Comportamento sexual compulsivo: um transtorno do impulso
DOI:
https://doi.org/10.25118/2763-9037.2024.v14.1366Palavras-chave:
compulsão sexual, disfunção sexual, tratamento, medicamento, terapêutica, preparações farmacêuticasResumo
Introdução: Na Classificação Internacional de Doenças, 11ª edição (CID-11), o Transtorno do Comportamento Sexual Compulsivo (TCSC) é classificado entre os transtornos mentais, no capítulo Transtornos do Impulso. O indivíduo apresenta um padrão persistente de falha no controle de impulsos ou impulsos sexuais intensos e repetitivos como critério diagnóstico. O quadro deve persistir por pelo menos seis meses e levar a sofrimento acentuado ou prejuízo na vida pessoal. Métodos: Revisão narrativa da literatura sobre sintomas, causas e tratamento do TCSC. Resultados e Discussão: São fundamentais os diagnósticos de outros transtornos sexuais, quadros psiquiátricos e somáticos. Medicamentos, psicoterapia e fisioterapia pélvica podem ser de grande valia. O tratamento da compulsão sexual visa inibir tal comportamento e, ao mesmo tempo, favorecer o exercício sexual saudável, sem sofrimento. Antidepressivos, Antipsicóticos, Estabilizadores do Humor e Naltrexona podem ser utilizados, dependendo de diagnóstico e comorbidades. Tratar possíveis doenças clínicas como hiperandrogenismo é primordial. Casos graves representam risco para outras pessoas e ao próprio paciente, podendo-se recorrer a antiandrogênicos como a Ciproterona. Medicações que levam a níveis de castração química, como os agonistas parciais do hormônio de liberação de hormônio luteinizante (LHRH) não são autorizadas para tal uso no Brasil. Conclusões: Tratar transtornos sexuais, psiquiátricos e clínicos adequadamente é fundamental. No entanto, mais pesquisas são necessárias para elucidar as causas do TCSC e possíveis alternativas de tratamento.
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Gola M, Lewczuk K, Potenza MN, Kingston DA, Grubbs JB, Stark R, Reid RC. What should be included in the criteria for compulsive sexual behavior disorder? J Behav Addict. 2020;11(2):160–5. https://doi.org/10.1556/2006.2020.00090 PMID:34329192 - PMCID:PMC9295236 DOI: https://doi.org/10.1556/2006.2020.00090
Stahl SM, Grady MM. Transtornos relacionados a substâncias e do controle de impulsos: ilustrados. Porto Alegre: Artmed; 2016.
Kafka MP. What happened to hypersexual disorder? Arch Sex Behav. 2014;43(7):1259-61. https://doi.org/10.1007/s10508-014-0326-y PMID:24951045 DOI: https://doi.org/10.1007/s10508-014-0326-y
Montgomery-Graham S. Conceptualization and assessment of hypersexual disorder: a systematic review of the literature. Sex Med Rev. 2017;5(2):146-62. https://doi.org/10.1016/j.sxmr.2016.11.001 PMID:28041854 DOI: https://doi.org/10.1016/j.sxmr.2016.11.001
Organização Mundial de Saúde. Classificação de transtornos mentais e de comportamento da CID 10: descrições clínicas e diretrizes diagnósticas. Porto Alegre: Artmed; 1993.
World Health Organization. ICD 11: International classification of diseases 11th revision. Geneva: World Health Organization; [citado em 12 de agosto de 2024]. https://icd.who.int/en
Grant JE, Chamberlain SR. Expanding the definition of addiction: DSM-5 vs. ICD-11. CNS Spectr. 2016;21(4):300-3. https://doi.org/10.1017/s1092852916000183 PMID:27151528 - PMCID:PMC5328289 DOI: https://doi.org/10.1017/S1092852916000183
Karila L, Wéry A, Weinstein A, Cottencin O, Petit A, Reynaud M, Billieux J. Sexual addiction or hypersexual disorder: different terms for the same problem? A review of the literature. Curr Pharm Des. 2014;20(25):4012-20. https://doi.org/10.2174/13816128113199990619 PMID:24001295 DOI: https://doi.org/10.2174/13816128113199990619
Bőthe B, Tóth-Király I, Potenza MN, Orosz G, Demetrovics Z. High-frequency pornography use may not always be problematic. J Sex Med. 2020;17(4):793-811. https://doi.org/10.1016/j.jsxm.2020.01.007 PMID:32033863 DOI: https://doi.org/10.1016/j.jsxm.2020.01.007
Stahl SM. Psicofarmacologia: bases neurocientíficas e aplicações práticas. 5. ed. Rio de Janeiro: Guanabara Koogan; 2022.
