What is Exhibitionism?
Exhibitionism is the exposure of one's genitals to non-consenting strangers for sexual arousal or gratification, also known by more common terms such as "flashing".
The diagnostic criteria of the DSM-IV-TR are that the individual has experienced intense sexual urges, arousal or behaviour involving the exposure of their genitals to strangers for at least six months. Further, the individual has either acted upon these urges or they cause significant personal distress or interpersonal difficulty.
Exhibitionism may involve either display of the genitals or active masturbation in front of the victim.
The shock of the victim provides the sexual arousal for the exhibitionist. In most cases, when no other factors are present, there is no actual contact with the victim. Some have suggested, however, that there may be two categories of exhibitionism: aggressive and non-aggressive.
Exhibitionists use a number of ploys to attract unsuspecting victims and although most incidents are carried out in public places, perpetrators tend to select more isolated areas or opportunities where exposure will be limited only to the victim(s). such as: quiet public areas (eg outside or in a mall) , while sitting on a park bench, or while driving their car. Many do not make serious attempts to hide their identity. Taking such risks may constitute a necessary component for their sexual arousal.
It is difficult to assess the prevalence of exhibitionism in the general population but, in sex offenders, approximately 30% have exhibitionistic tendencies and it is one of the more common sex offences.
As with most paraphilias, exhibitionism usually surfaces in early adolescence, although it may not be acted upon until later adolescence or early adulthood.
Most exhibitionists are male and the victims are female adults or children but female exhibitionists are also known. Females have been known to take employment where exhibitionism can be practiced as part of the job (ie. topless bars).
Many practitioners are married or in relationships and although there may be some degree of sexual dysfunction within the relationship, this is not always the case and the individual may function normally sexually within that relationship.
Although incidents may decrease with age, they are still not uncommon in older men.
The individual often has concurrent paraphilias which may include scatologia, frotteurism, and voyeurism although individuals who consistently expose to young children may also have pedophilic interests.
Although some exhibitionists present themselves for treatment, the majority do not receive treatment until after arrest, where treatment has been recommended as part of the process.
Treatment is similar to that of other paraphilias: Cognitive behavioural therapy may help some individuals. Others may be helped by sex-drive reducing medications either in the form of SSRI's. Extreme cases may be considered for hormonal sex drive reducing medications.
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Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line)
© Stephen Hucker, MB,BS, FRCP(C), FRCPsych 2003,2004,2005
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