DSM 5: Understanding Exhibitionistic Disorder

Exhibitionistic disorder is a mental health condition that centers on a need to expose one’s genitals to other people (typically strangers caught off guard) in order to gain sexual satisfaction. The American Psychiatric Association (APA) classifies the condition within a larger group of illnesses called paraphilic disorders.

All people with exhibitionistic disorder have a pattern of sexual conduct called exhibitionism; however, not all exhibitionists qualify for a diagnosis of exhibitionistic disorder. The specific criteria for such a diagnosis are contained in the new fifth edition of an APA reference guide called the Diagnostic and Statistical Manual of Mental Disorders.

Exhibitionism Basics

Exhibitionism is a specific form of a pattern of sexual behavior called a paraphilia. All people with paraphilias derive sexual pleasure from conduct that most people would view as atypical or abnormal (other forms of this type of conduct include voyeurism, fetishism and transvestism). Sometimes, a society or culture places the “abnormal” label on mutually agreed upon behavior that takes place between adults.

However, the behaviors involved in a paraphilia may also involve people who don’t or can’t consent to sexual participation, including children, infirm individuals and healthy adults.

In addition to exposing their genitals to unsuspecting or non-consenting others, individuals with exhibitionism may purposefully arrange to be observed while having sex with other people. Some exhibitionists demonstrate conscious awareness of their need to expose themselves, while others do not.

In addition, some exhibitionists attempt to incorporate their targets into their fantasies by imagining that those targets would also receive sexual gratification from observing exhibitionistic behaviors.

Men make up the vast majority of the people who participate in exhibitionism, the Merck Manual for Health Care Professionals reports.

Conversely, nearly all of the targets of exhibitionists are women, underage girls, or underage boys. Usually, the behavior begins during the first decade of adulthood, although some individuals first start exposing themselves later in life or during their teenage years. Roughly one-third of all men arrested for sexual offenses in the US are exhibitionists, and anywhere from 20 percent to half of all those caught will re-offend and get arrested again at a later date.

Exhibitionistic Disorder Basics

The fifth edition of the Diagnostic and Statistical Manual (DSM 5) replaced the fourth edition of the manual (DSM IV) in May 2013. In DSM IV, exhibitionistic disorder was known as exhibitionism.

Because exhibitionism as a mental disorder and exhibitionism as a paraphilic behavior had the same name, both professionals and laypeople often became confused when discussing exhibitionistic tendencies. DSM 5 seeks to correct this situation and bring clarity by separating the definition for exhibitionistic disorder from the definition for exhibitionism as a general pattern of behavior.

In order to qualify for a diagnosis of exhibitionistic disorder, an exhibitionist must either experience harm from his or her behavior or inflict harm in some way on others. The main criterion for self-harm in people with exhibitionism is a feeling of mental anguish or distress that exists separate from any outside social or cultural judgment of exhibitionistic behavior.

The criterion for harm imposed upon others includes the infliction of anguish or distress, physical injury, or violation of a person’s rights as identified by the legal system. Apart from fulfilling either or both of these criteria, a person diagnosed with exhibitionistic disorder must engage in exhibitionistic behavior, engage in exhibitionistic fantasies, or experience exhibitionistic urges for a minimum of half a year.

If an affected individual does not meet all necessary criteria, he or she will not meet the standard for an exhibitionistic disorder diagnosis, even if he or she has clear exhibitionistic tendencies that meet the definition for a paraphilia.

Treatment Options

The treatment options for addressing the effects of exhibitionistic disorder largely resemble the options used to address the effects of most other paraphilic disorders.

Frontline treatment typically begins with some form of psychotherapy (performed in an individualized or group setting).

In some cases, doctors combine therapy with medications from a group of antidepressant/anti-anxiety drugs called SSRIs (selective serotonin reuptake inhibitors). If frontline treatments for the disorder don’t produce the desired effect (i.e., a reduction in exhibitionistic behaviors, fantasies and urges), a male patient may also receive any one of a number of medications called antiandrogens.

These medications achieve their effects by either blocking the actions of the male sex hormone testosterone or lowering the body’s normal level of testosterone production.