Exhibitionistic Disorder

Exhibitionism is characterized by achievement of sexual excitement through genital exposure, usually to an unsuspecting stranger. It may also refer to a strong desire to be observed by other people during sexual activity. Exhibitionistic disorder involves acting on these urges with a nonconsenting person or experiencing significant distress or functional impairment because of such urges and impulses.

Exhibitionism is a form of paraphilia, but most people who have exhibitionism do not meet the clinical criteria for a paraphilic disorder, which require that a person's behavior, fantasies, or intense urges result in clinically significant distress or impaired functioning or cause harm to others (which in exhibitionism includes acting on the urges with a nonconsenting person). The condition must also have been present for ≥ 6 months.

Although the true prevalence is unknown, estimated prevalence in men is approximately 2 to 4% (1); prevalence appears to be lower in women. Few females are diagnosed with exhibitionistic disorder. Thomas et al (2) suggest that sex differences in sociosexuality may be relevant in this long-observed sex difference.

Exhibitionists (usually male) may masturbate while exposing or fantasizing about exposing themselves to others. They may be aware of their need to surprise, shock, or impress the unwilling observer. The victim is almost always a female adult or a child of either sex. Actual sexual contact is rarely sought, and physical harm to the unsuspecting witness is unusual.

Onset is usually during adolescence; occasionally, the first act occurs at a wider range of ages, during preadolescence or middle age.

About 30% of apprehended male sex offenders are exhibitionists (3). Recidivism rates as high as approximately 40% have been reported (4). Although it is reported to occur, the vast majority of those with exhibitionism do not engage in physically aggressive sexual behaviors.

Although many exhibitionists marry, the marriage is often troubled by poor social and sexual adjustment, including frequent sexual dysfunction (see Male Sexual Function and Dysfunction and Female Sexual Function and Dysfunction).

Exhibitionists may also have a personality disorder (usually antisocial) or conduct disorder (5).

For some people, exhibitionism is expressed as a strong desire to have other people watch their sexual acts. What appeals to such people is not the act of surprising an audience but rather of being seen by a consenting audience. People with this form of exhibitionism may make pornographic films or become adult entertainers. They rarely experience distress or impairment due to this desire and thus may not have a psychiatric disorder.