Lüscher C, Robbins TW, Everitt BJ. The transition to compulsion in addiction. Nat Rev Neurosci. 2020;21(5):247-63. https://doi.org/10.1038/s41583-020-0289-z PMID:32231315 - PMCID:PMC7610550 DOI: https://doi.org/10.1038/s41583-020-0289-z
Granero R, Krug I, Jiménez-Murcia S. Editorial: new advancement in network and path-analysis approaches for the study of disorders within the impulse-compulsive spectrum disorders. Front Psychiatry. 2022;13:1029122. https://doi.org/10.3389/fpsyt.2022.1029122 PMID:36226102 - PMCID:PMC9549260 DOI: https://doi.org/10.3389/fpsyt.2022.1029122
Robbins TW, Banca P, Belin D. From compulsivity to compulsion: the neural basis of compulsive disorders. Nat Rev Neurosci. 2024;25(5):313-33. https://doi.org/10.1038/s41583-024-00807-z PMID:38594324 DOI: https://doi.org/10.1038/s41583-024-00807-z
American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais: DSM-5. 5. ed. Porto Alegre: Artmed; 2014.
Napier TC, Persons AL. Pharmacological insights into impulsive-compulsive spectrum disorders associated with dopaminergic therapy. Eur J Neurosci. 2019;50(3):2492-502. https://doi.org/10.1111/ejn.14177 PMID:30269390 DOI: https://doi.org/10.1111/ejn.14177
Bőthe B, Tóth-Király I, Potenza MN, Griffiths MD, Orosz G, Demetrovics Z. Revisiting the role of impulsivity and compulsivity in problematic sexual behaviors. J Sex Res. 2019;56(2):166-79. https://doi.org/10.1080/00224499.2018.1480744 PMID:29913087 DOI: https://doi.org/10.1080/00224499.2018.1480744
Briken P, Wiessner C, Štulhofer A, Klein V, Fuß J, Reed GM, Dekker A. Corrigendum to: who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD). J Behav Addict. 2022;11(4):1093-5. https://doi.org/10.1556/2006.2022.20000 PMID:36576727 - PMCID:PMC9881667 DOI: https://doi.org/10.1556/2006.2022.20000
Tripoli F. Problematic hypersexuality. In: Reisman Y, Porst H, Lowenstein L, Tripodi F, Kirana PS, editors. The ESSM manual of sexual medicine. 2nd ed. Amsterdam: Medix; 2015. p. 1034-71.
