The woman Ryan picked up at a secluded bus stop on a rainy night in Ottawa will probably never know how close she came to death, or that she was the reason the stranger who offered a ride ultimately sought help.

“In the trunk I had a lockbox with everything I needed. I had pull ties, I had a saw, I had an axe, I had knives.” Tweet This

He’d kept that box in his car for months as he spent spare moments driving around, compulsively scouting out areas of the city where he and his car wouldn’t be noticed or recognized.

Ryan had been racked for years by increasingly violent sexual obsessions. What began in his mid-20s with a desire for rough sex escalated to uncontrollable, arousing fantasies of rape and murder.

“It led me to wanting to, basically, kill, dismember and assault … women that I didn’t know,” he said in an interview. Tweet This

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“They got to the point of consuming me completely. …

“When I think about it now, I mean, driving around on trips and stuff looking for places that I could dispose of pieces of a body – I drive by those spots now and it just kind of freaks me out a little bit.”

The urges filled Ryan, who also has bipolar disorder, with such self-loathing he tried multiple times to kill himself rather than risk hurting someone, he said. One overdose was so extreme it left him with permanent brain damage.

But it was the specificity of his homicidal fantasy that he says saved him from himself: The stranger struck up a conversation, ceasing to be the anonymous woman his scenario demanded.

Ryan (whose name has been changed for his privacy) invented an excuse, dropped her off and told his psychologist everything.

“I was terrified.” Tweet This

He checked himself in to Ottawa Civic Hospital’s psych ward. It was during his two weeks there that a psychiatrist referred him to Paul Fedoroff.

Fedoroff has been director of the Royal Ottawa Hospital’s Sexual Behaviours Clinic for a decade. In that time, he says, two major things have changed about his work:

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Fedoroff says his program can treat paraphilia so successfully that people who were aroused by children, exhibitionism or rape can eventually lead healthy, consensual sex lives.

And he says the Sexual Behaviour Clinic has become more than a rehab centre for offenders and parolees: People who recognize they have a problem are referring themselves without ever having committed a crime.

“We’re happy to see anybody. And, in fact, we prefer to see people before they commit crimes,” he said. Tweet This

“We used to see none. And now we see more and more people coming in, saying they realize there’s something that is wrong and they want to get help with that. And they do very well.”

Most of the people Fedoroff works with are pedophiles, voyeurs and exhibitionists. But some are “sexual sadists”: people aroused solely or primarily by coercive, non-consensual sex.

(It’s important to note sexual sadists are very different from people who engage in BDSM, whose sadomasochistic activities are explicitly consensual.)

Most rapists, Fedoroff says, are simply opportunists or disinhibited. But about one in 10 are sexual sadists and can be treated so they’re turned on by consensual sex, instead.

Many believe sexual offenders can only be managed by drugs that would lower their sex drives enough so they won’t reoffend.

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But Fedoroff sees the use of these medications as a temporary measure, to be used until therapy has treated the paraphilic disorder enough to allow the individual to have a healthy relationship.

The possibility of treatment, he says, is definitely a factor in more people coming forward of their own accord.

“If you tell them, ‘What we’re going to do is we’re going to help you get control of your sexual interests until you are well enough that you can have sex that isn’t going to get you arrested,’ they are much more willing to consider that.”

But the science is hardly decided.

“There is absolutely, positively no evidence that we can cure” a paraphilic disorder, says James Cantor. Tweet This

The clinical psychologist with the Centre for Addiction and Mental Health‘s Law and Mental Health Program says it’s possible to reduce the symptoms of these disorders. And “we have every reason to attempt sex drive-reducing medication and therapy to help someone control their sexual interest.”

But he’s skeptical of claims that the urges associated with paraphilic disorders can be eliminated permanently. (That said, he thinks someone who sought help of their own accord and who never acted on harmful urges is not a cause for concern.)

Ryan, for his part, was skeptical when he entered the clinic.

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“I didn’t believe it was going to work,” he said.

“I’m just like, ‘You can’t fix me.’ … I thought I’d be that way forever.” Tweet This

But he was desperate.

So he began treatment with Lupron, which reduces testosterone levels and effectively kills your sex drive. It ended the all-consuming thoughts of rape and murder – but it also let Ryan talk frankly about them for the first time.

That, he says, made all the difference.

“That gave me a chance to talk about the feelings without getting excited so I could deal with it without having any interest.”

Progress was hardly immediate. A year into treatment, Ryan tried to kill himself again – not because the obsession had resumed, but because he was so scared it would.

But last year, when he went off the Lupron and did another battery of diagnostic tests, he was declared healthy.

“That was exciting,” he said. “It was good to have the reassurance from the same tests I’d had before, that said I was really dangerous, to not having any nothing. … It was weird. It was great to hear.”

Ryan’s been in a relationship for about six months. He said he told her everything a few dates in. It was an awkward conversation to initiate, to say the least, but Ryan says she’s been supportive.

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“I mean, it’s not easy to hear,” he said. “But if I want to have an honest relationship, I have to say that.”

She’s one of the few people Ryan’s told, however: His parents know everything, but his brothers don’t; nor does his employer. It’s somewhat ironic: Ryan works in education with at-risk teens and talks often about his own bipolarity and suicide attempts. But the societal stigma around having recovered from a criminal sexual disorder is too great, he says.

He wishes more people trapped by disorders like his knew they could get help, or even talk about it without being arrested.

Everyone who calls the Royal Ottawa and asks to be put in touch with the Sexual Behaviours Clinic does so in total confidentiality: No one’s call is traced; consultation and treatment are confidential.

“Therapy changed my life,” Ryan said. “I can say that any day of the week.” Tweet This