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Exhibitionistic Disorder

Kathryn Patricelli, MA

What is Exhibitionistic Disorder?

Prior to the release of the DSM-5, this disorder was known as Exhibitionism and was classified as an impulse control disorder. In the DSM-5, this disorder has been reclassified to be a Paraphilic Disorder and renamed Exhibitionistic Disorder. A Paraphilic Disorder requires the presence of a paraphilia that is causing significant distress or impairment, or involve personal harm or risk of harm to others.

A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity. Sometimes this sexual interest focuses on the person's own erotic/sexual activities while in other cases, it focuses on the target of the person's sexual interest.

In order to be diagnosed with a Paraphilic Disorder, the paraphilia needs to be causing significant distress or impairment, or involve personal harm or risk of harm to others. You can have a paraphilia, but not have a paraphilic disorder. It is only when it causes impairment, harm or the risk of harm that it become a clinical diagnosis.

Symptoms of Exhibitionistic Disorder include:

  • over a period of at least 6 months, a person has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger.
  • the person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Subtypes of the disorder are based on the age or physical maturity of the nonconsenting individual that the person prefers to expose his/her genitals to and include:

  • Sexually aroused by exposing genitals to prepubertal children (children who have not yet gone through puberty)
  • Sexually aroused by exposing genitals to physically mature individuals
  • Sexually aroused by exposing genitals to prepubertal children (children who have not yet gone through puberty) and to physically mature individuals

Clinicians can also specify if the disorder is

  • In a controlled environment - usually applicable to people who are living in institutions or other settings where opportunities to expose their genitals are restricted.
  • In full remission - the person has not acted on their urges and there has not been distress or impairment for at least 5 years while in an uncontrolled (non-institutional) environment.

How common is Exhibitionistic Disorder?

The prevalence rate for this disorder is not currently known, but is estimated to be 2-4% of the general population. It is also estimated to occur much less often in females than in males.

What are the risk factors for Exhibitionistic Disorder?

Risk factors including antisocial history, antisocial personality disorder, alcohol misuse, and pedophilic sexual preference (being sexually attracted/aroused by children) are thought to increase the risk of exhibitionistic tendencies.

Childhood sexual and emotional abuse, a preoccupation with sex, and hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity) have also been suggested as risk factors, but a cause and effect relationship between them has not been proven at this time.

What other disorders or conditions often occur with Exhibitionistic Disorder?

Research in this area has focused primarily on males who have been convicted of exposing their genitals to nonconsenting individuals. This means that the co-occurring conditions found in this population might not be the same as in the general population that has exhibitionistic disorder. They include depression and bipolar disorder, anxiety disorders, substance use disorders, hypersexuality, ADHD, other paraphilic disorders, and antisocial personality disorder.

How is Exhibitionistic Disorder treated?

People with this condition do not often seek treatment on their own and do not generally recognize that they have a problem until they have ended up in court and are then required to enter treatment.

Common treatments include psychotherapy and medication.

Behavior therapy is often used to help the person control their urges and use more acceptable means of coping with them than exposing their genitals to others.

Cognitive-behavioral therapy can also be used where the therapist helps the person identify triggers that cause their urges and then works with the person to teach skills to manage the sexual urges in more health ways. This typically includes cognitive restructuring (identifying and changing the thoughts that drive the behavior), relaxation training (to reduce exposure impulses), and coping skills training (different ways to behave when feeling aroused).

Various medications can be used to inhibit sexual hormones (testosterone or estrogen) in order to reduce sexual desire. Selective serotonin reuptake inhibitors (SSRIs), which are commonly used for depression and other mood disorders, can also be used as lower levels of serotonin in the brain has been found to cause an increased sex drive. Therefore, using a SSRI can reduce the sexual desire being felt.