178 Exhibitionism (302.4)
DSM-IV-TR criteria
- Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, urges, or behaviors involving the exposure of one’s genitals to unsuspecting strangers
- The person has acted on said urges, or the urges or fantasies cause marked distress or interpersonal difficulty
Associated features
Exhibitionists in some cases masturbate while exposing themselves (or while fantasizing that he/she is exposing himself/herself) to another person. There is a pattern in which males exhibit themselves and there are three characteristic features of the exhibition: 1) It is performed for unknown women. 2) It takes place where sexual intercourse is impossible (e.g. a crowded shopping center). 3) It seems designed to surprise and shock the woman. The male exhibitionist usually exposes his erect penis, but it is not necessarily essential for the activity. Ejaculation may occur at the moment of exposure or develop later with masturbatory stimulation. Some exhibitionists are aware of a conscious desire to shock or upset their target; while others fantasize that the target will become sexually aroused by their display.
Child vs. adult presentation
Generally, society accepts exhibitionism in children as a natural curiosity, not a disorder, however if the behaviors continue a paraphilia is probable. Disorder appears to develop before the age of 18, and rarely is found in people over the age of 50.
Gender and cultural differences in presentation
Most reported cases of exhibitionism involve males. Some scientists argue that women who undress in front of windows (as to invite a person to watch), or who wear low cut gowns are exhibitionists in a sense. Exhibitionism generally appears in Western society and is believed to be almost absent in such countries as Japan, Burma, and India. Additionally, in the American society it can be a crime when committed by a male, but when women expose themselves, excluding total nudity, they are often seen as victims of male voyeurism.
Epidemiology
Prevalence and incidence are not easily defined because people with this disorder usually do not seek treatment voluntarily. Exhibitionism is one of the three most common sexual offenses, the other two being voyeurism and pedophilia. It is rarely diagnosed in general mental health clinics, but most professionals believe that it is probably underdiagnosed and under-reported.
Etiology
- People with these types of paraphilia tend to have personalities accompanied by social isolation, low self-esteem, and, usually, feelings of sexual inadequacy. They are not generally comfortable with normal heterosexual relationships and they are not willing to risk the rejection of their attempts to create willing sexual relationships, so they resort to abnormal sexual activity. They suggest that sexual abuse as children or other traumatic childhood situations may be the cause. According to Freudian theory, during the phases of psychosexual development, fi