At times the individual may fantasize that the victim becomes sexually aroused by seeing his genitals. In reality, the victim is usually traumatized and may require treatment of her own.
It is a psychological need and pattern of behavior designed to captivate attention to parts of the body that would otherwise be left covered in nearly all other cultural circumstances. Said exposure gives the individual an ego rush.
In exhibitionism that involves exposing one’s genitals to a stranger, the exhibitionist may masturbate or fantasize about masturbating. However, he rarely seeks sexual contact with the victim, so exhibitionists almost never commit rape.
The condition is labeled as a paraphilia, which refers to persistent and intense sexual arousal in response to objects or stimuli not associated with “normal” (according to society) sexual behavior patterns and that may interfere with the ability to form and maintain intimate relationships. These sexual arousal patterns must cause the individual distress or handicaps the person’s ability to function in other areas of life (work, recreation, or relationships) for there to be a diagnosis of paraphilia.
Some exhibitionists have a strong desire for an audience to observe them during sexual activity. These people are not motivated by a desire to shock. These types of people may make adult videos or become adult entertainers. Again, unless the behavior causes distress or impairs the person’s functioning, it is not considered a disorder or a mental illness.
Causes of Exhibitionism Disorder
Risk factors for developing exhibitionism disorder may include a diagnosis of antisocial personality disorder, alcohol abuse and a pedophilic interest. Other factors include sexual/emotional abuse in the family or origin, and excessive sexual preoccupation in childhood.
Exhibitionists may perceive their victim’s shocked reaction to their behavior as a sign of sexual interest. In his mind, exhibiting his genitals is a form of flirting. The behavior is not harmless as some exhibitionists go on to commit more serious sex crimes. In addition, the behavior is illegal and may result in criminal charges.
In some instances, the unusual behavior may become the person’s exclusive means of sexual activity, impacting the establishment of heathy, related sex with a partner.
Approximately one-third of all reported sex crimes involve acts of exhibitionism.
Treatment of Exhibitionism
Treatment of exhibitionism is indicated under the following circumstances:
- The individual experiences distress in the form of guilt, shame or other emotional upsets.
- Social isolation.
- Difficulty in communicating with partners about sex.
- Partners of the individual may have emotional distress, such as not feeling attractive or desirable.
- Erectile dysfunction or premature ejaculation may occur.
People do not usually seek treatment of exhibitionism on their own because, in their minds, the behavior is harmless. It is usually not until they are caught and arrested do they come into treatment as dictated by the courts.
Treatment of exhibitionism be effective by providing the person with the skills to not act on impulses and by helping the individual find more effective ways of dealing with sexual urges than exhibiting their genitals to strangers.
Treatment of exhibitionism usually utilizes cognitive-behavioral therapy to identify high-risk internal and external triggers and then developing coping mechanisms to manage urges in different and appropriate ways. Patients are encouraged to recognize the irrational justifications for their behavior and to alter other distorted thinking patterns such as minimalization and denial.
Organic reconditioning may also be used in the treatment of exhibitionism. This is a technique wherein the person is conditioned, sometimes with the use of hypnosis, to replace fantasies of exposing himself with fantasies of more acceptable sexual behavior while masturbating.
Other therapeutic approaches include stress management techniques, developing empathy for the victim to understand the harm that’s been done, coping skills training and identifying and altering the thought process that lead to acting out.
Twelve-step programs for sex addiction may be helpful to the individual and may serve to break the isolation, shame and guilt sometimes associated with the behavior. Social support and emphasis on healthy sexuality, as well as the cognitive restructuring implicit in the twelve steps, may accompany individual therapy.
Medications may also be used in the treatment of exhibitionism. Some medications commonly used to treat depression, such as the SSRI’s, may result in a decrease in sexual drive and a resultant decrease in urges to act out. If SSRI’s are ineffective, a doctor may prescribe drugs that alter the sex drive be reducing testosterone levels. Psychotropic meditations may also be used to treat underlying mood disorders such as depression, anxiety or bi-polar conditions.
Prognosis
The prognosis for a person with an exhibitionism disorder depends on a number of factors including age of onset, willingness of the person to cooperate in treatment for exhibitionism, underlying mental disorders, and the reason the person is referred to treatment.
For some people, exhibitionism is a lifelong problem with potentially serious legal, interpersonal, financial and occupational consequences. The prognosis for these people is less than favorable. People with exhibitionism disorder have the highest recidivism rate of all the paraphilias.