Kowalewska E, Gola M, Kraus SW, Lew-Starowicz M. Spotlight on compulsive sexual behavior disorder: a systematic review of research on women. Neuropsychiatr Dis Treat. 2020;16:2025-43. https://doi.org/10.2147/ndt.s221540 PMID:32943868 - PMCID:PMC7478918 DOI: https://doi.org/10.2147/NDT.S221540
Briken P. An integrated model to assess and treat compulsive sexual behaviour disorder. Nat Rev Urol. 2020;17(7):391-406. https://doi.org/10.1038/s41585-020-0343-7 PMID:32561865 DOI: https://doi.org/10.1038/s41585-020-0343-7
Asiff M, Sidi H, Masiran R, Kumar J, Das S, Hatta NH, Alfonso C. Hypersexuality as a neuropsychiatric disorder: the neurobiology and treatment options. Curr Drug Targets. 2018;19(12):1391-401. https://doi.org/10.2174/1389450118666170321144931 PMID:28325146 DOI: https://doi.org/10.2174/1389450118666170321144931
Ballester-Arnal R, Castro-Calvo J, Giménez-García C, Gil-Juliá B, Gil-Llario MD. Psychiatric comorbidity in compulsive sexual behavior disorder (CSBD). Addict Behav. 2020;107:106384. https://doi.org/10.1016/j.addbeh.2020.106384 PMID:32244085 DOI: https://doi.org/10.1016/j.addbeh.2020.106384
Kühn S, Gallinat J. Neurobiological basis of hypersexuality. Int Rev Neurobiol. 2016;129:67-83. https://doi.org/10.1016/bs.irn.2016.04.002 PMID:27503448 DOI: https://doi.org/10.1016/bs.irn.2016.04.002
Hamidianjahromi A, Tritos NA. Impulse control disorders in hyperprolactinemic patients on dopamine agonist therapy. Rev Endocr Metab Disord. 2022;23(5):1089-99. https://doi.org/10.1007/s11154-022-09753-6 PMID:36125673 DOI: https://doi.org/10.1007/s11154-022-09753-6
Sousa SMC, Baranoff J, Rushworth RL, Butler J, Sorbello J, Vorster J, Thompson T, McCormack AI, Inder WJ, Torpy DJ. Impulse control disorders in dopamine agonist-treated hyperprolactinemia: prevalence and risk factors. J Clin Endocrinol Metab. 2020;105(3):dgz076. https://doi.org/10.1210/clinem/dgz076 PMID:31580439 DOI: https://doi.org/10.1210/clinem/dgz076
Barbieri SF, Costa Amaral S, Mazepa E, Santana Filho AP, Sassaki GL, Silveira JLM. Isolation, NMR characterization and bioactivity of a (4-O-methyl-α-D-glucurono)-β-D-xylan from Campomanesia xanthocarpa Berg fruits. Int J Biol Macromol. 2022;207:893-904. https://doi.org/10.1016/j.ijbiomac.2022.03.150 PMID:35358579 DOI: https://doi.org/10.1016/j.ijbiomac.2022.03.150
Lopes PMG, Prado CSC, Oliveira-Souza R. The neurology of acquired pedophilia. Neurocase. 2020;26(2):103-14. https://doi.org/10.1080/13554794.2020.1727929 PMID:32079483 DOI: https://doi.org/10.1080/13554794.2020.1727929
Burns JM, Swerdlow RH. Right orbitofrontal tumor with pedophilia symptom and constructional apraxia sign. Arch Neurol. 2003;60(3):437-40. https://doi.org/10.1001/archneur.60.3.437 PMID:12633158 DOI: https://doi.org/10.1001/archneur.60.3.437
Limoncin E, Ciocca G, Castellini G, Sansone A, Cavalieri F, Cavallo F, Cocchiaro T, Ricca V, di Lorenzo G, Rossi A, Fisher AD, Rochira V, Corona G, Jannini EA. Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI). J Endocrinol Invest. 2022;45(9):1787-99. https://doi.org/10.1007/s40618-022-01798-3 PMID:35527295 DOI: https://doi.org/10.1007/s40618-022-01798-3
Barbieri Filho A, Abdo CHN. Transtornos parafílicos: comorbidades e abordagem ética. Diagn Tratamento. 2019;24(3):106-10. https://docs.bvsalud.org/biblioref/2019/12/1026698/rdt_v24n3_106-110.pdf
Barbieri Filho A, Abdo CHN. Association between paraphilic and obsessive-compulsive symptoms in women. Disponível em: https://zenodo.org/records/3548597
