Exhibitionistic disorder consists of fantasies or behaviours that sexually arouse a person by showing one’s own private parts to others. These episodes are often non consensual in nature. The person may feel distressed as they feel like they have no control over their behaviour.
These episodes may involve exposing genitals to prepubescent children, teenagers under the age of 18 years, mature adults above the age of 18 or both.
This is different from exhibitionistic sexual interest which is consented by the parties involved and doesn’t cause significant distress to the person engaging in the behaviour. The acting on the urges is also missing among individuals who express exhibitionistic sexual interest.
Exhibitionistic sexual interest is different from Exhibitionistic Disorder. People with exhibitionistic sexual interest engage in these behaviours and fantasies with consenting adults and are capable of managing their urges.
There are no known physical causes for exhibitionistic disorder and other paraphilias. But researchers note psychological causes, especially relating childhood experiences to causes of various paraphilias. Certain neuroscientific theories relate increasing neuronal discharges as impulses which compel the person to engage in such a behaviour.
Common Signs and Symptoms of Exhibitionistic Disorder
Signs and symptoms include:
- Getting sexually aroused by fantasies, urges or behaviours to expose one’s genitals to an unsuspecting person
- Engaging in such behaviour with a nonconsenting person
- This behaviour may feel out of control. It may bring feelings of guilt and shame to the person who engages in such behaviour.
There are no clear statistics on the prevalence of Exhibitionistic Disorder. But it is generally believed to be more common among males than females.
Childhood sexual abuse, hypersexuality and preoccupation with sex are the noted risk factors of exbihitionistic disorder. Exhibitionism is socially disapproved as well as considered a criminal offense in most countries of the Middle East, Southeast and South Asia and some states of the United States of America and United Kingdom, which makes engaging in exhibitionism a risk taking act.
Risk taking behaviour, antisocial tendencies, drug and alcohol abuse are the noted risk factors of exhibitionistic disorder.
Exhibitionistic disorder is comorbid with a lot of other sexual paraphilias such as voyeurism and frotteurism, rape, etc.
Diagnosis of Exhibitionistic Disorder
Exhibitionism with a nonconsenting person or with children below the age of 18 years is considered a sexual offense in the United States. Hence, most of the patients diagnosed with Exhibitionistic Disorder are criminally charged sex offenders or in clinical settings and institutions.
Exhibitionism is considered a taboo. It is mostly practiced in private and not all people seek treatment for it readily. However, a psychologist often provides the diagnosis for Exhibitionistic Disorder.
To be diagnosed with Exhibitionistic Disorder, following criteria must be met:
- Recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviours.
- The person has acted upon these urges in the past 6 months with a non consenting person.
- These urges and fantasies cause a lot of impairment in social, occupational, and other important areas of functioning.
Psychologists have to specify whether the person feels arousal by engaging in exhibition with prepubescent children, mature adults or both. Often, three incidences are to be accounted for in the diagnosis. It can be three incidents with the same individual or three separate individuals. This behaviour should not occur under the influence of a substance, medication or other mental disorder.
Treatment for Exhibitionistic Disorder
A lot of people with exhibitionistic disorder rarely come into treatment programmes. Those who do, report intense urges to expose oneself based on numerous factors such as stress relief, boredom, inadequacy, attractive person, etc.
The main objective of treatment options for sexual paraphilias are to decrease the intensity and frequency of the urges.
One of the effective modes of treatment is aversion therapy. It’s a part of positive punishment therapy. Patients are asked to carry a bottle of ammonia mixture.
They have to inhale this mixture every time they get the urge. There is an intense pain reaction which ensures the dispelling of the urge to expose oneself.
Pharmacological treatment includes use of serotonergic antidepressant treatment. Generally, a low dose of trazodone is given to reduce libido and sexual urges. These have side effects such as decreased sex drive, erectile dysfunction and reduced libido.
Psychotherapy often depends on the client’s motivation to seek therapy and level of intelligence. They often feel like there’s a compulsive factor pushing them to engage in exhibitionistic behaviour and feel quite distressed over it.
1. Conduct disorder and antisocial personality disorder: Conduct disorder in adolescents and antisocial personality disorder would be characterized by additional norm-breaking and antisocial behaviors, and the specific sexual interest in exposing the genitals should be lacking.
2. Substance use disorders: Alcohol and substance use disorders might involve single exhibitionistic episodes by intoxicated individuals but should not involve the typical sexual interest in exposing the genitals to unsuspecting persons. Hence, recurrent exhibitionistic sexual fantasies, urges, or behaviors that occur also when the individual is not intoxicated suggest that exhibitionistic disorder might be present.
Conditions that occur comorbidly with exhibitionistic disorder at high rates include depressive, bipolar, anxiety, and substance use disorders; hypersexuality; attention-deficit/hyperactivity disorder; other paraphilic disorders; and antisocial personality disorder.
Generally, clinical psychologists, psychiatrists and forensic psychologists are equipped to deal with this disorder. A sex therapist may also be approached.
The majority of people with exhibitionistic disorder don’t seek treatment on their own and don’t recognise they have a problem until they find themselves in legal trouble. They frequently consider treatment for the first time at this point.
To learn how to manage the disease, it’s essential for the person suffering from exhibitionistic disorder to regularly attend therapy sessions. Cognitive behavioural therapy (CBT) can help a person understand the triggers for his cravings and learn coping mechanisms so that he can cope with them in a healthy way.
If you see someone in your vicinity showing the symptoms for Exhibitionistic Disorder, then it is adivsed that you help those individuals with therapy.
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