Exhibitionism; Exhibitionistic Disorder

Introduction

Exhibitionism, or exhibitionistic disorder, is a condition that is defined by the sexual excitement and stimulation of the temptation, desire, or act of exposing one’s genitals in a public place to a non-consenting individual, usually a stranger. As it is considered a paraphilia, the disorder is characterized as an illness that accompanies dysfunctional sexual arousal, in which the surroundings may become potentially dangerous for individuals involved. 

Most importantly, individuals with the mental-health disorder only feel satisfaction when their victim experiences distress or discomfort. Therefore, a potential victim that appears to be consenting and untroubled is interacting with someone that does not have exhibitionism. 

Typically misunderstood or feared as a precursor to achieving sexual intercourse with the victim, exhibitionism refers solely to the act of exposure, rather than attempting further sexual advances. However, about 10% of these incidents reported to the police result in physical contact; some cases also give an account of sexual assault or rape (Conger, I. S., 2020,).

Prevalence

Exhibitionistic disorder is one of the least understood paraphilias. Thus, the frequency of the disease’s occurrence is generally unknown. Regardless, recorded cases statistically show that there are more men with the disorder over women. About 2 to 4% is the estimated prevalence in men as it is rare in women to be diagnosed (Yogeshkumar, Dr. J. A., 2022). In fact, approximately a third of registered male sex offenders become involved within exhibitionism. And even then, up to about half of these convicts will violate others again. Unfortunately, women are not charged or arrested for exhibitionistic behaviors due to the lack of data regarding the prevalence in the female population. As a result, more information is required to understand the significance between the two sexes (Conger, I. S., 2020,).

Causes & Signs of Symptoms 

Although there is not a specific set of  reasons towards the disorder, many health professionals associate other mental health illnesses towards its causes. The core risk factors to developing exhibitionistic disorders are having antisocial personality disorder, alcohol or substance misuse or overconsumption, and an enthusiasm or interest in pedophilia (Exhibitionism | Psychology Today, 2022). Also, a history of past sexual or emotional abuse may trigger it. The last potential factor is sexual preoccupation (compulsive and consistent focus on sexual desires or fantasies) during childhood (Conger, I. S., 2020,).

Usually, symptoms become noticeable around adolescence or early adulthood, more specifically the early twenties (Yogeshkumar, Dr. J. A., 2022). Although, these behaviors may decrease as the years pass for unknown reasons.

One of the most predominant symptoms of the disorder is constantly experiencing urges or fantasies over a course of (at least) six months. Basic signs are a dismissal of others’ emotions or boundaries, a history of reckless tendencies, and these desires interfering with daily life (Crosby, J., 2022). In addition to those, other symptoms include a constant temptation to expose themselves as well as being preoccupied with thoughts to do so. Lastly, other lurking psychological disorders such as “bipolar personality, attention deficit, sex addiction,” conduct disorder, other paraphilia, and antisocial personality disorder (as stated before) may contribute to exhibitionism as well (Yogeshkumar, Dr. J. A., 2022).

Diagnosis

A diagnosis can only be formed when the signs mentioned above are executed; the individual must have persistent sexual pleasure from exposing their genitals to unsuspecting strangers. To emphasize once again, the perpetrator that suffers from the condition must display those symptoms over a period of six months or less. It is crucial to make sure that the victim in these situations is a non-consenting individual. The important aspect is that there will be a failure to reach sexual arousal unless the explicit act of exposing their genitals is carried out. 

In instances where these individuals cannot divert their attention from these urges or are unable to accomplish sexual pleasure they will display anxiety, restlessness, and distress as they will not accomplish sexual pleasure. On the other hand, the success of achieving these deeds may also result in impairment and discomfort, especially in certain social settings. The intensity of these fantasies may interrupt daily living for the violator in environments, as they may affect emotions in the workplace or other social situations.

Due to the circumstances, many of these individuals will not be diagnosed until they are caught in the midst of the lewd act of exposing their genitals. In order to find remedies, they are usually referred to get help through psychological care.

Treatment

Similar to other mental illnesses, the treatment may be psychotherapy or pharmaceuticals. There are multiple types of therapy these professionals, ranging from social workers to psychiatrists, may provide. Most beneficial in these cases is the help of a sex therapist, who is a licensed medical professional specialized in “sexual health and sexual problems'' (Sex Therapist: What They Do and When To See One). These experts, which range from social workers to psychiatrists, will determine if an individual is to be diagnosed, and whether they have a specific target, such as a preference to expose themselves to children or adults. They will also examine the individual to find when these urges began and study during what manner these impulses manifest. Once the individual is examined and this information is reviewed, coaching and guidance will be offered to explore (Crosby, J., 2022).

For these patients, the primary type of counseling advised is cognitive-behavior therapy (CBT), which is a form of rehabilitation that analyzes behaviors and emotions that one may feel. The aim of this treatment is to guide these individuals to control their thoughts and to challenge their behaviors (Services, D. of H. & H., 2021). CBT allows the patient to understand why their condition is triggered and results within positive thoughts and feelings. In addition to CBT, other forms of counseling that may be used by these professionals are relaxation therapy, group therapy, or different forms of cognitive therapy (Yogeshkumar, Dr. J. A., 2022). 

Another solution is medication, in which pharmaceuticals that are most effective towards exhibitionism are antiandrogens and SSRIs, or Selective serotonin reuptake inhibitors. Antiandrogens are drugs that “block androgen hormones, such as testosterone” (Osborn, C. O., 2018). These help the patient become alleviated from their urges and fantasies by lowering the bodies’ testosterone levels (Selective serotonin reuptake inhibitors (SSRIs), 2023) (Exhibitionistic Disorder - Symptoms, Causes, Types, Treatment, 2021). SSRIs, a type of antidepressants, are are commonly used to treat anxiety or other mental health disorders as well as reduce sexual desires (Exhibitionism | Psychology Today, 2022). 

Besides these therapies or prescribed medications, the other solution to treating this disorder may be training skills. Coping skills and empathy training are some of the options that may be available for people that need it. These two require the patient to understand and analyze their behaviors and the effects they may have on the outside world, which lead to prevention from indulging in these behaviors ((Yogeshkumar, Dr. J. A., 2022).