Engel J, Veit M, Sinke C, Heitland I, Kneer J, Hillemacher T, Hartmann U, Kruger THC. same same but different: a clinical characterization of men with hypersexual disorder in the Sex@Brain study. J Clin Med. 2019;8(2):157. https://doi.org/10.3390/jcm8020157 PMID:30704084 - PMCID:PMC6406591 DOI: https://doi.org/10.3390/jcm8020157
Doornwaard SM, van den Eijnden RJ, Baams L, Vanwesenbeeck I, ter Bogt TF. Lower psychological well-being and excessive sexual interest predict symptoms of compulsive use of sexually explicit internet material among adolescent boys. J Youth Adolesc. 2016;45(1):73-84. https://doi.org/10.1007/s10964-015-0326-9 PMID:26208829 - PMCID:PMC4698276 DOI: https://doi.org/10.1007/s10964-015-0326-9
Soldati L, Bianchi-Demicheli F, Schockaert P, Köhl J, Bolmont M, Hasler R, Perroud N. Association of ADHD and hypersexuality and paraphilias. Psychiatry Res. 2021;295:113638. https://doi.org/10.1016/j.psychres.2020.113638 PMID:33333439 DOI: https://doi.org/10.1016/j.psychres.2020.113638
Bőthe B, Koós M, Tóth-Király I, Orosz G, Demetrovics Z. Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. J Sex Med. 2019;16(4):489-99. https://doi.org/10.1016/j.jsxm.2019.01.312 PMID:30852107 DOI: https://doi.org/10.1016/j.jsxm.2019.01.312
Fuss J, Briken P, Stein DJ, Lochner C. Compulsive sexual behavior disorder in obsessive-compulsive disorder: prevalence and associated comorbidity. J Behav Addict. 2019;8(2):242-8. https://doi.org/10.1556/2006.8.2019.23 PMID:31079471 - PMCID:PMC7044559 DOI: https://doi.org/10.1556/2006.8.2019.23
Eskander N, Emamy M, Saad-Omer SM, Khan F, Jahan N. The impact of impulsivity and emotional dysregulation on comorbid bipolar disorder and borderline personality disorder. Cureus. 2020;12(8):e9581. https://doi.org/10.7759/cureus.9581 PMID:32923187 - PMCID:PMC7478747 DOI: https://doi.org/10.7759/cureus.9581
Piontek A, Szeja J, Błachut M, Badura-Brzoza K. Sexual problems in the patients with psychiatric disorders. Wiad Lek. 2019;72(10):1984-8. PMID:31982027 DOI: https://doi.org/10.36740/WLek201910125
Lew-Starowicz M, Lewczuk K, Nowakowska I, Kraus S, Gola M. Compulsive sexual behavior and dysregulation of emotion. Sex Med Rev. 2020;8(2):191-205. https://doi.org/10.1016/j.sxmr.2019.10.003 PMID:31813820 DOI: https://doi.org/10.1016/j.sxmr.2019.10.003
Stefanou MI, Vittore D, Wolz I, Klingberg S, Wildgruber D. Recurrent episodes of paraphilic behavior possibly associated with olanzapine and aripiprazole treatment in a patient with schizophrenia. Front Psychiatry. 2020;11:318. https://doi.org/10.3389/fpsyt.2020.00318 PMID:32425825 - PMCID:PMC7212450 DOI: https://doi.org/10.3389/fpsyt.2020.00318
Malandain L, Blanc JV, Ferreri F, Thibaut F. Pharmacotherapy of sexual addiction. Curr Psychiatry Rep. 2020;22(6):30. https://doi.org/10.1007/s11920-020-01153-4 PMID:32377953 DOI: https://doi.org/10.1007/s11920-020-01153-4
Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-93. https://doi.org/10.1097/gco.0000000000000584 PMID:31609735 DOI: https://doi.org/10.1097/GCO.0000000000000584
Barbieri Filho A. Um caso de ejaculação retardada em um paciente com TAG e TOC. Rev Bras Sex Humana. 2020;31(2):64-8. https://doi.org/10.35919/rbsh.v31i2.676 DOI: https://doi.org/10.35919/rbsh.v31i2.676
Mestre-Bach G, Potenza MN. Current understanding of compulsive sexual behavior disorder and co-occurring conditions: what clinicians should know about pharmacological options. CNS Drugs. 2024;38(4):255-65. https://doi.org/10.1007/s40263-024-01075-2 PMID:38485889 DOI: https://doi.org/10.1007/s40263-024-01075-2
Hallward A, Ellison JM. Antidepressants and sexual function. London: Harcourt Health Communications; 2001.
