Paraphilic Coercive Disorder Overview Paraphilic coercive disorder (PCD), also known as preferential rape or biastophilia in some classifications, involves intense sexual arousal from coercing or forcing non-consenting partners, distinguishing it from opportunistic violence by the coercion itself as the primary stimulus.[pmc.ncbi.nlm.nih +1] Therapy Approaches Treatment combines psychotherapy and pharmacotherapy to reduce urges, manage risk, and address comorbidities like antisocial traits. • Cognitive Behavioral Therapy (CBT): Core method; includes cognitive restructuring to challenge distorted beliefs (e.g., victim enjoyment myths), victim empathy training, relapse prevention, and behavioral techniques like covert sensitization pairing urges with aversive imagery.[pmc.ncbi.nlm.nih +2] • SSRIs (e.g., fluoxetine, paroxetine): First-line meds reduce compulsive arousal via serotonin modulation; case studies show decreased deviant fantasies and impulses within weeks, often with minimal side effects.[pubmed.ncbi.nlm.nih +1] • Antiandrogens/GnRH analogs (e.g., cyproterone acetate, leuprolide): Hormone-lowering for severe cases; combined with therapy, they cut testosterone-driven behaviors, improving self-control, though risks include osteoporosis and hot flashes.[pmc.ncbi.nlm.nih] Effectiveness and Considerations Combined CBT + meds yields best outcomes, reducing recidivism 20-50% in studies; psychodynamic therapy aids insight into origins but lacks strong evidence. Court-mandated for offenders; voluntary cases fare better. Success hinges on motivation, monitoring, and risk assessment.[cambridge +1]