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Attention-Deficit/Hyperactivity Disorder in Males With Paraphilias and Paraphilia-Related Disorders: A Comorbidity Study

J Clin Psychiatry 1998;59:388-396

Background: We describe a study of DSMIII- R Axis I diagnoses of lifetime comorbid nonsexual disorders in 60 males with paraphilias (PAs; N = 42) and nonparaphilic forms of sexual impulsivity–designated paraphilia-related disorders (PRD; N = 18).

Method: Subjects completed a semistructured intake questionnaire and sexual inventories, the Inventory to Diagnose Depression, and the Wender Utah Retrospective Scale for the diagnosis of childhood attention-deficit/hyperactivity disorder (ADHD). The lifetime prevalence of Axis I diagnoses of both sexual and nonsexual disorders was ascertained from the aforementioned data and follow-up psychiatric interviews.

Results: Subjects in both PA and PRD groups were diagnosed as having a lifetime prevalence of any mood disorder (71.7%), especially dysthymic disorder (66.7%); any anxiety disorder (43.3%), especially social phobia (28.3%); any psychoactive substance abuse disorders (45.0%), especially alcohol abuse (30.0%); and any impulse disorders NOS (25.0%), especially speeding/reckless driving (16.7%). The only diagnosis that statistically significantly distinguished the PA from the PRD sample (p = .01) was retrospectively diagnosed childhood ADHD, identified in 40.0% of the total sample (50.0% PA vs.16.7% PRD). Childhood ADHD was associated with the presence of educational and behavioral problems, lower current mean income, social/legal consequences associated with antisocial impulsivity, cocaine abuse, increased prevalence of comorbid lifetime mood and impulse disorder NOS, and more diagnoses of lifetime Axis I nonsexual and sexual disorders.

Conclusion: Although depressive disorders were the most common Axis I diagnoses across groups, childhood ADHD was the only Axis I disorder statistically significantly associated with paraphilias, socially deviant and aggressive forms of sexual impulsivity.