Montejo AL, Montejo L, Baldwin DS. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management. World Psychiatry. 2018;17(1):3-11. https://doi.org/10.1002/wps.20509 PMID:29352532 - PMCID:PMC5775119 DOI: https://doi.org/10.1002/wps.20509
Mété D, Dafreville C, Paitel V, Wind P. Aripiprazole, jeu pathologique et sexualité compulsive. Encephale. 2016;42(3):281-3. https://doi.org/10.1016/j.encep.2016.01.003 PMID:26923999 DOI: https://doi.org/10.1016/j.encep.2016.01.003
Chen LW, Chen MY, Chen KY, Lin HS, Chien CC, Yin HL. Topiramate-associated sexual dysfunction: a systematic review. Epilepsy Behav. 2017;73:10-7. https://doi.org/10.1016/j.yebeh.2017.05.014 PMID:28605628 DOI: https://doi.org/10.1016/j.yebeh.2017.05.014
Yang Y, Wang X. Sexual dysfunction related to antiepileptic drugs in patients with epilepsy. Expert Opin Drug Saf. 2016;15(1):31-42. https://doi.org/10.1517/14740338.2016.1112376 PMID:26559937 DOI: https://doi.org/10.1517/14740338.2016.1112376
Elnazer HY, Sampson A, Baldwin D. Lithium and sexual dysfunction: an under-researched area. Hum Psychopharmacol. 2015;30(2):66-9. https://doi.org/10.1002/hup.2457 PMID:25619161 DOI: https://doi.org/10.1002/hup.2457
Reis RM, Angelo AG, Sakamoto AC, Ferriani RA, Lara LA. Altered sexual and reproductive functions in epileptic men taking carbamazepine. J Sex Med. 2013;10(2):493-9. https://doi.org/10.1111/j.1743-6109.2012.02951.x PMID:23057419 DOI: https://doi.org/10.1111/j.1743-6109.2012.02951.x
Heare MR, Barsky M, Faziola LR. A case of mania presenting with hypersexual behavior and gender dysphoria that resolved with valproic acid. Ment Illn. 2016;8(2):6546. https://doi.org/10.4081/mi.2016.6546 PMID:27994833 - PMCID:PMC5136748 DOI: https://doi.org/10.4081/mi.2016.6546
Savard J, Öberg KG, Chatzittofis A, Dhejne C, Arver S, Jokinen J. Naltrexone in compulsive sexual behavior disorder: a feasibility study of twenty men. J Sex Med. 2020;17(8):1544-52. https://doi.org/10.1016/j.jsxm.2020.04.318 PMID:32532705 DOI: https://doi.org/10.1016/j.jsxm.2020.04.318
Verholleman A, Victorri-Vigneau C, Laforgue E, Derkinderen P, Verstuyft C, Grall-Bronnec M. Naltrexone use in treating hypersexuality induced by dopamine replacement therapy: impact of OPRM1 A/G polymorphism on its effectiveness. Int J Mol Sci. 2020;21(8):3002. https://doi.org/10.3390/ijms21083002 PMID:32344532 - PMCID:PMC7215378 DOI: https://doi.org/10.3390/ijms21083002
Mohseni Rad H, Zahirian Moghadam T, Hosseinkhani A, Nima Soluki N, Amani F. Comparison of dapoxetine /tadalafil and paroxetine/tadalafil combination therapies for the treatment of the premature ejaculation: a randomized clinical trial. Urol J. 2021;19(2):138-43. https://doi.org/10.22037/uj.v18i.6644 PMID:34773634
Yogarajah M, Mula M. Sexual dysfunction in epilepsy and the role of anti-epileptic drugs. Curr Pharm Des. 2017;23(37):5649-61. https://doi.org/10.2174/1381612823666171004115230 PMID:28982319 DOI: https://doi.org/10.2174/1381612823666171004115230
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