The presence of comorbid psychiatric disorders complicates the work of clinicians who treat paraphilic sex offenders. Research suggests that many sex offenders exhibit multiple paraphilic disorders and commit a range of sexual crimes. The research literature is reviewed and the authors offer the clinical implications of treating sex offending patients with co-occurring psychiatric conditions, including the importance of holding sex offenders accountable for their behavior. Assessment considerations are also reviewed and include the importance of determining whether the sexually offending behavior was in fact a symptom of an underlying syndrome or disorder. Differential diagnosis is necessary to confirm, clarify, or rule-out any new or existing psychiatric diagnoses. Thorough assessment for personality disorders is suggested. Finally, 10 treatment recommendations are offered that include the provision of psychoeducational forums for paraphilic sex offenders with co-occurring mental illness on issues of symptom management. More research needs to be conducted on comorbid psychiatric conditions among paraphilic sex offenders in order to guide effective treatment practices for this population. References