Voyeuristic Disorder

Voyeuristic disorder is a paraphilic disorder. There are several such disorders, with paraphilic referring to sexual interests, preferences, fantasies, urges, and behaviors outside the norm. These are considered symptoms of a disorder only if they are acted upon in ways that have the potential to cause distress or harm to oneself or others, especially non-consensual others.

The individual normally experiences sexual arousal when spying intentionally on unsuspecting people. The person being watched may be naked, disrobing, or engaging in sexual activities. The voyeur may also record these acts for later viewing. Unintentional viewing of such acts is not considered voyeuristic disorder. Voyeurs are also known as “Peeping Toms,” who use binoculars, mirrors, and recording cameras while peering through peepholes and windows.

Symptoms

To be diagnosed with voyeuristic disorder, a person must experience persistent and intense sexual arousal from the fantasy or act of watching an unsuspecting person who is naked, partially disrobed or sexually active, for at least six months. A subset of voyeurs derive sexual pleasure from watching people defecate or eavesdropping on highly erotic conversations. The viewer is likely to masturbate or have sexual fantasies while watching someone, but is not interested in having sex with the observed person. These behaviors must be causing severe distress or dysfunction in social, professional, or another significant area of the person’s day-to-day life. The viewer must be at least 18-years-old, and the viewing must occur without the other person’s consent. Males are more likely to engage in voyeuristic activities than females. Younger voyeurs are rarely arrested but adult voyeurism is a criminal act.

Criteria include:

  • Over a period of at least six months, recurrent and intense sexual arousal from observ­ing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.
  • The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.

Causes

No specific cause has been determined for voyeuristic disorder. However, certain risk factors tend to coincide with a person becoming a voyeur, including substance abuse, sexual abuse, and being hypersexualized. Some experts suggest that, given the opportunity, many people have voyeuristic tendencies but are afraid to admit it or get caught. Voyeuristic disorder may stem from an accidental sighting of someone who is naked, disrobing, or participating in sexual activity. Continued viewing then reinforces and perpetuates the behavior to a point where it goes beyond what is considered culturally acceptable, or “normal,” and becomes pathological.

Risk factors as cataloged by the DSM-5 include childhood sexual abuse, substance misuse, and sexual preoccupation, and hypersexuality, although the relationship to voyeurism is uncertain and the specificity unclear.

Adult males with voyeuristic disorder often first become aware of their sexual interest in secretly watching unsuspecting persons during adolescence. However, the minimum age for a diagnosis of voyeuristic disorder is 18 years because there is substantial difficulty in differentiating it from age-appropriate puberty-related sexual curiosity and activity. The persistence of voyeurism over time is unclear. Voyeuristic disorder, however, requires one or more contributing factors that may change over time with or without treatment: subjective distress (guilt, shame, intense sexual frustration, loneliness), psychiatric morbidity, hypersexuality, and sexual impulsivity; mental health impairment; and/or the propensity to act out sexually by spying on unsuspecting naked or sexually active persons. Therefore, the course of voyeuristic disorder is likely to vary with age.

Treatment

Voyeurs rarely submit themselves for treatment but may be referred by a parent, spouse, or the legal system when they are caught breaking the law. Treatment for voyeuristic disorder typically involves psychotherapy, support groups, and medication. Early treatment may also include teaching the voyeur socially appropriate behaviors, such as respecting others’ privacy, and training them to avoid locations where they will be more tempted to engage in voyeurism.

Cognitive-behavioral therapy can help the individual learn to control the impulse to spy on others learn new and healthier ways to become sexually aroused. Antidepressants that balance brain chemicals and reduce impulsive behavior or anti-androgenic drugs that suppress sex drive may be used to treat sexual sadism disorder.