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.
Exhibitionism is a form of paraphilia Overview of Paraphilias and Paraphilic Disorders Paraphilias are frequent, intense, sexually arousing fantasies or behaviors that involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of the person or a partner... read more .
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.
Exhibitionists may have a coexisting personality disorder Overview of Personality Disorders Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or... read more (usually antisocial Antisocial Personality Disorder Antisocial personality disorder is a mental health condition that is characterized by a pervasive pattern of disregard for consequences and for the rights of others. People with antisocial personality... read more ) or conduct disorder Conduct Disorder A conduct disorder involves a repetitive pattern of behavior that violates the basic rights of others. Children with a conduct disorder are selfish and insensitive to the feelings of others... read more .
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
Sometimes other medications
Treatment of exhibitionistic disorder usually begins after exhibitionists are arrested. It includes psychotherapy, support groups, and antidepressants called selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more (SSRIs).
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.