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Exhibitionistic Disorder

(Exhibitionism)

By

George R. Brown

, MD, East Tennessee State University

Reviewed/Revised Jul 2023
VIEW PROFESSIONAL VERSION

Exhibitionism involves exposing the genitals to become sexually excited or having a strong desire to be observed by other people during sexual activity. Exhibitionistic disorder involves acting on exhibitionistic urges or fantasies or being distressed by or unable to function because of those urges and fantasies.

  • Most exhibitionists do not have exhibitionist disorder.

  • Doctors diagnose exhibitionist disorder when people feel greatly distressed or become less able to function well because of their behavior, or they have acted on their urges with a person who does not consent.

  • Treatment, which usually begins after exhibitionists are arrested, includes psychotherapy, support groups, and certain antidepressants.

Exhibitionists (usually males) expose their genitals, usually to unsuspecting strangers, and become sexually excited when doing so. They may be aware of their need to surprise, shock, or impress the unwilling observer. The victim is almost always a woman or a child of either sex. Actual sexual contact is almost never sought, so exhibitionists rarely commit rape.

Although the true prevalence of exhibitionistic disorder is unknown, it is about 2 to 4% in men and appears to be much lower in women.

Exhibitionism usually starts during adolescence, but occasionally the first act can occur during preadolescence or middle age. Most exhibitionists are married, but the marriage is often troubled.

About 30% of male sex offenders who are arrested are exhibitionists. They tend to persist in their behavior. About 20 to 50% are re-arrested.

Exposure of genitals to unsuspecting strangers for sexual excitement is rare among women. Women have other venues to expose themselves: dressing provocatively (which is increasingly accepted as normal) and appearing in various media and entertainment venues. Participation in these venues of itself does not constitute a mental health disorder.

For some people, exhibitionism is expressed as a strong desire to have other people watch their sexual acts. Such people want to be seen by a consenting audience, rather than to surprise people. People with this form of exhibitionism may make pornographic films or become adult entertainers. They are rarely distressed or impaired by their desire and thus may not have a mental health disorder.

Most people with exhibitionistic tendencies do not have a disorder.

Diagnosis of Exhibitionistic Disorder

  • A doctor's evaluation, based on standard psychiatric diagnostic criteria

Doctors diagnose exhibitionistic disorder when

  • People have been repeatedly and intensely aroused by exposing their genitals or being observed by other people during sexual activity, and the arousal has been expressed in fantasies, intense urges, or behaviors.

  • As a result, people feel greatly distressed or become less able to function well (at work, in their family, or in interactions with friends), or they have acted on their urges with a person who does not consent.

  • They have had the condition for 6 months or more.

In diagnosing exhibitionistic disorder, the doctor also specifies whether the person is sexually aroused by exposing his or her genitals to prepubescent children, or physically mature individuals, or both.

Treatment of Exhibitionistic Disorder

  • Psychotherapy and support groups

  • Certain antidepressants

  • Sometimes other medications

If SSRIs are ineffective, medications that alter the sex drive and reduce testosterone levels may be used. These medications include leuprolide and medroxyprogesterone acetate. People must give their informed consent to the use of these medications, and doctors periodically do blood tests to monitor the medication’s effects on the liver, as well as other tests (including bone density tests and blood tests to measure testosterone levels.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
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