to drop out the treatment, and he did not answer the SCS after 16 sessions.

This is a first STPGP study with SC patients, and using standardized instruments before and after the intervention. We could see that the mean of SCS scores before and after the intervention, respectively, was above and below from the cut-off point. We consider the improvement on SC was due the STPGP because the first application of the SCS was done after achieving the therapeutic dose of the medication. Unfortunately, it is difficult to separate psychotherapy from medication effects without comparative groups of SC individuals under different therapeutic modalities. Future studies with more patients and control group may get more evidence. Finally, our study did not include women and the gender differences are relevant to design interventions⁸.

Figure 1 resumes the psychodynamic aspects, and vignettes, of each stage of STPGP.

Received: 1/20/2013

Accepted: 6/5/2013

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