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Voyeuristic Disorder

Kathryn Patricelli, MA

What is Voyeuristic Disorder?

The disorder was previously known as Voyeurism and someone with the condition has often been referred to as a "Peeping Tom." With the release of the DSM-5, it is now called Voyeuristic Disorder and is classified as a Paraphilic Disorder, which 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.

This diagnosis is given when:

  • over a period of 6 months, a person 18 years or older has had recurrent and intense sexual arousing fantasies, urges or behaviors from observing an unsuspecting person who is naked, in the process of disrobing, or engaged in sexual activity.
  • the person has acted on these sexual urges with a non-consenting person, or the sexual urges and fantasies have caused significant distress or impairment in social, occupational, or other areas of daily functioning.

How common is Voyeuristic Disorder?

The prevalence of Voyeuristic Disorder is not currently known. However, it is estimated that the highest possible lifetime prevalence is 12% in males and 4% in females, therefore making it 3 times more likely to occur in males.

What are the risk factors for Voyeuristic Disorder?

The cause and effect of risk factors has not been determined for this disorder, but possible risk factors include childhood sexual abuse, substance abuse, having a preoccupation with sex, and being hypersexual (having extremely frequent or suddenly increased sexual urges or sexual activity).

What other disorders or conditions often occur with Voyeuristic Disorder?

Research in this area has focused on males who are suspected or have been convicted of acts involving the secret watching of nude or sexually active people that have not consented to the watching. This means that the co-occurring conditions found in this population might not be the same as in the general population that has voyeuristic disorder. They include hypersexuality (having extremely frequent or suddenly increased sexual urges or sexual activity), other paraphilic disorders (especially exhibitionistic disorder), depression and bipolar disorder, anxiety disorders, substance use disorders, ADHD, conduct disorder, and antisocial personality disorder.

How is Voyeuristic 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 engaging in the watching of 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 those urges in healthier ways. This typically includes cognitive restructuring (identifying and changing the thoughts that drive the behavior), relaxation training (to reduce sexual 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 because 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.