Exhibitionism

Exhibitionistic disorder is a condition marked by the urge, fantasy, or act of exposing one’s genitals to non-consenting people, particularly strangers.

This condition is considered a paraphilic disorder, which refers to persistent and intense atypical sexual arousal patterns that are accompanied by clinically significant distress or impairment.

There are several subtypes of exhibitionistic disorder, and these depend on the age of the non-consenting person to whom someone with exhibitionistic disorder prefers to show their genitals. For example, the preference could be to show genitals to prepubescent children, adults, or both. Some people may deny that they show their genitals to unsuspecting others or deny that this act causes them distress; if they have indeed exposed themselves repeatedly to non-consenting people, they may still receive a diagnosis of exhibitionistic disorder.

The prevalence of exhibitionistic disorder is unknown, but it is thought to affect approximately 2-4 percent of the male population. This condition is less common in females, although prevalence estimates are unknown.

Symptoms

A diagnosis of exhibitionistic disorder can be made if the following criteria are met, according to the DSM-5.

  • Over a period of at least six months, a person has recurrent and intense sexually arousing fantasies, behaviors, or urges that involve exposing the genitals to an unsuspecting person.
  • The person has acted on these sexual urges with a non-consenting person, or the urges or fantasies cause marked distress or interpersonal difficulty in the workplace or in everyday social situations.

Exhibitionistic disorder is categorized into subtypes based on whether a person prefers to expose him or herself to prepubescent children, adults, or both.

Causes

Risk factors for the development of exhibitionistic disorder in males include antisocial personality disorder, alcohol abuse, and an interest in pedophilia. Other factors that may be associated with exhibitionism include sexual and emotional abuse during childhood and sexual preoccupation in childhood.

Some people who display exhibitionistic behavior engage in other paraphilias as well, and are consequently considered hypersexual,

The theory of courtship disorder as applied to paraphilias postulates that exhibitionists perceive their victims' shocked response to their behavior as a form of sexual interest. In the exhibitionists' mind, he is engaging in a form of flirting. However, the behavior is not harmless, and some exhibitionists go on to commit sexual crimes such as rape.

The onset of this condition typically occurs sometime in late adolescence or early adulthood. Similar to other sexual preferences, exhibitionistic sexual preferences and behavior may lessen as people get older.

Approximately one-third of sex crimes reported to the police involve incidences of exhibitionism.

Treatment

Most people with exhibitionistic disorder do not seek treatment on their own, and don't receive treatment until they are caught and are required to by authorities. If you or someone you care about may have exhibitionistic disorder, early treatment is strongly advised. The treatment for exhibitionism typically includes psychotherapy and medication.

Research suggests that behavioral models are effective in treating exhibitionistic disorder by providing individuals with tools to control their impulses and find more acceptable ways of coping with their urges than showing their genitalia to others. Cognitive behavioral therapy may help individuals identify the triggers that cause their urges and then manage these urges in healthier ways. Other psychotherapy approaches include relaxation training, empathy training, coping skills training and cognitive restructuring (identifying and altering the thoughts that lead to exhibitionism).

Medications that may be helpful in treating exhibitionistic disorder include medications that inhibit sexual hormones, resulting in a decrease in sexual desire. Some medications that are commonly used to treat depression and other mood disorders, such as SSRIs, can also reduce sexual desire.

References

  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • First, M. B. (2014). DSM-5 and paraphilic disorders. Journal of the American Academy of Psychiatry and the Law Online, 42(2), 191-201.
  • SexInfo Online, The University of California at Santa Barbara

Last reviewed 02/07/2019